Transcript of Get Ready Report Podcast, episode 33

This is the American Public Health Association’s Get Ready Report, coming to you from Washington D.C. Today’s episode, “Global Hand-Washing Day,” interviews Dr. Alfonso Contreras, regional advisor for health promotion at the Pan American Health Organization-World Health Organization. He is interviewed by Get Ready team member Lavanya Gupta.

My first question is, could you briefly discuss your role at PAHO?

Sure. My name is Alfonzo Contreras, and I am the regional advisor on health promotion at the Pan-American Health Organization, which is the regional office for the World Health Organization for the Americas.

Great. Global Hand-Washing Day is about getting people around the world to wash their hands with soap as a way to prevent the transmission of millions of viruses and bacteria. How can leaders, such as you at PAHO and APHA, spread the importance of hand-washing with soap?

It’s very important (that) we do so, because we are talking about one of the most cost-effective procedures that we have in public health, even nowadays. First of all, I would like to thank (you) for this opportunity, because this is very important. We don’t realize that some of the classic measures are still the best resources that we have in public health. Every year, all the time, we have to use creativity to not lower the guard with some of the good tools that we have available, that has happened many times in history and that shouldn’t happen with hand-washing. And that’s why since 2008, in conjunction with other global partners, we celebrate every year the Global Hand-Washing Day which is on Oct. 15. It’s around the corner. All the partners, we put our resources together, we try to update all of the tools and resources that we have available. And thanks to the social media and new resources that we have available, our job is to make sure that the key message is around hand-washing, is the subject and topic for that day. And hopefully for the rest of the year as well. But that’s what we do.

That’s great. I appreciate you mentioning the cost-effectiveness of something as simple or classic as hand-washing. At APHA we definitely promote public health and its return on investment, so I think hand-washing is definitely a great example of that. Our next question is: How can hand-washing protect children and their families from health emergencies?

In emergencies, we know that some of the basic measures are disruptive. In particular, access to water and sanitation is one of these events that are usually affected early in any kind of emergency. There are two particular diseases of concern that are quite related to hand-washing and hygiene, which are diarrhea and acute respiratory infections. We have seen, these days, some of the concerns with the cholera epidemic in several parts of the world, including the Americas, and continuous alerts of new viruses that require for all the public health agencies to remind us of the importance of hand-washing. So this is a must in not only dealing with prevalent diseases, but particularly in emergencies. Because there is a high-risk and mostly there is a compromise in water and sanitation measures. Hand-washing is one of the first measures that has to be put in place.

You mentioned that diarrhea and acute respiratory syndrome are two main sicknesses that can be prevented by hand-washing. Are there some other diseases that are quite prevalent and can be also put at bay by hand-washing with soap?

Remember, before mentioning any other, we are talking about the two major killers of children under (the age of) 5 globally, which are diarrhea and acute respiratory infections, particularly pneumonia. So this is critical to deal with the major public health concerns that we have on our hands. We have to be concerned and understand that it is important to use this opportunity as a reminder of how hand-washing is related to these two conditions.

With diarrhea, the critical moment in which hand-washing has to be performed and performed well is before eating. This is the time in which we use our hands to put food, and whatever else we are touching with our fingers, into our mouths, which is a main entry for germs and even (other) solid substances, whether we see dirt or not on our hands. And many of these germs are contaminated; they come from feces. And the other moment for mothers and kids to be very alert is after going to the bathroom, for the same reason that I just talked about. Those are moments in which it is very likely to be contaminated and transporting germs we everything we touch at that point. The second one is less known, I would say, for the general public, which is the connection between hand-washing and respiratory infections. And the reason is because coughing or sneezing creates an environment of micro-drops or sometimes saliva, bigger drops, in the air that we breathe, or on the surfaces where we sneeze. Sometimes we still see that it is a regular habit to cover our sneezes with our hands, and it is the worst thing that we can do, because the germs and viruses go directly to our hands and everything we touch from there. We think of kids with toys, and how close we are to each other and touching everything. When the hands go back to our eyes or our nose, there are plenty of studies with cameras tracking the number of times we touch our nose, and eyes without being aware of that. This is a very common practice. We don’t realize what we do with our hands, but basically what we’re doing is putting germs close to our respiratory systems, and other entry points. The mouth and our respiratory systems are closest the digestive and respiratory system, and that’s the origin of these two major killers. It’s very typical to prevent using other measures, but it is very easy to do it with proper hand-washing.

I read that hand-washing with soap is considered almost a vaccine in terms of it being a form primary prevention or intervention, similar to a vaccine.

Absolutely. For many scholars, they like to repeat that famous statement that I said when we started. This is one of the most, if not the most, cost-effective interventions that we have in public health these days. There are many others that are effective, vaccines and other medical interventions, but in terms of cost-effectiveness, the potential is tremendous: the amount of lives that could be saved using this very simple procedure, which is proper hand-washing.

Thank you. My next question is: What is the main reason that individuals around the world don’t wash their hands with soap?

Right. Sometimes I hear, “Oh hand-washing, there are so many other concerns, so many other problems, and we all know about this particular practice, why do we need to keep repeating these same messages and keep talking about hand-washing?” I would say that the problem is not so much people don’t wash their hands, the numbers are high. The proportion of people who brush their teeth and wash their hands is high. The real problem is that we don’t do it properly. We have to go a long way to use this practice to its full potential. What it is that we need to improve: first, is to do it with soap. For many reasons, even when soap is available, we don’t use it. And soap is very useful in breaking away all the grease that can be on our hands and letting the water wash out the grease that keeps the germs on our hands. Second, and this is another important subject, is that (you need to wash your hands) for at least 20 seconds. I invite all of our audience to check next time we go to a public bathroom, see how many people are washing their hands for the right amount of time. It takes at least 20 seconds to wash our hands in all the different angles, corners in our hands. It cannot be done in less than 20 seconds. And for some people, they go as far as saying we may even need a minute to do it properly. Another important aspect is that we don’t wash all the important parts in our hands. If we think of our hands and one hand is washing the other, then we wash one hand. For those of us who are left-handed, the right hand is probably going to get a good job. But, we have to be careful and be aware that we move one of our hands more than the other, and both hands need to be washed equally. There are parts of the hands that we don’t pay much attention to, like the fingertips. And these are the parts we use to grab any food. If they are not washed properly, whatever we have on our finger tips is going to go to the food and then to our mouths, and stomach. The thumbs are neglected many times. So the answer to your question is: more than saying (whether) we wash our hands, the question is “do we wash our hands properly?” And there’s a lot of room for improvement, and hopefully we’ll be able to do better with campaigns like this, and keep talking and informing ourselves and be more aware of what needs to be improved.

That makes a lot of sense. I definitely think that hand-washing, and doing it properly, is something that requires some degree of behavioral change, because it’s one thing to hear about it and learn what the impact is of washing effectively, but it’s another thing to do it consistently in your everyday life.

That’s correct. We have to break a regular habit of (just) wetting our hands; sometimes that’s what we do. I think that if hand-washing is a daily practice for many parents or doctors that might be listening, that is a beautiful, one-minute conversation for doctors to have with patients and even kids in schools. They love to hear about this because they realize that they’re not doing it, and it’s so easy to do it.

How is PAHO Celebrating Global Hand-Washing Day this year? 

We want to go big this year. What we are proposing is to break a Guinness World Record of the number of people that on Oct. 15, Global Hand-Washing Day, who demonstrate hand-washing in all the countries in the Americas at the same time. We did this in 2011, and we have to be proud to say that we broke the previous Guinness record. Right now, the region of the Americas holds the record. We were able to mobilize almost 750,000 people, mostly kids in schools, but also adults. And this year, we would like to pass 1 million. And with friendly competition, we would love for other regions to join, and to get the record, because that would mean that we are trying to have higher standards and a larger amount of individuals celebrating, and having fun. Having the media cover this event and talking about hand-washing is one way to achieve massive mobilization of community institutions to talk about hand-washing, and the media is also responsive. We’re grateful for that because we achieve ample coverage. So that’s the plan for this year. On Oct. 15, hopefully you’ll see on the news that there were a massive number of kids and adults taking a couple of minutes just to demonstrate hand-washing and make an impact around the world.

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More hand-washing information: For more information on proper hand-washing techniques and free fact sheets, visit Get Ready’s hand-washing page.

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Posted: Oct. 9, 2013