Hand washing with soap

Hand washing with soap is the act of cleansing the hands with soap for the sanitary purpose of removing soil and/or microorganisms.

October 15 has been appointed to become Global Handwashing Day in accordance with year 2008 as the International Year of Sanitation by the UN. Handwashing with soap is among the most effective and inexpensive ways to prevent diarrheal diseases and pneumonia, which together are responsible for the majority of child deaths [ en [http://www.globalhandwashingday.org/Planners_Guide_Global_Handwashing_Day.pdf Planner's Guide for Global Handwashing Day] ] . This behavior is projected to become a significant contribution to meeting the Millenium Developement Goal of reducing deaths among children under the age of five by two-thirds by 2015 [ en [http://www.globalhandwashingday.org/Planners_Guide_Global_Handwashing_Day.pdf Planner's Guide for Global Handwashing Day] ] .

Hands often act as vectors that carry disease-causing pathogens from person to person, either through direct contact or indirectly via surfaces. Human spread bacteria by constantly touching other people's hand, hair, nose, and face. Hands that have been in contact with human or animal feces, bodily fluids like nasal excretions, and contaminated foods or water can transport bacteria, viruses and parasites to unwitting hosts. Hand washing with soap works by interrupting the transmission of disease [ en Lorna Fewtrell, Kaufmann R.B., Kay D., Enanoria W., Haller L., dan Colford J.M.C., Jr 2005. "Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: A systematic review and meta analysis." The Kancet Infectious Diseases, Vol. 5, Issue 1:42-52. Also, Curtis, V. and Cairncross, S. 2003. "Effect of washing hands with soap on diarrhoea risk in the community: A systematic review." The Lancet Infetious Diseases, Vol.3, May 2003, pp 275-281. ] .

Washing hand with water alone is significantly less effective than washing hands with soap in terms of removing germs. Although using soap in hand washing breaks down the grease and dirt that carry most germs, using soap also meant additional time consume during the massaging, rubbing, and friction to dislodge them from fingertips, and between the fingers, in comparison with just using water for handwashing. For effective hand-washing with soap takes 8 - 15 seconds, followed by thorough rinsing with running water [ en [http://sciencelinks.jp/j-east/article/200321/000020032103A0678807.php Effective Hand-washing with Non-medicated Soap for Removing Bacteria] ] .

Another incentive for soap's use is it leaves hands smelling pleasant.

Disease prevention in handwashing with soap

Handwashing can prevent diarrhoeal disease (which can include shigellosis, typhoid and cholera) [ en [http://www.lboro.ac.uk/well/resources/fact-sheets/fact-sheets-htm/Handwashing.htm WELL Factsheet] ] , acute respiratory infections (including SARS and bird flu [ en [http://discuss.worldbank.org/content/interview/detail/3939/ World Bank: Speak Out interview with François Le Gall: New Global Threats] ] ), helminth infections (especially ascariasis [ en [http://www.lboro.ac.uk/well/resources/fact-sheets/fact-sheets-htm/Handwashing.htm WELL Factsheet] ] ), and eye infections [ en [http://www.lboro.ac.uk/well/resources/fact-sheets/fact-sheets-htm/Handwashing.htm WELL Factsheet] ] .

In a research published by British Medical Journal on November 2007, physical barriers, such as regular handwashing and wearing masks, gloves and gowns, may be more effective than drugs to prevent the spread of respiratory viruses such as influenza and SARS. The findings was published as Britain announced it was doubling its stockpile of antiviral medicines in preparation for any future flu pandemic. The researchers found that simple, low-cost physical measures should be given higher priority in national pandemic contingency plans. Other evidence suggests that the use of vaccines and antiviral drugs will be insufficient to interrupt the spread of influenza says the report. Handwashing and wearing masks, gloves and gowns were effective individually in preventing the spread of respiratory viruses, and were even more effective when combined. However, further trials needed to evaluate the best combinations. Another study, published in the Cochrane Library journal on 2007, finds handwashing with just soap and water to be a simple and effective way to curb the spread of respiratory viruses, from everyday cold viruses to deadly pandemic strains. [ en [http://www.reuters.com/article/healthNews/idUSSHA25252620071128 Reuters: Handwashing more useful than drugs in virus control] ]

Another research conducted by the world bank regarding health policy shows that health measurement like hand washing with soap did not get enough promotion compares to the promotion of influenza drugs by the medical staff. This happening worsen for people living in isolated location and difficult to reach by mass media (like radio and TV) [ en [http://siteresources.worldbank.org/DEC/600659-1109953265771/20382853/17901_Weak_Links.pdf Weak Links in the Chain II: A Prescription for Health Policy in Poor Countries] ] .

* Diarrheal disease. A review of more than 30 studies found that handwashing with soap cuts the incidence of diarrhea by nearly half. Diarrheal diseases are often described as water-related, as the pathogens come from fecal matter and make people ill when they enter the mouth via hands that have been contact with feces, contaminated drinking water, unwashed raw food, unwashed utensils or smears on clothes. Research shows [ en Lorna Fewtrell, Kaufmann R.B., Kay D., Enanoria W., Haller L., dan Colford J.M.C., Jr 2005. "Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: A systematic review and meta analysis." The Kancet Infectious Diseases, Vol. 5, Issue 1:42-52. Also, Curtis, V. and Cairncross, S. 2003. "Effect of washing hands with soap on diarrhoea risk in the community: A systematic review." The Lancet Infetious Diseases, Vol.3, May 2003, pp 275-281. ] handwashing with soap breaks the cycle and is effective in reducing diarrhea cases in comparison to other interventions. Reduction in diarrheal morbidity (%) per invention type shows that handwashing with soap (44%), point of use water treatment (39%), sanitation (32%), hygiene educaton (28%), water supply (25%), source water treatment (11%) [ en Lorna Fewtrell, Kaufmann R.B., Kay D., Enanoria W., Haller L., dan Colford J.M.C., Jr 2005. "Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: A systematic review and meta analysis." The Kancet Infectious Diseases, Vol. 5, Issue 1:42-52. Also, Curtis, V. and Cairncross, S. 2003. "Effect of washing hands with soap on diarrhoea risk in the community: A systematic review." The Lancet Infetious Diseases, Vol.3, May 2003, pp 275-281. ] .
* Acute respitory infection. Handwashing reduces respitory infections by two ways: by removing respiratory pathogens that are found on hands and surfaces and by removing other pathogens (in particular, entreric viruses) that are been found to cause not only diarrhea, but also respiratory symptoms. A study in Pakistan found that handwashing with soap reduce the number of of pneumonia-related infection in children under the age of five by more than 50 percent [ en [http://www.lboro.ac.uk/well/resources/fact-sheets/fact-sheets-htm/Handwashing.htm WELL Factsheet: Health impact of handwashing with soap] ] .
* Intestinal worm, skin infections, and eye infections. Hand washing with soap also reduces the incidence of skin diseases; eye infections like trachoma and intestinal worms, especially ascariasis and trichuriasis.

Critical times in hand washing with soap

[ en [http://www.aces.edu/pubs/docs/H/HE-0610/HE-0610.pdf Alabama A&M and Auburn University: Food Safety: It's in Your Hands!] ]

Here are some critical times to clean your hands:• Before and after meals and snacks • Before caring for young children • After touching a public surface• Before and after preparing food, especially raw meat, poultry, or seafood • After using the restroom • When hands are dirty• After touching animals • When you or someone around you is ill

Awareness of hand washing with soap

Handwashing is likely to be especially important where people congregate (schools, offices), where ill or vulnerable people are concentrated (hospitals, nursing homes), where food is prepared and shared and in homes, especially where there are young children and vulnerable adults.

A study of doctors handwashing practices in the U.S. revealed that the doctors 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, rough paper towels for drying, inconveniently located sinks and hands chapped by frequent washing with drying soaps. A handwashing campaign begun in New York City public hospitals has drastically reduced the number of serious infections, such as blood infections and pneumonia, contracted by hospital patients [ en [http://www.globalhandwashingday.org/Planners_Guide_Global_Handwashing_Day.pdf Planner's Guide for Global Handwashing Day] ] .

Around the world, the observed rates of handwashing with soap at critical moments range from zero percent to 34 percent [ en [http://www.globalhandwashingday.org/Planners_Guide_Global_Handwashing_Day.pdf Planner's Guide for Global Handwashing Day] ] . The belief that washing with water alone to remove visible dirt is sufficient to make hands clean is commonplace in most countries. In Ghana the drive to use soap for mothers was generally because it felt good to remove dirty matter from hands, refreshing, one way of caring for children, and enhancing their social status [ en [http://www.globalhandwashingday.org/Planners_Guide_Global_Handwashing_Day.pdf Planner's Guide for Global Handwashing Day] ] .

:::::::::::::: - Dr. Curtis (director of the Hygiene Center at the London School of Hygiene & Tropical Medicine) [ [http://www.nytimes.com/2008/07/13/business/13habit.html?_r=1&em&ex=1216180800&en=893d6d16b2643e20&ei=5087%0A&oref=slogin New York Times: Warning - Habbit May Be Good For You] ] .

Hand washing with soap around the world

* In U.S. a study shows that one-third of men didn't bother to wash their hands after using the bathroom, compared with 12 percent of women in public restrooms, the study was based on observations of more than 6,000 people in four big cities in 2007. Athough in an interactive survey 92 percent of Americans said they usually or always wash their hands after using the bathroom, when researchers for the American Society for Microbiology found that only 77 percent actually do, when it comes to public restrooms. A six percent decline from a similar study in 2005 [ en [http://www.msnbc.msn.com/id/20823288 MSNBC:1 in 3 men don't wash after bathroom visit] ]
* In New Zealand
* In Australia
* In Ghana, people buy a lot of soap, yet almost all used for cleaning clothes, washing dishes, and bathing. In a baseline study, 75 percent of mothers claimed to wash hands with soap after toilet use, but structured observation showed that only 3 percents did so, while 32 percent washed their hands with water only [ en [http://www.globalhandwashingday.org/Planners_Guide_Global_Handwashing_Day.pdf Planner's Guide for Global Handwashing Day] ] . On 2003 Dr. Val Curtis studied hundreds of mothers and their children thus discover that previous health campaigns had failed because mothers often didn’t see symptoms like diarrhea as abnormal, but instead viewed them as a normal aspect of childhood. The studies also revealed an interesting paradox: Ghanaians used soap when they felt that their hands were dirty — after cooking with grease, for example, or after traveling into the city and hand-washing habit was prompted by feelings of disgust and showed that parents felt deep concerns about exposing their children to anything disgusting. The commercials began running in 2003 didn’t really sell soap use and sold disgust instead. In one 55-second television commercial, an actual soapy hand washing was shown only for 4 seconds with a clear message that toilet cues worries of contamination, disgust, and cues soap. The ad was a radical different approach from most public health campaigns because it didn't mention of sickness, just the yuck factor. By 2006, Ghanaians surveyed by members of Dr. Curtis’s team reported a 13 percent increase in the use of soap after the toilet. Another measure showed even greater impact: reported soap use before eating went up 41 percent [ [http://www.nytimes.com/2008/07/13/business/13habit.html?_r=1&em&ex=1216180800&en=893d6d16b2643e20&ei=5087%0A&oref=slogin New York Times: Warning - Habbit May Be Good For You] ] .
* In Malawi an approach to handwashing with soap was done by Unicef in honoring the right of children to participate in a process of developing and instituting national standards for sanitation facilities and hygiene promotion in primary schools. National review teams interviewed children on what they liked and disliked about their sanitation facilities and hygiene education programs. The children candid and perceptive answers used to modify the technical designs and approach to the behavior change. Comic book from the children feed back was designed for grades five to eight [ en [http://www.globalhandwashingday.org/Planners_Guide_Global_Handwashing_Day.pdf Planner's Guide for Global Handwashing Day] ] . Since August 2008, a cheerful animated character called ‘SOPO’ uses the slogan ‘Did You Wash Your Hands?’ to promote hand-washing with soap at four critical times: after defecation, after cleaning a child, before feeding a child and before preparing food. The proportion of women currently following these recommendations in Malawi is negligible. Paradoxically, Malawians have better access to safe water and soap than most others in Africa. Three-quarters of the population has access to piped water, a public tap, a borehole or a protected well or spring. A third of all households have soap or washing powder or liquid. Yet diarrhoea continues to be a major cause of sickness and death among young children. On average, a Malawian child will experience six bouts of diarrhoea a year, and 20 per cent of deaths in infants and children under the age of five are due to diarrhoea. The main causes are the use of contaminated water, as well as unhygienic practices in food preparation and excreta disposal. [ en [http://www.unicef.org/infobycountry/malawi_45225.html UNICEF: Campaign aims to promote hand-washing and save young lives in Malawi] ]
* In Pakistan a study found that children in communities that received intensive handwashing interventions were half as likely to get diarrhea or pneumonia than children in similar communities that did not receive the intervention.
* In Indonesia
* In Phillipines [ en [http://www-wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2008/06/23/000333038_20080623011756/Rendered/PDF/443260v20WSP001mic0impacts01PUBLIC1.pdf The World Bank: Economics impacts of sanitation in the Philippines] ] .

ee also

Global Handwashing Day

References