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Jason Tetro


The Group Most in Need of Hand Hygiene

Posted: 05/03/2013 12:33 pm

When it comes to advice, there is nothing more common than the saying, "Keep Your Nose Clean." The rather odd advice has a long history, stemming from the 17th Century. In 1659, a collection of sermons from a University of Oxford professor, John Hales, was published under the enigmatic title, "The Golden Remains of the ever memorable Mr. John Hales." Deep inside the 1688 third impression of the book -- it was a bestseller in its time -- a passage appears:

"Suppose ye unto your selves some such Man as Epictetus was, let him have all Graces that are, Piety, on excepted, let him wear out himself with Studies, pine himself with Temperance, keep his Hands clean from Corruption, his Heart from unchaste Desires."

The words were so strong that the term was adopted to describe a person who was right and just and caused no harm to others. In many sectors, this term is still preferred over its nasal counterpart.

One such group is the World Health Organization although their perspective on the meaning involves an entirely different sort of corruption.

On May 5th, the WHO will be celebrating its annual SAVE LIVES: Clean Your Hands day to mark its campaign to help save lives from infections in healthcare. The celebration is less of a party and more of a pledge whereby individuals, facilities and governments take on the responsibility to do their best to help improve patient safety and prevent an already unpleasant experience worse. The program is still not as widely known as John Hales' sermons were but the momentum is growing.

In 2013, there is a new twist to the campaign. Instead of solely focusing on health care, the WHO is hoping to spread the message to everyone to not only raise awareness, but also to help change the way we all look at hand hygiene and how important it is to our lives.

The WHO has reason for taking this approach. Back in 2010, a review of the burden of healthcare associated infections revealed that up to 15% of all patients suffer some type of infection as a result of care. That number varied from country to country but was still startling. By looking further into the reason for this problem, there was a clear association between infections and the rate of hand hygiene amongst healthcare workers. While the association between infections and having clean hands had been known there was little indication that it could have been this bad.

When the reasons for such poor adherence to hand hygiene were identified last year, there was little doubt that the problems were not due to lack of knowledge, but behaviour. To make the situation worse, that behaviour trumped any intervention -- there was simply a psychological barrier in place.

As anyone who has tried to change someone's behaviour knows, it cannot be done well through simple individual interventions. This has to be done through a mass movement. For the WHO, this meant getting the word out into the community and the public in the hopes that they would know about healthcare acquired infections, the link to hand hygiene and the push to adhere to John Hales' advice.

The efforts have been somewhat successful as public organizations from all the over the world at taking part. Their efforts will be centred on keeping the pressure on healthcare to ensure hand hygiene is kept at the forefront of the mindset and the action. The movement appears to be working as the doctors of tomorrow have heard the message and ascribing the importance of hand hygiene. Compliance is going up and infection rates in many areas are going down.

Yet, more can always be done, especially at home. After all, up to 80 per cent of infections can still be transmitted by the hands and in many cases of infections, such as MRSA, norovirus and influenza, most cases are secondary, that is, were caught from someone else. There's little doubt that here is a place for hand hygiene in the home and especially out in public.

If you also care about keeping your hands clean and keeping those around you free from a microbial corruption, then you too can play a role. Thankfully, unlike the requirements of healthcare institutions, the best way to show your support is not to take a pledge.

Rather, on May 5th, take a moment to wash your hands -- or use hand sanitizer -- and then tell someone about it. It may lead to a rather odd reaction but in the larger picture, not only will you be helping to spread the word but you'll also be helping to not spread the infections.

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  • Vitamin C

    "Research has found no evidence that vitamin C prevents colds," says Dr Hasmukh Joshi, vice-chair of the Royal College of GPs. In 2007, the authors of a review of 30 trials involving 11,000 people concluded that, "regular ingestion of vitamin C has no effect on common cold incidence in the ordinary population". A daily dose of vitamin C did slightly reduce the length and severity of colds. When it comes to flu, one person in three believes that taking vitamin C can cure the flu virus. It can't. "Studies found that vitamin C offers a very, very limited benefit," says Dr Joshi. "I wouldn't recommend it." Information from <a href="http://www.nhs.uk/Livewell/coldsandflu/Pages/Preventionandcure.aspx" target="_hplink">NHS Choices</a>.

  • Echinacea

    The root, seeds and other parts of echinacea plants are used in herbal remedies that many people believe protect them against colds. There have been a number of studies into echinacea's effect, but no firm conclusions. A review of trials involving echinacea showed that, compared with people who didn't take echinacea, those who did were about 30% less likely to get a cold. However, the studies had varying results and used different preparations of echinacea. It's not known how these compare with the echinacea in shops. This review also showed that echinacea did not reduce the length of a cold when taken on its own. "There is a belief that echinacea aids the immune system, but a survey of studies in 2005 showed that it did not," says Dr Joshi. "I wouldn't recommend that it helps, but if people believe it, they can take it. There's no harm in it." Information from <a href="http://www.nhs.uk/Livewell/coldsandflu/Pages/Preventionandcure.aspx" target="_hplink">NHS Choices</a>.

  • Zinc

    There is some evidence that taking zinc lozenges as soon as cold symptoms appear may reduce how long a cold lasts. However, some trials have found no difference in the duration of colds in people who took zinc compared with those who did not. There has also been research into nasal sprays containing zinc. "Some people believe that the zinc lines the mucosa [the lining of the nose] and stops a cold virus attaching itself to the nose lining," says Dr Joshi. "Unfortunately, this has been found to be no more effective than a placebo." Information from <a href="http://www.nhs.uk/Livewell/coldsandflu/Pages/Preventionandcure.aspx" target="_hplink">NHS Choices</a>.

  • Getting cold or wet

    The only thing that can cause a cold or flu is a cold or flu virus. Getting cold and/or wet won't give you a cold. However, if you are already carrying the virus in your nose, it might allow symptoms to develop. A study at the Common Cold Centre in Cardiff found that people who chilled their feet in cold water for 20 minutes were twice as likely to develop a cold as those who didn't chill their feet. The authors suggest that this is because some people carry cold viruses without having symptoms. Getting chilled causes blood vessels in the nose to constrict, affecting the defences in the nose and making it easier for the virus to replicate. "Getting a cold from going out in the cold or after washing your hair is a myth," says Dr Joshi. "Colds are common. If the virus is already there and then you go out with wet hair and develop symptoms, it's common to think that is what caused it." Information from <a href="http://www.nhs.uk/Livewell/coldsandflu/Pages/Preventionandcure.aspx" target="_hplink">NHS Choices</a>.

  • So what does work?

    The flu vaccine can prevent you from catching flu. Apart from that, the best way to protect yourself from colds and flu is to have a healthy lifestyle. "Eat a healthy diet, take regular exercise and drink plenty of warm drinks in the winter months," says Dr Joshi. "The important thing to remember is that most people are going to catch a cold in winter anyway, because there is no effective cure for cold viruses." Information from <a href="http://www.nhs.uk/Livewell/coldsandflu/Pages/Preventionandcure.aspx" target="_hplink">NHS Choices</a>.


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