HAND WASHING: A Despised Centuries-old Vaccine By Dr Mark Godwin

Somewhere in rural Africa, a 4-week old baby is rushed to the Children Emergency Room with complaints of persistent passage of copious loose stools, at an average frequency of 10 per day which were initially pale and cheesy, but lately, greenish or blood stained and caffeinated. There’s a preceding history of fever that was gradual in onset, with progressive loss of weight lasting 10 days.

The doctor examines the child, and finds a toxic-looking child in respiratory embarrassment. He is also febrile, paper white pale and severely dehydrated. Resuscitation commences, and the child is admitted for severe anaemia due to persistent bacillary dysentery.  Further history gotten from the mother confirms that the baby has had a couple of immunisations, had been breastfeeding exclusively and frequently, although she doesn’t wash her hands before breastfeeding. She neither does after using the loo nor after cleaning up the infant’s older siblings. Depending on the quality of service and facility at the caring hospital, this baby may survive. Many times, sadly however, they do not! Especially in rural localities and even in the larger urban tertiary centres replete with annoying protocols.

If your baby suffers with a diarrhoeal disease, especially one that has been persistent, and spikes her temperature, this is not just the baby’s system rejecting a type of food staple or due to teething problems as ignorantly held by some. Literally speaking, your baby must have eaten a piece of shit – yes, poop! This may happen, if you don’t wash your hands after handling raw foods; after using the toilet; if you don’t clean your floors properly; if you do not wash your baby’s hands and toys especially after defecation or allow people with unclean hands handle your baby.

A couple of germs can be transmitted from person to person or from self to self, by contaminated hands, resulting in ill health.  This can happen after using the toilet, changing a baby’s diaper, after doing dirty chores, coughing or sneezing, after touching unclean objects or contaminated surfaces, and after handshakes with other people. Some of these diseases include but are not limited to, infections of the stomach and intestines, such as salmonella, respiratory infections like pneumoniae and influenza, as well as diverse skin and eye ailments, and other diseases of contact including Ebola.  Jointly, diarrhoea and pneumonia kills an estimated 1.7 million children yearly. The simple yet effective practice of hand washing prevents the spread of these germs, particularly bacteria and viruses, which may cause illnesses.

Take it or not, disturbances of the stomach and intestines, especially those of infective causes, have the faeco-oral route as the most implicated mode of transmission. This means they are contracted when faecal matter or its constituents enter the mouth.

 Put simply, this implies that at the root of most “running stomach” complaints one ever had, the chances are that, one ate a bit of one’s own or someone else’ poop. Yes, you read that right!

A single gram of human faeces contains over 1 trillion germs – 10 million viruses and about one million bacteria (Franks et al, 1998), and infant faeces are especially very pathogenic (disease causing).

From Handshake to Hand Death

According to CDC data, an estimated 80 percent of known infections are transmitted by hands. The last Ebola scare claimed several lives intercontinentally including those of frontline health workers. Similarly, the last Lassa fever outbreak in Nigeria claimed about 149 lives (WHO, 2016) and was substantially due to environmental uncleanness. The recent outbreak of Cerebrospinal Meningitis in Northern Nigeria claimed over 500 lives. All that was required in many of these instances was just a simple contact with someone or environment or materials contaminated with the implicated pathogens. Sometimes, an innocent handshake was all it took.

The handshake is a western culture that is now a transnational symbol for acceptance, courtesy, approval, confidence, friendship or integration. We attach a million and one meanings to handshakes. There are even etiquette workshops and online body language coaches who continue to churn out advice on how to deliver the perfect handshake, to either seal a deal, land your dream job, or win the attention of the love of your life. Nevertheless, beyond the varied connotations we may attach to this seemingly innocent act, handshakes should be suspiciously seen as “hand deaths”. This is especially true for children and the elderly who have less robust immune systems and as also true in the face of emerging/re-emerging deadly contagions like Ebola for example. Handshakes could be more than just handshakes! They may be “ticking germ bombs” waiting to explode. Simply put, there is death in the hands. This is because people frequently touch dirty surfaces, their hands, their eyes, their nose, mouth, ears and even their privates without washing their hands afterwards.

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Many healthcare workers consider hand hygiene as the single most important tool in preventing the spread of HAIs (healthcare associated infections) between patients. Sadly however, this practice is also sub-optimum among many healthcare professionals.

We should endeavour to wash our hands as oft as is possible: after using the toilet, before and after handling or eating food (including after handling raw meats or vegetables that may have invisible amounts of animal dung), before and after examining patients, after sneezing, after handshakes etc. As previously explained, this is because the hand can get to every part of the body without difficulty. Hand washing is like a “do-it-yourself” vaccine. Water is cheap, and soap is cheap. Hand washing is cheap, simple, and quick. It can keep us from contracting deadly infections, and save us both costs and life.

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Benefits of Hand Washing

1.            Keeps people neat, fresh and healthy.

2.            Reduces the incidence of diarrhoeal illnesses by 31% (Aiello et al, 2008; Ejemot at al, 2008).

3.            Lowers diarrhoeal diseases in people with weakened immune systems by 58% (Huang and Zhou, 2007).

4.            Reduces respiratory infections like flu, in the general population by 16 – 21% (Aiello et al, 2008; Rabie and Curtis, 2006).

5.            Hand washing with soap could protect about 1 out of every 3 young children who contracts a diarrhoeal illness (Aiello et al, 2008; Ejemot et al, 2008) and every 1 out of 5 young children with respiratory infections like pneumonia (Aiello et al, 2008; Rabie and Curtis, 2006).

6.            Hand washing education and access to soap in schools could help improve children health and attendance rates (Azor-Martinez et al, 2013; Lau et al, 2012; Master et al, 1997).

7.            Although people world-over clean their hands with water, very few use soap to wash their hands. Washing hands with soap disinfects them from germs much more effectively (Burton et al, 2011).

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It is difficult to carry water everywhere, or find water and soap everywhere, however cheap these items may be. Therefore hand sanitizers have recently gained popularity as a good alternative. They are instant cleansing solutions usually having an active disinfecting agent, mostly alcohols. They can be safely used by children and adults in almost every setting. They are light to carry, and simple to use. They require neither water nor towel to use, and a drop of the chemical agent can be spread between the hands and fingers, and rubbed together until absorbed. They dry up quickly, kill or inactivate germs, cleanse the hands and sometimes leave them smelling so fresh and sweet. They have three market variants (gel, liquid wipes, and lather). Gel forms are the most preferred forms because they fit easily into pockets and purses, do not easily pour over and are light enough to be carried as walking or travel accessories. Many nursing mothers use liquid wipes while hospitals often have lather disinfectants and other forms.

Finally, hand washing is now a global health movement; I hope this article convinces you to key into the movement. Thank you for reading!

Godwin Mark (MBBS) (Currently Commonwealth Scholar at Edinburgh Napier University, Scotland).