Health Rule #1: Wash Your Hands - Good Hand Hygiene for Flood Victims

Hand washing is rule number one in preventive health, and it becomes even more important in the aftermath of a flood, where nearly everyone and everything has been touched by contaminated water. Most nurses would agree that hand hygiene is the one health practice most likely to sustain optimum health through the crisis and recovery process initiated by Hurricane Harvey. But good hand hygiene depends on access to supplies as well as safe water, and in a flood of this magnitude, public water and private wells are compromised and likely to remain so for some time.

Disaster relief centers and temporary shelters provide ready access to the necessary tools for hand washing, including clean water, soap, and alcohol-based sanitizer. But regular hand washing remains an issue of paramount importance for disaster victims who may not have ready access to hygiene supplies. Amid competing concerns, nurses, public health officials, and volunteers must continue to promote hand washing as a top-of-the mind priority by providing education and information to help flood victims practice good hand hygiene during every phase of disaster recovery.

First, obtain clean water then observe the right techniques for handwashing at the right times during your daily activities. These tips can not only assist with promoting safe water and proper hand hygiene techniques, but can help disaster victims and the professionals assisting them develop creative solutions in response to real-time circumstances. No matter how busy or chaotic the circumstances during the recovery process, it is important to remember health rule number one: wash your hands.

Making Water Safe

According to the CDC, water that is appropriate for personal hygiene including handwashing must be clean, safe, and running. Unfortunately, after a flood, clean, safe, running water can be difficult to find. Local authorities will have on-the-ground information about safe sources of water in a particular area.

Meanwhile, any water identified as being safe for drinking, washing, and food preparation is also appropriate for handwashing. Bottled water is usually a safe source unless the bottles have been compromised by contact with flood water. If bottled water is unavailable, water from certain sources can be boiled or otherwise disinfected. It may take considerable time for public water supplies to be available again. Wells exposed to flood water should be tested and disinfected after flood waters recede.

Making water safe to use for drinking and personal hygiene involves boiling, filtering, or other means of disinfection. Bringing clear water to a rolling boil for one minute and allowing it to stand will kill most disease-causing bacteria, viruses, and parasites. Adding ½ teaspoon of unscented liquid chlorine bleach to each gallon of water will kill many bacteria and viruses, but may miss certain parasites.

Other means of disinfecting water are available depending on individual community needs and circumstances, and are explained on the CDC web site.

Making Handwashing Stations

Making handwashing stations and using them often will not only promote the physical health of a recovering community but can foster a sense of hope and community renewal among the group it serves. Handwashing stations require refillable sanitized containers and an accessible supply of clean water as well as soap, towels, a catch basin and a trash can.

Wash Hands in 5 Steps for 20 seconds

Once you have clean water, you must use proper handwashing technique (most nurses are familiar with these steps), but it's worth repeating so you can help keep the information top-of-the-mind with flood victims. To keep it simple, remember that handwashing has five steps (like hands have five fingers): Wet, lather, scrub, rinse, dry.

1. Wet your hands with clean, running water (warm or cold) and apply soap.
2. Work the soap into a lather rubbing your hands together vigorously.
3. Be sure to scrub the backs of your hands, between your fingers, and under nails-for at least 20 seconds. Hum the "Happy Birthday" song all the way through twice if you think you need a timer. (to conserve clean water, stop the flow of running water during the 20 seconds you are humming "Happy Birthday")
4. Rinse well under running water.
5. Dry your hands using a clean (uncontaminated) towel or air dry.

A Note on Hand Sanitizers

When soap and clean water are not available, alcohol-based sanitizer containing at least 60% alcohol can help reduce but not eliminate germs on hands. Apply the product to one hand and rub palms together, making sure to distribute product to all surfaces of hands and fingers. Keep rubbing until hands are dry. Note that alcohol based sanitizer may not remove harmful chemicals. Note that sanitizer is not as effective when hands are greasy or visibly dirty.

Remember When...

There is nothing "normal" or "routine" in the aftermath of disaster and along the road to recovery. No matter how chaotic or disruptive the day's activities may be, remembering when to wash your hands is key because routine handwashing, before and after particular activities is one of the most effective disease prevention methods. Get in the habit of washing your hands whenever you do the following.

According to the CDC, Your Hands Should Be Washed

• Before, during, and after preparing food
• Before (and after) eating
• Before and after treating a cut or wound
• After using the toilet
• After changing diapers
• After cleaning up a child (or adult) who has used the toilet or had diarrhea
• After blowing one's nose, coughing, or sneezing
• After touching an animal, animal feed, or animal waste
• After touching garbage
• After being exposed to potentially contaminated flood waters
• After contacting objects/surfaces that have been in contact with flood waters

All nurses know that good health begins with good hand hygiene, and now is the time to teach that lesson to others in a way that promotes public health in the aftermath of the historic flooding from Hurricane Harvey. While clean water, soap, and hand sanitizer may be difficult for victims to find in the aftermath of a flood, and proper handwashing technique may not seem important to those who have lost their homes, nurses can help spread the word about the importance of good hand hygiene. Without our health, we can't rebuild our communities.

Question for Discussion

How did this information enhance what you already know about hand hygiene? Disaster recovery?

Sources and Resources

Food and Water Safety During Power Outages and Floods

Handwashing - Clean Hands Save Lives | CDC

Handwashing Station

Making Water Safe in an Emergency

| Water, Sanitation, & Hygiene-related Emergencies & and Outbreaks | Healthy Water | CDC

Personal Hygiene After a Disaster or Emergency|Floods