The Medical Minute: National Hand Washing Awareness

By John Messmer 

This time of year, it seems almost everyone is either sick themselves or just getting over something. Where do all the germs come from? Other than the flu, which does not become active in the U.S. until December, most of our infections are self-inoculated.
As children, we were told to cover our mouths and noses when we cough and sneeze. This puts the viruses into our hands. Then we touch things: papers, doorknobs, keyboards or other people’s hands transferring the viruses to the things we touch. Or, if we have clean hands, we pick up the organisms left behind by someone else. By touching noses or eyes they put the virus right where they can begin to cause infection. Our eyes are connected to our noses by a duct that drains tears so touching our eyes is a risk, too.
One way to avoid spreading infection to others is to cough or sneeze into the crux of the elbow, not the hand. That protects others, but to keep ourselves healthy, the best defense is to wash our hands.
To be effective, hands should be rubbed together vigorously with soap and warm water for at least 15 seconds. Brief rubbing or simply rinsing under running water is not enough. Contaminants are stuck in oils that adhere to the skin. Agitation by rubbing loosens the dead skin cells and soap keeps the contaminants and germs suspended in the water so they rinse off. Soap does not kill the bacteria. In fact, germicidal soaps must remain in contact with the skin for several minutes to kill germs. Anti-bacterial soaps may give a false sense of security that could lead to less vigorous washing and are not really better or needed.
This technique also removes bacteria and viruses that can cause intestinal diseases. Cruise lines and restaurants have made the news in recent times because of large numbers of people affected by infections passed on by improper hand washing. Hepatitis A can be passed on by food handlers at home or in restaurants. Even bacteria from raw meat can be spread to others without proper hand washing.
Methicillin resistant Staphylococcus aureus (MRSA) infections are hard to cure. While the existence of the bacteria is partly due to the widespread use of antibiotics, the organism is no more infectious than others we can have on our skin or in our noses. It’s just harder to eliminate once an infection is present. Preventing infection is the first line of defense against hard to treat infections. Medical personnel must be the leaders in this movement to reduce infections cleaning or sanitizing hands before and after each patient encounter.
If washing with soap is not an option, alcohol gel sanitizers are a good option. These alcohol based sanitizers have been shown to kill pathologic bacteria in seconds. They can be kept close at hand to eliminate walking to a sink. With their introduction, non-medical people may also benefit. Research has shown significant reductions in illness in schools where hand sanitizers have been used because they can be kept in the classroom so sinks are not needed. Visible dirt should still be removed by washing, but hand sanitizers can eliminate germs that cause colds and other illnesses.
The germ elimination effort can be carried a bit too far, though. Some scientists believe that our immune systems learn to distinguish bad germs from good germs by being exposed to dirt and germs early in life. Studies are ongoing, but many doctors think that excessively clean environments may not be a good idea. It may not be necessary to maintain a completely antiseptic environment for children, but teaching children to wash their hands before eating and after using the bathroom is important.
More information on clean hands and hand washing can be found at the Centers for Disease Control website at or Penn State Milton S. Hershey Medical Center Health Information Library online.
John Messmer is associate professor of family and community medicine at Penn State College of Medicine and a staff physician at Penn State Hershey Medical Center.


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Last Updated March 19, 2009