Proper handwashing with soap takes just 20 seconds – about the time needed to say the alphabet twice.

Washing hands, saving lives - the surprising health benefits of clean hands (9 min read)

Soap and water can save lives. Every day, by washing their hands properly, people can prevent the spread of diseases and infections. In hospitals, good hand hygiene slows the spread of resistant bacteria. We examine some of the health effects of handwashing.

اكتوبر 13, 2017

Listen to audio version (8:48)

Before illness sets in and access to medicines becomes necessary, access to medical information can help people change certain behaviors and avoid becoming sick in the first place. Particularly during daily activities, people may not think enough about behaviors that can promote good health, or lead to risk. Handwashing, for example, should be a routine daily task. But is the public well-informed about its importance, and how to do this properly? Global evidence suggests there is massive room for improvement – and the stakes for getting this information out are high.

According to data from UNICEF, one in every four childhood deaths – some 1.4 million – under age five globally result from diarrhea and pneumonia.¹ “This is more than AIDS, malaria and tuberculosis combined,” says Sam Stephens, head of Clean the World Foundation, a nonprofit that provides soap and hygiene education to vulnerable communities around the world. “And just handwashing with soap can reduce death rates from these diseases up to 65%,” he says.

“When people wash their hands in the right ways at the right times, it can be more effective than medication, vaccine, or even clean water, as a single intervention against pneumonia and diarrhea,” Stephens continues. Washing hands well takes only about 20 seconds, costs next to nothing, and yet it can prevent serious diseases and save lives. It helps to stop antibiotic-resistant bacteria from spreading, and reduces infections in hospitals. Not surprisingly, this simple habit can also help save economies billions of dollars in working days that are otherwise lost to stomach upsets, colds and the flu.²

Just handwashing with soap can reduce death rates from pneumonia and diarrhea by up to 65%.

Sam Stephens, Clean the World Foundation

Avoiding contamination and resistance

Hand-transmitted illnesses, including diarrhea and pneumonia, can be treated effectively where people have access to clean water, soap and medical care. Yet bacterial infections also threaten lives in hospitals and clinics where these things are so easily available. One key to slowing the spread of bacteria is good hand hygiene, which includes the use of hand sanitizers, alcohol-based liquids or gels.

Healthcare professionals have to clean their hands about 100 times per shift. The use of hand sanitizer, an alcohol-based liquid or gel, is a fast and convenient way to remove bacteria from visibly clean hands. Credit: Mauritius images/MITO Images

When doing his rounds in his US hospital ward, Dr. Arjun Srinivasan, Associate Director of Healthcare Associated Infection Prevention Programs at the US Centers for Disease Control and Prevention (CDC), wears a large blue button that says, “Ask me if I’ve washed my hands.” If patients or others ask, Srinivasan says he cleans his hands again while the person watches. “We won't trivialize how hard it is for patients and healthcare professionals alike, but in the United States at least, a culture change is taking place.” Busy healthcare professionals need to clean their hands before and after touching each patient, and patient’s surroundings. This can add up to 100 times in a 12-hour shift, explains Srinivasan. However, on average, they actually clean their hands about half of the time they are supposed to.

Anyone with an interest in preventing hospital-acquired infection really has to have a passion for hand hygiene

Dr. Arjun Srinivasan, US Centers for Disease Control and Prevention (CDC)

One practical means to achieve good hand hygiene quickly and effectively already exists in hospitals today: alcohol-based hand sanitizers. Srinivasan says these liquids or gels are “transformational.” Dispensers can be placed everywhere, so they are also convenient for patients and visitors to use. But for people to actually do that, proper information is key. Campaigns such as Clean Hands Count run by the CDC, and Save Lives: Clean Your Hands by the World Health Organization, help to raise awareness and change behaviors. In medical facilities with hand hygiene programs, for example, healthcare professionals clean their hands 90% of the time that they should. Srinivasan notes that, in addition, when senior physicians demonstrate good hand hygiene, other staff members will do the same. “Anyone with an interest in preventing hospital-acquired infection really has to have a passion for hand hygiene,” he says.

Bacteria and viruses are present on the skin. Handwashing can help to remove pathogens by sliding them off the skin.

Preventing deadly diseases

Primarily in Africa and Southeast Asia, where diarrhea and pneumonia are often fatal, handwashing campaigns aim to save lives. In some places, people are not aware that washing their hands can prevent the spread of disease, or soap is not available, or not used for cleaning hands. “Our mission is to get soap into the hands of people around the world who are at the risk of dying because of lack of access to it,” says Stephens of Clean the World Foundation.

Based in Orlando, Florida, Clean the World collects leftover soap bars from hotels, recycles them into brand-new bars of soap, and delivers these – now 10 million bars a year – to the Americas, Eastern Europe, the Middle East, Asia and Africa. They also provide lessons on when and how to wash hands properly. In many places, people wash their hands only with water, explains Stephens. “And particularly if they wash their hands with dirty water, there is no positive effect from a global health standpoint.” Clean the World intends to change that shortage of soap and information.

Handwashing helps to prevent the spread of deadly diseases. With donated soap from Clean the World Foundation, school children in Guatemala learn how to wash their hands well. Credit: Clean the World

Stephens, who has 20 years of experience in international development, describes the foundation’s recent soap-in-schools program in Kenya, which has reached roughly 4,000 schoolchildren. “When we arrived, a third of them were so sick that they missed a week of school every month,” he says. During the entire school year, they acquired the habit of handwashing through fun activities. “Children could also take soap home and teach their families handwashing and hygiene.”

“After nine months, reported instances of hygiene-related illnesses among schoolchildren dropped by more than half, and we saw a 45% increase in attendance,” Stephens continues. “Children become healthier, so they stay in school. And their parents are healthier and able to work,” says Stephens. By learning how to avoid bacterial diseases or infections, accompanied by behavior change, people can enjoy better health and more prosperous lives.

Good Handwashing

Five simple steps for good hand hygiene and better health:

Wet hands under running water.
Lather hands with soap.
Rub all surfaces of the hands for about 15-20 seconds. This is about the time you need to say the alphabet or to hum “happy birthday” twice.
Rinse hands thoroughly under running water.
Dry hands completely – moisture will transmit remaining bacteria.

Step-by-step pictures of thorough handwashing and hand hygiene techniques for healthcare settings are available from the CDC and WHO.

Sources: US Centers for Disease Control and Prevention (CDC), World Health Organization (WHO)

The science and history of handwashing

What makes soap so effective in the fight against infection and disease? Normal skin flora includes transient micro-organisms such as bacteria, including those that are present as a result of contamination. Washing hands with soap and water removes the bacteria and other pathogens by sliding them off the skin’s surface.³

However, even medical professional have not always understood that washing their hands removes bacteria and prevents infection. In the mid-1800s, up to 30% of women in European hospital maternity wards were dying from childbed fever. While working in Vienna Hospital, Hungarian physician Ignaz Semmelweis, observed that student doctors were performing barehanded autopsies in one chamber, then going directly into the delivery room. Once Semmelweis ordered handwashing with chlorine between patient visits, rates of infection fell to just 1% within two years.⁴

Another handwashing champion was frontline British nurse Florence Nightingale who arrived at the military hospital in Scutari, Turkey in 1854 during the Crimean War. She was shocked to discover that nearly ten times as many soldiers were dying from infections and diseases such as cholera than in battle. Nightingale brought in soap, towels, fresh sheets, and she insisted on handwashing. “Every nurse ought to be careful to wash her hands very frequently during the day,” she later wrote in her book Notes on Nursing (1859).

Today, clean hands are the foundation of medical care and hygiene standards have increased dramatically since those days. However, some infections are life threatening again because bacteria have become resistant to the antibiotics commonly used to fight them. Besides the many steps the medical community is taking to slow the development of resistant bacteria, the rather simple practice of handwashing can go a long way in slowing the spread of such resistances. It’s truly a practice that helps save lives.

Who washes their hands?

Better habits for better health

People collect and spread bacteria any time they touch anything or anyone, and a proper handwashing habit can increase people’s health in general. Critical times to wash hands include: Before eating or handling food; after using the toilet, or changing an infant’s diaper; after coughing or sneezing; after touching animals, including pets. Yet some reports reveal that people tend to wash their hands only 30% - 90% of the time following these activities. On average, nearly half of office workers wash their hands just five times per day. And when they do, it’s often just a rinse, lasting fewer than 10 seconds, usually without soap, and then not properly dried.⁵

“I think there is strong evidence that hand hygiene can be effective in preventing infection,” says Srinivasan from the CDC. “It can keep you and your family members from getting sick, especially from gastrointestinal episodes, colds and flu.” And where sinks are not readily available, he says alcohol-based hand sanitizers should be used on hands that are visibly clean.

Dr. Arjun Srinivasan, Associate Director of Healthcare Associated Infection Prevention Programs, US Centers for Disease Control and Prevention (CDC)
Sam Stephens, Head of Clean the World Foundation