Washing your Hands!

An infection control nurse shows us how best to wash our hands.
24 February 2014

Interview with 

Rachel Thaxter, Addenbrooke's Hospital


If someone you know has norovirus how can you protect yourself? Infection control Person washing his handsnurse Rachel Thaxter joins Chris Smith in the studio to show us how to wash our hands properly..

Rachel -   This is a gadget we use in hospitals to teach student nurses and medical students how to wash their hands.  We use a cream that's got a UV impregnated particle in it and we asked the staff to put this cream onto their hands and rub it in like hand cream all over the surface of their hands and their nails.  We then asked them to go and wash their hands and see how successful they are at actually washing this cream off.

Chris -   Because if they were potentially infectious for norovirus or had contacted a surface with norovirus, hands are presumably the main route via which infections spread.

Rachel -   Yes, hands are key in all infections really.  So, good hand washing, good hand hygiene at all times is what we recommend.

Chris -   Well, I found you a victim.  Harriet Johnson who's here with us from the Genetic Society.  How's your hand washing, up to spec?

Harriet -   They look pretty clean.  They look alright.

Chris -   What do you want her to do, Rachel?

Rachel -   I'm just going to put some cream onto Harriet's hands.  So, just a nice splodge of that.  all of your hands like a hand cream, your nails, your wrists, your thumbs.

Chris -   So, this is called glow and tell.  So, this is just a dye which will glow under UV.  The idea being that you're going to send her off to wash her hands.

Rachel -   That's correct, yeah.

Chris -   And if she misses bits, we'll know.

Rachel -   We will, yeah.  It's not actually highlighting the bugs on the skin.  It's just like a cream which will then dry and wash off to mimic the possibility we have all these bugs on our hand and Ian said there's thousands of them.  So, off you go and wash your hands.

Chris -   Okay, Harriet so, off you go and wash your hands now as you would do normally.  So, just how you would judge your hands to be clean after washing say, you've been to the loo or something.  I presume you wash your hands after.

Harriet -   Yep, always, never  a walker.

Chris -   We'll see you in a minute.  So Rachel, what some practical tips can you give people if someone goes down with D&V in their house?  What's the best way of someone not spreading it around the family?

Rachel -   Isolate yourself.  So, stay in your room. If you've got the luxury having many toilets in your house then try and allocate a toilet to the sick individual with their own hand washing basin.  If you haven't got that luxury, then making sure that the affected person has their own towels and flannels.  There's no sharing of those kind of items.  Keep yourself hydrated.  We don't really want the sick person preparing meals for the family.  Obviously, if that's vital then scrupulous hand hygiene will be needed.  Keep yourself segregated until your well.  As we said, that normally is within 1 to 2 days and then you can start getting things back to normal within your lifestyle.  And that's why when you come into the hospital, we ask you not to come if you've been unwell and not to come if you've been unwell in the last 2 days.  We don't want the community bringing bugs into the hospital and then giving it to our vulnerable patients.  At the moment, we've only got I think 2 or 3 cases in the hospital Chris.  So, we know it's out in the community.  I mean, we want to keep it that way.

Chris -   What about the cleanup measure because we hear a lot about people saying, "I use alcohol hand rubs and I wipe the taps" and that kind of thing?  What practical advice can you give people for a.) their own hand hygiene to make sure that they don't either transmit it or pick it up and b.) cleaning surfaces where someone has been unwell?

Rachel -   Alcohol gels are really good in hospital when we've had social contact with patients and we're not dealing with patients who are unwell or dealing with their body fluids.  Really, in the home, I only use hand gels if I'm out on a picnic or somewhere where I can't actually wash my hands properly.  I don't use it as a substitute to washing my hands.  So in the household, good old fashioned soap and water is the best thing.

Chris -   Because I did read that those alcohol gels are actually no use against norovirus because like Ian was saying at the beginning, it's a particle that doesn't get broken down by alcohol.

Rachel -   That's correct.  So again, we're ask you not to use it in hospitals when we have problems and say, not use them at home as a hand hygiene product.

Chris -   Mark has got in touch and says, "How long does it take for symptoms of this to come on?  I'm surprised I've not caught it from spending time on underground trains that are packed with people from around the world."

Rachel -   It's pretty rapid I think as we all know if we've looked at people with it.  People can feel fine at 10:00 o'clock in the morning and then half past 11:00, actually vomiting and feeling really unwell.  They tend to look a bit grey and ashen.  So, it's a bit of a giveaway then.  But as I say, normally, the patient can be quite well and then suddenly, they'll just be unwell.  So, you may well have to clean up at home.  And again, good cleaning, you can use sort of bleach based products.  They're good for cleaning body fluids.  If your clothing become soiled or bed sheets then wash them on a hot wash and again, do them separate to the rest of the family.

Chris -   Our hand washing victim Harriet is back.  Did you do a good job?

Harriet -   Yeah, I did what I regularly do.

Chris -   You would judge your hands to be clean.  Rachel, what's the verdict?

Rachel -   Let's pop your hands into my UV box, Harriet.  Okay, so we can see actually the areas that Harriet hasn't washed quite as well as she thought she had, are glowing nice and bluey white under my UV box.

Chris -   All the backs of her hands.

Rachel -   The backs of her hands.

Chris -   Where her watch is...

Rachel -   Yeah, you can see where her watch is.  Which is why we don't wear watches in the hospital or bracelets because we need people to be bare below the elbows, so they can wash their hands properly.

Chris -   Too much bling, Harriet.

Rachel -   There's quite a lot as well around your finger nails there.  So again, these areas, you'll find it difficult to wash and also, Harriet is showing quite nicely that her thumb on her less dominant hand is pretty well covered whereas her other hand is quite good.  So, if your right handed, you washed your left hand really well, but if your - obviously, your dominant hand is the one you're going to be doing all the things with and that's the area unfortunately we don't wash as well.  So, it's quite a big difference between Harriet's right and left thumb and as Chris said, that she got loads in the back of your hands, Harriet there.  You've done quite well in the front of your hands.  It's really just showing up all the nooks and crannies where bugs can be hiding.  And also, if your skin is quite dry like it is in the winter then again, these areas where bugs can hide quite happily.

Chris -   I suppose it's worth emphasising as Ian Goodfellow pointed out the infectious dose for norovirus is 20 particles and each person is shedding millions and millions.  Enough in fact to infect the entire world from one infectious person.  And any patch of Harriet's skin could have easily an infectious dose of noro.

Rachel -   It could, yeah.  What do you think, Harriet?

Chris -   What do you think about it?  Are you shocked?

Harriet -   Yeah, yeah I'm filthy.

Chris -   We know that, but I mean, were you quiet surprised at the finding?

Harriet -   Yeah, I mean, there were ones that I was expecting like the back of the hands.  I always think people don't pay attention to that, but I did find the difference between the two hands themselves interesting, as one of my hands is dirtier than the other one.  So, I'll change the way I shake hands next time.

Chris -   Rachel, one quick question from Jonathan Bowman who got in touch and has said on Facebook that, is it true that it's virtually impossible to eradicate norovirus from surfaces without resorting to industrial strength bleaches, presumably and hopefully not?

Rachel -   I mean again, good soap and water, so good basic cleaning you have in your house.  I'm not sure whether Lydia knows any more than that, but generally, infection control is all about good hygiene and common sense.  So, what do you think Lydia?  Can you help me out there?

Lydia -   Yeah, actually, in studies where they were cleaning wards and then swabbing afterwards to identify whether or not they cleaned well, they actually did show that a bleach, type of 10% bleach solution plus additional soap and water washing was what was required.  So, my guess is it's repeated washing if you can't use a 10% bleach solution.

Chris -   Thank you to both of you.  Kat...


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