Proper handwashing may seem trivial to some, but it is more important than many realise – in schools, in healthcare facilities, and in the home. Global Handwashing Day, observed on October 15th, is an important reminder of an often neglected practice.
UNICEF India points out the importance of handwashing, noting its connection with diarrhoea – the most common cause of infectious disease outbreaks in India and the second most common cause of death among children under five worldwide according to the World Health Organization (WHO). Every day, at least 1,300 children die due to diarrhoea and diseases linked to infections of the respiratory tract. Of these deaths, 320 happen in India.
As UNICEF notes, of the 1.5 million child deaths which occur yearly due to diarrhoeal diseases, forty percent can be prevented by “handwashing with soap at critical times – including before eating or preparing food and after using the toilet.” Similarly, acute respiratory infection deaths can be prevented 23 percent of the time by proper handwashing practices and the habit can also be linked to a number of improved health outcomes. Newborn survival rates improve by 55 percent if proper handwashing practice is followed, whilst controlling the spread of infectious diseases and viruses ranging from pneumonia to severe acute respiratory syndrome (SARS) can be bolstered if handwashing is helped.
In India, improved sanitation has been a flagship priority of the Narendra Modi government. This is perhaps best exemplified in its Swachh Bharat (Clean India) campaign which has achieved considerable success in expanding access to sanitation facilities such as toilets throughout the country and reducing rates of open defecation.
The campaign does not neglect handwashing. An editorial penned by Sanjay Banka and published last year on the Global Handwashing Partnership website notes that “Swachh Bharat Abhiyaan (Clean India Mission) program and subprogram Swachh Bharat – Swachh Vidyalaya (Clean India – Clean Schools) are working to improve WASH services and practices across India.” WASH refers to water, sanitation, and hygiene, of which handwashing is a vital component.
In addition, Banka points to efforts by the private sector to support Swachh Bharat Abhiyan. A partnership between electrical goods firm Havells and social enterprise Banka BioLoo, of which Banka is executive director, “has already installed bioloos with handwashing stations in over 350 schools” he wrote at the time. According to Every Woman Every Child, in 2018 alone, Banka BioLoo installed 800 bioloos in 100 schools.
Despite these encouraging efforts, handwashing practices in India are poor among the populace. As a study reported in 2017, “only 26.3 percent washed hands before child feeding, 14.7 percent before breastfeeding, 16.7 percent after disposing child faeces, and 18.4 percent after cleaning a child’s bottom.”
Schools are a key part of the equation. Globally, Yahoo Finance reports that “53 percent of schools worldwide lack handwashing facilities with water and soap. Additional research found that globally children lose 443 million school days each year because of water-related illnesses.” In India, WASHWatch reports that 69 percent of schools have access to basic water services; of the remainder, 22 percent have access to limited water services and nine percent do not have any access to a water service. Urban schools are more likely to have access to water services than those in rural areas. These disparities translate to access to sanitation and hygiene — a divide which is notable across healthcare as a whole.
Concerningly, 24 percent of schools in India do not have access to any sanitation services (73 percent have access to basic sanitation and services and three percent have access to limited services). For hygiene services, the figures are even more dismal: 54 percent have access to basic hygiene and five percent to limited hygiene. This means that 41 percent of schools in India do not have access to any form of hygiene services.
Not only do staggering numbers of schools lack access to these basic and essential amenities, it is prevalent in hospitals too. Two billion people worldwide do not enjoy access to basic sanitation services in their healthcare facilities, including 1.5 billion who do not have access to any sanitation services.
Handwashing is among the most simple ways of reducing the risk of hospital-acquired infections, which occur at a rate of one in every four hospital visits in India. Hygiene has been pinpointed as a major driver of this. As previously reported by Health Issues India, “despite hygiene protocols — covering both usage of medical devices and basic practices such as hand washing — being in place, a lack of compliance with infection control guidelines has resulted in an increased infection rate.”
As previously noted by Dr Bruce Gordon, the WHO’s coordinator of its work on water and sanitation, “the one thing that you need to do is wash your hands, whatever bug it is, whatever resistance it has. It’s not a matter or diarrhoeal disease, it’s a matter of any opportunistic infection that can just happily live on skin, or get in cuts, and get inside your body and give people sepsis.”
Lack of sanitation and hygiene facilities in hospitals are major drivers of infectious diseases. The WHO has issued guidelines for handwashing for medical professionals, but every person should take note of proper handwashing procedure, with recommendations available here. Meanwhile, any sanitation drive undertaken by policymakers must take into account the need for basic WASH services at the least and to raise public awareness of why handwashing is not a trivial activity, but one which can save lives.