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Better Hand Washing as First Line of Defense Against the Flu



The Centers for Disease Control and Prevention (CDC) is urging better, more frequent hand washing as the first line of defence against the flu epidemic which has been occurring in many parts of the world this winter. According to the CDC, deaths in the current flu season in the US have now officially crossed the line into "epidemic" territory and 47 US states now have widespread outbreaks of the influenza virus.  Get more facts on the flu along with prevention tips here.


Hand Washing and the Flu"With this year's flu epidemic in full force, we are urging everyone to take all of the necessary precautions to guard against the flu and to prevent its spread, including getting a flu shot and practicing proper hand washing," says Paul Alper, vice president strategy and business development for DebMed and 30-year veteran of the hand hygiene industry.


Vaccination each year is regarded as the single best way to prevent seasonal flu, however, the CDC has noted that this year's vaccine is only "moderately" effective with a 62 percent rating; effectiveness typically ranges from 50 percent to 70 percent. Aside from vaccination, the best method to avoid the spread of seasonal flu is to adopt a rigorous hand hygiene approach, with proper hand washing being essential, according to the CDC. However, the frequency and quality of hand washing among the general population is poor.


Improper Hand Washing


Separate studies from around the world show that after visiting the washroom only 70% of people wash their hands, with only 30% of people actually using soap; the remaining 40% use water alone. The sad reality is, people do not wash their hands frequently or adequately enough. In fact, the average person washes their hands for only around 10 seconds which at best will remove about 90% of germs. The problem is the remaining bacteria will grow and can double in number in less than 20 minutes and in 80 minutes can be back to the number prior to washing.


In addition to these in adequate hand washing habits, most people also do not use the correct technique for washing hands and indeed many, critical parts of the hands are missed during normal hand washing, even  when soap is used. The image below shows the most frequently missed parts of the hands when the correct hand washing technique is not followed.


Incorrect Hand Washing Technique


As can be seen, finger-tips in particular are the most frequently missed areas, yet these are the parts of our hands that we most use for contact with surfaces and other people. Therefore, a significant contribution to the improvement in hand washing performance is to adopt the following simple 6-step hand washing technique, in combination with soap and fresh running water.


Correct Hand Washing Technique


It is recommended that hands are rubbed for at least 20 seconds; if a timer is required, it has been suggested the "Happy Birthday" song can be hummed from beginning to end twice! Once rubbing has been completed, hands need to rinsed well under running water and dried using a clean towel or air-drier. "In addition to raising general hand hygiene awareness, I believe that public authorities should also put a focus on educating the simple 6-step technique to hand washing; ideally, this technique along with some simple rules on the when/how to wash hands should be routinely taught to children at a young age where it can become embedded as 'unconscious competent behaviour'" say Alper.


There are many videos available on YouTube that promote hand hygiene and hand washing technique, but the following video from the UK is a very clear and simple way to demonstrate all the steps of an effective hand wash event.



However, there are also many situations where hand hygiene is required (e.g. after sneezing), but soap and water are not available - this could be whilst on-the-move or even in workplaces and public facilities where hand washing facilities are simply not immediately or conveniently available. In these situations, the use of hand sanitizer, specifically formulated for rapid use without the need for water rinsing is recommended. For antimicrobial effectiveness, speed of action and human safety, alcohol-based hand sanitisers containing at least 60 percent alcohol are recommended. 


Additional Flu Prevention Tips


Other flu precautions include good health habits like covering your mouth when coughing. To help battle the flu, here are five more quick tips from DebMed based on information from the CDC and Blue Cross Blue Shield of Massachusetts:


  1. Avoid close contact: Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too. 
  2. Stay home when you are sick: If possible, stay home from work, school and errands when you are sick. You will help prevent others from catching your illness. 
  3. Cover your mouth and nose: Cover your mouth and nose with a tissue when coughing or sneezing. Throw out the tissue in the nearest wastebasket and immediately wash hands or use a hand sanitizer.  
  4. Avoid touching your eyes, nose or mouth: Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose or mouth before handwashing
  5. Practice other good health habits: Clean and disinfect frequently touched surfaces at home, work or school, especially when someone is ill.


About DebMed:


describe the imageDebMed is the creator of an electronic hand hygiene compliance monitoring system based on the World Health Organization (WHO)'s "Five Moments for Hand Hygiene" and is now the only hand hygiene system that meets the WHO's "Save Lives: Clean Your Hands" recommendation. DebMed GMS encourages increased hand hygiene among hospital staff, thereby reducing the risk of spreading the flu virus and other infectious diseases between patients and improving patient safety and care.




A very good video and well made. I do have some observations that should have been incorporated: (1) suggest that clean hands do not come in contact with any part of the sink bowl while rinsing - this may be difficult due to the placement of the faucets, the shape of the bowl, or the amount of water flow; (2) they showed the person picking up a paper towel off the counter - the towel was contaminated from contacting the counter, thus the hands were re-contontaminated. A towel should never be used if it is resting on a counter. (3) When removing a paper towel from a dispenser, never let one's hands contact any part of the dispenser due to possible contamination of the dispenser and re-contamination of the clean hands.  
Many people fail to realize that the "20 second rule" applies to the washing and agitation of the hands and does not include the rinsing step of the process. 
Finally, many people have asked me how long they should rinse their hands after washing and my response is always the same: If the odor of the soap used is still on their hands after rinsing, they have not rinsed long enough. Hands should be odor free. If odor is lingering, soap is lingering, and bacteria is lingering. In short, "If one can smell the odor or fragrance, then the process is incomplete."  
Germs can kill, let's get rid of them before they kill us or others. Proper hand hygiene is a process that should not have short-cuts.
Posted @ Wednesday, February 13, 2013 9:32 AM by John Scherberger
Influenza A virus (flu virus) belongs to the large family of orthomyxoviridae. These RNA viruses are enveloped which means that they have an external lipid bilayer envelope covering their capsid (composed of proteins). These viruses are also classified into 144 subtypes on the basis of their 2 surface antigenic proteins: the Hemagglutinin (H), which helps the virus to bind onto the host cell, and the Neuraminidase (N) which helps the virus to be released from the host cell after its multiplication.  
The subtypes mute very often rending the vaccine less effective as the involved antibodies are extremely specific to genotypes. 
The good thing with antimicrobial products, especially those based on alcohol or hydrogen peroxide, is that their mode of virucidal action is not specific to the composition of the viral external proteins. These biocides simply and quickly destroy the lipid envelop and also denature the viral proteins without any distinction.  
Isn't this another very good reason for washing and sanitizing hands as many times as possible every day?
Posted @ Wednesday, February 13, 2013 9:34 AM by Dr GRASCHA Pierre
John makes some good points in his comments. I think the 'educational' message in the article is for the general public and whilst the touching sink and paper towel on the counter etc are important points in a healthcare setiing, I think we need to be realistic about what can be achieved in general washroom environments. Also, I completely agree with the comments regarding washing time as opposed to the rinsing time; in fact, the 10 second statistic relates to the whole washing and rinsing process and the actual washing time is nearer 6 seconds!! So, there's a lot to do to get the public educated!!
Posted @ Wednesday, February 13, 2013 10:08 AM by Paul Blount
And don't bother wasting time or money on sanitisers as good old fashioned soap used in the right way works! (make sure you take rings off too, thats where many germs hide)
Posted @ Thursday, February 14, 2013 8:50 AM by Des
As the article states Des, "...there are also many situations where hand hygiene is required (e.g. after sneezing), but soap and water are not available - this could be while on-the-move or even in workplaces and public facilities where hand washing facilities are simply not immediately or conveniently available. In these situations, the use of hand sanitizer, specifically formulated for rapid use without the need for water rinsing is recommended. For antimicrobial effectiveness, speed of action and human safety, alcohol-based hand sanitisers containing at least 60 percent alcohol are recommended."
Posted @ Thursday, February 14, 2013 8:57 AM by Patrick
Are there any alcohol or hydrogen peroxide based 'Sanitizers' available in sachets soaked in a tissue, just like the freshener sachets? This could be kept handy in a pocket / bag for ready use. 
Very educative article, and equally educative advisory comments. Thank you all.
Posted @ Thursday, February 14, 2013 11:13 AM by Homi R. Mullan
Whilst I agree with your sentiment Patrick we do have a tendency in the UK to resort to using hand sanitiser from a point of laziness, and many people don't even know how to wash their hands properly, if they even bother to do it at all. 
Something positive I can add though is my son started primary school last September, and maybe this is getting through at the right level where he's being taught how to wash his hands properly - I can tell when he's at home doing it himself, would probably put many adults to shame lol
Posted @ Thursday, February 14, 2013 12:07 PM by Des
Thanks for sharing this great article Patrick! Technique and consistency are key to a propper handwash with soap and water and are rarely found. If you haven't seen or tried the CleanTech Automated Handwashing Systems, please check them out The systems are now in over 3,000 food plants, 1,000 restaurants and 300 hospitals nationwide. They are also now on three cruise lines for passenger use. Every handwash provides the same results every handwash and the systems use 75% less water, waste and labor. Feel free to e-mail me if you have any questions
Posted @ Thursday, February 14, 2013 12:33 PM by Michele Colbert
A very well focused article and useful video. The following idea of Paul Alper is just what shoud be implemented as an alphabet of the strategy in infection control and prevention: "educating the simple 6-step technique to hand washing; ideally, this technique along with some simple rules on the when/how to wash hands should be routinely taught to children at a young age where it can become embedded as 'unconscious competent behaviour'"
Posted @ Thursday, February 14, 2013 6:20 PM by Nina Gatcheva
Regarding the negative comments about alcohol (and otherwise) hand sanitizer, I have a brief story. About a dozen years ago leading up to the momentous APIC/HICPAC/SHEA/IDSA/CDC Hand Hygiene Report of 2002, I was contacted 45 minutes before air time by a Good Morning Today ? national TV program networks as one of the very qualified TV doctors was going to teach America to hand wash to prevent the winter epidemics and he wanted to know if alcohol hand sanitizer worked. The evidence was so overwhelming that in those 45 rapidly faxing minutes he was convinced. Not long after that all of our professional organizations (as above) with backing by CDC also agreed. Lets not fight it, lets just to learn to use it to maximize its effectiveness.
Posted @ Friday, February 15, 2013 8:40 AM by Barry Michaels
A supplemental process to increase hand washing safety would be a final rinse or the complete 20 second rinsing of the soap off your hands with ozonated water.
Posted @ Monday, February 18, 2013 5:38 PM by Jonathan Cuyno
Thanks for the comment Jonathan. I know ozonated water is used commonly in food processing and wondering if it's as common in other typical workplace and home environments?
Posted @ Monday, February 18, 2013 6:01 PM by Patrick Boshell
While I appreciate the safety aspects of drinking ozonated water and many commercial water bottling companies use this technology, I believe that rinsing with any water will do. If anyone out there has data that ozone water rinses can provide efficacy in standard in vivo hand hygiene testing, I would be interested. That said, I performed extensive rinse testing in the late 1990's under a variety of conditions at different ozone concentrations, combined with bland and highly antimicrobial soaps, to no avail. The testing lab, ozone system manufacturer and I were all fairly disappointed that there was no difference between plain vs. ozonated water rinse. Conclusion: Just rinse hands well.
Posted @ Monday, February 18, 2013 6:11 PM by Barry Michaels
Patrick ozonated water is used for many hygienic conditions especially outside the US. The problem is that chemical companies control the laws here in the US. Patrick I do agree with your test results. However the issue is about quality of Ozone molecules PPM truly dissolved in the water. 23 years ago most commonly they could achieve on average .05 - .10 PPM in water. Today the portable on demand machines that I have used can safely produce (no NOx) 4.00 to 6.00 PPM in the water stream making the water a true disinfectant. We know that at 2.0 PPM an instant kill will occur through cell lysing where the cell structure of the bacteria or virus is completely destroyed. Not just retarding that can cause strains. The other thing is that the ozone molecule is completely dissolved into the water so the water now becomes the carrier for the ozone molecule can be absorbed into the cracks of skin and under the finger nails thus killing bacteria where scrubbing tools would be needed. Another benefit is that fact the water will become 3 times more oxygenated than typical tap water. It will help the healing process for minor scrapes and wounds by killing bacteria in the wound and allow the skin to absorb oxygen through the water absorption. We have SGS test results and I have personally showered in 1.5 - 2.0 PPM ozonated water everyday for the last two years. Again, I will say that I am biased but there is too much old and misinformation that lives on the Internet. It has taken me two years but finally there are many organizations including schools that are looking into using this level of ozonated water for safer hygiene and food safety as it will kill MRSA. Again, This is about supplemental insurance to achieve higher standards where chemicals and process have failed to the point of deaths.
Posted @ Monday, February 18, 2013 8:05 PM by Jonathan Cuyno
Thanks for the message Homi. We do have a personal size alcohol foam hand sanitizer in a 50 ml size which is great when you're on the go. We'll keep you informed of other new developments.
Posted @ Monday, February 18, 2013 9:36 PM by Patrick Boshell
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