ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846

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Hand-Washing and Public Health

The importance of hand-washing in personal and public hygiene has evolved over the centuries. While the market with its countless number of soaps and hand-wash products for personal hygiene with the accompanying advertising has created a false sense of security, it is community hygiene implemented through public health measures that is really effective in the battle against disease.

Infectious diseases remain a serious public health threat and hand-washing has emerged as one of the components of a package of public health tools to be used in preventing them. To be effective, the different components, including water supply, personal hygiene, food security and sanitation have to function in coordination with one another. Cholera, typhoid and hepatitisA are some of the communicable diseases that are spread via the faecal–oral route. They occur when microorganisms enter the mouth through food, water and unhygienic toilet practices. Coignard et al (1998) observe that such infectious diseases are usually spread via hands.

Compared to techno-centric packages and “magic bullets,” fingers and hands are outliers as far as public health is concerned, despite the fact that they have been at the centre of some of the major milestones in the history of medical practice. For instance, the significance of hand-washing in patient care was first recognised in the early 19th century by Semmelweis, a physician and epidemiologist (Timmreck 1998). Through observation of clinical practice, he noted that medical students who assisted in childbirth often did so after performing autopsies on patients who had died from sepsis (of bacterial origin), as a result of which maternal mortality was high. After instituting a strict policy of hand-washing, death rates fell considerably, demonstrating that the transfer of diseases could be reduced significantly using this simple hygienic practice. Labarraquee later provided evidence of the association between hand contamination and maternal mortality. Today, hand hygiene is considered to be a key measure in preventing the transmission of many communicable diseases. Important preventive strategies include hygiene education and appropriate hand-washing (Benenson 1995). According to the Centers for Disease Control (CDC) (1985) there are four different levels of compliance in hand-washing: washing both hands with soap and rubbing them together to produce lather for 15 seconds (full compliance or level four); washing both hands with soap for less than 15 seconds (partial compliance or level three); rinsing both hands with water but no soap (minimal compliance or level two); and neither washing nor rinsing (non-compliance or level one). The CDC admits that in the absence of well-controlled studies, absolute indications for the frequency of hand-washing are not known.

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