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The Art of Hand Washing

Author: Kirk Pappas, M.D.
March, 2016 Issue

James DeVore, M.D.
All articles by columnist
Author: Kirk Pappas, M.D.
March, 2016 Issue

Prevention starts with the simplest of actions: washing your hands.

We’re in the midst of another busy flu season in the North Bay; the coughing and sneezing is just starting. Prevention starts with the simplest of actions: washing your hands. I can’t stress enough the importance of washing your hands, so I’ll use science to support the choices I’m going to recommend (starting with “Put Your Hands Together” on YouTube: The rubric of “why, when and how” really applies here.

Why you wash your hands

None of us wants to become ill and, even more, we don’t want those we love, the people we work with or those we come in contact with to become sick because of our actions. It’s about keeping yourself healthy and protecting friends and family.
Those of us who care for patients know this is a critical issue. It’s our responsibility to keep you safe when you’re in our care; it’s part of the oath we take to do no harm.

When to wash your hands

According to the Centers for Disease Control (CDC) and the British National Health Service (NHS), you should wash your hands:
• Before, during and after preparing food;
• Before eating food;
• Before and after caring for someone who’s sick;
• Before and after treating a small cut or wound (on ourselves or anyone else);
• After using the toilet;
• Before and after cleaning up for a toileted child (including diapering);
• After blowing your nose, coughing or sneezing (and please sneeze into your elbow—watch “Clean Hands Help Prevent the Flu”:;
• After touching animals, feeding animals or handing animal waste;
• After handling pet food or pet treats; and
• After touching garbage.

How to wash your hands

Here’s a very simple and scientifically based rubric:
• Use clean running water (warm or cold);
• Turn off the tap after wetting hands (the drought’s not over);
• Apply soap, then lather your hands, including the backs of your hands, between your fingers and under your nails (dance along to “Hand Washing Gangnam Style”:;
• Scrub your hands for at least 20 seconds. Some experts recommend singing “Happy Birthday” or “Row, Row, Row Your Boat.” I prefer the chorus for Springsteen’s “Born to Run”;
•Dry your hands using some a clean towel or air dry.
Hand sanitizing gels are a subset to hand washing. If you don’t have access to soap and water, gel is the next best way to clean your hands. But gel is far less effective than soap, especially when hands are visibly dirty or greasy. Here’s the “how” of gel:
• Each product will tell you the specific amount of gel to use (they’re all different);
• Apply the product to the palm of your hand;
• Rub the product over all the surfaces of your hands and fingers (including nails, just like hand washing) until dry.
The last part of this habit is the power of repetition—reminding both ourselves and those we work with, our families and our friends. I think this is where many of us fall victim to being less than conscientious about keeping our hands clean. It’s not on purpose, but our attention spans in this multi-tasking world are often under siege. All of us can work on being in the moment.

Make me wash my hands

To close, I have a very personal request for everyone reading this. Those of us in health care are held to a higher standard as part of our responsibility to keep you, our patients, safe. We need to wash/gel our hands before and after every time we interact with you, especially if we come in contact with any blood, body fluids or items that might have been contaminated—even if we wear gloves. And after we remove our gloves, we need to make sure our hands are clean, because gloves alone don’t protect our patients fully.
So please ask us, every time, whether we’ve washed or gelled before we examine you. Every time.
Let’s all do the Hand Jive:
Kirk Pappas, M.D., is a board certified physical medicine and rehabilitation doctor. He’s the physician-in-chief of the Kaiser Permanente Medical Center in Santa Rosa.



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