Impact of In-Home Handwashing Stations on Hand Hygiene During the COVID-19 Pandemic in Unpiped Rural Alaska Native Homes

Abstract

Objectives: More than 3300 rural Alaska Native homes lack piped water, impeding hand hygiene. During the COVID-19 pandemic, the Alaska Native Tribal Health Consortium and the Centers for Disease Control and Prevention partnered with 10 Tribal communities and regional Tribal health organizations to install a low-cost, intermediate-technology water and sanitation system, the Miniature Portable Alternative Sanitation System (Mini-PASS). We assessed the impact of the Mini-PASS handwashing station on handwashing, other water-related uses, and problems encountered over time. Methods: In this pre–postintervention study, we conducted semi-structured interviews by telephone seasonally with representatives of 71 households with the Mini-PASS from February 2021 through November 2022 to assess the impact of the units on water use and health. Results: Before Mini-PASS installation, all participating households primarily used washbasins for handwashing. Postintervention, more than 70% of households reported using the Mini-PASS as their primary handwashing method in all 3 follow-up intervals (3, 6-9, and 12 months postintervention). The proportion of households using the handwashing station for other household tasks increased during 12 months, from 51.4% (19 of 37) at 3 months postintervention to 77.8% (21 of 27) at 12 months postintervention. Although approximately 20% to 40% of households reported problems with their handwashing station during the 12 months postintervention, a large proportion of interviewees (47% to 60%) said they were able to conduct repairs themselves. Conclusions: Households in rural Alaska quickly adopted the Mini-PASS for hand hygiene and other needs and were largely able to troubleshoot problems themselves. Further research evaluating the impact of improved handwashing behaviors facilitated by the Mini-PASS should be conducted.

Practice-Based Research From the Frontlines: Selected Strategies for Reducing Health Disparities and Accelerating Progress Toward Health Equity in the United States

“…31 It is also crucial given connections of high maternal mortality to racial inequities, low numbers of hospitals providing maternity care, and workforce shortages for health care positions, such as nursing. [31][32][33] Articles by Harmon et al, 34 Nawaz et al, 35 and Bakshi et al 36 share a primary emphasis on expanding access to health protective resources. In rural Alaska homes lacking access to piped water, installing in-home handwashing stations expanded access to clean water as a condition vital for health, the importance of which increased when basic hygiene practices, such as handwashing, were recommended to reduce the spread of COVID-19.…”

“…In rural Alaska homes lacking access to piped water, installing in-home handwashing stations expanded access to clean water as a condition vital for health, the importance of which increased when basic hygiene practices, such as handwashing, were recommended to reduce the spread of COVID-19. 34 Adherence to COVID-19 recommendations was facilitated by strategic public-private partnerships promoting the use of low-cost, innovative Mini Portable Alternative Sanitation Systems. This promising multiagency partnership demonstrates how to leverage diverse resources and systems-change openings (ie, opportunities for change that could alter systems in ways that would expand access to conditions vital for health and well-being) accompanying public health emergencies to address enduring inequities.…”

“…Articles by Harmon et al, 34 Nawaz et al, 35 and Bakshi et al 36 share a primary emphasis on expanding access to health protective resources. In rural Alaska homes lacking access to piped water, installing in-home handwashing stations expanded access to clean water as a condition vital for health, the importance of which increased when basic hygiene practices, such as handwashing, were recommended to reduce the spread of COVID-19.…”