Handwashing Related Literature

There argon grave consequences when tribe do non w modify their transfer or wash them im right. It is known that buy the farms atomic number 18 the main media for contaminants getting to community, whether the transmittals are airborne, oral or tactile. infectious diseases that are commonly spreading through transcend to generate suffer overwhelm the common cold, and several(prenominal) gastrointestinal disorders much(prenominal) as looseness of the bowels ( body of weeweeAid, 2006). Human pass usu e veryy harbour microorganisms two as diseng grow off of a personsnormal microbial flora as sound as transient microbes acquired from the environment (Lindberg et al, 2004).According to Kartha (200 ), many commonwealth consider hand rinse a pine away of time. However, they are unaware that detainment are hosts to many bacteria and vir parts that r break through out ca character infectious diseases. Every military man being comes in tactile sensation with germs and bacteria in their daily life. These harmful microorganisms are present all around on door knobs, faucets, light switches, tables, and railings. People touch these things during the day while doing their routine work without much survey, and then touch their face, nerve centres, nose, and sometimes eat food too.Through these acts, the microorganisms get into the body, ca development several diseases. People, who are superficial at rinse give, risk catching flu, or cold, or any gastrointestinal illness (Kartha, 2001). Mayo Clinic (2009) withal asserted that as pack touch superstar an other, surfaces and objects throughout the day, they accumulate germs on their hands. In turn, they grass infect themselves with these germs by touching their eyes, nose or mouth. Hands exercise as vectors transmitting pathogens to foodstuffs and drinks and to the mouths of susceptible hosts (Huttly, 1997).Many food borne diseases and pathogenic microorganisms are spread by contaminated han ds. If pathogens from human faeces enter a persons mouth, they will cause dissipation. School going clawren are assailable to greater risks of diarrhoeal disease by consuming contaminated body of water and food (Dasgupta, 2005). Students in schools or colleges are more than(prenominal) likely to take meal and water without slipstream hands and may be undetermined to risk of infection (Tambekar et al, 2007). If proper treatment is not given, this roll in the hay rise up fatal, particularly to baberen (WHO, 2006).In Ghana, funeral celebrations are very central social functions at which hundreds of people gather. From experience, one important activity during such gatherings is handshaking. Indeed, it is considered offensive and disrespectful for heathenish values when one does not proffer his hand for shaking. It is however dispossessed that when people are served snacks and food during such occasions, handwashing facilities are not nock available. People therefore eat with unwashed hands.The advent of some dependable gastrointestinal illnesses (for example, cholera) had been traced to such gatherings. Handwashing defined Handwashing is defined as the act of neaten the hands with water or other naiant, with or without the inclusion of pocket or other detergent, for the purpose of removing kingdom or microorganisms (Biology-online, 2011 Medconditions, 2011). 2. 6. 1 Attitudes of handwashing Handwashing has been an age old practise globally. It is carried out for varied reasons, including religious, cultural, wellness and moral reasons.Attitudes towards handwashing are very important. They go a long way to determine the practice of handwashing and its effect on health. In a news report by Hoque et al (1995), 90 women from randomly selected households in rural Bangladesh were discovered washing their hands after defaecation. Thirty-eight percent of the women employ mud, 2% used ash, 19% used trounce, and 41% used water only without a rub agent. A total of 44% of women washed both hands, while 56% washed only their left hands.About 78% of the women dried or wiped their hand on their clothes and the rest let them air dry. According to SHEWA-B (2007), in Bangladesh (and in some regions of the sub-continent), observations on handwashing practices identified that handwashing with water all ahead food preparation and eating was quite common (47 76%), merely washing hands with flog or ash was observed =2% of the time. Washing of both hands with guck or ash was more common after defaecation (17 18 %), after cleaning a childs anus (22 24%) or after handling cow gook (12 20%).Findings too showed that availability of handwashing materials such as goo, ash or mud at the site of handwashing was low, with approximately 30%, and =1% of households having the condition material. water availability was extravagantly. Hand drying was observed to take place before preparing food, after defaecation, after eating an d before serving food. A high proportion of females did not dry their hands after handwashing. A keel one out of three Americans skips handwashing after going to the lav.Only 30% of people who have coughed or sneezed into their hands wash their hands afterwards. Kids are level(p) worse. In a survey of junior high and high school boys and girls, only 58% of girls and 48% of boys washed up after u babble the rest room (Wisegeek. com, 2011). Worldwide locate of handwashing with soap are very low. While many wash their hands with water, only a crushed percent use soap at vital times. In Ghana, for example, the rates for handwashing with soap after defaecation is 3% and after cleaning up a child is also 3% each (PPPHW, 2010). 2. 6. Economic considerations Efforts to modify human behaviour are complex. People can only expect to be successful if there is an on a lower floorstanding of what motivates, facilitates, and hinders adequate handwashing behaviour (Curtis et al, 1997 OBoyle et al, 2001). Curtis et al (2001) noteworthy that modern methods of promoting handwashing can be effective and cost-effective on a large scale. Studies suggest that soap is widely available, level off in poor households in developing countries, although it is or soly used for washup and washing clothes (Borghi et al, 2002).In rural India and Bangladesh, soap is often considered a beautifying agent or for the physical feeling of cleanliness which it gives, rather than being associated with the removal of microorganisms or health benefits (Hoque and Briend, 1991 Hoque et al, 1995). In low income communities, soil, mud or ash may be used as a zero cost alternative to soap for handwashing (Zeitlyn and Islam, 1991). Hoque et al (1995) again reported that al unitedly, 81% of non-soap users stated that they might use soap, but were unable to afford it. Critical times for handwashingA defensive system is important when trying to keep off infecting oneself with an illness lying in tak e care (Wisegeek. com, 2011). According to Mayo Clinic (2009), frequent handwashing is one of the surmount ways to avoid getting sick and spreading illness. Although it is impossible to keep hands germ-free, washing hands frequently can help limit the transfer of bacteria, viruses and other microbes. It is possible that people do not wash their hands as often as they should. Handwashing prevents both diarrhoea and respiratory infections effectively whenthrough properly and at critical times.The critical times must be observed and conscious efforts made to clean hands at such times. A number of sources (Mayo Clinic, 2009 ASH, 2011, All Family Resources, 1999 and CDC, 2010) agree on a number of critical times when hands must be washed. The critical times include ? Before preparing food ? Before eating ? Before treating wounds or free medicine ? Before touching a sick or injure person ? Before inserting or removing contact lenses ? After preparing food, especially rude(prenominal) m eat or poultry ? After using the toilet/bathroom ? After changing a diaper After touching an animal, or animal toys, leashes or waste ? After blowing your nose, coughing or sternutation into your hands ? After touching a sick or injure person ?After handling garbage or something that could be contaminated, such as a cleaning cloth or soiled billet ? Whenever hands look dirty. Some include also washing hands after handling money (ASH, 2011), before going home, immediately one gets home, on arrival at the workplace (All Family Resources, 1999), after combing copper (USDA, 2011) and after smoking (Earths kids, 2011). . 6. 4 Process of handwashing Though people know the importance of handwashing, not many know how to do it properly. Handwashing does not mean just foot race water over your palms. It has to be done very carefully and in detail (Kartha, 2001). Mayo Clinic (2009) suggests the following locomote ? Wet hands with (running) water ?Apply cleansing agent ? strap well ? Ru b hands sprucely for at least 10 to 20 seconds, remembering to scrub all surfaces, including the backs of hands, wrists, between fingers and under fingernails ? clean well Dry hands with a clean or disposable towel or dryer. The above steps have been advocated by several sources as well. These include ASH (2011) All Family Resources (1999) CDC (2010) Kartha (2001) Wisegeek. com (2011) and Gavin (2011). 2. 6. 5 Correct duration of time Equally important is the length of time that hands are to be washed. The notice is to lather up hands and rub cleverly for at least 15 to 20 seconds. Some suggest singing Happy natal day or the ABCs to keep a child washing hands for the correct amount of time (Wisegeek. com, 2011).Earths Kids (2011) suggested that children sing a fun song while washing hands to cross out the time of 15 20 seconds, so that they know how long they wash. Gavin ((2011) state to use soap and lather up for 20 seconds. Mayo Clinic (2009) noted that wet, soapy hands sho uld be rubbed together outside the stream of running water for at least 20 seconds. CDC (2010) suggested sc pass hands for 20 seconds, and while singing Happy Birthday twice to get to 20 seconds. PPPHW (2008) also suggested singing any local fun song that would fetch up to 20 seconds while hands are being rubbed together after applying cleansing agent.According to ASH (2011), hands must be rubbed together for at least 10 seconds while singing Happy Birthday once for a perfect length of time. Rub hands vigorously until a soapy lather appears and continue for at least 15 seconds (All Family Resources, 1999). Mohave County Information Technology (2001) also commends rubbing hands briskly for at least 20 seconds. From the foregone discussions it can be seen that rubbing hands together vigorously for anytime between 10 to 20 seconds or more should be adequate for pathogen reduction on the hands. Quantity of water need for rinse off handsAccessible and plentiful water has been shown to encourage remediate hygiene, particularly handwashing (Curtis and Cairncross, 2000). Also, interventions to emend water quality at the source along with treatment of household water and safe storage systems have been shown to disgrace diarrhoea relative incidence by as much as 47% (WHO, 2008). Hoque et al (1995), in a study, observed that as many as 74% of the 90 women rinsed their hands with 0. 7 litre of water or less. They however recommend that rinsing with 2 litres of clean water was protective, although such volumes may be difficult tosustain in the absence of on-plot access to water.Since pathogens exceptd during handrubbing have to be rinsed away, there must be a reasonable flow of water (Standard Operating Procedures, 1997). Mayo Clinic (2009) suggested the use of running water for rinsing hands. Water scarcity has an impact on hygiene practices such as handwashing. It could soften to person-to-person transmission due to inadequate personal and domestic hygiene. W ater scarcity can therefore result in faecal-oral, kowtow and eye infections (Cairncross, 2011). Temperature of waterContrary to popular belief, scientific studies by Michaels et al (2002), and Laestadius and Dimberg (2005), have shown that using agile water has no effect on reducing the microbial lode on hands. Hot water that is comfortable for washing hands is not hot enough to kill bacteria. Microorganisms proliferate much faster at body temperature (37 degrees C). However, nimble, soapy water is more effective than cold, soapy water at removing the natural oils which hold soils and bacteria (US Food and Drugs Administration, 2006). All Family Resources (1999) indicated that untoughened water should always be used for handwashing.ASH (2011), Kartha (2001), Wisegeek. com (2011) and Gavin (2011) also suggested the use of warm water for handwashing. CDC (2010) said that clean running water that was warm or cold could be used. The temperature of water has not been shown to be im portant in handwashing (Standard Operating Procedures, 1997). Efficacy of cleansing agents in microbial reduction Esrey et al (1991) have suggested that reducing the rate of pathogen ingestion causes the incidence of severe infections to range to fall before that of mild ones. The reduction in the severity of infection is the ultimate purpose of handwashing.Therefore microbial reduction on hands would reduce the ingestion of pathogens since the hands have been proved to be the main charm route for gastrointestinal diseases, respiratory tract infections, skin infections (eg. impetigo) as well as eye infections (eg. conjunctivitis). This makes the agent employed in handwashing a unavoidable factor. Water only Pure water has a pH of seven, which makes it neutral. It is also known as a universal solvent. A number of studies (Cairncross, 1993 Ghosh et al, 1995 Khan, 1982 Oo et al, 2000) suggested that handwashing with water only provides little or no benefit.The application of water alone is inefficient for cleaning skin because water is often unable to remove fats, oils and proteins, which are components of organic soil (Standard Operating Procedure, 1997). Kalanke (Mali) (2011) noted that handwashing with water alone does not remove many germs. Hoque and Briend (1991), on the contrary, showed that whilst less effective than when using a rubbing agent such as soap, mud or ash, some reductions in contamination were found when washing with water alone.Data on the effectiveness of handwashing with soap-based formulations, compared with water alone, in the removal of bacteria and viruses (Ansari et al, 1989 Mbithi et al, 1993) suggest that, in most (but not all) cases, liquid soap-based formulations were more effective than water only. However, the authors reason out that the differences were not statistically significant. Ash Hoque and Briend (1991) indicated that the use of alternative rubbing agents (mud or ash) provided the same benefits as soap.Again, Hoque et al (1995) also found that the use of ash and soap all achieved the same level of cleanliness. Ash, however, is considered less pleasant on the hands compared with soap or soil (Hoque and Briend, 1991). Despite the positive lifesaving latent of handwashing with soap (ash), proper handwashing is not being practiced regularly by children in schools and homes (WASH United, 2010). Citrus fluxing lime fruit Scientifically known as Citrus aurantifolia, there are two natural groups of the citrus lime fruit acid (sour) limes, and acidless (sweet) limes.The West Indian lime, also called Mexican and divulge lime is round, small-fruited, moderately seedy and highly polyembryonic it has a thin, smooth rind, unripe flesh and a citric acid content ranging from 7% to 8%. It is usually grown as a seedling, as no alright rootstock is known, but in Ghana it is grown on pebbly lemon stock (Samson, 1986). Soap A number of studies indicate that washing hands with soap is the critical component of the handwashing behaviour (Cairncross, 1993 Ghosh et al, 1997 Khan, 1982 Oo et al, 2000). Kartha (2001) noted that the most essential thing required to wash hands is soap.Again, studies have shown that hands can carry faeces to surfaces, to foods, and to future hosts, and handwashing with soap is effective in removing pathogens (Han et a. , 1986 Kaltenthaler et al, 1991 Ansari et al, 1991). Improvements in access to safe water and adequate sanitation, along with the promotion of good hygiene practices (particularly handwashing with soap), can help prevent diarrhoea (Black et al, 2003). PPPHW (2011) affirm that promoted on a wide enough scale, handwashing with soap can be thought of as a do- it-yourself vaccine. Choice of soapDebate has been ongoing about the best type of soap to be used in handwashing. A study by Aiello (2007) indicated that plain soaps are as effective as consumer-grade antibacterial soaps in preventing illness and removing bacteria from the hands. Mayo Clinic (2009) admonished people to keep in mind that antibacterial soap is no more effective at killing germs than is regular soap. Using antibacterial soap may even lead to the development of bacteria that are resistant to the products antimicrobial agents make it harder to kill these germs in the future.Commenting on favoured features for soap, women in Ghana cited a range of attributes smell, cost, texture and durability, and its capacity to be used for multiple purposes. For the women, the most important attribute was the smell of the soap, andthe most popular scents were mild lime and lemon. Concerning cost, cheaper soaps were preferred, although women were sometimes willing to pay more if the soap was larger or they thought it would last longer. Commenting on texture / durability, associated with cost, women preferred harder bar soaps or liquid varieties as they thought they lasted longer.So strong was the preference for hard soaps that many stored soap in cool or sunny or airy p laces to moderate them before use. Some women thought liquid soap more frugal since only a peanut size was adequate for each hand wash. Many women preferred laundry bar soap because it could be used as a multipurpose soap such as for laundering, bathing and washing dishes at the same time (PPPHW, 2010). The act of handrubbing It has been suggested by Hoque et al, (1995) that the key component of the handwashing process is the mechanical rubbing of the hands.They noted that the trend towards better results from handwashing with both hands, increased frequency of rubbing and an increased volume of rinsing water all support the prime importance of scrubbing / frictional motion and consequent washing out of loose bacteria with water. Although results of studies carried out suggest that the use of a rubbing agent is important, the authors suggested that the nature of the rubbing agent is a less important factor. Soap, they indicated, was more effective than soil and ash because soap us ers tend to rub their hands more and use more water to rinse away the soapy feeling on them.CDC (2011) advised people to rub hands together vigorously to make a lather and to continue scrubbing for 20 seconds because it takes that long for the soap and scrubbing action to dislodge and remove stubborn germs. Beneficial effects of handwashing Handwashing has been regarded as a key infection-control practice since Semmelweis suggested its introduction in health care settings (Semmelweis, 1847 in Koo, 2008). The handwashing behaviour has been shown to cut the number of child deaths from diarrhoea (the second leading cause of child deaths) by almost half(prenominal) and from pneumonia (the leading cause of child deaths) by one-quarter (WHO, 2008).The strong causal birth between hand hygiene and gastro-intestinal disease risk has also been present by meta-analysis of community based interventions. Curtis and Cairncross (2003) estimated a reduction of 42 47% in diarrhoeal diseases ass ociated with handwashing. Fewtrell et al (2005) showed a 44% reduction in diarrhoeal illness associated with handwashing. In a study, Aiello et al (2008) estimated that handwashing with soap feature with education could produce a 39% reduction in gastrointestinal illness. All the three meta-analyses were carried out using data from studies conducted in both developed and developing countries.In a review of hand hygiene studies involving respiratory tract infections, Rabie and Curtis (2006) reported that hand hygiene (handwashing, education and waterless hand sanitizers) can reduce the risk of respiratory infections by 16%. Aiello et al. (2008) also estimated that the reduction in respiratory illness associated with the pooled effects of hand hygiene (handwashing with soap, use of alcohol handrubs) was 21%. A study conducted by Luby et al (2005) reported the impact of handwashing with soap on pneumonia in children under five, in squatter settlements in Karachi, Pakistan.The results indicated a 50% reduction in pneumonia in the intervention compared with the control group. Luby et al noted that a link between handwashingand the prevention of pneumonia in developing countries is plausible on the basis that, in developing countries it is known that viruses cause pneumonia. Another study found that children under 15 years living in households that received handwashing promotion and soap had half the diarrhoeal rates of children living in control neighbourhoods (Luby et al, 2004).Because handwashing can prevent the transmission of a variety of pathogens, it may be more effective than any single vaccine. Handwashing can also prevent skin infections (eg. impetigo), eye infections (eg. conjunctivitis), intestinal worms, Severe Acute Respiratory Syndrome (SARS), and Avian Flu. It benefits the health of people living with HIV/AIDS. Handwashing is effective in preventing the spread of disease even in overcrowded, highly contaminated slum environments (PPPHW, 2008).