Product Code Database
The World Health Organization (WHO) recommends washing hands for at least 20 seconds before and after certain activities. These include the five critical times during the day where washing hands with soap is important to reduce fecal-oral transmission of disease: after using the toilet (for urination, defecation, menstrual hygiene), after cleaning a child's bottom (changing ), before feeding a child, before eating and before/after preparing food or handling raw meat, fish, or poultry.
When neither hand washing nor using hand sanitizer is possible, hands can be cleaned with uncontaminated ash and clean water, although the benefits and harms are uncertain for reducing the spread of viral or bacterial infections. However, frequent hand washing can lead to skin damage due to drying of the skin. Moisturizing lotion is often recommended to keep the hands from drying out; dry skin can lead to skin damage which can increase the risk for the transmission of infection.
Handwashing with soap is the single most effective and inexpensive way to prevent diarrhea and acute respiratory infections (ARI), as automatic behavior performed in homes, schools, and communities worldwide. Pneumonia, a major ARI, is the number one cause of mortality among children under five years old, taking the lives of an estimated 1.8 million children per year. Diarrhea and pneumonia together account for almost 3.5 million child deaths annually. According to UNICEF, turning handwashing with soap before eating and after using the toilet into an ingrained habit can save more lives than any single vaccine or medical intervention, cutting deaths from diarrhea by almost half and deaths from acute respiratory infections by one-quarter. Hand washing is usually integrated with other sanitation interventions as part of water, sanitation, and hygiene (WASH) programmes. Hand washing also protects against impetigo which is transmitted through direct physical contact.
A 2014 study showed that Saudi Arabia had the highest rate of 97%; the United States near the middle with 77%; and China with the lowest rate of 23%.
Several behavior change methodologies now exist to increase uptake of the behavior of hand washing with soap at the critical times.Abdi & Gautam, R. & O.P, Approaches to promoting behaviour-change around handwashing-with-soap
Group hand washing for school children at set times of the day is one option in developing countries to engrain hand washing in children's behaviors.UNICEF, GIZ (2016). Scaling up group handwashing in schools – Compendium of group washing facilities across the globe. New York; Eschborn, Germany The "Essential Health Care Program" implemented by the Department of Education in the Philippines is an example of at scale action to promote children's health and education.UNICEF (2012) Raising Even More Clean Hands: Advancing Health, Learning and Equity through WASH in Schools , Joint Call to Action Deworming twice a year, supplemented with washing hands daily with soap, brushing teeth daily with fluoride, is at the core of this national program. It has also been successfully implemented in Indonesia.
A 2007 meta-analysis from the University of Oregon School of Public Health indicated that plain soaps are as effective as consumer-grade anti-bacterial soaps containing triclosan in preventing illness and removing bacteria from the hands. Dissenting, a 2011 meta-analysis in the Journal of Food Protection argued that when properly formulated, triclosan can grant a small but detectable improvement, as can chlorhexidine gluconate, iodophor, or povidone.
Contrary to popular belief, scientific studies have shown that using warm water has no effect on reducing the microbial load on hands. Using hot water for handwashing can even be regarded as a waste of energy.
A hand sanitizer or hand antiseptic is a non-water-based hand hygiene agent. In the late 1990s and early part of the 21st century, alcohol rub non-water-based hand hygiene agents (also known as alcohol-based hand rubs, antiseptic hand rubs, or hand sanitizers) began to gain popularity. Most are based on isopropyl alcohol or ethanol formulated together with a thickening agent such as Carbomer (polymer of acrylic acid) into a gel, or a humectant such as glycerin into a liquid, or foam for ease of use and to decrease the drying effect of the alcohol. Adding diluted hydrogen peroxide increases further the antimicrobial activity.
Hand sanitizers are most effective against bacteria and less effective against some viruses. Alcohol-based hand sanitizers are almost entirely ineffective against norovirus (or Norwalk) type viruses, the most common cause of contagious gastroenteritis.
US Centers for Disease Control and Prevention recommend hand washing with soap over hand sanitizer rubs, particularly when hands are visibly dirty. The increasing use of these agents is based on their ease of use and rapid killing activity against micro-organisms; however, they should not serve as a replacement for proper hand washing unless soap and water are unavailable. Despite their effectiveness, non-water agents do not cleanse the hands of organic material, but simply disinfect them. It is for this reason that hand sanitizers are not as effective as soap and water at preventing the spread of many pathogens, since the pathogens remain on the hands.
In situations with limited water supply (such as schools or rural areas in developing countries), there are water-conserving solutions, such as "tippy-taps" and other low-cost options. A tippy-tap is a simple technology using a jug suspended by a rope, and a foot-operated lever to pour a small amount of water over the hands and a bar of soap.
Low-cost hand washing technologies for households may differ from facilities for multiple users.Coultas, M. and Iyer, R. with Myers, J. (2020). Handwashing Compendium for Low Resource Settings: A Living Document. Edition 1, The Sanitation Learning Hub, Brighton: IDS, ( alternative URL) For households, options include tippy taps, bucket/container with tap (such as a Veronica Bucket), conventional tap with/without basin, valve/tap fitted to bottles, bucket and cup, camp sink. Options for multiple users include: adapting household technologies for multiple users, water container fitted to a pipe with multiple taps, water container fitted to a pipe with holes.
Certain environments are especially sensitive to the transmission of pathogenic microorganisms, like health care and food production. Organizations attempting to prevent infection transmission in these environments have started using programmed washing cycles that provide sufficient time for scrubbing the hands with soap and rinsing them with water. Combined with AI-powered software, these technological advancements turn the hand-washing process into digital data, allowing individuals to receive insights and improve their hand hygiene practices.
The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) are clear and straightforward concerning hand hygiene, and recommend paper towels and hand dryers equally. Both have stressed the importance of frequent and thorough hand washing followed by their complete drying as a means to stop the spread of pathogens, like COVID-19. Specifically, the World Health Organization recommends that everyone "frequently clean their hands..." and "dry them thoroughly by using paper towels or a warm air dryer." The CDC report that, "Both clean are effective ways to dry hands."
A study in 2020 found that hand dryers and paper towels were both found to be equally hygienic hand-drying solutions.
However, there is some debate over the most effective form of drying in . A growing volume of research suggests paper towels are much more hygienic than the electric found in many public toilets. A review in 2012 concluded that "From a hygiene standpoint, paper towels are superior to air dryers; therefore, paper towels should be recommended for use in locations in which hygiene is paramount, such as hospitals and clinics."
Jet-air dryers were found to be capable of blowing micro-organisms from the hands and the unit and potentially contaminating other users and the environment up to away. In the same study in 2008 (sponsored by the paper-towel industry the European Tissue Symposium), use of a warm-air hand dryer spread micro-organisms only up to from the dryer, and paper towels showed no significant spread of micro-organisms. No studies have found a correlation to hand dryers and human health, however, making these findings inconsequential.
The purpose of hand-washing in the health-care setting is to remove pathogens ("germs") and avoid transmitting them. The New England Journal of Medicine reports that a lack of hand-washing remains at unacceptable levels in most medical environments, with large numbers of doctors and nurses routinely forgetting to wash their hands before touching patients, thus transmitting microorganisms. One study showed that proper hand-washing and other simple procedures can decrease the rate of catheter-related bloodstream infections by 66%.
The World Health Organization has published a sheet demonstrating standard hand-washing and hand-rubbing in health-care sectors. The draft guidance of hand hygiene by the organization can also be found at its website for public comment. A relevant review was conducted by Whitby et al. Commercial devices can measure and validate hand hygiene, if demonstration of regulatory compliance is required.
The World Health Organization has "Five Moments" for washing hands:
To 'scrub' one's hands for a surgery, it is necessary to have a tap that can be turned on and off without touching it with the hands, some chlorhexidine or povidone-iodine wash, sterile towels for drying the hands after washing, and a sterile brush for scrubbing and another sterile instrument for cleaning under the fingernails. All jewelry should be removed. This procedure requires washing the hands and forearms up to the elbow, usually 2–6 minutes. Long scrub-times (10 minutes) are not necessary. When rinsing, water on the forearms must be prevented from running back to the hands. After hand-washing is completed, the hands are dried with a sterile cloth and a surgical gown is donned.
For control of Staphylococcus infections in hospitals, it has been found that the greatest benefit from hand-cleansing came from the first 20% of washing, and that very little additional benefit was gained when hand cleansing frequency was increased beyond 35%. Washing with plain soap results in more than triple the rate of bacterial infectious disease transmitted to food as compared to washing with antibacterial soap.
Comparing hand-rubbing with alcohol-based solution with hand washing with antibacterial soap for a median time of 30 seconds each showed that the alcohol hand-rubbing reduced bacterial contamination 26% more than the antibacterial soap. But soap and water is more effective than alcohol-based hand rubs for reducing H1N1 influenza A virus and Clostridioides difficile from hands.
Interventions to improve hand hygiene in healthcare settings can involve education for staff on hand washing, increasing the availability of alcohol-based hand rub, and written and verbal reminders to staff. There is a need for more research into which of these interventions are most effective in different healthcare settings.
Hand washing at a global level has its own indicator within Sustainable Development Goal 6, Target 6.2 which states "By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations. The corresponding Indicator 6.2.1 is formulated as follows: "Proportion of population using (a) safely managed sanitation services and (b) a hand-washing facility with soap and water" (see map to the right with data worldwide from 2017)."
One example for hand washing promotion in schools is the "Three Star Approach" by UNICEF that encourages schools to take simple, inexpensive steps to ensure that students wash their hands with soap, among other hygienic requirements. When minimum standards are achieved, schools can move from one to ultimately three stars. Building hand washing stations can be a part of hand washing promotion campaigns that are carried out to reduce diseases and child mortality.
Global Handwashing Day is another example of an awareness-raising campaign that is trying to achieve behavior change.
As a result of the ongoing COVID-19 pandemic, UNICEF promoted the adoption of a hand washing emoji.
Designing hand washing facilities that encourage use can use the following aspects:
| + Cost-Effectiveness of Water Supply, Sanitation and Hygiene Promotion | |
| Hand pump or standpost | 94 |
| House water connection | 223 |
| water sector | 47 |
| Basic sanitation – construction and promotion | ≤270 |
| Sanitation promotion only | 11.2 |
| Hygiene promotion | 3.4 |
In the 1980s, foodborne outbreaks and healthcare-associated infections led the United States Centers for Disease Control and Prevention to more actively promote hand hygiene as an important way to prevent the spread of infection. The outbreak of swine flu in 2009 and the COVID-19 pandemic in 2020 led to increased awareness in many countries of the importance of washing hands with soap to protect oneself from such infectious diseases. For example, posters with "correct hand washing techniques" were hung up next to hand washing sinks in public toilets and in the toilets of office buildings and airports in Germany. Research indicates that the COVID pandemic shifted social norms regarding hand washing, making it more prevalent worldwide.
In Shakespeare's Macbeth, Lady Macbeth begins to compulsively wash her hands in an attempt to cleanse an imagined stain, representing her guilty conscience regarding crimes she had committed and induced her husband to commit.
|
|
