Today is Global Handwashing Day – an annual global advocacy day to recognize the importance of handwashing with soap as an easy, effective, and affordable way to prevent diseases and save lives. With the increased attention on clean hands during the pandemic, it is a good time to review best hygiene practices for both hand hygiene and surface hygiene, as they are linked together.
Additionally, as cool weather settles in and everyone spends more time indoors, winter germ season also approaches. The dry, cool air during the fall and winter months is the perfect environment for respiratory and gastrointestinal viruses (such as cold and flu viruses, RSV, and norovirus) to circulate. These viruses spread easily indoors and settle onto surfaces where they can live for hours (or, in the case of norovirus, weeks) and infect others. With the continuing presence of COVID-19 throughout the U.S., it's crucial to maintain a heightened awareness of hygiene. While the indiscriminate cleaning of every surface isn't necessary, a targeted hygiene approach which focuses on high-risk activities for hands and high touch surfaces – is shown to be effective. Targeted Hygiene practice in home and everyday life settings is central to the work of the International Forum on Home Hygiene.
What is targeted hygiene?
Targeted hygiene is an evidence-based approach used to prevent the transmission of pathogens (commonly known as germs) and thereby reduce the risk of infectious disease by targeting only surfaces that are considered high risk for pathogen transmission. These include frequently touched surfaces such as doorknobs, elevator buttons, handles and faucets, food contact surfaces, and the cleaning utensils used on all of these surfaces. This approach also discourages the indiscriminate use of broad-spectrum disinfectants for lower-risk surfaces. Disinfecting frequently touched surfaces breaks the chain of infection – if these commonly touched surfaces are decontaminated at regular intervals, there is less risk of someone touching the surface and transferring germs onto their hands, and in turn, touching other shared surfaces where others can pick up germs.
What are frequently touched surfaces, and how often should they be treated?
As I mentioned, the focus of targeted hygiene is on the surfaces that serve as the critical control points in the transmission of pathogens. Regularly decontaminating these surfaces at moments of high risk helps to maintain a healthy facility or home. High-traffic areas in shared spaces will need frequent disinfecting. The CDC recommends that if there has been a sick person or someone who tested positive for COVID-19 in your facility within the last 24 hours, you should clean AND disinfect the space.1 Similarly, more frequent disinfecting is recommended if someone is sick in your home.
Examples of surfaces with the highest risk of transmitting pathogens include:
- Common shared surfaces in all settings: doorknobs, hand railings, elevator buttons, countertops, sink faucets, toilets seats, and flush handles.
- Homes: computer mice/keyboards, tablets, mobile devices, remote controls, telephones, door handles, light switches, kitchen countertops, and sinks. The image at the bottom of the page contains examples of surfaces in the home ordered by risk for pathogen transmission (from Scott et al.2 ). The red and yellow dots represent pathogenic and nonpathogenic microorganisms, respectively.
- K-12 schools, preschools, and daycares: desktops, computer mice/keyboards, drawer handles, toys and shared learning objects, food contact, prep areas and eating areas, diaper changing stations (after every use or following any state/local/regulatory guidelines).
- Restaurants, grocery stores, convenience stores, dining areas at colleges/universities or cruise ships: tables, menus, highchairs, food contact and prep areas, shopping cart handles, grocery belts, self-serve areas, condiment stations, beverage self-serve areas, electronic touch screens, and register/PIN pad.
- Health and fitness or athletic facilities: locker rooms, workout areas, training room benches, shared equipment, athletic training rooms, treatment tables, water cooler nozzles, or water fountains/bottle refill stations.
- Offices or other shared space environments: coffee pot handles; telephones; desks; shared tables in break rooms or conference rooms, or other shared spaces; computer mice/keyboards; copier machine buttons; refrigerator handles
- Cleaning tools: cleaning cloths, towels, sponges, gloves, or other cleaning tools can cause cross-contamination of surfaces, when you transport germs from one area to another. Keep separate cloths for use in the kitchen or bathroom. At home, wash cleaning cloths every day, use a separate towel to dry dishes, and use disposable cloths or wipes to clean if someone is ill. Wash your gloves with soap and water after every use.
How are contaminated surfaces and hands linked?
Commonly touched surfaces like doorknobs, hand railings, and remote controls can potentially harbor high numbers of pathogens resulting from the many hands that have touched them. Everyone carries both healthy and harmful microbes around on their hands – the harmful ones are the pathogens, or germs, that can make you sick. When you touch surfaces, you leave some of those germs behind, and then when the next person touches that surface, they can pick them up. Those germs can then be introduced into your body when you touch your eyes, nose, or mouth.
Pairing good surface hygiene with good hand hygiene can help reduce the amount of illness-causing germs on surfaces you touch and your hands. Keep in mind that as you move about your day touching other common surfaces, you will continue to pick up germs, so it's essential to practice good hand hygiene at key moments throughout your day.
When should I wash or sanitize my hands?
Practicing good hand hygiene – handwashing with soap and water for at least 20 seconds or using an alcohol-based hand sanitizer when a sink is not convenient – is one of the most effective ways to kill germs that can make you sick. It washes away or kills the germs, leaving the healthy skin flora to help protect you. Consider cleaning your hands regularly in the following moments:
- Before or after touching your eyes, nose, or mouth: After you blow your nose, cough, or sneeze; before applying contact lenses or makeup.
- Before and after touching food: Before you eat; before, during, and after preparing food; before and after preparing raw food; before handling ready-to-eat foods.
- After touching potentially contaminated, shared surfaces: After using the restroom, after handling garbage, after handling or laundering clothing or household linens, after shaking hands, after using sports equipment or gym facilities, after touching pets or other animals, after working outdoors, after participating in sports, after caring for someone who is ill.
- Stop leaving germs around town: At home, stop germs from entering your home by washing your hands as soon as you arrive home. This also applies to other community settings, like grocery stores or gyms, where you frequently touch shared objects – use hand sanitizer upon entering, then again as exiting.
For more information on hygiene, visit the International Scientific Forum on Home Hygiene consumer hygiene page. Read more about targeted hygiene in my study, "A 21st century view of infection control in everyday settings: Moving from the Germ Theory of Disease to the Microbial Theory of Health."
Examples of surfaces in the home ordered by risk for pathogen transmission (from Scott et al.2 ). The red and yellow dots represent pathogenic and nonpathogenic microorganisms, respectively.