It may be the most frequently repeated advice for avoiding illness—especially during the coronavirus pandemic—and it’s a simple one: Wash your hands. “Among the many infection prevention practices available to doctors, good handwashing has made the single biggest impact on infection transmission and resulted in savings millions of lives,” says Arjun Venkatesh, MD, MBA, MHS, a Yale Medicine emergency medicine specialist.
Good handwashing—with the help of soap and the friction of rubbing hands together—is a strategy that can minimize germs, or pathogens that cause disease. One new analysis even suggests we could dramatically decrease coronavirus infections by increasing traveler engagement with hand hygiene at certain highly traveled airports. But there are studies that show people still don’t really understand this—in one 2018 study, the vast majority of people didn’t wash their hands properly.
“The most common mistake made when it comes to handwashing is forgetting to do it in the first place; the second most common mistake is doing it so fast that you don’t get every part of both hands,” says Dr. Venkatesh. Here are handwashing tips from the Centers for Disease Control and Prevention (CDC) and Yale doctors whose work depends on good hand hygiene.
- Use clean, running water to wet your hands. The water can be cold or warm—cold water actually does work and warm water is more likely to irritate skin.
- Rub your hands with soap (and rub your hands together to lather the soap).
- Lather both the front and back of your hands, in between all of your fingers, under the fingernails, thumbs, and up to the wrist.
- Wash your hands for at least 20 seconds—about as much time as it would take to sing the Happy Birthday song twice from start to finish. (But keep in mind that a thorough cleaning—the friction, how intensely you rub your hands together—is more important than time spent washing hands.)
- Dry your hands completely. You can dry them under a warm air dryer, or use a paper towel. Avoid a recently used towel as moisture is a good breeding ground for bacteria, which makes drying your hands an important step.
Once your hands are clean, avoid touching surfaces such as the sink and faucet, door handles, your phone, or other objects where you can potentially pick up new germs. A good strategy after using the bathroom, for instance, is to push the door open with your elbow if you can or use the same paper towel with which you dried your hands to grasp the door handle and open it. Then, throw the towel in the trash.
According to the CDC, you should wash your hands before and after preparing and eating meals, when caring for another person who is sick, after using the bathroom, after coughing or sneezing, after changing a diaper, before and after treating a cut or wound, after touching an animal or anything animal-related (including pet food and pet treats), or any time your hands are dirty.
Alcohol-based sanitizer or soap?
According to the CDC, while antibacterial hand sanitizers aren’t as effective as soap, it is better to use one (look for one that contains at least 60% alcohol) than not, if you are in a situation where you don’t have access to soap. (Contrary to a popular myth, alcohol-based sanitizers do not cause antibiotic resistance.)
“Using alcohol-based hand sanitizers properly can be almost as good as using soap and water,” says Dr. Venkatesh, “but you must be sure to use enough sanitizer to cover both sides of your hands, in between digits, and under nails while also allowing enough time for your hands to completely dry—about 20 seconds—before touching anything. Do not wipe off any hand sanitizer or try to use a towel to dry it as that can cancel any benefit.”
Yale Medicine emergency medicine specialist Sharon Chekijian, MD, MPH, also recommends washing your hands frequently throughout the day, and especially at home. “You should make your home your 'safe zone.' Have all household members wash their hands when they return from the outside world. Make a habit of wiping down surfaces, including counters, doorknobs, remotes, light switches, and especially your phone,” she says.
Dr. Chekijian suggests using convenient Lysol, or Clorox or alcohol-based sanitizing wipes to clean surfaces and to avoid re-contaminating your hands within your home. “If wipes are running low, you can spray a disinfectant product on a clean paper towel. As a last resort, you can dilute bleach in water per the manufacturer’s instructions or use undiluted isopropyl alcohol on a clean cloth (launder the cloth immediately afterward). In this era of product shortages, if all else fails, soap and water works for surfaces such as counters,” she says, adding that you should check with manufacturers of phones and electronics that have sensitive surfaces about cleaning products to avoid. “Allowing for drying time is a key step in disinfecting,” she says. “If you haven’t cleaned it yourself, assume it could be contaminated.”
In the end, keeping your hands clean is a key strategy for avoiding germs, staying healthy, and keeping those around you safe as well.
“Handwashing is a key to preventing surgical infections. There is no question that it works,” says Dr. Chekijian.
Patients and members of the community can call the COVID-19 hotline of Yale New Haven Health at 203-688-1700 (toll-free, 833-484-1200) if they have questions.