Hand hygiene a crucial component of preventing viral spread

Handwashing, wearing face masks and physical distancing: They’re the triple threat for stopping the spread of coronavirus. Although face masks and distancing are new experiences for everyone, handwashing is a universal activity—something we learned before we could spell it.

St. Jude follows the Centers for Disease Control’s handwashing guidelines, with recommendations for duration, methods, and when to use gel or soap and water.

But are you washing your hands properly?

Maybe so, but it’s possible you might be leaving behind germs on often-forgotten spots.

“While performing hand hygiene, people sometimes miss the fingertips and under the nails,” said Bethany Glover, an infection preventionist in the St. Jude Infection Prevention and Control Program. “Individuals will apply and spread hand sanitizer all over their hands, omitting the tips of their fingers.”

Other troublesome spots are the thumbs and back of the hands. It’s important for St. Jude staff to clean these areas since tiny microbes and organisms can lead to severe infections in children with weakened immune systems.

“Contaminated hands are the most common way to spread infections,” said Hana Hakim, MD, medical director of Infection Prevention and Control. “If we chose a single intervention that is most effective in preventing transmissions of infections in a hospital setting, it would be hand hygiene.”

Hand hygiene in clinical areas

The Infection Prevention and Control team at St. Jude oversees the hospital’s hand hygiene program. Employees in clinical areas volunteer or are recruited to be secret observers in inpatient and outpatient areas. They are trained on different scenarios and enter their observations into a database. The total number of observations and compliance rate for each day is available within 24 hours to help areas identify and improve their practices.

Prior to the pandemic, 700 to 800 observations a month were logged on average. Those numbers dipped to around 400 during the pandemic’s early days due to fewer staff members on the floors. Still, clinicians maintained a high compliance rate. As employees returned to campus, the number of observations recorded has increased. It’s not uncommon for Infection Prevention and Control members to walk through the hospital and see their work in action.

“From time to time, a staff member will come out of a room, and they’ll start applying their hand gel properly. Then they will look up and see one of us in Infection Prevention, and they’ll smile,” said Craig Gilliam, Infection Prevention and Control director. “We can tell they’re smiling, even in their masks. We smile back because we are acknowledging, ‘Hey, you’re doing the right thing.’”

Compliance is high because staff members realize that most St. Jude patients have compromised immune systems. From July 2018 through June 2020, observers noted a 98.08% compliance rate. The goal is 95%.

“Hand hygiene is a behavioral thing. We learn it from mentors and family members,” Gilliam said. “We know from strong data that there are some people who use the handwashing or alcohol gel all the time. They need no reminders, but at St. Jude we have learned how to model that good behavior.”

Learning how to wash your hands

To show the effectiveness of handwashing, the Infection Prevention and Control team demonstrates the proper way to clean hands with a gel that replicates germs. Glover and her colleagues rub a small amount of the gel into their hands. There’s nothing to see until they place their hands underneath an ultraviolet hood that reveals fluorescent markings. These imitation germs then meet their match as the team member walks over to a sink and washes their hands vigorously.

You should scrub your hands together vigorously with soap and water for at least 15 seconds. That includes both hands, wrists, palms, back of hands, fingers and all surfaces before a thorough rinse. When students visiting campus participate in the demonstration, they are often shocked by the results.

“The students feel they’re on the spot from peers watching while performing the demonstration, so they tend to pay extra attention to detail while washing their hands,” Glover said. “When they put their hands into the hood under the ultraviolet light, they realize how much has been missed.”

To ensure that you are washing your hands for the proper amount of time, the team suggests humming the “Happy Birthday” song from beginning to end twice.

Hand hygiene alternatives

Handwashing is the preferred method for visibly soiled hands, before eating, and after using the restroom or caring for diapered children. Soap and water are more effective at removing certain organisms and rinsing them down the sink. But at St. Jude and most other hospitals, alcohol-based hand gel (or hand sanitizer) is the most common method.

Gels must contain a required minimum amount of alcohol and are often dispensed from containers in pre-determined amounts. When dispensing gel from a bottle, a dime-sized or nickel-sized amount is enough depending on hand size. Read the label for specific details. It’s also important to rub the gel into all areas of your hands until it dries.

While hand hygiene might be the easiest way to slow the spread of the new coronavirus, Hakim cautions that one intervention by itself is not enough.

“You should be practicing physical distancing, wearing your mask, practicing good hand hygiene and disinfecting surfaces,” Hakim said. “Picking and choosing one thing is not going to be effective.”


Handwashing 101 tips

When washing your hands with soap and water, remember:

  • Wet your hands first with water
  • Dispense soap into your hands and begin to lather
  • Rub hands together, covering all surfaces on both hands and fingers
  • Thoroughly rinse with water and use disposable towel to dry
  • If the sink is not automatic, use a towel to turn the faucet off

When performing either hand hygiene method, remember:

  • Don’t omit often-forgotten spots: Your fingertips, under the nails, around cuticle areas, between fingers, the thumb and the backside of both hands
  • Use the palm of your hand to scrub the tips of your fingers adequately
  • Pay special attention to scrub around rings or jewelry
  • For staff providing direct patient care, if hand lotion is needed at times or during dry weather months, use hospital supplied lotions that are compatible with soap and hand sanitizer
  • Rub hands until dry if using hand sanitizer and ensure proper duration of scrub time occurs with soap and water

About the author

Mike O’Kelly is a member of the Communications Department at St. Jude Children’s Research Hospital.
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