The Covid-19 pandemic has brought everyone’s attention to the simple practice of hand-washing - when to do it, and how to do it well. Here are the NHS Guidelines and the advice to sing for two rounds of “Happy Birthday”. At this time, whether you are working from home, a laboratory, hospital or office, the current importance and relevance of this advice should escape no one. Hand-washing with soap, or alcohol-based hand-sanitiser is effective at destroying the novel coronavirus, and will prevent infection spread via touch. However, one can learn this fact, yet still the environment and the complexity of real-time events may mean it does not always translate into instilling and maintaining the habit. The consequence of all communities not establishing a reliable habit of frequent hand-washing threatens confidence to venture out of your home and to enter spaces where you can mix with non-household members. Therefore, we need research that generates visceral demonstrations of how human interaction with the virus can foster its journey into living human cells, if the effective barrier of hand-washing, and other infection prevention measures, are absent.
In research I led a few years ago, published last year, myself and an interdisciplinary research team from nursing, microbiology, engineering, creative arts and cultural geography worked together to explore novel ways to communicate the effectiveness of hand-washing (Roe, Veal and Hurley 2019). Previous research suggested that the principles of infection prevention were still difficult for healthcare workers to grasp and apply consistently (Prieto 2016) and there was considerable evidence of the risks of infection spread when hand-washing does not take place (Kelsall et al 2006). The research experimented creatively with an aesthetic which gave visibility to pathogenic microbial life and how they could be spread around a hospital ward between different patients, if healthcare staff failed to wash hands between patients. Using a mixture of Ultra-Violet lit images and normal ward lighting, we demonstrated the hidden mobility of harmful pathogens, that could be stopped if hands were washed thoroughly between caring for different patients. We made a short film ‘In Our Hands’ that includes Michael Rosen’s famous NHS 60th Anniversary celebration poem ‘These are the hands’, to convey the findings to a non-academic audience and support the training of healthcare staff.
Today, the need for infection prevention compliance is a priority not only for healthcare staff in our hospitals, but for all in wider society, as we take individual responsibility to care for ourselves and others through frequent, thorough hand-washing, along with other measures. Effective, timely, skilled hand-washing has moved beyond the skill-set of healthcare professionals to instead become a matter of civic-responsibility, urging a common-sensibility extending from collective participation in lockdown to now collective participation in infection prevention measures. In the UK, with the easing of lockdown, comes a greater need for compliance with high levels of infection prevention practice by ordinary people who are spending progressively more time outside their homes and come into contact with a greater number of people.
Instilling these new habits that prevent infection are critical to the safe return to workplaces, schools, nurseries and the opening up of non-essential shops as well as increasing socialisation with people living outside your household. Whilst in schools and nurseries it is possible to put in routines of monitored hand-washing at key moments through the day, and “after touching your cheek” (as my 3 years old nursery-goer reported to me). It is quite another thing for adults to police each other in a workplace, retail shop, pub or on the bus or train. In these spaces creative interventions that illustrate the life of the virus interacting with the actions of people in these spaces may support efforts to encourage compliance.
There are a number of reasons why compliance maybe a challenge. The emotional responses to a world where infection prevention measures are critical are complex. The masked faces of colleagues, awkward distance between those you used to hug in greeting, and the squirt of sanitiser after you touch something or someone, paradoxically, can be frustrating, uncomfortable, disquieting, saddening or reassuring, and confidence-building to witness for example careful, attentive hand-sanitising in practice. For now, social-distancing, face masks, and the ability to frequently hand-wash or sanitise are critical measures in controlling the spread of the virus. Encounters between strangers are being shaped by our approaches to infection prevention measures, with an added sense of being vulnerable to a stranger’s compliance level. Does one request greater distance, or suggest they hand-sanitise or they improve the position of their face-mask as they are coughing? This is a new area of conflict-management for those people supervising these public or semi-public spaces from bus-drivers to shop security-guards. Here there is considerable scope to provide strong, supporting uniquely-tailored information for different types of places - pubs, mosques, supermarkets - about how the virus may be deposited, thrive, be inadvertently picked up, and then enter the human body, across these familiar spaces, without any control measures.
Infection prevention rests ultimately on sets of practices that make, or keep something or someone, clean. Education and attitudes to cleaning and hygiene may be reflected in how effective infection prevention measures are taken-up by those who don’t believe it is their job to clean, or who position themselves as clean in their skin, or who don’t attend to the effectiveness of cleaning, or have never worked to make something clean; those holding these attitudes or lower hygiene education levels (Suen et al 2019) may be missing links in community-wide responses to the virus challenge. Therefore, infection prevention compliance may also be challenged by complex cultural relations to cleaning itself. We know that communities have established norms about who cleans what, who is clean, what is clean in defining relations between different people and objects. Cleaning in the home is a domestic chore. Cleaning is perceived as an unskilled, low-wage job. Making visible microbial/viral life on the move around familiar places, may energise conversations about responsibility, action and values attached to the act of cleaning and keeping clean, from personal respiratory etiquette through to domestic/public space cleanliness expectations. Here again, attention towards how creative experimentation with viral aesthetics in everyday spaces may support the compliance levels of life-saving infection prevention practice.
There is too little attempt to couple the creative-arts, social science and microbiology in supporting public health communication materials during the Covid-19 pandemic. Whilst there is a history of arts-engagement with pathogenic life – making it relevant to daily excursions through a world shaped by the Covid-19, is an urgent challenge. Our previous work has shown the effectiveness of viscerally-arresting illustration of the mobility of pathogenic life (whether bacteria or virus) to demonstrate the effective intervention of hand-washing, one of a suite of infection prevention measures we are urged to adhere to as lockdown eases.
Kelsall, N., Griggs, R., Bowker, K., & Bannister, G. (2006) Should finger rings be removed prior to scrubbing for theatre? Journal of Hospital Infection, 62, 450- 452. https://doi.org/10.1016/j.jhin.2005.09.002
Prieto, J. (2016) Guest editorial. Journal of Research in Medicine, 21, 5 7. https://doi.org/10.1177/1744987115624573
Roe E., Veal C. and Hurley P. (2019) Mapping microbial stories: Creative microbial aesthetic and cross‐disciplinary intervention in understanding nurses’ infection prevention practices Geohttps://doi.org/10.1002/geo2.76
Suen L., So Z., Yeung, S. and Lo, K and Lam, S. (2019) Epidemiological investigation on hand hygiene knowledge and behaviour: a cross-sectional study on gender disparity. BMC Public Health 18, 401 doi: 10.1186/s12889-019-6705-5