Global Handwashing Day (GHD) was marked on Sunday (Oct 15, 2023).

Initiated by the Global Handwashing Partnership, it is a global advocacy day that aims to increase the understanding of the importance of handwashing at critical times in daily life, as an effective measure to prevent diseases and save lives.

The theme for GHD 2023 is “Clean hands are within reach”.

The message: “Through strong leadership and collective efforts, we can close gaps in access and practice to achieve hand hygiene for all.

“Everyone has a role to play to ensure clean hands are within reach.”

Why wash?

There are various ways in which microorganisms can spread, including:

From person to person.

From surfaces when one touches the eyes, nose and mouth with unwashed hands.

By preparing or eating food and drinks with unwashed hands.

From touching surfaces or objects with microorganisms on them.

From blowing one’s nose, coughing or sneezing into hands, then touching other people’s hands or common objects.

Clean water, good hygiene practices and decent toilets contribute significantly to a reduction in the spread of many infectious diseases.

There are many health benefits of hand hygiene, which primarily reduces the spread of many diseases.

Handwashing with soap can reduce diarrhoeal diseases and acute respiratory infections by 30% and up to 20% respectively.

It also reduces the spread of microorganisms during outbreaks of infectious diseases like cholera, shigellosis, hepatitis E, SARS (severe acute respiratory syndrome) and Covid-19.

Hand hygiene protects against the spread of healthcare-associated infections and reduces the spread of antimicrobial resistance.

Apart from individual benefits, handwashing also has economic and societal impacts, such as reduced work and school absenteeism, improved physical wellbeing and worker productivity.

When to wash

There are many moments in daily life when the hands should be washed, e.g.:

Before, during and after food preparation.

Before and after eating food.

Before and after providing care to anyone at home who is ill with diarrhoea and/or vomiting.

Before and after treating a wound.

After using the toilet.

After touching garbage.

After coughing, blowing the nose and/or sneezing.

After changing nappies or cleaning up children who have used the toilet.

After touching animals, their feed or waste.

After handling pet food.

In a healthcare setting, handwashing with soap and water, or the use of a sanitiser, should be done:

Prior to and after touching a patient.

After touching objects, including medical equipment, in a patient’s immediate vicinity.

Before moving from a soiled body site to a clean body site on the same patient.

After contact with body fluids, blood or contaminated surfaces.

Prior to performing an aseptic (i.e. surgically sterile) task, e.g. inserting a medical device or handling invasive medical device(s), regardless of whether gloves are used.

After removal of sterile or non-sterile gloves.

How to wash

In most situations, handwashing with soap and water is the best method of getting rid of microorganisms.

There are five basic steps to remember in handwashing with soap and water.

Firstly, the hands should be made wet with clean, running water – preferably cold – followed by application of soap to the hands.

Liquid, bar or powdered soap are all acceptable.

When bar soap is used, it should be kept on a rack that facilitates drainage so that the bar can dry.

The hands should then be rubbed together with the soap creating a lather.

This process should include the backs of the hands, between the fingers and under the nails.

The hands should be scrubbed for a minimum of 20 seconds, then rinsed with clean, running water.

The hands are then dried thoroughly with a clean single-use towel or an air dryer.

The duration of the whole procedure is about 40-60 seconds.

The towel should not be used multiple times or by multiple people.

Sometimes, soap and water may not be readily available.

In such situations, a hand sanitiser containing at least 60% alcohol can be used to clean the hands.

The product label on the sanitiser will have information about the alcohol content.

While sanitisers can reduce the number of microorganisms on the hands in many situations, it is important to remember that these gels, liquids or foam:

Do not get rid of all microorganisms

May not be as effective when the hands are visibly dirty, and/or

May not remove harmful chemicals like pesticides on the hands.

When a 60% or more alcohol-based hand sanitiser is used, the liquid or gel should be applied to the palms covering all surfaces of both hands, particularly between the fingers.

The correct amount is usually stated on the product label.

The hands and fingers should be rubbed until they are dry.

This would normally take about 20-30 seconds.

Soap and alcohol-based hand sanitisers should not be used together.

Healthcare providers should be provided with products that have low irritancy potential as frequent handwashing or use of alcohol-based hand sanitisers can lead to contact dermatitis and other skin damage.

Encouraging washing

There is much that can be done by the authorities, healthcare providers and civil society to promote hand hygiene, particularly handwashing.

The authorities can, for example:

Ensure that all buildings have adequate facilities for handwashing and that hand sanitisers are easily accessible and available.

Promote hand hygiene in public communication.

Have hand hygiene targets and monitor the progress towards achieving them.

Fund research, particularly in behaviour change and return on investment in hand hygiene.

Healthcare providers should ensure that they walk the talk as it has been reported that sizeable numbers do not practise what is preached.

They can ensure hand hygiene targets in healthcare facilities are met all the time and not just some of the time.

Civil society can improve hand hygiene in schools, workplaces and other institutional settings with multiple measures.

Patient safety advocacy groups can increase public awareness that hand hygiene is critical to human health.

Donors can invest in programmes that are hygiene sensitive and promote hand hygiene.

Businesses can play a role through partnerships, financing, innovation and research.

Last, but not least, academia can clarify evidence gaps, particularly behaviour change, and innovations to enhance hand hygiene.

Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email starhealth@thestar.com.my. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.