Dear Dr. Jeff: This may sound pretty dumb, but with all the talk you hear about hand washing and the flu, is there some special way you're supposed to be washing your hands? J.N.
Dear J.N.: Very timely question, and nothing dumb about it at all!
Hand washing is felt to be the single most effective way to prevent the transmission of infectious disease.
This was not always so clear. In the mid 1800s, Oliver Wendell Holmes advocated handwashing to prevent the spread of childbed fever among newly delivered mothers. His ideas were widely greeted with disdain by other physicians.
Meanwhile, in a Viennese maternity ward, one Dr. Ignaz Semmelweis ordered his medical students and residents to wash their hands with a chlorinated solution after working on cadavers in anatomy class before they began their rounds on the maternity floors. The idea was considered quaint at best, but the result was a dramatic five-fold decrease in the death rate of women who delivered on Dr. Semmelweis' floor. His colleagues at the University, however, greeted these findings with hostility, and Dr. Semmelweis was forced to resign.
It was another 50 years or so, after the pioneering work of Pasteur and Koch, that the medical profession finally accepted the "germ theory" of infectious disease and embraced hand washing as a central bulwark against its spread.
Enough history: on to technique!
To be effective, hand washing must include these three components:
1. Friction - to remove gross contamination, dead skin, and other particles that might harbor potentially harmful organisms.
2. Soap - to break down skin oils that hold these particles and clumps together.
3. Warm running water - to remove debris and soap.
Here we go!
1. Turn on the warm water and wet your hands thoroughly.
2. Apply some soap (helpful if bactericidal, but certainly doesn't have to be.)
3. Rub your hands together vigorously, palm to palm, then right palm over back and side of left hand, and then left palm over the back and side of right hand.
4. Make sure you clean in between your fingers, over the backs of your fingers and knuckles, and along both sides of your thumbs.
5. Steps 3 and 4 should last no less than 30 seconds.
6. Rinse your hands thoroughly in warm, running water.
7. Dry your hands with a clean paper towel or a fresh cloth towel.
Close off the water with the paper towel.
You're done! Wash your hands before meals, before preparing food, after using the bathroom, after touching animals or animal waste, when your hands are dirty (of course), AND when you're sick (coughing and sneezing) or around someone else who's sick.
If you're going to use an alcohol-based cleanser (like "Purell"), you obviously only need to follow steps 3 and 4. Having a bottle along with you during the day might prove practical and convenient.
Wash up! Wash often! And stay well!
Jeff Benson, MD
Dudley Coe Health Center