Improving water, sanitation, and hygiene (WASH), with a focus on hand hygiene, globally for community mitigation of COVID-19

Abstract

Continuity of key water, sanitation, and hygiene (WASH) infrastructure and WASH practices—for example, hand hygiene—are among several critical community preventive and mitigation measures to reduce transmission of infectious diseases, including COVID-19 and other respiratory diseases. WASH guidance for COVID-19 prevention may combine existing WASH standards and new COVID-19 guidance. Many existing WASH tools can also be modified for targeted WASH assessments during the COVID-19 pandemic. We partnered with local organizations to develop and deploy tools to assess WASH conditions and practices and subsequently implement, monitor, and evaluate WASH interventions to mitigate COVID-19 in low- and middle-income countries in Latin America and the Caribbean and Africa, focusing on healthcare, community institution, and household settings and hand hygiene specifically. Employing mixed-methods assessments, we observed gaps in access to hand hygiene materials specifically despite most of those settings having access to improved, often onsite, water supplies. Across countries, adherence to hand hygiene among healthcare providers was about twice as high after patient contact compared to before patient contact. Poor or non-existent management of handwashing stations and alcohol-based hand rub (ABHR) was common, especially in community institutions. Markets and points of entry (internal or external border crossings) represent congregation spaces, critical for COVID-19 mitigation, where globally-recognized WASH standards are needed. Development, evaluation, deployment, and refinement of new and existing standards can help ensure WASH aspects of community mitigation efforts that remain accessible and functional to enable inclusive preventive behaviors.

Access to and Use of Hand Hygiene Resources during the COVID-19 Pandemic in Two Districts in Uganda, January–April 2021

“…This assessment is one of the few to compare hand hygiene access and use between both healthcare and community settings. 6 Critically, 38% of HCWs interacting with patients, 48% of patrons after using a latrine, and 21% of patrons entering and exiting a community setting were observed to practice hand hygiene, representing low adherence despite increases in global and local awareness of hand hygiene as a key preventive measure during the COVID-19 pandemic. 20 With the COVID-19 pandemic, the importance of mitigation measures—including hand hygiene—in community spaces has grown.…”

“… 39 Local production of ABHR may enable more affordable, consistent access in community settings, although supply chain models are currently undefined, as are roles and guidance for management. 6 Community settings may require managers or influencers to ensure hand hygiene materials are consistently available and used, similar to the role played by infection prevention and control focal persons in HCFs. 9 , 40 , 41…”

“…4 , 5 In 2019, 30% of schools in Uganda had basic hygiene services (at least one handwashing station with water and soap), 24% had limited hygiene services (handwashing station with water but no soap), and 46% had no hygiene services (no handwashing station or no water). 3 Assessments of hand hygiene in other community locations, such as community congregation points of elevated importance (e.g., markets, points of entry) during the pandemic 6 were rare.…”

Lessons Learned from the Ebola Virus Disease and COVID-19 Preparedness to Respond to the Human Monkeypox Virus Outbreak in Low- and Middle-Income Countries

“…In response to the Ebola virus, countries initiated the IPC cascade, standardizing training curricula and enforcing modifications for resilient health security at entry points, hospitals, and community sites which cabbed the further spread of infections. 24 Notably, there have been sustainable global investments geared towards improving hand hygiene practices, 25 and various non-pharmaceutical measures, such as social distancing, have been tested with positive results in reducing the rate of infection transmission 26 that could be leveraged to stop the escalation of Monkeypox Infections.…”

Improving Access to WHO Formulations of Alcohol-Based Hand Rub in Healthcare Facilities: A District-Wide Approach

“…In response to the coronavirus disease 2019 (COVID-19) pandemic, various non-pharmaceutical public health measures were newly established or enhanced to prevent transmission, including the use of face masks and increased access to hand hygiene, both in healthcare facilities (HCFs) and communities. 6 , 7 Alcohol-based hand rub (ABHR) and handwashing with soap and water are both effective hand hygiene methods for healthcare workers. The WHO promotes ABHR use in HCFs because of its fast-acting and broad-spectrum microbicidal activity with minimal risk of generating resistance to antimicrobial agents.…”