A Unique Child: Handwashing - In a lather

Handwashing may seem a simple, routine part of our day, but with a national campaign and global initiative dedicated to it, it may be time we gave it more attention.

'Washing your hands properly with soap and warm water is the single most important thing you can do to help reduce the spread of infections and help protect you, your family and those around you,' according to Healthy Protection Scotland, which has just relaunched its handwashing campaign.

That message was brought home to people this winter with the lightning spread of the Norovirus, which affected 2.8 million people (200,000 a week). Once again the advice - this time from Health Protection Agency epidemiologist Professor Martyn Regan - was the same: 'Thorough handwashing is vital in preventing the spread of Norovirus and other gastro-intestinal infections.'

The effectiveness of good handwashing was revealed only last month in a Cochrane Collaboration healthcare review, which showed that promoting handwashing with soap and water can cut episodes of diarrhoea by a third.

In the international study, the Cochrane team carried out a series of randomised controlled trials, including eight in daycare centres and schools, mainly in high-income countries, and five in community-based trials in low- and middle-income countries.

Their analysis showed the reduction can be 29 per cent for the daycare centres and 31 per cent for the people in the community-based trials.

MP for Edinburgh West, John Barratt, is a supporter of the Global Public-Private Partnership for Handwashing with Soap and he has campaigned for a greater focus on handwashing in the UK.

Mr Barratt wants having unwashed hands to be 'as anti-social as smoking'. He says, 'Improved handwashing, not only in the UK but also worldwide, could potentially save thousands of lives every year. But it's still a taboo subject, because few people want to admit that they might be among the 50 per cent or so of people who do not wash their hands when they should!'

Figures on handwashing vary greatly, though none are encouraging. More conservative figures, from the American Society of Microbiology, claim that a quarter of men and a tenth of women don't wash their hands after using the toilet.

How and when

For those in caring professions such as childcare, the problem usually lies more with the 'how often' and 'how well', rather than the 'whether' people wash their hands.

Pat Brunton, a microbiologist and now early years consultant and nursery owner in Worthing, East Sussex, says, 'Achieving consistently high hygiene routines in a nursery is no easy matter. The potential for the introduction and transmission of infection in a nursery setting is so much greater than in the home, because of the large number of individuals all together in one place. The hygiene standards, therefore, have to be significantly higher to protect both children and staff' (see box).

According to the various health promotion campaigns and NHS websites, washing our hands should involve six stages (see diagrams) and take at least 15 seconds - 'about how long it takes to sing "Happy Birthday to You" twice through', according to Health Protection Scotland.

The agency's handwashing campaign this time around includes a Children's Pack, produced with the help of Learning and Teaching Scotland and aimed at the three- to six-year-old age group.

Included in the pack are stickers, posters, a cartoon DVD and ideas on how to make handwashing part of the nursery day and a lifelong habit for young children.

Don't panic

Any hygiene messages for young children need to be balanced, however. Scaremongering stories about superbugs and a proliferation of bacteria-busting sprays on the market can confuse adults and cause alarm.

Child psychologist and early years consultant Jennie Lindon says, 'Children need to know about the importance of handwashing, but it's important too that adults aren't overzealous in their approach and leave children scared to get dirty. Children also need to understand that not all bacteria are bad; there are friendly bacteria which our bodies need to work properly.'

Dr Ken Spaeth, a physician and Research Fellow at the Harvard School of Public Health, agrees that the simple approach is best. He says, 'A large percentage of cases of diarrhoea in children results from viruses, in which case using "antibacterial" agents is of no relevance. There is also evidence that use of antimicrobial soaps promotes the development of "super" bacteria; that is, harmful bacterial strains that are resistant to antibiotic medicines.

'Proper handwashing with water and standard soap is as effective at cleaning one's hands as the use of antibacterial soaps. This is equally true for those caring for young children; it is the act of handwashing, not the properties of the soap that matters most in reducing the spread of infections.'

GOOD PRACTICE
Handwashing routines should be in place:
- before eating or handling food
- after using the toilet
- after blowing your nose, coughing or sneezing
- after touching animals or animal waste
- after playing outdoors
- after handling rubbish
- after changing a nappy.
To help build a culture where effective handwashing becomes the norm,
managers need to:
- provide appropriate handwashing facilities
- draw up a handwashing policy
- remind staff about the importance of handwashing - by both adults and
children
- be vigilant in ensuring that the policy is followed by carrying out
spotchecks throughout the day
- let senior staff lead by example.

BEATING THE BUGS

At Teddies Day Nursery, we recognise the importance of hygiene and make efforts to instil in children good hygiene standards from an early age, writes nursery supervisor Michelle Baker.

We encourage the children to wash their hands before and after meals, after outdoor and messy activities and after using the toilet, but we frequently hear them say, 'I don't need to wash my hands; they're not dirty.' So, we planned an activity that would show them otherwise.

Step by step

- We are in the grounds of Royal Oldham Hospital, so decided to get on board with the hospital campaign to 'Beat the Bugs'.

- We talked to the children about the importance of handwashing to remove any 'bugs' from our hands.

- The children drew pictures and made collages of how they imagined these nasty bugs would look if we could see them.

- Next, we borrowed an ultraviolet cabinet and some 'magic' cream from the hospital to show the children how harmful bacteria can stay on your hands if you don't wash them properly.

- In this test, the children have to imagine that the 'magic' cream is bacteria. They then rub it into their hands and place their hands inside the 'magic' box, which makes the cream on their hands glow.

- We then talked the children through the six-step handwashing technique, as recommended by the NHS campaign, and the staff then demonstrated it to the children.

- After we had all washed our hands properly, we took it in turns to put our hands back in the 'magic' box. If any part of our hands were still glowing with the cream, it showed that we hadn't washed our hands properly.

- The test made the children realise that things can be on their hands even if they can't see them. Reminding them of the test is useful when they wash hands that are not 'dirty'.

Testing time

For a handwashing experiment that doesn't require a UV cabinet, see 'Bathroom Science', part of the 'Domestic Science' challenge pack available at the BA (British Association for the Advancement of Science) website:www.the-ba.net.

Teddies Day Nursery is part of Network Nurseries Ltd

MORE INFORMATION

- Health Protection Scotland's handwashing campaign: www.washyourhandsofthem.com. The downloadable children's pack is at: www.washyourhandsofthem.com/campaign/campaign_childrenspack.html

- The Cochrane Collaboration research can be viewed at: www.liv.ac.uk/cfgd/Frames/CC_Colllaboration_Homepage.htm. See also www.cochrane.co.uk

- John Barrett, MP for Edinburgh West, www.johnbarrettmp.com/campaigns/hand_washing.php

- The Global Public-Private Partnership for Handwashing with Soap, www.globalhandwashing.org

- Most NHS trust sites includes details (and diagrams) of handwashing, including: www.sheffieldpct.nhs.uk/about/policies/handhygiene.pdf.