Hand Washing

Jinhee Park Kim

 The first thing I learned at my first clinical class of nursing school was hand washing. I was told to wash hands in lukewarm water with soap, while singing “Twinkle twinkle little star” or “Happy Birthday” since it takes 20 seconds thoroughly to clean underneath fingernails and between fingers. The instructors urged the nursing students to do it very faithfully because hand hygiene is the most fundamental and important part of our profession.

I realized why they emphasized the importance of hand washing so much as I started clinicals. I had seen a few immunosuppressant patients’ conditions worsen by contamination during their hospitalization. A senior nurse could not come to work for a few weeks after she touched her mouth by accident when she took care of one of her very sick patients. She was contaminated by that simple and short touch. She could have contaminated other patients as well with the germs she had from the patient. It was more critical to wash hands more seriously even when we were wearing facial masks and gowns to take care of patients with traumatic brain injuries, chest tubes, or tracheostomies, etc. We should not transmit any germs to anyone, not even our close family members and friends. We were constantly educated to wash hands before stepping into and out of a patient’s room, before and after wearing gloves, and whenever touching any objects in each room. I often washed hands more than one hundred times each shift. When my hands got numb and dry from washing, I usually applied some hand cream every so often. It is amazing to feel soft hands the next morning.

It seems hard to believe that there is a history to hand hygiene.  Dr. Ignaz Semmelweis was born in Hungary and studied Medicine in Austria. He wondered why the death rate was higher in the Maternity Department in Vienna General Hospital than that in clinics in 1847. He found out the fact that medical students and doctors went to the Maternity unit directly right after autopsy. Therefore, the deaths of mothers who just had babies were contaminated by other diseases right after their own painful labor caused their family members to become extremely sad without knowing the causes of their death.

Dr. Semmelweis set up the policy of antiseptic procedures to wash hands with a solution of chlorinated lime to the medical interns coming out from autopsy work to the examination of newborn deliveries. It actually did decrease the death rates of the maternity unit. But he could not prove that new hand hygiene was the direct reason of it among other possible contaminated routes. He finally was treated as a mad person not only by the medical staff but also by his own wife. Ironically and tragically, he died of sepsis after a prison guard whipped him so harshly in a jail.

Louis Pasteur proved Dr. Ignaz Semmelweis was right in his book <Germ Theory> soon after Semmelweis’ death. Florence Nightingale, the founder of modern nursing, saved a lot of people’s lives by emphasizing hospital hygiene and sanitation to take care of wounded soldiers during the Crimean War. There was cutting-edge hand hygiene research in Semmelweis University in Budapest, Hungary. The World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) are actively educating the public with the slogan “Clean Hands Save Lives.” I am glad to see the tendency of hand washing is spreading all over the world because it is the most economical and effective to avoid diseases and spreading germs to other people.

It was really scary and threatening to see how H1N1 Flu was spreading in 2009 and MERS in 2015. When Avian flu was starting in Hong Kong, the carrier of the germs was in an elevator of a hotel and touched the button. He was found dead soon, and other people who touched a button also died from the flu in a few days after. I believe the death rate could have been much more decreased if they washed their hands with soap and water.    

There are habits for us to prevent spreading diseases in our lives. You should cover your mouth when sneezing and cough with your sleeves, push elevator buttons with sleeves, and use your body to push a public door. It is nice to make a habit of keeping a hand sanitizer handy in your car or purse and use it after touching public objects. It is great to see hand sanitizers in many public places after MERS in South Korea.

I definitely realized the importance of hand hygiene when I worked in a hospital. I had an idea of hand washing for patients, which would be beneficial to prevent the secondary infection during their hospitalization. This idea was selected to a project of Evidence Based Committee in the hospital where I was RN, and I worked with a mentor and got a full support from the committee as well as the infection department of the hospital for a few months. I educated patients and their family members to wash their hands and to show the real photos of petri dishes that I collected from patients’ hand prints, proving germs on hands. The infection rates were higher in the unit where had no education of patients’ hand hygiene compare to the unit had education for four months. But it was not easy to convince the committee that hand hygiene of patients had a big impact on the decreasing rates. I could not introduce the plan to all units of the hospital because of the lack of proof and trial timing. It seems difficult to persuade people to wash hands now and then.

I still wash my hands over and over again. I am glad hand washing has not worn out my hands. It takes 20 seconds to wash hands, 16 minutes if you wash 50 times, and about 33 minutes if you wash 100 times a day. I willingly invest my time to save lives as a health care provider. It may sound exaggerated but hand washing is saving my life as well as other lives. I strongly believe that it is important to have clean hands and minds because it comes with true respect and value of other people’s lives.