London School of Hygiene & Tropical Medicine

We've all heard people say 'I won't kiss you, I've got a cold'. But a report just published warns that we may be far more at risk of passing on an infection by shaking someone's hand than in sharing a kiss.

A group of hygiene experts from the United States and the UK have published the first detailed report on hand hygiene in the home and community, rather than in hospital and healthcare settings. Their findings are published in the American Journal of Infection Control. They say that, if we want to avoid catching flu or tummy bugs, or protect ourselves and others from organisms such as MRSA, salmonella or C. difficile, then we have to start in our own homes, by paying greater attention to good hand hygiene. They also warn that, in the event of a flu pandemic, good hand hygiene will be the first line of defence during the early critical period before mass vaccination becomes available. This new report follows on from a study published last month in the British Medical Journal which indicated that physical barriers, such as regular handwashing and wearing masks, gloves and gowns may be more effective than drugs in preventing the spread of respiratory viruses such as influenza and SARS.

Good hygiene at home prevents organisms spreading from one family member to another. By reducing the number of carriers in the community, the likelihood of infections being carried into health care facilities by new patients and visitors is reduced. Good hygiene at home also means fewer infections, which means fewer patients demanding antibiotics from the GP, and fewer resistant strains developing and circulating in the community.

Cold and flu viruses can be spread via the hands so that family members become infected when they rub their nose or eyes. The report details how germs that cause stomach infections such as salmonella, campylobacter and norovirus can also circulate directly from person to person via our hands. If we put our fingers in our mouths, which we do quite frequently without being aware of it, or forget to wash our hands before preparing food, then stomach germs can also be passed on via this route. Some of us also carry MRSA or C.difficile without even knowing, which can be passed around via hand and other surfaces to family members or, if they are vulnerable to infection, go on to become ill.

Professor Sally Bloomfield, one of the report's authors, is the Chairman of the International Scientific Forum for Home Hygiene, the international organisation which produced report. She is also a member of the London School of Hygiene & Tropical Medicine's Hygiene Centre. She comments: 'With the colds and flu season approaching, it's important to know that good hand hygiene can really reduce the risks. What is important is not just knowing that we need to wash our hands but knowing when to wash them. Preventing the spread of colds and flu means good respiratory hygiene, which is quite different from good food hygiene. That's why the new respiratory hygiene campaign from the Department of Health in the UK, which advises people to "catch it, bin it, kill it", is spot on'.

The authors say that breaking the chain of infection from one person to another all depends on how well we wash our hands. If we don't do it properly, washing with soap and rinsing under running water, then we might as well not do it at all. They recommend also using an alcohol handrub in situations where there is high risk, such as after handling raw meat or poultry, or when there is an outbreak of colds or stomach bugs in the family home or workplace, or if someone in the family is more vulnerable to infection. They suggest carrying an alcohol rub or sanitiser at all times so that good hand hygiene can still be observed away from home in situations where there is no soap and water available.

Carol O'Boyle, of the School of Nursing, University of Minnesota, and a co-author of the report, says: 'Hand hygiene is just as important when we are outside the home - on public transport, in the office, in the supermarket, or in a restaurant. Quite often it's not possible to wash our hands in these situations, but carrying an alcohol-based hand sanitizer means we can make our hands hygienic whenever the need arises'.

The report warns that good hygiene is about more than just washing our hands. Although the hands are the main superhighway for the spread of germs - because they are the 'last line of defence', surfaces from which the hands become contaminated, such as food contact surfaces, door handles, tap handles, toilet seats and cleaning cloths also need regular hygienic cleaning. Clothing and linens, baths, basin and toilet surfaces can also play a part in spreading germs between family members in the home.

Professor Elaine Larson, of the Mailman School of Public Health in New York and another co-author, says: 'Because so much attention has been paid to getting people to wash their hands, there is a danger that people can come to believe this is all they need to do to avoid getting sick'.

Professor Bloomfield concurs. 'We hear a lot of discussion about whether being "too clean" is harming our immune systems, but we believe that this targeted approach to home hygiene, which focuses on the key routes for the spread of harmful organisms, is the best way to protect the family from becoming ill whilst leaving the other microbes which make up our environment unharmed'.

Dr Val Curtis, Head of the London School of Hygiene & Tropical Medicine's Hygiene Centre concludes: 'Handwashing with soap is probably the single most important thing you can do to protect yourselves and your loved ones from infection this Christmas'.

The full report can be found at: http://www.ajicjournal.org/article/PIIS0196655307005950/abstract?browse_volume=35&issue_key=S0196-6553%2807%29X0152-4&issue_preview=no&select1=no&select1=no&vol

Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review, British Medical Journal 2007, November 27th 2007. http://www.bmj.com/cgi/content/full/bmj.39393.510347.BEv1