Why Global Handwashing Day highlights the needs for better hand hygiene compliance everywhere

Global Handwashing Day is here again, and with it should come fresh impetus for us all

Global Handwashing Day is an annual campaign dedicated to “increasing awareness and understanding about the importance of handwashing with soap as an easy, effective, and affordable way to prevent diseases and save lives”. The event first was held in 2008, when over 120 million children around the world washed their hands with soap in more than 70 countries. Since then, Global Handwashing Day has continued to spread the word about handwashing, build facilities, and demonstrate the value of clean hands – especially in developing countries where education and those facilities are still often lacking.

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These are very admirable goals that should be fully supported by everyone. But this is also a campaign that can be an excellent reminder for all of us. Whilst the precise metrics and understanding of hand hygiene in relation to the spread of disease might be unknown, the need to wash your hands is something that is often taught from a young age, yet as adults is something that may be easily ignored in our busy day to day lives.

Even in businesses where good hand hygiene is essential, for example, in the food industry, hand hygiene practices are not always adhered to. Indeed, in one observational study of food handlers involving over 31,000 hand activities, only 14% of them performed hand hygiene correctly at all times. In another study based on self-reporting, 59% admitted to sometimes not washing their hands all of the time, with 4% admitting they often did not.   What this tells us that even when education and awareness are prevalent, there is still more to do to make handwashing a habitual practice.

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Solutions need to be long term, and need to focus on a better understanding of human psychology

Of course, ensuring compliance starts with the provision of all the necessary facilities, which is one of the key campaigning points of Global Handwashing Day. To maximise the removal of soil and microorganisms, these facilities should include clean running water (not too hot or too cold with an ideal of about 38oC), soap and a means of hygienically drying the hands. However, when you look closely at all the available research, you can easily see that provision of facilities is only half the story. Even in developed countries, where the latest facilities (including ‘no-touch’ appliances) are provided, compliance can still be as low as 40%.

Getting to the next level of hand hygiene – and providing an effective barrier against the spread of pathogens – requires something more. Partly, this is about creating the right organisational culture. This needs to start at the top management level, because the practices of peers and managers are increasingly important determinants of employee compliance. Indeed, ensuring an appropriate hand hygiene culture with high levels of compliance should be senior management hygiene responsibility in the food industry, care environments or any other kind of organisation.

However, the challenge isn’t just about creating the culture. Where possible, it’s also about changing fundamental attitudes and behaviours at an individual, psychological level.  Indeed, psychologists who have studied non-compliance have found individuals can convince themselves that any risks associated with not decontaminating hands will not affect them (known as optimistic bias).  Another psychological construct (known as attitudinal ambivalence) happens when people recognise hand decontamination is important but perceive other things to be more important. These are issues and barriers that need to be overcome.

Making the change

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Establishing new habits and associated behaviour change is not easy, but it can be done.  One approach is to consider the change needed in terms of ‘stage models’, where behaviour change involves a sequence of discrete, qualitatively distinct stages. These start with the individual not really considering changing behaviour (pre-contemplation), then moving towards considering behaviour change (contemplation), to preparing to change behaviour (preparation stage), then actually changing behaviour (action stage), followed by a stage evaluating the costs and benefits of the change in behaviour and if it should be continued.

Awareness raising campaigns can be a very good start here. They are really useful in the precontemplation / contemplation stages outlined above, for example. But what more could we do? Perhaps it’s now time to think how this can be done in practical times by re-examining the way people absorb information in modern times.

One way of doing this would be to look at trends like social media marketing. For example, we could look closely at the methods major companies use to market their products  and engage with people over time. They use digital channels to market their ideas, sell their products and then maintain communication with a combination of further educational content, feedback channels, surveys and so on. A similar approach could be used to “selling “ hand hygiene behaviour and although , this would be more time consuming to put in place and maintain, it is  ultimately more likely to achieve behavioural change and a long term connection with the target audience.

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Overall, what we need to remember is that good hand hygiene is a key life skill, regardless of where you are from. It is a relatively cheap and effective method of preventing infectious diseases, and is in the interests of everyone. We just need to find the right approaches  to ensure that awareness turns into long term change. Developments in technology, such as automated non touch facilities, will no doubt help, but ultimately, we all need to recognise that compliance rests with the individual. Our future, and that of our children, literally lies in our own hands.

Professor Chris Griffith

Professor Chris Griffith has been involved in hygiene (medical, consumer and food safety) research and training for over 40 years. He has been awarded numerous international awards including the 2006 IAFP International Food Safety Leadership award. He has edited the British Food Journal for 15 years and authored / co-authored more than 430 books, book chapters, scientific papers and conference proceedings relating to hygiene. He has served on the board of trustees of the International Scientific Forum for Home Hygiene for 7 years and is an Emeritus Professor of the University of Wales. He now works as an independent consultant for different organizations on various aspects of microbiological control. Professor Griffith has a BSc and PhD in Microbiology, a postgraduate diploma in education and is an ISO and a BRC trained auditor.

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