HANDWASHING: THE MOST EFFECTIVE WEAPON AGAINST INFECTIONS

Today, October 15 is the global handwashing day. This day is set aside annually to promote awareness on the importance of hand washing with soap or ash.

WHY HAND WASHING

Hand washing with soap is one of the most important public health interventions in the world. According to global public – private partnership for handwashing,  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 behavior 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.

Handwashing with soap improves health and saves lives by preventing infections. Many infections start when hands are contaminated with disease-causing bacteria and viruses. This can happen after using the toilet, changing a child’s diaper, coughing, sneezing, touching other people’s hands, and touching other contaminated surfaces. A single gram of human feces can contain 10 million viruses and one million bacteria, and infant feces are particularly pathogenic. Handwashing with soap works by removing bacteria and viruses from hands before they get a chance to cause infections or spread to other people. This is why cleaning hands with soap, particularly after contact with fecal material from using the toilet or cleaning a child’s bottom, is so important.

When hands are contaminated with disease-causing bacteria and viruses, these pathogens can enter the body or pass from person-to-person. Once these bacteria and viruses enter the body, they can cause a wide range of infections.

Two major illnesses that are transmitted on the hands are diarrhea and pneumonia. Together, diarrhea and pneumonia kill an estimated 1.7 million children every year. Many of these deaths can be prevented by handwashing with soap. Other infections that handwashing with soap can help prevent include Ebola, skin and eye infections; intestinal worms, and healthcare-associated infections.

Diarrhea

Each day 2,195 children die from diarrhea. This makes it one of the top killers of children under the age of five globally. Almost all causes of childhood diarrhea are caused by infections, which means that most of these deaths are entirely preventable. One of the most effective ways of preventing diarrhea is by handwashing with soap. In fact, a review of more than 40 studies found that handwashing with soap can prevent four out of every 10 cases of diarrhea. Children living in households where there is active handwashing promotion and available soap have half the rates of diarrhea compared to children without these.

Diarrheal diseases are often described as water-related but should more accurately be known as excreta-related, as the bacteria and viruses (germs) that cause diarrhea come from fecal matter (poo). These germs make people ill when they enter the mouth via hands that have been in contact with feces, contaminated drinking water, unwashed raw food, unwashed utensils, or smears on clothes. Handwashing with soap breaks this cycle.

Pneumonia and Acute Respiratory Infections

Acute respiratory infections like pneumonia are another leading cause of death in children under the age of five. Handwashing reduces the rate of respiratory infections in two ways: by removing respiratory pathogens found on hands and surfaces and by removing other pathogens, such as viruses that affect the gut, found to cause both diarrhea and respiratory symptoms. Evidence suggests that washing hands with soap after defecation and before eating could cut the respiratory infection rate by about 21-25 percent. However, the full effect might turn out to be even bigger. For example, a study in Pakistan found that handwashing with soap reduced the number of pneumonia related infections in children under the age of five by more than 50 percent.

Proper handwashing helps prevent the spread of cold and flu by removing viruses that get onto hands from coughs and sneezes. This is particularly important during flu season. Materials such as posters that can be used to promote good hand hygiene during peak seasons of respiratory illness or flu transmission can be found at this link.

Ebola

Ebola virus disease is a severe and often fatal 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 and through contact with surfaces that have been contaminated with these infected bodily fluids. Handwashing with soap is an important component of Ebola infection protection.

Given the impact of Ebola and the role of handwashing, the PPPHW has developed an Ebola Key Topics page. Additional information about Ebola is available on this World Health Organization factsheet and FAQs, as well as the WHO/UNICEF Ebola and water, sanitation, and hygiene questions and answers page.

Skin & Eye Infections

Though not as extensive and robust as the research evidence for diarrheal disease and respiratory infections, studies have shown that handwashing with soap reduces the incidence of skin diseases and eye infections like trachoma.

Intestinal Worms

While more evidence is needed, existing research shows that handwashing with soap reduces the incidence of intestinal worms, especially ascariasis and trichuriasis.

Healthcare-Associated Infections

Healthcare-associated infections (HAIs) affect 15 out of every 100 patients during a hospital stay; the rate is even higher in intensive care units, in low-resource settings, and for new-borns. HAIs impact hundreds of millions of patients every year. They can cause short-term illness, long-term disability, and death. They also contribute to longer hospital stays, antibiotic resistance, and a massive financial impact for patients, families, and entire health care systems. Most HAIs can be prevented through good hand hygiene—cleaning hands at the right times and in the right way, either by handwashing with soap or utilizing alcohol-based hand rubs. Good hand hygiene in healthcare has saved millions of lives, but currently only about 40 percent of health workers globally practice good hand hygiene.

Have additional questions about handwashing with soap? click here to ask an expert.

Hand Washing and Nutrition

Good nutrition is about more than access to nutritious foods: it is also about the body’s ability to absorb the nutrients in the food a person consumes, and this ability can be affected by germs carried on a person’s hands.

The World Health Organization (WHO) estimates that 50 percent of child undernutrition cases are due to repeated diarrhea and intestinal infections caused by poor sanitation and hygiene conditions or lack of safe water. Handwashing with soap is a critical determinant for achieving and maintaining good nutrition, and this healthy behavior plays an important part in preventing micronutrient deficiencies, stunting, wasting, and deaths.

Stunting, or low height for age, is caused by long-term insufficient nutrient intake and frequent infections in early childhood, resulting in delayed motor development, impaired cognitive function, and reduced school performance. Nearly one third of children under the age of five in low income countries are stunted.

Wasting, or low weight for height, is caused by acute insufficient nutrient intake and/or disease, and is a strong predictor of mortality among children under the age of five.

If disease-causing bacteria, viruses, or parasites on a person’s hands enter their mouth, they can travel down to the gut where they may damage the body’s ability to use nutrients from food. The likely ways that these germs can do this are by directly consuming nutrients before the body can use them and by damaging the intestinal lining (this is referred to as environmental enteropathy). Environmental enteropathy includes flattening out parts of the (villus blunting), which reduces places where nutrients can be absorbed into the body. As such, nutrients that pass through the gut but fail to be absorbed can be lost in diarrhea. These pathogens can also irritate the gut, which can damage its barrier functions, make it easier for toxins to get inside the body, and cause chronic inflammation, which can further damage the gut and use up nutrients in the process.

Diarrhea and undernutrition can become a vicious cycle.

Children are susceptible to infection by bacteria and viruses in fecal matter (poo) that cause diarrhea. When children get diarrhea, they (a) often eat less food, and (b) have a reduced ability to absorb and benefit from nutrients in the food they do eat, contributing to the development of under-nutrition. When children are undernourished, they become more susceptible to developing diarrhea when they come into contact with the bacteria and viruses in fecal matter. And so the cycle goes around again.

Handwashing breaks the vicious cycle of diarrhea and undernutrition.

Good handwashing with soap can prevent nearly half of all cases of childhood diarrhea. It is also estimated that drinking clean water and handwashing with soap can reduce the loss of nutrients through diarrhea and reducing stunting in children under the age of five by up to 15 percent, giving children a better chance of maintaining good nutrition and growing up to thrive.

Given the important role of handwashing in nutrition, the PPPHW helped co-found the Clean, Fed & Nurtured Community of Practice  which works to explore and promote the integration of WASH, nutrition, and early childhood development in the 0-3 age range. We also provide a number of resources relating to the integration of nutrition and handwashing in our resources section.

Adopted from Global public – private partnership for handwashing.

Compiled by 
FCS aid4Life Directorate
National Headquaters, Jos
Nigeria