Global Handwash Day
October 15 is Global Handwashing Day, a global advocacy day dedicated to increasing awareness and understanding about the importance of handwashing with soap as an effective and affordable way to prevent diseases and save lives.
This year’s theme “Clean Hands for All” follows the push to leave no one behind in the Sustainable Development Agenda. Inequalities in handwashing facilities and effective handwashing promotion programs can put individuals at higher risk for diseases that impact their health, education, and economic outcomes.
Handwashing with soap is a “do-it-yourself vaccine” that prevents infections and saves lives.
Here is why: Human feces are the main source of diarrheal pathogens. They are the source of shigellosis, typhoid, cholera, all other common endemic gastro-enteric infections and some respiratory infections such as influenza and pneumonia. A single gram of human feces can contain 10 million viruses and one million bacteria.
These pathogens are passed from an infected host to a new one via various routes but all of these illnesses emanate from feces. Removing excreta and cleaning hands with soap after contact with fecal material – from using the toilet or cleaning a child – prevents the transmission of the bacteria, viruses and protozoa that cause diarrheal diseases.
Other measures (food handling, water purification, and fly control) have an impact on these diseases as well, but sanitation and handwashing provide the necessary protection against fecal contact. They start by creating initial barriers to fecal pathogens from reaching the domestic environment. Handwashing with soap stops the transmission of disease agents and so can significantly reduce diarrhea and respiratory infections, and may impact skin and eye infections.
Research shows that children living in households exposed to handwashing promotion and soap had half the diarrheal rates of children living in control neighborhoods. Because handwashing can prevent the transmission of a variety of pathogens, it may be more effective than any single vaccine. Promoted on a wide enough scale, handwashing with soap can be thought of as a “do-it-yourself” vaccine because it is easy, effective, and affordable. Ingraining the habit of handwashing could save more lives than any single vaccine or medical intervention.
Lesson learned: Two key actions isolate fecal material and prevent it from reaching the environment and the four F’s:
- Adequately disposing of adult and child feces and
- Handwashing with soap after using a toilet or cleaning a child after defecation.
Some respiratory tract infections, including influenza H1N1 and the SARS-causing coronavirus, are also transmitted in part by the hands. Proper handwashing with soap is an effective preventative measure against these infections as well.
- Feces are the source of diarrheal pathogens, microscopic “bugs”.
- If not disposed of safely, these bugs enter the environment and are then spread by the four Fs: flies, fingers, fluids, and surfaces such as fields. Blocking these routes of transmission is critical to the prevention of diarrheal disease. Which of the many possible hygiene practices would eliminate the most diseases?
- Boiling or disinfecting water in the home would reduce diarrhea, but preventing fecal pathogens from ever reaching household water is likely better and more cost-effective. Similarly, while foods should be reheated carefully to kill bugs that have multiplied during storage, preventing fecal pathogens from ever reaching food is more effective.
- Failure to do so results in new diarrheal infections.
Diarrheal disease and respiratory tract infections are the two biggest killers of children in the developing world.
The simple act of washing hands with soap can significantly cut the risk of diarrhea (from 30 percent to 50 percent) and that of respiratory tract infection (from 21 percent to 45 percent)
UNICEF estimates that diarrhea kills one child every 30 seconds. Scientific research shows that handwashing with soap prevents disease in a more straightforward and cost-effective way than any single vaccine.
Handwashing with soap thus represents a cornerstone of public health. It can be considered an affordable, accessible “do-it-yourself” vaccine.
- Helps prevent the spread of disease: Handwashing with soap works by interrupting the transmission of pathogens that cause disease. Hands often act as vectors that carry disease-causing pathogens from person to person through direct contact or indirectly via surfaces and foods. Together, soap and water form a formidable ally in efforts to combat a host of other illnesses, such as helminthes (worms), eye infections like trachoma, and skin infections like impetigo.
- Cost-effective: The isolation and safe disposal of feces and the provision of adequate amounts of clean water are essential, but handwashing with soap is one of the most effective and least expensive ways to prevent diarrheal diseases.
The World Health Organization (WHO) estimates that diarrheal infections claim the lives of 1.87 million children under five each year, making diarrhea the second-most common cause of death among children under five.
Diarrheal diseases are often described as water-related, but they are more accurately excreta-related since the pathogens come from fecal matter. These pathogens make people ill when they enter the mouth via hands that have been in contact with feces. Handwashing with soap breaks the disease cycle.
Acute respiratory infections
Acute respiratory infections such as pneumonia are another primary cause of child deaths. Handwashing reduces the rate of respiratory infections in two ways: by removing respiratory pathogens found on hands and surfaces; and by removing other pathogens (in particular, enteric viruses) found to cause diarrhea and respiratory symptoms. Evidence suggests that better hygiene practices – washing hands with soap after defecation and before eating – could cut the infection rate by about 25 percent.
A study in Pakistan found that handwashing with soap reduced the number of pneumonia-related infections in children under five by more than 50 percent, as well as skin infection – impetigo – by 34 percent.
Intestinal worm infections
Research shows that handwashing with soap reduces the incidence of infections like intestinal worms, especially ascariasis and trichuriasis. While more evidence is needed, existing research points to the effectiveness of handwashing in reducing the incidence of these diseases.
Benefits beyond Health
The cost-effectiveness of handwashing
Handwashing with soap is the single most cost-effective intervention and it reduces disability-adjusted life years (DALYs) related to diarrheal diseases by a significant margin.
Research suggests that soap is available in most households in the world, including poor households in developing countries although it is primarily used for bathing and washing clothes.
What are DALYs?
The term DALYs (Disability-Adjusted Life Years) is used to measure the burden of disease and the effectiveness of health interventions by combining information on the “years of life lost” and the “years lived with disability”.
Impact on education
- Handwashing with soap can mean more school days for children.
- Diarrhea is responsible for children missing hundreds of millions of school days every year. By having children integrate the habit of handwashing with soap in their daily routines, school absenteeism could be reduced substantially. A recent study suggests that handwashing with soap at critical times could help reduce school absenteeism by around 42 percent. (Bowen et al, 2007)
- For this to happen, children must have access to soap in schools. Unfortunately, this is not always the case. UNICEF and IRC conducted research in 2006 by in six developing countries that showed low rates of soap availability in schools. The report concluded, “ensuring students’ access to soap is urgently needed.”
What are the benefits of handwashing with soap?
- Each year, diarrheal diseases and pneumonia together kill 2 million children under five in developing countries. Children from the poorest 20 percent of households are more than 10 times as likely to die as children from the richest 20 percent of households. Hands are the principal carriers of disease-causing germs: if widely practiced - and based on scientific research and intensively monitored trials at both household and school levels - it is estimated that and handwashing with soap could avert one million of those deaths. Washing hands with soap after using the toilet or cleaning a child and before handling food can reduce rates of diarrheal disease by nearly one-half and rates of respiratory infection by about one-quarter. Handwashing can also prevent skin infections, eye infections, intestinal worms, SARS, and avian flu. It can also benefit people living with HIV/AIDS.
Why isn’t it enough to rinse hands with water alone?
- The more common practice of rinsing hands with water alone is significantly less effective than washing hands with soap. Fecal pathogens lodge in the natural oils of hands, and water alone will not dislodge them. Using soap adds to the time spent washing, removes the oils carrying most germs, and leaves hands smelling pleasant. The clean smell and feeling that soap creates is an incentive for its use.
What are the “critical moments” when hands should be washed with soap?
- Hands should be washed with soap after using the toilet or cleaning a child’s bottom and before handling food – e.g., before cooking, eating, and feeding a child.
What is the “correct” way to wash hands?
- Proper handwashing requires soap and only a small amount of water. Running water from a tap is not necessary; a small basin of water or “Tippy Tap” - cans or plastic bottles that release just enough for a clean hand wash each time they are tipped - is sufficient. One should cover wet hands with soap; scrub all surfaces, including palms, back, between the fingers, and especially under fingernails for about 20 seconds; rinse well with running water rather than still water, and dry on a clean cloth or by waving in the air. An easy way to gauge 20 seconds is to find a familiar song that takes about that long to sing; for instance, it takes about 20 seconds to sing the “Happy Birthday” song twice. Every country has short, popular children’s songs that can be used for this purpose.
Is antibacterial soap better than regular soap at stopping the spread of disease?
- With proper use, all soaps are equally effective at removing the germs that cause diarrheal disease and respiratory infections.
What about people who don’t have access to soap?
- Lack of soap is not a significant barrier to handwashing at home. The vast majority of even poor households have soap in their homes. Research in peri-urban and rural areas found that soap was present in 95 percent of households in Uganda, 97 percent of households in Kenya, and 100 percent of households in Peru. The problem is that soap is rarely used for handwashing. It is more often used for laundry, bathing, and washing dishes. Additionally, soap is often perceived as a precious commodity, and so families may be reluctant to use it for handwashing.
- However, lack of soap can be a barrier to handwashing at schools which, in developing countries, rarely have either soap or appropriate handwashing facilities. Building Tippy Taps and getting help from parents’ groups to supply soap or to create a small fund for soap are good options. In schools, toilets and handwashing stations are critical to students’ health and to reducing absenteeism.
How clean does water have to be for effective handwashing?
- So far, research has found that handwashing with soap and running water reduces the risk of diarrhea and respiratory diseases, irrespective of water quality.
Can handwashing with soap make a difference in overcrowded, highly contaminated slum environments?
- Yes. A study in Karachi, Pakistan found that children in communities that received intensive handwashing interventions were half as likely to get diarrhea or pneumonia as children in similar communities that did not receive the intervention.
Once people understand the health benefits of handwashing with soap, won’t they automatically do it?
- No. Human beings the world over fail to do things they should do. If they did, everyone would maintain a healthy weight, no one would smoke or drink to excess, and all of us would rise at dawn for an hour of cardiovascular exercise.
Is lack of handwashing with soap a problem only in developing countries?
- Even in places where handwashing is a comparatively entrenched practice and both soap and water are plentiful, people often fail to wash their hands with soap. A study in England found that people washed their hands only about half the time after cleaning a child after defecation; a recent study of doctors’ handwashing practices in the USA revealed that they failed to wash their hands with soap between patient visits with surprising frequency. Medical personnel who fully understand the health benefits of handwashing with soap often failed to do so because of lack of time, because of rough paper towels for drying, inconveniently located sinks, and hands chapped by frequent washing with drying soaps. However, handwashing with soap remains very important in the industrialized world.
How can you change people’s handwashing behaviors?
- Practitioners in the water supply, sanitation, and hygiene sector and soap manufacturers are learning about what works – and what doesn’t – in changing private, personal behaviors and habits. What doesn’t work is top-down, technology-led solutions or campaigns that hinge on health education messages. What is more effective is using approaches that build on the lessons of social marketing. This approach emphasizes the role of careful formative research (a thorough study of the interests, attributes, needs, opportunities, and motivations of different people within a community). It is also based on the recognition that one size does not fit all and on evidence showing that promoting a single message is more effective than promoting multiple messages. These programs seek to reach and influence their target audiences using multiple mass media and interpersonal communication channels with specific messages designed to respond to expressed needs and preferences. In short, best results come from treating people as active customers motivated by a diverse range of preferences and motivations, rather than passive project beneficiaries.
- There is much to be learned from successful interventions in other sectors. Evidence from reproductive health programs shows that paying attention to consumer needs and preferences works better than imposing top-down targets. Similarly, approaches that create incentives for positive provider attitudes and behaviors get better results than those that rely on targets and punitive management practices. Successful sanitation programs generate community demand for toilets and latrines by appealing to people’s desires for status, acceptance, community solidarity, privacy, convenience, safety, and comfort; appeals to health tend to be significantly less effective in motivating behavioral change. The non-health motivations can be compared to the reasons people try to lose weight; maintaining a healthy weight is very important to one’s health but people generally go on diets to look better.
Whose handwashing behaviors are the handwashing promotion programs aiming to change?
- Mothers and other caregivers of children under five are the primary target groups of PPPHW programs. School-age children, who are often caregivers for younger siblings are another target group for handwashing programs. School programs could help establish lifelong healthy habits.
Who else can take part in promoting handwashing with soap?
- Everyone can contribute to promoting handwashing with soap! A good first step is to find out and build on what individuals and organizations are already doing. WASH (Water, Sanitation, and Hygiene) coalitions' campaigns – national alliances of governments, parliamentarians, NGOs, media, religious leaders, community groups, schools, private sector actors, and other stakeholders – are active in many countries. WASH campaigns aim to advance hygiene and sanitation goals.
Source: The Global Public-Private Partnership for Handwashing (PPPHW)