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The Group Most in Need of Hand Hygiene

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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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