The importance of hand hygiene

CAGAYAN DE ORO — Hand sanitizers are everywhere these days, from convenience store tables to mall entrances to fitness centers and, of course, people’s handbags. In SM Downtown here in CDO, two large containers of hand sanitizers greet visitors as they pass through security. “This is a sanitized zone,” posters all over the mall announce, adding: “Thank you for using the alcohol/disinfectant provided.” In mall restrooms, I see more people washing their hands—longer and more vigorously, too.

As with the rise of face masks, the sudden popularity of hand hygiene practices (and products) has doubtless been spurred by the ongoing COVID-19 outbreak, which has stoked anxieties — some justified, others misplaced — all over the world. Similar such outbreaks led to similar global responses. Although we will have to confirm with Ben Chan, I will not be surprised if the introduction of Bench’s Alcogel in 1998 was spurred in part by the 1997 H1N1 outbreak.

While the use of face masks for general use is of questionable value, the benefits of hand hygiene — when properly done — is based on solid science. Relevantly for COVID-19, increasing hand hygiene in airports from 20 percent to 60 percent has been projected by a recent MIT study to delay global disease spread by nearly 70 percent. Beyond epidemics, there is also robust scholarship that identify proper hand washing as a preventive measure for diarrhea and acute lower respiratory infections, two of the top causes of child deaths worldwide.

Meanwhile, although it is not as efficacious as handwashing with soap and water, the use of hand sanitizers with 60 percent or more alcohol is recognized by the US Centers for Disease Control and Prevention as an acceptable alternative — with the additional benefit of convenience.

All the above raise the question of why the popularity of hand hygiene is as seasonal as the epidemics it is supposed to counteract.

One factor is the cultural or religious significance of hand washing. Some societies, for instance, have had a longer, deeper history of handwashing both for hygienic and symbolic purposes, lending a hand to biomedical imperatives. In Ethiopia, for instance, I was surprised to see restaurant waiters offering a silver jug of water, some soap, and a wash-basin before the food is served. In Islamic countries, meanwhile, many are mindful that the Prophet Muhammad himself encouraged the frequent washing of hands.

Aside from culture and religion, other factors include access and awareness. Washing with soap and water requires facilities and flowing water itself — which, lest we take for granted, is a luxury in many poor communities, and even hand sanitizers come with a price.

Moreover, there’s also the lack of awareness as to what constitutes “proper handwashing” (globalhandwashing.org has excellent resources). In the above-cited MIT study, the researchers found that although 70 percent wash their hands in one way or another, only 20 percent of people in airports actually have clean hands.

It is possible that, owing to COVID-19, more people will make it a habit to practice proper handwashing. But for this to happen, we must promote it not just as a response to epidemics, but as part of our everyday hygiene culture. In this, schools and families are important allies. As behavioral scientists have pointed out, the first 10 years of life are decisive in establishing hand cleansing patterns.

Beyond individual habit, however, we also have to work for an enabling environment for hand hygiene. Alas, in countries like the Philippines, restrooms have been notoriously limited both in number and the range of amenities, and while various establishments today are making a show of offering free hand sanitizers, they should actually invest in better washrooms. Access to flowing water—a political and economic issue—must likewise be addressed, particularly among the urban poor.

Hand hygiene, of course, is no panacea, but its public health benefits should encourage us to practice and promote it. Indeed, just as I hope that the COVID-19 outbreak disappears soon, I also hope that the interest and awareness it raises about hand hygiene will be here to stay.

glasco@inquirer.com.ph