The importance of touch, washing our hands

The importance of touch, washing our hands

by Elsabe Brits

The views expressed belong to the guest blogger/columnist

Have handshakes and hugs made a comeback yet? Have people who know each other well started to kiss each other on the cheek again? I hope so, because it is good for us, and we have done it for millions of years.

One of my all-time favourite paleoanthropologists, Ella Al-Shamahi,  wrote a delightful book, The Handshake – A Gripping Story, about why the handshake will never be consigned to history. It did not die in March 2020 and it never will, because from the Black Death to the Spanish Flu it has been banned and dropped many times – and each time it returned.

The Greeks shook hands on the battlefield, the Romans did so to mark marriages, and diplomats have done so for thousands of years. Al-Shamahi argues the handshake is part of our evolutionary biology and DNA. Great apes hold hands, hold out their hands, gesture and greet.

The symbolism of the hand itself and the handshake is entrenched in humans. It is political, cultural, psychological, and social.

It is true that most people have about 150 bacterial species in the palms of their hands, and maybe even some viruses and fungi. But the issue is less about the handshake itself, than the poor hand hygiene of the handshaker. Before Covid-19 we did not do too well in this regard.

Covid-19 taught us that touch is important. Al-Shamahi writes: As a basic unit of touch, nothing works as well as the handshake: it allows us to transmit chemo signals, build trust, gesture quickly and universally, and send positive signals of agreement, unity and acceptance. Human history would look very different without it.

According to the Social Safety Theory, developing and maintaining friendly social bonds is a fundamental principle of human behaviour. Threats to social safety are a critical feature of psychological stressors that increase risk for disease. Physical contact increases the immune system’s function and helps relieve stress.

Research has also provided evidence that social support improves outcomes or recovery following many types of human diseases. For example, holding another person’s hand helps to buffer against stress. Holding hands with a loved one can reduce anxiety and pain, and massages positively affect psychological symptomatology. In addition, interpersonal touch is associated with a higher quality of life.

Even fleeting forms of touch may profoundly impact our emotional and social functioning. In a research experiment, pairs of participants were asked to sit at a table with a curtain between them, so they could not see one another.

One of the participants, the encoder, was asked to communicate distinct emotions (such as anger, disgust, fear, and sympathy) by touching the other person’s arm. The person being touched, the decoder, was asked to identify the communicated emotion from several response options. Although they could neither see nor talk to each other, the participants could encode and decode distinct emotions such as anger, fear, and disgust at above-chance levels.

The emotional impact of interpersonal touch is ingrained in our biology. Indeed, there is some direct evidence that, in mammalian species, touch triggers the release of oxytocin, a hormone that decreases stress-related responses.

The irony is that Covid-19 probably did and still does not spread via surfaces, including our palms: this virus spreads through our breath. But it did increase our awareness about hand hygiene.

Studies have shown that gender influences handwashing. Nurses tend to wash their hands more often than physicians, and among non-health care workers, women tend to wash their hands more often than men. In the health setting, it is a habit that needs to be enforced.

A study published in 2015, conducted in a tertiary hospital in Johannesburg, observed a total of 745 hygiene opportunities. Handwashing with soap and water was indicated in 156 (20.9%) of these opportunities, while hand cleansing with an alcohol-based hand rub was indicated in the remaining 589 (79.1%).

Of the 156  opportunities where the use of soap and water was indicated, this was only used on 89 occasions (57.1%), while an alcohol-based hand rub was inappropriately used on 34 occasions (21.8%) and no hand hygiene was observed on 33 occasions (21.1%). In contrast, an alcohol-based hand rub was used in 312 (53.0%) of the 589 opportunities where it was indicated.

Strategies such as regular internal audits, increasing availability and accessibility of washbasins and alcohol-based hand rubs, regular training and retraining of staff, and frequent reminders were recommended to improve compliance with hygiene practices.

According to the CDC, on average, healthcare providers clean their hands less than half the time they should. On any given day, about one in 31 hospital patients has at least one healthcare-associated infection – something that should give us pause.

As a health care worker always remember this. You can prevent death by doing this.

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