If there is a practice that has survived over centuries, through wars and peace, and across religions and cultures, it is the humble hand hygiene. The roots lie in ancient times. One of the common attributes that religions, ranging from Hinduism, Judaism and Christianity, to Islam, lay emphasis on hand hygiene. Handwashing rituals became a mark of good manners – and even part of fads and fashion, as the rich displayed expensive utensils like basins, aqua-manilia and ewers.
The practice has not only survived, but more recently has become a critical one to follow. Handwashing with soap is one of the most important weapons to fight Covid. If done six-times-a-day, it cuts down the risk of infection by over a third, as per research at UCL Institute of Health Informatics. It will continue to play a key role in future pandemics too, as medical science scurry to find preventive or curative solutions.
Hand hygiene’s medical importance is not limited. It has a bigger role beyond pandemics. It is the most effective and affordable preventive measure to significantly reduce incidences of diarrhoea and acute respiratory infection, according to research studies. It is noteworthy that diarrhoea and pneumonia count amongst the main causes of death in children under five.
In modern times, over 170 years ago (1848), a Hungarian, Dr Ignaz Semmelweis, working at Vienna General Hospital, discovered the life-saving qualities of handwashing. He noticed a high rate of maternal mortality during delivery of babies, as medical students transited straight to maternity wards from morgues, after training on corpses. When he asked doctors to wash hands with chlorine, the death rate dropped dramatically. But his finding did not find acceptance among elite doctors in Vienna, who refused to believe that they were responsible for the demise of mostly working-class patients.
The now-recognised father of modern handwashing lost his job, as well mental faculties, and died prematurely at 47 in an asylum. Fortunately, the importance of the discovery was not lost. The movement got intermittent booster doses with Florence Nightingale giving a push to hygiene in hospitals and homes. Other major figures intervened – Robert Koch, who founded modern bacteriology, Louis Pasteur, who showed how to neutralise disease-causing micro-organisms, Joseph Lister, who pioneered antiseptic surgery, and Alexander Fleming, who discovered penicillin to treat bacterial infections.
While the practice gathered momentum, alcohol entered the scenario, as it was put to good use as an antiseptic to dress wounds. Even instances of film heroes using it to treat their wounds are common. The use of alcohol in healthcare institutions spread with the advent of alcohol-based handrubs in the past 50 years. The spirit has lesser drying time and higher efficacy. In 2009, World Health Organization (WHO) laid down five moments to practise hand hygiene – from before touching a patient, before clean/aseptic procedures, after body fluid exposure/risk, after touching a patient, and after touching patient surroundings.
The case for hand hygiene is not religious or medical, but makes economic sense. Investment deficit in it causes increased healthcare costs, reduced productivity, and lost lives. A national handwashing programme promises net returns of $5.64 billion or 92-fold return on investment in India, according to estimates. The return on investment is estimated to be more than from toilet construction, household water supplies or immunisation. For example, $3.35 investment in handwashing leads to health benefits equivalent to $11 investment in building toilets.
Handwashing is a part of UN Sustainable Development Goal (SDG) 6.2.1b. The goal targets to achieve adequate and equitable hygiene for all, paying special attention to the needs of women and girls, and those in vulnerable situations by 2030. Besides, SDG 6 impacts a host of others goals such as No Poverty (SDG 1), Zero Hunger (SDG 2), Good Health & Well-Being (SDG 3), Quality Education (SDG 4), Gender Equality (SDG 5), Clean Water & Sanitation (SDG 6), Decent Work & Economic Growth (SDG 8), and Reduced Inequalities (SDG 10). According to a recent WHO report, there is a need to increase our current rates of progress by four times to realise hygiene targets under SDG 6.
We are approaching the mid-way mark of the Water Action Decade (2018-2028), which seeks to advance efforts to overcome water-related challenges. United Nation Water, a mechanism of UN and other global organisations working on water and sanitation issues, has developed a new framework to enable countries to achieve SDG 6 by 2030. The Acceleration Framework rallies stakeholders on funding, data and information, capacity development, innovation, and governance to catalyse action on sustainable management of water and sanitation.
Though the challenge is big, it is achievable because handwashing is easy, effective and affordable. The aim should be to make every day a handwashing day, and every moment of touching mouth, nose and eyes a handwashing moment. But the act is good enough if it is done correctly. It is recommended that we wash hands thoroughly with clean water and soap, scrub hands for atleast 40-60 seconds followed by rinsing and drying hands.
Apart from practising handwashing, digitisation can play an important role to ensure that sufficient quantity of hand cleaning agent is used to clean hands completely. IoT is helping to gather functionality and user information from soap or sanitiser dispensers, which have become contact-free to reduce cross-contamination. Behaviour change has to be initiated and sustained with regular nudging. Habits can be reinforced creatively, making the practice interesting and fun. Dispenser formats like gels, foams and alco-foams have lent a variety.
All of us, including governments, companies and NGOs need to come together and promote collaborations like Global Handwashing Partnership, Hand Hygiene for All Global Initiative, and Global Interfaith WASH Alliance. A sustained mass movement will lay the foundations of self-care in a world fighting to overcome pathogens.
