OPRP - General information on Hand Hygiene
Good hand hygiene is one of the most critical control strategies in outbreak management. Hand hygiene is defined as any method that removes or destroys microorganisms on hands. It is well-documented that the most important measure for preventing the spread of pathogens is effective handwashing. Hand hygiene programs should include clear guidance on procedures for the removal of common pathogens from the hands of passengers and crew members. Included in this program should be detailed instructions on when, where, why and the "how to's" of proper hand hygiene, including the use of soap and water, followed by effective hand drying. When supplied to either passengers or crew members, instructions should also be given on the effective use of antiseptic hand washes and hand rubs/sanitizers.
During outbreaks of acute gastroenteritis, enhanced hand hygiene messages should be inserted into printed materials and announcements should be made throughout the day encouraging proper hand hygiene.
Handwashing and Drying
Hand washing is defined as the vigorous, brief rubbing together of all surfaces of lathered hands, followed by rinsing under a stream of water. Handwashing suspends microorganisms and mechanically removes them by rinsing with water. The fundamental principle of hand washing is removal, not killing.
The amount of time spent washing hands is important to reduce the transmission of pathogens to other food, water, other people and inanimate objects (fomites), such as door knobs, hand railings and other frequently touched surfaces. Proper hand hygiene involves the use of soap and warm, running water, rubbing hands vigorously for at least 20 seconds. The use of a nail brush is not necessary or desired, but close attention should be paid to the nail areas, as well as the area between the fingers.
Wet hands have been known to transfer pathogens much more readily than dry hands or hands not washed at all. The residual moisture determines the level of bacterial and viral transfer following hand washing. Careful hand drying is a critical factor for bacterial transfer to skin, food and environmental surfaces.
The drying times required to reduce the transfer of these pathogens varies with drying methods. Repeated drying of hands with reusable cloth towels is not recommended and should be avoided. Recommended hand drying methods and drying times are outlined below:
Total drying time
Single-use paper towels
Rub hands on two paper towels drying hands for 10 seconds on each
The first towel removes the bulk of the water; the seconds achieves complete drying
Rub hands together for while rotating them under warm air
30 - 45 seconds
A prolonged drying period is required to achieve complete drying
Single-use cloth towel
Rub hands on two sections of the towel, drying hands for 10 seconds on each section
The first section of the towel removes the bulk of the water; the seconds achieves complete drying
When Is Handwashing Required?
In general, hand washing is required whenever significant hand contamination occurs and the spread of pathogens through cross-contamination may occur. Some specific activities where hand washing is required include:
- using the toilet
- cleaning toilets and bathrooms
- handling potentially contaminated or soiled clothes and bed linens
- cleaning up after s vomiting or fecal accident
- cleaning and sanitizing environmental surfaces
- before preparing food
- after eating, drinking and smoking
- after removing gloves
Using Alcohol-Based Hand Sanitizers
The use of alcohol-based hand antiseptics (hand sanitizers) does not replace the need for frequent and proper hand washing. The efficacy of most alcohol-based hand antiseptics approximates simple hand washing. In addition, many alcohol-based hand antiseptics have very poor activity against bacterial spores, protozoan cysts and certain non-enveloped viruses, such as noroviruses. Alcohol-based hand antiseptics appear to have very good to excellent activity against many bacteria and some enveloped viruses. Some scientific evidence suggest that ethanol-based hand antiseptics containing 60-90 percent alcohol, appear to be the most effective against common pathogens (including non-enveloped viruses) that cause acute gastroenteritis on cruise ships. In general, ethanol-based hand antiseptics appear to have greater antimicrobial activity against viruses than isopropanol-based hand antiseptics, although both appear to offer some activity against these pathogens.
It should be noted that alcohol-based hand antiseptics are not effective on hands that are visibly dirty or those contaminated with organic materials. Hands that are visibly dirty or contaminated with organic material must be wash with soap and water, even if hand antiseptics are to be used as an adjunct measure. It is also worth noting that the amount of alcohol-based hand antiseptic is important to its overall effectiveness. Failure to cover all surfaces of the hands and fingers will also greatly reduce the efficacy of alcohol-based hand antiseptics.
The Vessel Sanitation Program (VSP) position on the use of hand antiseptics is that they may be used as an adjunct to proper hand washing. Given the environment of a cruise ship and the types of pathogens present, we believe, if alcohol-based hand antiseptics are used, ethanol-based products should be considered over isopropanol-based products.