The vast majority of infections among people result in a minor illness that does not require medical attention. However, despite this, 90% of GP consultations in the UK are for minor illnesses, costing the NHS more than £371 million annually.
Far more significantly, the average UK worker loses the equivalent of 2.7 working days a year as a result of sickness. The total cost of lost productivity is a staggering £77 billion.
The potential gains from reducing minor illness in the workforce are enormous. This is something that is already understood within elite sports training. Team GB cycling coach Dave Brailsford came up with a concept of ‘marginal gains’ (small incremental improvements in any process adding up to a significant improvement when they are all added together), which included training the team to avoid minor infections. The ideas are now practiced widely.
Our hands frequently move between potentially infected surfaces, our faces and our food. Hand hygiene is, therefore, the most important way to prevent infection. The World Health Organization (WHO) has developed an empirically-validated Hand Hygiene Technique. It is advised that hands are washed before entering and after leaving a site with a risk of infection. Because the advice is intended primarily for healthcare workers, infection risk is defined in terms of patient contact. In other situations, contact with different groups of people, touching surfaces that other people have come in contact with, and food preparation areas, may all be considered relevant sites.
Screenshot taken from WHO guidance 'Hand Hygiene - Why, how and when
The WHO advice is that visibly clean hands should be sanitised using an alcohol-based formulation, as this is faster and more effective than washing with soap and water. Visibly dirty hands should always be cleaned with soap and water. However, this advice is also aimed predominantly at clinical settings where the transmission of bacteria, such as MRSA, is a major concern.
Many of the germs more commonly encountered in everyday life are more effectively neutralised by conventional hand washing. Germs for which washing with soap and water is more effective than alcohol gels include Rhinovirus – the predominant cause of common colds, and Clostridium difficile – a common cause of stomach upsets. It is generally advised that where possible, soap and water should be used to wash hands in non-healthcare settings. Where this is not possible, an alcohol-based formulation may be used but it should be left to dry on the hands as it requires some time to destroy viruses.
An often overlooked aspect of regular hand hygiene is hand care using moisturiser or barrier cream. This is important so that hands do not become irritated by regular washing.
The smartphone app SureWash can be used to train staff in the WHO Hand Hygiene Technique for good hand hygiene. SureWash uses augmented reality and gesture recognition to provide instant feedback on handwashing techniques. The smartphone camera is used to track hand movements and an avatar provides feedback. The aim is for the technique to become a habitual, muscle-memory behaviour.
Germs are deposited on to surfaces and equipment when they are touched or encounter body fluids, for example, by sneezing. When another person touches the contaminated surface, the infection may then spread. Cleaning and disinfecting should, therefore, focus on the areas where germs are most likely to spread. These include obvious areas, such as toilets, kitchens and cafeterias. Other important areas include door knobs, light switches, hand rails and any shared equipment that is touched, such as hand tools and keyboards. The general rule is to regularly disinfect surfaces and objects that are touched often.
The terms cleaning, disinfecting and sanitising are sometimes used somewhat interchangeably, although they do have distinct meanings.
|- Cleaning typically uses water and a detergent to physically remove dirt and germs from an object. It generally doesn’t kill germs but reduces the number present and therefore reduces the risk of infection.|
- Disinfecting uses chemicals to kill germs but, because it generally doesn’t remove dirt, it may not be effective on very dirty objects where germs below the surfaces might not be reached.
- Sanitising reduces germs to a safe level, using cleaning and/or disinfecting as appropriate.
Much of the advice on disinfecting schools is directly applicable to workplaces. This generally means daily sanitising of surfaces and objects such as desks, countertops, doorknobs, keyboards, tap handles, phones and tools. Surfaces should first be washed with a general household cleaner and rinsed with water. They should then be disinfected using a product that has been approved for effectiveness against influenza virus and any other infections of concern.
If a surface appears clean, it can be immediately disinfected without cleaning first. Surfaces should always be dried after sanitising, as moisture provides an ideal environment for any remaining microorganisms to reproduce. Bacteria, in particular, can multiply very rapidly, meaning that preventing survival and reproduction may be more important than periodic sanitising.
The NHS recommends that germ hotspots should be cleaned after use, rather than on a weekly schedule. This might mean wiping any shared tools with disinfectant wipes before they are put back into a common store.
Cleaners and disinfectants must not be mixed unless labels clearly indicate this is safe – mixing could have fatal consequences. For example, mixing chlorine bleach with ammonia cleaner produces chloramine gas, which causes breathing problems, irritation and nausea. If significant amounts are inhaled it can cause pneumonia and even death.
Ideally, a disinfectant would kill all known germs without harming other forms of life or corroding surfaces. In practice, disinfectants involve some compromise between their effectiveness and the harm they cause to people and assets. Alcohol-based sanitisers and disinfectants are highly-effective and widely used in healthcare. They are a good choice for frequently touched surfaces, such as switches, handles and tools. Chlorine bleach is a much cheaper disinfectant that can be effective for disinfecting large areas such as floors.
On that topic, it is important that cloths and mops are germ-free, or they may actually make the problem worse by spreading germs around. Disposable cloths and paper towels, made from biodegradable materials, should be used where possible. Reusable cloths and mops should be disinfected or washed at 60C or above. Using a mop bucked filled with hot water is also a good idea to treat large floor surfaces. Separate mops and buckets should be used for cleaning with detergent and rinsing.
Considering the significant amount of productivity lost to minor illness, there may also be a business case for removing many of the surfaces that can act as disease vectors. For example, light switches, taps and door handles may be touched by many different people. Replacing them with systems that use proximity sensors and automatic actuation can completely remove the need for many people to touch the same objects.
Smartphones and digital devices have almost become extensions of our bodies. Therefore, we hardly notice how often we contact the surfaces of these devices with our hands. Disinfectant wipes are an effective way to clean phones and keyboards.
The potential to increase productivity by reducing minor illness, not to speak of more serious ones such as Covid-19, is enormous. Increased awareness of hygiene habits, brought about by the current pandemic, provides a unique opportunity to embed behaviour change that will be of lasting benefit.
Remembering to wipe down objects that are shared in the workplace such as tools after every use may be difficult to remember and it may become virtually impossible to sustain if it is not normal cultural behaviour. For this reason, it’s vital that new hygiene practices are implemented properly within the workplace.
|Box: Video content|