Post-pandemic, we all have a greater awareness of the importance of good hand hygiene in combatting potentially deadly infections. But one common flaw in cleaning processes often undermines our efforts in that area.

Even the best hand-hygiene practices can be compromised if facility managers and cleaners do not properly clean and sanitise high-touchpoint areas such as door handles, escalator handrails and light switches.

Dr Gavin Macgregor- Skinner, senior director of the Global Biorisk Advisory Council (GBAC) wants greater focus on this cleaning “loop”.

“Washing your hands and cleaning surfaces leads to better hand hygiene, so making that loop work would significantly decrease the transmission of germs, as well as the transmission of chemicals, contaminants, allergens and anything that’s on a surface,” Macgregor-Skinner says.

Complacency setting in

Four years since the start of the COVID-19 pandemic, the World Health Organisation (WHO) is still championing the impact of good hand hygiene on health. It believes hand-hygiene practices remain “suboptimal” around the world, with half of all healthcare facilities worldwide lacking the necessities for hand hygiene, such as soap and water, or alcohol-based hand rubs.

Renowned infection-prevention expert Dr Greg Whiteley, executive chair of Whiteley Corporation, agrees that hand- hygiene complacency is occurring, including within many Australian healthcare facilities.

“It’s like the pandemic never happened, and all the lessons they learned have gone out the window,” Whiteley says. “There are more people catching COVID in Australia now than there were in 2020.”

In addition to cleaners having more robust hand-hygiene practices, Whiteley urges some medical professionals to rethink their hygiene routines and follow WHO guidelines.

With winter approaching, he also calls on people to check their vaccination status, including for COVID-19, influenza virus and measles. There is also a new vaccine available for respiratory syncytial virus, or RSV, which is especially harmful to children. “I’d just encourage everyone to get their vaccines up to date,” Whiteley says.

Helping the hygiene fight

There are some well-accepted best practices to ensure good hand hygiene, including:

• Washing hands with soap and water for at least 20 seconds (rinse well to remove germs and bacteria).
• Using an alcohol-based hand sanitiser, if soap and water are not available, with at least 60 percent ethyl alcohol or isopropyl alcohol (rub the gel over all parts of your hands and fingers until they are dry).
• Cleaning hands before, during and after activities such as preparing food, caring for people who are sick, or treating wounds.
• Changing or washing gloves that get contaminated (as often as you would wash your hands).

For facility managers and cleaning contractors, steps that can make a difference include:
• Ensuring soap dispensers are available and fully stocked.
• Placing sanitisers in high-traffic areas such as entrances, exits, check-out counters, bathrooms, cafeterias and any other high-touchpoint locations, rather than hiding them away in low-access zones.
• Putting up signage in bathrooms, food-preparation areas and other high-traffic areas to remind people to wash their hands.
• Placing footprint decals on the floor leading directly to handwashing stations.

Macgregor-Skinner recommends washing hands with soap and water as a first line of defence to break the transmission cycle of touching your eyes, nose and mouth with unwashed hands. Although alcohol-based hand rubs have their place, they do not physically wash away germs and bacteria.

“The germs stay on your hands,” Macgregor-Skinner says. “Alcohol-based hand sanitisers do not kill norovirus, nor do they kill cryptosporidium and there is a cryptosporidium problem in Australia right now.”

Cleaners are important in the transmission cycle and, therefore, proper hygiene training is a crucial issue.

Dr Greg Whiteley

Winter warning

With the United States having just emerged from a challenging winter during which COVID-19-related deaths remained high and outbreaks of norovirus, RSV and measles caused health concerns, Australia should be on high alert as winter approaches.

Macgregor-Skinner, who is based in Washington DC, says the American winter is a reminder to Australia to refocus on hand hygiene. “Hand hygiene and handwashing with soap and water are critical to protect your health and the health of others. But we just don’t get it right,” Macgregor-Skinner says.

The signs are already pointing to a challenging winter in Australia. Towards the end of March, New South Wales Health advised there had been 10,976 confirmed cases of influenza A and B in New South Wales alone, up from just over 6000 cases at the same time last year. “Now that’s a really early start to our flu season,” Whiteley says.

In such a highly infectious environment, he notes that Whiteley research shows once a person touches biofilms – slimy layers of microorganisms such as bacteria or fungi that grow as a community on surfaces – and gets bugs on their fingers, those bugs will stay on hands for up to 19 subsequent touches.

The findings, cited in a recent research review on dry-surface biofilms by eminent American infectious-diseases experts Dr David Weber and Dr Bill Rutala, underline the importance of proper training of staff on hygiene practices, and communicating hand-hygiene rules and regulations to visitors at healthcare facilities.

“If you work within a healthcare establishment, and you touch something that’s contaminated … now you’re going to touch a whole bunch of things that weren’t contaminated,” Whiteley explains. He adds that it does not matter if those touches are with dry hands or dry gloves.

“The really interesting part of our research was that when you touch a contaminated surface with wet gloves, you get 10 times the number of bugs. So, cleaning staff who have often got wet gloves on are going to pick up 10 times the number of bugs on those wet gloves.

“Cleaners are important in the transmission cycle and, therefore, proper hygiene training is a crucial issue.”

And some good news…

On a positive note, a Food Safety Information Council survey indicates that there has been an increase in the number of young Australians who always wash their hands before handling food. Two-thirds of 18- to 34-year-olds say they always wash their hands before handling food, up from 57 percent in 2022.

A negative, though, is that 17 percent of Australians say they do not always wash their hands after going to the toilet (compared with 18 percent last year). Another 34 percent admit they do not always wash before touching food (compared with 47 percent last year).

This news comes on the back of Food Standards Australia New Zealand and Australian National University research on the annual cost of foodborne disease in Australia. The findings reveal that there are an estimated 4.67 million cases of food poisoning in Australia each year that result in 47,900 hospitalisations and 38 deaths, costing the economy $2.1 billion. Poor handwashing could be a major contributor to these figures.

As 2024 unfolds, Whiteley says the cleaning industry will play a key role in infection control given the importance of rigorous high-touchpoint cleaning in tandem with strong hand hygiene.

“Here’s the really good news for our sector,” he says. “Cleaning is still the number one preventative activity. Whether it’s your hands or a surface, cleaning is the main infection-prevention strategy because it cuts off indirect transmission.”

The fab five

For medical practitioners, the World Health Organisation recommends following the “five moments” of hand hygiene. That means cleaning your hands:

1. Before touching a patient (to protect the patient against harmful germs carried on your hands).
2. Before performing any clean/aseptic procedure (to protect the patient against harmful germs, including the patient’s own, from entering his or her body).
3. After an exposure risk to body fluids (to protect yourself and the healthcare environment from harmful patient germs).
4. After touching a patient (to protect yourself and the healthcare environment from harmful patient germs).
5. After touching any object or furniture in the patient’s immediate surroundings (to protect yourself and the healthcare environment from harmful patient germs).

[Source: World Health Organisation]

Photo by Mélissa Jeanty on Unsplash