Did you know that only 5% of people wash their hands correctly? According to a study of 3,749 people in a college environment, the majority of people do not wash their hands as recommended by the Centers for Disease Control and Prevention (CDC) (Borchgrevink et al, 2013). In contact lens wearers, up to 50% of patients may disregard or neglect proper handwashing whenever they use their contact lenses despite education and instructions provided by their eyecare practitioner (Fonn and Jones, 2018). Of interest, it is quite common for people to over-report handwashing, which may be associated with socially desirable responding, encoding and recall of information, and dissonance processes (Contzen et al, 2015).

Handwashing and Contact Lens Safety

When handling contact lenses, proper handwashing is of utmost importance because poor hand hygiene is a risk factor for microbial keratitis (Fonn and Jones, 2008), sterile keratitis (Radford et al, 2009), and corneal inflammatory events (Fonn and Jones, 2008). In a recent study of 963 daily disposable contact lens wearers, overnight wear, contact lens wear every day compared to less frequent use, smoking, and poor hand hygiene were determined to be significant risk factors for microbial keratitis with daily disposable contact lenses (Stapleton et al, 2017).

In an analysis of the U.K. outbreak of Acanthamoeba keratitis, which had a three-times higher incidence from 2010 to 2018 compared to 2004 to 2009, one of the risk factors was deficient hand hygiene (Carnt et al, 2018). Improving hand and lens hygiene was one of the recommendations to prevent AK. In a different study of soft contact lens wearers, a protective factor to prevent AK was regular handwashing before using contact lenses (Taher et al, 2018).

Contact lens cases can be a source for infection (Szczotka-Flynn et al, 2010). The use of soap and water to wash hands rather than just water or no washing was associated with lower levels of lens case contamination (Wu et al, 2015).

Another option to lessen contact lens and hand interactions is a daily disposable contact lens; these lenses are discarded daily (Fonn and Jones, 2018) and do not require storage cases unless wearers need to remove the lenses midday and reapply them.

Tips for Proper Handwashing

According to the CDC, hand-washing is the most effective thing that people can do to reduce the spread of infectious diseases. The CDC recommends simple but effective protocols regarding handwashing and contact lenses. It is important to wash and dry hands prior to handling lenses (CDC, 2013).

The CDC recommends the following five steps for proper handwashing (CDC, 2018):

1. Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.

2. Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers, and under your nails.

3. Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.

4. Rinse your hands well under clean, running water.

5. Dry your hands using a clean towel or air dry them.

There are several resources to gain awareness about handwashing:

• The CDC has printable posters available free of charge at www.cdc.gov/handwashing/posters.html .

• Global Handwashing Day is Oct. 15 each year. Tools and materials are available at www.globalhandwashingday.org .

• Contact lens care instructions for lens wearers are available from the Centre for Ocular Research and Education at https://core.uwaterloo.ca/for-the-public . CLS

To obtain references for this article, please visit www.clspectrum.com/references  and click on document #278.

Melissa Barnett, OD, FAAO, FSLS is a principal optometrist at the University of California Davis Eye Center in Sacramento, specializing in anterior segment disease and specialty contact lenses. She is the past president of the Scleral Lens Education Society. She is an advisor to and/or has received honoraria or travel expenses from AccuLens, Alcon, Alden Optical, Allergan, Bausch + Lomb, Contamac, CooperVision, EveryDay Contacts, Johnson & Johnson Vision, Novabay, Ocusoft, Paragon Bioteck, RaayonNova, ScienceBased Health, Shire, SynergEyes, and Visioneering Technologies.