Hand Hygiene — Essential For Disease Prevention

Today, we continue our series of guest posts written by students of the Mortenson Center.

“By the time this countdown ends [30 seconds], a child will be dead somewhere in the world, and it won’t be because of a war, nor for any kind of violence; it will be caused by somebody who before cooking, or after changing a diaper, or after being at the toilet, didn’t wash his hands with water and soap, and because his hands were infected with diarrhea, a child passed away in this very moment. Life lies on your hands. Wash your hands with water and soap.”

These words are spoken by a Columbian child in a World Bank Water and Sanitation Program (WSP) TV advertisement, focusing on the benefits of hand washing with soap.

Hand washing with soap is critical to proper hygiene and good health, as hands are important vectors that can transport diarrheal and infectious disease agents. One half of child deaths worldwide are attributable to acute diarrheal disease (ADD) and acute respiratory infection (ARI) (0.751 million and 1.071 million child deaths per year respectively). Unsurprisingly, infectious disease is more common in developing versus developed countries, as it causes 62% of all deaths in Africa and 31% in Southeast Asia, yet only 5% in Europe. In fact, in developing countries, the two leading killers of children under age five are ADD and ARI. The good news is that instances of diarrhea among children in low and middle income countries has declined slightly from 1.9 million cases in 1990 to 1.7 million cases in 2012, perhaps due to hygiene promotion and programs. Nonetheless, this rate remains unacceptably high.

One of the easiest, most cost-effective ways to prevent the spread of disease is hand washing with soap (HWWS) at key times. These times include after using sanitary facilities, after cleaning children’s feces, before eating, before preparing food, and before feeding children. Actually, studies show that HWWS prevents 45% of diarrhea incidences and 23% of respiratory infections. It is particularly important for people who have vulnerable immune systems, such as children, the elderly and people with HIV/AIDS.

In addition to saving lives, good hand hygiene provides a plethora of benefits including reduction of non-fatal infections, lessened illness incidence, increased school attendance, improvements in child growth, and possible development as a result of better nutritional status and health.

Some might ask, does hand washing with water only work? The answer is that hand washing with soap or ash is far more effective than water alone. The major benefits of using soap are increased contact time and friction that breaks down grease and dirt, matter which holds the largest concentrations of microbes.

Interestingly, some surveys claim that soap is almost universally present in households, but usage for hand washing ranges from 3-47%. Moreover, HWWS is only practiced a mere 5-15% of those key times. This begs the question, since hand washing with soap appears to be an easy measure for preventing illness, why isn’t it more commonly practiced? Well, it is not quite that simple. Imagine never having been taught to wash your hands, living in a place where your cultural traditions teach against hand washing, or lacking access to clean water. These are all factors that contribute to hand hygiene deficiency, and they all require attention.

Though essential, hand washing health education and information are not enough to bring about lasting hand hygiene behavioral change; good hand hygiene must become a social norm and a habit that is formed, ideally at a young age. Greater local and cultural support need be generated to spread acceptance and capacity to practice proper hand hygiene daily. Governments and NGOs might consider implementing programs or supporting businesses that deliver affordable or free soap, water, and hand rubs to communities. Local soap making could also be a way to boost health, women’s empowerment, an entrepreneurial spirit, and the economy in certain locations.

Ultimately, any hand hygiene approach must be backed by continual support in order to bring about a total and permanent behavioral change. Widespread, regular, correct hand hygiene holds the potential to increase the freedom to live healthy and dignified lives for people living in developing communities worldwide.


Curtis, V., Danquah, L., & Aunger, R. (2009, March 13). Planned, motivated and habitual hygiene behavior: an eleven country review. Retrieved from Oxford Journals: http://her.oxfordjournals.org/content/24/4/655.full.pdf

Ensink, J. (n.d.). Health impact of handwashing with soap. Retrieved from Well Factsheet: http://www.lboro.ac.uk/well/resources/fact-sheets/fact-sheets-htm/Handwashing.htm

Greenland, K., Cairncross, S., & Curtis, V. (2012, October). What can hand hygiene do for the world?

USAID Hygiene Improvement Project, Academy for Educational Development. (2011). USAID Hygiene Improvement Project, September 30, 2004–Novemeber 20, 2010, End of Project Report. February.

Water and Sanitation Program. (2009, April 28). Promoting Handwashing with Soap in Columbia. Retrieved from YouTube: (http://www.youtube.com/watch?v=0CdeX4TJaWE&feature=share&list=PLE8F1CFF6E9008310&index=9)


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