The Fight for ‘Clean’ Hand Hygiene

As a traveling physician, you know it is important to encourage your patients to practice the correct hand washing technique. However, as a travel physician, you might be aware of the age-old battle between using paper towels or hand dryers. Funded studies have looked into both sides of the hand hygiene battle.

On one hand, you have researchers telling you that paper towels are just sopping wet lumps of germs! On the other side of the spectrum, you have studies claiming that hand air dryers actually spread bacteria all over the place. But the fundamental issue is less about paper towels and hand dryers, and more about redefining the definition of clean.

Defining Cleanliness in Hand Hygiene

At first thought, most of us assume that all bacteria are bad and the fewer bacteria the better. Of course, as a physician, you know better than that. You know that there are harmless and even beneficial microorganisms that are found on healthy skin. You also know that removing these healthy microbes can result in the growth of pathogens.

If clean doesn’t mean bacteria-free, then what exactly does clean mean? A recent study released from the University of Oregon seeks to determine just that. When it comes to hand hygiene, it is not as simple as eliminating as many microorganisms as possible. We must determine how we can eliminate as many as the bad bacteria while keeping the beneficial microbes.

This is not something easily tested. Traditionally, scientists have swabbed dirty hands to grow the bacteria in a petri dish in order to study it, but only 1 percent of these microbes can grow in a petri dish. Furthermore, our complex bodies have different kinds of microorganisms on different parts of the skin that have evolved for that specific environment. You would find different microbes in your armpit than you would find on your elbow or your nose.

Microbiology vs. Microbial Ecology

There is a divide between two groups of people that study microbes that affect human hand hygiene. There is a group of microbiologists that tend to study microbes with a general focus on defeating bad microbes. This is the more traditional way of thinking and has resulted in the antibacterial we know and love. But these soaps and sanitizers also get rid of good bacteria on the skin, making people even more prone to dangerous pathogens.

On the other hand, microbial ecologists focus more so on how these communities of microorganisms behave. Are the microbes harmless but benefitting from living on you, or are these pathogens that are you going make you sick? Microbial ecologists take the idea of good-germ-bad-germ and turn it into a much more gray area.

It is going to take a balance between the traditional clinical microbiology school of thinking and the new school microbial ecology. If both of these groups can cross-link their research we may be able to find better hand hygiene solutions.

What does a future of hand hygiene developments look like? Well, we aren’t quite sure yet. Even if scientists could develop a new soap or sanitizer that would only eliminate the bad bacteria, there would still need to be efforts made to educate the common public about the benefits of beneficial microbes. For a long time, all people have heard about is the “99.99% effectiveness” to kill germs.

Perhaps if we would have more physicians and practitioners teach their patients about what it really means to have clean hands, we might see more funding come for further research and studies. With the rise of antibacterial-resistant “superbug” infections in the U.S., it is likely we will see infection control and new hand hygiene developments in the near future.


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