From the Guidelines
Proper handwashing involves wetting hands with clean water, applying enough soap to create a good lather, and thoroughly scrubbing all surfaces for at least 20 seconds, as recommended by the most recent guidelines 1. To effectively wash hands, one should start by wetting them with clean, running water, then apply soap and rub hands together to make a lather, scrubbing well, including the backs of hands, between fingers, and under fingernails, for at least 20 seconds, as outlined in the guidelines 1. Some key points to consider when washing hands include:
- Wetting hands with clean, running water (warm or cold) and applying soap 1
- Rubbing hands together to make a lather and scrubbing them well, including the backs of hands, between fingers, and under fingernails, for at least 20 seconds 1
- Rinsing hands well under running water and drying them using a clean disposable paper towel or air dry, without drying hands on clothing 1
- Assisting young children with washing their hands, as they may not be able to perform the task effectively on their own 1 The importance of handwashing cannot be overstated, as it is a crucial step in preventing the spread of infectious diseases, particularly in healthcare settings or when interacting with individuals who may be more susceptible to illness, as highlighted in the guidelines 1. In addition to the basic steps of handwashing, it is also important to consider the indications for hand hygiene, such as:
- Before and after treating each patient 1
- Before donning gloves and immediately after removing gloves 1
- After contact with body fluids or excretions, mucous membranes, nonintact skin, and wound dressings 1 By following these guidelines and making handwashing a priority, individuals can significantly reduce the risk of spreading infectious diseases and promote overall health and well-being.
From the Research
Handwash Methodology
- The most effective method for removing Clostridium difficile from hands is washing with soap and water, as shown in studies 2, 3, 4
- Alcohol-based hand rubs are not effective against C. difficile spores, with studies showing minimal reduction in spore counts 2, 3
- The World Health Organization-recommended handwashing technique is more effective than an unstructured technique in removing C. difficile from hands, with a median log10 CFU reduction of 1.71 5
- A modified washing technique, dubbed the WHO shortened repeated technique, was also shown to be effective in removing C. difficile from hands, with a median log10 CFU reduction of 1.70 5
- Hand hygiene with soap and water was more effective than alcohol-based handrub in removing C. difficile from the hands of patients with C. difficile infection, with 2 out of 4 patients still having C. difficile present after hand hygiene with soap and water, compared to 3 out of 3 patients still having C. difficile present after hand hygiene with alcohol-based handrub 4
Factors Affecting Handwash Efficacy
- The type of soap used can affect the efficacy of handwashing, with warm water and plain soap showing the greatest adjusted mean reductions in C. difficile colony-forming units (CFUs) 2
- The surface of the hand being washed can also affect the efficacy of handwashing, with the hypothenar and thenar surfaces being more likely to remain heavily contaminated after handwashing 2
- The use of antiseptic hand wipes was shown to be less effective than washing with soap and water in removing C. difficile from hands 2, 3
Environmental Contamination
- C. difficile spores can be transferred from one person to another through physical contact, such as handshaking, even after the use of alcohol-based hand rubs 3
- However, one study found that C. difficile was not present on alcohol-based gel dispensers in a hospital setting, although other potentially pathogenic organisms were detected 6