question: How does washing your hands with soap and water remove germs?
comment: Oil, dirt, and bacteria bind to soap, and the water rinses them off. It doesn't kill the bacteria unless it has some antibacterial properties added to it. "The soap molecule has two different ends, one that is hydrophilic (polar head) that binds with water and the other that is hydrophobic (non-polar hydrocarbon tail) that binds with grease and oil. When greasy dirt or oil is mixed with soapy water, the soap molecules arrange themselves into tiny clusters called micelles." URL_0
passages: Skin flora do not readily pass between people: 30 seconds of moderate friction and dry hand contact results in a transfer of only 0.07% of natural hand flora from naked with a greater percentage from gloves.
  
  Section::::Hygiene.:Removal.
  
  The most effective (60 to 80% reduction) antimicrobial washing is with ethanol, isopropanol, and n-propanol. Viruses are most affected by high (95%) concentrations of ethanol, while bacteria are more affected by n-propanol.
  
  Unmedicated soaps are not very effective as illustrated by the following data. Health care workers washed their hands once in nonmedicated liquid soap for 30 seconds. The students/technicians for 20 times.
   Despite their effectiveness, non-water agents do not cleanse the hands of organic material, but simply disinfect them. It is for this reason that hand sanitizers are not as effective as soap and water at preventing the spread of many pathogens, since the pathogens still remain on the hands.
   An important use of hand washing is to prevent the transmission of antibiotic resistant skin flora that cause hospital-acquired infections such as Methicillin-resistant "Staphylococcus aureus". While such flora have become antibiotic resistant due to antibiotics there is no evidence that recommended antiseptics or disinfectants selects for antibiotic-resistant organisms when used in hand washing. However, many strains of organisms are resistant to some of the substances used in antibacterial soaps such as Triclosan.
   Water, sanitation and hygiene interventions help to prevent many neglected tropical diseases (NTDs), for example soil-transmitted helminthiasis. An integrated approach to NTDs and WASH benefits both sectors and the communities they are aiming to serve. This is especially true in areas that are endemic with more than one NTD.
   BULLET::::- Mechanical removal (i.e., cleaning) using a soap or detergent. To be effective as a hygiene measure, this process must be followed by thorough rinsing under running water to remove pathogens from the surface.
  
  BULLET::::- Using a process or product that inactivates the pathogens in situ. Pathogen kill is achieved using a "micro-biocidal" product, i.e., a disinfectant or antibacterial product; waterless hand sanitizer; or by application of heat.
  
  BULLET::::- In some cases combined pathogen removal with kill is used, e.g., laundering of clothing and household linens such as towels and bed linen.
  
  Section::::Home and everyday hygiene.:Hand washing.
   An increase in hand washing compliance by hospital staff results in decreased rates of resistant organisms.
  
  Water supply and sanitation infrastructure in health facilities offer significant co-benefits for combatting AMR, and investment should be increased. There is much room for improvement: WHO and UNICEF estimated in 2015 that globally 38% of health facilities did not have a source of water, nearly 19% had no toilets and 35% had no water and soap or alcohol-based hand rub for handwashing.
  
  Section::::Prevention.:Industrial wastewater treatment.
   A 2013 study showed that improved hand washing practices may lead to small improvements in the length growth in children under five years of age
  
  In developing countries, childhood mortality rates related to respiratory and diarrheal diseases can be reduced by introducing simple behavioral changes, such as hand washing with soap. This simple action can reduce the rate of mortality from these diseases by almost 50 percent.
   Improving patient hand washing has also been shown to reduce the rate of nosocomial infection. Patients who are bed-bound often do not have as much access to clean their hands at mealtimes or after touching surfaces or handling waste such as tissues. By reinforcing the importance of handwashing and providing santizing gel or wipes within reach of the bed, nurses were directly able to reduce infection rates. A study published in 2017 demonstrated this by improving patient education on both proper hand-washing procedure and important times to use sanitizer and successfully reduced the rate of enterococci and "S. aureus".
   Section::::Medical use.:Effectiveness in healthcare settings.
  
  To reduce the spread of germs, it is better to wash the hands or use a hand antiseptic before and after tending to a sick person.
  
  For control of staphylococcal infections in hospitals, it has been found that the greatest benefit from hand-cleansing came from the first 20% of washing, and that very little additional benefit was gained when hand cleansing frequency was increased beyond 35%. Washing with plain soap results in more than triple the rate of bacterial infectious disease transmitted to food as compared to washing with antibacterial soap.
   A comprehensive analysis from the University of Oregon School of Public Health indicated that plain soaps are as effective as consumer-grade anti-bacterial soaps containing triclosan in preventing illness and removing bacteria from the hands.
  
  Section::::Substances used.:Water.
   Washing hands with soap and water eliminates microorganisms from the skin and hands. This provides some protection against transmission of VHF and other diseases. This requires at least cake soap cut into small pieces, soap dishes with openings that allow water to drain away, running water or a bucket kept full with clean water, a bucket for collecting rinse water and a ladle for dipping, if running water is not available, and one-use towels.
   Sanitizing surfaces is part of nosocomial infection in health care environments. Modern sanitizing methods such as Non-flammable Alcohol Vapor in Carbon Dioxide systems have been effective against gastroenteritis, MRSA, and influenza agents. Use of hydrogen peroxide vapor has been clinically proven to reduce infection rates and risk of acquisition. Hydrogen peroxide is effective against endospore-forming bacteria, such as "Clostridium difficile", where alcohol has been shown to be ineffective. Ultraviolet cleaning devices may also be used to disinfect the rooms of patients infected with "Clostridium difficile" or MRSA after discharge.
  
  Section::::Prevention.:Antimicrobial surfaces.
   In developing countries, child mortality rates related to respiratory and diarrheal diseases can be reduced by introducing simple behavioral changes, such as handwashing with soap. This simple action can reduce the rate of mortality from these diseases by almost 50 per cent.
   In the United States, OSHA standards require that employers must provide readily accessible hand washing facilities, and must ensure that employees wash hands and any other skin with soap and water or flush mucous membranes with water as soon as feasible after contact with blood or other potentially infectious materials (OPIM).
  
  In the UK healthcare professionals have adopted the 'Ayliffe Technique', based on the 6 step method developed by Graham Ayliffe, JR Babb and AH Quoraishi.
   The addition of antiseptic chemicals to soap ("medicated" or "antimicrobial" soaps) confers killing action to a hand-washing agent. Such killing action may be desired prior to performing surgery or in settings in which antibiotic-resistant organisms are highly prevalent.
   Comparing hand-rubbing with alcohol-based solution with hand washing with antibacterial soap for a median time of 30 seconds each showed that the alcohol hand-rubbing reduced bacterial contamination 26% more than the antibacterial soap. But soap and water is more effective than alcohol-based hand rubs for reducing H1N1 influenza A virus and Clostridium difficile spores from hands.
   Other sterilization methods exist, though their efficiency is still controversial. These methods include gas, UV, gas plasma, and chemical sterilization with agents such as peroxyacetic acid or paraformaldehyde.
  
  Section::::Infection control in healthcare facilities.:Cleaning.
  
  Infections can be prevented from occurring in homes as well. In order to reduce their chances to contract an infection, individuals are recommended to maintain a good hygiene by washing their hands after every contact with questionable areas or bodily fluids and by disposing of garbage at regular intervals to prevent germs from growing.
  
  Section::::Infection control in healthcare facilities.:Disinfection.
   Section::::Fresh water applications.:Window cleaning.
  
  An increasingly popular method of cleaning windows is the so-called "water-fed pole" system. Instead of washing the windows with detergent in the conventional way, they are scrubbed with highly purified water, typically containing less than 10 ppm dissolved solids, using a brush on the end of a long pole which is wielded from ground level. Reverse osmosis is commonly used to purify the water.
  
  Section::::Landfill leachate purification.
   As a general rule, hand washing protects people poorly or not at all from droplet and airborne diseases, such as measles, chickenpox, influenza, and tuberculosis.
  
  Section::::Substances used.
  
  Section::::Substances used.:Soap and detergents.
  
  Removal of microorganisms from skin is enhanced by the addition of soaps or detergents to water. The main action of soaps and detergents is to reduce barriers to solution, and increase solubility. Water is an inefficient skin cleanser because fats and proteins, which are components of organic soil, are not readily dissolved in water. Cleansing is, however, aided by a reasonable flow of water.
  
  Section::::Substances used.:Soap and detergents.:Solid soap.
   Good home hygiene means engaging in hygiene practices at critical points to break the chain of infection. Because the "infectious dose" for some pathogens can be very small (10-100 viable units or even less for some viruses), and infection can result from direct transfer of pathogens from surfaces via hands or food to the mouth, nasal mucous or the eye, 'hygienic cleaning' procedures should be sufficient to eliminate pathogens from critical surfaces.
  
  Hygienic cleaning can be done through:
   Hand washing with soap consistently at critical moments during the day prevents the spread of diseases like diarrhoea and cholera which are transmitted through fecal-oral routes. People can become infected with respiratory diseases such as influenza or the common cold, for example, if they do not wash their hands before touching their eyes, nose, or mouth. 
  
  Section::::Public health.
  
  Section::::Public health.:Health benefits.
  
  Hand washing has the following health benefits:
  
  BULLET::::- Minimizes the spread of influenza
  
  BULLET::::- Prevents infectious causes of diarrhea.
  
  BULLET::::- Decrease respiratory infections.
  
  BULLET::::- Decrease infant mortality rate at home birth deliveries.
   If soap and water are not available, use an alcohol-based hand sanitizer with at least 60% alcohol (check the product label to be sure). Hand sanitizer with at least 60% alcohol is effective in killing Cronobacter germs. But use soap and water as soon as possible afterward because hand sanitizer does not kill all types of germs and may not work as well if hands are visibly greasy or dirty.
   This technique uses low-energy waves produced from a battery powered device. The device delivers periodic rectangular pulses through an actuator holding a thin piezo plate. The waves spread to the surface, in this case a catheter, creating horizontal waves that prevent the adhesion of planktonic bacteria to surfaces. This technique has been tested on white rabbits and guinea pigs. The results showed a lowered biofilm growth.
  
  Section::::Techniques.:Ozonation.
   The main sources of infection in the home are people (who are carriers or are infected), foods (particularly raw foods) and water, and domestic animals (in the U.S. more than 50% of homes have one or more pets). Sites that accumulate stagnant water—such as sinks, toilets, waste pipes, cleaning tools, face cloths, etc. readily support microbial growth and can become secondary reservoirs of infection, though species are mostly those that threaten "at risk" groups. Pathogens (potentially infectious bacteria, viruses etc.—colloquially called "germs") are constantly shed from these sources via mucous membranes, feces, vomit, skin scales, etc. Thus, when circumstances combine, people are exposed, either directly or via food or water, and can develop an infection.
   During laundering, temperature and detergent work to reduce microbial contamination levels on fabrics. Soil and microbes from fabrics are severed and suspended in the wash water. These are then "washed away" during the rinse and spin cycles. In addition to physical removal, micro-organisms can be killed by thermal inactivation which increases as the temperature is increased. Chemical inactivation of microbes by the surfactants and activated oxygen-based bleach used in detergents contributes to the hygiene effectiveness of laundering. Adding hypochlorite bleach in the washing process achieves inactivation of microbes. A number of other factors can contribute including drying and ironing.
  