Frequently Asked Questions About Handwashing with Soap. By the Global Public-Private Partnership for Handwashing.
Frequently Asked Questions About Handwashing with Soap.
By the Global Public-Private Partnership for Handwashing.
All content for this article has been culled from www.globalhandwashing.org on 12th October, 2015
Handwashing with soap is one of the most important public health interventions in the world.
Every year, 1.7 million children do not live to celebrate their fifth birthday because of diarrhea and pneumonia. Handwashing with soap is among the most effective and inexpensive ways to prevent these diseases. This simple behaviour can save lives, cutting diarrhea by almost one-half and acute respiratory infections by nearly one-quarter. Handwashing with soap impacts not just health and nutrition, but also education, economics, and equity. We like to call this the HN3E argument.
Handwashing with soap is key to protecting public health and a mainstay in infection control.
However, despite the many benefits associated with this simple behaviour, it is seldom properly practiced. This is why it is essential that we join together to promote handwashing with soap.
Governments, non-governmental organizations, the private sector, religious groups, healthcare facilities, and others can all play an influential role in handwashing promotion, both through project implementation and advocacy.
FAQs – Frequently Asked Questions
Is handwashing with soap really more beneficial than washing with water alone?
Yes! Handwashing with soap is substantially more effective at cleaning your hands than handwashing with water alone. Handwashing with water is preferable to not handwashing at all, but handwashing with soap is much better.
Dr. Stephen Luby and colleagues conducted a study in Bangladesh (available here) that examined the effectiveness of handwashing with soap and water compared to handwashing with water only. The research found that while washing your hands with only water does help reduce the risk of diarrhea, handwashing with soap is substantially more effective.
When should I wash my hands?
The two primary times to wash hands are after contact with feces (such as using the toilet or cleaning a child) and before contact with food (preparing food, eating, feeding a child, and so on). Research has shown that these times have the greatest impact on child health. Handwashing is also recommended after contact with animals, after coughing or sneezing, after contact with a sick person, and if hands are visibly soiled.
What is the correct way to wash hands?
Proper handwashing requires soap and running water. A tap is not necessary for handwashing: running water can also be achieved by pouring water from a basin or other container, or constructing a “Tippy Tap ”—cans or plastic bottles that release just enough for a clean hand wash each time they are tipped.
To wash properly, follow these steps:
- Wet hands
- Cover wet hands with soap
- Scrub all surfaces, including palms, back of the hands, between the fingers, and under the fingernails for about 20 seconds
- Rinse well with running water
- Dry on a clean cloth or by waving in the air
An easy way to gauge 20 seconds is to use a familiar song that lasts for 20 seconds. One such example is “Happy Birthday,” which, when sung twice, is about 20 seconds long.
Why do we recommend 20 seconds for handwashing?
There has not yet been rigorous scientific evaluation of the optimal duration of handwashing with soap, but our experts recommend 20 seconds of scrubbing and rubbing hands with soap as the most effective duration for handwashing for a number of reasons. It seems that scrubbing for 10 seconds is not long enough to achieve a fully effective lather and sufficient friction to properly clean hands. We know scrubbing for 15-20 seconds effectively cleans hands, and there does not appear to be significant extra benefit from scrubbing for longer than 15-20 seconds. Generally, people tend to overestimate how long they spend washing their hands, so aiming for 20 seconds helps ensure people achieve an effective wash.
UNICEF, the U.S. Centers for Disease Control and Prevention, and other expert bodies endorse the 20-second handwashing recommendation. The World Health Organization recommends 40-60 seconds for handwashing, but this encompasses the entire handwashing process from wetting hands and applying soap until hands are fully dried, whereas the 20-second recommendation focuses only on the process of scrubbing hands with soap.
How does handwashing with soap work?
Germs than can cause diseases lodge in dirt, grease, and the natural oils on hands. Water alone does not dislodge them, but adding soap helps break down germ-carrying oils, and soap facilitates rubbing and friction which can remove germs form the hands, and can then be rinsed away with water. Using soap also adds to the time spent washing and ensures a more effective wash. With proper use all soaps are equally effective at removing germs that cause disease.
The clean smell and feeling that soap creates are also incentives for its use.
Do I need clean water for handwashing?
Water for handwashing does not have to be as clean as drinking water, but it should not be contaminated with fecal bacteria. Water that has been used for other purposes, such as cleaning dishes, can be reused for handwashing. Even when clean water is not available, handwashing can still be effective: research has found that washing hands with soap even using likely very contaminated water from the municipal water supply still delivered health benefits including diarrhea reduction.
What temperature should water used for handwashing be?
The temperature of the water does not make a difference in handwashing with soap.
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?
Access to soap is not universal. Where soap is available, particularly in poorer households, it may not be designated for handwashing due to its perception as a precious commodity. Rather, soap may be used for laundry, bathing, and washing dishes.
Where soap is not available or difficult to obtain for handwashing, soapy water is an effective low-cost alternative. Otherwise, handwashing with other cleansing agents like ash can help remove bacteria from hands. Even washing hands with water alone can help reduce diarrhea, though using soap delivers substantially greater health impact.
It is important to note that handwashing stations without soap can be a significant barrier to effective handwashing in schools. This is a significant concern, as handwashing stations and toilets at schools are critical to student health and reduced absenteeism. Parent groups, communities, and governments can all contribute to addressing this issue through working together to raise awareness about the importance of handwashing with soap and ensure that these essential supplies are readily available.
Can alcohol-based hand sanitizers be used instead of handwashing with soap?
Waterless hand cleansers, such as those containing alcohol or alternative agents such as chlorhexidine or hexalkonium may be useful, particularly in healthcare settings, including labor and delivery wards, and for the newborn period, and for times where access to soap and water is challenging, for example as part of disaster management. However, the feasibility and scalability of waterless options for hand cleansing to improve child health in the general population is currently limited due to a lack of robust supply chains and the cost of the product.
If hands are visibly soiled, handwashing with soap should always be used.
What should I do if I don’t have handwashing facilities? What equipment do I need to set up a handwashing station?
Handwashing station designs vary depending on the context, but they should always have clean water and soap. In schools, for example, construction of a group handwashing station can ensure that many students are able to wash their hands prior to eating their mid-day meal.
The PPPHW has many resources that can be useful for those looking to construct handwashing stations. Some recommended tools are:
Do you have an innovative handwashing station design? Share it with us!
Where should I set up handwashing stations?
Handwashing stations should be located so they are convenient to use at the critical times, such as before handling food or after using the toilet. If water for handwashing is unavailable, or far from the toilet, food preparation area, food consumption area, or far from the soap, this can reduce the likelihood of handwashing. The location of a handwashing station should serve as a reminder or ‘cue to action’ when people leave the latrine or are about to cook or feed.
Handwashing stations can vary in sophistication and design, but they should always have water and soap and be conveniently located.
How can I ensure people wash their hands habitually?
Sustaining handwashing is very important. Unlike other health interventions, such as vaccines, handwashing must be practiced consistently to work. It must be a habit that people automatically and regularly perform at critical times. This requires first that people have the tools necessary to wash their hands (soap and water) and that they are reminded or persuaded to do so on a regular basis.
To help answer this difficult question, we hosted a webinar with the USAID/WASHplus project on handwashing and the science of habit formation. This webinar can be viewed here. A whitepaper on the topic is forthcoming.
If people know they should wash their hands, won’t they automatically do so?
Unfortunately, knowledge does not automatically translate into consistent action. Globally, people wash their hands only 19 percent of the time after using the toilet or changing a child’s diaper. In some parts of the world, people wash their hands with soap just 1-2 percent of critical times. People need to be motivated to change their handwashing behaviour, and knowledge is only one component that may nudge someone toward that new behaviour.
For this reason, it is important to learn from other sectors about what methods work to promote sustainable behaviour change. We know from the private sector that emotional drivers, such as nurture or disgust, are powerful motivators. The SuperAmma campaign is one example of how these drivers have been successfully incorporated into a handwashing promotion initiative.
Given the critical role that behaviour change plays in handwashing, the PPPHW is a thought leader in this area and we connect practitioners with the latest knowledge on behaviour change through our Handwashing Behaviour Change Think Tanks.
Do you have questions about handwashing behavior change? Ask us and we might include them in an upcoming Think Tank.
How can you change people’s handwashing behaviours?
Practitioners in the water supply, sanitation, and hygiene (WASH) sector and soap manufacturers are learning about what works—and what doesn’t—in changing private, personal behaviours and habits. What does not work is top-down, technology-led solutions or campaigns that hinge primarily 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 research and studies the interests, attributes, needs, opportunities, and motivations of different people within communities. It is also based on the recognition that messaging and drivers vary depending on audience and context. These programs reach their target audiences using mass media and interpersonal communication with messages that respond to their 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 learn from successful interventions in other sectors. Evidence from reproductive health programs demonstrates that paying attention to consumer needs is both essential and effective, and that despite clear health benefits from a behaviour, health is not always the most effective motivator. For example, an overweight man may be more strongly motivated to lose weight by the promise of a change in his appearance than by the health benefits that weight loss would deliver. Sanitation programs have successfully generated community demand for toilets and latrines by appealing to the desire for status, acceptance, community solidarity, privacy, convenience, safety, and comfort. These lessons can be applied to handwashing with soap.
Learn more about handwashing behaviour change here.
Which diseases does handwashing with soap help to prevent?
Handwashing with soap helps prevent gastrointestinal diseases like diarrhea; respiratory diseases like pneumonia and influenza; and other infections such as Ebola and healthcare-associated infections. Handwashing with soap may help prevent soil-transmitted helminth infections, which infect over 1.5 billion people. Further information about the significant role that handwashing plays in promoting health can be found on the About Handwashing page.
Does handwashing have any benefits beyond health?
In addition to its impact on health, handwashing also benefits nutrition, education, equity, and the economic development of countries. Read about these benefits on our Why Handwashing page.
Are poor handwashing behaviours only a problem only in developing countries?
Globally, less than a fifth of people currently wash their hands properly at critical times. 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 at critical times.
What is Global Handwashing Day?
Founded by the PPPHW, Global Handwashing Day is an annual global advocacy day dedicated to increasing awareness and understanding about the importance of handwashing with soap as an easy, effective, and affordable way to prevent diseases. It is an opportunity to design, test, and replicate creative ways to encourage people to wash their hands with soap at critical times.
Global Handwashing Day is designed to:
- Foster and support a global and local culture of handwashing with soap
- Shine a spotlight on the state of handwashing around the world
- Raise awareness about the benefits of handwashing with soap
To learn more about Global Handwashing Day, including how you can celebrate, please visit www.globalhandwashingday.org
When is Global Handwashing Day?
Global Handwashing Day is celebrated annually on October 15. This is an excellent opportunity to spread the word about the importance of handwashing with soap, which should be practiced and promoted throughout the year.
What is this year’s theme?
The theme for Global Handwashing Day changes each year; the 2015 theme has not yet been decided. If you have a theme that you would like to suggest, please contact us here.
Where can I get advice or suggestions of things I can do for Global Handwashing Day?
The Planner’s Guide is the main source of information and tools for planning a Global Handwashing Day celebration. The PPPHW’s Global Handwashing Day website also provides many resources, such as posters. Celebration ideas for various audiences can be found here. Activity suggestions are available here.
What are examples of successful GHD activities others have done?
Can I register or promote the GHD activities I am organizing?
Yes! Please let the PPPHW what activities you are planning ahead of time by completing this form. We will then add your event to our index allowing us to know what events are planned globally. This can also help us connect you with potential partners. After your event, please upload pictures and a report to the interactive Global Handwashing Day website.
How can I find others near me who are doing GHD activities?
One way to find Global Handwashing Day activities near you is to reach out to similar organisations. This can provide an opportunity to collaborate with like-minded organisations. You can also contact the PPPHW to see if any events in others in your region have registered an event.
How can I fund the activities I want to do for GHD?
While the PPPHW is unable to provide funding for specific Global Handwashing Day events due to overwhelming global demand, there are many ways to secure funding for Global Handwashing Day activities or materials. Collaborating with other organisations is one way to reduce the cost of events.
The PPPHW offers a number of resources that can help guide individuals who are working on handwashing promotion projects. These include:
- Our free handwashing behaviour change programdistance learning course
- Findings from our annual handwashing behaviour changethink tank
- Awebinar on handwashing and the science of habit
- Listing of behaviour changetheories and models
Other key resources that might be of interest to implementers are available here.
Have more questions? Contact us, as we would love to help!
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