Employees must wash hands before returning to work

Believe it or not, October 15 was "Global Handwashing Day". There really is a day (or week or month) for everything, but despite the silliness of designating a "Global Handwashing Day" (and yes, yes, it provides a focal point for awareness raising activities), handwashing (or not) is an activity that can help save (or not) millions of children's lives every year.

According to the Global Handwashing Day website: "Of the approximately 120 million children born in the developing world each year, half will live in households without access to improved sanitation, at grave risk to their survival and development. Poor hygiene and lack of access to sanitation together contribute to about 88% of deaths from diarrheal diseases, accounting for 1.5 million diarrhea-related under-five deaths each year. Children suffer disproportionately from diarrheal and respiratory diseases and deaths." Children older than five suffer as well: diarrheal and respiratory diseases kill around 3.5 million children a year worldwide.

Handwashing with soap is one of the most cost-effective means of preventing infection in developing countries, but a recent study of behavior in 11 countries found that on average, only 17% of child caretakers wash hands with soap after visiting the toilet. Of the 11 countries (Ghana, India, Madagascar, Kyrgyzstan, Senegal, Peru, China, Tanzania, Uganda, Vietnam and Kenya), Indians washed their hands with soap most frequently (42%) after visiting the toilet, while Ghanaians and Madagascaris washed least frequently (3% and 4% respectively). Chinese washed their hands 12-13% of the time, and Kenyans 29% of the time.

Including people who rinsed their hands with water but did not use soap, the numbers were much higher, leaping to 39% in Ghana and 57% in Kenya. The India study did not report "no soap" handwashing statistics, and bizarrely, the two China studies, done in Sichuan and Shaanxi (and admittedly featuring small data samples), which produced nearly identical "handwashing with soap" results, returned extraordinarily different results on the question of handwashing without soap (Sichuanese rinsed 87% of the time and Shaanxi only 14% of the time).

Hygiene is in great part a function of culture and convenience (if you had to collect all of your washing and cooking water every day, and had no water facilities in your toilet, which you were sharing with hundreds of others, how good a handwasher would you be?), but poor hygiene is not exclusive to developing countries. A study in the U.K. found that only 43% of mothers washed their hands with soap after changing a dirty diaper/nappy. That's five points ahead of Kenya (38%).

Of course, you don't have to be a health and sanitation researcher to know that poor hygiene knows no economic or national boundaries. The next time you visit the toilet in a luxury hotel or posh restaurant, pause for a moment (trying not to get arrested for loitering with intent to solicit) and see what percentage of people wash their hands with soap. No matter how exclusive the venue, a sizable minority (or majority!) of people will head straight out the door without even a glance at the sink.

I included a couple of photos above, The first shows a handwashing cistern at a Medecins Sans Frontieres hospital in Gety, Ituri province. These cisterns frequently have a piece of soap nearby, but although this one doesn't, the water contains antiseptic. The second photograph shows a toilet in a camp in North Kivu for internally displaced refugees (IDPs). The toilets are scattered around the camp and segregated by sex (though I imagine that in the middle of the night most people head for the nearest). They're drop toilets and probably needless to say, they don't feature sinks and running water. If you want to wash your hands, you do so after returning to your hut.