Five Things You Might Not Know About Washing Your Hands

Kid washing hands with mother.

Keeping your hands clean is one of the most important steps you can take to avoid getting sick and spreading germs to the people around you. Many diseases and conditions are spread by not cleaning your hands properly. Here are five important things you might not know about washing your hands and why it matters.

  1. Soap is key. Washing your hands with soap removes germs much more effectively than using water alone.[i] The compounds, called surfactants, in soap help remove soil and microbes from your skin. You also tend to scrub your hands more thoroughly when you use soap, which also helps to removes germs.[ii]Make handwashing a habit
  1. It takes longer than you might think. The optimal length of time to wash your hands depends on many factors, including the type and amount of soil on your hands. Evidence suggests that washing your hands for about 15–30 seconds removes more germs than washing for shorter periods.[iii] CDC recommends washing your hands for about 20 seconds, or the time it takes to hum the “Happy Birthday” song twice from beginning to end.
  1. It’s all about technique. Make sure to clean the spots on your hands that people miss most frequently. Pay particular attention to the backs of your hands, in between your fingers, and under your nails. Lathering and scrubbing your hands creates friction, which helps to remove dirt, grease, and germs from your skin.
  1. Don’t forget to dry. Germs can be transferred more easily to and from wet hands, so you should dry your hands after washing.[iv] Studies suggest that using a clean towel or letting your hands air dry are the best methods to get your hands dry.[v],[vi],[vii]
  1. Hand sanitizer is an option. If you can’t get to a sink to wash your hands with soap and water, use an alcohol-based hand sanitizer that contains at least 60% alcohol. Make sure you use enough to cover all surfaces of your hands. Do not rinse or wipe off the hand sanitizer before it is dry.[viii]

Note: Hand sanitizer may not kill all germs, especially if your hands are visibly dirty or greasy,[ix] so it is important to wash hands with soap and water as soon as possible after using hand sanitizer.

Why it Matters

Remember, clean hands save lives. Diarrheal diseases and pneumonia are the top two killers of young children around the world, killing 1.8 million children under the age of five every year.[x] Among young children, handwashing with soap prevents 1 out of every 3 diarrheal illnesses [xi] and 1 out of 5 respiratory infections like pneumonia worldwide.[xii],[xiii]

October 15th is Global Handwashing Day

Handwashing is for everyone…everywhere. Global Handwashing Day is an opportunity to support a global and local culture of handwashing with soap and water, shine a spotlight on the state of handwashing in each country, and raise awareness about the benefits of washing your hands with soap. Although people around the world clean their hands with water, very few use soap to wash their hands because soap and water for handwashing might be less accessible in developing countries.

Get Involved!


[i] Burton M, Cobb E, Donachie P, Judah G, Curtis V, Schmidt WP. The effect of handwashing with water or soap on bacterial contamination of hands. Int J Environ Res Public Health. 2011 Jan;8(1):97-104.

[ii] Burton M, Cobb E, Donachie P, Judah G, Curtis V, Schmidt WP. The effect of handwashing with water or soap on bacterial contamination of hands. Int J Environ Res Public Health. 2011 Jan;8(1):97-104.

[iii] Jensen D, Schaffner D, Danyluk M, Harris L. Efficacy of handwashing duration and drying methods. Int Assn Food Prot. 2012 July.

[iv] Patrick DR, Findon G, Miller TE. Residual moisture determines the level of touch-contact-associated bacterial transfer following hand washing. Epidemiol Infect. 1997 Dec;119(3):319-25.

[v] Gustafson DR, Vetter EA, Larson DR, Ilstrup DM, Maker MD, Thompson RL, Cockerill FR 3rd. Effects of 4 hand-drying methods for removing bacteria from washed hands: a randomized trial. Mayo Clin Proc. 2000 Jul;75(7):705-8.

[vi] Huang C, Ma W, Stack S. The hygienic efficacy of different hand-drying methods: a review of the evidence. Mayo Clin Proc. 2012 Aug;87(8):791-8.

[vii] Jensen D, Schaffner D, Danyluk M, Harris L. Efficacy of handwashing duration and drying methods. Int Assn Food Prot Annual Meeting. 2012 July 22-25.

[viii] Widmer, A. F., Dangel, M., & RN. (2007). Introducing alcohol-based hand rub for hand hygiene: the critical need for training. Infection Control and Hospital Epidemiology, 28(1), 50-54.

[ix] Pickering AJ, Davis J, Boehm AB. Efficacy of alcohol-based hand sanitizer on hands soiled with dirt and cooking oil. J Water Health. 2011 Sep;9(3):429-33.

[x] Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, Rudan I, Campbell H, Cibulskis R, Li M, Mathers C, Black RE; Child Health Epidemiology Reference Group of WHO and UNICEF. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet. 2012 Jun 9;379(9832):2151-61.

[xi] Ejemot RI, Ehiri JE, Meremikwu MM, Critchley JA. Hand washing for preventing diarrhoea. Cochrane Database Syst Rev. 2008;1:CD004265.

[xii] Rabie T and Curtis V. Handwashing and risk of respiratory infections: a quantitative systematic review.Trop Med Int Health. 2006 Mar;11(3):258-67.

[xiii] Aiello AE, Coulborn RM, Perez V, Larson EL. Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis. Am J Public Health. 2008;98(8):1372-81.

Posted on October 14, 2016 by Blog Administrator

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Strengthening The Regional Referral System: Learning from East Java Province


Since 2014, the Indonesian government has been implementing the National Health Insurance (JKN). Accordingly, the health referral system is crucial because it concerns the sustainability of health care ranging from primary health care in puskesmas up to the tertiary level of health care in the hospital, but moreover, because a referral system is needed to ensure that individuals receive optimal care at the appropriate level of health care.

The Minister of Health regulation (Permenkes) No. 1 Year 2012 on Individual Health Care Referral System article 11 (1) requires each health care provider to refer patients when necessary, unless there is a legitimate reason not to, and approved by the patient or their family.

The East Java Province, with support of the Australia – Indonesia Partnership for Health Systems Strengthening (AIPHSS), has issued guidelines specific to the region as a follow up to the Governor Decree SK no 188/786 / KPTS / 013/2013 governing the referral system.

Health check-up at Puskesmas

The Process of Setting Up and Regionalising the Referral System

The setting up of the referral system in East Java was developed based on the results of a case study in the AIPHSS districts in East Java (Sampang, Bangkalan, Situbondo and Bondowoso).

The commitment of the East Java Regional Government- led by the East Java Provincial Health Office- to produce a basic law governing the referral system in East Java province is driven by:

  1. The standard quality is not met by service providers. The health centers and hospital service quality achievement is less than 20%;
  2. Not every district/city has a referral system that regulates the procedures and referral mechanism;
  3. Although there is a governor decree on the referral system, not all of the procedures, workflow, recording and reporting of referral processes are done properly by district/city;
  4. The absence of continuous guidance and supervision for implementing the referral system;
  5. The number of non-compliance cases in the referral system which therefore cannot be financed by BPJS.

The new governor decree is enacted following the seven (7) stages of the improvement process and development of the referral system, namely:

  1. Development of assessment instruments for health clinics and hospitals, including TOT (training of trainers) for Focus Group Discussions (FGD);
  2. Assessment of health facilities and FGD, including mapping of health facilities, DKT for health centers, hospitals, community and Provincial and District Health Office, as well as the analysis of assessment results;
  3. Disseminate the results of the assessment and FGD through workshops at the provincial and district / city;
  4. Development of the referral system model, including the dissemination and finalisation of the referral system model at the provincial and district / city;
  5. Disseminate the referral system model through workshops at the provincial and district / city;
  6. Piloting the referral system including monitoring and evaluation, and drafting guidelines of the referral system in provincial and district / city;
  7. Finalising guidelines of the referral system, including a workshop on the results of the implementation of the referral system.

The Governor’s Decree No. 118/359 / KPTS / 013/2015 determines that the regionalisation of the referral system in East Java is divided into eight (8) regional and tertiary hospitals as follows: 1). RSU Dr. Saiful Anwar, Malang; 2). RSU Haji, Surabaya; 3). Ibn Sina Hospital, Gresik; 4). Sidoarjo Hospital; 5). Jombang Hospital; 6). Iskak Hospital, Tulung Agung; 7). RSU Dr Soedono, Madiun; 8). Dr Soebandi Hospital, Jember. Each hospital serves as a Center of Referral for the surrounding areas.

Learning from East Java, other areas may follow similar steps to develop a referral system in their region using the Governor decree or regional regulation. The process to establish a legal basis for this regulation should involve as many agencies and other relevant stakeholders as possible, as well as community groups, including the private sector and health professional organisations. This can be done through forums, hearings and other similar events according to the local need. These processes are part of the process of improving the understanding of the Health Office and other regional bodies, as well as the process of grounding legislation according to the real need of the people. When the legislation is drafted, these processes should also be applied to members of the Legislature, which upon having a better understanding of health, will provide legislative support to the Governor.


To ensure the sustainable implementation of a regional referral system, the local budget commitment should be allocated and improved for:

  1. Socialisation to the local leaders, staff at health care facilities, and communities;
  2. Supporting health care facilities in order to meet quality standards, more so following the reduction in state budget support;
  3. Provision of technical guidance for health care facilities, including district health care facilities, and monitoring and evaluation in an integrated manner;
  4. Integration of information systems between basic and referral facilities;
  5. Effective cooperation and coordination with BPJS.

TTU Success Story: Strengthening Access to Quality Health Services Reduces Poverty

“With the Bupati regulation on Standard Operation Procedure (SOP) of Individual  Health Referral System, it is expected that morbidity and mortality rate in Timor Tengah Utara (TTU) district could be reduced.        Similarly, the implementation of back referral from RSUD of Kefamenanu to Puskesmas will improve the performance of Puskesmas in providing services to patients.”


“Now the community has been more aware of doing a referral from a Puskesmas both for inpatient and outpatient care. Patients who come to the hospital bring complete  reference letter, so in accordance with the regulation the patients need not pay for  medical treatments. Patients  receive  accurate and quick information about the condition of diseases they have”.

dr. Christina Tarigan, Sp.PD, Head of Medical Committee,  District Hospital Kefamenanu, Timor Tengah Utara

Indonesia has experienced rapid economic growth however health outcomes particularly for women and children in rural communities remains poor.  The weak referral system in Indonesia is an enormous barrier to economic development as people are not able to access appropriate and timely health services.

The effect is crippling for families who have to pay for some health services reducing spending on food and education and the delays in receiving appropriate treatment mean further days off work and loss of income. Women in particular are affected as they are often contributing to household earnings as well as to the care of family members.

However, in Timor Tengah Utara changes to the legislation, policy and practice of health referrals will ensure that the best possible care is provided close to home, making cost-effective use of hospitals and primary health care services.

In 2014 Timor Tengah Utara (TTU) District Health Office in partnership with District Government developed legislation and Standard Operating Procedures (SOP) to clarify the roles and responsibilities of health        facilities in the referral process, improve referral system communication and transport and build capacity at decentralized levels to better provide effective, appropriate and timely health services making efficient use of limited resources.

The District Referral System in TTU —with support from the Australian Government through Australia Indonesia Partnership for Health Systems Strengthening (AIPHSS) Program — will ensure that patients receive optimal care at the appropriate health facility; that facilities are used  optimally and cost-effectively reducing health care costs to both the    district and patients and that patients who need specialist services can    access them in a timely way ensuring that primary health services are well utilized and enhanced.

The  District Referral System is a significant step towards reducing    household poverty by improving access and quality to health care for   rural communities, especially for women and children.

Henti Jantung

Education for Patient, 07 May 2015
PERKI Henti Jantung

Apa itu henti jantung?

Henti jantung adalah hilangnya fungsi jantung untuk memompa darah yang terjadi secara mendadak. Angka kejadian henti jantung atau cardiac arrest ini berkisar 10 dari 100.000 orang normal yang berusia dibawah 35 tahun dan per tahunnya mencapai sekitar 300.000-350.000 kejadian.  Hal ini menyebabkan kurangnya oksigen yang dapat disalurkan ke seluruh tubuh terutama otak dan jantung itu sendiri. Bila kurang oksigen ke otak, maka sel-sel otak akan mati dan hilangnya kesadaran dan fungsi otak lainnya. Pada jantung, sel-sel jantung akan kekurangan oksigen, dan akan mati. Sel-sel  yang telah mati tidak dapat dihidupkan kembali. Bila tidak cepat di tangani, maka dapat berujung pada kematian.

Penyebab dari henti jantung

Kejadian ini dapat disebabkan oleh

  • Gangguan irama jantung
  • Penyakit jantung koroner
  • Abnormalitas lainnya pada jantung

Penyebab lainnya dapat berupa:

  • gangguan metabolik/elektrolit seperti kekurangan kalium dapat menyebabkan gangguan irama jantung
  • pemakaian obat-obatan,
  • keracunan obat,
  • trauma atau kecelakaan

Tanda-tanda waspada:

Tanda-tanda gangguan irama jantung yang dapat menyebabkan henti jantung dapat dirasakan seperti pusing, atau rasa seperti mau pingsan, kehilangan keseimbangan tubuh. Dapat juga langsung terjatuh dan kehilangan kesadaran.

Bila sedang berpegian dan menemukan kerabat ataupun orang lain yang langsung jatuh tergeletak. Cobalah untuk memanggil dan membangunkan orang tersebut. Bila tidak kunjung bangun, panggil bala bantuan dan kalau bisa, lakukan pertolongan pertama yaitu kompresi jantung dan paru (CPR).


by Ang/KM/Su.

Right care, right time, right place: how Lithuania transformed cardiology care

July 2016

Surgeons operate on a patient.

Ministry of Health of the Republic of Lithuania

Long wait times to see specialists. Poor coordination between family doctors and hospitals. Duplicated tests. And some of the highest rates of heart disease-related death in Europe.

They were some of the challenges facing Lithuania 20 years ago, particularly in the country’s eastern region, where mortality from heart disease and stroke was highest, especially among middle-aged men and women outside major cities.

Health officials concluded that many of the problems patients experienced in getting the care they needed stemmed from the way services were organized and provided. Specialist cardiology centres were overstaffed while regional hospitals were understaffed, particularly in rural areas. As a result, patients typically sought out specialists, even for routine matters, cutting primary care providers out of their traditional roles as first contact providers and treatment coordinators. A failure to collaborate left family doctors, workers in regional hospitals and those in tertiary-care centres working in separate silos, unaware of what their colleagues had done.

Transforming cardiology services

In response, health professionals from Vilnius University Hospital Santariskiu Klinikos and health care institutions in Eastern Lithuania founded the Eastern Lithuanian Cardiology Programme (ELCP), which set out to transform the delivery of cardiology services. Their goal: to break down the hospital-centric delivery of care and the inequality of service between urban and rural areas.

“We tried to bring them together and to convince them that organizing services in this way was easier and would avoid more serious problems,” said Prof Aleksandras Laucevicius, leader of the initiative working group from Vilnius University Hospital Santariskiu Klinikos. “That took time.”

Boosting the role of primary care and emphasising the coordination of services proved to be key in reducing the need for hospital outpatient consultations and admissions. A stronger referral system improved the flow of patients among primary care settings, regional hospitals and central and tertiary facilities and training helped to shift the provision of cardiovascular health services to regional hospitals and local clinics.

Patients were taught to manage their disease and given access to their health records, giving them improved awareness of their health and greater confidence that their health providers would be available when they needed them.

The results? The availability of providers increased by 45%, with the biggest increase at secondary-level health care facilities outside the capital city of Vilnius; and the provision of outpatient services across secondary-level hospitals outside Vilnius increased by 26%. Best of all, mortality from heart attack and stroke has dropped, and the prevention and management of risk factors such as high blood pressure, high cholesterol and diabetes has been stepped up, including availability of medication.

Integrating services improves results

“The change has been dramatic,” said Prof Laucevicius. “Integrating services, from cardiovascular prevention to advanced treatment, as well as from the primary care level to specialized secondary and tertiary level , means people are getting the services they need in less time, with improved results.”

Lithuania’s example shows how an integrated, people-centred way of delivering health services pays big dividends to patients, as well as the efficiency of the health system. WHO’s framework on integrated people-centred health services, adopted by WHO’s 194 member states at the World Health Assembly in May 2016, sets out five strategies that countries can pursue to ensure that all people have equal access to quality health services where and when they need them.

“Addressing the needs of people rather than individual diseases, and improving coordination of care, must be the focus of health services and public health programmes,” said Dr Hernan Montenegro, coordinator of WHO’s Services Organization and Clinical Interventions unit. “Countries and communities that make that shift see some important gains: their health services become more effective and efficient, they empower people to take charge of their own health, and they become more trusted by the community.”

WHO is helping other countries and regions learn from Lithuania’s example. A new website on integrated people-centred care provides a database of resources and real-life examples of people-centred health service reform.

The website allows ministries of health, health-care providers, policy-makers and other interested parties to access the latest knowledge on integrated people-centred health services and to build a global network of people who work towards the same goal.

The website for the initiative is a collaboration between WHO and the Andalusian School of Public Health.

Menkes Tegaskan PP RI No. 61 Thn. 2014 tentang Kesehatan Reproduksi Tak Legalkan Aborsi

Menkes Tegaskan PP 61/2014 tentang Kesehatan Reproduksi Tak Legalkan Aborsi
Jakarta, Disahkannya PP No 61 tahun 2014 tentang kesehatan reproduksi menuai kontroversi. Sebab, pasal 31 yang menyebutkan tindakan aborsi hanya bisa dilakukan berdasarkan indikasi kedaruratan medis atau kehamilan akibat perkosaan dianggap melegalkan aborsi.

Menanggapi hal ini, Menteri Kesehatan Nafsiah Mboi menegaskan pasal tersebut mengikuti amanah Undang-undang dan fatwa Majelis Ulama Indonesia, sehingga mestinya jadi payung hukum bagi dokter yang akan melakukan tindakan tersebut.

“PP ini melegalkan aborsi? Tidak, karena aborsi dilarang dengan alasan apapun kecuali ada indikasi kedaruratan medis dan kehamilan akibat perkosaan,” tegas Nafsiah di Gedung Kemenkes, Selasa (19/8/2014).


Apalagi, dalam pasal 34 disebutkan indikasi perkosaan yakni tanpa adanya persetujuan dari pihak perempuan sesuai dengan ketentuan peraturan perundang-undangan. Selain itu, kehamilan akibat perkosaan juga dibuktikan dengan usia kehamilan yang sesuai dengan kejadian perkosaan, yang dinyatakan surat keterangan dokter.

Kemudian, diperlukan keterangan penyidik, psikolog, dan/atau ahli yang berhubungan dengan adanya dugaan perkosaan. Lalu, Nafsiah menambahkan perkosaan merupakan kejahatan seksual yang melanggar Hak Asasi Manusia.

“Jika kedaruratan mengancam jiwa, perkosaan mengorbankan hak perempuan dua kali, sudah jadi korban kejahatan seks, dilanggar pula hak dia untuk memutuskan mampu atau tidak menghidupi anak,” imbuh Nafsiah.

PP ini juga menyesuaikan dengan fatwa MUI No 4 Tahun 2005 dan UU No 36 pasal 75 bahwa pada prinsipnya aborsi dilarang atau dalam fatwa MUI haram hukumnya, terkecuali dalam keadaan darurat (menyangkut kesehatan ibu dan anak) serta untuk korban perkosaan, di mana maksimal usia kehamilan 40 hari sejak hari pertama terakhir haid.

Penyelenggaraan aborsi pun ditegaskan Nafsiah harus dilakukan dokter sesuai dengan standar dan di fasilitas kesehatan yang memenuhi syarat yang ditetapkan menteri.

“PP ini bertujuan agar tiap orang berhak mendapat hak kesehatan reproduksi. Tiap pria dan wanita yang berhubungan seks tanpa kondom maka pasti bisa mengakibatkan kehamilan. Mestinya kalau Anda saling cinta, sebelum menikah janganlah lakukan hubungan seks,” imbuh Nafsiah.

Radian Nyi Sukmasari – detikHealth
Selasa, 19/08/2014 16:28 WIB

Management of difficult multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis: update 2012.


Multidrug-resistant (MDR) tuberculosis (TB) denotes bacillary resistance to at least isoniazid and rifampicin. Extensively drug-resistant (XDR) TB is MDR-TB with additional bacillary resistance to any fluoroquinolone and at least one second-line injectable drugs. Rooted in inadequate TB treatment and compounded by a vicious circle of diagnostic delay and improper treatment, MDR-TB/XDR-TB has become a global epidemic that is fuelled by poverty, human immunodeficiency virus (HIV) and neglect of airborne infection control. The majority of MDR-TB cases in some settings with high prevalence of MDR-TB are due to transmission of drug-resistant bacillary strains to previously untreated patients.


Global efforts in controlling MDR-TB/XDR-TB can no longer focus solely on high-risk patients. It is difficult and costly to treat MDR-TB/XDR-TB. Without timely implementation of preventive and management strategies, difficult MDR-TB/XDR-TB can cripple global TB control efforts. Preventive strategies include prompt diagnosis with adequate TB treatment using the directly observed therapy, short-course (DOTS) strategy and drug-resistance programmes, airborne infection control, preventive treatment of TB/HIV, and optimal use of antiretroviral therapy. Management strategies for established cases of difficult MDR-TB/XDR-TB rely on harnessing existing drugs (notably newer generation fluoroquinolones, high-dose isoniazid, linezolid and pyrazinamide with in vitro activity) in the best combinations and dosing schedules, together with adjunctive surgery in carefully selected cases. Immunotherapy may also have a role in the future. New diagnostics, drugs and vaccines are required to meet the challenge, but science alone is insufficient. Difficult MDR-TB/XDR-TB cannot be tackled without achieving high cure rates with quality DOTS and beyond, and concurrently addressing poverty and HIV.

© 2012 The Authors. Respirology © 2012 Asian Pacific Society of Respirology.