How washing your hand could really slow an epidemic

Doctors suggest using good hand hygiene to avoid viral infections. The public health recommendations continue to stress this in light of the recent coronavirus outbreak. Was hand washing really that effective in an epidemic? New research suggests it is.

Washing hands
A new study explains why hand washing is so vital for preventing the spread of a virus.

Washing the hands is always the first-line measure when it comes to preventing viral infections— particularly those that spread by droplets from coughs and sneezes—.

Now, appropriately washing your hands in the aftermath of the latest coronavirus outbreak remains the top recommendation of public health officials when it comes to controlling infection rates.

The World Health Organization (WHO) states in its recommendations on how to avoid infection with the novel coronavirus that people should “wash[ their] hands regularly with soap and water.”

However, people continue to question that something as simple as basic personal hygiene could have any impact in the sense of an outbreak.

New research from Cambridge’s Massachusetts Institute of Technology aims to put those questions to rest by demonstrating how effective hand washing can be in slowing infectious disease spread.

The study, now appearing in the journal Risk Analysis, used epidemiological modeling and data-based simulations to determine whether and how better personal hygiene could affect the rate of transmission of the disease.

30% of people do not wash their hands

The researchers began from existing data that shows that after using the toilet, a large number of people do not wash their hands.

According to Prof. Christos Nicolaides, co-author of the study, “70% of[…] people who go to the toilet launder their hands afterwards.”

“The other 30% don’t [wash their hands]. And of those that do, only 50% do it right.”

– Prof. Christos Nicolaides

The Centers for Disease Control and Prevention (CDC) says best hand washing practices include not only rinsing the hands with water, but also applying soap and scrubbing the wrists, the back of the hands, between the fingers and under the fingernails.

A person should scrub his hands with a clean towel for at least 20 seconds before rinsing the soap and drying it.

Prof. Nicolaides, however, notes that many of the people who do wash their hands after using the restroom never apply soap and spend the procedure under 15 seconds.

“We find that at most 1 in 5 people at an airport have washed[ their] hands at any given time (i.e. 20 per cent of the population at the airport),” the researchers write in their study paper.

Better hygiene may reduce disease spread

The researchers took advantage of existing evidence on global flights. In particular, they looked at the duration of the flight, flight frequency, connections and estimates of the amount of time travelers spend at airports.

Based on these indicators and data from research on how people interact with others and their environments— as well as what this could mean for the potential to come into contact with pathogens — the investigators developed models of the patterns of contagion.

They established 120 airports which they believe play a key role in the spread of infectious agents. They also note however that these are not always the highest traffic airports.

Airports in Tokyo, Japan, and Honolulu, Hawaii, for example, are likely to be key players in the spread of disease because they provide direct connections to many of the world’s largest airports. Yet these don’t have the highest overall traffic.

These airports are also transfer points between a large number of countries in both the Eastern and Western hemispheres.

Such factors combined make these airports important players in the spread of contagious diseases.

The researchers suggest, however, that if more people were to wash their hands regularly and correctly, the rate at which pathogens are likely to spread would be significantly slowed.

Specifically, if 60 percent of air travelers kept clean hands rather than 20 percent, the spread of infections could be reduced by nearly 70 percent, according to researchers.

Even if the number of people with clean hands increased by 10%, the pace at which disease would spread could slow down by as much as 24%.

“Increasing hand hygiene is a challenge, but new approaches to education, communication and social media[…] have proved effective in hand-washing interaction,” says Professor Nicolaides.

Implementing targeted hygiene campaigns

Although the researchers argue that educational campaigns on personal hygiene may help improve the overall situation, they agree that in such a large number of airports, this can be difficult to attain.

However, they suggest that equally positive results can be obtained by recognizing “the 10 most important airports” near the source of an outbreak and introducing an informative hand-washing program in each one.

This approach can help slow down infection spread by about 37 percent, the researchers suggest.

Prof. Nicolaides and colleagues also note that adding more wash basins to airports, even outside bathrooms, might be helpful to encourage people to wash their hands more often.

The researchers say another helpful step could be to clean and disinfect surfaces more frequently at airports, particularly those with which a large number of people come in contact.

“Current research can potentially shape the way policymakers design and implement strategic interventions based on the promotion of hand-washing at airports that could help[ keep] any infection within a confined geographic area during the early days of an outbreak, inhibiting its expansion as a pandemic,” the researchers write in their paper.

“Our research,” they add, “concludes that engaging the population with proper hand hygiene could be a simple and effective solution to prevent infection transmission and to reduce the risk of massive global pandemics.”

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