{"id":800,"date":"2019-07-30T12:21:48","date_gmt":"2019-07-30T12:21:48","guid":{"rendered":"https:\/\/randomthoughtsltd.com\/?p=800"},"modified":"2024-04-03T14:34:54","modified_gmt":"2024-04-03T14:34:54","slug":"now-wash-your-hands","status":"publish","type":"post","link":"https:\/\/randomthoughtsltd.com\/?p=800","title":{"rendered":"Now Wash Your Hands"},"content":{"rendered":"\n
First published in the NASGP Newsletter in June 2019<\/em><\/h5>\n\n\n\n
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A century after Semmelweis published his paper on reducing the spread of infection in maternity wards, his advice reached the Department of Health.<\/strong><\/p>\n\n\n\n

In post-war Italy TB was still rife and notices in buses commanded \u201cNo\nSpitting\u201d. In Britain in 1946 the message \u201cCoughs and sneezes spread diseases\u201d\npromoted the use of handkerchiefs to catch the germ-laden droplets. Presumably\na reasonably successful public health campaign, although if you are trapped\nlike a sardine in a rush-hour tube train, you may have no alternative but to\nsneeze into the shoulder of the person jammed in front of you.<\/p>\n\n\n\n

Reducing\ndroplet spread is a great step forward, but rhinoviruses are also transferred\nfrom noses to hands and so to any surface we touch. They survive there for\nseveral hours for the next person grabbing the handrail or turning on the tap\nto pick up. So do more dangerous infective agents from other sources. Hence the\nslogan I recall from my childhood \u201cNow wash your hands\u201d. So, a century after Semmelweis\npublished his paper on reducing the spread of infection in maternity wards, his advice\nhad reached the Department of Health. If followed today, it could cut\ngastrointestinal upsets by a third, reduce sickness absence from school and\nwork, and save the UK economy more than \u00a31 billion every year. But the E coli\ncounts on peanuts set out for grabs on pub bars demonstrate that the general\npublic still isn\u2019t heeding the message. A surgical scrub isn\u2019t necessary, but\nthe more thorough the wash, the better. The NHS recommends washing with soap\n(antibacterial not helpful) for as long as it takes to sing \u2018Happy Birthday to\nYou\u2019. Twice. Though as most of the pathogens are on the fingertips, even waving\nthe fingers under a dribbling tap may be better than nothing.<\/p>\n\n\n\n

Wet hands\nstill pass on a lot of pathogens, but effective drying removes almost all the\nbugs. Dryers in public toilets are a relatively recent introduction \u2013 the\nresearchers of the 1965 Good Loo Guide found that less than five percent of\npublic toilets had hot air dryers, though they probably had roller towels.\nPaper towels came later. Jet dryers (OK, Dyson Airblades \u00ae) are a 21st century\ninvention.<\/p>\n\n\n\n

Which works\nbest? Cloth towels are quick and effective, though try finding a clean area on\na jammed roller towel. Studies comparing the effectiveness of paper and jet\ndryers are limited, and the results tend to support the product of the industry\nwhich sponsored them.<\/p>\n\n\n\n

It does seem\nclear that jet dryers are more economical than paper towels, which have to be\nsourced, delivered, stocked, cleared away, and disposed of in landfill. Add in\nthe cost of calling the plumber to unblock the loos and the fire service to put\nout fires in waste baskets. But on the road to reduction of infection, cost isn\u2019t\neven a surrogate end point, it\u2019s just a station on a by-line for institutions\nthat are counting the pennies, not the pathogens.<\/p>\n\n\n\n

The paper\nindustry claims that jet dryers blast bugs into the air. The jet dryer industry\nclaims more effectiveness and less mess. The only independent study, a\nliterature search by the Mayo clinic in 2012, found (in a 2009 survey) that\nmost members of the US public preferred paper towels, and recommended that\nsingle-use paper towels be used in health care settings.<\/p>\n\n\n\n

The bottom line\nis, do people use whatever drying method is provided? And do they use it\neffectively?<\/p>\n\n\n\n

Time is one\nhurdle. Traditional hot air dryers are too slow. Jet dryers are quick, but not\nthat quick, and if there is a queue and the curtain is about to go up on the\nfinal act, you probably shake your hands and rush to your seat.<\/p>\n\n\n\n

People will wash thoroughly if they find their hands contaminated by something that disgusts them, like dog-shit, but they don\u2019t make the same connection with illness after a visit to a toilet.<\/p><\/blockquote><\/figure>\n\n\n\n

Paper towels\nare quicker. But paper towels dissolving to pulp on a wet floor don\u2019t encourage\nusers to spend time doing even a cursory wash.<\/p>\n\n\n\n

Poorly\nmaintained facilities may make users feel they need to clean themselves of the\ngrot, but probably make it more difficult to do so. Fastidious users don\u2019t like\nthe idea of contaminating themselves with other people\u2019s germs, and it does\nseem illogical to turn on a tap with dirty hands and then re-contaminate them\nwhen you turn it off. No-touch facilities reduce cross-contamination and taps\nwhich turn themselves off must save water \u2013 as long as the system works.<\/p>\n\n\n\n

Ultimately,\nit\u2019s a matter of culture. People will wash thoroughly if they find their hands\ncontaminated by something that disgusts them, like dog-shit, but they don\u2019t\nmake the same connection with illness after a visit to a toilet. Pete\nHesgeth, the Fox News presenter, says he doesn\u2019t wash his hands \u2013 he can\u2019t\nsee the pathogens so they aren\u2019t there. A majority of Britons seem to share his\nview, at least unconsciously. Accurate statistics on the public\u2019s hand-washing\nhabits are hard to obtain, but apparently more than 60% of people don\u2019t bother.<\/p>\n\n\n\n

Behaviour\nchange is difficult when the threat is invisible. Establishing a hand-washing\nritual early in life is a challenge. Health visitors and Sure Start \u2013 where it\nstill functions \u2013 can explain to mothers that leaving children\u2019s hands unwashed\nis equivalent to feeding them faeces \u2013 sorry, poo \u2013 and teach them how to get\ntheir children into the habit. Schools have a responsibility to provide\nadequate facilities and to ensure they are used.<\/p>\n\n\n\n

In the\nconsulting room, hand-washing means more than just removing infective agents.\nIt\u2019s a brief time out. It\u2019s a demonstration to the patient. Water or alcohol?\nSome GPs like the feeling that they are washing those germs down the basin.\nOthers prefer an alcohol rub. It\u2019s quick and it\u2019s effective.<\/p>\n\n\n\n

Some\nfacilities are a pleasure to use. Upmarket gastro-pub loos are tastefully\ndecorated with scent sticks and an orchid, maybe a real one. You take a\npleasingly coloured fluffy towel square from the pile, enjoy getting your hands\nreally dry and drop it into a wicker basket. But even there I bet you won\u2019t\ntime yourself by singing Happy Birthday \u2013 twice.<\/p>\n\n\n\n

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First published in the NASGP Newsletter in June 2019 A century after Semmelweis published his paper on reducing the spread of infection in maternity wards, his advice reached the Department of Health. In post-war Italy TB was still rife and notices in buses commanded \u201cNo Spitting\u201d. In Britain in 1946 the message \u201cCoughs and sneezes … <\/p>\n

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