Which of the following practices is essential to ensure effective handwashing techniques?

According to the Centers for Disease Control and Prevention (CDC), proper hand hygiene is vital to lowering infectious disease transmission.

In fact, research has shown that handwashing lowers the rates of certain respiratory and gastrointestinal infections up to 23 and 48 percent, respectively.

According to the CDC, washing your hands frequently is particularly important to help prevent the spread of the new coronavirus known as SARS-CoV-2, which causes the disease known as COVID-19.

In this article, we’ll look at the key steps to washing your hands correctly to ensure they’re free of germs that can cause serious infections.

Below is the seven-step handwashing technique endorsed by the CDC and World Health Organization (WHO):

The key to washing your hands is to make sure you thoroughly clean all surfaces and areas of your hands, fingers, and wrists.

Here are more detailed handwashing steps recommended from the WHO. Follow them after you’ve wet your hands with water and soap.

After you’ve completed these steps, you can rinse and dry your hands.

Plain soap is just as good at disinfecting your hands as over-the-counter antibacterial soaps. In fact, research has found that antibacterial soaps aren’t any more effective at killing germs than regular, everyday soaps.

In 2017, the Food and Drug Administration (FDA) banned the use of the antibacterial agents triclosan and triclocarban. The reasons cited by the FDA for the ban of these agents included:

• antibacterial resistance
• systemic absorption
• endocrine (hormone) disruption
• allergic reactions
• overall ineffectiveness

So, if you happen to have older bottles of antibacterial soap stocked away, it’s best not to use them. Throw them out, and just use regular soap instead.

Also, there’s no evidence to suggest that the water temperature makes a difference. According to one study, washing your hands in warm water doesn’t seem to get rid of more germs.

The bottom line is that it’s safe to use whatever water temperature is right for you, and use any regular liquid or bar soap you have on hand.

Washing your hands is particularly important when you’re in situations where you’re more likely to acquire or transmit germs. This includes:

• before, during, and after you prepare food
• before and after you:
  • consume foods or drinks
  • are exposed to someone with an infectious illness
  • enter a hospital, doctor’s office, nursing home, or other healthcare setting
  • clean and treat a cut, burn, or wound
  • take medication, such as pills or eye drops
  • use public transportation, especially if you touch railings and other surfaces
  • touch your phone or other mobile device
  • go to the grocery store
• after you:
  • cough, sneeze, or blow your nose
  • touch visibly dirty surfaces, or when there’s visible dirt on your hands
  • handle money or receipts
  • have touched a gas pump handle, ATM, elevator buttons, or pedestrian crossing buttons
  • shake hands with others
  • engage in sexual or intimate activity
  • have used the bathroom
  • change diapers or clean bodily waste off others
  • touch or handle garbage
  • touch animals, animal feed, or waste
  • touch fertilizer
  • handle pet food or treats

Dry, irritated, raw skin from frequent handwashing can raise the risk of infections. Damage to your skin can change the skin flora. This, in turn, can make it easier for germs to live on your hands.

To keep your skin healthy while maintaining good hand hygiene, skin experts suggest the following tips:

• Avoid hot water, and use a moisturizing soap. Wash with cool or lukewarm water. Hot water isn’t more effective than warm water, and it tends to be more drying. Opt for liquid (instead of bar) soaps that have a creamy consistency and include humectant ingredients, such as glycerin.
• Use skin moisturizers. Look for skin creams, ointments, and balms that help keep water from leaving your skin. These include moisturizers with ingredients that are:
  • occlusive, such as lanolin acid, caprylic/capric triglycerides, mineral oil, or squalene
  • humectants, such as lactate, glycerin, or honey
  • emollients, such as aloe vera, dimethicone, or isopropyl myristate
• Use alcohol-based hand sanitizers that contain skin conditioners. Alcohol-based hand sanitizers with humectants help ease skin dryness, while emollients replace some of the water stripped by alcohol.

FDA Notice

The Food and Drug Administration (FDA) has announced recalls of several hand sanitizers due to the potential presence of methanol.

Methanol is a toxic alcohol that can have adverse effects, such as nausea, vomiting, or headache, when a significant amount is used on the skin. More serious effects, such as blindness, seizures, or damage to the nervous system, can occur if methanol is ingested. Drinking hand sanitizer containing methanol, either accidentally or purposely, can be fatal. See here for more information on how to spot safe hand sanitizers.

If you purchased any hand sanitizer containing methanol, you should stop using it immediately. Return it to the store where you purchased it, if possible. If you experienced any adverse effects from using it, you should call your healthcare provider. If your symptoms are life threatening, call emergency medical services immediately.

When handwashing isn’t feasible or your hands aren’t visibly soiled, disinfecting your hands with alcohol-based hand sanitizers can be a viable option.

Most alcohol-based hand sanitizers contain ethanol, isopropanol, n-propanol, or a mixture of these agents. The most effective antimicrobial activity comes from alcohol solutions with:

• 60 to 85 percent ethanol
• 60 to 80 percent isopropanol
• 60 to 80 percent n-propanol

Ethanol seems to be the most effective against viruses, whereas propanols work best against bacteria.

Alcohol-based hand sanitizers quickly and effectively destroy many disease-causing agents, including:

• the flu virus
• HIV
• hepatitis B and C
• MRSA
• E.coli

A 2017 study also found that alcohol-based hand sanitizer formulations with ethanol, isopropanol, or both were effective at killing viral pathogens, such as:

• severe acute respiratory syndrome (SARS) coronaviruses
• Middle East respiratory syndrome (MERS) coronavirus
• Ebola
• Zika

Like handwashing, the effectiveness of hand sanitizers depends on using the right technique.

To apply hand sanitizer properly, follow these steps:

1. Apply about 3 to 5 mL (2/3 to 1 teaspoon) in your palm.
2. Rub vigorously, making sure to rub the product all over the surfaces of both your hands and between your fingers.
3. Rub for about 25 to 30 seconds, until your hands are completely dry.

Hand hygiene is a simple, low cost, evidence-based intervention that can help protect your health and the health of others.

In the wake of the COVID-19 pandemic, governments and community leaders worldwide have called for rigorous and collective efforts to improve public hygiene practices such as handwashing.

Although washing your hands with plain soap and clean, running water is the preferred method for hand hygiene, using an alcohol-based hand sanitizer with at least 60 percent alcohol can also be an effective option.

Good hand hygiene isn’t a measure to be used only during pandemics and other disease outbreaks. It’s a time-tested intervention that needs to be practiced consistently and mindfully to have the greatest effect on individual, community, and global health.