Are you washing your hands properly?
Hand washing is a habit.
Hand washing is a skill.
Hand washing is something that you do every day, often, without even thinking about it. Hand washing is probably 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 (Centers for Disease Control and Prevention) issued the following advice: “Scrub your hands for at least 20 seconds. Need a timer? Hum the ‘Happy Birthday’ song from beginning to end 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?
Duration alone is not enough to assure you will wash your hands properly (or completely).
Hand washing 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 hand washing was brought up to the forefront.
When I tell people that we have been working on creating a hand washing app to bring the quality of handwashing to another level, people often (unprompted) tell me: “I wash my hands” or “I use hand sanitizer religiously.”
That is a great news, because hand washing 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 hand washing can decrease spread of a variety of diseases.
However, despite this heightened awareness of importance of hand washing, people still do not do it properly.
We made a number of observations while visiting restaurants, hotels, airports and even health care facilities and educational institutions (post pandemic), that confirmed our previous insights: even with the best intentions people often do not wash their hands properly or 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 wash your hands properly? It means washing them with soap and clean running water, mindfully, being focused on each part of the hand as you scrub them.
Properly also means that you wash all the areas of your hands where pathogens (i.e. germs) might hide. That includes washing your palms, back of your hands, in between your fingers, thumbs, fingernails, fingertips, and your wrists.
Do you wash all of these areas of your hands regularly?
Here is Indelible Hand Washing Scoring Table that we created to evaluate how people wash their hands.
What is your hand washing score?
| HANDWASHING STEPS | SCORE |
| Turn on clean running water | 1 |
| Wet hands under water | 1 |
| Apply soap | 1 |
| Scrub palms | 1 |
| Scrub BACK OF HANDS Right | 1 |
| Scrub Back of Hands Left | 1 |
| In Between the fingers | 1 |
| Scrub Thumbs Right | 1 |
| Scrub Thumbs Left | 1 |
| Scrub Fingernails Right | 1 |
| Scrub Fingernails Left | 1 |
| Scrub Fingertips Right | 1 |
| Scrub Fingertips Left | 1 |
| Scrub Wrists Right | 1 |
| Scrub Wrists Left | 1 |
| Rinse | 1 |
| Dry hands | 1 |
| Turn off water with towel | 1 |
| TOTAL SCORE | 18 |
What hand washing score did you get? Can you do better?
Share this table or this article with your friends or family.
What are their hand washing scores? Can they do better?
We are continuing to study hand washing health habits and our health 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.
Healthy habits can keep us all healthier. And you know, good health, is our greatest wealth.
References:
- 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/
- 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/
- 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/
- 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/
- 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/
Jasminka Vukanovic-Criley MD, FACP, FHM is a multiple award-winning physician, from cancer researcher, internal medicine physician, and Medical School Associate Clinical Professor to entrepreneur. She has mentored many undergraduate, graduate, and postgraduate students and faculty. She is the Principal Investigator on studies from the National Institutes of Health and the U.S. Department of Education creating research-driven #edtech games and digital media to improve health, civics, science education, and healthy habits. Dr Criley is also a founding Board member of Physician’s Weekly. She can be reached on X at @criley_md and at www.linkedin.com/in/jasminka-criley-md