…and don’t forget to dry them!

I went to Alexandra Street Junior School way back when Goole was still in the West Riding of Yorkshire and we were still force-fed warm bottles of milk and cod liver oil on a daily basis. The school isn’t there any more, which is a pity. I believe it closed in 1976. The red brick building was far more attractive than those that now inhabit its space.

I didn’t spend a lot of time at that school. Actually some might argue that I didn’t spend much time at any of the schools I went to for one reason or another. I got by though. The reason for my absence from Alexandra Street between the ages of 5 and 7 was because I developed a nasty infection in my bone marrow called href=”http://www.bjj.boneandjoint.org.uk/content/89-B/5/667.full”>Osteomyelitis. Cause? Probably S. aureus in the first instance but the subsequent chronic infection may have been caused by a number of organisms, including S. epidermidis, Pseudomonas aeruginosa or Serratia marcescans. I was hospitalised for long periods of time and went through some painful surgery and aftercare. Antibiotics were few and far between at the time and the emerging resistance of S. aureus to what was available was perhaps one of the reasons my recovery was so slow. About three years as I recall. Although I wasn’t at Alexandra Street that much, there are lots of things I remember about it. One thing in particular is the toilets!

The toilets were situated across the playground from the school main building. It was a brick-built block with girls toilets on one side and boys on the other. The inner walls were brick as far as I remember and there was no heating in there. The toilet seats were wooden and if one of them had a crack in it you avoided it because it could give you a vicious nip when you got up! The whole place smelled of disinfectant; a little bit like hospitals at the time. The toilet paper was ‘Izal’…and each piece was printed with the message

‘now wash your hands’.izalmessage

It was fascinating stuff; smooth and slippery on one side and a bit more absorbent on the reverse. If you didn’t rub it together to soften it up a bit, it wasn’t very efficient, in fact, it made much better tracing paper than toilet paper. It was great for doing ‘rubbings’ to reproduce coins etc. It was absolutely no good for blowing your nose. The toilet paper was described by the makers as ‘medicated’ and it did smell of disinfectant, contributing to the overall smell in the room and your hands!

Having to walk across the playground to get to the toilet was no problem in the warmth of Spring and Summer but an absolute nightmare in the wet and cold months. Hat, coat, scarf and gloves were required for a visit at this time. You had to be very quick to do the business and I would guess that despite the message on the toilet paper, we were less likely to wash our hands in the Winter months than in the Summer. This remains a factor today.

The sinks (or hand wash basins) were in a row on the right as you entered the building, or left as you came out of the toilet. There was cold water only and the pipes would constantly freeze in the winter. We used to get some excellent icicles from the guttering. I can’t really remember how we dried our hands but I think it was a roller towel; constantly wet and hopelessly ineffective.

Drying your hands, as I have mentioned in previous blogs, is an important part of the hand-washing process. Any item used (outside of the home) for drying the hands that is communal, i.e. roller towel, cotton towels is inappropriate and only serves to redistribute micro-organisms. Either paper towels or jet stream dryers are preferable in these areas. Hot air dryers have been criticised for not being efficient in drying hands because they take too long,  using too much energy and redistributing dust, skin scales and microorganisms into the environment thus posing a cross contamination and infection risk.

How many times have you been into a toilet in a restaurant or motorway services for example and had the opportunity to observe other people’s hand hygiene habits? I can’t help but take note when someone comes straight out of the loo and through the exit, or washes their hands and shakes them a bit before wiping them on the back of their trousers and walking through the door. Very few large public places like railway stations or airports provide paper towels nowadays, although arguably they are the most efficient way of drying your hands and removing bacteria from the skin surface. Rather they, like many other places, opt for the new generation of hot air jet stream hand dryers that, if used as directed dry your hands thoroughly in 10-12 seconds. The Dyson Airblade was the first but it is way too noisy, particularly if there is more than one in use. This has now evolved and the dryers are more compact and 50% quieter. Arguably this system is still not appropriate for clinical areas but certainly ideal for high traffic areas such as motorway services.

The arguments about how efficient hot air hand dryers are is ongoing. I was in a motorway service station the other day and used a hot air dryer with an added beam of UV light that shone onto parts of my hands whilst I was drying them. I had come across UV light as an antibacterial agent before in water purification but thought I would investigate it in relation to hand dryers.The broad aim with the new hand dryers (and I am sure there are variations) is to filter the air that dries your hands so that 99.9% of any harmful organisms present are removed.I really don’t think that’s too important in a motorway service station, is it? I would like to see everyone washing their hands using a reasonable technique and then drying them thoroughly, by whatever means. Let’s face it, as soon as you walk out the door, you’re recontaminating those hands again. BUT, that’s not an excuse for not washing them. We have to remember it’s often the germs that you pick up in the toilet that have the potential for causing infection, for example, E.coliE. coli. Anyway, the jet stream dryers are great; fast and efficient. But what about that UV light?  I think the general consensus of opinion is that it really has no effect on your hands via the hand dryer; they aren’t exposed to it long enough in the time it takes to dry them. Great in theory maybe…but not convincing to me.

Now, the use of UVC in e.g. Asda toilets may be a different thing. The air in the toilets is pretty static so it may be that the constant UV light can effectively kill organisms in the air created by the aerosols from flushing the loo…IF it’s the right concentration. But that’s another story.

Basically, UV kills cells because of the cumulative DNA damage. UV radiation disrupts the chemical bonds that hold the atoms of DNA together in the microorganism. If the damage is severe enough, the damage cannot be repaired and the cell will die. Longer exposure to UV light is necessary to ensure complete kill off of all micro-organisms. Unlike chemical treatments, UV treated air or water does not resist re-contamination.

Inevitably, drying your hands is an important final step in the hand-washing process and should be carried out thoroughly, ensuring no moisture remains on the hand surface, between the fingers or underneath jewellery. I think the arguments can continue in health care as to which is the best method to achieve this but for me the most important thing is to get the public on board and make sure when they wash their hands, they understand how to complete the process.

We have come a long way since I was at Alexandra Street School but the message given out on that toilet paper remains relevant. After using the loo, ‘please wash your hands’. Perhaps we should then write on the mirrors above the sinks…’and don’t forget to dry them!’

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