Reprinted from the Fall 2021 issue of The Ohio Family Physician
By: Will Sawyer, MD, FAAFP, Sharonville Family Medicine, Henry the Hand Foundation.
Most people harm themselves by self-inoculation with many organisms that hide on commonly touched surfaces because they have bad hand hygiene habits.
There are many different hand hygiene products and tools. With the rise of infection awareness due to the COVID-19 pandemic, the practice of hand hygiene has again surfaced as a critical behavior. However, the public still does not fully understand that the five holes in our heads need to be protected to prevent ALL respiratory and gastro-intestinal infections including the facial mucous membranes of the eyes, nose, and mouth—commonly referred to as the T-Zone.
Eighteen months ago, the social debate about masking vs. no masking vs. staying at home created tremendous turmoil and caused people to question public health messaging. During the SARS 2004 outbreak, more health workers in Toronto died from SARS than the public. Since then, I have worn a face shield in the office when treating patients with potential respiratory illness. This practice has helped me “break the unconscious habit” of touching my T-Zone and as a result, I have not had a respiratory infection since, despite my allergies and asthma condition.
There are a few basic principles both the American Academy of Family Physicians and the American Medical Association endorsed in 2001 which would go a long way in reducing infectious disease and helping individuals stay well:
- WASH your hands when they are dirty and BEFORE eating.
- DO NOT cough into your hands.
- DO NOT sneeze into your hands.
- Above all, DO NOT put your fingers into your eyes, nose, or mouth.
Had we been more deliberate in teaching these critical life skills, we would see less infectious disease events, health care associated infections, and perhaps a lesser spread of the COVID-19 infection. Simply observe others on your next Zoom or in-person meeting to see their vulnerability. Since we all have experienced a major reset in our practices and lives, perhaps we should be more intentional in teaching the “4 Principles of Hand Awareness” in daycares, schools, and our practices. An ounce of prevention is worth a pound of cure!
If we emphasized the “4 Principles of Hand Awareness” as consistently and frequently as we stress vaccinations, our patients would be healthier. Very few schools closed during the 2009 H1N1 pandemic. And while there was no vaccine, the big box stores could not keep up with the demand for soap, sanitizer, wipes, and paper towels. In the past 18 months, with the emphasis on handwashing, masking, and staying home, there was virtually no influenza.
Emphasizing these behaviors is the responsibility of health care, public health, and school health professionals. It has been said if you were not trained at home, then you did not learn it. Teaching youth these life skills will contribute to health and wellness throughout their lifespan, by reducing acute infectious disease, chronic disease, and morbidity. A multi-pronged approach delivered by many stakeholders with an interest in an individual’s health and productivity is needed. This naturally falls into the spheres of school health centers, school nurses, family physicians, pediatricians, and daycares; and can be emphasized with a simple hand hygiene curricular thread weaved into regular classroom work.
None of us want the devastation experienced during the past 18 months repeated. We can counter those predictions of a pandemic every 10 years.
It took 20 years for the Austrian medical society to accept Dr. Ignaz Semmelweis’ observation that rinsing hands in a dilute chlorine solution before going from the morgue to the delivery room reduced maternal-fetal fever and sepsis. It took 20 years to identify the organism spreading cholera which Dr. John Snow solved when he removed the handle from the Broad Street public water source in London.
Now, 20 years later, family physicians can popularize these “4 Principles of Hand Awareness” they endorsed in 2001. The newest twist is “do not put your finger in your eyes, nose, or mouth,” commonly referred to as the T-Zone! So, help colleagues “break their bad hand hygiene habit,” so they can teach others. We adults need to have the knowledge first, then the awareness, before we can implement behavior change through Planned Behavior Theory.
A few organizations with a natural collaboration include the American Speech-Language- Hearing Association, the American School Health Association, the National Association of School Nurses, the American Academy of Family Physicians, the American Academy of Pediatrics, the National Association for the Education of Young Children, Head Start, and the American Public Health Association, as well as the Association for Professionals in Infection Control and Epidemiology, the Society for Healthcare Epidemiology of America, the Centers for Disease Control and Prevention, the National Public Health Information Coalition, and the National Association of County and City Health Officials.