Hand hygiene for infection prevention against COVID-19
by: Chris Packham
Hand hygiene as a method of infection prevention
Hand hygiene is probably the most important measure that the individual person can adopt in the attempt to prevent, or at least minimise, the possibility of infection with the COVID-19 virus. However, it is essential to ensure that the method of hand hygiene adopted and the way in which it is then carried out is such that the risk of skin contact with the virus and colonisation is genuinely minimised.
It is highly likely that in our day to day life our hands will come into contact with surfaces that are contaminated with the COVID-19 virus and thus become contaminated. This then raises the possibility that we transfer the virus to the face and it is then able to enter the body and cause infection. Another consequence is that the virus can colonise the skin, without our being aware of this, with the result that we transfer it to other surfaces, or through contact with other persons directly to them, ensuring the spread of infection.
What is important, therefore, is that the hands are regularly decontaminated. Considerable experience in hand decontamination exists within the healthcare sector and this should form the basis of hand decontamination among the general public.
There are two main approaches to hand decontamination, the first being the removal of the virus, the second the inactivation of the virus such that even if transferred it can cause no harm.
Hand washing aims to remove the virus from the skin. To achieve this it must be done in such a manner that the removal is complete. So hand washing technique must be of a high standard. Much attention has been given to the correct application of the soap and water. Relatively little attention has been given to the process of rinsing the skin, yet if this is not done properly a soap residue will remain on the skin and contribute to skin damage. Furthermore, incomplete rinsing will result in active viruses remaining on the hands thus largely negating the whole process. The same technique as used for the application of the soap should be applied when rinsing the hands.
All soaps will tend to remove the surface layer of emulsion from the skin. This will have an adverse effect on skin barrier properties and make it easier for transient micro-organisms to colonise the skin. Thus, post hand-washing application of a moisturiser should form an integral element in any hand washing procedure in order for the skin to remain healthy.
The alcohol sanitising rub, if correctly formulated, can inactivate the COVID-19 virus and studies in healthcare have shown that it can be more effective than hand washing. It is quick and simple to apply and does not require the availability of a hand wash basin. This makes it easier to use as and when needed. Personal issue applicators for alcohol sanitiser are available so that anyone can have immediate access whenever required. Furthermore, in contrast to hand washing, the alcohol sanitiser has been shown not to cause skin damage as the formulation allows the inclusion of moisturising elements. Some studies have even shown that it can actually assist in maintaining a high standard of skin condition.
However, alcohol sanitising rub has its limitations. If hands are visibly soiled with organic matter this will inactivate the alcohol, so hand washing becomes the essential alternative.
One objection to alcohol sanitiser is that it sometimes stings when applied. This is not because it is damaging the skin. If alcohol sanitiser is applied to skin that is damaged, even if this damage is not yet visible, it can reach nerves in the skin and trigger the stinging sensation. On-going use of the sanitiser will help restore skin condition so that sensation will disappear. This should be explained when someone is first starting to use the alcohol sanitiser.