Efficacy of Waterless Hand Hygiene Compared with Handwashing with Soap: A Field Study in Dar es Salaam, Tanzania

Abstract

Abstract. Effective handwashing with soap requires reliable access to water supplies. However, more than three billion persons do not have household-level access to piped water. This research addresses the challenge of improving hand hygiene within water-constrained environments. The antimicrobial efficacy of alcohol-based hand sanitizer, a waterless hand hygiene product, was evaluated and compared with handwashing with soap and water in field conditions in Dar es Salaam, Tanzania. Hand sanitizer use by mothers resulted in 0.66 and 0.64 log reductions per hand of Escherichia coli and fecal streptococci, respectively. In comparison, handwashing with soap resulted in 0.50 and 0.25 log reductions per hand of E. coli and fecal streptococci, respectively. Hand sanitizer was significantly better than handwashing with respect to reduction in levels of fecal streptococci ( P = 0.01). The feasibility and health impacts of promoting hand sanitizer as an alternative hand hygiene option for water-constrained environments should be assessed.

Variability in Hand Contamination Based on Serial Measurements: Implications for Assessment of Hand-Cleansing Behavior and Disease Risk

“…It is possible that the organisms detected on hands in the recontamination sample were not as a result of recontamination but, rather, just residual contamination since handwashing does not always lead to complete elimination of organisms from hands. 21 Still, the implications for pathogen transmission would be expected to be similar, irrespective of whether hands are residually contaminated or recontaminated.…”

Access to Waterless Hand Sanitizer Improves Student Hand Hygiene Behavior in Primary Schools in Nairobi, Kenya

“…20,21 However, because of its broad effectiveness, proven improved disinfection capabilities over plain soap, and ease of use, the World Health Organization (WHO) now recommends alcoholbased hand sanitizer as the preferred hand cleaning method for most clinical situations in healthcare facilities around the world. 22 There is evidence that alcohol-based sanitizers perform as well as handwashing with soap and water in settings where hands are highly contaminated with fecal bacteria and show visible dirt 23,24 ; however, limited research has been conducted on the behavioral and health impacts of hand sanitizer use in low-income settings. A randomized controlled trial in Colombia found that access to waterless hand sanitizer in daycare centers reduced the risk of both gastrointestinal and respiratory illnesses among enrolled children.…”

Evaluation of antibacterial activity of hand sanitizers – an <i>in vitro</i> study

“…These hand sanitizers have been shown to be effective in various situations such as the reduction of gastrointestinal infection, reducing infection in University hostels and reducing absenteeism in elementary schools (Meadows andLe Saux 2004, Reynolds et al, 2006). And has been previously reported to give better results than hand washing (Pickering et al, 2010) The 2014 outbreak of EVD in Nigeria led to an increased awareness of the role of hand sanitizers in infection control (Olalekan andAdeola 2014, Nwabueze et al, 2016) and an upsurge of various brands of hand sanitizers into the Nigerian market (Odebisi-Omokanye 2015, Ogoina et al, 2016). Most of these products have made numerous claims, notably their ability to eliminate 99.9% of microorganisms.…”

“…This changed by the early 2000s, when the Centers for Disease Control and Prevention (CDC) issued a guideline recommending that alcohol-based hand rub (ABHR) be routinely used for decontaminating hands (CDC 2002). These ABHRs which are the most commonly used hand sanitizers are often composed of alcohol, ethanol, isopropanol or propanol (Pittet 2001, Pickering et al, 2010. They have a recommended concentration range of 60% to 95% (Reynolds et al, 2006).…”