Hand washing for hand hygiene is the act of cleaning ones hands with or without the use of water

or another liquid, or with the use of soap, for the purpose of removing soil, dirt, and/or microorganisms.
HAND HYGIENE DEFINITIONS Hand hygiene is a term that applies to the process of hand washing or hand decontamination. Hand washing involves mechanically removing transient organisms from hands with soap and water. Hand decontamination reduces the number of both transient and resident micro-organisms on the hands. This is accomplished by either washing with antimicrobial soap and water or application of an alcohol or alcohol/chlorhexidine based hand rub.

The Benefits of Hand Washing

Regular hand washing is important to your health year-round because it can keep you from getting sick or from spreading germs to friends, family or even an entire community.

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Hand washing is especially important during the stretch between Thanksgiving and New Years Eve. Thats because the holidays coincide with the height of the cold and flu season as people congregate in close quarters and out-oftown guests can come bearing new strains of bacteria,

viruses and other microbes along with their big boxes of presents. Numerous illnesses can be spread by people who neglect basic hand hygiene, either through hand-to-hand contact or by leaving germs on commonly used surfaces. So its essential to regularly wash your hands with soap and running water or use a hand sanitizer containing at least 60 percent alcohol. Your Mom was correct. You should always wash your hands before eating food. You also should always wash your hands:

Before, during, and after preparing food. After using the toilet. After changing diapers or cleaning up a child who has used the toilet. Before and after caring for someone who is sick. After blowing your nose, coughing, or sneezing. After touching an animal or animal waste. After touching garbage. Before and after treating a cut or wound. Before giving medicine.

Unfortunately, too many of us either ignore these basic precautions or wash in such a perfunctory manner that we walk away from the sink with our hands still crawling with

germs. Although not even the most thorough hand washing can remove every germ, appropriate hand washing can remove most of them. Heres how to correctly wash your hands:

Wet your hands with clean, running water (warm or cold) and apply soap. Rub your palms together to make a lather and scrub them well Also scrub the backs of your hands, between your fingers, and under your nails. Continue rubbing your hands for at least 20 seconds. How long is that? If you cant keep your eye on a watch, just hum The Happy Birthday Song twice from beginning to end.

Rinse your hands well under running water. Dry your hands using a clean towel or air dry them.

Soap and running water are the best ways to remove germs. But if theyre not available, an alcohol-based hand sanitizer is a good alternative even though it cant eliminate all types of germs and is ineffective when hands are visibly dirty. To correctly use a hand sanitizer:

Apply the product to the palm of one hand.

Rub your hands together. Rub the product over all surfaces of your hands and fingers until your hands are dry.

Quick Quiz: True or False 1. Antibacterial soap is more effective at killing germs than regular soap. 2. Using a towel to turn off the faucet can prevent the spread of germs. 3. Antibacterial wipes or towelettes kill as many germs as alcohol-based sanitizers. 4. You can safely touch people or surfaces before your hands are completely dry. 5. Children in care settings need to wash their hands at least several times per day, not just before meals. Answers 1. False. Research shows that regular liquid, bar, or powder soap is just as effective. 2. True. This last little step can minimize exposure to another common source of germs, especially in public restrooms. 3. False. Although antibacterial wipes or towelettes are better than nothing, alcohol-based sanitizers are significantly more lethal to germs. 4. False. Moist hands are a germ-friendly environment.

5. True. Children cared for in groups outside the home are at high risk of respiratory and gastrointestinal illnesses which they can spread to family members and others.

A delicious mud pie, a good-luck rock, or a friendly frog are the types of goodies kids love to bring home. But these adorable gifts can also bring millions of germs with them. Kids don't always listen when you tell them to wash their hands before eating, after using the bathroom, or when they come inside from playing. But it's a message worth repeating hand washing is by far the best way to prevent germs from spreading

and to keep your kids from getting sick.

First Line of Defense Against Germs

Germs can be transmitted many ways, including:

touching dirty hands changing dirty diapers through contaminated water and food through droplets released during a cough or a sneeze

via contaminated surfaces through contact with a sick person's body fluids

When kids come into contact with germs, they can unknowingly become infected simply by touching their eyes, nose, or mouth. And once they're infected, it's usually just a matter of time before the whole family comes down with the same illness. Good hand washing is the first line of defense against the spread of many illnesses, from the common cold to more serious illnesses such as meningitis, bronchiolitis, influenza, hepatitis A, and most types of infectious diarrhea.

Washing Hands Correctly

Here's how to scrub those germs away. Demonstrate this routine to your kids or better yet, wash your hands together often so they learn how important this good habit is: 1. Wash your hands in warm water. Make sure the water isn't too hot for little hands. 2. Use soap and lather up for about 20 seconds (antibacterial soap isn't necessary any soap will do). Make sure you get in between the fingers and under the nails where uninvited germs like to hang out. And don't forget the wrists! 3. Rinse and dry well with a clean towel. To minimize the germs passed around your family, make frequent hand washing a rule for everyone, especially:

before eating and cooking after using the bathroom after cleaning around the house after touching animals, including family pets before and after visiting or taking care of any sick friends or relatives

after blowing one's nose, coughing, or sneezing after being outside (playing, gardening, walking the dog, etc.)

Don't underestimate the power of hand washing! The few seconds you spend at the sink could save you trips to the doctor's office. Reviewed by: Mary L. Gavin, MD Date reviewed: March 2011

Summary

Washing hands properly after using the toilet, changing nappies, handling animals and before and after handling food helps prevent the spread of various forms of gastroenteritis, some of which can cause serious health problems. Use soap and warm running water and wash hands for at least 10 seconds. Liquid soap is best. A number of infectious diseases can be spread from one person to another by contaminated hands, particularly gastrointestinal infections, influenza and hepatitis A. Washing your hands properly can help prevent the spread of the organisms that cause these diseases. Some forms of gastroenteritis can cause serious complications, especially for young children, the elderly, or those with a weakened immune system. Drying your hands properly is as important as washing them.
When to wash your hands

You should wash your hands thoroughly:

Before preparing food Before eating Between handling raw and cooked or ready-to-eat food After going to the toilet or changing nappies After smoking After using a tissue or handkerchief After handling rubbish or working in the garden After handling animals After attending to sick children or other family members.

How to wash your hands properly

To wash hands properly:

Wet your hands with warm water. Apply one dose of liquid soap and lather (wash) well for 1520 seconds (or longer if the dirt is ingrained). Rub hands together rapidly across all surfaces of your hands and wrists to help remove dirt and germs. Dont forget the backs of your hands, your wrists, between your fingers and under your fingernails. If possible, remove rings and watches before you wash your hands, or ensure you move the rings to wash under them, as microorganisms can exist under them.

Rinse well under running water and make sure all traces of soap are removed, as residues may cause irritation. Pat your hands dry using paper towels (or single-use cloth towels). Make sure your hands are thoroughly dry. Dry under any rings you wear, as they can be a source of future contamination if they remain moist. Hot air driers can be used but, again, you should ensure your hands are thoroughly dry. At home, give each family member their own towel and wash the towels often.

How to wash and dry hands with liquid soap and water (Click to open larger image)

Use warm water

Cold water is better than no water at all for a one-off hand wash, but should not be used for routine handwashing. Soap lathers (soaps up) better with warm water. The active ingredients on the surface of the soap are released more easily, making them more effective in cleaning your hands of dirt, grease and oils, without stripping away the natural oils in your skin. Using

cold or hot water can also damage the skins natural oils. Over time, this can cause dermatitis.

Soap is important

Soap contains ingredients that will help to:

Loosen dirt on your hands. Soften water, making it easier to lather the soap over your hands.

Rinse your hands, leaving no residues to irritate and dry your skin. Soaps can have different pH they may be neutral, slightly alkaline or slightly acidic. Thats why some soaps irritate some people and not others. Perfumes in soap can be another reason why some people have skin reactions.

Liquid soap is best

Generally, it is better to use liquid soap than bar soap, particularly at work. The benefits of liquid soap include:

Hygiene it is less likely to be contaminated. Right amount liquid soap dispensers do not dispense more than required (more is not better). Less waste its easier to use, with less wastage. Drop-in cassette dispensers use all the soap.

Saves time liquid soap dispensers are easy and efficient to use. Disposable liquid soap cassettes are convenient, as you do not have to wash and thoroughly dry the refillable container before refilling. If you want to use refillable containers, they must not be topped up. When they are empty, they must be thoroughly cleaned and dried before they are refilled to avoid contamination.

At home, refillable dispensers are more likely to be used rather than drop-in cassettes, which are designed for commercial use.

The problems with bar soap particularly in public places

There are many reasons why bar soap can be a problem, particularly if its used by a lot of people. These problems include:

Bar soap can sit in pools of water and become contaminated with many harmful germs. People are less likely to use bar soap if it is messy from sitting in water. Contaminated soap may spread germs and may be more harmful than not washing your hands. Bar soap can dry out people are less likely to use it to wash their hands because it is difficult to lather. Dried-out bar soap will develop cracks, which can harbour dirt and germs. Again, you may be adding more harmful germs to your hands than you were

trying to remove. Its fine to use bar soap at home, but it might help to keep it on a soap rack (so its not sitting in a pool of water) and change it if it becomes old and cracked.

Take care of your hands

Handwashing is only one part of hand hygiene. Looking after your skin generally is important, as your skin is the perfect barrier against infection. After your hands have been dried thoroughly, you can help to look after your hands if you:

Apply a water-based absorbent hand cream three to four times a day, or more frequently if your hands are constantly in water.

Use gloves to wash dishes to protect your hands. Use gloves when gardening to prevent a build-up of ingrained soil or scratches. Consult a doctor if a skin irritation develops or continues. Your doctor Your local councils health department Proper handwashing can protect you and others from a range of diseases. Liquid soap is better than bar soap, especially at work. Wash and dry your hands carefully.

Where to get help

Things to remember

Hand Washing: Reducing the Risk of Common Infections

Is it important to wash your hands?

Simply put, yes. Hand washing is the single most effective way to prevent the spread of infections. You can spread certain "germs" (a general term for microbes like viruses and bacteria) casually by touching another person. You can also catch germs when you touch contaminated objects or surfaces and then you touch your face (mouth, eyes, and nose). "Good" hand washing techniques include using an adequate amount of soap, rubbing the hands together to create friction, and rinsing under running water. The use of gloves is not a substitute for hand washing. There is additional information in OSH Answers about how the common cold is transmitted by contaminated hands. Also see Influenza and Pandemic Influenza. Other steps that can be taken to reduce the spread of infections are discussed in the OSH Answers document Good Hygiene Practices - Reducing the Spread of Infections and Viruses. Please note: In some workplaces, universal precautions should be followed when workers are exposed to blood and certain other body fluids. Please see the OSH Answers document Routine Practices for more complete information.

When should I wash my hands?

Different situations where people can pick up "germs" include:

when hands are visibly soiled after using the washroom (includes changing diapers) after blowing your nose or after sneezing in your hands before and after eating, handling food, drinking or smoking after touching raw meat, poultry, or fish after handling garbage visiting or caring for sick people handling pets, animals or animal waste

Ensuring that employees wash their hands properly after using the washroom is very important in reducing disease transmission of stomach "flus" (which really is not a "flu" or influenza) and other gastrointestinal infections. Using soap and lathering up is very important (rinsing hands in water only is not as effective). Use comfortably warm, running water. Hands should be washed for a minimum of 15 seconds - longer if the hands are visibly soiled. To help people (especially children) wash long enough, one option may be to sing a short song such as "Happy Birthday" or "A, B, C" twice. The idea of surgeons scrubbing for an operation (as on TV) is very similar.

How do I properly wash my hands?

For effective hand washing, follow these steps:

remove any rings or other jewelry use warm water and wet your hands thoroughly use soap (1-3 mL) and lather very well scrub your hands, between your fingers, wrists, and forearms with soap for 15 seconds scrub under your nails rinse thoroughly turn off the taps/faucets with a paper towel dry your hands with a single use towel or air dryer protect your hands from touching dirty surfaces as you leave the bathroom

Other tips include:

Cover cuts with bandages and wear gloves for added protection (cuts are very vulnerable to infections).

Artificial nails and chipped nail polish have been associated with an increase in the number of bacteria on the fingernails. Be sure to clean the nails properly. Keep your hands away from your eyes, nose or mouth. Assume that contact with any human body fluids is infectious. Liquid soap in disposable containers is best. If using reusable containers, they should be washed and dried before refilling. If using a bar of soap, be sure to set it on a rack that allows water to drain or use small bars that can be changed frequently.

What about antibacterial soaps and waterless hand scrubs?

While it is true that regular soap and water does not actually kill microorganisms (they create a slippery surface that allows the organisms to "slide off"), antibacterial soaps are typically considered to be "overkill" for most purposes. The exception may be in a hospital where special situations are present (e.g., before invasive procedures, when caring for severely immuno-compromised patients, critical care areas, intensive care nurseries, etc.). Antibacterial agents should be chosen carefully based on their active ingredients and characteristics, and when persistent antimicrobial activity on the hands is desired. When there is no soap or water available, one alternative is to use waterless hand scrubs. Some of these products are made of ethyl alcohol mixed with emollients (skin softeners) and other agents. They are often available as a

rinse, or on wipes or towelettes. They can be used by paramedics, home care attendants, or other mobile workers where hand washing facilities are not available. However, these agents are not effective when the hands are heavily contaminated with dirt, blood, or other organic materials. In addition, waterless hand scrubs may have a drying effect on the skin and may have odours which may be irritating to some users.

Document last updated on July 4, 2011

Handwashing: Clean Hands Save Lives

Keeping hands clean through improved hand hygiene is one of the most important steps we can take to avoid getting sick and spreading germs to others. Many diseases and conditions are spread by not washing hands with soap and clean, running water. If clean, running water is not accessible, as is common in many parts of the world, use soap and available water. If soap and water are unavailable, use an alcohol-based hand sanitizer that contains at least 60% alcohol to clean hands.

When should you wash your hands?

Before, during, and after preparing food Before eating food Before and after caring for someone who is sick Before and after treating a cut or wound After using the toilet After changing diapers or cleaning up a child who has used the toilet After blowing your nose, coughing, or sneezing After touching an animal or animal waste After handling pet food or pet treats After touching garbage

What is the right way to wash your hands?

Wet your hands with clean, running water (warm or cold) and apply soap. Rub your hands together to make a lather and scrub them well; be sure to scrub the backs of your hands, between your fingers, and under your nails. Continue rubbing your hands for at least 20 seconds. Need a timer? Hum the "Happy Birthday" song from beginning to end twice. Rinse your hands well under running water. Dry your hands using a clean towel or air dry them.

What if I dont have soap and clean, running water?

Washing hands with soap and water is the best way to reduce the number of germs on them. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol. Alcohol-based hand sanitizers can quickly reduce the number of germs on hands in some situations, but sanitizers do not eliminate all types of germs. Hand sanitizers are not as effective when hands are visibly dirty. How do you use hand sanitizers? Apply the product to the palm of one hand. Rub your hands together. Rub the product over all surfaces of your hands and fingers until your hands are dry.

HAND WASHING
Hand washing and hand sanitizers reduce the spread of germs. Hand washing is simple to do and is the best way to prevent infection and its spread because your hands are constantly coming into contact with germ-laden surfaces and transferring those germs to your eyes, nose and mouth. According to the Centers for Disease Control, heres when to wash your hands: Before preparing or eating food After going to the bathroom After changing diapers or cleaning up a child who has

gone to the bathroom Before and after tending to someone who is sick After blowing your nose, coughing, or sneezing After handling an animal or animal waste After handling garbage Before and after treating a cut or wound

Those recommendations are pretty straightforward and obvious. Less obvious, however, is that common surfaces are loaded with germs and you come into contact with them all day. Recent studies have shown that the worst offenders are things like refrigerator door handles, TV remotes, doorknobs, telephones, light switches, faucets, even salt and pepper shakers. With many people touching these things one after another leaving their germs behind, its easy for you to pick one up and infect yourself the next time your hands unconsciously stray to your face. So frequent hand washing throughout the day is critical. Heres the CDC advice on how to wash your hands: Wet your hands with clean running water and apply soap. Use warm water if it is available. Rub hands together to make a lather and scrub all surfaces. Continue rubbing hands for 20 seconds. Need a timer? Imagine singing Happy Birthday twice through to a friend! Rinse hands well under running water Dry your hands using a paper towel or air dryer. If possible, use your paper towel to turn off the faucet. If soap and water arent available, use alcohol-based hand sanitizers. Some people wonder if overuse of alcohol sanitizers could be a problem similar to the overuse of antibiotics, which is known to promote bacterial resistance. The good news is that alcohol sanitizers do not cause resistance, they work differently than antibiotics and therefore can be used as

often as your sensitive skin allows (some alcohol hand sanitizers have skin-sparing ingredients like aloe built in). Heres the CDC on how to use hand sanitizers: Apply product to the palm of one hand Rub hands together Rub the product over all surfaces of hands and fingers until hands are dry In addition to keeping your hands clean, remember to cover your coughs and sneezes. And dont cough or sneeze into your hands (and if you do, wash them after). Rather, cough or sneeze into the crux of your elbow, keeping the germs away from your hands and reducing the airborne spread of germ-filled droplets. Or use a disposable tissue if one is handy. It is not recommend repeatedly using a pocket handkerchief, which are just germ reservoirs.

In my line of work, you meet lots of people. You shake lots of hands. And those people have shaken lots of hands, wiped noses and touched lots of different things, over and over. They could have, well, dirty hands. Any of them, even the celebrities. Did you know that 80 percent of all infectious diseases are passed by human contact, either direct or indirect? That includes viruses like pneumonia, salmonella and the common cold. But beyond the people I come in contact with every day, I got to thinking, what about the things I come in contact with every day?

"Did you wash your hands?"

How many times did you hear that today? Probably a lot. But why are adults so hung up on hand washing? Why are they so in love with lather? Washing your hands is the best way to stop germs from spreading. Think about all of the things that you touched today from the telephone to the toilet. Maybe you blew your nose in a tissue and then went outside to dig around the dirt. Whatever you did today, you came into contact with germs. It's easy for a germ on your hand to end up in your mouth. Think about how many foods you eat with your hands. You can't wear rubber gloves all day long, but you can wash your hands so those germs don't get a chance to make you or someone else sick. When germs go down the drain, they can't make anyone sick. So when are the best times to wash your hands? when your hands are dirty before eating or touching food (like if you're helping cook or bake, for example) after using the bathroom after blowing your nose or coughing after touching pets or other animals after playing outside before and after visiting a sick relative or friend Now you have the when and the why of hand washing. But did you know that a lot of people don't know how to get their paws perfectly clean? The next time you're told to step up to the sink and scrub up, remember these handy hints: 1. Use warm water (not cold or hot) when you wash your hands.

2. Use whatever soap you like. Some soaps come in cool shapes and colors or smell nice, but whatever kind gets you scrubbing is the kind you should use. Antibacterial soaps are OK to use, but regular soap works fine.

3. Work up some lather on both sides of your hands, your wrists, and between your fingers. Don't forget to wash around your nails. This is one place germs like to hide. Wash for about 10 to 15 seconds about how long it takes to sing "Happy Birthday." (Sing it quickly two times or just once if you go nice and slow.) 4. Rinse and dry well with a clean towel. Reviewed by: Mary L. Gavin, MD Date reviewed: March 2011