Do You REALLY Know How To Wash Your Hands?

More Important Now Than Ever

The original idea for this post was to discuss the importance of handwashing in relation to food safety. And while handwashing is still essential for food safety, in these days of viral pandemic it is even more important than ever to wash your hands frequently and well. That said, you'd be surprised at how many people don't really know how to wash their hands.

Studies from 2019 show that only about five percent of people wash their hands correctly. Most people only wash for around six seconds and thirty-three percent don't use soap. Only twenty percent wash their hands before preparing food and just thirty-nine percent wash up before eating. The same percentage don't wash their hands after sneezing, coughing, or blowing their noses, and men lead women in the “not washing after using the bathroom” category by a rate of fifteen percent to seven percent.

Now I'm pretty sure some of these stats have changed as the pandemic broadens, deepens, and raises awareness. I know from personal observation that there are a lot more men heading for the sinks in public restrooms than there used to be, but how many of them are doing any better at washing than they usually do?

I learned proper hand washing technique some forty years ago when I was in nursing school. Oh sure, my mama taught me how to wash my hands many years before that, and likely yours did, too. But my nursing instructor taught me how to wash my hands like my life depended on it – because it did. And the lives of my patients as well. My brief days as an ER nurse are now long, long behind me but the skill I learned back then is still with me.

So what's so hard about washing your hands, right? Anybody can do it. You turn the water on, hold your hands under there for a few seconds, maybe rub them together a little bit with some soap if you've got any, then shake them off, dry them on your pants, and you're done, right? Easy-peasy!And you only have to do that if they are really dirty, like after you've been into something nasty, you know? After all, as long as you can't see any dirt, they must be clean, right? And if you've got hand sanitizer around, well, you don't need to wash them at all. Squirt, squirt, rub, rub and tah-dah, clean, safe, sanitary hands.

In a word: no.

There was a time when hand washing wasn't a thing at all. Doctors didn't even do it. In fact, when Hungarian Dr. Ignaz Semmelweis, an early pioneer of antiseptic theory, mandated hand washing among students and doctors at the Vienna General Hospital in 1847 and later took to the stage to present the practice to the Vienna Medical Society, he was roundly ridiculed by the medical community, who faulted his science, his logic, and probably his sanity. His ideas about “cadaverous particles” and “decomposing organic animal matter” earned him professional scorn Despite compelling evidence that hand washing reduced mortality rates, the Vienna Hospital eventually discontinued mandatory hand washing and Semmelweis struggled with gaining acceptance for his theories until the day he died, possibly from an infected wound on his hand.

A few years later, Scottish surgeon Joseph Lister had a little better luck promoting hand washing in the medical community and soon after, Louis Pasteur's groundbreaking development of germ theory – much of it based on Semmelweis' work – forever changed the medical landscape. Even so, it took nearly another hundred years before hand hygiene was officially incorporated into American health care with the institution in the 1980s of the first codified national hand hygiene guidelines.

The importance of clean hands when handling food is something of which we are all aware nowadays. Besides having your mother drill it into your thick little head, there are signs posted in every restaurant rest room in the country assuring us that employees are required to wash their hands after “visiting” the rest room. (I love that term: “visiting.” Sounds so warm and inviting, doesn't it? Like you go in there to socialize and maybe have a spot of tea.) And you find yourself just hoping they all adhere to the requirement. Foodborne illnesses are no fun and lots and lots of them are caused by improper (or non-existent) handwashing. (Salmonella is a particular favorite, along with Norovirus, Clostridium perfringens, Campylobacter and the always popular Staphylococcus aureus.)

But these days we are all being hammered by the specter of a more potentially deadly threat: COVID-19. And proper handwashing is promoted as one of the key elements in controlling the spread of the virus that causes the disease.

I don't care who you are and how disciplined you think you may be, you're gonna touch your face. A recent study published in the American Journal of Infection Control says people touch their faces more than twenty times an hour on average. About forty-four percent of that time, the touching involves contact with the eyes, the nose, and/or the mouth. All three of those areas are made up of mucous membranes that act as direct pathways to your throat and your lungs. And that's why the CDC, the WHO, your doctor, and your mama all tell you to wash your hands.

Most soap and water handwashing doesn't actually kill germs; it removes them. “But what about the antibacterial soap I use,” you ask. “Doesn't that kill germs?” Meh. The FDA says there is no real scientific proof that using soap labeled as “antibacterial” is any better at preventing illness than using good ol' ordinary soap and water. Truth be told, all soap is technically antibacterial. And because many of the germs you're worried about – including the novel coronavirus – are viruses rather than bacteria, “antibacterial” soaps are even more superfluous.

Handwashing comes in different flavors, the most intense of which is surgical hand hygiene. This is what you see the doctors on TV doing when it's time to “scrub up.” Employing water, scrub brushes, and heavy duty antimicrobials like CHG (chlorhexidine gluconate), iodophor, or PCMX (parachlorometaxylenol) and utilizing specific scrubbing techniques, this level of fingertip-to-elbow cleansing isn't practical or necessary for everyday hygiene.

What is practical and necessary is social or routine hand washing. This is what you want to do to remove dirt, organic matter, and most nasty transient organisms. How often you do it depends upon how often you come in contact with said dirt, organic matter, and nasty transient organisms. In these days of hyper-awareness, it's a good idea to be cognizant of how many times you lay your hands or fingers on things like light switches, elevator buttons, ATM keypads, door handles, sink faucets, stairway handrails, etc.; things that scads of other folks have laid their hands or fingers on before you. And you need to adjust your handwashing regime accordingly. Most people come in contact with three hundred or so surfaces every thirty minutes. Think about it with the realization that whenever you touch something somebody else has touched, you are touching everything that person has touched. Then look at the people around you. That alone should make it easier for you to remember to run for the soap and water.

And soap and water is all you need to perform routine handwashing, the caveat being that if you don't do it right you might as well not do it at all. How do you do it right? Glad you asked because that is (finally) the point of this long-winded exercise.

This is the basic technique recommended by the Centers for Disease Control (CDC):

1. Wet your hands in running water and apply soap. Neither the temperature of the water nor the type of soap you use (antibacterial or otherwise) impacts how many microbes are removed.

2. Lather the soap by rubbing your hands together. The friction will increase the number of microbes removed.

3. Scrub for at least 20 seconds, or the approximate amount of time it takes to hum the “Happy Birthday” song twice.

4. Rinse your hands completely in clean, running water.

5. Dry your hands either on a clean towel or by air drying them.

Okay, let's go a little deeper. As the first item says, and contrary to popular belief, you don't need hot water. You can wash your hands in ice water if you want, but hot or at least warm water feels a lot better and it generally improves the lathering ability of most soaps. However, in order for water to be hot enough to have any germicidal properties, it would have to be far too hot for your skin to tolerate. So don't worry about water temperature.

Now, the CDC guidelines say to “lather the soap by rubbing your hands together.” Sorry, but that's way too general an instruction. Look at your hands for a minute and consider all the acreage involved. You've got palms, right? And fingers? Those are the spots that will get nice and squeaky clean if you just rub your hands together. But what about your fingertips and the area in between your fingers? And the backs of your hands? Will you get there or under your fingernails by just “rubbing your hands together?” Not so much.

There's a specific six-step order that people who wash their hands as part of their livelihood are taught. Step one is rubbing palm to palm, at least five strokes. Then you want to rub your right palm over the back of your left hand and then repeat left over right, again about five strokes. Step three goes back to palm to palm, this time with interlaced fingers. Then you want to curl your fingers and rub the backs of them into your opposing palms. Next, make sure your thumbs get in on the act via rotational rubbing of the right thumb clasped in the left palm and vice-versa. Finally, get those fingertips and under the nails by bunching the fingers of one hand together and rubbing them into the palm of the other. At least five strokes for each motion. And while you don't have to scrub up to your elbows like the doctors do, how about giving your wrists a little attention? It sounds like a lot, but believe me, it gets to be second nature after awhile. If you do it right, it times out to about two choruses of “Happy Birthday.” (I know: I just tried it as I was describing it. Which I'm sure made me look like a demented Captain Queeg to anybody who might be watching me type.)

Anyway, rinse your hands thoroughly, making sure you rinse all sides and surfaces, then move on to drying.

Single use disposable paper towels are the best option. Electric hand dryers have long been under scrutiny with numerous studies raising concerns about whether or not they live up to their health hype. The thought that these little tornadoes-in-a-box might actually be blowing leftover germs all over hell and gone is particularly concerning in these days of COVID mania.

Obviously, unless you have a paper towel dispenser mounted in your home bathroom, a cloth towel is what you're going to use there. Try to make it a clean one even if it means doing a little more laundry. In theory, you're wiping your freshly cleaned hands on the towel so how can it get dirty, right? I'll give you half a point on that one, but I'll also invite you to sniff that damp towel after a few uses and see how clean you think it is. Damp surfaces and germs just go hand in hand, no pun intended.

Finally, let's look at the much-hoarded darling of the coronavirus age; alcohol-based hand sanitizer. Hey, as long as you've got hand sanitizer, you don't need all that birthday song rubbing and scrubbing and soap and water and paper towels. A few squirts and a couple of rubs and you're instantly ready to deal with whatever Mother Nature throws at you, right? Not right.

There are limits to how well sanitizers sanitize. Even ones with the recommended sixty percent alcohol content don't remove all types of bacteria and viruses. This is due largely to the fact that while they might nominally disinfect, they don't actually clean your hands. They're okay if you're working in a clinical setting or an office environment where you're not actually getting your hands dirty. But if you're working with tools or equipment or handling food or chemicals or playing sports, etc., hand sanitizers just aren't up to the task. Plus, most of us don't use them the right way to begin with. Hand sanitizer is ineffective if you don't use enough of it or if you wipe it off before it's completely dry. In short, hand sanitizers are better than nothing and okay in a pinch but are not a replacement for soap and water.

Oh, one more thing: I've heard it everywhere these days; “All that handwashing is killing my skin!” Yeah. Kind of an occupational hazard, I guess. But fear not, the American Academy of Dermatology has good news for you; you can use hand cream to hydrate your dry, red hands. They say to apply a pea-sized amount of fragrance-free cream containing mineral oil or petroleum jelly to your skin and work it in well. Only a little is needed. Too much may cause greasy hands and then you're back where you started.

Final final thought: if you don't feel like humming or singing “Happy Birthday” twice, you might try a chorus of Dolly Parton's “Jolene” or Prince's “Raspberry Beret.” Twice through the alphabet song/”Twinkle, Twinkle Little Star” works, too, as does a rousing rendition of “God Save the Queen” if you're an anglophile or “My Country 'Tis of Thee” if you're not. Culture Club's “Karma Chameleon” is a good alternative choice or you could try the chorus to “Mambo No. 5” by Lou Bega. Just be aware that you may wind up with the damn thing stuck in your head for the rest of the day. If you want to be an overachiever, try humming the “Jeopardy” theme. It's thirty seconds long but what can it hurt? The famous handwashing chorus to the Bee Gee's “Stayin' Alive” is certainly appropriate these days and definitely a more uplifting choice than the chorus to Don McLean's “American Pie.” I mean, do you really want to be singing “this will be the day that I die, this will be the day that I die” while washing up these days?

Which reminds me, the Lord's Prayer is also about twenty seconds long. Hey, it can't hurt.