A (Surprisingly) Brief History Of Handwashing

Handwashing can help kill the coronavirus. But you may be surprised by how short the history of handwashing actually is among humans.


Miryam Wahrman, professor of biology at William Paterson University. Author of “The Hand Book: Surviving in a Germ-Filled World,” published in 2016. (@MiryamWahrman)

Peter Ward, professor emeritus of history at the University of British Columbia. Author of the 2019 book “The Clean Body: A Modern History.” (@UBC_History)

Emma Robbins, director of the Navajo Water Project at DigDeep, a human rights nonprofit dedicated to water access in America. Navajo artist and activist. (@robbinzintherez)

Interview Highlights

On the effectiveness of handwashing

Miryam Wahrman: “Soap is hydrophobic. And as are cell membranes. And also the coverings around viruses. And so that type of hydrophobic interaction can disrupt the structure. But the other part of the process of cleansing hands is that various things can stick on our hands. And soap helps to break the bonds between what has attached to our skin and it helps to get rid of it. And then we just rinse it down the drain. So that’s another really important part of the process of why soap and water are the most effective way to cleanse the hands. Not everything has to get killed, not all the microbes have to get killed, as long as they are removed from the surface of the skin. Then we rinse them away.”

When is it that we first began to see soap or handwashing in the context of health?

Peter Ward: “It’s a surprisingly recent development, actually. And it’s really related to the long, long, complicated history of human hygiene. It’s a story that … [goes] back to the Roman times. But it really picks up in the period from about the beginning of the 17th century onward. And there’s been since that period of time a huge transformation of body care and body treatment that sort of began in the upper reaches of a number of Western communities and gradually diffused and percolated downwards to our own dear times, when we are now obsessed with our cleanliness. At least in some respects, it seems we exempt our hands to some extent. But the rest of us, we really pay a lot of attention to.”

On handwashing in the 20th century

Miryam Wahrman: “As we get to the mid-20th century, we begin to see that hand hygiene, in fact hygiene in general and the access to clean water, has changed the landscape in terms of human health very dramatically. And the average life expectancy from 100 years ago to today has increased from about the mid-40s, up to about 80 or more. And some of that has to do with public health and hygiene and even the simple act of having access to soap and water and the types of procedures that are done in hospitals using a septic technique now. Where now we don’t have as high a risk of infection of our patients, going from patient to patient.

“These are all tremendously important improvements in terms of health, in terms of average life expectancy, in terms of recovery from disease. And these all came about thanks to scientists that were able to show the link between germs and disease, and specific germs and specific disease. So it is a long story and it does cover about 150 years, but they’re really tremendously exciting. 150 years in terms of science. I think the thing we have to keep in mind is that the science is critical in terms of helping us to move forward and to be able to deal with this challenge.”

How have things changed in terms of access to running water, bathrooms, et cetera?

Peter Ward: “About half of American homes had a bathroom in the 1940 census. And today, virtually all American homes have a bathroom. As indeed, the homes everywhere [in] the Western world. Some of them have many. So that transformation has been gradual and varied from one part of the country to the next. One social group to the next, as well. But it’s really been one of the fundamental changes that’s been associated with the hygienic revolution and the handwashing part of all that.”

” … There are these additional layers that have to do with access to privacy, access to water, development of effective sewage systems, and so on and so forth. And the people who are marginal in our world today are the people who live beyond the edges of these things. There are certainly — I know people in the United States who do live beyond the edges. And there certainly are people in my own country as well. Who many of them are First Nations people, the indigenous peoples of North America, who live in more remote areas and who do not have easy access to clean water.”

On access to clean water in the Navajo Nation

Emma Robbins: “When you are able to wash your hands, it’s very empowering. You’re reducing the risk and you’re literally in your hands, you have the ability to save lives. However, when you don’t have running water in your homes, you can’t do that for 20 seconds. You know, you can use bottled water, but that takes a ton of bottled water to wash your hands. And many families don’t have that luxury. And so there’s a third element that I always say.

“Well, number one, when you’re leaving your house to go get water, you’re exposing yourself to the virus potentially. You know, oftentimes you can get to stores and there isn’t any bottled water that’s left either on the reservation or in border towns. The second thing is when you’re doing that, there’s a lot of stress that’s involved. And we see constantly on social media, on the Internet and TV that those are the things that we can do, staying at home, handwashing. But when you can’t do that, it’s scary. You know, you start to feel like the other, that you’re not able to protect yourselves or your families. And it can be really, really, really impactful on everybody of all ages. And, you know, we’re already all experiencing not having money, not having work, you know, having to stay at home, especially in the Navajo Nation. They have a 57 hour curfew on the weekends and it’s hard. And so not having that is a lot more stressful.”

From The Reading List

Excerpt from “The Clean Body: A Modern History” by Peter Ward

Excerpted from “The Clean Body: A Modern History” by Peter Ward © 2019. Published by McGill-Queen’s University Press. Reprinted with the permission of the publisher, McGill-Queen’s University Press. All rights reserved.

Excerpt from “The Hand Book: Surviving in a Germ-Filled World” by Miryam Wahrman

Excerpted from “The Hand Book: Surviving in a Germ-Filled World” by Miryam Wahrman © 2016. Published by ForeEdge, an imprint of University Press of New England. Reprinted with the permission of the publisher, University Press of New England. All rights reserved.

The Embryo Project Encyclopedia (Originally published in The New England Quarterly Journal of Medicine and Surgery): “‘The Contagiousness of Puerperal Fever’ (1843), by Oliver Wendell Holmes” — “In 1843, physician Oliver Wendell Holmes wrote and published “The Contagiousness of Puerperal Fever,” an essay about puerperal fever, a disease that occurs mainly as a result of bacterial infection in the uterine tract of women after giving birth or undergoing an abortion. In the essay, Holmes argues that puerperal fever is spread through birth attendants like physicians and midwives who make contact with the disease and carry it from patient to patient. The article was published in The New England Quarterly Journal of Medicine and Surgery in 1843.”

Vox: “The evolution of hand-washing, explained by a historian” — “Are we all washing our hands several times a day? As the Covid-19 coronavirus pandemic spreads, we should all be washing our hands several times a day. Take a moment right now, go give your hands a scrub with some warm soapy water for 20 seconds, and then come back. Maybe spritz around some hand sanitizer if you don’t have access to a sink. Put on a little hand lotion so your skin doesn’t get too chapped.”

Popular Mechanics: “The Shockingly Recent History of People Actually Washing Their Hands” — “It has become a ubiquitous mantra in the time of COVID-19: Wash your hands. Cheap and easy to do, it’s one of the few pieces of advice that is essentially without controversy. And yet, hand-washing is a more recent development than you might expect, and the habit did not catch on quickly.”

Washington Post: “Americans are told to wash hands to fight coronavirus. But some don’t trust the tap.” — “For the Chavez family and many others in California’s fertile San Joaquin Valley, bottled water is the toilet paper of their coronavirus pandemic — an everyday necessity that vanished from supermarket shelves.”

The Guardian: “Keep it clean: The surprising 130-year history of handwashing” — “It felt strange when Boris Johnson emerged from the first Covid-19 Cobra meeting on 2 March and told us to wash our hands while singing Happy Birthday. The preppers among us had panic-shopped while awaiting his pronouncements, and others fretted about vulnerable loved ones, travel plans, the nightmare of simultaneous homeworking and home-schooling, and not being able to work at all. And all our leader had was this?”

Freethink: “COVID’s Unique Challenge For the Navajo Nation” — “Sprawling across roughly 27,000 square miles of deserts and high plateaus, the Navajo Nation is not immune to the impact of the COVID-19 pandemic. The sovereign nation’s battle with SARS-CoV-2 has seen 2,373 confirmed cases, as of May 2, and 73 deaths. Its per capita infection rate trailed only New York and New Jersey by late April.”

This article was originally published on WBUR.org.
Copyright 2020 NPR. To see more, visit https://www.npr.org.

Published May 11th  2020 at: https://wamu.org

Don’t Let Hand Hygiene Standards Dip When COVID-19 Ebbs

As communities move into the next phase of COVID-19, healthcare organizations must keep hand hygiene top of mind in all environments to ensure patient and employee safety, and to ultimately reduce the risk of cross-contamination and HAIs.

Keeping healthcare staff informed of the latest protocols and essential hygiene measures will have a profound impact on the post-pandemic world, but driving behavioural change can be extremely challenging. To achieve hand hygiene compliance, healthcare facilities should focus on three areas:

· Hygiene training

· Hygiene tools and dispenser placement

· Signage

With 40% of surveyed healthcare workers saying they would like better training in hand hygiene, healthcare facilities can combine technology with hand hygiene training to help staff easily adapt to the demands of their environment.

Implementing a technology-first approach to training is an engaging and interactive way to reinforce hand-hygiene and sanitization protocols within a facility. According to educational technology pioneer Edgar Dale, learning by doing (direct, purposeful experience) is essential to keeping learners actively engaged as opposed to being passive observers. In fact, the University of Oklahoma created a similar learning hierarchy that emphasizes the usefulness of virtual reality in the learning process today. Virtual reality apps are a readily available and effective means to reinforce the World Health Organization’s “5 Moments of Hand Hygiene.” These apps can serve as an innovative alternative to hand hygiene training.

It is equally important to consider the critical factors of hygiene access in a facility, such as location of hygiene tools and hand-washing stations. Dispenser placement is key to promoting hand hygiene compliance within a healthcare environment.

It is imperative that dispensers are placed throughout walking routes and corridors to ensure accessibility for nurses and other staff on-the-go. Increasing the accessibility and visibility of hand hygiene stations throughout a facility can have a significant impact on hand hygiene practices without adding an extra burden to your environmental services staff (EVS).

Most healthcare staff understand the importance of hand washing, but visual cues for staff and patients are essential in the ongoing education of hand hygiene best practices and are especially helpful for nurses working long shifts.

Hand hygiene focused signage is an effective way to further hygiene and sanitization communication with staff, on an everyday basis. In addition to improving health standards, hand hygiene posters can also have a positive effect on a facility’s image. In fact, more than 8 in 10 patients indicate that the presence of hand hygiene signage makes them feel more confident about a facility’s cleanliness and its quality of care.

These simple steps can have a far-reaching impact on the success of hygiene compliance within a healthcare facility and takes hand hygiene from an afterthought to a long-lasting habit and routine—as it should be.

Deborah Chung is the regional marketing manager for Essity Professional Hygiene, North America.

By Deborah Chung
May 8, 2020

Published at: https://www.infectioncontroltoday.com

Deborah Chung is the regional marketing manager for Essity Professional Hygiene, North America.

Hygiene reduces the need for antibiotics by up to 30%

Everyday hygiene reduces the need for antibiotics by up to 30%, helping to prevent daily deaths from antimicrobial resistance (AMR), new paper reveals.

According to a new Position Paper published in the American Journal of Infection Control (AJIC) online, improved everyday hygiene practices, such as hand-washing, reduces the risk of common infections by up to 50%, reducing the need for antibiotics, by up to 30%. Global public health experts responsible for the Position Paper, are now calling for home and community hygiene to become part of strategic plans to reduce hundreds of thousands of deaths from AMR globally each year.

As witnessed during the recent global efforts to delay the spread of COVID-19, hygiene practices, including hand-washing, have become an essential part of everyone’s daily routine and are considered to be the first line of defence in reducing the spread of common infections. However, national and international AMR strategies, while focussing on the important role of hygiene in the healthcare setting, fail to recognise the key role that home and community hygiene plays.

This Position Paper, developed on behalf of the Global Hygiene Council (GHC), and published online in AJIC, explores the role of targeted hygiene in the home and everyday life settings to reduce antibiotic prescribing and its likely impact on antibiotic resistance. It provides evidence that practising hand hygiene in homes and community settings can prevent infections and therefore reduce the need for antibiotics. One intervention study demonstrated a 30% reduction of antibiotic prescriptions for common respiratory infections in a group who used hand sanitisers compared with a control group.

The Position Paper, also demonstrates the increasing prevalence of multidrug-resistant bacteria in the home and community. It is considered that 35% of common infections occurring in healthcare and the community are already resistant to antibiotics, and that in some low-and middle-income countries, resistance to antibiotics is as high as 90%,4 causing 2,000 people to die every day globally.

According to the lead author, Jean-Yves Maillard, Professor of Pharmaceutical Microbiology at the School of Pharmacy and Pharmaceutical Sciences, at Cardiff University; “In light of the current COVID-19 pandemic and evidence presented in this Paper, it is more urgent than ever for policy makers to recognise the role of community hygiene to minimise the spread of infections, which in turn will help in reducing the consumption of antibiotics and help the fight against AMR.

To coincide with the publication of the Paper, the GHC has launched a Manifesto calling upon national and international policy makers, health agencies and healthcare professionals to further recognise the importance of hygiene in the home and everyday life settings and acknowledge the following:

1/ IPC committees, responsible for implementing national AMR plans, should recognise that improved hand and surface hygiene in the home and community are key to minimise the spread of infections and as a consequence the consumption of antibiotics, which will then help in the fight against AMR. To achieve this, recommendations for improved hygiene in the wider community should be included in global AMR action plans by 2022 and in all national plans by 2025.

2/ IPC advice, guidance and education for HCPs on hand and surface hygiene and its relation to AMR should not be limited to healthcare settings, but also include recommendations to influence the wider community with immediate effect.

3/ Relevant medical associations should ensure messaging around home and community hygiene is cascaded to members through amending on-going and existing AMR training and education.

With evidence to show that home and community hygiene urgently needs to be taken more seriously, it is time for the global community to collaborate and recognise that reducing the need for antibiotic prescribing and the circulation of AMR strains in healthcare settings cannot be achieved without also reducing the circulation of infections and AMR strains in the community.

The Position Paper ‘Reducing antibiotic prescribing and addressing the global problem of antibiotic resistance by targeted hygiene in the home and everyday life settings,’ was developed on behalf of the Global Hygiene Council, following a scientific meeting in London 2019 with global hygiene, AMR and public health experts.

Published by: https://www.eurekalert.org/


Curtis V, Cairncross S. Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. Lancet Infect Dis. May 2003; 3 (5): 275-81

Azor-Martinez E, Yui-Hifume R. Effectiveness of a hand hygiene program at child care centers: a cluster randomized trial. Pediatrics. November 2018;142 (5). Available from:ncbi.nlm.nih.gov/pubmed/30297500 (Accessed 15 April 2020)


Interagency Coordination Group on Antimicrobial Resistance. No Time to Wait. Securing the Future from Drug-Resistant Infections. April 2019. Available from: https://www.who.int/antimicrobial-resistance/interagency-coordination-group/IACG_final_report_EN.pdf?ua=1. (Accessed April 15, 2020.)

Review on Antimicrobial Resistance: Tackling Drug-resistant Infections Globally. 2014. Available from: https://amr-review.org/Publications.html. Accessed July 3, 2019.

Hvorfor er det noen som aldri vasker hendene?

Det har blitt innprentet som det aller viktigste smitteverntiltaket i kampen mot coronaviruset. Likevel er det mange som sjeldent eller aldri vasker hendene.

– Jeg tror ikke jeg har vasket hendene på ti år. Jeg vasker aldri hendene, sa Fox News-programleder Pete Hegseth på lufta i februar 2019, til latter fra sine medverter.

– Bakterier er ikke en virkelig greie. Hvis jeg ikke kan se dem, så finnes de ikke. Jeg gjør meg selv immun og blir aldri syk , sa han videre.

Dette førte naturlig nok til en del reaksjoner i amerikanske medier, og ble blant annet omtalt av Forbes. Fox-programlederen måtte senere gå ut og melde at han mente det som en spøk.

Mange slurver

Likevel kan de fleste som har brukt offentlige toaletter si seg enige i at han definitivt ikke er den eneste som slurver med håndvasken. En fransk forskningartikkel fra 2015 kom med de slående resultatene at på global basis, er hendene vaskes med vann og såpe kun 26,2 prosent av alle toalettbesøk, med potensiale for kontakt med avføring.

Noe av grunnen til de lave tallene skyldes at spesielt i utviklingsland, kun 27% av befolkningen har tilgang på tilstrekkelige toalettfasiliteter.

I undersøkelsen ble 64.000 personer fra totalt 64 land spurt om «å vaske hendene med vann og såpe er noe man gjør automatisk etter toalettbesøk».

Hver fjerde slurver i Norden

Best i studien kom Saudi-Arabia der 97 prosent sa de som automatikk vasket hendene, mens det i Kina, Japan og Sør-Korea var under halvparten som sa seg enig i det utsagnet.

Norge var ikke en del av studien, men våre nordiske naboer Sverige, Finland og Island kom alle noenlunde likt i sine resultater, der i overkant av 75 prosent sa seg enig i utsagnet. Det var på nivå med Storbritannia og Tyskland og noe høyere enn land som Frankrike (62 prosent), Italia (57 prosent) og Nederland (50 prosent).

Det pågår nå forskning på hvorvidt det er en korrelasjon på smitten i forskjellige land og holdningene til håndvask. De foreløpige resultatene ser ganske klare sammenhenger mellom utbredelse av smitte og håndhygiene-vaner.
Menn dårligere på håndvask

I slutten av mars gikk to forskere ved SIFO ut i et debattinnlegg i VG og stilte spørsmål ved om det var en sammenheng mellom hvorfor flere menn enn kvinner i Norge ble smittet av viruset og at menn oftere slurver med håndvasken.
De henviste til nasjonal forskning fra henholdsvis 2011 og 2007 som viste at menn vasket hendene sjeldnere enn kvinner og var dårligere til å følge helseråd.


«Vi vet ikke om det er noen sammenheng mellom håndvaskevaner og den økte risikoen blant menn for å blir smittet av coronaviruset. Men vi vet at menn vasker hendene mindre. Kanskje det er riktig med en ekstra oppfordring til det sterke kjønn? Dere er ikke bare de som er mest utsatt for å bli smittet, men også de som har mest å «gå på» når det gjelder å forbedre håndvaskevaner», skrev Sifo-forskerne Ingun Grimstad Klepp og Silje Elisabeth Skuland i innlegget.

– Det høres så enkelt ut, men jeg har jobbet med dette i 25 år og det er fortsatt mye å gå på , sier Robert Aunger, ved London School og Hygiene and Tropical Medicine til BBC. Han tror slurvet for mange rett og slett kan skyldes latskap.

– Et problem med håndvask er at, spesielt i utviklingsland, så kan du unngå å vaske hendene ofte, og likevel ikke bli syk, sier Aunger og utdyper at det kan ta flere dager fra man blir smittet til man får symptomer, noe som gjør at man ikke ser sammenhengen med dårlig håndvask.

– Selv med coronaviruset så sier de at forsinkelsen fra man får smitten til man ser symptomer, kan være fem-seks dager, så koblingen er vanskelig å gjøre, sier han til BBC.

Bedre med såpe enn håndsprit

Både håndvask og desinfisering med sprit fungerer bra mot coronaviruset, hvis det gjøres riktig.

– Håndvask er best når du er møkkete eller har organiske ting som mat eller urin på hendene. Du må være synlig ren for å bruke sprit. I helsevesenet passer dette helt supert , forklarte Mette Fagernes, seniorrådgiver i FHI, som leder den nasjonale arbeidsgruppa for håndhygiene, til NRK tidligere i mars.

Se video: Slik vasker du hendene riktig (Video: Folkehelseinstituttet)

I lys av pandemien som tvinger oss til å holde oss hjemme har kjendiser fra hele verden oppfordret folk til å vaske hendene ofte og lenge – minst 20 sekunder.

Til og med pornonettstedet Pornhub har laget en parodi-konto kalt Scrubhub, som inneholder folk som vasker hendene og overholder sosial distansering i det offentlig rom.


Magnus Fossen
22. april 2020 09:20 – Oppdatert 23. april 2020 08:26

Could COVID-19 Permanently Change Hand Hygiene?

An anthropologist tackles the slippery subject of hand sanitization in a world torn between concerns over contagion and antibiotic resistance.

Here in the Philippines, as in many parts of the world, there’s been an outbreak of hand sanitizers. Since late January, pump dispensers and bottles have appeared everywhere: airports, schools, dining tables, handbags. In SM, the country’s largest chain of shopping malls, large containers of hand sanitizers greet visitors as they pass through security. “This is a sanitized zone,” SM’s posters read. “Thank you for using the alcohol/disinfectant provided.”

When the enhanced community quarantine started here on March 17, sanitizer showed up at road checkpoints. And though the shops in the mall are closed, customers can still shop at mall supermarkets—after the staff sprays alcohol on their hands.
This is not surprising. The COVID-19 pandemic has spurred people around the world to panic-buy Purell and other hand sanitizers, soaps, and antibacterial wipes. What is surprising is that, until the pandemic hit Western countries, the trend was going in the opposite direction.

Over the past decade, there’s been a growing concern that the impulse to kill all germs could have serious consequences, such as the creation of resistant superbugs. This has certainly impacted people’s hand hygiene habits.

For the last few years, the U.S. Food and Drug Administration (FDA) has advised people to stop using antibacterial soap, which is no more effective at preventing illness than regular soap and may negatively impact health. After discovering that common ingredients in antibacterial soap—most notably triclosan and triclocarban—disrupt hormones in lab animals and induce antibiotic resistance, the FDA banned those chemicals in 2016 and replaced them with alternatives.

However, when soap and water are unavailable, hand sanitizers and wipes are considered an acceptable alternative because they rely on alcohol to vanquish certain viruses (including coronaviruses) and bacteria.

Still, before the current pandemic, some health experts urged people to cut back even on alcohol-based hand sanitizer. That’s partly because some bacteria are becoming more tolerant of alcohol. And it’s partly due to concerns that sanitizers might harm the microbiome—the trillions of microbes living on and in the human body that are essential for healthy immune function, digestion, and more.
In recent years, many researchers have expressed concerns that over-sanitized societies are contributing to autoimmune disorders, allergies, and inflammatory conditions. This “hygiene hypothesis” is controversial, but there’s no question that scientists and the public have been awakening to the fact that some microbes can be beneficial.

Yet in the midst of the COVID-19 pandemic, everyone is understandably consumed by the process of hand sanitizing, and many people are finding it nearly impossible to buy sanitizer online or in stores. People who just weeks ago purposely petted dogs to boost the diversity of their microbiomes now find themselves disinfecting their hand sanitizer bottles with antibacterial wipes.

To understand this sudden change, it is revealing to explore the complex history and anthropology of hand cleansing. What motivates people’s handwashing habits? How do beliefs about sanitizers and microbes figure in? How have previous epidemics led to shifts in these notions? And what might the post-COVID future hold for hand hygiene?
Even before 19th-century scientists discovered that germs cause disease, handwashing was important for hygienic and symbolic purposes in many societies and religious traditions. The Prophet Muhammad, for instance, called on Muslims to wash their hands in a variety of situations, including “before and after any meal,” “after going to the toilet,” “after touching a dog, shoes, or a cadaver,” and “after handling anything soiled.”

In other societies, hand hygiene practices primarily originated from secular discoveries. In 1846, Hungarian doctor Ignaz Semmelweis observed that mothers giving birth were more likely to die if they were treated by doctors who handled cadavers beforehand. So, Semmelweis mandated that hospital staff wash their hands with soap and chlorine. He later became known as the father of hand hygiene. A few years later, forward-thinking nurse Florence Nightingale implemented handwashing in British army hospitals.

Despite the efforts of these pioneers, the practice of widespread, regular handwashing was slow to take off in most of the world. In the U.S., the first national hand hygiene guidelines weren’t published until the 1980s, spurred by several foodborne outbreaks and hospital-associated infections. It was in that decade that a global hand cleansing movement was born.

The rise of hand sanitizers mirrors this move of hand hygiene from the hospital to the world at large. Some accounts claim that Lupe Hernandez, a nursing student in California, invented hand sanitizer in 1966 when she realized alcohol mixed with gel could help hospital staff clean their hands in a jiffy.

Others trace its beginnings to Gojo, a family-owned Ohio company that launched a hand cleanser for auto mechanics then tweaked the recipe and released it in 1988 as Purell. After a slow start, the product achieved the near ubiquity it enjoys today.
Incidentally, alcohol-based hand sanitizers once caused ambivalence among Muslims, owing to alcohol being haram (forbidden). But today, Muslim health care workers largely accept them, even though the question of whether hand sanitizers are halal (permissible) continues to spark debate.

Epidemics have repeatedly stimulated the popularity of hand sanitizers. In the Philippines, a clothing store called Bench introduced Alcogel shortly after the 1997 H1N1 outbreak. It attained “phenomenal success,” according to Bench’s CEO Ben Chan. A similar sanitization surge occurred in the U.S. during the H1N1 epidemic of 2009.
As The Guardian’s Laura Barton wrote in 2012, “Thanks to the heightened fear of contamination experienced during recent flu epidemics, there is now a value judgment attached to carrying and using an antibacterial gel.”

Infectious disease outbreaks have also influenced societies’ soap-and-water habits. A 2003 study of six international airports found that in Toronto—which was hit by a major outbreak of severe acute respiratory syndrome (SARS) that year—95 percent of male travelers and 97 percent of female travelers washed their hands in the public restrooms. By contrast, in New York’s John F. Kennedy Airport, only 63 percent of men and 78 percent of women washed their hands.

So, is fear of disease a great motivator for soaping up or squirting hand gel? Perhaps during a pandemic, the answer is yes. However, fear generally has only a temporary effect on ablutions, according to a review led by anthropologist Valerie Curtis. Furthermore, Curtis has warned, creating cleanliness campaigns that play on people’s anxiety is not good for mental health.

Instead, she recommends harnessing a different emotion.

In the early 2000s, Curtis was aiming to change the handwashing habits of people in Ghana, where only 4 percent of adults regularly used soap after going to the bathroom. Previous campaigns had failed, and the situation was urgent, since an estimated 84,000 children were dying of diarrhea each year.

So, Curtis created a campaign designed to generate disgust. At the time, bathrooms were considered cleaner alternatives to pit latrines, so they didn’t inspire an ick factor that might prompt Ghanaians to lather up. Curtis and her group developed ads that showed mothers and children exiting bathrooms with their hands covered in purple pigment, which they then transferred to everything they touched. Soap use subsequently rose by 13 percent following trips to the toilet and by 41 percent before eating.

Such a campaign could inspire future efforts in the wake of COVID-19. In a study released in December 2019, researchers at the Massachusetts Institute of Technology (MIT) and the University of Cyprus calculated that if travelers at airports raised the bar on their soap-use habits, the impact of a future pandemic could be reduced by 24 to 69 percent. Yet the same researchers estimated that, although 70 percent of air travelers wash their hands, most do not wash them adequately (frequently, with soap, for at least 20 seconds), so only 20 percent actually have clean hands.
Pandemics arguably tip the scale back to a Pasteurian paradigm.

Shifting views about microbes may complicate the issue of disgust. MIT anthropologist Heather Paxson has written that many people hold a Pasteurian worldview, in which they “blame colds on germs, demand antibiotics from doctors, and drink ultra-pasteurized milk and juice, while politicians on the campaign trail slather on hand sanitizer.”

But Paxson also points out that there is an emergent, alternative paradigm: a “post-Pasteurian” view. Post-Pasteurians “might be concerned about antibiotic resistance” and embrace microbiome diversifiers like probiotics, unpasteurized milk, kombucha, and unsanitized handshakes.

Since Paxson’s work was published in 2008, this post-Pasteurian paradigm has grown. Scientists have even considered ways they might promote more positive feelings for microorganisms and foster collaboration in human-microbe relationships.

Pandemics arguably tip the scale back to a Pasteurian paradigm. Currently, people are bombarded with images (and imaginings) of a potentially deadly virus for which there is, at least at the moment, neither vaccine nor cure. Thus, hand sanitizers and wipes emblazoned with the statement “kills 99.9 percent of germs” give people a sense of control over an unseen, and suddenly hostile, microbial world.
But people’s hand hygiene practices are also motivated by a visible and often friendlier force.

In 2016, researchers found that doctors and nurses at a California hospital washed or sanitized their hands 57 percent of the time when they knew that designated “hygiene patrol” nurses were watching them but only 22 percent of the time when volunteers who they didn’t recognize observed them.

Just like the wearing of face masks, social pressure can certainly motivate people to clean their hands. A recent review from Curtis and other researchers showed that people were more likely to lather up when there was more than one person present in a public restroom.

Prompted by the COVID-19 pandemic, some health experts are attempting to “responsibilize individuals” by framing handwashing as a selfless act that saves lives. Social media campaigns like #SafeHands and #HandwashingHeroes are also making appeals to social responsibility by showing celebrities and adorable children getting sudsy to prevent disease.

Similarly, face masks became an emblem of “public spiritedness” during the 1918 influenza pandemic. In some places, for instance, Japan, the practice of wearing masks continued and became part of the country’s hygiene culture.

In the aftermath of past pandemics, people have generally returned to their previous handwashing habits. But the COVID-19 crisis is different from other outbreaks. Never before have hand sanitizing and social distancing practices been enacted on such a global scale.

So, could COVID-19 cause permanent changes to handwashing habits around the planet? Could hand sanitizer become an enduring symbol of responsible world citizenship? Could the pro-microbe perspective swing back to a Pasteurian panic over germs?
Only time will tell. But it’s something to ponder while you scrub or sanitize your hands for at least 20 seconds.

By Gideon Lasco
He is a senior lecturer of anthropology at the University of the Philippines.
Published  8 April 2020

In a pandemic, hospital staffers need to get better at hand-washing

After visiting Ellis Island in 1906, President Theodore Roosevelt noted the lack of hand-washing by doctors and wrote the Public Health Service that he was “struck by the way doctors made the examinations with dirty hands,” turning the examinations themselves into “a fruitful source of carrying infection.”

Fast forward 114 years: Today’s hospitals aren’t doing much better at hand-washing. That’s a serious problem in ordinary times; during the Covid-19 national emergency it could become extraordinarily dangerous. One way the government can protect public safety is by immediately setting specific hand hygiene standards for doctors, nurses, and hospital staff.

There’s not even monitoring of a national compliance rate, although hand-washing remains “the most important intervention” to reduce the “staggering mortality” associated with hospital infections, according to an article in an infection control journal.

The most recent hand hygiene data — an 18-year-old study from the Centers for Disease Control and Prevention — is discouraging. It concluded that adherence “has remained low.”

How low is “low”? According to the CDC, health care providers in U.S. hospitals clean their hands less than half the time they should. In comparison, people using bathrooms in New York train stations washed their hands afterward 80% of the time.

The medical literature doesn’t show much systemic improvement in hand-washing since the CDC last looked at the issue or, for that matter, since the Public Health Service issued an educational video showing hospital staff how to wash their hands back in 1961!

Hospitals with hand hygiene compliance in the 50% to 60% range include the kind of large, urban medical centers designated by the CDC as “first tier” treatment centers during the 2014-16 Ebola outbreak. After reviewing hundreds of inspection reports, ProPublica recently reported that “infection control has been a recurring problem at some of the very hospitals that would likely be called upon to treat Covid-19 patients.”

Better hand-washing won’t solve all infection control issues, of course, but it would significantly improve safety. The first step to achieving it is valid measurement.

A new standard from the Leapfrog Group, a nonprofit focused on improving patient safety where one of us (L.B.) works, encourages hospitals to measure hand hygiene using electronic monitoring of clinician compliance. This kind of technology is commonplace in retail and other industries.
‘We didn’t follow through’: He wrote the Ebola ‘lessons learned’ report for Obama. Now he weighs in on coronavirus response

Hospitals traditionally measure hand hygiene by having someone spot violations and report them, a technique with questionable reliability. Monitoring hand hygiene in a way that yields accurate data is vital. The Leapfrog standard is evidence-based; the government should adopt it.

The next step, getting to universal compliance with hand hygiene best practices, is even more crucial.

Based on what hospitals have already shown they can achieve, the secretary of Health and Human Services should call on all hospitals to meet an 85% hand hygiene goal within 90 days. While President Trump’s well-known use of hand sanitizer even before the Covid-19 crisis should make this an easy step for the administration to take, its obvious importance should also draw support from both parties in Congress.

Meanwhile, the Centers for Medicare and Medicaid Services should start the process of issuing formal regulations that would include an aggressive time frame for 100% hand hygiene compliance by any health care facility receiving Medicare payments — which is virtually all of them.

It took 98 years from the time President Roosevelt pointed out the hand-washing problem at Ellis Island until U.S. hospitals were required to institute a hand hygiene program that followed the CDC’s recommendations. If a deadly pandemic doesn’t justify urgently demanding accountability for making patients safer by the simple act of clinicians washing their hands, it’s hard to imagine what will.

Leah Binder is CEO of the Leapfrog Group. Michael L. Millenson is a patient safety activist, researcher, consultant, and author of “Demanding Medical Excellence: Doctors and Accountability in the Information Age” (University of Chicago Press).



By Leah Binder and Michael L. Millenson

Published March 25, 2020

Coronavirus & Water Pandemics: Doing the Math

As the COVID-19 coronavirus pandemic spreads, guidance on how wash your hands and other measures intensifies.

These recommendations are important, but they are hardly of value to the 40% of humanity lacking access to even the most basic hand washing requirements — soap and water 1.

In most African countries or India, the proportion is even higher – between 50% and 80% of the population.

Even many health centres lack facilities for hand hygiene and safe segregation and disposal of health care waste 2.

In the Least Developed Countries (LDCs), basic water services are absent in 55% of health centers, used by an estimated 900 million people — more than the population of the USA and Europe combined.

More than 1 million deaths each year – newborns and mothers – are associated with unclean births. Overall, poor sanitation and a lack of safe drinking water take the lives of an estimated 4.3 million people annually 3.

This ongoing health crisis — a “water illness pandemic” in all but official definition — has been around for generations but, unlike COVID-19, hardly makes a ripple in international news.

It is unfair to say nothing has been done about it, but progress is so slow 4 5 that many members of vulnerable groups are likely to continue dying without ever having known what it means to have clean water within a five minute walk, much less a home tap.

Since the year 2000, this hidden water pandemic has quietly killed more people than World War II 6.

And it is on pace to kill over 40 million more — roughly equal to the population of Canada — in the next 10 years, by which time the Sustainable Development Goals (SDGs) of the UN’s Agenda 2030 are supposed to have been met.

Those 17 goals include one that aims to “ensure availability and sustainable management of water and sanitation for all.”

During the Severe Acute Respiratory Syndrome (SARS) crisis of 2002-2003, nearly 8,100 people were infected and nearly 800 died. COVID-19 is much less deadly but has already infected 25 times as many people. So, human losses are now over 10 times more than those due to SARS and they keep growing.

Be that as it may, even as COVID-19 takes more lives in the remainder of 2020 despite all efforts of health care providers, and all the measures already taken by governments around the world, the toll will almost surely be dwarfed by the four million people likely to die this year from the lack of safe WAter, Sanitation and Hygiene (WASH).

And the water pandemic deaths will not make headlines.

Those who die due to the water pandemic are, naturally, poor. They do not trade or travel internationally, they do not have mortgages, they do not buy insurance. Callous world financial markets pay little attention.

The ongoing water pandemic is even more distressing because many prerequisites for eradicating it already exist. We know how many people do not have WASH, and we know where they live. We even know precisely what to do — the technologies needed are available, including low-cost ones.

The problem is primarily a lack of political will and finance, and each, of course, connects to the other.

The water pandemic is not particularly “sexy,” nor visible in the myriad of other problems that many countries face. Even a decent politician who makes it a priority issue will likely be distracted within her or his term.

As for financing, about 20 years ago we needed an estimated USD 24 billion per year on average over 10 years to bring low-cost, safe water and sanitation to all those who needed it then (inclusive of population growth) 7.

That was probably an underestimate, but even that number was never met. And the shortfall of some USD 17 billion was about equal to annual pet food purchases in Europe and USA…

The absolute numbers required now have not changed much — roughly USD 28 billion per year (from 2015 to 2030) to extend basic WASH services to all those unserved 8. With “safely managed” “continuously available,” and “improved” services, the annual requirement rises to USD 114 billion. Yet, four years into the SDG era, we have not been able to meet the required financing levels even for basic services.

To meet the goals by 2030, we will, naturally, need more in the remaining decade, but it is difficult to express optimism that this will be achieved, even though the investment required represents just around 3% of NATO’s total annual military spending.

It would also be naive to think that suddenly the world would focus entirely on the water pandemic.

And, let’s face it, resolving a big development problem like the lack of WASH requires political stability and the absence of corruption, neither of which is the case in many of the most acute problem areas. So, most likely and unfortunately, progress will only continue slowly.

Can today’s coronavirus crisis “help” accelerate this progress? It might, if the virus seriously hits the countries with low levels of WASH and that, in turn, elevates even higher the risks and levels of infection in wealthier countries.

Only then funds might flow, motivated by self-interest of the world’s most fortunate people. The world really needs to “internalize” caring about the lack of WASH to resolve it. One wonders if it ever will.

So, for the time being, at the very least, stay safe from COVID-19 yourself. Wipe your desk and wash your hands, if you are lucky enough to have water.

1   www.washdata.org
2   https://www.who.int/water_sanitation_health/publications/wash-in-health-care-facilities-global-report/en/
3   https://www.voanews.com/archive/who-waterborne-disease-worlds-leading-killer
4   https://www.unwater.org/publication_categories/sdg-6-synthesis-report-2018-on-water-and-sanitation/
5   https://sustainabledevelopment.un.org/content/documents/24978Report_of_the_SG_on_SDG_Progress_2019.pdf
6   https://courses.lumenlearning.com/suny-hccc-worldhistory2/chapter/casualties-of-world-war-ii/
7   http://archive.unu.edu/env/water/2000-waterday.html
8   Hutton, G. and Varughese, M. (2016) The Costs of Meeting the 2030 Sustainable Development Goal Targets on Drinking Water, Sanitation, and Hygiene. Summary Report. World Bank Group, 11 pp


This article is to commemorate World Water Day on March 22

Vladimir Smakhtin is Director of the UN University Institute for Water, Environment and Health, funded by the Government of Canada and hosted by McMaster University, Hamilton, Ontario.

By Vladimir Smakhtin

Published HAMILTON, Canada, Mar 19 2020 (IPS)

How Do You Wash Your Hands To Fend Off Coronavirus If Water Is Scarce?

It’s something we’ve heard again and again from health authorities in the coronavirus pandemic. Wash your hands. Frequently. With soap and water. For at least 20 seconds. That’s an effective way to eliminate viral particles on your hands.

But for the 2.2 billion people in the world who lack safe drinking water — mostly in low- and middle-income countries — that advice will be difficult to heed. In these places, water is scarce for a number of reasons. It could be due to drought or climate change. Or local water supplies could be contaminated. Or the nearest source of water may be far away from home.

Aid groups and public health officials are doing all they can to help people in these communities overcome the obstacles and wash up. Washing your hands, they say, is a small action that can make a huge difference in the coronavirus pandemic.

“Hand-washing is one important tool to check and control spread,” says Amanda Glassman, executive vice president at the think tank Center for Global Development — along with other known interventions such as testing, isolating the sick and social distancing.

Water that is safe enough to drink is the best option for hand-washing. The ideal is to use clean, running water to wash away germs because it is less likely to contain harmful pathogens like e-coli, which can make you sick.

So how do you get water to those in need? Aid groups can truck in vast amounts of water, for example, but many say that’s expensive and unsustainable.

In less than ideal circumstances, other types of water can be used to wash hands. Non-potable water (for example, water that’s been used to clean dishes or do laundry) — along with soap — can be effective, according to a 2019 study published in the journal Environmental Science and Technology.

Small-scale solutions work, too – like setting up a network of public hand-washing stations – something done in West Africa during the Ebola outbreak of 2014. “When Ebola hit, one of the big concerns was the lack of running water and sanitation for hand-washing and proper waste disposal,” says Joia Mukherjee, chief medical officer of Partners In Health and associate professor of global health at Harvard Medical School. “It almost seemed like an unsolvable problem. And yet relatively rapidly, solutions were put together.”

The simplest kind of hand-washing station needs just two buckets. One bucket contained a mix of chlorine and water for the washing, with a spigot so people could tap into the supply, she explains. A second bucket, underneath the spigot, caught the wastewater.

These hand-washing stations were put in public buildings, schools and markets in Ebola-affected areas — and public health officials stressed why it was important to wash hands. Soon “people adopted this hand-washing technique everywhere,” says Mukherjee.

Mukherjee was heartened to see these stations again in February on trips to Liberia and Sierra Leone — set up by the countries’ health authorities to combat the spread of coronavirus. “I was very pleasantly surprised that they had already re-initiated this type of hand-washing at airports and outside of public buildings like the Ministry of Health. The lessons learned from Ebola were immediately being used.”

This kind of innovation is exactly what the developing world needs right now to ward off coronavirus, says Glassman, who is the author of Millions Saved: New Cases of Proven Success in Global Health. “We should deploy and test everything we’ve got,” she says, citing the hand-washing stations. “Affordability and fast availability is what matters now.”

The lower the technology, the better, says Glassman. If people can use objects and materials available in their own communities, like buckets, it makes the solution more likely to work.

One such device — which has been praised by global water researchers — is the SE200 Community Chlorine Maker. Developed by the global organization PATH, it can make chlorine from just water, salt and a car battery. Chlorine is commonly used to disinfect water because it kills many bacteria and viruses but isn’t always easy to obtain. The clean water can then be used to safely wash hands.

In preparation for the surge in coronavirus cases, 13 countries from sub-Saharan Africa as well as from Myanmar and Vietnam have put in requests to PATH for the devices. The group is finalizing logistics to get them up and running.

Then there’s the question of how to keep hand-washing stations safe from being a hot spot for disease transmission. Myriam Sidibe, a senior fellow at the Harvard Kennedy School, is working with the aid group WaterAid in Kenya to figure that out. They are trying to find ways to make 10,000 water stations across the country safe for people to congregate around.

The plan is introduce “social distancing nudges on the ground, similar to what we are seeing in supermarkets in some countries,” says Sidibe, who is based in Nairobi. “These can be red dots painted on concrete or if the surface is more uneven you can get stones or pieces of wood and sort of partially bury it in the dirt and then paint the visible bit red.”

As for soap, it’s not as much of a problem as water.

Soap is available to purchase almost everywhere in the world, says Sidibe. Most people, including those living in poverty in rural and urban areas, have some kind of basic soap, even if just for laundry, she says.

But in this time of crisis, soap supplies may run short — or people who lose their income because of the pandemic may find soap is not affordable.

In New Delhi, Sudhanshu S. Singh, CEO of the nonprofit Humanitarian Aid International, has been collecting donations of soap and hand sanitizer — increasingly in short supply as the city is in lockdown — for the 1,000 refugee families he serves in Delhi.

The families fled Pakistan from persecution and are living in camp settlements in a slum. Because they are stateless, they don’t have the same rights to water as Indians living in the slum, says Singh, and have even less access to water. “They’re living in absolute abysmal conditions. They’re vulnerable to different kinds of diseases and health issues. Eventually the virus is going to affect them.”

So far, he’s distributed a 15-day ration of hygiene materials and taught them proper hand-washing. To ensure the families have enough water to wash their hands, he and other groups petitioned the government to bring more water to the part of the slum where the refugees live. Last week, the authorities brought in a tanker of water to provide additional supply for drinking and hand-washing and will do so regularly.

But offering soap and water is no guarantee that people are going to wash their hands. In every country, from high income to low income, there are a lot of folks for whom a thorough scrub is not a regular habit.

“Just instructing people to wash their hands is not going to get them to do it,” says Sidibe, who previously worked at a project at Unilever focused on changing hand-washing behaviors in 55 countries. “People don’t practice hand-washing. It’s inconvenient and they have other priorities. To change behavior, you need to create an enabling environment. You need to establish a positive social norm. And you need to make it a desirable thing to do.”

In Nigeria, where there are only 111 reported coronavirus cases so far, aid groups like UNICEF have been emphasizing the importance of hand-washing in the low-income areas they serve. “We are trying to spread the message through celebrities, community and religious leaders, and reaching out to media and radio stations,” says Zaid Jurji, head of UNICEF’s water, sanitation and hygiene program, based in Abuja.

They’re collaborating with artists to sing about hand-washing, too.

On Sunday, UNICEF posted “We go win (Corona)” to their YouTube channel. It’s an original song from the popular Nigerian musician Cobhams Asuquo.

The lyrics go, “Corona no big pass us … as long as we remember to always do the right thing: wash your hands, love each other, we go win.”

The idea that a song could change behavior may seem naive, but it did work during the Ebola outbreak.

By Malaka Gharib
Published March 30, 2020

Hand hygiene a key defence in Europe’s fight against antibiotic resistance

Antimicrobial resistance (AMR), and resistance to antibiotics in particular, continues to grow in the WHO European Region and hundreds of thousands of patients die or are considerably affected each year by health care-associated infections (HAI) and diseases caused by germs that are resistant to antimicrobial medicines.

This year’s SAVE LIVES: Clean Your Hands campaign on 5 May uses the slogan “Fight antibiotic resistance – it’s in your hands” to highlight the fact that health-care workers and the public have a responsibility to prevent and control AMR and HAI, in turn helping to prevent related complications and deaths.

It is estimated that 7–10% of patients will acquire at least one HAI at any given time under treatment. A large percentage of these are preventable by improving hand hygiene practices and other infection prevention and control measures.

Taking action from many sides

HAI, including those resistant to antibiotics, are among the most common adverse events in health care delivery. Such infections can impact quality of life and lead to serious disease or even death. Action across all sectors of society is required to effectively prevent AMR. The following key recommendations will help prevent the spread of AMR and protect people in the Region from HAI:

• Health workers must clean their hands at the right times (see below).
• Chief executive officers and managers of health facilities need to support hand hygiene campaigning and infection prevention and control (IPC) programmes.
• IPC leaders should champion hand hygiene campaigns and comply with WHO’s “core components” for IPC.
• Policy-makers should stop the spread of AMR by demonstrating national support for and commitment to infection prevention programmes.

Cleaning hands at the right times

Protecting patients against HAI can be achieved by improving hand hygiene at five key moments, preferably by using an alcohol-based rub or by hand washing with soap and water if hands are visibly dirty. The “five moments” for hand hygiene comprise:

• before patient contact
• before preparing and administering injections
• after contact with body fluids
• after patient contact
• after touching patient surroundings.

Reinforcing the importance of hand hygiene through policy-making

Making infection prevention and hand hygiene a national policy priority by aligning and strengthening existing programmes will go far in combating AMR and protecting patients from resistant infections.

National authorities should implement or reinvigorate any or all of the following options according to the new WHO recommendations on core components for IPC programmes:

• establish a national IPC programme linked with other relevant national programmes and professional organizations;
• ensure that any national IPC programme supports the education and training of the health workforce as one of its core functions;
• establish an HAI surveillance programme and networks that include mechanisms for timely data feedback;
• consider hand hygiene as a key national performance indicator providing vital feedback data on health-care practices;
• have a system in place to ensure patient care activities are undertaken in a clean and/or hygienic, well-equipped environment to prevent and control HAI.


Building momentum in the fight against antibiotic resistance

This year’s campaign builds important momentum ahead of World Antibiotic Awareness Week (WAAW), which takes place on 13–19 November 2017. WAAW encourages all countries, health partners and the public to help raise awareness of AMR and to emphasize that we all have a part to play in preserving the effectiveness of antimicrobial medicines.


By WHO Europe
Publihed May 4th 2017

World Water Day: Hand hygiene essential to containing spread of COVID-19

Today is World Water Day. It is set aside to celebrate water and raise awareness of the 2.2 billion people living without access to safe water.

It is about taking action to tackle the global water crisis. A core focus of World Water Day is to support the achievement of Sustainable Development Goal 6: water and sanitation for all by 2030.

According to the UN, “The theme for 2020 is “Water and Climate Change” and explores how the two issues are inextricably linked.

“In light of the growing COVID-19 pandemic, the 2020 campaign also promoted messages around handwashing and hygiene and gave guidance on staying safe while supporting the campaign.

“The campaign also shows how our use of water will help reduce floods, droughts, scarcity and pollution, and will help fight climate change itself.

“By adapting to the water effects of climate change, we will protect health and save lives. And, by using water more efficiently, we will reduce greenhouse gases.

“Our key messages for this day are clear:

We cannot afford to wait. Climate policy makers must put water at the heart of action plans.
Water can help fight climate change. There are sustainable, affordable and scalable water and sanitation solutions.

“Everyone has a role to play. In our daily lives, there are surprisingly easy steps we can all take to address climate change.

“Hand hygiene is essential to containing the spread of COVID-19, as well as other infectious diseases. Wash hands with soap and water

Published 24 March 2020: https://www.tvcnews.tv