Wednesday, May 31, 2023
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Hand hygiene matters

Dr Milton Lum

ANN/THE STAR – The World Health Organization (WHO) and its partners launched the first global patient safety challenge “Clean Care is Safer Care” in 2005.

World Hand Hygiene Day (WHHD), which is commemorated annually on May 5, was launched in 2009.

The core of WHO’s “Save Lives: Clean Your Hands” global campaign is that all healthcare workers should clean their hands at the right time and in the right way.

Hand hygiene saves millions of lives annually when performed at the right time and in the right way during healthcare delivery.

In addition, improving hand hygiene in healthcare settings saves approximately USD16.50 in healthcare expenditure for every USD1 invested.

The WHO has produced several hand hygiene tools, which are based on evidence, research, testing and input from global experts.

These tools facilitate a multipronged strategy to improve and sustain hand hygiene in health and healthcare.


While there have been some studies of hand hygiene practices among healthcare professionals in Malaysia, there is limited data on hand hygiene in the community.

The following studies provide some insights.

A study, published in December 2020 in the Global Paediatric Health journal, involved 435 children aged five and six from two pre-schools within Klang Valley.

The children were divided into two groups for the study, ie test and control.

The test group was provided with comprehensive hand hygiene education, including videos on proper handwashing technique during the two-month intervention period, whereas the control group did not receive any form of intervention.

It was found that the majority of pre-schoolers gained knowledge of handwashing from their parents.

However, only 63 per cent demonstrated good handwashing technique.

The test group were significantly better in handwashing technique and hand hygiene routine scores.

The authors concluded that “comprehensive hand hygiene education programmes should include proper handwashing facilities, resources and awareness of the caregivers in instilling and sustaining good hand hygiene behaviour”.

Eating out is a habit of many Malaysians.

Readers may have some reservations after reading about a study, published in October 2017 in the Asia Pacific Journal of Public Health, which used microbial indicators to assess the hygiene status of 383 migrant food handlers from three urban cities in Peninsular Malaysia.

The findings revealed that all the hand swabs tested 99.5 per cent positive for aerobic plate counts (where aerobic bacteria are grown from the samples), 63.4 per cent positive for Staphylococcus aureus, and 20.8 per cent positive for total coliform/Escherichia coli.

In addition, aerobic plate counts and S. aureus counts exceeded the acceptable standard levels.

Bacterial counts were found to be significantly associated with the participants’ country of origin and working responsibilities.

The authors concluded that their “findings indicate high probability of transmission of pathogenic bacteria from the food handlers’ hands to customers during meal preparation and serving.

“This calls for improvements in personal hygiene and sanitation standards by the relevant health authorities among migrant food handlers”.


The focus of WHO’s WHHD 2023 campaign is civil society organisations (CSOs), or non-governmental organisations (NGOs) in Malaysian parlance.

The role of CSOs in health and healthcare were acknowledged by the then health minister in the 1990s when there were regular dialogues with CSOs.

Whether the Health Ministry acted in toto on the issues raised was a matter of debate, but certainly, the CSOs’ views were sought and listened to.

Since then, the practice has been given varying emphasis by subsequent health ministers.

It was during the COVID-19 pandemic, when the public healthcare delivery system was staring at the abyss in July to September of 2021, that some policymakers remembered the role that CSOs could play. And the CSOs delivered within the framework they were given.

It is time that the government reviews its approach to CSOs and mobilise the resources of these organisations in delivering health and healthcare.

The majority of CSOs work in conjunction with the communities they serve.

Their value systems are driven by social justice agendas and passion, which may vary.

They have, and continue to, focus on and accelerate societal change for universal healthcare at local, national and international levels.


The campaign theme for WHHD 2023 is: “Together, we can accelerate action to prevent infections and antimicrobial resistance in healthcare and build a culture of safety and quality in which hand hygiene improvement is given high priority.”

The slogan is “Accelerate Action Together. Save Lives. Clean your hands”.

The campaign’s objectives are twofold:

“Strengthen and empower communities of actors in healthcare to accelerate action to improve hand hygiene and infection prevention and control at point of care”, and “Foster collaboration and working together of people and organisations towards the common goal of minimising the risk of infections and the development of antimicrobial resistance in health care.”

The campaign calls on health and care workers to love the five moments in hand hygiene; infection prevention control (IPC) practitioners to lead the way for clean hands; policymakers to invest for health and dignity; and everyone who accesses healthcare to join the movement.

The WHO’s messages for policymakers were:

“Hand hygiene is not a luxury; it is a smart investment that saves lives and money.

“Up to 50 per cent of healthcare-associated infections can be reduced by investing in recommended IPC practices and following the core components for IPC; improving hand hygiene in healthcare is the ‘best buy’ – it saves USD7 to USD16.50 for every USD1 health expenditure.

“Investing in IPC and hand hygiene is highly cost-effective and yields a seven-fold return (on average).

“Improve IPC training and education: mandate professional development to ensure knowledge and best practices of hand hygiene in your entire workforce.

“Strengthen IPC programmes and infrastructures at national and facility level: commit to making the investments required to improve and maintain hygiene services in your country.”

The WHO’s messages for everyone who accesses healthcare are:

“Infections acquired in healthcare are avoidable. Clean hands protect you and your healthcare team.

“Keep learnings from the COVID-19 pandemic in mind: protect yourself and others from infection by cleaning your hands.

“Be interested in your own care, talk to health and care workers about the importance of clean hands. Safe healthcare involves good communication.

“Being part of the WHO hand hygiene campaign and movement helps to protect yourself and others from infection. Clean hands save lives.”

In summary, everyone has a role to ensure that hand hygiene at the right time and in the right way makes a substantial difference in healthcare and daily living.

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