Hand Hygiene

Hand Hygiene

Hand hygiene is arguably our most important life skill. So, teach it well and teach it often to your children. Michael J. Blackburn.

Hand hygiene includes two primary actions:

Washing the hands with soap and water to decrease colonization of transient flora by removing bacteria, soil, and loose dirt. Rubbing hands with a small amount of highly effective, fast-acting antiseptic agent, termed such as a sanitizer.

Proper hand hygiene practices are one of the most important actions we can take to reduce the spread of infection in our homes between and among family members (Aziz, 2013). Germs spread by hands are the most frequent source of infections affecting hundreds of millions of people globally (World Health Organizations, 2014)


Skin physiology and normal skin flora/bacteria:

Primary functions of skin:

Skin is a body organ and varies in thickness from less than one millimeter in the eyelids to greater than four millimeters on the soles of the feet. It is composed of two layers, the epidermis and dermis, and is underlain by subcutaneous tissue called the hypodermis (Habif, 2004). It reduces water loss and provides protection against abrasive action and microorganisms. The skin also, acts as a permeable barrier to the environment and helps maintain body temperature and transmits awareness of external. It also serves as a barrier function for body by secreting glycerolipids and sterols to protect and nourish skin cells.


Flora (microorganisms) of the Skin:

Skin is covered with colonies of microorganisms. The two categories of flora on the skin: transient and resident. Transient flora colonizes the superficial layers of skin and are more amenable to removal by routine handwashing, and most frequently found in infections. Resident flora attach to deeper layers of the skin and are more resistant to removal.


Transmission of microorganisms by the hands:

Microorganisms are transmitted from person to person by our hands. They are present on our skin and objects in the environment that we touch (e.g., paper, computers, etc.). Pathogenic organisms may become resident flora on some people’s hands. Inadequate hand cleansing allows organisms to contaminate other people’s hands. Cross-transmission of organisms occurs by contaminated hands (WHO, 2009). The number of organisms present on intact areas of the skin varies from individual to individual.

Hand Hygiene Products:

With contamination by infectious organisms everywhere, properly practiced hand hygiene reduces the incidence infections. Studies have compared the rates of infection of handwashing with plain soap and water versus some form of chemical antiseptic hand-cleansing products. When hand cleansing was performed correctly, the infection rates were lower with chemical antiseptic products than with plain soap and water. Handwashing technique, wearing artificial nails or rings, contaminated soaps or cleansers all increase transmission of pathogens (WHO, 2012).

Soaps are detergent-based products that possess a cleansing action. Their cleansing activity is due to their detergent properties, which remove dirt, soil, and various organic substances from the hands.

Plain soaps have minimal, if any, antimicrobial activity that destroys or inhibits growth of microorganisms. However, handwashing with plain soap removes loose transient flora, but does not remove pathogens from the hands.


Does handwashing really reduce the spread of bacteria? Yes!  A scientific study found that when hands were not washed Staph bacteria was much more frequent than when hands washed with an antimicrobial soap. Several other studies also showed that washing hands reduces the spread of bacteria. Most of us don’t realize when we have germs on our hands. We can get hundreds of bacteria on our hands by doing simple tasks, like:

  • Shaking hands
  • Touching another person
  • Touching doors and door knobs
  • Touching the refrigerator handle or microwave or other equipment

Are alcohol-based handrubs really effective?

While handwashing is very good and necessary, published studies have also shown that alcohol-based hand-rubs, when used properly are more effective than either plain soap or antibacterial soaps in

Reducing the number of live bacteria on the hands. Advantages of cleaning hands with alcohol-based hand-rubs: Alcohol hand-rubs have the following advantages over soap and water:

  • take less time to use
  • can be made more accessible than sinks
  • cause less skin irritation and dryness 
  • are more effective in reducing the number of bacteria on hands
  • more likely to be used because of increased accessibility
  • leads to improved hand hygiene practices

Since alcohol hand-rubs work, when should I wash my hands with soap and water?

The Centers for Disease Control and Prevention (CDC) and infection control organizations now recommend that if hands are not dirty, it is very effective to use an alcohol-based hand-rub (a gel, rinse or foam). However, it is recommended that hands be washed with plain soap and water, or with antimicrobial soap and water if:

  • your hands are visibly soiled (dirty)
  • before eating
  • after using the restroom 

How do I wash my hands effectively with soap and water?

  • wet hands with warm water first
  • apply 3 to 5 ml (double pump) of soap to hands
  • rub hands together for at least 15 seconds
  • cover all surfaces of the hands and fingers
  • rinse hands with water and dry thoroughly
  • use paper towel to turn off water faucet
  • Open bathroom door with paper towel

Tips on how to use an alcohol-based hand-rub:

  • Apply 1.5 to 3 ml (double pump) of an alcohol gel or rinse to the palm of one hand, and rub hands together
  • Cover all surfaces of your hands and fingers
  • Include areas around/under fingernails
  • Continue rubbing hands together until alcohol dries

If you have applied enough alcohol hand rub, it should take at least 10 -15 seconds of rubbing before your hands feel dry. If after cleaning your hands 5 to 10 times with an alcohol-based hand-rub, you feel a “build-up” of emollients on your hands, wash your hands with soap and water.

What’s on your hands? Be sure to wash !