Doesn't Anybody Have Clean Hands?

Why is that so few of us wash our hands? And why do most of us who actually do wash our hands do a lousy job?

As a parent, it's been a constant battle to get my kids to wash their hands--whether that's before eating, after going to the bathroom, sneezing, petting an animal, or for any other reason. And as a human being, I'm constantly restraining myself from pointing out to non-family members--especially other adults--that they need to wash their hands (especially after using the bathroom).

Why am I so obsessed? 

Well, according to the Centers for Disease Control and Prevention (CDC), washing your hands is the most effective way of preventing the spread of disease. Multiple studies have found that unwashed hands are directly responsible for well over half of outbreaks of foodborne illness (including food poisoning and salmonella) and are major contributors to spreading the flu, pneumonia, and diarrhea. (The CDC estimates that if we all washed our hands properly, we'd reduce the number of people who get sick with diarrhea by 31 percent and the number of respiratory infections in our communities by 16-21 percent.) Unwashed hands can also spread hepatitis A, strep throat, some STDs, and a number of other nasty diseases.

The battle for better hand hygiene has been going on for a long, long time. Back in 1846, a young doctor named Ignaz Semmelweis noticed that women in maternity clinics staffed by doctors or medical students were dying of a disease called puerperal fever at a rate five times higher than those in clinics staffed by midwives. After doing some rudimentary investigation, he discovered that quite a few doctors who delivered babies had just come from doing autopsies. Semmelweis thought that some of the diseases from the cadavers were being transmitted to the new mothers. So he made a revolutionary claim: Doctors should wash their hands after performing autopsies and before touching living patients. Semmelweis' reward? He was fired from his job by his colleagues who thought he was trying to embarrass them (he was, but he was right to do so).

Now, 170 years later, our understanding of germs and disease transmission is far more sophisticated, but we're still looking for ways to get people to wash their hands. Actually, not just to wash them, but to wash them correctly.

To have the best shot at killing germs and bacteria, the CDC recommends washing hands with soap and water and rubbing vigorously for 15-20 seconds (that's twice through the "ABC" song). If your hands aren't visibly dirty, an alcohol-based hand sanitizer that's 60-95 percent alcohol will work. Squirt a dime-size glob of the gel onto your hand and rub vigorously until the gel disappears and your hands are dry.

Despite these simple guidelines, 95 percent of us don't follow that protocol after using the toilet, according to a recent study by researchers at Michigan State University. Most don't wash long enough--the average time was six seconds. A third of the people didn't use soap, and 10 percent didn't wash their hands at all.

In the Michigan study, true to stereotypes, women were better about hygiene than men. Only 7 percent of women didn't wash their hands at all, and 79 percent of those who did used soap. Only half of the men who washed used soap, and 15 percent of men didn't wash at all.

So what can we do to encourage more frequent--and better--hand washing? There are actually quite a few strategies that have been shown to work in restrooms and other places.

Post signs

Yes, you can do this at home. Having a sign that reminds people to wash their hands and includes information on what to do and how long to do it increases the percentage of people who comply on both fronts.

Watch

In one study of women in the bathroom of a bar, 40 percent washed their hands after using the toilet when another person (a female researcher) was in the room not doing anything. When a researcher chatted with the subject and washed her own hands, the rate went up to 56 percent. But when the researcher was talking on her cell phone, the rate dropped to 27 percent. 

Post Pictures 

If you can't physically be there to remind people to wash their hands, a picture may be the next best thing. Researchers at a teaching hospital in Miami, Florida, noticed that only 15 percent of hospital staff and visitors (9.3 percent of men and 19.7 percent of women) in an intensive care unit used alcohol gel dispensers at stations outside patients' rooms. When behavioral scientist Ivo Vlaev and his colleagues at the Warwick Business School posted photos of a man's eyes next to the gel dispensers, a third more people cleaned their hands. Interestingly, a photo of a woman's eyes had the opposite effect, reducing the number of people who used the gel. 

Lemons 

In another part of the same study, Vlaev and his colleagues exposed some subjects to a citrus smell near the gel dispensers. That increased gel usage to 47 percent (42 percent of men, 52 percent of women).

Whether you use one or more of these strategies or you come up with something else, do whatever you can to get your friends and family (and even less-than-hygienic strangers) to wash their hands. It might just save a life.

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