Clean hands are important to prevent and control infections and reduce the spread of disease

Handwashing with soap is a cost-effective public health measure that can help control and reduce infections, and act as an essential line of defence against many disease outbreaks. It can reduce the risk of diarrhoea by up to 30%, of acute respiratory infections by up to 23%, and of seasonal coronavirus infections by 36%. Rigorous hygiene, including handwashing, is also key to reducing the spread of cholera, COVID-19, dysentery, Ebola, hepatitis E, SARS and many more.

Hand hygiene also plays a fundamental role in the treatment and care of neglected tropical diseases – at home, in healthcare settings, and in communities. Regular handwashing with soap and water, especially at key times like after using the toilet, helps reduce the risk of diseases such as schistosomiasis, hookworm and trachoma.

Clean hands are a fundamental defence against the spread of superbugs

Good hand hygiene also helps protect people from antimicrobial resistance – also known as “superbugs” – both directly, by reducing the spread of infections, and indirectly, by lowering the need to prescribe antibiotics.

In healthcare settings, hand hygiene is the single most important measure to reduce healthcare-acquired infections (PDF) and the transmission of resistant pathogens. For example, handwashing alone can reduce deaths linked to AMR by 4.2%, on average, in low and middle-income countries.

Clean hands are also important for the care of patients, such as those being treated for cancer, who are vulnerable to developing opportunistic infections because of reduced levels of white blood cell counts – the body’s key defence against infection. Good hand hygiene is essential for both patients and the health workers they come into contact with.

Clean hands are important for maternal health

Obstetric infections, including sepsis, are the third most common cause of maternal mortality and more than one million maternal and newborn deaths are linked to unclean births every year.

As far back at the 18th century, there has been evidence of the critical role of hand hygiene in improving women’s health, through the work of Gordon and Semmelweis. Studies from Bangladesh, India and Nepal have shown that birth attendants practicing handwashing during home deliveries reduced the risk of death in childbirth by 49%, and can reduce infection-related infant deaths by 27% (PDF).

Clean hands are important in schools

All children have the right to learn in a safe and clean school environment. Schools are densely populated and without appropriate hand hygiene services and behaviours, they can become centres for the spread of disease.

These illnesses can cause children to miss school and, if they are affected by parasites or worms, suffer from malnutrition – all of which makes it harder for them to reach their full academic potential.

Hygiene in schools, on the other hand, can boost a child’s achievements, enhance their dignity, and improve their health. It can also lower the risk of school absenteeism by a staggering 43% in some countries.

Clean hands make good economic sense

Investing in hand hygiene reduces healthcare costs and the burden of illness on people and their carers. It also supports healthy, more productive workforces. In fact, the net benefit of achieving universal hand hygiene is estimated to be US$45 billion, every year.

However, handwashing is not a low-cost intervention. Over the next 10 years, achieving universal hand hygiene in the 46 least developed countries is expected to cost US$12-15 billion. The majority of this cost – 58% – is for facilities including soap and water. It will cost even more to build and sustain handwashing facilities in schools, healthcare facilities and public places.

Towards universal hand hygiene

The importance and benefits of good hand hygiene are clear, but we are still a long way from everyone, everywhere having access to this fundamental.

• Globally, 25% of households do not have somewhere for people to wash their hands with soap and water.
• In 2022, 42.9% of healthcare facilities didn’t have basic handwashing facilities with soap and water at points of care.
• And around 33% of schools in developing countries don’t have handwashing facilities. That means that 646 million students don’t have anywhere to wash their hands with soap while at school.

Data show huge disparities between low- and high-income settings, and between urban and rural areas. Without handwashing facilities, people cannot hope to practise proper hand hygiene, putting their health at risk.

So how do we address this? The current rate of progress needs to triple to achieve universal hand hygiene by 2030. In the least developed countries, progress needs to increase 12 times to achieve this goal.

There are two parts of this equation: access to handwashing facilities with soap and water, and robust behaviour change programmes.

And to achieve scale, government leadership is key. Government-owned programmes have previously managed to scale programmes nationally, even during emergencies. And by training existing staff, programmes can continue well into the future.

How is WaterAid working towards universal hand hygiene?

A key part of our work is helping to build behaviour change programmes. We work to ensure that hygiene is part of any water and sanitation programme, and is integrated into core public health programmes – including child health, immunisation and nutrition – as well as in education, workplaces and emergencies.

We have, for example, supported the government of Nepal since 2015 to integrate hygiene into nationwide immunisation programmes and we have implemented robust hygiene responses to COVID-19 across 26 countries. We have also helped to model hygiene in schools and healthcare facilities in countries across Asia and Africa.

To coincide with this Global Handwashing Day, we have released a second edition of our Technical Guide for Handwashing Facilities in Public Places and Institutions. The guide, co-produced with UNICEF, provides best practice guidelines for the design, installation, construction, operation and maintenance, and sustainability of handwashing facilities. It also includes sample designs from WaterAid and UNICEF programmes, and checklists for monitoring, safety and inclusivity.

This year, we have also partnered with WHO and UNICEF to establish a group of 10 champion countries that are designing and testing a framework and guidance on system-strengthening for hand hygiene.

Looking forward

As we reflect on the question being posed on Global Handwashing Day this year, the evidence overwhelmingly tells us that clean hands are a critical defence against current and emerging health threats.

We urge governments to build hygiene programmes and integrate water, sanitation and hygiene (WASH) into health, education and AMR programmes. We encourage donors to focus on financing large-scale programming and for businesses to focus on providing access to affordable products, especially in rural areas where there is a lack of resources.

Together, we can ensure everyone enjoys the benefits of regular handwashing.

Om Prasad Gautam is Hygiene Lead and Sophie Hickling is Interim Lead Policy Analyst – Health at WaterAid.

Top Image: Olivia, 8, with her best friends, Koloina, 8, and Diana, 7, wash their hands at the handwashing station of their school sanitation block in Manjakandriana commune, Madagascar. January 2023.