03 May 2009

WELL BEING GUEST BLOG: Brushing Up On Hand-Washing

Joel B. Cooperman, D.O. is a trustee of the American Osteopathic Association and a past president of the Colorado Society of Osteopathic Medicine. He practices at the Denver Osteopathic Center.

Brushing up on hand-washing
By Dr. Joel B. Cooperman

Patients and physicians alike fret about the public health emergency and the possibility of a swine flu pandemic.
Now seems an ideal time to brush up on the importance of hand-washing. Washing one’s hands is one of the best preventative practices any time—even when a public health emergency has not been declared. But now that informed and concerned people are looking sideways at anybody with a hacking cough or an aaaah-chooo, I hear myself repeating to patients this sage stay-well advice: Wash your hands; wash your hands; wash your hands. Doctor’s orders.
It’s handy advice, particularly when considering how readily microorganisms transfer from doorknobs, shopping cart handles, and other innumerable publicly held surfaces.

Cleanliness is next to healthiness.

But as a former orthopedic surgeon accustomed to the rigorous rituals of scrubbing in, I assure you there’s more to the matter than mere soap and water. If you watch ER or Gray’s Anatomy on television, you’ve seen the surgeons painstakingly scrubbing in before entering the surgical theater. Compared to casual hand-washing, scrubbing-in requires more time, more temperature, and more friction to rid the hands of bacteria that spread infection.
A surgeon’s first scrub of the day is 10 minutes. Every subsequent scrub is five minutes. Surgeons routinely use antiseptic solutions and brushes to meticulously scour all surfaces of the hands from fingertips to elbows. This includes over nails, under nails and all sides of fingers, as well as the webbing between the fingers.
The average citizen doesn’t perform surgery, and their hand-washing routine is considerably less detailed. But we’re seeing that the invisible influenza virus is a huge force to be reckoned with. And once you view a virus through a microscope, you don’t easily dismiss these viral critters. Think science fiction bugs.

It's not enough to wash your hands

So it’s not enough to wash your hands; you have to wash your hands thoroughly. The average person rubs a bit of soap between the palms, rinses in tepid water, and grabs the hand-towel that the last person--or persons--used to dry. Which is better than not washing the hands at all, but nowhere near effective enough to protect against germs.
Effective hand-washing is therefore a combination of the antibacterial agents used and the mechanical action involved. Here’s the drill for effective hand-washing:
• Just as dentists tell us to brush our teeth for four minutes, doctors advise washing hands for at least 60 seconds.
• Wash in hot running water. As hot as you can handle.
• Rub the hands together. The idea is to create a lot of friction, then rinse hands under running water so germs are washed away.
• You might also use a nail brush for added dermabrasion and for scrubbing under fingernails.
• Wash the backs of your hands, too. Wash between fingers. In fact, wash as far up your wrist as you’re able without soaking your sleeves.
• Rinse. Rinse. Rinse.
• If more than one person washes at a sink, paper towels are, hands down, more sanitary. If you’re an environmentalist, alleviate your conscience by tossing the used towels in your compost bin.
• Liquid soaps tend to be less messy, but bar soap is acceptable.
• In between hand-washing opportunities, you might use antiseptic gels to keep hands fresh.
• Keep tissues on hand so you don’t have to sneeze or cough into your unprotected palm. Tissues, not handkerchiefs. For what should be obvious reasons, handkerchiefs are an abomination.
• Teach your children to sneeze or cough into the crook of their elbow instead of into their bare hands if they don’t have tissues available.
• Avoid touching your eyes, nose and mouth, where germs spread more easily into mucous membranes.
While scrupulous hand-washing won’t guarantee a clean bill of health, this dose of common sense will help prevent the spread of colds, influenza and other germ warfare waged day to day in your home and in your body.


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