How much do you know about handwashing culture

In the face of the new coronavirus epidemic that is raging around the world, the soap-washing culture has once again become popular. Hygiene experts in various countries recommend that people wash their hands frequently or use alcohol-based hand sanitizers to reduce the risk of infection. In many countries and regions, public health institutions, charities, politicians and ordinary people have jointly launched one of the hottest handwashing propaganda campaigns in recent years. Celebrities from all walks of life responded positively and stepped up to demonstrate the “correct hand washing posture.” The Internet is full of materials introducing hand washing methods, and a series of special videos against the epidemic have been released.

Reduced risk of respiratory infections
The range of hand movement is very large, and there are many things in contact with it. It is easy to be contaminated with some harmful and toxic substances such as bacteria, viruses, and parasite eggs. It has been observed that there are as many as 10,000 various microorganisms on the skin of 1 square centimeter of hands, especially the folds of the skin of the hands. On our hands, there are three types of microorganisms: resident flora, temporary flora and incidental bacteria. The resident flora is fixedly parasitizing on the surface of the skin stratum corneum and the outermost layer of the epidermis. The number and composition of the bacteria Keep relatively stable; Temporary bacterial flora mainly exists in the exposed part of the skin, and its number and fungi have great changes; incidental bacteria occasionally exist on a small number of humans, and only attach to the skin and proliferate in a short period of time. The effect of resident flora activity.

Tasha Sturm, a 52-year-old American microbiologist, asked her 8-year-old son to print a handprint after he returned from playing outside. The handprint was incubated in a petri dish for 48 hours before taking a picture. In the microbiology class, the microbes shown in Tasha’s photos were really shocking. The largest colony is Bacillus, which is a rod-shaped bacterium commonly found on hands; the white colony may be a staphylococcus, which is the most common pyogenic cocci and has become an important source of hospital cross-infection. Humans have a certain degree of natural immunity to pathogenic staphylococci, but when the skin and mucous membranes are injured or the body’s immunity is reduced, it is easy to cause infection.

Frequent hand washing is by no means optional. As the most conducive and simple hygiene habit in human history, hand washing can help us effectively reduce the threat of super bacteria and infectious diseases. 2008 is the International Year of Environmental Sanitation. The Public-Private Partnership for the Promotion of Handwashing with Soap (PPPHW) launched the “Global Handwashing Day” initiative, calling on countries around the world to carry out handwashing activities with soap on October 15 each year from 2008 onwards. The simplest and most economical measures to control infection and reduce disease risks have been widely recognized by governments, international agencies, civil society organizations, non-governmental organizations, private companies and individuals.

“Global Handwashing Day” is a worldwide event aimed at cultivating and supporting the global and regional culture of washing hands with soap, advocating governments and communities to improve environmental sanitation (including hand washing facilities), and urging people to improve hygiene behaviors. Every year, 3.5 million children under the age of 5 die from diarrhea and acute respiratory infections worldwide, and proper hand washing methods can reduce the incidence of diarrheal diseases by 53% and the rate of respiratory infections by 6%-44%. In addition, washing hands with soap also makes people feel comfortable, reflects a person’s cultural quality and education, and makes people closer to each other.

The first person to propose washing hands
In the 19th century, hand hygiene was criticized. It was not until the 1870s that surgeons began to perform routine hand cleaning before surgery, and daily hand washing became widespread more than a century later. In the 1980s, hand hygiene was officially incorporated into the American healthcare system, and the first “Hand Hygiene Guidelines” came out.

The Hungarian doctor Ignac Zemelweis first revealed the importance of hand washing and became the “savior of mothers”, but he was misunderstood by the world for many years. Zemelweiss entered the Vienna General Hospital in Austria in 1846. The hospital had two independent obstetric wards: the first obstetric ward was run by male doctors, and the second obstetric ward was run by female midwives. Zemel Weiss found uncomfortably in the first month of work that 36 out of 208 pregnant women had died unfortunately; even more strangely, the number of deaths in the first obstetric ward during the year was 451, while the second obstetrics Only 90 people died of puerperal fever in the ward, and the death rate was much lower than that of the first obstetric department.

Zemel Weiss studied this phenomenon and found that there is a certain connection between the death toll and autopsy. It turned out that the doctors in the first obstetric ward had to take the interns to observe and practice autopsy in the morning. In the afternoon, the doctors and interns returned to the obstetric ward to examine the patients and deliver the babies. The midwives in the second obstetric ward never participate in autopsy and only work in the ward. He believes that doctors and interns transferred the “corpse particles” to the parturients, who died of fever after being infected with the “particles”. At that time, the theoretical research on germs was just beginning. Zemel Weiss did not say “germs” but called “decomposed animal organic matter”. At that time, doctors didn’t have to scrub their hands between seeing different patients, so any pathogens they came into contact with during the autopsy process would be taken into the maternity ward.

In 1847, Zemmelweis forced his doctors and interns to wash their hands carefully with soap and water before touching patients, and then soak them in a chlor-lime solution until their hands became no longer able to smell the body. Smell of rotting. The ward must be disinfected with calcium chloride, especially for prenatal or postpartum women’s examinations. One month later, the maternal mortality rate of the first obstetric disease under his management plummeted to 2%. In the two years since then, the number of patients who died of puerperal fever in the obstetric ward has dropped significantly, and the mortality rate has almost dropped to zero.

In the spring of 1850, Zemel Weiss participated in the annual meeting of the Vienna Medical Association and praised the benefits of hand washing to many doctors on the scene when he read the paper. Because he violated the recognized medical wisdom at the time, his hand-washing theory was refuted by the medical community. The Vienna General Hospital abandoned the doctor’s rule to wash and disinfect hands again after autopsy, and soon the maternal mortality rate returned to its original level. Zemelweis was forced to leave Vienna and returned to work in the maternity ward of the old St. Roach Hospital in Budapest. Although his concept was unacceptable, he took the lead in insisting on washing hands, which greatly reduced the maternal mortality rate.

Zemel Weiss published two articles on hand washing in 1858 and 1860 respectively, and published his book “The Causes, Concepts and Prevention of Puerperal Fever” a year later. However, his theory was still rejected by the medical profession, and doctors with different views generally condemned his book for causing the continued spread of puerperal fever. Zemelweiss health began to deteriorate a few years later and he was sent to a mental hospital. He died shortly afterwards. The cause of death may be sepsis caused by a wound on his hand. Two years after Zemelweis’ death, the Scottish surgeon Joseph Lister proposed in 1867 the idea of ​​disinfecting his hands and surgical instruments to prevent infectious diseases, but he was also criticized.

To commemorate this great man, the Budapest Medical University was renamed Zemmelweis University, and Budapest also built a Zemmelweis monument to commend him for his unnamed persistence in improving medical care by washing his hands. His deeds have been put on the screen 7 times.

Cognitive judgment is wrong
According to the World Health Organization, globally, only 26.2% of people who “may have been in contact with feces” after going to the toilet will wash their hands with soap. One of the reasons may be explained by the lack of adequate hand washing facilities and soap in underdeveloped areas. According to data from WHO and UNESCO, these two things are not available in the homes of about 3 billion people in the least developed countries, and only 27% of them can use them. However, even in many high-income countries where sinks and soap are abundant, only 50% of people wash their hands after using the toilet.

In the 1850s when hand washing first became popular, the average life expectancy in the world was only about 40 years old. Today’s life expectancy is around 80 years old. This is inseparable from the habit of hand washing. In order to help people develop the habit of washing hands frequently, public health experts have been working hard. Unfortunately, there are still not many people who can do it, and it is even more incredible. In 2015, Hollywood movie star Jennifer Lawrence laughed on a TV show saying that he “does not wash hands after going to the bathroom”. Unexpectedly, as soon as this remark came out, the media began to question Lawrence’s personal hygiene habits, which forced her to clarify with a short video on Facebook, saying that it was just a joke that day. Coincidentally, in 2019, American Fox TV host Pete Huggs said a shocking sentence: “I think I haven’t washed my hands in 10 years.” Although he later explained that this is an ironic statement, but The “unreliable” person setting has already been established, just as when he ran for the Minnesota Senate in 2012, he once said that bacteria are not real because “I can’t see them.”

In fact, as long as you observe carefully, there are almost everywhere people who stubbornly refuse to wash their hands with soap after going to the toilet. Psychologists point out that this may not only be laziness, but many psychological factors such as way of thinking and cognitive attitude (blind optimism) all play a role in people’s subconsciousness. They hope that by understanding these hidden cognitive biases, they can further persuade more people to change their minds and develop the simple hygiene habit of washing hands.

One of the reasons why psychologists have to find out the psychological factors behind hand washing is that this matter is about life, especially for patients in hospitals. Although many medical workers have received years of training to treat diseases and save people, they ignore the basic habit of washing hands that helps prevent deadly viruses and super bacteria. In 2019, a study conducted in a hospital in Quebec, Canada found that medical workers wash their hands only 33%. Even in Saudi Arabia, which values ​​handwashing culture, medical workers often do not wash their hands seriously.

Are these people who do not listen to handwashing advice really afraid of contracting the virus? In fact, this phenomenon is called “optimism bias” in psychology. Simply put, I think that under the same situation, others are more likely to encounter “bad things”, but I don’t. Although this expectation deviation reflects an optimistic attitude, it is indeed a wrong cognitive judgment.

“Many people are overconfident. Even if they don’t wash their hands often, they will never get sick. Even if they are really sick, they will never associate the disease with not washing their hands.” Professor Robert Ogg, University of London School of Hygiene and Tropical Medicine For example, “It takes at least 5-6 days from the time of infection of the new coronavirus to the appearance of symptoms of new coronary pneumonia. It is difficult for people to think that infection is related to not washing their hands.”

“Optimism bias” can be described as ubiquitous, pervading a variety of human cultures, and manifesting in different genders and age groups. For example, some medical staff who have just entered the industry tend to overestimate their understanding and mastery of hand hygiene knowledge, while the food industry practitioners always underestimate their own risk of causing food poisoning to others. These caused them to misjudge the probability of their own bad things. In this epidemic, people with “optimistic bias” overestimated their luck, had a fluke mentality in dealing with the epidemic, and believed that they were unlikely to be infected by the virus. Specifically, the first is that it is relatively far from the severely affected area in terms of space and social relations, and there are no confirmed cases around; the second is that it does not pay attention to social news and shows that “the ignorant is fearless”; and the third is that the new crown pneumonia is blindly identified as Self-limiting disease, with strong autoimmunity, no infection. But the reality taught them a lesson: the nucleic acid test was positive, with mild or severe symptoms of infection, and some became asymptomatic.

Make a fuss about “disgusting”
Dick Stevenson, a psychologist at Macquarie University in Australia, believes that to make more people develop the habit of washing hands frequently, listing a large number of reasons why they should wash their hands may not be the best way, but it is right. Jie’s disgust is the decisive factor. Rather than making hand washing look interesting, you might as well make a fuss about “disgusting”.

The research team he led did a test in a study on hand washing habits. The researchers first asked the subjects about their current hand-washing habits and their sensitivity to disgusting things, and then asked them to watch one of three videos: one was a purely educational video, one was a video with disgusting pictures, and the other was related to content Unrelated documentary excerpts. About a week later, the research team invited the subjects to sit next to a table with disinfectant wipes and alcohol-based hand sanitizer, and then asked them to hold all kinds of dirty things. In their hands, they included dirty fly swatters, used toilet brushes, etc., and then asked them to take a cookie from the plate to eat.

So before touching food, do these people disinfect their hands? As the researchers expected, the probability that the students who watched the disgusting video cleaned their hands was much higher than the other two groups. And follow-up research confirmed that this is also valid in the real world. The research team secretly observed people’s hand-washing behavior in several toilets and found that after people saw posters with disgusting pictures (such as feces on bread, bacteria on hands), the probability of washing their hands was greatly increased. In contrast, pure educational posters are not as effective.

How long this effect can last remains to be studied, but Stevenson’s test shows that simple preaching is far less effective than “intimidation”. First, we must encourage people to wash their hands in certain situations, such as through advertisements and hand-washing signs. If this kind of advocacy can continue, washing hands may become a habit, but it’s not clear how long the improvement process is. “The current situation is very special. Affected by the new crown epidemic, many people pay more attention to hand washing.” Stevenson pointed out, “The question is can we let enough people keep this habit? I am afraid there is only time. That’s all. But at least we won’t hear a celebrity brag about how long he hasn’t washed his hands.”

A study on hand washing in Haiti and Ethiopia found that nausea is an evolved protective psychology, just like other emotions, each person’s feelings vary. People who are not sensitive to nausea wash their hands less frequently and wash their hands for a shorter time. Compared with the individual’s feeling of nausea, the correlation between health knowledge and awareness and the frequency of hand washing is not so high. In a study conducted in France, 64,000 subjects from 63 different countries asked to answer the question “Do you agree that washing your hands with soap after going to the toilet is a natural behavior?” It turns out that among the citizens of many Asian countries, the proportion of people who have the habit of washing hands after going to the toilet is low; in Europe, the proportion of people who have the habit of washing hands after going to the toilet is relatively high. Even within countries, people’s hygiene concepts will be different. For example, a study found that women are twice as likely to wash their hands in highway service areas as men. Another example is an online survey conducted by the US “Business Insider” news website that shows that to avoid contracting the new coronavirus, women tend to wash their hands more frequently than men.

“Whether a person washes his hands or not is also related to social norms, which contain complex psychological systems.” Professor Ogg explained, “Research shows that people’s behavior is related to whether they see other people doing the same thing. In the bathroom. When I see others washing their hands, I will follow them; but if no one washes their hands, the pressure to wash their hands will disappear.”