With Global Handwashing Day fast approaching on October 15th, we take a look at the history of handwashing and consider why it now needs to be taken more seriously than ever.
Why hand hygiene is important
If we delve deep back into history, it’s widely acknowledged that microorganisms were the first forms of life to evolve. They emerged approximately 3.8 billion years ago, and they are still to this day the most abundant life forms; always ready to adapt to new opportunities and challenges.
One of the biggest of those opportunities was the arrival of our own Genus, Homo sapiens approximately 200,000 years ago. Suddenly (relatively speaking!) some microorganisms were provided with an ideal new environment to colonise: the human skin, and in particular the human hand.
For other microorganisms, humans presented a great new way for them to spread. Human hands are naturally contaminated, and are usually host to a variable but often large number of microorganisms that can then be spread to other people and surfaces by hands.
Most are harmless, some are beneficial, but a minority are potentially pathogenic (i.e. they cause diseases). If these evade the body’s natural defences, the harsh reality is that they can go on to cause an infection, with the potential to contribute to a global pandemic.
There is evidence we’ve always known this
Hand hygiene is not new! There is evidence that primitive man used similar principles but with slightly different methods and materials to practice hand hygiene (for example, rubbing their hands with sand, grass, leaves, bark or ash). These practices far predate the reported discovery of microorganisms (in about 1674), let alone their causation of infectious diseases. What this suggests is that originally there was possibly more to hand hygiene than the fear of disease – but the question is what? This has been answered in part by the work of anthropologists and sociologists, who have suggested that it was because we are hard-wired to remove visual soil, and experience disgust at feeling unclean. Whatever the reason, there can be little doubt that these practices played a significant role in helping humans to protect themselves from diseases.
Misplaced complacency
Despite the development of these early innate habits, and the recognition by Ignaz Semmelweiss in the 1840s of the importance of hand hygiene in disease prevention with the progress of science something has been lost. In the 1960s, it was common to read statements such as its “time to close the book on infectious diseases” or “that books on infectious diseases were a thing of the past”.
Of course, it hasn’t turned out that way. Diseases that spread via hands are still major causes of human morbidity and mortality. August 2017 data show a mean of 1.31 million people a year (the upper estimate puts this at 31 million) die from diarrhoeal diseases. There is a disproportionate impact on the under 5s.
An estimated 2.74 million people (upper estimate puts this at over 100 million) also die from lower respiratory tract infections, again with a disproportionate effect on the under 5s. This is something we really need to be mindful of, because although respiratory infections are classically spread by airborne routes, a substantial number of these infections (for example colds and flu) are also spread via contaminated surfaces.
Why Global Handwashing Day is more important than ever
Global Handwashing Day has an agenda to “increase awareness and understanding about the importance of handwashing with soap as an easy, effective, and affordable way to prevent diseases and save lives.” Quite rightly, it serves to remind us that there is no room for any complacency, and that it is still important to wash your hands properly, whether you live in the developed or developing world.
At Initial, we couldn’t agree more. Improved hand hygiene has been shown beyond doubt to reduce the spread of diseases and infection substantially. Overall it has been estimated that good hand hygiene, if implemented correctly and universally, would reduce the number of diarrhoeal diseases by 50%, and respiratory diseases by 25%. Contaminated hands are also responsible for contributing to the spread of other infections, such as skin or eye infections, or hospital-acquired infections (urinary tract, surgical site or wound infections) which alone may be the cause of 75000 deaths a year in the US. Good handwashing can help to stop these unnecessary deaths.
Complicating the matter further, many of the current pathogens (bacterial, fungal, protozoan and viral) are increasingly displaying resistance to the antimicrobial agents used to treat them. This is a very serious issue. Indeed, bodies like the World Health Organisation (WHO) and national governments alike now view antimicrobial resistance (AMR) as a serious threat to global public health. They’re particularly concerned that new mechanisms of resistance are emerging, and that the resistant organisms can spread easily from person to person.
Hope for the future
There’s no need to be all doom and gloom, however, and this is exactly why initiatives like Global Handwashing Day should be supported, endorsed and celebrated as much as possible. This is because studies have shown that hand decontamination and cleansing, if performed correctly, can significantly reduce the number of microorganisms on the hands, with the potential for a 3 log (99.9%) reduction or more.
There are provisos, because when we’re thinking about disease prevention, these figures need to be considered in relation to how many organisms were on the hands in the first place, what the infective dose of any particular pathogen is and how much immunity or resistance the potential victim possess. But the bottom line is that while good hand hygiene will not eliminate diseases and antimicrobial resistance from occurring, it will help to stop the spread. For that to happen, global coordinated action is needed, and events like Global Handwashing Day are a beacon of hope.
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