A little water clears us of this deed.

When I was a little boy, I was always told to wash my hands before dinner because my mother was never sure where they’d been. Neither was I, in fact, so I usually complied –our bathroom was spotless, and cleanliness was obviously a key that unlocked the dinner plate. I liked the fact that I was the agent of my gastrological destiny. My fate was in my hands; it was a power trip of sorts –a brief sojourn in the adult world of command and respect. Soap was my mother’s god. It both rewarded hands, and punished mouths -yin and yang both lying innocently by the faucet, fused at the hip like the gum I religiously sacrificed to the bottom of the dining room table before I was caught.

But as the years moved on, dragging me from sink to sink, I began to appreciate the heritage to which I was forced to be privy. I survived with all the right germs, and religiously scrubbed off the rest. Or so I presumed… But how do I know that? I mean apart from cogito ergo sum, how do I know that, lurking somewhere unwashed, there is not a whole different germian world of cogitamus ergo sumus? Aye, there’s the rub. I fear it is a too frequently unasked question –too un-Descartian, perhaps.

But it’s a fair one I think. Sometimes we believe we are washing, and yet all we are doing is transferring. My mother was hopeless at supervision. For her, my act of picking up a bar of soap and rubbing it a couple of times across my palms was sufficient evidence of pathogen destruction. Only if she noticed that my nails still exhibited what I would call ‘emergent phenomena’ did she rescind the absolution. I had to learn to use the various cutleries with my hands tightly and resolutely enfisted when she was around. But I digress.

I meant to focus on our unfounded assumptions of cleanliness. Now, I’m sure we will all agree that we need some germs –they’re not all bad. Most of the microbial flora in our guts, for example, are essential for our survival, but it is unwise to trust a soldier out of the barracks. Hence soap; it doesn’t kill many of them, I don’t imagine, but it gets them off where they shouldn’t be. That’s important because my mother was right about hands -it’s amazing where they go when you’re not watching. And because germs are very little –which is good in an odd sort of way, because they’re not poster material- you can’t see if you’ve got them off. Neither the unwanted bads nor the tolerable good ones. It’s a matter of trust, really. And in the manner of most trusts, possibly unwarranted.

In a way, germs are like real estate: location, location, location -a place for everything and everything in its place. Unfortunately we are often sadly mistaken in our beliefs as an article in the BBC news was quick to point out: http://www.bbc.com/future/story/20170519-does-it-matter-how-you-wash-and-dry-your-hands?

The article is not designed to be an academic treatise on cleanliness, and does not really plumb the depths of hygiene, but it is at least a flickering spotlight on the stage of hand washing -a platform on which we are all expected to perform.

For example, ‘An observational study of more than 3,000 people found 10% left public toilets without washing them at all and even if they did, 33% didn’t use soap.’ And of course, ‘This matters because, unfortunately, we can’t resist touching our faces, allowing germs to spread nicely from our hands to our noses and mouths, where they can get into the body. Researchers in Brazil and the US found that we touch surfaces in public spaces an average of 3.3 times an hour and we touch our mouths or noses about 3.6 times an hour.’

I have to admit that despite my background in medicine, I had always assumed that warm water would be more efficient than cold in cleaning skin. Quite apart from the mechanical effect of rubbing, I thought that warming the oils that skin produces would better enable soap to remove them by making them less viscous. (One end of soap molecules love water – they are hydrophilic. The other end of soap molecules hate water – they are hydrophobic. Hydrophobic ends of soap molecules all attach to the oil. … This is how soap cleans your hands – it causes drops of grease and dirt to be pulled off your hands and suspended in water: http://www.planet-science.com/categories/under-11s/chemistry-chaos/2011/06/soap—how-does-it-get-things-clean.aspx ) But alas, mea culpa –we doctors don’t know everything… Researchers in Florida ‘found that whether the water was cold, hot or middling made no statistically significant difference to the quantity of bacteria remaining on people’s hands.’ The article added what I thought was a prudent caveat, however: ‘In these experiments the hand washing was carefully timed, but in real life if the water is very hot or very cold, then we tend not to wash our hands for long. Just showing our hands the water isn’t enough, and some nice warm water might encourage us to tarry a while by the wash basin.’ I feel at least a touch of amnesty in that, I suppose. One can still lose face, even in retirement.

And how about drying your hands after the deed? ‘When you’re in a hurry it’s tempting to let your hands drip dry. That’s fine if you don’t touch anything on your way out of the bathroom. If you do, you could pick up germs because they transfer to your hands more easily if they’re wet.’ But how to do this? I will admit that I’ve always been a paper towel guy, although I do feel guilty if I use too many.

I just can’t seem to get my hands dry with a blower, so I felt vindicated when I read that ‘[…]the jet dryers have come under criticism, with the suggestion that they are so powerful that they could spread germs around the room. A study conducted at Westminster University found the most powerful hand dryers can spread a virus as far as 1.5 m. across the room and a later study increased this to three metres.’

But, despite the appeal of cleanliness, I am still motivated by my mother’s insertion of guilt into any unobserved cleaning ritual. There is a washroom adjacent to a cafeteria I was wont to frequent that used to be a blower-church, using noisy, exculpatory air dryers. True, because of user demand, they eventually added paper towels, but I felt that people still stared at me while pretending to enjoy their sandwiches if they didn’t hear that annoyingly unmistakable sound of the drier before I exited. So I ended up using both –I’d use the towels then wave my hands for a few swipes under the blower so they’d know.

Well, as the article points out, ‘Any method that encourages people to dry their hands, rather than leaving them wet, is an improvement. Making toilets nicer could make a difference. The study which observed more than 3,000 people in a college town in the US, found that if the toilets were clean and well-kept, people were more likely to stop and wash their hands properly. When the sinks were dirty, they just wanted to get out of there.’

I think they’re right about that. A little water clears us of this deed, as Lady Macbeth observed, but maybe noisy blowers are important, too -surely I’m not the only person raised with the unforgiving blush of shame.