THE STORY OF HAND WASHING
Ignaz Philip Semmelweis (1818-1867) championed the importance of hand washing among the medical
professional. Yet there is no other procedure which is simple and cost effective in preventing the spread
of infections in hospital environment. Throughout the nineteenth century, physicians were realizing the
value of soap as a medicinal agent. In the History of Medicine,A well-known protagonist of soap was
scientist and educator Ignaz Phillipp Semmelweis, who in 1847 discovered the infectious etiology of
puerperal fever and therefore required medical students to wash their hands before they examined
patients. Semmelweis encouraged his colleagues to adopt his antiseptic methods, telling them, "while
we talk, talk, talk, gentlemen, women are dying. I am not asking anything world-shaking. I am asking you
only to wash.… For God's sake, wash your hands." In a circular handed out in Budapest during the
summer of 1865, he implored new mothers: "Unless everything that touches you is washed with soap
and water and then chlorine solution, you will die and your child with you!" It is utmost important duty
of every medical, paramedical and nursing staff to educate, promote and monitor hand washing. In spite
of more than a century of knowledge many times, this simple procedure is ignored by the many senior
staff. The simple procedure of hand washing is the best prayer in prevention of infections in a hospital,
continues to be the best remedy in reducing the hospital acquired infections.
The basis of spread of infections in hospital is that microbes are commonly exchanged from patients to
patients, patients to medical staff and medical staff to patients
In the above methods of spread our hands play a great role in transmission of infections. By simple
procedure of hand washing the chain of events in spread can be minimized.
Methods of hand washing
Social hand washing
Hygienic hand washing or disinfection
Surgical hand washing
Social hand washing
Most commonly practiced procedure involves vigorous mechanical friction applied to all surfaces of
hand using simple plain (toilet) soap and water for 15-20 seconds. If no running water is available store
water in a clean container, close lid and only necessary amount drawn to the needs with a clean mug.
After washing, dry hands with tissue paper or a clean towel. Never use a common towel as the very
purpose of washing is lost when you do a clean procedure on the patients.
Hygienic hand washing and disinfection
Hand washing using a disinfectant as 4% chlorhexidine gluconate- detergent or Povidone- Iodine
detergent solution (containing 0.75% available Iodine and alcohol) is preferred.
The following types of alcohols can be added such as Ethanol- 70% or Isopropanol-70% to 0.5%
chlorhexidine or povidone.
Surgical hand washing
Hand washing practiced more intensely, usually done before surgical procedures or any interventions.
Soap/ liquid detergent used with warm water. Washing extends up to elbow apart from washing fingers
and palms. Practical Tips in Hand Washing
Use soap and water (if possible mild warm water) Vigorously rub your hands together until you have
Scrub your wrist between your fingers, under our nails, around the tips and palms of the hands, practice
this for 15-20 seconds and rinse and dry your hands with clean towel.
In view of configuration of hands certain areas of the hands are relatively less cleared of microbes than
other surrounding areas.
Common infections spread by unclean hands:
Drug Resistant Staphylococci
Salmonella, E.coli, Shigella, Hepatitis A&E.
When you are working in ICU and ICCU the patients are invariably on broad spectrum antibiotics
and colonized with multi drug resistant bacteria. Your dedicated effort in hand washing will save the
lives of serious patients, from infection.
In the era of AIDS and Hepatitis B infection all the blood and body secretions are identified as
health risk to all medical/paramedical staff. Hand washing is included as primary importance in the
Wearing a glove is not a total protection in handling infectious cases. Even the new gloves
contain micro holes. Washing is equally important after you remove gloves.
Your children can be effectively protected from infection if you teach simple hand washing, even
in school after attending a toilet or before taking food. It is observed that in schools with good washing
facilities the children are less likely to be sick with infection from communicable diseases.
Our goals in hand washing promotion Experience has shown that most effective way to increase hand
washing is to have physicians, surgeons, senior paramedical staff and other respected individuals as role
Most experts in infection control and epidemiology maintain that hand washing remains the most
powerful defense against infections. Microbes are all around us, and can spread anywhere: the office
phone, door handles, shopping baskets, money, even the button you push when you call for an elevator.
You can unknowingly come into contact with germs. One simple rub of the eye or bite of a sandwich
using unwashed hands can introduce any number of illnesses into your body. Teaches to consistently
wash their hands and encourage others to do so, means everybody has a role.
Social hand washing is also an important procedure to be explained to all the patient attendants. As
even attendants get infected while serving and may take home the infection or bring some infections
from outside when they attend the patients.
Dr.T.V.Rao MD Professor of microbiology Freelance writer