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People just do not know proper handwashing technique.
Or do they?
When I tell people that we have been creating an app to improve people’s handwashing technique, and upgrade their health habits, I often hear: “I always wash my hands,” or “I always use hand sanitizer to wash my hands.” Implying: “I already do it.”
But does doing it mean doing it well?
The only way to wash your hands well is by doing it properly.
Doing it properly means more than washing for 20 seconds as often recommended. Doing it well means being aware of things you touch around you that are potentially contaminated, and washing your hands, well, mindfully.
Are you aware of how you wash your hands? At all times?
If you touch poop, you would probably be aware that you need to wash your hands well. But what if you are distracted? Or if you touch a handle that someone else with poop on their hands touched? You would not know that you got poop on your hands too. If you do not wash your hands thoroughly, you might still have some “poop remnants” on your hands. And if that poop came from person with infectious diarrhea, theoretically, you might get it too.
During and/or after the pandemic, I made a number of personal observations while visiting restaurants or hotels that confirmed my suspicion: even with good will, and good intentions to wash their hands, people often do not do it well.
Here is only one example (from a restaurant) that illustrates my point:
A woman comes out of the restroom. She is beautifully groomed with a long hair, impeccable makeup, and fashionable outfit. As she comes out after using the toilet, this is what she does:
How did she do?
Let’s analyze her steps:
She went out to the real world, hugging, touching her friends, eating, drinking, and living her life.
What was her Handwashing Score?
Turn on clean running water
Wet hands under water
Scrub BACK OF HANDS Right
Scrub Back of Hands Left
In Between the fingers
Scrub Thumbs Right
Scrub Thumbs Left
Scrub Fingernails Right
Scrub Fingernails Left
Scrub Fingertips Right
Scrub Fingertips Left
Scrub Wrists Right
Scrub Wrists Left
Turn off water with towel
She did 8 out of 18 total steps.
In relation to the 12-handwashing scrubbing steps she did only 3 out of 12 steps (she washed her palms and backs of her hands only).
It is easy to see how even well-meaning people do not do a good enough job washing their hands. In our example, she had good intentions. If asked, she would honestly say that she washed her hands.
But she missed so many steps. That might potentially contribute to spreading germs to others. Especially if, let’s say, she had diarrhea. Some pathogens that we transmit via diarrhea and dirty hands include: E. coli, the notorious norovirus that continues to be a problem, salmonella and shigella. Dirty hands can also transmit germs from a upper respiratory infection, like the common cold, the flu or RSV.
Any of these germs could have been spread this way from incompletely washed hands. Even clean hands that touch something dirty can undo the best of hand hygiene efforts.
While advising people to wash their hands for 20 seconds might have been a good initial public health strategy, more could be done.
We need to teach people healthy habits including how to wash their hands properly. Ideally, we would start instruction at an early age. That includes practicing all handwashing steps, especially handwashing scrub steps. Adults might need a refresher and reminder too. People are capable of learning more. Let’s not underestimate them.
What are your observations about how people wash their hands at home, work, in hotels, restaurants, or other public places? Are they doing it well? What could they do even better?
Jasminka Vukanovic-Criley is Awards winning physician internist, hospitalist, mentor, educator, speaker and can be reached on Twitter @criley_md.