The main purpose of washing hands is to cleanse the hands of pathogens (including bacteria or viruses) and chemicals which can cause disease. This is especially important for people who handle food or work in the medical field. With the emergence of infectious agents ("germs") that are resistant to antibiotics, hand washing is taking on new urgency, as the use of antibiotics and even hand washing with antibiotic soap have favored the natural selection of more resistant bacteria.
Personal hand washingEdit
To maintain good hygiene, hands should always be washed after using the toilet, changing a diaper or tending to someone who is sick; before eating; before handling or cooking food and after handling raw meat, fish or poultry. Conventionally, the use of soap and running water and the washing of all surfaces thoroughly, including under fingernails is seen as necessary. One should rub wet, soapy hands together outside the stream of running water for at least 20 seconds, before rinsing thoroughly and then drying with a clean or disposable towel. After drying a dry paper towel should be used to turn off water and open exit door. Moisturizing lotion is often recommended to keep the hands from drying out, should ones hands require washing more than a few times per day.
Antibacterial soaps have been heavily promoted to a health-conscious public. However, these soaps (usually containing triclosan as the antibacterial agent) are rarely necessary in a personal, non-health care setting, and can increase the prevalence of antibiotic-resistant bacteria just as antibiotics can. These soaps are quite different from the non-water-based hand hygiene agents referred to below, which do not promote antibiotic resistance.
Medical hand washingEdit
The purpose of hand washing in the health care setting is to remove or destroy (disinfect) pathogenic microrganisms ("germs" in common parlance) to avoid transmitting them to a patient. Water alone is fairly effective, simply by removing many agents loosely adherent to the skin. Ordinary soap aids in removal and also helps to kill pathogens. Other "medicated" soaps or hand disinfectants are used in certain settings when higher levels of disinfection are required, e.g. surgery (see below).
The proper washing of hands in a medical setting generally consists of the use of generous amounts of soap and water to lather and rub each part of ones hands systematically. Hands should be rubbed together with digits interlocking. If there is debris under fingernails, a bristle brush is often used to remove it. Finally, it is necessary to rinse well and wipe dry with a paper towel. After drying, a dry paper towel should be used to turn off water and open exit door.
To scrub one's hands for a surgical operation, one requires a tap that can be turned on and off without touching with the hands, some chlorhexidine or iodine wash, sterile towels for drying the hands after washing, a sterile brush for scrubbing and another sterile instrument for cleaning under the fingernails. All jewellery should be removed. This procedure requires washing the hands and forearms up to the elbows, and one must in this situation ensure that all parts of the hands and forearms are well scrubbed several times. When rinsing, it is ensured at all times that one does not allow water to drip back from the elbow to your hands. When done hands are dried with the sterile cloth and the surgical gown is donned.
In the late 1990s and early part of the 21st century, non-water-based hand hygiene agents began to gain popularity. Most are based on isopropyl alcohol formulated into a gel or lotion for ease of use and to decrease the drying effect of the alcohol. The increasing use of these agents is based on speed and ease of use--it's easier to do a good job quickly with these agents than with soap and water. Used properly, soap and water are as good as the non-water-based agents. Of note--the non-water agents don't clean, they simply disinfect. If visible soiling of any sort is present on the hands, they need to be washed with soap and water. The alcohol-based disinfectants are not effective in the presence of large amounts (i.e. visible amounts) of extraneous material.