A year and a half ago I wrote a piece on Backcountry Hygiene: The Infamous Pee Rag. Hygiene is something I highly stress as a crucial element to one’s health not only in the backcountry, but in everyday life. The recent coronavirus pandemic has inspired me to write about the importance of hand hygiene.
I often get asked by students and clients why I make them each carry a 2oz bottle of Dr. Bronners on top of a bottle of soap in each stove bag and see eyes rolling when I demo how to wash your hands. “Why not just use hand sanitizer? Isn’t it better? It kills everything!” Hand sanitizer does not kill everything. While it can be used in conjunction with hand washing, it should NOT be used as a substitute. This is what the Centers for Disease Control and Prevention has to say:
- “Alcohol-based hand sanitizers can quickly reduce the number of microbes on hands in some situations, but sanitizers do not eliminate all types of germs”. Hand sanitizer does not work well for miroorganisms such as norovirus and Clostridium difficile.
- “Hand sanitizers may not be as effective when hands are visibly dirty or greasy.”
Source: https://www.cdc.gov/handwashing/show-me-the-science-hand-sanitizer.html (Retrieved March 11, 2020)
Why I am PRO HAND WASHING!
As an outdoor educator and guide I have observed several people suffer from bouts of nausea and diarrhea. Early in my career I didn’t think much of it until I started noticing infection patterns that stemmed from poor hand washing technique, lack of hand soap, reliance on hand sanitizer, and poor hygiene practices in general. On one course, we were issued only hand sanitizer. I had to fight for a bottle of soap to have for our kitchen. The number of GI incidents increased profoundly. In fact, it did school wide and the school went back to issuing soap.
“Why are you showing us how to wash our hands? I already know how!” Before I ventured into the outdoor education field I was a middle school science teacher. I worked with kids and was constantly on them about hand washing and coughing/sneezing into the crook of their elbow to mitigate the spreading of the flu and the common cold. My biggest mistake when I transitioned to outdoor education was assuming that grown adults understood how to take care of daily hygiene. Surely, they had been taught as a youngster. I was terribly wrong. Turns out there are a lot of misconceptions, ones that still have a stronghold today.
So, what is the proper way to wash hands?
How often should hands be washed?
Hands should be washed….
- After using the restroom
- Before eating, preparing, or handling food
- Before giving yourself or someone else medicine
- For those of you that work in a healthcare or pre-hospital care setting…
- Immediately before and after touching a patient even when gloves are worn
- Before moving from work on a soiled part of the body to a clean part of a patient’s body
- After touching a patient’s immediate environment
- After contact with bodily fluids, blood, or contaminated surfaces
What pro-tips do you have for outdoor educator and guides?
TIP #1: Don’t Assume! Educate!
Don’t assume that people have good hand hygiene or good hygiene in general. They need to be taught. Even though I get some doubting questions and rolling eyes before my demonstrations, I often have students and clients remark afterwards that they realize they have been doing it all wrong and were grateful for the tools that they can transfer to their everyday lives.
TIP #2: Practice Non-Judgement!
Practice non-judgement and compassion. We have all been there….realized that what we thought we knew, we didn’t. It can be a humbling experience. When discussing and demonstrating hygiene practices, make it a part of the course/trip culture. I often state “You may already know how to do this, but I am going to demonstrate and talk about it in an effort to get everyone more comfortable with uncomfortable topics since will be living very closely together for the next month and to make sure we are all on the same page”. Why wouldn’t people be comfortable washing their hands? This talk is part of a much bigger picture that includes not just hand washing, but using the “facilitrees” (peeing and pooping in the backcountry), managing menstrual cycles, and other basic human functions. Things get uncomfortable really fast. Break the ice and start talking about the taboo subjects right away!
TIP #3: Hold High Standards, BUT Make It Fun!
It may sound ridiculous, but busting out a hand washing song could come off hilarious and infectious, pun intended, when done right. Songs, interpretive dance, skits have all been successful.
TIP #4: Remove the Barriers!
A comment I often here is “I couldn’t wash my hands. I didn’t have much water.” You don’t need a lot of water to wash your hands. It is the abrasive action of rubbing hands together for at least 20 seconds that dislodges debris and microbes. Soap helps with degreasing, but you don’t need very much. When I coach students/clients, I demonstrate trickling a little water on my hands to get them moist and a couple drops of Dr. Bronner’s followed by the “WHO Technique” shown in the above video. When I am done, I rinse with a little bit of water and let my hands air dry. Snow, while cold, is also a good alternative. Overall, I have found that showing this makes a difference in one’s decision making. If they think they can do it they will!
Another barrier that I have found is access to soap. Early in my career we would carry just a few bottles of soap and issue each person hand sanitizer. Although we made it an expectation that students/clients were to wash their hands once they were finished using the “facilitrees”, this did not happen. The group soap seemed to always be missing in action. They would use hand sanitizer, which does not kill certain microorganisms found in feces. If it was during the day, hands just wouldn’t get washed. If we were in camp, they would return to the kitchen and if, good kitchen practices (see below) were not established, would start touching food without washing their hands. This was a recipe for GI bugs!
A similar situation occurred when I started issuing both soap and hand sanitizer to each person. Which do you think they used more? Hand sanitizer. It’s easier, doesn’t require water, and it takes a lot of brain file overwriting to delete the misconception that hand sanitizer kills everything.
To remove these barriers I now do the following:
- Issue each person 2oz Dr. Bronners
- Do not issue hand sanitizer
- Include one 2oz bottle of Dr. Bronners and one 2oz bottle of hand sanitizer in each stove set. The hand sanitizer is merely there to ease anxiety. Students/clients may use after hand washing if they feel the need for it.
TIP #5: Role Model and Hold People Accountable!
Walk the talk! Part of getting people to “buy in” and to think they can is through role modeling. If they see others doing it chances are they will too. Actively role model good hygiene practices. For example, I start out each course and trip making a big deal about setting up hand washing stations in the kitchen area (i.e. a dromedary hanging from a tree with a bottle of soap perched near by). I wash my hands not once, but multiple times. Every time I touch something other than food or cooking utensils I make it a point to go wash my hands. Excessive? No. I constantly role model the following in the kitchen.
- Wash hands.
- Pull out food bags and pull out all ingredients needed for the meal.
- Fill pot with water.
- Set up stove, prime (if needed), and light.
- Wash hands.
- Prepare food for cooking. This may involve washing hands at least once more if I am preparing different meal variations for food sensitivities.
- Ask people to wash their hands.
Another rule for the kitchen…if you went to the restroom, it is expected that you wash your hands right afterwards at your “facilitree” spot and again, when reentering the kitchen.
On my outdoor education trips, students learn to cook and prepare food in small cook groups. Oftentimes, they offer instructors food proud of their accomplishments, “Check out what we made! Try some! It’s so good!” Reward students with good hygiene practices and try some. On the flip side, use this as an opportunity to correct poor hygiene. If I see a group’s hygiene habits falter, not only do I make a point to mention it early on, but when they offer food I refuse and comment that I will be happy to next time if I see better hygiene explaining that getting sick in the field would result in my decreased capacity to care for the group.
TIP #6: If a GI issue pops up, address it right away!
As soon as someone complains of diarrhea, hygiene habits need to be revisited with the entire group. I often start out with “someone fed ‘Billy’ (made up name) their poop!”. They know what this means as this rhetoric is already included in my hygiene lessons. This is used as a spring board to review good hygiene practices and the importance for both personal health, but the health of the group.
I hope that you have found these tips useful not only in a backcountry setting, but in the frontcounty as well. Stay tuned for more on backcountry hygiene and please wash those hands! 🙂
Centers for Disease Control and Prevention. Clean Hands Count for Healthcare Providers. January 31, 2020. https://www.cdc.gov/handhygiene/providers/index.html (Accessed March 2020)
Centers for Disease Control and Prevention. Show Me the Science – When & How to Use Hand Sanitizer in Community Settings. September, 17, 2019. https://www.cdc.gov/handwashing/show-me-the-science-hand-sanitizer.html (Accessed March 2020)
John Hopkins Medicine. Hand-washing Steps Using the WHO Technique. March 26, 2019. https://youtu.be/IisgnbMfKvI (Accessed March 2020)