October 27, 2020
Every year, the UNC Water & Health Conference convenes actors from civil society, government, research institutions, and the private sector to discuss successes, identify current gaps, and highlight ways to move forward. Given the COVID-19 pandemic, this year’s conference was held on a virtual platform, allowing individuals from around the world to participate in interactive sessions. The Global Handwashing Partnership along with Emory University, FHI 360, the London School of Hygiene and Tropical Medicine, UNICEF, University College London, Unilever, USAID, and the 2030 Water Resources Group hosted by the World Bank convened a special session on Monday, October 26, 2020 focused on hand hygiene during COVID-19 and beyond.
The COVID-19 pandemic places a spotlight on the importance of hand hygiene as a simple and cost-effective solution to reduce the spread of disease. The special session encouraged hand hygiene as a response to COVID-19 and emphasized the need to focus on longer-term uptake to form handwashing habits. Overall, the session presented the science behind hand hygiene, provided best practices for handwashing and hand hygiene programming, and highlighted the way forward for hand hygiene for all.
Why is hand hygiene important to reduce the spread of COVID-19 and other diseases?
The session started with a series of presentations offering the science behind hand hygiene. Handwashing with soap at key moments has long been known to significantly reduce the incidences of diseases, such as diarrheal diseases, pneumonia, influenza, soil-transmitted helminths, and neonatal infections. Since the start of this pandemic, the World Health Organization has advocated for frequent handwashing with soap to prevent the spread of COVID-19.
Dr. Vibhav Sanzgiri, Global Vice President of R&D for skin cleansing at Unilever and Executive Director of R&D at Hindustan Unilever, first presented the basic concepts and mechanisms behind handwashing with soap. In his presentation, he explains that SARS-CoV-2, the new strain of coronavirus that causes COVID-19, has an oily envelope which protects its genetic materials. When handwashing with soap, the soap molecules insert into the oily layer, thereby inactivating and disrupting the infection cycle.
Dr. Alicia Kraay, a postdoctoral fellow at Emory University, then shared her modeling results on the impact of handwashing and SARS-CoV-2 transmission with emphasis on fomite (surface) transmission, as that is where handwashing can have the largest impact. She used a transmission model to study the impacts of key interventions such as mask wearing, surface disinfection, and handwashing. She found that handwashing can prevent transmission from surfaces when combined with other interventions, including mask wearing and surface decontamination. Furthermore, she found that even when handwashing does not prevent transmission from surfaces, it may be able to reduce the severity of diseases. Overall, her models conclude that improved handwashing may influence the transmission of SARS-CoV-2 and other pathogens beyond coronavirus.
Ms. Sarah Beale, a researcher at UCL’s Institute of Epidemiology and Health Care, concluded the first set of presentations by presenting findings from a large UK community cohort. Using data collected from the Flu Watch UK Community Cohort Study of Households, the researchers analyzed demographics and hygiene measured at baseline as well as reported symptoms to examine whether handwashing frequency predicted risk of seasonal coronavirus infections in community settings. They tested for three seasonal coronaviruses with similar structure or transmission mechanisms to SARS-CoV-2. Compared to low hand hygiene frequency, moderate-frequency hand hygiene was associated with a 36% reduction in risk of a coronavirus infection across a winter season. Overall, their results indicated a protective effect of handwashing on the risk of seasonal coronavirus infections in community settings and supports the important role of promoting hand hygiene as part of public health initiatives during the pandemic and beyond.
How can we improve handwashing practice through sustainable programming?
Following the presentations, the session shifted to a moderated panel discussion focused on how to design effective handwashing programs to ensure handwashing practices in response to COVID-19 and long into the future. The panel featured representatives from USAID, FHI 360, the London School of Hygiene and Tropical Medicine and COVID-19 Hygiene Hub, and the 2030 Water Resources Group, which is hosted by the World Bank.
The panel focused on considerations of designing and adapting handwashing behavior change programs that are effective during COVID-19 and focus on habit formation in the long-term. Panelists presented a number of key resources, including the COVID-19 hygiene hub, as well as examples from Bangladesh through the 2030 Water Resources Group. A recent webinar hosted by the Global Handwashing Partnership goes into more detail about designing and implementing handwashing programs here.
How can we move forward?
The session concluded with a presentation by Ms. Janita Bartell, a Hygiene Specialist at UNICEF, highlighting the Hand Hygiene for All Global Initiative. Building on the insight provided in the presentations and panel discussion, she outlines the way forward for hand hygiene and shares examples from the field as well as resources to draw on.
The Hand Hygiene for All Global Initiative was launched in June 2020 to accelerate global action on hand hygiene in support of country-level action. Through this global initiative, UNICEF and WHO bring together a group of partners around a shared vision to address universal hand hygiene through a whole-of-society approach focused on three interdependent elements, including a robust supply and demand for hand hygiene facilities and supplies, evidence-based behavior change interventions, and a strong enabling environment. These elements must be embedded with strong political leadership at all levels to move the dial on hand hygiene. The initiative operates in three phases: the respond phase with a focus on controlling the outbreak, the re-build phase focused relaxing restrictions while ensuring health and safety and the re-imagine phase with a strong enabling environment to sustain a culture of hand hygiene.
Ms. Bartell also offered three country examples from Cambodia, Mozambique and Bangladesh, showcasing activities that bridge COVID-19 to longer-term commitment and prioritization. She also offered resources, which can all be found on the Global Handwashing Partnership website, and ended with an invitation to reach out to the initiative if you would like to connect at a country or global level.
A full recording of the special session is currently available on the UNC Conference platform here.
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