Water Currents: Global Handwashing Day 2020

This Water and Development Alliance project in Ghana improved water access to six beneficiary communities through decentralized water treatment kiosks and improved sanitation facilities and hygiene behaviors for schools. Photo credit: Water and Development Alliance

On October 15, join USAID and its partners to celebrate Global Handwashing Day 2020. This year’s theme—Hand Hygiene for All—highlights the elevated importance of handwashing during the COVID-19 pandemic, since regular handwashing with soap is one of the most effective means of preventing the spread of the virus. To better contain the virus today and lay the foundation for improved health outcomes once the pandemic recedes, governments, businesses, and donors must make universal access to handwashing infrastructure, soap, and reliable water service a priority now and into the future.

Around the globe, USAID is responding to the urgent need for improved access to water, handwashing facilities, and soap and continues to promote behavior change interventions that lead to better hand hygiene. USAID also works with partners such as the Global Handwashing Partnership to strengthen policy, coordination, and financing that underpin hand hygiene services.

Studies and resources in this issue focus on hand hygiene in schools, humanitarian situations, health care facilities as well as hand hygiene and COVID-19. We would like to thank the Global Handwashing Partnership for contributing content to this issue of Water Currents. 

In Focus

October 14, 2020 USAID Event – Twenty Seconds that Saves Lives and Economies: Handwashing and Water in a Time of COVID-19. This event will feature speakers from USAID and Government of Ghana, the World Bank, Sanitation and Water for All, and other global partners to highlight the importance of handwashing, the challenges facing the water, sanitation, and hygiene (WASH) sector and global efforts to fight the current pandemic. Register for the event here.

Global Handwashing Day 2020: Hand Hygiene for All – October 15,2020 is Global Handwashing Day, a global advocacy day dedicated to increasing awareness and understanding about the importance of handwashing with soap as an effective and affordable way to prevent diseases and save lives. This year’s theme, “Hand Hygiene for All,” follows the recent global initiative calling on all of society to scale up hand hygiene, especially through handwashing with soap. Resources on the website include a ForumSocial Media ToolsSupporters, and the Guide du Planificateur.

Handwashing Thursday Series, October 1–November 5, 2020 – The Handwashing Thursday webinar series will amplify the launch of a new Global Handwashing Partnership resource: The Handwashing Handbook. The handbook presents best practices and new concepts to improve the uptake of handwashing. This learning series will discuss various topics from the handbook and highlight the efforts of partners who contributed to its development.

Standard Precautions: Hand HygieneWHO. This one-hour course, available in multiple languages, is intended to expand health care workers’ understanding of hand hygiene as a critical aspect of infection prevention and control. Proper handwashing technique, use of gloves, and application of alcohol-based hand rub in health care settings are covered.

Global Handwashing Day 2020 Fact SheetGlobal Handwashing Partnership, September 2020. This fact sheet explains the research and rationale behind this year’s Global Handwashing Day theme, “Hand Hygiene for All,” and includes other information to scale up hand hygiene now and in the future.

Opinion: Three Billion People Can't Wash Their Hands in COVID-19 Pandemic. Here's How We Plan to HelpUSA Today, September 2020. Representative Earl Blumenauer, who represents Oregon’s 3rd District, and Representative Darin LaHood, who represents Illinois’ 18th District, serve as founders and co-chairs of the recently launched bipartisan Congressional International Water and Sanitation Caucus. In this editorial, they explain why investment in improved water, sanitation, and hygiene (WASH) access needs to be a cornerstone of U.S. development, diplomacy, and defense.

Correlates of Access to Hand Hygiene Resources in Ghanaian Households: An Exploratory Analysis of the 2014 Demographic and Health SurveyHeliyon, August 2020. This study estimates that only a fifth of Ghanaian households have access to hand hygiene resources.

Handwashing Compendium for Low Resource Settings: A Living DocumentSanitation Learning Hub, April 2020. Bringing existing information from different organizations into one place, the compendium provides guidance and local examples of and further resources on accessible low-cost handwashing facilities, environmental cues, and physically distanced hygiene promotion.

Hygiene Baselines Pre-COVID-19: Global SnapshotUNICEF; WHO, May 2020. Two out of five people in the world do not have a handwashing facility with soap and water on premises. Almost half of the schools in the world do not have handwashing facilities with soap and water available to students. Data are not available to determine global access to hand hygiene facilities with soap and water in health care facilities.

The Determinants of Handwashing Behaviour in Domestic Settings: An Integrative Systematic Review. International Journal of Hygiene and Environmental Health, June 2020. This review demonstrates that the understanding of behavioral determinants remains suboptimal. Hygiene promotion programs are likely to be most successful if they use multi-modal approaches, combining infrastructural improvement with “soft” hygiene promotion that addresses a range of determinants rather than just education about disease transmission.

Use, Adoption, and Effectiveness of Tippy-Tap Handwashing Stations in Promoting Hand Hygiene Practices in Resource-Limited Settings: A Systematic ReviewBMC Public Health, June 2020. The availability of tippy taps increased handwashing and use of soap among participants. Furthermore, the majority of people who were oriented to tippy taps or recruited to participate in tippy tap studies built tippy tap stations even after the promotional activities or programs had ended.

Hand Hygiene in Low- and Middle-Income CountriesInternational Journal of Infectious Diseases, September 2019. The International Society for Infectious Diseases convened a panel of experts to review evidence-based strategies geared toward low-and middle-income countries to reduce the transmission of pathogens via the hands of health care workers.

Hand Hygiene and Children/Handwashing in Schools
RinseFree Hand Wash for Reducing Absenteeism Among Preschool and School ChildrenCochrane Database of Systematic Reviews, April 2020. The application of, and adherence to, a rinse‐free hand wash, hygiene program may be associated with small, but potentially beneficial effects in reducing the number of days students were absent from school due to illness compared to a no rinse‐free hand wash, hygiene program.

Progress on Drinking Water, Sanitation and Hygiene in Schools: Special Focus on COVID-19UNICEFWHO, August 2020. The latest global estimates found that in the 60 countries identified as having the highest risk of health and humanitarian crisis due to COVID-19, one in two schools lacked basic water and sanitation services and three in four lacked basic handwashing facilities at the start of the pandemic. | Summary | Complete report |

Impact of a Teacher-Led School Handwashing Program on Children’s Handwashing with Soap at School and Home in Bihar, IndiaPLoS One, February, 2020. Promoting handwashing with soap through teachers in schools may be an effective way to achieve behavior change at scale.

Good Mums: A Gender Equality Perspective on the Constructions of the Mother in Handwashing CampaignswH2O: The Journal of Gender and Water, March 2020. The goal of this paper is to illustrate how promotional approaches are targeting mothers to change handwashing and hygiene behavior, and to contrast such interventions with the possibility of more gender transformative approaches.

Key Messages and Actions for COVID-19 Prevention and Control in SchoolsUNICEFWHOIFRC, March 2020. The purpose of this document is to provide clear and actionable guidance for safe operations through the prevention, early detection, and control of COVID-19 in schools and other educational facilities.

Associations Between Intestinal Parasitic Infections, Anaemia, and Diarrhoea among School-Aged Children, and the Impact of Hand-Washing and Nail ClippingBMC Research Notes, January 2020. Handwashing with soap and nail clipping were effective in preventing intestinal parasite reinfection and can be universally used as infection prevention interventions among school‐aged children to break the vicious cycle of infection and malnutrition for the long‐term health benefits of this population.

Hand Hygiene and COVID-19
Celebrating Global Handwashing Day Around the World with USAIDGlobal Waters Radio, September 2020. In celebration of Global Handwashing Day on October 15, the latest podcast from Global Waters Radio features two USAID WASH experts from Indonesia and South Sudan. Among other topics, they describe the ways USAID has been elevating the role of handwashing in response to COVID-19 in recent months, and share some of the challenges they have been facing as they work to create sustainable handwashing behavior change during the pandemic.

Summary Report on Handwashing and COVID-19COVID-19 Hygiene Hub, August 2020. To understand why handwashing is so effective in killing and removing COVID-19, it is necessary to understand how soap works at a microscopic level.

20 Seconds That Save Lives: Prioritizing Water & Hygiene to Fight COVID-19Agrilinks, August 2020. As the global community continues to grapple with how best to ensure that everyone, everywhere, has the water and soap needed to wash their hands to prevent the spread of COVID-19 now, the authors look ahead to the risk of reduced access to water and sanitation in the future, as limited resources are redirected toward other priorities.

Learnings and Reflections of Contactless Handwashing FacilitiesWaterAid Nepal, August 2020. Contactless handwashing facilities are an effective way to promote handwashing, and people find these facilities useful. However, the location to install the contactless handwashing facilities should be carefully selected, making it visible to a maximum number of potential users.

New Evidence for Improving Handwashing Access and Behavior during COVID-19 and BeyondR&E Search for Evidence, September 2020. The latest handwashing research coupled with the current spotlight on handwashing provides a unique opportunity to achieve what is most needed to save lives today and in the future.

Inequalities in Access to Water and Soap Matter for the COVID-19 Response in Sub-Saharan AfricaInternational Journal for Equity in Health, June 2020. The authors analyzed data from Demographic and Health Surveys of 16 countries in sub-Saharan Africa. Only 33.5 percent of households with an observed handwashing place at home have water and soap. Rural residents, who represent the majority of the population in the region, have much lower access compared to their urban counterparts, and significant inequalities exist between the richest and poorest households.

Recommendations to Member States to Improve Hand Hygiene Practices to Help Prevent the Transmission of the COVID-19 VirusWHO, April 2020. WHO recommends that member states provide universal access to public hand hygiene stations and make their use obligatory on entering and leaving any public or private commercial building and any public transport facility. It is also recommended that health care facilities improve access to and practice of hand hygiene.

Five Ideas for Handwashing Promotion during the 1st Phase of COVID-19 ResponseCOVID-19 Hygiene Hub, September 2020. This report provides practical tips on how to encourage community-level handwashing behavior with the aim of controlling and preventing the spread of COVID-19.

Summary Report on Making Soap and Alcohol-Based Hand Rub at the Community LevelCOVID-19 Hygiene Hub, September 2020. Several safety considerations must be taken into account when making soap, meaning soap making may not be a quick solution to increase supply for a COVID-19 response.

Hand Hygiene and Health Care Facilities
Ten Immediate WASH Actions in Healthcare Facilities for COVID-19 ResponseGlobal Water 2020. This report describes 10 immediate water, sanitation, and hygiene actions that low-resource health care facilities can undertake with limited budgets in the near-term (0–3 months) to prepare for and address COVID-19.

Water, Sanitation and Hygiene in Health Care FacilitiesUNICEF; WHO, April 2019. This document presents eight practical steps that can be taken at the national and subnational level to improve WASH in health care facilities.

Formative Research to Scale Up a Handwashing with Soap and Water Treatment Intervention for Household Members of Diarrhea Patients in Health Facilities in Dhaka, Bangladesh (CHoBI7 Program)BMC Public Health, June 2020. Formative research identified existing WASH and diarrhea patient care practices, target population experiences with and acceptability of a health facility–initiated WASH intervention, and facilitated modifications to the CHoBI7 intervention program in an effort to identify a scalable approach to deliver this program in Bangladesh.

Evaluation of an Inexpensive Handwashing and Water Treatment Program in Rural Health Care Facilities in Three Districts in Tanzania, 2017Water, May 2020. This study demonstrates that a relatively low-cost intervention can be implemented in the short term and contribute to modest improvements in access to handwashing facilities and safe drinking water in rural health care facilities in Tanzania. However, resource limitations and incomplete integration of the intervention into the local health system served as barriers to accomplishing full coverage in the target facilities.

Behavioural Determinants of Hand Washing and Glove Recontamination before Aseptic Procedures at Birth: A Time-and-Motion Study and Survey in Zanzibar Labour WardsInternational Journal of Environmental Research and Public Health, February 2020. Recent research calls for distinguishing whether the failure to comply with WHO hand hygiene guidelines is driven by omitting to rub/wash hands, or subsequent recontamination of clean hands or gloves prior to a procedure. This study examines the determinants of these two behaviors.

Guidelines on Hand Hygiene in Health Care: A SummaryWHO, 2009. These guidelines provide health care workers, hospital administrators, and health authorities with a thorough review of evidence on hand hygiene in health care and provide specific recommendations to improve practice and reduce transmission of pathogens from health care worker to patient.

Hand Hygiene and Humanitarian Situations
Child Handwashing in an Internally Displaced Persons Camp in Northern Iraq: A Qualitative Multi-Method Exploration of Motivational Drivers and Other Handwashing DeterminantsPLOS One, January 2020. Provision of soap and water alone is not sufficient to encourage children to practice handwashing with soap in a humanitarian context. Findings suggest that equal consideration should be given to the quality and location of handwashing materials and facilities, and social norms could be leveraged to promote and enhance child handwashing.

Designing a Theory and Evidence-Based COVID-19 Prevention Programme that Is Feasible within a Refugee CampCOVID-19 Hygiene Hub, September 2020. UNHCR, World Vision, and RANAS Ltd. designed a theory-driven, evidence-based behavior change intervention aiming to increase handwashing with soap and physical distancing among Tongogara Refugee Camp residents in response to the COVID-19 pandemic.

Hygiene Programming during Outbreaks: A Qualitative Case Study of the Humanitarian Response during the Ebola Outbreak in LiberiaBMC Public Health, January 2020. This study describes humanitarian perspectives on changing behaviors in crises, through a case study of hygiene promotion during the 2014–2016 Liberian Ebola outbreak.

A Pilot Study of the Effect of Improved Hygiene Kits on Handwashing with Soap among Internally Displaced Persons in EthiopiaResearch Square, August 2020. The study shows that improved kits have potential to make handwashing more desirable and easier to practice, and further research including formative assessments prior to the design of hygiene kits should be conducted to ensure uptake.

If you would like to feature your organization's materials or suggest other content for upcoming issues of Water Currents, please send them to Dan Campbell, Knowledge Creation/WASH Specialist, at