1. Soap or Sanitizer? Hand Hygiene in Today’s World
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    Soap or Sanitizer? Hand Hygiene in Today’s World

    May 10, 2017
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    Hand Hygiene: Soap vs. Sanitizers

    Hand hygiene is recognised as an essential component of good health practices. Here is a medical expert’s hands-on approach to hygiene in a world of soaps and sanitizers.

    Hand Hygiene: Soap vs. Sanitizers

    Hand hygiene is recognised as an essential component of good health practices. Here is a medical expert’s hands-on approach to hygiene in a world of soaps and sanitizers.

    Hand Hygiene: Soap vs. Sanitizers

    Hand hygiene is recognised as an essential component of good health practices. Here is a medical expert’s hands-on approach to hygiene in a world of soaps and sanitizers.

    • Hand Hygiene: Soap vs. Sanitizers

      Hand Hygiene: Soap vs. Sanitizers

      “Wash your hands!” This is every parent’s command when ravenous children returning from school rush to have a snack.

      Indeed, hand hygiene, like bathing, is something that we are introduced to very early in life and continue to practise all through our existence. While hygiene maybe something that a child does not take very seriously, as adults, we acknowledge the importance of cleanliness being next to godliness not just for cosmetic or social reasons but for the maintenance of good health.

      Hand hygiene, in particular, has taken on increasing importance in the last decade. This is relevant not just to how we practice hand hygiene at home; there is increasing awareness of the transmission of Healthcare Associated Infections (HAIs) with improper hand hygiene practices, and this has led to a sea change in the way we view our hands and the uses that we put them to.

      Hands at home

      Hand hygiene at home plays a very important role. We are instructed, as children, to wash our hands before and after we eat. This is the very basic.

      Hands should be kept clean whenever we handle food- cooking, serving and after clearing up. Visits to the washroom need to be followed up with washing hands. Taking care of family members suffering from bouts of communicable infections like diarrhoea and jaundice necessitates extra attention and care to be directed towards keeping hands clean. Hand washing plays a very important role in checking community-acquired infections like common coughs and colds, flu, viral conjunctivitis, typhoid, etc. which are spread via contaminated hands and fomites such as soiled wash and kitchen cloths, sponges, and utensils.

      Lovable pets are big carriers of bacteria too. So, due attention must be paid to hand hygiene while handling them.

      Hand hygiene in public places

      This is essentially the same as what hand hygiene at home involves but with extra care especially during the use of public toilets. Hands that are used to work with food, as in the restaurant business, also need to maintain high standards of hygiene.

      Wash those hands

      • Before and after preparing food
      • When rotating between handling raw or frozen food and food that is ready to eat
      • After using the toilet
      • Before wearing gloves to handle food
      • After handling dirty utensils or soiled equipment
      • After eating, drinking, coughing, sneezing, using a disposable tissue or handkerchief
      • Caring for or handling service or pet animals including aquatic ones

      Liquid soap or bar soaps?

      Soap works by attaching to the molecules of grease and grime on our hands which are then washed off. Unfortunately, in the process of washing, bar soap harbours bacteria on its surface. Its warm wet surface has the potential for further bacterial growth too. Of course, this is just a thin film which can be washed off, but why risk it? No one knows where the previous user’s hands have been!

      At home, bar soaps may be used to wash hands as their use is usually limited to family members. But liquid hand washes are a better choice. They are more sanitary as they dispense limited quantities with the rest of the liquid ‘safe’ in the dispenser. Here too, it is important to clean the dispenser, particularly the nozzle, if it is not a disposable one.

      Hand hygiene and Hospital Acquired Infections

      ‘Clean' hands are of particular importance where all workers dealing with health care are concerned. . Hand hygiene is considered one of the most important measures to be adopted by healthcare workers (HCWs) to prevent the horizontal transmission of pathogens from one patient to the other or from HCW to patient and vice versa.

      Here, hand hygiene encompasses various ways in which hands can be cleaned and the burden of microorganisms reduced. This includes using alcohol based products called hand rubs or detergent based products called hand washes or the surgical hand wash which is done before surgery by the surgical team.

      The WHO recommendations for healthcare workers include:

      • Before patient contact
      • Before performing an aseptic task
      • After body fluid exposure risk
      • After patient contact
      • After contact with patient surroundings

      Hand sanitizers in healthcare

      While obviously greasy or dirty hands need soap and water, alcohol-based hand rubs are to be recommended in the healthcare environment. They are easy to use, quick to dry and are now being formulated with moisturisers and emollients to be kinder on the skin than soaps. They not only destroy pathogens on skin surfaces instantly, but they also discourage their regrowth.

      Here we lay more emphasis on using alcohol rubs because HCWs are faced with plenty of opportunities for hand hygiene that during their shifts. Still, as per World Health Organization (WHO), an HCW must use a hand wash, when the hands are visibly soiled, before eating food, after visiting the washroom and when the HCW is caring for a patient suspected to have Clostridium difficile diarrhoea.

      The sane use of sanitizers

      While we have always focussed on the advantages of using alcohol rubs, these may not be the best options for hand hygiene in the community. Many times I have observed, especially in the local trains of Mumbai , a large number of school and college going students using hand rubs before opening their snack or lunch boxes. Children going to school, often bully their parents to bring them alcohol rubs to be taken to school to match up to peer-pressure. This use of alcohol rubs as being à la mode in the community is better discouraged.

      Centres for Disease Control (CDC), USA has reported alcohol intoxication leading to serious consequences, including apnoea, acidosis, and coma in young children. This exposure could be through ingestion, inhalation, dermal or ocular. The use of hand sanitizers/rubs is contraindicated in children <2 years of age since their skin is not fully developed as a barrier to prevent absorption of alcohol.

      It is, therefore, crucial that all contact with hand sanitizers/rubs in the community be under strict supervision of adults. Instead, I encourage the use of soap and water to wash hands when at home, in school, or in your workplace. The only workplace that is different is a healthcare organization.

      Make this your motto to good health via hand hygiene: Spread the word, not the germs!

      Author: Dr.Aruna Poojary MD, DNB,D(ABMM),Dip (HIC)

      HOD, Dept of Pathology & Microbiology, Breach Candy Hospital Trust, Mumbai, India

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