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Have you washed your hands? This question is heard in many homes and daycare centres throughout Canada several times a day. The source? Parents and caregivers. The reason? Handwashing is highly effective in reducing the spread of bacteria and viruses that cause disease. In fact, according to the World Health Organization, handwashing is the single most important way to prevent the spread of infectious diseases and has the ability to save an estimated one million lives annually (Curtis and Cairncross, 2003). But, like many things in life, what often seems like a very simple solution can often be difficult to put into practice on a regular basis.

In order to be effective, handwashing must be done regularly and correctly. That’s because bacteria, viruses, and other infectious agents are found everywhere around us: in our homes, workplaces, and the community.

Germs can be spread easily among people and they can live for a surprisingly long time on hard surfaces like desks, doorknobs, and counters. Most people get sick when they touch something that is contaminated with germs and then touch their eyes, nose, or mouth. These germs are then passed to other people through direct contact, such as with a handshake, or indirectly through coughing and sneezing. Sometimes, what we eat or drink is contaminated, which then acts as a vehicle for spreading germs or bacteria like salmonella or E.coli. Even our pets, such as dogs and cats, can be a source of more than 100 different germs that can make us sick. Simply put, germs spread from people to people, people to food, food to people, and from animals to people, either directly or indirectly.

Just like wearing a seat belt or putting on an oven mitt before touching something hot, washing your hands routinely and correctly makes good sense. So, ask yourself: Do I know how many times I washed my hands today? Do I follow the recommended procedure when I do wash my hands? Read on for more information on when handwashing is recommended, and to ensure that it is being done correctly.

HAVE YOU WASHED YOUR HANDS TODAY?

It is important to wash your hands often and after certain activities to limit the spread of bacteria, viruses and other disease-causing germs. Pay attention for a day to see how many of the following activities you do and if you wash your hands after each one. If not, you may be transmitting harmful germs to yourself and those around you.

Did you wash your hands...

After:
• using the bathroom, private and public?
• changing a diaper?
• dealing with animal waste?
• blowing your nose?
• handling garbage?

Before and after:

• preparing food, especially before and immediately after handling raw meat, poultry or fish?
• eating?
• treating wounds or cuts?
• touching a sick or injured person?
• inserting or removing contact lenses?

WHY IS HANDWASHING SO IMPORTANT?

There are hundreds of infectious diseases that can be largely prevented through immunization. However, there are many for which there are no vaccines. These include everything from the common cold to life-threatening diseases such as necrotizing fasciitis, otherwise known as flesh-eating disease.

Viruses, bacteria, parasites, and fungi can cause many types of infections. These disease-causing germs can be easily picked up from other people, from surfaces we touch, from foods we eat, and from the animals we come into contact with.

Handwashing, when done correctly and routinely, is one of the most effective ways to reduce the spread of infectious diseases. It removes disease-causing germs from our hands and prevents their spread to others.

The value of handwashing has been widely recognized for some time in significantly preventing food borne illnesses as well as other infectious diseases that can be severe and even life-threatening. As an indication of how many Canadians could reduce their risk through proper handwashing, the Canadian Food Inspection Agency estimates that between 11 and 13 million of us suffer from food borne illnesses annually (2006). Most of these illness are entirely preventable.

Sneezing and coughing are other ways that many viruses and bacteria are commonly spread. That’s because they live in saliva and mucus found in our nose and throat. When we consider how often we touch our nose, mouth and eyes during a day, it’s easy to see how many opportunities infectious agents have to spread.

“Handwashing is the single most effective way you can prevent the spread of infection or disease.”

World Health Organization, Health Canada, Public Health Agency of Canada, Centers for Disease Control and Prevention, Ontario Ministry of Health and Long-Term Care

HOW HANDWASHING WORKS

Handwashing removes the visible dirt and any attached germs by pulling the dirt and oily soils free from your skin. This happens when you rub your hands together with warm, soapy water for at least 15 seconds, and then rinse everything off. There are two ways to remove germs, including viruses and bacteria, from your hands: by washing them and by using a hand sanitizer. If it is not possible to wash your hands, then hand sanitizers are the next best option. While sanitizers do not remove the dirt on your hands, they do kill any germs present. An effective sanitizer should contain at least 60% ethyl alcohol. If your hands are too dirty, the sanitizer may not be able to penetrate through all the soil. For this reason, using soap and water is still the best option for keeping yourself and those around you healthy.

When it’s so easy to wash or sanitize our hands, why doesn’t everyone do it as often as they should?

Some reasons and possible solutions include:
• No soap available.
Use the hand sanitizer you carry with you. If you don’t already carry one, this may be a good time to start.

• Skin irritation/allergy to products.
Find a soap/sanitizer that works for you, such as hypoallergenic, perfume-free soaps or ones with moisturizers.

• Belief that it takes too much time.
A few seconds for washing your hands will save you many days and possibly weeks that you might otherwise spend sick.

WHAT ELSE CAN I DO TO REDUCE THE SPREAD OF GERMS?

Along with handwashing, you can take several other measures to reduce the spread of germs. These include:

• Keep your vaccinations up to date.
• Cover your cough or sneeze with your arm or tissue.
• Stay at home if you have signs and symptoms of an infection. Don't go to work if you're vomiting, have diarrhea, or a fever. Don't send your child to school if he or she has these signs and symptoms.
• Clean and disinfect your home regularly, especially the kitchen and bathroom.
These places usually have the highest concentration of germs.
• Use your own toothbrush, comb, or razor. Avoid sharing dishes and eating utensils.
• Travel wisely. Avoid going on the plane, bus, or train when you're ill. With so many people confined to a small area, you may infect other passengers.
• Use paper towels. When visiting public restrooms, use paper towels to turn the taps on and off, and to open the door when leaving.

Photos adapted from: Ministry of Health and Long-Term Care. (2006) Handwashing techniques. Retrieved July 18, 2006 from www.health.gov.on.ca/english/public/pub/pubhealth/pdf/handwash_tech.pdf

REDUCE THE HARM COUGH INTO YOUR ARM

While many people think that it is clean and sanitary when they cover their cough with their hand, this is not the case. Instead, they have just deposited thousands of germ-containing droplets onto their hands, spreading them to everything they touch, including the hands of others. If you don’t have a tissue, the proper coughing etiquette is to cough into your elbow or arm. This significantly reduces the number of airborne droplets and helps keep your hands clean.

MAKE IT HAPPEN …AT YOUR WORKPLACE!

Here are some suggestions to encourage and support infection protection practices.

• While at work, wash your hands routinely throughout the day.
• Place alcohol-based hand sanitizer dispensers (at least 60% alcohol) throughout the workplace, including outside all bathrooms and eating areas.
• Consider organizing a flu clinic for workers, retirees, and family members to help increase the number of people who receive their flu shot.
• Insert information on vaccine recommendations for children and adults in employee pay stubs.

• Keep your workstation clean to help protect co-workers from being exposed to infectious agents. This includes office equipment, machinery, and steering wheels. Be aware that even though you don’t feel sick, you may still be contagious.
• If having a refrigerator at work is not possible, always keep hot foods hot and cold foods cold in a thermos or insulated lunch bag with freezer packs.
• Instead of shaking hands with friends and coworkers, consider other possible ways of greeting to help reduce the spread of germs.

VISIT THESE WEBSITES FOR MORE INFORMATION

Centers for Disease Control and Prevention, Clean Hands Resources

Canadian Partnership for Consumer Food Safety Education

Canadian Food Inspection Agency

American Society for Microbiology, Clean Hands Campaign

Handwashing for Life: Reducing the risk of foodborne illness

Canadian Pediatric Society: Handwashing for parents and kids.

Key References
Canadian Food Inspection Agency. (2006). Causes of food borne illness. Retrieved July 24, 2006, from
http://www.inspection.gc.ca/english/fssa/concen/causee.shtml

Curtis, V., & Cairncross, S. (2003). Effect of washing with soap on diarrhoea risk in the community: A systematic review. The Lancet Infectious Diseases 3, May, 275-281. Retrieved July 10, 2006, from http://infection.thelancet.com

Luby, S., Agboatwalla, M., Feikin, D., Painter, J. Billhimer, W., Altaf, A., & Hoekstra, R. (2005). Effect of handwashing on child health: A randomized controlled trial. The Lancet, 366 (9481), 225-33. Ministry of Health and Long-Term Care. (2002). Why is handwashing important? Toronto, ON: Queen’s Printer for Ontario.