Last updated December 2, 2014
Handwashing and Ebola: the facts
Ebola virus disease is a severe acute viral disease that can spread from animal to human or from human to human, both through direct contact with an infected person or animal’s bodily fluids, or through contact with materials that have been contaminated with these infected bodily fluids. As many as nine out of every ten people who are infected with Ebola virus can die from the disease; in the current outbreak, the average fatality rate is around 50%. For more information about Ebola virus disease, please refer to the World Health Organization factsheet and FAQs and to the WHO/UNICEF questions and answers regarding water, sanitation and hygiene.
For any infection that is transmitted through human to human contact involving bodily fluids, handwashing with soap after any contact (or potential contact) with body fluids is one method to help protect yourself and others from infection. Ebola response teams are working to reach affected and at-risk communities and households with key messages on how to properly wash their hands. As such, behavior change communication is particularly important. The Ebola Communication Network is one resource that provides tools for those working on Ebola behavior change communication efforts; this article is particularly useful.
“Handwashing protection works by washing the infection-causing germs off your hands before they get a chance to infect you, and before you accidentally touch things that could help spread these infection-causing germs to other people,” says Dr Layla McCay, Secretariat Director of the Global Public Private Partnership for Handwashing. “Wet your hands with water, lather with soap for 20 seconds, rinse with running water, and shake your hands dry. Remember: infection-causing germs are too small to see with the naked eye, so you should wash your hands after any possible exposure.”
Handwashing with soap is an important method for protecting yourself and your community from the spread of Ebola virus. Since there has not yet been enough research on Ebola and handwashing, the following handwashing advice is based on the best available evidence and expertise available at present, and may change as more research is conducted and more evidence becomes available.
Please check back regularly for up-to-date, detailed handwashing recommendations to help stop Ebola.
FREQUENTLY ASKED QUESTIONS ABOUT EBOLA
Along with several other protective measures, including avoiding contact with the bodily fluids of anybody who may be infected by Ebola virus, handwashing has a role in preventing the spread of Ebola.
Ebola virus is present in all body fluids of an infected person, and once they become symptomatic, is transmitted by direct contact with these body fluids, including blood, sweat, vomit, diarrhea, urine, saliva, tears, semen and breast milk. Direct contact may involve directly touching infected body fluids, or touching items and surfaces (aka ‘fomites’) like doorknobs that have been recently contaminated with these infected fluids.
Once it is on your hands, Ebola virus can enter your body through breaks in the skin of your hands, or when you touch your eyes, nose or mouth (mucous membranes). Similarly, if you are wearing gloves that have Ebola virus on them, Ebola virus can enter your body if you touch your eyes, nose or mouth with your gloved hands. Finally, when you remove gloves that may have Ebola virus on them, you must wash your hands immediately in case any Ebola virus on your gloves or other protective clothing is transferred to your bare hands during removal.
GENERAL PUBLIC/LOW RISK GROUP: If you have had no known contact with any confirmed or suspected cases of Ebola infection, wash your hands:
WHO guidelines for the general population are here.
CONTACTS/HIGH RISK GROUP: If you have had contact or live with a confirmed or suspected case of Ebola infection:
The above precautions, PLUS wash your hands:
The World Health Organization recommends washing your hands with soap and running water immediately after visiting or taking care of people who are (or may be) infected with the Ebola virus.
HEALTHCARE GROUP: If you work in health services in an at-risk area:
The above precautions, PLUS wash your hands:
Health workers are advised to practice good hand hygiene while treating all their patients, because the time interval from infection to onset of symptoms is from 2 to 21 days – so a diagnosis of Ebola is not always immediately apparent.
It is important to note that neglecting to perform hand hygiene after removing PPE will reduce or negate any benefits of the PPE.
Alcohol-based hand rubs should be made available at every point of care (at the entrance and within the isolation rooms and areas); running water, soap, and single use towels should also be always available. Soap and running water should always be used when hands are visibly soiled.
Further information for healthcare staff is from WHO is available here.
The CDC says the virus can survive on dry surfaces for several hours, and much longer in fluids.
While it can take up to two weeks from diagnosis for a person’s blood to be cleared of Ebola virus, it may persist for longer in other body fluids, for example there is evidence that it can persist in breast milk for up to 15 days, and in semen for up to 7 weeks. You should therefore continue washing your hands after contact with the body fluids, clothing, bed clothes and other fomites of a person convalescing from Ebola virus infection for at least two months after diagnosis to avoid the risk of becoming infected.
HANDWASHING TECHNIQUE TO PREVENT EBOLA
We know that Ebola virus can be killed by: soap, chlorine, alcohol-based hand rub (CDC recommends at least 60% alcohol), very high heat, and exposure to many hours of sunlight.
The preferred way to remove Ebola virus from your hands is with soap and running water. Soap and running water should always be used when hands are visibly dirty/soiled. If hands are not visibly dirty/soiled, you may alternatively use alcohol-based hand rub (at least 60% alcohol).
Some organizations advocate the use of 0.05% chlorine solution in place of, or in addition to, running water as an added precaution. This is acceptable, if water is not available, but note:
You should wash your hands with soap in the usual way:
The whole handwashing process should take 40-60 seconds.
If you are using alcohol-based hand rub, you should apply a palmful of alcohol-based hand rub and use a similar technique as above to cover all parts of your hands, rubbing for 20-30 seconds, and then air dry.
There is a theoretical risk that after using water to wash Ebola virus from your hands, the virus may persist in that water for some time. While there is no definitive or quantitative evidence of this risk, as a precaution, if you are washing your hands after contact with a confirmed or suspected person infected with the Ebola virus, you should dispose of this waste water in a way that does not expose yourself or others to potential infection, for example if your handwashing facility does not have effective water drainage, consider adding extra chlorine to the waste water, or disposing of it in a pit.
If you have washed your hands properly with soap, you should either air dry your hands, or dry them with a clean towel or paper as usual. Do not dry your hands on your clothes or on a dirty towel, as this risks re-contamination with a wide range of germs.