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.
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.
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.
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.
With proper use, all soaps are equally effective at removing the germs that cause diarrheal disease and respiratory infections.
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.
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.
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.
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. A handwashing campaign begun in 2005 in New York City public hospitals has drastically reduced the number of serious infections, such as blood and pneumonia, contracted by hospital patients.
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.
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.
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.