COMMITMENT to civic duty is borne within a framework of appreciation of purpose. Health safety measures must mean something to everyone.

In the waiting room of a friend’s clinic, I observed many health instructions plastered neatly on every wall.  

A teenager who was reading those instructions seemed uninclined to follow the steps of hand hygiene. Seemingly non-compliant, she said, “I feel as if my wings are clipped, for I enjoy flitting like a butterfly and being free”. I told her to sing her favourite song while following the steps of hand hygiene, which she then gladly did!

“Restrictive, authoritative, an intrusion to personal space, can’t get it,” are expressed reasons for resistance to rules.

Instructions, flow charts or diagrammatic representations describe constant operations required of everyone, to educate society on the do’s and dont’s to safeguard health. Written instructions, in the active voice with command verbs, carry a tone of authority, sometimes with a hint of legality.  

With a background to these things, I tried to decode policies from standard operating procedures (SOPs), a seemingly daunting task for me.

We’ve been doing this all along

What makes us flout rules, regulations and SOPs? Why would we hurt ourselves and others when we are, in essence, of the fabric of empathy?

Muddled perspectives, unsupported by proper appreciation of health issues at hand, lack of adequate awareness, warped notions and the like, are some clear excuses for non-compliance.

Repeated, reproducible tasks, in accordance with rules and regulations, have been done by us, from time immemorial. To improve an organisation, to grow, develop and be worthy of a job and for safety reasons, we do it all the time.

Take for example, practical chores, like getting meals ready for the family, shopping and selecting healthy fruits, vegetables or tender cuts of meat; in essence, we follow inherent procedures that must achieve standards in quantity and quality. The food on the dinner table is ready as a result of rules, steps and regulations followed unconsciously without fail, almost in a knee-jerk manner. If there were safety issues, for example, people coming down with illness after eating the food, then, every step taken may have to be recalibrated or modified and improved.

Laboratories follow SOPs, otherwise, conclusions drawn from results can be disastrous. The nurse hands the swabs to the surgeon following strict aseptic SOPs, electricians strictly follow rules, steps and regulations for safety and efficiency. Military standing operations are dynamic, with great flexibility and immense potential for change.

Audited and tested, they bridge concept to reality.

Infection control

Infection control requires holistic participation with a spirit of willingness and alacrity.

The assumptions made with infectious disease control, for a disease like Covid-19, is that everyone, everywhere is potentially infective.

Hand-washing, coughing etiquette, appropriate handling of linen, appropriate use of skin disinfectants, routine environmental cleansing or waste management become everyone’s business. Environmental risks are addressed and “non-touch” techniques for surgical procedures, as well as personal protective equipment (PPE) and so on are crucial preventive measures.

However, for those who are known or suspected to be infected, an additional set of precautions called transmission-based precautions (TBPs) are used, tailored to the mode of transmission.

For Covid-19, TBPs must consider transmission via direct, indirect or close contact, as well as droplets, airborne and through contaminated surfaces, to prevent further ominous spread of the disease.

Handwashing a case in point

Handwashing with soap and water at home, in communities and around the globe, is imperative for everyone to stay healthy.

There are steps to be followed to sharpen it as an effective tool to combat diseases. The details of the procedure do matter, as highlighted by the World Health Organisation, Centre of Disease Control and Health Ministry, and this advice is supported by a compendium of knowledge and scientific evidence.

History provides knowledge its depth and breadth. A historical peek into hand hygiene indicates that religious ablutions included meticulous handwashing rituals, dating back to ancient civilisations. The concept that hands were routes of disease transmission has been a part of medical credence for more than a century.

Science has highlighted that commensal residents and dangerous new microbes potentially survive on our hands. Decreasing disease-causing microbes on our hands interrupts the infective chain and saves lives.

Systematic reviews repeatedly document the importance of proper hand hygiene and its impact in reducing workplace illnesses, as well as respiratory and gastrointestinal diseases.

Evidence-based data reveals that SARS-COV-2 has an envelope made up of a lipid bilayer, its vulnerable link. Washing hands by soap lathering, scrubbing and rinsing removes the virus from the skin, and disrupts the essential coat.

Alcohol-based hand sanitisers, an effective alternative to hand washing, inactivates the enveloped virus. A sufficient volume of sanitiser ensures complete hand coverage and compliance is crucial for proper hand hygiene.

In hospitals, hand hygiene is monitored with data, guiding feedback, identifying areas with poor compliance and evaluating targeted interventions.

People’s advice: wash hands regularly, following procedures, sing a song or whistle if you wish, and never touch the nose, eyes or mouth because they lead directly into your body, until hands are clean. You can remove viruses on your skin but not when they get into your body. Then, dry your hands with a disposable hand towel, not a hand drier, and touch the door knob with the disposable hand towel on your way out.

Consequences

Operating procedures may benefit when enlivened by greater humane dimensions. A pragmatic understanding of the do’s and dont’s with insight of inclusiveness has greater holistic impact on disease prevention.

Making tedious procedures a bit of fun and a tad innovative, may also help. – October 12, 2020.

* Dr Prameela Kannan Kutty is a professor of paediatrics at Universiti Pertahanan Nasional.

* This is the opinion of the writer or publication and does not necessarily represent the views of The Malaysian Insight. Article may be edited for brevity and clarity.