The Science of Handwashing: Rub, Don’t Scrub Hands Raw

By | March 21, 2020

Rub Palm to Palm, Back to Back of Hands,
Over the Fingers Into the Web Spaces, Around Nails, and Up the Wrists

The biggest mistake is “the super-hot water” many erroneously feel is necessary to leave washed hands germ-free, said Daniela Kroshinsky, MD, from Massachusetts General Hospital in Boston.

Lukewarm water works just as well when combined with soap to remove pathogens, but isn’t as likely to cause irritation that leads to chapping and subsequent skin infections, she told Medscape Medical News.

“The perfunctory hand-over-hand motion during washing — rather than systematically going from palm to palm, back to back of hands, over the fingers, in the web spaces, around nails, and up to the wrists” — is also a problem, she explained.

Covering the entire hand is necessary, but there’s a fine line between rubbing and scrubbing. Yes to rubbing, but no to scrubbing.

“You don’t want to scrub because scrubbing will damage the skin barrier and possibly let in germs,” said Carrie Kovarik, MD, from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. “As physicians, we want to get the germs off, but sometimes the things we do to do that are counterproductive.”

“We think the physicality of rubbing the hands together disrupts the adhesion of pathogens more than the soap,” Friedman said. “The 20-second rule is somewhat arbitrary, but we need time to physically disrupt anything adhering to the skin. Surfactants in the soap will kill organisms as well.”

When you’re using hand sanitizer, “make sure you’re not putting on just enough to cover your palms,” Kroshinsky said. “I’ve seen people do one pump of sanitizer, and it doesn’t usually give you enough. You need a good coating all the way to the wrists.”

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A moisturizer that contains mineral oil or petrolatum is ideal, as are products you can squeeze from a tube rather than a pump, according to the American Academy of Dermatology. Also, contrary to advice prevalent on social media, moisturizing after cleansing doesn’t negate handwashing efforts or create vulnerability to pathogens.

When possible, choose paper towels instead of hand dryers, Kovarik advised. Jet dryers in public bathrooms disperse more than 190 times more virus particles than paper towels, according to a 2018 study.

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