As a solo Family Medicine physician in Cincinnati, Ohio for 33 years I have been teaching/coaching/changing patient’s behavior to benefit their health as well as being the creator of the Henry the Hand Infection Prevention Program training adults and children about the 4 Principle of Hand Awareness

4 Coronavirus Prevention Tips that Work:

    • 1.Do Not touch your eyes, nose or mouth (i.e. facial mucous membranes =T Zone) the portal of entry for ALL respiratory infections. Wear a face shield (clear plastic shield) to change this unconscious behavior.
    • 2. Handwash/sanitize regularly before eating and when arrive home.
    • 3. Clean commonly touched surfaces regularly (more frequently if active disease is present).
    • 4. Follow the 4 Principles of Hand Awareness

33 years of Family Medicine and changing human behavior as a keen interest I created a Hand (Hygiene) Awareness program in 1990’s that all thought was for children, when in reality targeted adults. Then SARS (2002-3) impacted Toronto I developed a simple strategy to help the healthcare worker (and others) break the habit of touching the facial mucous membranes wearing a face shield when seeing a sick patient. I haven’t been sick with a respiratory infection in 17 years! Only seasonal allergies.

Your facial mucous membranes are the eyes, nose and mouth we call the T Zone are the only portal of entry into the human body for ALL respiratory infections including coronavirus and flu. So, if you break this unconscious habit the result is you will not give yourself the coronavirus. I have developed tools to help you break the habit.

How do you break this unconscious habit of touching your facial mucous membranes?

First, you need to have the knowledge that the facial mucous membranes are THE portal of entry for ALL respiratory infections, then have enough interest (self-efficacy) to want to be healthy and need to develop better Hand Awareness practices (mindfulness around your hands). Hand Awareness is knowing where your hands are and what they are doing at ALL times.

The first method we implement the use of a barrier method, a self-teaching tool face shield (health shield) which is a clear plastic barrier that alerts you to how many times you try to touch your face. This increases your awareness so you can begin to “extinguish” the unconscious habit. As you wear the face shield you become more mindful of the position of your hands (hand awareness). Ultimately the muscle movement and hand motion when you raise your hand to touch your T Zone initiates a conscious alert that you are attempting to touch your face. Yes, it is the repetition and practice of wearing the face shield to effectively change the unconscious habit. While wearing the face shield you can breathe, wear glasses, speak clearly and simple push up to eat. Now with your new knowledge that ALL respiratory infections only enter through your facial mucous membranes (T Zone) and your new muscle memory you begin to “extinguish” this bad habit. Then you need to have enough interest in staying well by not contracting an infectious disease (self-efficacy). In addition, the face shield also serves as a protective device when being around sick people or doing patient care as the shield blocks the respiratory droplets from hitting your facial mucous membranes someone might “spray” out when you are directly in front of them within 3 feet. Remember, we humans are the factory that replicates the viruses once inside us, so If enough of us stop touching (self-inoculating) our T Zone there will never be another epidemic or pandemic. With a large enough population of people complying with this correct hand hygiene behavior the result creates the BEST vaccine-like effect to protect your community and yourself from any respiratory infection!

Second technique, for those not keen on the face shield techniques, is to wear gloves. Gloves increase your awareness of your hands as they simply modify your tactile response to daily activity can cause mild harm or irritation when putting your fingers into your eyes, nose or mouth. This change in your tactile (hand sensation) serves as a gentle reminder of where your hands are and what they are doing which is the beginning of becoming more mindful of your hands (Hand Awareness).

A third technique to help groups who are interested in improving their hand hygiene awareness behavior is to use our operant conditioning re-training tool which is commonly called a clicker, also used to train dogs. This technique modestly invokes the Hawthorne effect as people are aware that they are being monitored. We adapted for use in committee or any congregation of people to alert the group that someone is touching the T Zone.  Sounds adolescent but the morbidity and mortality from respiratory infections may be worth helping maintain co-workers and community health. Particularly with the recent Coronavirus news a little “disruptive innovation” may save a life and help mitigate the infectious disease agent impact on a community

What was your motivation for this effort of the T Zone?

I saw the benefit in my practice since 1986 and when we had children in late 80’s and early 90’s it became more personal. As I developed the knowledge that viral infections are a leading cause of many chronic diseases (Diabetes, thyroiditis, Rheumatoid Arthritis, etc.) and the severe complications of acute diseases and realized that NO ONE in Public Health and health care was teaching the critical role that the facial mucous membranes (T Zone) play in an individual’s health. Since 1986 as a family medicine physician I have been a teacher/coach for patients on how to change their personal behaviors for better health outcomes. Personally being the allergic and asthmatic individual which can lead to increased facial mucous membrane touching (rubbing itching etc.) combined  with one particular event 17 years ago when looking into a patients throat and doing a swab they coughed in my face and I felt the droplets hit my face and two days later I manifested the symptoms the patient had. Since then I have worn a Healthshield (face shield) when seeing a patient suspected of having a respiratory infection and have not been sick with a respiratory infection. Although Spring and Fall allergies can still be challenging for my respiratory symptoms. Finally, the knowledge that healthcare workers in Toronto accounted for the majority of the deaths from SARS (2003).

What are the 4 Principles of Hand Awareness?

The 4 Principles of Hand Awareness which are listed below are the foundation for a hand hygiene education curriculum created in the 1990’s and uses Henry the Hand Champion Handwasher as the spoke teacher/coach/change agent so the message has better retention. It is a science-based adult and children’s program that uses effective multi-media strategies and to help individuals become more mindful of their hands (Hand Aware) to benefit their health.

  1. WASH your hands when they are dirty and BEFORE eating.
  2. DO NOT cough into your hands.
  3. DO NOT sneeze into your hands.
  4. Above all, DO NOT put your fingers into your eyes, nose, or mouth.

The 4 Principles of Hand Awareness have been endorsed by the AMA and AAFP in 2001.

Further detail, these principles are the basis for the Hand Hygiene program I created that started when my children were in daycare in the early 90’s in order to help them stay well.  We gave baby wipes to the daycare and asked them wipe every child’s hands 4 times per day and taught the staff and children to “cough /sneeze” into their elbow, not their hand. At home, I played with a sock “henry the Haand” asking the children if they had or directed them to wash their hands. They were healthier than other children in the neighborhood who were cared for at home. As my wife is and has been the office manager for my solo practice since 1986. Seeing the benefit to my family I created a character Henry the Hand Champion Handwasher and a curriculum in a Tool Kit to teach both adults and children. Furthermore, I created the Henry the Hand Foundation in 2001 because I saw this would reduce the impact of infectious disease on the individual and public health. Leading to healthier learners and to better prepare students for careers in health care, public health, food service, and many other industries where being mindful of your hand behavior is important.

Finally to document this unconscious behavior I reached to UCCOM to help me with a study which Nancy Elder MD helped me implement and get published.

Hand Hygiene and Face Touching in Physician Offices:

https://www.jabfm.org/content/27/3/339/tab-references