The French Emperor Napoléon Bonaparte once remarked, “Water, air, and cleanness are the chief articles in my pharmacy.” He seemed to have traversed the right course. Clean water undoubtedly remains the safest of drinks, despite human progress over centuries, having several remedial properties as well.
Clean air is a blessing unavailable to the majority of humankind and is likely to get more scarce with the monster called climate change. Similarly, the state of being clean is the gateway to everything good from honour and integrity to spirituality and inner purity. We are even told in the Holy Kor’an (2:222): that God loves those who turn to Him and who keep themselves clean. Yet, it takes a pandemic occurring once in a century, to remind us of the importance of personal hygiene and the simple act of frequent handwashing, with the use of sanitisers and alcohol wipes for retaining human security and protection. This may have been the most valuable lesson learned during COVID-19 and assumes greater relevance as we observe World Hand Hygiene Day on May 5 every year.
Due to inappropriate or excessive use, many antimicrobials are losing their efficacy transporting us back to ancient times when we did not have antibiotics.
Cleanliness begins with washing our hands in the right manner. While learning public policy, my professor at the University of Missouri asserted, “There is no such thing as international best practices,” reminding me of a meeting of the National Committee on Government Reform in Islamabad a few years before where the Chairman told me, “What we want from the World Health Organization are international best practices.” Both the gentlemen were correct and my mind quickly fathomed everything I had experienced during my 15-year stint with WHO. There is little prescriptive in what WHO recommends because everything has to be adapted in the local context. Everything with one sole exception – handwashing – is recommended for people living anywhere and requiring daily practice. Remaining healthy is not a one-time effort but a perpetual struggle against germs that want to get hold of us.
Correct handwashing with soap and water can bring the world together better than CNN or BBC while saving numerous lives. There are times when handwashing is more required, such as after using the toilet, while cooking, before eating, after changing baby diapers, touching pet foods, treats or garbage, and after coughing or sneezing. Therefore, both the timeliness and the proper method of handwashing are crucial.
The practice is all the more essential for healthcare professionals who need to protect themselves and the persons under their care while guarding against healthcare-associated infections. We are told on flights to wear our safety mechanisms before assisting others and the same principle applies here. WHO has provided health workers with a multimodal strategy for sustaining hand hygiene while performing their duty in sterile environments like operation theatres, or even routinely in hospital wards and outpatient departments.
In Pakistan, most of us are aware of how hand hygiene can significantly reduce the risk of people getting sick with diarrhoea and respiratory illnesses, particularly in people with weakened immune systems. This awareness, which hit us half a century ago in a big way, has yet to trickle down to the communities. I remember with misty eyes the late Farooq Qaiser who with his puppet ‘Unkal Sargam’ said during the 1970s, ‘Bachey ki Sehat us ke maan ke saaf hathon mein hai’ (the health of a child lies in the clean hands of the mother) in his inimitable style. And how true that assertion was.
Capacity building of communities is required to let the message sink in and draw attention to hand hygiene with soap and water, which though inexpensive can avert so many illnesses and millions of deaths, particularly of infants and young children, making it a highly cost-effective and least cumbersome intervention in health. Thus, countries can derive enormous economic dividends inherent in this simple – almost innocuous – practice, with a healthy population and workforce yielding more than twenty-fold benefits for the meagre amount spent.
We must not touch our eyes, nose or mouth with unwashed hands, particularly while eating or drinking and sneeze or cough sensibly without infecting others. During handwashing, we lather the back of the hands, between fingers and under the nails by rubbing them together with soap, while imaginatively conserving water. Then the hands need to be scrubbed for at least 20 seconds, following rinsing under clean water. Subsequently, hands can be dried with a clean towel or air dryer.
Here I must make mention of anti-microbial resistance (AMR). Due to inappropriate or excessive use, many antimicrobials are losing their efficacy transporting us back to ancient times when we did not have antibiotics. Globally, 136 million cases of healthcare-associated antibiotic-resistant infections occur every year. In Pakistan, some efforts have been made to contain this challenge. Nevertheless, the single most effective measure to reduce AMR, namely, banning the off-the-counter sale of antibiotics has not been taken warranting immediate executive or legislative action with stringent regulation. The sole rationale here would be to prescribe and dispense antibiotics only to persons truly requiring them.
These behaviour changes need to be inculcated urgently to achieve universal health coverage with access to quality essential healthcare services, medicines and vaccines for all. Infection prevention and control, including hand hygiene, is critical to achieving this huge undertaking, which has to be achieved by 2030 across all levels of the health system including the community level. What we require is a change in mindsets, by placing Health high on our list of priorities and not merely providing lip service.
The writer is a senior global health and public policy specialist.