Мытьё рук: гигиена и профилактика заболеваний.

Act of cleaning one's hands

Hand washing (or handwashing), also known as hand hygiene, is the act of cleaning one's hands with soap or handwash and water to remove viruses/bacteria/microorganisms, dirt, grease, and other harmful or unwanted substances stuck to the hands. Drying of the washed hands is part of the process as wet and moist hands are more easily recontaminated. Hand hygiene is central to preventing the spread of infectious diseases in home and everyday life settings. The World Health Organization (WHO) recommends washing hands for at least 20 seconds before and after certain activities. These include the five critical times during the day where washing hands with soap is important to reduce fecal oral transmission of disease: after using the toilet (for urination, defecation, menstrual hygiene), after cleaning a child's bottom (changing diapers), before feeding a child, before eating and before/after preparing food or handling raw meat, fish, or poultry. When neither hand washing nor using hand sanitizer is possible, hands can be cleaned with uncontaminated ash and clean water, although the benefits and harms are uncertain for reducing the spread of viral or bacterial infections. Moisturizing lotion is often recommended to keep the hands from drying out; dry skin can lead to skin damage which can increase the risk for the transmission of infection.

A small detrimental effect of handwashing is that frequent hand washing can lead to skin damage due to the drying of the skin.

In many countries, there is a low rate of hand washing with soap. A study of hand washing in 54 countries in 2015 found that on average, 38.7% of households practiced hand washing with soap. A 2014 study showed that Saudi Arabia had the highest rate of 97%; the United States near the middle with 77%; and China with the lowest rate of 23%. Several behavior change methodologies now exist to increase uptake of the behavior of hand washing with soap at the critical times. Group hand washing for school children at set times of the day is one option in developing countries to engrain hand washing in children's behaviors. The "Essential Health Care Program" implemented by the Department of Education in the Philippines is an example of at scale action to promote children's health and education. Deworming twice a year, supplemented with washing hands daily with soap, brushing teeth daily with fluoride, is at the core of this national program. It has also been successfully implemented in Indonesia.

Removal of microorganisms from skin is enhanced by the addition of soaps or detergents to water. Soap and detergents are surfactants that kill microorganisms by disorganizing their membrane lipid bilayer and denaturing their proteins. It also emulsifies oils, enabling them to be carried away by running water.

Solid soap, because of its reusable nature, may hold bacteria acquired from previous uses. A small number of studies which have looked at the bacterial transfer from contaminated solid soap have concluded transfer is unlikely as the bacteria are rinsed off with the foam. The CDC still states "liquid soap with hands free controls for dispensing is preferable".

Antibacterial soaps have been heavily promoted to a health conscious public. To date, there is no evidence that using recommended antiseptics or disinfectants selects for antibiotic resistant organisms in nature. However, antibacterial soaps contain common antibacterial agents such as triclosan, which has an extensive list of resistant strains of organisms. So, even if antibiotic resistant strains are not selected for by antibacterial soaps, they might not be as effective as they are marketed to be. Besides the surfactant and skin protecting agent, the sophisticated formulations may contain acids (acetic acid, ascorbic acid, lactic acid) as pH regulator, antimicrobially active benzoic acid and further skin conditioners (aloe vera, vitamins, menthol, plant extracts). A 2007 meta analysis from the University of Oregon School of Public Health indicated that plain soaps are as effective as consumer grade anti bacterial soaps containing triclosan in preventing illness and removing bacteria from the hands. Dissenting, a 2011 meta analysis in the Journal of Food Protection argued that when properly formulated, triclosan can grant a small but detectable improvement, as can chlorhexidine gluconate, iodophor, or povidone.

Hot water that is still comfortable for washing hands is not hot enough to kill bacteria. Bacteria grow much faster at body temperature (37 °C). WHO considers warm soapy water to be more effective than cold, soapy water at removing natural oils which hold soils and bacteria. Using hot water for handwashing can even be regarded as a waste of energy.

In situations where hand washing with soap is not an option (e. g., when in a public place with no access to wash facilities), a waterless hand sanitizer such as an alcohol hand gel can be used. They can be used in addition to hand washing to minimize risks when caring for "at risk" groups. To be effective, alcohol hand gels should contain not less than 60%v/v alcohol. Enough hand antiseptic or alcohol rub must be used to thoroughly wet or cover both hands. The front and back of both hands and between and the ends of all fingers must be rubbed for approximately 30 seconds until the liquid, foam or gel is dry. Finger tips must be washed well too, rubbing them in both palms. A hand sanitizer or hand antiseptic is a non water based hand hygiene agent. In the late 1990s and early part of the 21st century, alcohol rub non water based hand hygiene agents (also known as alcohol based hand rubs, antiseptic hand rubs, or hand sanitizers) began to gain popularity. Most are based on isopropyl alcohol or ethanol formulated together with a thickening agent such as Carbomer (polymer of acrylic acid) into a gel, or a humectant such as glycerin into a liquid, or foam for ease of use and to decrease the drying effect of the alcohol. Adding diluted hydrogen peroxide increases further the antimicrobial activity. Hand sanitizers are most effective against bacteria and less effective against some viruses. Alcohol based hand sanitizers are almost entirely ineffective against norovirus (or Norwalk) type viruses, the most common cause of contagious gastroenteritis. US Centers for Disease Control and Prevention recommend hand washing with soap over hand sanitizer rubs, particularly when hands are visibly dirty. The increasing use of these agents is based on their ease of use and rapid killing activity against micro organisms; however, they should not serve as a replacement for proper hand washing unless soap and water are unavailable. Despite their effectiveness, non water agents do not cleanse the hands of organic material, but simply disinfect them. It is for this reason that hand sanitizers are not as effective as soap and water at preventing the spread of many pathogens, since the pathogens remain on the hands.

Hand washing using hand sanitizing wipes is an alternative during traveling in the absence of soap and water. Alcohol based hand sanitizer should contain at least 60% alcohol.

Many people in low income communities cannot afford soap and use ash or soil instead. The World Health Organization recommended ash or sand as an alternative to soap when soap is not available. Use of ash is common in rural areas of developing countries and has in experiments been shown at least as effective as soap for removing pathogens. However, evidence to support the use of ash to wash hands is of poor quality. It is not clear if washing hands with ash is effective at reducing viral or bacterial spreading compared to washing with mud, not washing, or with washing with water alone. One concern is that if the soil or ash is contaminated with microorganisms it may increase the spread of disease rather than decrease it, however, there is also no clear evidence to determine the level of risk.

Various low cost options can be made to facilitate hand washing where tap water and/or soap is not available e. g. pouring water from a hanging jerrycan or gourd with suitable holes and/or using ash if needed in developing countries. In situations with limited water supply (such as schools or rural areas in developing countries), there are water conserving solutions, such as "tippy taps" and other low cost options. Low cost hand washing technologies for households may differ from facilities for multiple users. For households, options include tippy taps, bucket/container with tap (such as a Veronica Bucket), conventional tap with/without basin, valve/tap fitted to bottles, bucket and cup, camp sink. Another device uses
light based rays to detect contaminants on the hands after they have been washed. Certain environments are especially sensitive to the transmission of pathogenic microorganisms, like health care and food production. Organizations attempting to prevent infection transmission in these environments have started using programmed washing cycles that provide sufficient time for scrubbing the hands with soap and rinsing them with water. Combined with AI powered software, these technological advancements turn the hand washing process into digital data, allowing individuals to receive insights and improve their hand hygiene practices.

Effective drying of the hands is an essential part of the hand hygiene process. Therefore, the proper drying of hands after washing should be an integral part of the hand hygiene process in health care. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) are clear and straightforward concerning hand hygiene, and recommend paper towels and hand dryers equally. Both have stressed the importance of frequent and thorough hand washing followed by their complete drying as a means to stop the spread of pathogens, like COVID 19. Specifically, the World Health Organization recommends that everyone "frequently clean [their] hands " and "dry [them] thoroughly by using paper towels or a warm air dryer." The CDC report that, "Both [clean towels or air hand dryers] are effective ways to dry hands." A study in 2020 found that hand dryers and paper towels were both found to be equally hygienic hand drying solutions. However, there is some debate over the most effective form of drying in public toilets. A growing volume of research suggests paper towels are much more hygienic than the electric hand dryers found in many public toilets. A review in 2012 concluded that "From a hygiene standpoint, paper towels are superior to air dryers; therefore, paper towels should be recommended for use in locations in which hygiene is paramount, such as hospitals and clinics." In the same study in 2008 (sponsored by the paper towel industry the European Tissue Symposium), use of a warm air hand dryer spread micro organisms only up to from the dryer, and paper towels showed no significant spread of micro organisms. No studies have found a correlation to hand dryers and human health, however, making these findings inconsequential.

Making hand washing facilities accessible (inclusive) to everyone is crucial to maintain hand washing behavior. There are electronic devices that provide feedback to remind hospital staff to wash their hands when they forget. One study has found decreased infection rates with their use.

To reduce the spread of pathogens, it is better to wash the hands or use a hand antiseptic before and after tending to a sick person. For control of staphylococcal infections in hospitals, it has been found that the greatest benefit from hand cleansing came from the first 20% of washing, and that very little additional benefit was gained when hand cleansing frequency was increased beyond 35%. Washing with plain soap results in more than triple the rate of bacterial infectious disease transmitted to food as compared to washing with antibacterial soap. Comparing hand rubbing with alcohol based solution with hand washing with antibacterial soap for a median time of 30 seconds each showed that the alcohol hand rubbing reduced bacterial contamination 26% more than the antibacterial soap. But soap and water is more effective than alcohol based hand rubs for reducing H1N1 influenza A virus and Clostridium difficile spores from hands. Interventions to improve hand hygiene in healthcare settings can involve education for staff on hand washing, increasing the availability of alcohol based hand rub, and written and verbal reminders to staff.

The phrase "washing one's hands of" something, means declaring one's unwillingness to take responsibility for the thing or share complicity in it. It originates from the bible passage in Matthew where Pontius Pilate washed his hands of the decision to crucify Jesus Christ, but has become a phrase with a much wider usage in some English communities. In Shakespeare's Macbeth, Lady Macbeth begins to compulsively wash her hands in an attempt to cleanse an imagined stain, representing her guilty conscience regarding crimes she had committed and induced her husband to commit. It has also been found that people, after having recalled or contemplated unethical acts, tend to wash hands more often than others, and tend to value hand washing equipment more. Furthermore, those who are allowed to wash their hands after such a contemplation are less likely to engage in other "cleansing" compensatory actions, such as volunteering.