Introduction

Enhanced hand hygiene is at the core of public health measures underpinning the reopening of early child care services across the UK. Settings are now expected to ensure that there are increased hand washing facilities available, allowing children and practitioners to access them more frequently throughout the day.

What is effective hand washing?

We have heard a lot about this in the media over the last year and we are all now aware that washing our hands with soap and water for at least 20 seconds at appropriate and regular times throughout the day will help prevent transmission of a variety of infectious diseases.

Soap vs hand sanitiser

Using soap and water has now been highlighted as the most effective and practical way of cleansing your hands. Soap contains a fat-like material that dissolves parts of the SARS-CoV-2 virus making it inactive. In tests it has been shown that you need a lot of antibacterial gel to be as effective as soap and water.The effectiveness of gel is also decreased when hands are dirty, eg covered in mud.

**Non-statutory guidance for early learning and childcare (ELC) providers states only use antibacterial hand gel for children when soap and water is unavailable. Antibacterial hand gel should not be used by children under 12 months.

Water use

Use clean, running, tepid water.Running water is important as it washes any contamination off the hands. Do not use a communal bowl. Ideally the water should be

tepid (lukewarm). Although water temperature doesn't affect the effectiveness of hand washing, it will make the experience more comfortable, which means that the

individual is more likely to wash their hands for the required length of time than if the water is too cold or too hot.

When to hand wash

For hand washing to be effective practitioners need to create and apply protocols for their own settings. Hand washing should be encouraged on arrival, after toileting, before and after eating, and when moving between different areas.

Intuitive hand hygiene

Ideally children need to hand wash independently, the systems and equipment used need to support this.Provide height-appropriate hand washing stations and consider the type of tap being used for age and ability. Explore ways to make hand hygiene more fun - use visual cues, hang photographs up, and sing songs, ideally ones that the children have created themselves for increased ownership. Gradually incorporate hand washing into daily routines and always supervise children washing their hands and provide assistance if required.

Dry hands thoroughly

A system that does not allow cross contamination is required - no shared towels.Disposable paper towels or kitchen roll are the obvious choice to be used as each piece is thrown away after use - but this does bring with it environmental considerations.Many settings have designed systems using small towels (hand flannels) that are used once and put in a bin to be washed and reused. Others have devised named hand towels and peg systems that are re-used throughout the day by the same individual and washed at the end of the day. This is harder to achieve with larger numbers.

Hand washing outdoors

There are many advantages of adding hand washing stations to your outdoor space but also a couple of significant barriers and issues. It's important to consider what sort of hand washing
system will work best for your setting.

Why outdoors?

Settings are being encouraged to maximise the use of their outdoor space with hand wash stations outside because:

• Children & practitioners can clean their hands without having to head indoors to a confined space

• Portable stations can be placed & moved wherever you like and do not need to be plumbed in, making them a versatile & cheaper option

• There are not the same concerns about spillages & splashes outdoors that you may have indoors

• Sunlight or, more specifically, solar UV radiation (UV) acts as a natural virucide which means there is a natural sanitation of surfaces occurring when in direct sunlight, helping to reduce chances of virus spreading

What are the potential issues?

• A non-plumbed system needs filling & emptying - with lower capacity units this could become tiresome and a chore that pulls practitioners away from supporting rich play to frequent visits to empty waste water

• The weather - a successful system will be required to protect hand towels from the rain. If it is cold then it's even more important to dry hands well to prevent chills & chapping. In
temperatures below freezing, units with water in them will need to be protected

• Cleaning & maintenance - an outdoor wash station may well
require a different cleaning regimen to an indoor sink & a cover may be required to prevent bird droppings etc.

See also