Why are you not washing your hands properly?

Jasminka Criley, MD, FACP, FHM

Jasminka Criley, MD, FACP, FHM

President and CEO, Indelible Learning
Associate Clinical Professor of Medicine, UCLA School of Medicine

Handwashing in water

Why are you not washing your hands properly?

Or are you?

Handwashing is a habit.

Handwashing is a skill.

Handwashing is something that you do every day, often, without even thinking about it.

Handwashing is one of those automatic things you do in your everyday life, like tying your shoes.

At the beginning of the COVID-19 pandemic, the CDC issued the following advice: “Scrub your hands for at least 20 seconds. Need a timer? Hum the ‘Happy Birthday’ song twice.”

Is 20 seconds really enough to properly wash your hands? Why only 20 seconds?

Recommendation for 20 seconds of handwashing was practically extended, by some, who suggest washing your hands for 30 or 40 seconds. Even if you wash your hands for 60 seconds, does duration ensure you will wash your hands properly?

No, it does not.

Even if you do allot enough time for handwashing, do you know how to wash your hands properly?  Do you wash your hands well when you do it? How confident are you that your hands are clean?

Handwashing is an essential habit for maintaining good health. How you wash your hands makes a real difference not only for your own personal health, but for the health and well-being of those around you.

When asked, almost all people will say that they do wash their hands. Many say they wash them regularly.

During the COVID-19 pandemic, awareness about the importance of handwashing was brought up to the forefront.

When I tell people that we have been working on creating a handwashing app to bring the quality of handwashing to another level, people often tell me: “I wash my hands all the time” or “I use hand sanitizer religiously.”

That is great news, because handwashing is one of the most effective methods to eliminate many germs that we acquired on our hands as we touch and explore the world around us. Not washing our hands with soap and clean running water can cause us to get sick or to spread different infections to those around us beyond COVID including diarrhea (1-4) and different respiratory infections (3-5).

Literature is abundant in showing that improvements in handwashing can decrease spread of a variety of diseases.

However, despite this heightened awareness of importance of handwashing, people still do not do it properly.

I made a number of personal observations to that effect while visiting restaurants and hotels (post pandemic) that confirmed my suspicion: even with the best intentions people often do not wash their hands properly and consistently.

What does it mean to wash your hands consistently? It means you wash them any time they might be contaminated, especially before eating. There are times, however, you might forget to do it.

Why do you forget? Do you get distracted?

What does it mean to do it properly? It means washing it with soap and clean running water, mindfully, focused on each part of the hand as you clean them.

Properly also means that you wash the areas of your hands where pathogens might hide. That includes your palms, back of your hands, in between your fingers, your thumbs, your fingernails, your fingertips, and your wrists.

Do you wash all of these?

Here is the Handwashing Scoring Table that we created while evaluating how people wash their hands.

What is your score?

Table of handwashing scrub steps.

What is the score of those around you?

What can you/we do better?

We are continuing to study handwashing health habits and our behaviors, so we can make impactful improvements. If we can achieve even small incremental improvements, those could compound to overall better health not only for us personally but for those around us, our communities and beyond.


  1. Ejemot-Nwadiaro RI, Ehiri JE, Arikpo D, Meremikwu MM, Critchley JA. Hand washing promotion for preventing diarrhoea. Cochrane Database Syst Rev. 2015 Sep 3;2015(9):CD004265. doi: 10.1002/14651858.CD004265.pub3. Update in: Cochrane Database Syst Rev. 2021 Jan 6;12:CD004265. PMID: 26346329; PMCID: PMC4563982. https://pubmed.ncbi.nlm.nih.gov/26346329/
  2. Ejemot RI, Ehiri JE, Meremikwu MM, Critchley JA. Hand washing for preventing diarrhoea. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD004265. doi: 10.1002/14651858.CD004265.pub2. Update in: Cochrane Database Syst Rev. 2015;(9):CD004265. PMID: 18254044. https://pubmed.ncbi.nlm.nih.gov/18254044/
  3. Stedman-Smith M, DuBois CL, Grey SF, Kingsbury DM, Shakya S, Scofield J, Slenkovich K. Outcomes of a pilot hand hygiene randomized cluster trial to reduce communicable infections among US office-based employees. J Occup Environ Med. 2015 Apr;57(4):374-80. doi: 10.1097/JOM.0000000000000421. PMID: 25719534; PMCID: PMC4374724. https://pubmed.ncbi.nlm.nih.gov/25719534/
  4. Warren-Gash C, Fragaszy E, Hayward AC. Hand hygiene to reduce community transmission of influenza and acute respiratory tract infection: a systematic review. Influenza Other Respir Viruses. 2013 Sep;7(5):738-49. doi: 10.1111/irv.12015. Epub 2012 Oct 8. PMID: 23043518; PMCID: PMC5781206. https://pubmed.ncbi.nlm.nih.gov/23043518/
  5. Jefferson T, Del Mar CB, Dooley L, Ferroni E, Al-Ansary LA, Bawazeer GA, van Driel ML, Jones MA, Thorning S, Beller EM, Clark J, Hoffmann TC, Glasziou PP, Conly JM. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev. 2020 Nov 20;11(11):CD006207. doi: 10.1002/14651858.CD006207.pub5. PMID: 33215698; PMCID: PMC8094623. https://pubmed.ncbi.nlm.nih.gov/33215698/