It's flu season again.
All of our staff members want to do what's best for our clients. That includes, we decided, making sure that we, as an office community, make good hand hygiene a habit. At our last staff meeting, I gave a presentation on how to avoid getting the flu, respiratory, and GI illnesses that are so easily spread, especially during this time of year. I'd like to share highlights of what I presented and of our staff discussion.
Personally, I hate getting sick. So I got a flu shot, which the CDC says is about 60% effective. The Center for Disease Control recommends getting a flu shot as soon as the vaccine becomes available. I like the fact that getting the flu vaccine protects the people around me, as well. And I read up on what else helps prevent illness.
The best thing we can do is like a painless vaccination: wash our hands. It seems the most effective way we can follow the Golden Rule is to practice excellent hand hygiene. We owe it to each other, and especially to our clients, to do what we can to avoid spreading illnesses. In fact, nearly 80% of sickness-causing germs spread via the hands.
The average hand contains about 150 species of bacteria and viruses, including those that cause flu and other diseases.
How Diseases are Commonly Spread
How are diseases most commonly spread? First, you touch a contaminated surface with your hands. Think of all the places where there are a lot of germs: ATMs, elevator buttons, cell phones, dishcloths, sponges, keyboards, faucet handles, work desks, and bathrooms, to name a few. Second, you touch your eyes, nose, or mouth. That will transfer the germs into your body. Keep in mind that viruses live for hours outside the body, sometimes even days. They settle on surfaces after being breathed, coughed, or sneezed out. People who are sneezing or coughing frequently get them on their hands, which become contaminated. Same with the extra microbes you acquire when you visit the restroom. Unless you wash these off, your hands are officially contaminated. They, in turn, touch surfaces which become contaminated. UC Berkeley researchers found that over a three hour period, people touched their faces an average of about 16 times per hour.
Since we can't see microbes, it's hard to avoid them. A University of Arizona study used a non-infecting virus similar to those causing colds and stomach ailments to contaminate a push-plate door at a building with 80 employees. Within two hours, the virus had contaminated the coffee pot, microwave button, fridge door handle -- and then continued to spread. This is similar to what happens in stores, theaters, even our own homes. Clearly, it is impossible to completely avoid cold and flu viruses -- but it isn't pure luck whether you catch them or not. You don't usually get sick with only one virus; you become ill when so many viruses enter your body that you cannot cope with them. If fewer viruses enter your body, you have a much better chance to fight them back.
It is easy to touch your face without noticing you're doing it. If your fingers have viruses on them and you touch your eyes, nose, or mouth, you are likely to infect yourself. What do you do?
We've all been taught to wash our hands after we go to the bathroom. But do we always?
Well, actually only about two out of three people wash their hands after they go to a restroom. And, according to a study at Michigan State, only five percent of the 3,749 people observed in restrooms washed their hands correctly! Virtually everything the other 95% touch is likely to have some contamination.
That makes it all the more important that each of us wash hands as often as possible. Washing correctly and often will stop viruses and other nasty microbes from being passed from your hands to your eyes, nose, and mouth. This can be done with soap and water or with an antibacterial hand gel. Water alone doesn't do it. And you should NOT use an antibacterial hand soap because that can breed superbugs, harder to get rid of. However, hand gel should have at least 60% alcohol.
In fact, good hand hygiene -- washing or gelling -- is the single most effective way to stop the spread of infections. And it is the major method used in hospitals to fight infection.
Make it a Habit
We talked about making it a habit to wash hands at certain times, including 1) before eating a meal OR A SNACK, 2) after going to the toilet, 3) when returning home after work or shopping, 4) after being close to someone who has a cold or flu, and 5) after sneezing or coughing. Of course, good etiquette means using a tissue to catch a sneeze or a cough, disposing of the tissue, then washing hands, and if no tissue is available, cough or sneeze into your elbow instead of your hands.
We pledged to remind each other to wash hands as well as to be more mindful. We'll make reminder signs to put up in strategic places. We also have hand sanitizers at our desks and make them available for anyone who comes into the office. So feel free to use our gel!
Some people think that catching colds or the flu makes their immune system stronger. This is true -- but only for children under a year old who are still building their immune systems. There are over 200 different viruses that cause these illnesses, so it is decidedly better to avoid catching them at all. And you can catch a virus when someone sneezes or coughs if you're with three to six feet of them. So, if you notice someone sneezing or coughing, keep your distance. But, again, remember the real danger is that the viruses fall on surfaces (think stair rails, tables, keyboards, TV controls, desk tops, counters, etc.) that you may be likely to touch. These viruses can live on your hands for as long as three hours, and up to three days on some surfaces. Deceptively simple, hand washing/gelling is the single most important way to stop them from spreading.
We wouldn't shake hands with someone whose hands were clearly dirty, or if we saw them sneeze or cough into their hands, but we do shake hands with others whose hands are full of microbes that can be harmful.
To our clients: We pledge to wash our hands often.
We enjoy greeting you, but there are ways other than a handshake that would let you know how glad we are to see you. We discussed several less germy possibilities: a fist bump, a bow, even a hug is less likely to pass germs, as long as we don't breathe into your face! What kind of greeting would you prefer?
Does it Really Work?
People often remain skeptical. We don't see germs. A lot of folks think they just won't get sick. Some even think it's kind of "macho" to avoid washing hands or that it takes too much time. Does it really make a difference to wash/cleanse your hands?
There have been many studies that demonstrate that frequent hand cleansing does indeed cut down numbers of illness. One that I like involved a survey showing that a lot of new recruits in the Navy had some form of cough or flu-like illness in the first few months of training. Living in dorms (think of your college kids, too) increases the chance of illness spreading. Sick soldiers or sailors are not good security. So in 1996 an Illinois Navy base began "Operation Stop Cough," a course to teach new recruits to be more hygienic. The rules: 1) Recruits must wash their hands at least five times per day; 2) Soap must be available at all sinks; and 3) Officers in charge trained on hand washing by medical staff. To determine effectiveness, the number of illnesses the recruits had were recorded before "Operation Stop Cough" was implemented and compared with the number after. Findings: When they washed hands more often, the recruits caught HALF the number of illnesses they had before. The more times per day a recruit washed hands, the more likely NOT to catch a cough or flu. The U.S. Center for Disease Control confirms, "Hand washing is the single most important means of preventing the spread of infection." More: A Wirthlin study of 305 Detroit students washed their hands at least four times a day, resulting in 24% fewer colds and 51% fewer stomach upsets. A Minnesota daycare provider reported that teachers helped kids wash their hands every morning when they arrived and the staff disinfected areas parents may have touched. The result was 50% fewer illnesses at those daycares.
Needless to say, washing or gelling your hands is most important when you've been in busy places -- work, school, cafes, shops, public transport, where a lot of people have touched hard surfaces, like escalator and stair rails, table tops, chairs, handles, computer keyboards, shop counters and money. So it's a good idea to wash when you come home or into your office after being away. And of course, being in close quarters with someone who is ill means you should wash your hands before you accidentally touch your face.
We already practice good hygiene in many ways. We store our food in refrigerators, we throw away spoiled food, we wash our dishes and eating utensils. Washing hands regularly is at least as important. Make it easier to do by providing non-antibacterial soap at every sink, preferably one that smells good and is in a pump dispenser. Remember, antibacterial soap can breed the bad superbugs that are so hard to get rid of. If it smells good, your hands will smell good, and that will remind you not to touch your face when you bring your hand close to it -- an added precaution.
Keep hand sanitizing gel in rooms in convenient locations. Match hand washing with everyday cues. For example, keep a hand gel near where you put your keys when you come in. Be a role model for others. People are more likely to wash or gel if they see others do it and agree to remind each other.
How to Effectively Clean Hands
So we know to keep our hands clean, but most people do a pretty cursory job. Many don't even bother with soap. They fulfill the "letter" of the "law" but not the substance and reason for it. Washing without soap has little effect on, say E. Coli, for example.
So what's the best way -- the effective way -- to wash or clean hands? First of all, you need to realize that you should clean all surfaces, including backs of hands, wrists, between fingers, tips of fingers (the number of germs on your fingertips double after you use the toilet), thumbs, under fingernails (90% of the germs on hands are found under fingernails), and under rings, watches and bracelets. If you wear a ring, there could be over 700 million germs under it.
Wet your hands; then use enough soap to cover them completely with soapy "gloves." Rub the palms together, interlace fingers. Then rub the backs of the hands and interlace fingers. Then...Better yet, take a moment to watch this video. You can use a paper towel to turn off the faucet. I often use my elbow instead since we're in the middle of a drought.
Drying Your Hands
Drying your hands is also important. Damp hands spread 1,000 times more germs than dry hands. Do it with a paper towel gently but thoroughly. Wet hands can pick up bacteria more easily, so make sure they're thoroughly dry. Don't rub your hands together to dry them. It's okay to use a hand blower that doesn't require rubbing your hands together. Use a paper towel to open the door.
Too Much Time?
If you're worried that it takes too much time to wash long enough, remember that the 20 seconds you spend may save you days in bed. Also, use the time that you're scrubbing your hands to meditate, to breathe, and enjoy the break. Clear your mind. Think about something good. As you wash, roll your shoulders and neck to ease tension. If you can't stand singing "Happy Birthday" twice or the ABC Song once in your head, pick another song that you like that takes about 20 seconds and sing that one instead. It will also save time to keep hand gels near where you work.
Gels can be less drying to the skin than normal soap and water, and are usually just as effective, so use them except when your hands are soiled or if there is an outbreak of C. difficile. C. diff is a nasty sickness that can cause life-threatening diarrhea and can only be defeated with soap and water washing. Stay hydrated. Drink lots of water. Avoid harsh soaps and detergents. Use warm, rather than hot water. Use a moisturizing soap or gel. Keep a cream or lotion next to the sink and use it after you dry your hands. Keep your skin healthy; avoid chapping.
What Else Can We Do?
Carry an anti-bacterial hand gel with you. There are a lot of occasions when it is not convenient or easy to wash your hands. You can use the gel to wipe down surfaces that might be contaminated, such as that restaurant table where you're about to have your meal.
Don't forget to clean surfaces that are likely to be contaminated with bacteria and viruses -- doorknobs, keyboards, light switches, tables, etc. that are in your environment.
You can use a solution of one part bleach to 10 parts water. Spray surfaces and wipe with a paper towel.
Avoid using artificial nails and remove chipped nail polish. These have been associated with an increase in the number of bacteria on the fingernails.
Spread the Word -- Not the Germs
Encourage children to wash their hands regularly. Show them how and when, by doing it with them. Sing songs while washing hands. Give them their own foamy soap dispensers. For children too young to wash their own hands, get them used to keeping them clean by helping them and by using gel on their hands.
Hand hygiene improves community health as well. Hand washing education reduces the number of people who get sick with diarrhea by 31%. It reduces diarrhea illness in people with weakened immune systems by 58%, and it reduces respiratory illnesses, like colds, in the general population by 21%.
Convincing People to Wash their Hands: What Works.
Education definitely helps, but there's more.
For example, the "ick" factor often works. One mom showed her kids a video about parasites that can reside on hands. She never had another problem getting them to wash up after seeing photos showing all kinds of microbes on hands. Videos of people sneezing on their hands, then touching doorknobs or other objects that we commonly have to come into contact with. Setting an example. People take cues from others. If you wash your hands, the people who see you will be more likely to wash theirs. Help people realize that washing their hands protects others. We tend to be more motivated to help others and we're more likely to think we're "immune" (literally and figuratively) to getting sick, while knowing that others are not.
A Quick Checklist:
- Wash/cleanse your hands as regularly as possible. In addition to washing visibly dirty hands, you should also wash your hands before you eat or drink and after you use the bathroom, play with animals or take out the trash.
- Avoid touching your face (or try to use a tissue if you need to).
- Use tissues to "catch" a sneeze or cough, then put them in a bin immediately. Wash or gel your hands as soon as possible.
- Keep at least a 3-foot distance between yourself and ill people.
- Keep frequently touched surfaces clean. Use a mix of 10 parts water to one part bleach. For cell phones, make an alcohol and water solution: 1:1 ratio of 70% isopropyl alcohol and distilled water.
- Use a spray bottle, lightly moisten a lint-free microfiber cloth and gently wipe down screen and case.
- Clean corners with lint-free foam (not Q-tips) and don't ever spray directly onto the phone.
- If you're ill, stay home until your fever has subsided for at least 24 hours. Flu is contagious a day before symptoms appear and for four to five days after symptoms occur. If someone in your family is ill, use separate towels and keep them in one room.
- Wear a mask if there is a risk that catching a virus will make you seriously ill. The best are Particulate Respirators, which are round. These are called N95, FFP2 or FFP3 masks. These need to fit properly to work, so learn how to put them on. Also, since viruses will collect on the outside of the mask, throw it away carefully by putting it into a plastic bag, seal, and then wash your hands.
- Practice other good health habits. Be active, eat healthy foods, stay hydrated, and get enough sleep.
- To help avoid breeding superbugs, ask questions when your doctor wants to prescribe an antibiotic.
- At least 30% of antibiotic prescriptions are unnecessary and taking one can kill the good bacteria, leaving you more susceptible to other illnesses, especially C. difficile. Ask your doctor if you really need an antibiotic. If you do, then ask if it can be one that is specifically targeted to your particular "bug." Find out the minimum time necessary to use it for it to be effective. Ask about the possibility of using probiotics (even a few bites of yogurt) to counteract the bad effects of killing off the good germs.
- Spread the Word -- Not the Germs. Let other people benefit from your knowledge about preventing infections. Teach your children. Remind your family, co-workers and friends.
Ms. Gilfix is a longtime proponent of both family and professional “patient advocates” when loved ones are hospitalized for any reason, any duration. She counsels family members about effective advocacy in health care settings. Click here to read her full bio.