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Hand-washing is the first line of defence against the spread of most infectious diseases. Even as simple a one as the common cold with other means of transmission (45% decrease in transmission)[1]. It is possible to improve community use of handwashing with simple teaching and training processes to impact on diarrhoeal illness[2] and with internet training packages influenza[3].

All doctors and nurses should be very good at:

  • Washing their hands effectively (to reduce risk to themselves, and to reduce the risk of spreading infection to others);
  • Teaching others (including their patients) how to wash their hands effectively.
  • Pointing others towards proven resources such as four weekly web based training sessions for URTI (Simple Steps to Reduce Colds and Flu[3])
Healthcare workers are expected by society to set good hand hygiene standards. Societies own standards are interesting as a baseline. Hand hygiene when toileting is a function of culture and sex as these studies show (No good UK public toilet data is available) and can increase when awareness increases as with the SARS outbreak[4]. Even fewer observed members of the public use soap or dry their hands than attempt some basic hand washing after toileting. Females consistently are observed to wash their hands more than males
  • ~1605 William Shakespeare's Lady Macbeth Out damned spot.
  • 1773 Charles White obstetrician and cofounder of Manchester Royal Infirmary advocates necessity of absolute cleanliness in the lying-in chamber and the isolation of infected patients with puerperal fever. He considerably reduced child mortality by this and other practices as expounded in the first edition of The Management of Pregnant and Lying-in Women[5]
  • 1795 Alexander Gordon recommends that nurses and doctors "ought carefully to wash themselves" and showed that puerperal fever was transmitted by birth attendants[6].
  • 1843 Oliver Wendell Holmes essay The Contagiousness of Puerperal Fever[7]
  • 1847 Ignaz Semmelweis
  • 1864 Louis Pasteur


  1. Ryan MA, Christian RS, Wohlrabe J. Handwashing and respiratory illness among young adults in military training. American journal of preventive medicine. 2001 Aug; 21(2):79-83. (link to subscription article)
  2. Ejemot-Nwadiaro RI, Ehiri JE, Arikpo D, Meremikwu MM, Critchley JA. Hand washing promotion for preventing diarrhoea. The Cochrane database of systematic reviews. 2015; 9:CD004265.(Epub) (Link to article – subscription may be required.)
  3. a b Little P, Stuart B, Hobbs FD, Moore M, Barnett J, Popoola D, Middleton K, Kelly J, Mullee M, Raftery J, Yao G, Carman W, Fleming D, Stokes-Lampard H, Williamson I, Joseph J, Miller S, Yardley L. An internet-delivered handwashing intervention to modify influenza-like illness and respiratory infection transmission (PRIMIT): a primary care randomised trial. Lancet (London, England). 2015 Aug 6.(Epub ahead of print) (Link to article – subscription may be required.)
  4. Fung IC, Cairncross S. How often do you wash your hands? A review of studies of hand-washing practices in the community during and after the SARS outbreak in 2003. International journal of environmental health research. 2007 Jun; 17(3):161-83.(Link to article – subscription may be required.)
  5. White C. "The Management of Pregnant and Lying-in Women" 1773 Edward and Charles Dilly
  6. Alexander Gordon, A treatise on the epidemic puerperal fever of Aberdeen, London, printed for G G and J Robinson, 1795
  7. Holmes OW, The Contagiousness of Puerperal Fever. The New England Quarterly Journal of Medicine 1843 alternative link
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