Flu season is upon us, and our friends at the Center for Disease Control (CDC) are franticly threatening us with Ebola. The most scientifically sensible advice I’ve heard from the official sources is that, due to the lack of a proven preventative for this potential scourge, the best defense is “extreme cleanliness.” This approach involves at least three key steps that are within our spheres of control:
1. Minimize unnecessary exposure— avoid picking up the bug!
2. Scrupulous hand washing—don’t get it in your mouth and don’t “hand it off” to others!
3. Keeping a fastidiously clean and sanitary environment at home and the workplace, wherever you can control it, is critical to lowering the risks of perpetual recontamination.
The first part of my series on hand washing (October 2014) is an updated course on the critical skill of how to properly wash your hands.
The second part (November-December 2014) reviews the tools, pitfalls, and critical triggers for hand washing.
› “…if any man have a quarrel
This final installment (January 2015) covers life-enhancing and lifesaving benefits of hand washing for the hand washer and those “downstream.” Also, we’ll consider our duty to be part of the solution rather than nonchalantly skipping out of the loo and right past the wash-up station.
Hand Washing for All Seasons-part 3
Bacteria are virtually everywhere and on nearly everything. Learning to live with them includes neither indifference nor obsessively washing until your hands fall off.
There are times when an extreme position is better than the middle. We read that Laodicea receives a ballistic rejection because it is neither hot nor cold but rather dead center, with thermostat stuck at “insipidly lukewarm.” When it comes to hand washing, I think it’s best to find a personal balance that is definitely off center toward the obsessive end while likewise definitely shy of the over-wash extreme. I never want hand washing to become merely a rote behavior; this toward-the-extreme method helps. Working by following a few simple steps, and mindfully making adjustments for new learning, will fashion a personal plan to keep your hands attached, while lowering the number of transient bacteria to levels the immune system can handle.
Outside of the medical industry and a couple of other hand-sacrificing professions, it will be difficult to hand wash too much. However, there are a few who persistently wash too vigorously, too frequently, or use harsh washing agents, and manage to extract too much of the protective cell layers and oils from the skin. This could be a problem even if using only plain water, especially if using a coarse brush. This rough treatment often causes the skin to lose moisture, and roughen or crack and potentially bleed, providing germs a point of entry into the body where they can do more harm.
Barring any underlying skin condition, and the use of harsh agents, this should not be a concern, so use moderate friction for the requisite number of washings to cover the personalized critical “When to Wash” events (plus a few more a day for good measure). For example: assuming that your daily routine requires three dozen washing and drying bouts, if each takes thirty seconds your total hand washing time would be only eighteen minutes a day. This modest investment will contribute significantly to keeping fecal and other pathogenic contact contaminates off your hands and out of your body, and protects the community by not serving the stuff to others.
Why Wash Hands—Blessings reaped by hand washers:
• Hand washing reduces ARI (Acute Respiratory Infection) risk up to 44%, by reducing viruses like adenovirus, corona virus, Asian flu virus transmitted by the fecal-oral route.
• A study of 305 school children found that youngsters who washed their hands four times a day had 24% fewer sick days due to (ARI) and 51% fewer days due to upset stomach.
• Hand washing reduces risk of diarrheal diseases by 45%.
• Hand washing by mothers lowers incidence of childhood diarrhea.
Globally, hand washing could prevent over a million child deaths from diarrheal diseases and pneumonia.
Knowing thy Enemy—Here’s a short list of hand washing highlights to help:
• World-wide washroom studies show that up to 70% of people using washrooms wash their hands, and 30% of people who do so use soap as the cleaning agent. [As you’ll see below, many other studies show less optimistic results.] Unfortunately, even if accurate, these numbers only work for those who have access to, and use washrooms. Millions of people in the world have neither washing facilities nor clean water.
• All washing agents, including plain water, are similarly effective in reducing bacterial counts from hands.
• Physical action of scrubbing, washing and clean towel drying was more important than which washing agent was used.
• Proper washing should remove about 90% of transient bacteria with 15-30 seconds of systematic rubbing.
• Bacteria double in number in less than 20 minutes, so there is no need to worry about washing too often.
• Between 2 and 10 million bacteria live between the fingertip and elbow.
• Transient germs on hands can live up to three hours.
• Millions of germs hide under watches and bracelets, and there could be as many germs under a ring as there are people in Europe!
• Up to half of all men and a quarter of women fail to wash their hands after they use the bathroom.
• The number of germs on fingertips doubles after toilet use.
• It is important to make sure all parts of the hands and fingers are cleaned, especially the fingertips, which often get missed.
• Bacteria carried on pathogen contaminated hands can cause food poisoning, colds, flu, diarrhea, and death.
8 out of 10 people have fecal material under their fingernails, and in 5 of the 8 the material is not their own.
Fecal-oral Route and Chain Breaker
Note: the top bubbles (Fingers & Flies) represent all animate vectors.
Breaking the chain—The way hands are involved in passing on pathogens is through a chain of events starting at infected fecal contamination and winding up in the mouth of some unsuspecting victim. The fecal contamination can be carried by water, soil, hands, flies and food, which become reservoirs of contamination and infection. This chain is usually called the fecal–oral route, or alternatively, the oral–fecal route or even orofecal. Of course, animate feces is not the only source of pathogens, but it is the most significant to public health around the world. This writing focuses on the fecal to hand to mouth route and using hand washing to break the orofecal chain.
As the graphic shows, hand washing can break or inhibit all chains of transmission coming from the Fing-ers reservoir except Flies. Fly vectors are independent vectors, moving freely from sources to deposit sites, and require use of direct fly control methods.
The most common source of pathogenic bacteria on hands is from infected human or animal feces (this same process also works with other body secretions). This can occur as far back as the field where crops or animals were contaminated by birds, reptiles, rodents, amphibians, farm animals, workers, or feed, etc. After hands touch anything that is contaminated with pathogenic bacteria, they work like rubber stamps and transfer the germs to whatever they touch. Contaminated inanimate things are called fomes or fomites. Contaminated hands (finger reservoirs) can now make new fomites by hand stamping food, utensils, counters, plastic cutting boards, sink faucet handles, banisters, door knobs and a multitude of other things and surfaces, or directly to new victims by handshaking or other forms of touching. A worse case is when the new owner/victims eat before washing and become infected germ factories. Now, as reservoirs and vectors (animate germ couriers), they can do a lot more damage unless they wash up and break the chain frequently to keep from stamping out new fomes or donating their morbid gifts to receiving victim-vectors.
Ever fly with the germs? Well hold on. It will be a quick mindful moment trip with an imaginary fulltime professional courier who unwittingly becomes a part-time vector. The victim courier just picked up the germ load from a chance meeting with a friend who stepped out of the airport toilet room—with unwashed hands. It was a quick greeting and a firm handshake, Ka-ching♫! The victim, and now a germ courier (vector), grabbing the carry-on, Ka-ching♫, stamps the handle with a share of his newly acquired germ load and zooms off to catch his plane on the last boarding call. Zipping right past the washroom, not daring to take the time now to wash, not that it is ever a top priority, stamping, Ka-ching♫, Ka-ching♫, the banister is now ready for the slower stragglers. He stows the carry-on and shuts the overhead luggage door—Ka-ching♫, and nestles into the seat, Ka-ching♫, the seat belt, Ka-ching♫, to the arms of the seat. Ka-ching♫, Ka-ching♫, Ka-ching♫, all the way to lunch. It’s a sandwich! Clutching that Big Zac burger as if it were trying to get away, KA-CHING♫, swallowed in almost one bite! Finally gets washed up. Halfway around the world it’s off and running again, grabbing the carry-on, Ka-ching♫, a fresh batch! Lots of Ka-ching♫-ing and some business to do in town. Back home two days and the worst case of Montezuma’s revenge on record. Thinks the courier, “It must have been the water at that little restaurant in the middle of Tuikaba.” The whole family gets sick by the end of the week and friends follow suit within a few days. Wonder what happened in Tuikaba? We can only assume. We never hear.
Post-flight assignment: take a mindful moment and think of all the things the courier’s hands may have touched during his Tuikaba trip. Be sure to include the opportunities to access his mouth, nose, or to rub his weary eyes. What about all the places hands have gone and what they have touched. It’s a lot isn’t it? They have even been to the moon.
Next assignment: go to a busy mega-market-type department store and observe what all those hands (loaded rubber stamps) are touching in the toy, housewares, tool, and, heaven help us, the fresh produce areas. Take a mindful moment to think about the implications, and don’t forget that eight out of ten of those hands have something to share. Try to resist the urge to shout out, “STOP RIGHT WHERE YOU ARE and go wash those grimy hands. AND DO NOT FORGET THE FINGERNAILS because I know what’s there!”
Well that was enlightening! So, why aren’t we all dead? There is a wonderful praiseworthy reason: First, thank God for the immune system! Because of this gift most fecal donors are not infected. So, even if the donor is extra generous, the donation is not infected and cannot infect the receiving victim. Sorry, but the gifted fecal debris will still belong to the receiving victim. Yucky but not deadly—so there is the silver lining behind this tarnished cloud. Say the gift does arrive infected, if the victim’s immune system is healthy and robust, then pathogenic germs on the donor’s fecal debris will be killed. That’s why we don’t get sick every time we shake hands or go to the market. Queasy enough to wash our hands? Always! Sick? Rarely! Thank you Father!
Since the mid 1800s, the link between hand washing and contact transmission of infection has been well established in both US and Europe, and it has yet to be disputed. Centuries before such noted advocates of hand washing as Holmes and Semmelweiss, the “Vishnu Purana,” an ancient document from India, details wash-up instructions after latrine use. Here is a translation of those steps:
The generative organ is to be washed once,
The anus is to be washed three times,
The left hand to be washed ten times and
The right hand to be washed seven times.
Both feet are to be cleaned three times.
Fist full of earth is to be used for washing before use of water.
The water utensil is to be washed too.
Sharing the Woe—If knowledge were perfectly related to performance, then one would think that microbiologists would be right-on with hand washing. Not so! An observational study reported that 80% of qualified microbiologists attending a national meeting for microbiology scientists failed to wash their hands after visiting the toilet. Personal observations have confirmed that hand washing among state health department inspectors was not much better than the general public.
Hospitals—That’s it! Surely medical people have it together. Why, failure to wash up there would kill. A national healthcare safety and quality performance auditing organization recently reported that 51% failed to meet hand washing standards. Compliance to the standards for doctors was 60% and 80% for nurses. Performance standards, by the way, are not always set at 100%, so reported compliance numbers may seem higher than actual practice. If 100% compliance is set at 80%, then the actual number of proper wash-up events would be 64 out of 100 rather than 80.
The rationale for this method is to allow a way of setting targets that are attainable and not totally discouraging. It’s a lot easier to face the need to eat an elephant one bite at a time than in one swallow; so, though it may not be ideal, it’s not cheating. Everyone in the system knows how and why it works, but outsiders—customers or patients—need to know too so they can better calculate actual personal risk. Yes, it is fair to ask why highly paid professionals can’t handle the reality of 100%. Apparently the gender gap phenomenon is working in hand washing too, just as the ubiqui-tous “Please Wash Your Hands” improves hand washing in women but not in men. Likewise, in hospitals, female physicians wash their hands between patient contacts much more often (but still shy of 100%) than male doctors.
Hats off to Dr. Anwar Ul Haque, MD, Chief Editor for the “International Journal of Pathology” (Published from Islamabad), for his candid disclosure and admonition: “…it is a common knowledge that doctors are reluctant to use this most efficient and effective means of curtailing infections after seeing each patient.… We have an absolute obligation on ourselves not to become a vector of transmission of infections to the patients. Simple hand washing by clean water may reduce communicable and oral-fecal route diseases by 90%. So let us make it a habit to do frequent hand washing, especially before eating, drinking and after examining each patient.”
How can any thinking, caring healthcare practitioner escape bearing the mark of Cain when consciously choosing not to wash their hands when they know that failing to do so can do mortal harm to those who are trusting that their healthcare provider will answer “Yes!” to the question: “Am I my brother’s keeper?” Jesus answered this question positively by his selfless life, and made it clear that agreement with him by our works is prerequisite to His Kingdom (see James 4:17 and Luke 9:23).
Knowing is not enough—Starting with a question: Is it true that clean, healthy hands save lives? Yes, this is a fact that has been well known for centuries, so why does it continue to be ignored or rejected? The lackluster behavior by professionals topping our modern scientific and medical professions is especially discouraging and, just as faith without works is dead, neither understanding nor even teaching hand washing is enough to save lives. It is every person’s responsibility to be doers of what is known about hand washing. Hand washing is the most effective and inexpensive way to prevent diarrheal diseases and pneumonia, which together are responsible for the majority (36%) of child deaths. Globally, these two diseases result in 3.5 million children dying before they celebrate their 5th birthday! Effective hand washing can prevent 1.1 million of these deaths.
And the last question: Because it is true that failing to keep our hands clean kills people, dare we view hand washing as anything less than a moral obligation?
Thank God for a steadily growing number of people (worldwide) who are mindfully acting on the fact that they are accountable to break the chain of contamination, to protect their health and wellbeing and that of their families, and of the world, starting from where they wash their hands. We can also thank Him for inspiring people to help folk have access to clean water—the only essential ingredient for proper hand washing.
The following internet link will take you to one of the most innovative clean water initiatives I’ve seen to date, and it is as beautiful as it is functional. To maximize you time, first click “Story” on the front piece Menu—next click on “Design.”