Water Currents: Handwashing Research


Frequent and proper handwashing with soap is one of the most important measures that can be used to prevent the spread of diseases and infections, such as the coronavirus. Yet recent statistics demonstrate that 40 percent of households lack access to a handwashing facility with soap and water. And 18 percent of those households have nowhere to wash their hands.
These statistics translate into billions of households without the basic essentials to fight the coronavirus—soap and a sufficient water supply. USAID and the Global Handwashing Partnership (GHP) continue their collaboration to raise awareness about the persistent inequalities in access to water, sanitation, and hygiene (WASH) and work to ensure that lifesaving supplies of soap and water will be available to those in need to prevent new infections now and provide a foundation for economic recovery later.
We would like to thank GHP for its collaboration on this issue of Water Currents, which contains peer-reviewed studies and reports on handwashing that were published from January through June 2020.

In Focus

Hand Hygiene for All: A Call to Action for All of Society to Achieve Universal Access to Hand HygieneUNICEF, June 2020. The Hand Hygiene for All initiative aims to move the world toward supporting the most vulnerable communities with the means to protect their health and environment. This document outlines why universal hand hygiene is important and how all of us can work together to achieve it.

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

Assessing the Impact and Equity of an Integrated Rural Sanitation Approach: A Longitudinal Evaluation in 11 Sub-Saharan Africa and Asian Countries. International Journal of Environmental Research and Public Health, March 2020. This article explores the impact of the Sustainable Sanitation and Hygiene for All approach on key WASH indicators. The authors estimate that 4.8 million people gained access to basic sanitation during the project period. Most countries also demonstrated movement up the sanitation ladder, in addition to increases in handwashing stations and safe disposal of child feces.

The Determinants of Handwashing Behaviour in Domestic Settings: An Integrative Systematic ReviewInternational Journal of Hygiene and Environmental Health, March 2020. This literature review sought to synthesize evidence surrounding the determinants of handwashing behavior to help practitioners enhance their hygiene promotion programming. The authors found hygiene promotion programs are likely to be most successful if they use multi-modal approaches, combining infrastructural improvement with “soft” hygiene promotion, which addresses a range of determinants rather than just education about disease transmission.

Handwashing with Soap: Our Best Defence Against CoronavirusWash’Em, April 2020. This brief has practical tips on encouraging community-level handwashing behavior with the aim of controlling and preventing the spread of the coronavirus.

Ruminant Fecal Contamination of Drinking Water Introduced Post-Collection in Rural Kenyan HouseholdsInternational Journal of Environmental Research and Public Health, January 2020. This article suggests multiple pathways contribute to the transmission of ruminant fecal contamination in rural homes in Kenya.

Use, Adoption, and Effectiveness of Tippy-Tap Handwashing Station in Promoting Hand Hygiene Practices in Resource-Limited Settings: A Systematic Review. BMC Public Health. June 2020. This systematic review aims to establish the use, benefits, adoption, and effectiveness of tippy tap handwashing stations in resource-limited settings.

A Cluster-Randomised Trial to Evaluate an Intervention to Promote Handwashing in Rural NigeriaInternational Journal of Environmental Health Research, July 2020. Handwashing with soap at critical times helps prevent diarrheal diseases. Changing handwashing practices through behavior change communication remains a challenge. This study designed and tested a scalable intervention to promote handwashing with soap.

Handwashing and COVID-19
‘How to’ Brief: Communicating for Hand Hygiene during COVID-19GHP, May 2020. This brief provides suggestions for crisis planning and risk communication particular to hand hygiene and related issues for COVID-19.

How Long Should Hands Be Washed? COVID-19 Hygiene Hub, June 2019. This document gives guidance on the suggested duration of handwashing: given that COVID-19 can transmit via surfaces as well as respiratory droplets, it is important that hands are washed at additional and different times than what would normally be recommended for the control of diarrheal diseases.

Beyond Handwashing: Water Insecurity Undermines COVID-19 Response in Developing AreasJournal of Global Health, June 2020. This article explores the wide-ranging ways in which water insecurity impedes COVID-19 control strategies beyond simply limiting handwashing, especially in high-density urban areas.

Beyond Raising Awareness: Promoting Handwashing in Nepal Amid the COVID-19 CrisisWorld Bank, May 2020. This report proposes a framework for policy actions to effectively promote handwashing in Nepal amid COVID-19. Raising awareness about proper handwashing is the cheapest, easiest, and most important way to prevent the spread of the coronavirus, but it is far from sufficient in Nepal.

Pedal Operated Handwashing Station Responding COVID-19 PandemicWaterAid Bangladesh, May 2020. In response to COVID-19, WaterAid Bangladesh has demonstrated different handwashing options including pedal-operated handwashing stations, which help sanitize hands without physically touching the water tap and soapy water or other liquid soap dispensers, thereby limiting potential for contamination at public and common places.

Inequalities in Access to Water and Soap Matter for the COVID-19 Response in Sub-Saharan AfricaInternational Journal for Equity in Health, June 2020. This article argues interventions such as mass distribution of soap and ensuring access to clean water, along with other preventive strategies, should be scaled up to reach the most vulnerable populations.

Global Access to Handwashing: Implications for COVID-19 Control in Low-Income CountriesEnvironmental Health Perspectives, May 2020. Handwashing is a key component of guidance to reduce transmission of COVID-19. This article found more than 50 percent of the population in sub-Saharan Africa and Oceania were without access to handwashing in 2019, and in eight countries, 50 million or more persons lacked access.

Handwashing Stations and Supplies for the COVID-19 ResponseUNICEF, May 2020. This document provides an overview of available handwashing station designs for policymakers, implementers, and procurement officers.

COVID-19 Action Toolkit: Handwashing and Other Preventative MeasuresBusiness Fights Poverty, May 2020. This action toolkit provides guidance on what businesses can do immediately and in the longer term to increase awareness of and access to handwashing and other preventative measures.

COVID-19 Handwashing with Soap Facilities: Compendium of Indicative Layouts, Designs and Cost EstimatesUNICEF, May 2020. This document provides details of different handwashing station designs and their estimated costs.

Potential Utilities of Mask-Wearing and Instant Hand Hygiene for Fighting SARS-CoV-2. Journal of Medical Virology. March 2020. Mask-wearing and handwashing can slow the spread of the virus, but mask shortages and timely handwashing is often impossible. This efficacy study evaluates three types of masks and instant hand wiping using the avian influenza virus to stand in for the coronavirus.

Hand Hygiene in Health Care Facilities
Interim Recommendations on Obligatory Hand Hygiene Against Transmission of COVID-19WHO, May 2020. Contact transmission of COVID-19 occurs through the spread of respiratory droplets or when contaminated hands touch the mucosa of the mouth, nose, or eyes. Contaminated hands can also transfer the virus from one surface to another. This document makes recommendations to improve hand hygiene to prevent the transmission of the virus.

Evaluation of an Inexpensive Handwashing and Water Treatment Program in Rural Health Care Facilities in Three Districts in Tanzania, 2017Water, May 2020. This program evaluation found persistent challenges in achieving full coverage of basic levels of WASH services in the communities studied, highlighting the importance of health system strengthening for sustainability of interventions and achievement of the Sustainable Development Goals.

Recommendation on Water, Sanitation and Hygiene Measures in Healthcare Facilities. Pan American Health Organization, April 2020. Existing recommendations on WASH measures in health care facilities are important to provide adequate patient care and protect both patients and staff.

Ten Immediate WASH Actions in Healthcare Facilities for COVID-19 Response. Global Water 2020. April 2020. This document lists 10 immediate WASH 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.

Handwashing 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, February 2020. Provision of soap and water alone is not sufficient to encourage children to practice handwashing with soap in a humanitarian context. The authors’ findings suggest that equal consideration should be given to the quality and location of handwashing materials and facilities and that social norms could be leveraged to promote and enhance child handwashing.

The Determinants of Handwashing Behaviour Among Internally Displaced Women in Two Camps in the Kurdistan Region of IraqPLoS One, May 2020. Handwashing programs should seek to improve the convenience and quality of handwashing facilities, create cues to trigger handwashing behavior, and increase perceived risk.

Access to Functional Handwashing Facilities and Associated Factors Among South Sudanese Refugees in Rhino Camp Settlement, Northwestern UgandaJournal of Environmental and Public Health, March 2020. Hand hygiene in refugee camp settlements remains an important measure against diarrheal infections. Handwashing with soap and water is an effective way of preventing such diseases. Despite this knowledge, information is limited about access to functional handwashing facilities in these settings.

Interim Guidance on Public Health and Social Measures for COVID-19 Preparedness and Response Operations in Low Capacity and Humanitarian Settings. Interagency Standing Committee. May 2020. This interim guidance outlines how public health and social measures, including availability of handwashing supplies, can be adapted in low capacity and humanitarian settings.

Handwashing and Children
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. This study examined the efficacy of the “School of Five” program promoting handwashing with soap using interactive stories, games, songs, and behavioral diaries to encourage habit formation and public commitment.

Mother's Handwashing Practices and Health Outcomes of Under-Five Children in Northwest EthiopiaPediatric Health, Medicine, and Therapeutics. March 2020. Improving handwashing practices of mothers is important in developing countries to reduce child morbidity, mortality, and hygiene-related illnesses. This study aimed to assess mothers’ handwashing practices and the health effects on under-5 children in northwest Ethiopia.

Health Outcomes of an Integrated Behaviour-Centred Water, Sanitation, Hygiene and Food Safety Intervention—A Randomised Before and After TrialInternational Journal of Environmental Research and Public Health, April 2020. This study concludes that food hygiene interventions (including handwashing with soap) can significantly reduce diarrheal disease prevalence in children under 5 years in a low-income setting.

Knowledge Map: WASH in Schools and CoronavirusWASH in Schools Network, April 2020. This knowledge map has links to relevant materials about COVID-19 for learners, their families, and the education system.


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