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Dr. Randeep Guleria is former director, AIIMS, Delhi, and is known for Covid management efforts. He has co-authored a book Till We Win: India’s Fight Against The COVID-19 Pandemic. He is the head of ICMR’s National Task Force on Covid and founding member of Reckitt Global Hygiene Institute. Here are the edited excerpts from an interview with Naina Gautam:

What comes to your mind when we talk about hand hygiene?

Many infections can be prevented by good handwashing by healthcare workers in hospitals and ICUs. In a community where everyone washes hands before a meal, it can prevent infections.

Is the humble handwashing still the best bet against pandemics?

It’s one of the strategies we must adopt. In pandemics, there are two phases. In the early phase in which we have no drug and vaccine. In it, we consider non-pharmaceutical measures to control the pandemic. Handwashing is important, along with physical distancing and wearing masks.

Will handwashing be as crucial in future pandemics?

This is something that we saw during the 1918 Spanish Flu. We had no vaccines and drugs in the pre-antibiotic era. What worked was handwashing, physical distancing, and wearing masks. This will continue in subsequent outbreaks.

What mistakes do we commit in handwashing?

Handwashing is a proper procedure. It is not rubbing soap on the palm. Rub your hands with soap, and make sure the thumb is properly soaped and clean. Ensure that the back of your hand, especially the area between fingers, is soaped and nails are rubbed, so that the nail bed is clean. It’s important not to touch the tap with clean hands.

How do we deal with scarce water?

Sanitizers are available, and one can carry a bottle. They are equally effective when used properly. You can use material that will help get rid of pathogens from hands. Even disposable strips of soaps can be used. There are innovations that are available due to Covid.

Does too much handwashing have negative impacts?

Not really, unless you use a strong soap or substance that causes irritation or dryness of skin. As physicians, we do handwashing regularly, more frequently than most people, because it is mandatory. There is data to suggest that when doctors examine a patient and move on to the next, they carry bacteria and pathogens if they do not wash hands, and can pass them to the next patient.

Just washing hands is not good enough; you have to do it properly. Before the pandemic we did workshops on handwashing with the senior faculty. We blindfolded them, and put their hands in paints, and asked them to wash hands.  Once they finished, there was paint on parts of hands. This was a learning experience for them.

There are reports that hand hygiene is not maintained properly at medical facilities. What is your experience?

Now, many practices have been introduced. Earlier, it was a questionnaire-based feedback. Many hospitals now use CCTV or a nurse who observes and monitors. Hospitals have designated a worker to remind doctors. There is a checklist in hospitals. But I agree that there are many hospitals in our country, and globally, where handwashing is not done aggressively.

How good are traditional products like neem, basil, and lavender?

They work. If you are able to get good amount of lather, which helps pathogens to come off hands, these items work.

How do we ensure sustainable handwashing behaviour?

A number of initiatives are taken by various organizations, and we have to continue them, especially in emerging markets, rural India and among poor people. They are not aware of the importance of handwashing. We need public awareness campaigns. We need to work on developing strategies to reach out to people, increase awareness and have champions who push for handwashing in the country.

How important is the role of influencers?

If they become role models, it helps. They are important in terms of moulding society and starting a movement. But sustainability is important.

What are the differences between developed and developing nations?

I won’t say hand hygiene is extremely good in the Western world. Many papers suggest that they are not as good as they should be, but they are better than other countries. The problems seem to be relatively higher in emerging markets and developing world. Still, it is a significant problem even in the developed world.

Are medical guidelines for hygiene in healthcare facilities good?

The guidelines are there. But I feel that this should not be on paper. They have to be implemented in letter and spirit. This is why we must have champions and people to monitor and provide feedback and encourage others. We must follow good practices in restaurants and outdoor places. In hospitals, we can develop strategies to make it a habit.

How strong is the business case for handwashing?

A few papers have looked at the economical impact. Since this has preventive aspects, you need modelling data. But the case is strong. If you are able to prevent infection, you prevent hospitalisation, use of antibiotics and drugs and loss due to absentees and reduced wages. The health economics suggests that these are important measures in terms of economy and burden on the healthcare system.

How do you look at the contribution of Reckitt Global Hygiene Institute?

The institute does pioneering work. It started research and academic activities in emerging countries. It is raising awareness among policy makers. It is developing strategies to bring handwashing to the masses and look at what can be done in terms of control practices. Reckitt is looking at models of health economics to develop strategies for increasing public awareness.