Health

All Your Handwashing Questions, Answered

Everything you need to know about soap and water and hand sanitizer.

A pandemic has handwashing top of mind—experts have advised it’s one of the best things we can do to keep ourselves (and those around us) healthy. But what’s the right way to wash your hands? And how does hand sanitizer compare to good ol’ soap and water? We spoke with two experts from Public Health Ontario to compile everything you need to know about washing your hands.

(Oh, also, stop touching your face. Right now. We see you.)

Why is washing your hands so important?

According to Shelley Deeks, chief health protection officer at Public Health Ontario, washing your hands is the first line of defence when it comes to infectious disease.

“For [COVID-19], it’s spread by what we call droplet or contact spread. So what that means is it’s not centred in the air or airborne. If somebody coughs or sneezes, the virus can spread for a maximum of about two metres … It’s similar to how influenza spreads,” Deeks says. So if these microorganisms gather on your hand and you fail to wash them off or kill them with an alcohol-based rub, they might be transmitted into your body—which is when infection occurs.

When should you wash your hands and when should you use hand sanitizer?

According to Deeks, both work for coronaviruses, including COVID-19. Maureen Cividino, Infection Prevention and Control (IPAC) physician with Public Health Ontario, says the alcohol in alcohol-based hand rub is an effective way to kill organisms on your hands. But, if you have any visible dirt or grease—such as oil from food—on your hands, use the soap and water method instead.

The Centers for Disease Control and Prevention (CDC) specifically recommends washing your hands with soap and water whenever possible.

What is the correct way to wash your hands?

(Photo: Public Health Ontario)

“It’s typically a friction thing, where you’re using the lubrication of the water and the soap to remove organisms from the hands,” says Cividino.

You should be washing your hands for 15 to 20 seconds. Cividino suggests singing the alphabet song, though social media has kindly provided some alternatives you might prefer.

“If you think about the last time you washed your own hands, it probably was more like six or seven seconds. Chances are, you would have got your fingertips and part of your palm, but you wouldn’t have done the full fronts and backs of your hands,” Cividino says. You’ll need to wash up to and on the wrist, in between the fingers and the base of your thumb. There’s also an online generator where you can input your favourite lyrics and it’ll pair them with different steps in the hand washing routine. Necessity breeds innovation!

What is the correct way to use hand sanitizer?

According to the Centers for Disease Control and Prevention, apply the product to the palm of one hand (read the label to see how much is recommended) and rub the product all over the surfaces of your hands until they’re dry.

(Photo: Public Health Ontario)

What type of hand sanitizer should I get?

Any type you want (and can get your hands on), though alcohol should be the main ingredient. There are two types of alcohol you should look for. Either ethanol or isopropyl will work, at the minimum account of 60 percent. “They suggest 60 to 90 percent,” Cividino says, noting that anything higher than 90 percent is a fire hazard. Anything lower than 60 percent will not be effective against microorganisms.

Cividino strongly recommends a 70 percent alcohol ratio, as then it’ll also kill norovirus—a highly contagious gastrointestinal bug. “Anyone who’s ever had it would never want it again. You have vomiting and diarrhea, it lasts 24 to 48 hours. It’s highly contagious and it’s often a cause of outbreaks on cruise ships.”

Why shouldn’t you touch your face?

Every centimetre of our hand has about 1,500 bacteria on it, according to Cividino. Generally microorganisms are invisible, so you can’t possibly know of all the germs you’ve accumulated on your hands throughout the day. “Typically what happens is it’s not so much if you would just be touching your face, [but] if you’re touching a mucosal surface.” In other words, your nose, mouth, and eyelids—surfaces which provide an essential barrier between the body and the outside environment, but can also serve as entry points for harmful microorganisms.

So avoid rubbing your eyes or nose, touching your mouth, applying lipstick or lip balm with unwashed hands, anything that might bring your hands in contact with a mucosal surface. Otherwise, you might supply germs to those entry points—and potentially cause infection.

Should you use liquid soap or bar soap?

“Bar soap should be personal soap,” Cividino says. “So if you’ve got your favourite bar soap in the shower, that’s fine. But if you have a shared sink then it should be liquid soap.” Fragrances can be irritating to some and can cause allergic reactions, so workplaces should use plain liquid soap.

Should you use a paper towel to dry your hands or an air dryer?

This is a great point of contention. While air dryers are widely considered better for the environment, paper towels are said to stop the spread of germs immediately. A research project conducted by Mayo Clinic in 2012 found that “from a hygiene viewpoint, paper towels are superior to electric air dryers.” They recommended them in locations where hygiene is “paramount,” including hospitals and clinics. According to Deeks, you don’t want to have to touch anything once you’ve finished washing your hands, though. So if you have to push down on a lever to get paper towel, a motion-activated hand dryer is probably better. The most important thing is you use something clean, so stay clear of shared towels in public places.

Do you still need to wash your hands a lot if you’re at home all day?

Yes—though regularity depends on what types of activity you engage with throughout the day. In a personal home setting, Cividino says you should wash your hands before and after you go to the washroom, before and after you eat, and before and after you prepare food. So no matter what celebrities tell you, you need to be washing your hands even if you’re in your own home.

If you’re going to be providing care for children, the elderly or others, you’ll also want to be doing that with clean hands.

Should I stay away from acrylic nails or gel manicures?

“Well, if you’re asking me from an infection control perspective, I would say just look after your own clean, short nails,” Cividino says. “That’s going to be the safest thing for you. We do know that gels, adornments, artificial nails, long nails—they harbour bacteria. So if you look on the surfaces of the hand and you sample different areas underneath the cuticles [and] in between the fingers … those are all areas that are going to have much higher concentrations of bacteria.”

Should I remove jewelry while washing my hands?

Yes, you should. Bacteria will hide underneath rings.

What are best handwashing practices when taking public transit?

“Try not to touch your face,” Cividino says. “I know that’s a very difficult thing.” You may want to wash your hands before getting on any mode of public transit and then again as you’re leaving the train. Having hand sanitizer on you is also a good tactic, especially if you’re holding onto things in the train or bus. Deeks emphasizes that people should employ appropriate cough etiquette by coughing into your elbow, and as much as possible avoiding crowded environments.

Should I moisturize after washing my hands?

If you’re washing your hands multiple times throughout the day, you can expect dryness. But you don’t want your skin to have cracks. “That could provide a mechanism of entry for organisms,” Deeks said. “So it’s very important that along with hand hygiene, make sure your hands are healthy—and that would include moisturizing.”

What about when COVID-19 passes and we return to regular life?

Hand hygiene should be maintained forevermore, even when there’s no pandemic. Cividino sees this as an opportunity. “We can’t see bacteria on our hands. We’re not always thinking about it. But if we can incorporate this into our day to day routine and it becomes automatic practice, we will really reduce [the] opportunity for [Gastrointestinal] illness by 30 percent and respiratory illness by 16 percent.”

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