Setting the Hand Hygiene Standards• PracticalrecommendationsfromtheHygieneCouncil

tohelpimprovehandhygienestandards

• Findingsofthe2009Internationalconsumersurvey

Supported by Dettol – Leaders in Hygiene

IntroductIon

wHyIsItsoImPortant toImProveHygIene?theglobalincreaseininfectionduetobacteria,viruses,fungi,prions,orparasitesisevidentinallnations.westerndevelopednationshaveseenanincreaseinhospitalacquiredinfectionandantibioticresistantstrainsofbacteria,whilesomedevelopingnationshaveseenincreasesinresistanttuberculosis1 andinmalaria.2

regardlessofgeographicallocation,manyinfectiousdiseasescanbepreventedorcontainedthroughgoodhygienepracticeandeducation.whetherthisistoensurethatstoredwateriscoveredtoreducethespreadofdengueormalaria,thatpurifyingtabletsareusedfordrinkingwater,thatthemouthiscoveredwhencoughing,orsimpleeffectivehandwashingwhenrunningwaterisavailable.

Prevention is better than cure.

Childhood infections Pneumonia,diarrhoea,and

HIv/aIDseachaccountforapproximately30%of

childdeathsindevelopingnations,particularlyafrica.3

HygIenestanDarDs

Hygiene Council 3

IntroductIon

tHeHygIeneCounCIl

theHygieneCouncilisagroupofleadingglobalexpertsinthefieldsofmicrobiology,virology,infectiousdisease,immunology,andpublichealth. theCouncilreviewscurrentinfectiousdiseasethreatstosocietyandformulatesrealisticrecommendationsonsimplehygienemeasurestohelpthepublicimprovelevelsofhygieneinthehomeandcommunityandinturnhelptopreventthespreadofallkindsofinfections.

thisyear,theHygieneCouncil,respondingtoconsumerconfusionabouthowbest tobehygienicallysafeduringthespreadofinfectiousdiseases,hascomeupwithasetofpracticalrecommendationstohelpallofuspracticegoodhandhygiene.Bytranslatingscienceintopractice,everyonecanhaveaclearideaofbestpractice.

From leFt to right:BaCkrow:ProFessorexner(germany),JoeruBIno(DIreCtor,r&DlaBs),

DrletlaPe(soutHaFrICa),PHIlIPPegaertner(FranCe)mIDDlerow:Drlee(malaysIa),ProFessorsIgnorellI(Italy),ProFessorsCHouB(soutHaFrICa)

Frontrow: ProFessortIerno(usa),ProFessoroxForD(uk), DrnarenDrasaInI(InDIa),Drlow(CanaDa)

HygIenestanDarDs

Hygiene Council 5

did you know?The hands are one of the most important

causes of cross contamination and cross infection in

the home.

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HandwasHing your first line of defence

“After hand washing with soap, hands should be thoroughly dried on a clean dry towel”

HAndWASHInG

wHyIsHanDwasHIngsoImPortant?

thehandsareoneofthemostimportantcausesofcrosscontamination,andthespreadofflu.

wHensHoulDyouwasHyourHanDs?

Before...eatingorbeforefeedingchildren•applyingcontactlenses•givinganymedicationorfirstaid•

after...Coughing,sneezingorblowingandscratchingthenose•touchingfrequentlytouchedsurfacesandobjects•usingthetoiletorchangingachild’snappy•Handlingpetsanddomesticanimals•

Beforeandafter...Handlingrawfood•tendingtosomeonewhoissick•

andwhenever...Handsappeardirty•

HowsHoulDHanDsBewasHeD?

wheresoapandcleanwaterareavailable,followthesix-step • handwashingprocess-See next page »

wheresoapandcleanwaterarenotavailable,alcohol-based • handrubscanbeusedtokillgermsonthehands,butnotif thehandsarevisiblydirtyastheseproductsdon’tclean

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HygIenestanDarDs

Hygiene Council 7

“only 42% people in India believe that hand

washing is the most effective way to prevent

the spread of flu”

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tHe2009gloBalsurveyFounDtHat:

• only42%peopleinIndiabelievethathandwashingisthemosteffectivewaytopreventthespreadofflu

• 29%ofpeopleinIndiamightnotwashtheirhandsproperlyaftercoughingorsneezing

• 70%ofIndiansdon’twashtheirhandsfortherecommendedduration(atleast20seconds)

wethandsandapplysoap.rubpalmstogetheruntilsoapisbubbly1.

rubeachpalmoverthebackoftheotherhand2.

rubbetweenyourfingersoneachhand3.

rubbacksoffingers(interlocked)4.

rubaroundeachofyourthumbs5.

rubbothpalmswithfingertipsthenrinseanddryyourhands6.

THe Six-STeP ProceSS To waSHing Your HandS

HAndWASHInGH

ygiene Stand

ards

Hand

washing

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f defence

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2009 InternatIonal Consumer survey

overvIew

anInternationalConsumersurveyhasbeencarriedoutbytheHygieneCouncilinordertoidentifyandassessworldwideandcountry-specificpublicbehaviours,attitudesandopinionstowardshygiene.thesurveyprovidesaninsightintocurrentbeliefsandaffordstheCounciltheabilitytoidentifytrendsandshiftsinconsumerattitudesovertime.

surveymetHoD

thesurveywasconductedonbehalfoftheHygieneCouncilbytaylornelsonsofres(tns)marketresearchCompanybetweenFebruaryandapril2009.asurveywascarriedoutin8countries;australia,germany,India,malaysia,saudiarabia,southafrica,ukandusa.

respondentsinallcountrieswereaskedquestionstoallowforworldwideanalysisandcross-countrycomparisons.eachcountrywasthenaskedaseriesoflocallyrelevantquestions.

results

theglobalsurveyquestionswithkeyfindingsare:

SurveyHygIenestanDarDs

Hygiene Council 11

Survey

Q.wHICHoFtHeFollowIngmeasuresDoyoutHInkIstHemosteFFeCtIvewaytoHelPProteCtagaInstCatCHIngaColDorFlu?

*calculatedfromweightedbasefigure

only 42% of indians• feelthatwashinghandsregularlyisaneffectivewaytohelpprotectagainstcatchingacoldorflu.

only 26% of indians• feelthatcoveringyournoseandmouthwhilesneezingisaneffectivewaytohelpprotectagainstcatchingacoldorflu.

Country Wash hands Cover your Avoid public Disinfect Avoid being None of Don’t know/ regularly nose and places / surfaces you near animals / these Refused mouth when transport frequently birds sneezing touch

australia 46% 16% 12% 7% 0% 15% 5%

germany 60% 8% 17% 5% 1% 8% 2%

greatBritain 46% 27% 11% 10% 0% 5% 1%

India 42% 26% 10% 13% 5% 5% 0%

malaysia 21% 30% 17% 14% 14% 2% 2%

saudiarabia 20% 42% 15% 14% 8% 1% 0%

southafrica 53% 16% 3% 13% 5% 7% 4%

usa 79% 9% 3% 4% 1% 2% 1%

Total Avg* 45% 22% 10% 10% 5% 6% 2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Wash handsregularly

Cover your noseand mouth when

sneezing

Avoid publicplaces /

transport

Disinfectsurfaces you

frequently touch

Avoid being nearanimals / birds

None of these Don't know /Refused

Australia Germany Great Britain India Malaysia Saudi Arabia South Africa USA

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12 Hygiene Council

Survey

Q.onwHICHoFtHeFollowIngoCCasIonsmIgHtyounotwasHyourHanDsProPerly?

70% of people in india might not wash their hands after touching commonly •touched surfaces.

29% of people in india might not wash their hands after coughing or sneezing.•

Country After touching After Before Before After using None of Don’t know / commonly Sneezing / cooking / eating the toilet these Refused touched coughing serving food surfaces like a remote / phone etc.

India 70% 29% 7% 5% 5% 15% 1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

After touchingcommonly

touched surfaceslike a remote /

phone etc.

After sneezing /coughing

Before cooking /serving food

Before eating After using thetoilet

None of these Don't know /Refused

India

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Hygiene Council 13

Q.onaverage,HowlongDoyoutaketowasHyourHanDs?

70% of people in india do not wash their hands for the recommended •duration (at least 20 seconds).

Country Upt to 5 5 – 10 10 – 20 20 – 30 30 Don’t wash Don’t know / seconds seconds seconds seconds seconds + hands at all Refused

India 8% 33% 29% 10% 19% 0% 1%

Survey

0%

5%

10%

15%

20%

25%

30%

35%

Up to 5 seconds 5-10 seconds 10-20 seconds 20-30 seconds 30 seconds + Don't wash handsat all

Don't know /Refused

India

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14 Hygiene Council

Survey

Q.oFtHeFollowIngoPtIons,wHICHDoyouFeelIstHemosteFFeCtIvewaytoPreventtHesPreaDoFgermsIntHeHome?

*calculatedfromweightedbasefigure

only 44% of people in india believe ‘washing hands regularly’ is the most •effective way to prevent the spread of germs in the home,withregularsurfacedisinfection(31%)thenextpriority

Country Wash hands Surface Prevent Avoid kissing or Disinfect None of Don’t know/ regularly disinfection on animals from close physical the these Refused a regular entering the contact with laundry basis house family & friends

australia 53% 36% 2% 2% 1% 4% 2%

germany 55% 27% 6% 5% 2% 5% 1%

uk 51% 40% 3% 2% 2% 1% 1%

India 44% 31% 10% 3% 8% 4% 0%

malaysia 31% 31% 21% 4% 11% 1% 1%

saudiarabia 16% 43% 30% 3% 7% 0% 0%

southafrica 56% 24% 10% 4% 1% 2% 3%

usa 65% 25% 3% 2% 1% 2% 2%

Total Avg* 47% 31% 11% 3% 4% 2% 1%

0%

10%

20%

30%

40%

50%

60%

70%

Wash handsregularly

Surfacedisinfection on a

regular basis

Prevent animalsfrom entering the

house

Avoid kissing orclose physical

contact with familyand friends

Disinfect thelaundry

None of these Don't know /Refused

Australia Germany Great Britain India Malaysia Saudi Arabia South Africa USA

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Hygiene Council 15

Survey

Q.wHenyouCleanyourHanDs,wHICHoFtHeFollowIngDoyouusuallyuse…?

*calculatedfromweightedbasefigure

9%ofpeopleinIndiawashtheirhandswithrunningwateronly.•

Country Runnign water Running Running Hand Hand None of Don’t know/ and antibact- water and water sanitizer wipes these Refused erial liquid regular only only only hand soap soap

australia 39% 52% 4% 3% 0% 1% 1%

germany 8% 90% 1% 1% 0% 0% 0%

greatBritain 52% 43% 2% 1% 0% 1% 0%

India 45% 43% 9% 2% 2% 0% 0%

malaysia 33% 53% 12% 1% 1% 0% 0%

saudiarabia 38% 54% 2% 5% 1% 0% 0%

southafrica 22% 60% 15% 2% 0% 1% 0%

usa 48% 45% 2% 3% 0% 1% 1%

Total Avg* 34% 55% 7% 2% 1% 0% 0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Running waterand antibacterialliquid hand soap

Running waterand regular hand

soap

Running wateronly

Hand sanitizeronly

Hand wipes only None of these Don't know /Refused

Australia Germany Great Britain India Malaysia Saudi Arabia South Africa USA

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16 Hygiene Council

Survey

Q.onwHICHoFtHeFollowIngoCCasIons’mIgHtyourCHIlDrennotwasHtHeIrHanDs?

59% of people in india admit that their children might not wash their hands •during in between meal snacking.

Country Before Before Before In between Don’t know/ breakfast Lunch Dinner meal snacking Refused

India 14% 16% 11% 59% 33%

0%

10%

20%

30%

40%

50%

60%

70%

Before breakfast Before lunch Before dinner In between meal snacking Don't know / Refused

India

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HygIeNe CoUNCIL MeMBeRS

CHaIr:ProfessorJohnoxford,Professorofvirologyatst•

Bartsandthelondonschoolofmedicineand

Dentistry,uk

Professormartinexner,managingDirector,Instituteof•

HygieneandPublicHealth,universityofBonn,germany

DrChristopherlee,ConsultantPhysicianInfectious•

Diseases,sungaiBulohHospital,malaysia

Drkgosiletlape,ImmediatepastPresidentoftheworld•

medicalassociation(wma),southafrica

DrDonaldlow,microbiologist-in-Chiefattoronto•

medicallaboratories/mountsinaiHospital,Canada

Professortariqahmedmadani,ProfessorofInternal•

medicineandInfectiousDiseases,Facultyofmedicine,

kingabdulazizuniversity,Jeddah,advisortotheminister

ofHealth,ministryofHealth,riyadh,saudiarabia

Drsandipkray,secretarygeneral,IndianPublicHealth•

association,India

Joerubino,Directorsharedservices,r&Dlaboratories,•

reckittBenckiser

Drnarendrasaini,HeadofDepartmentmicrobiology&•

ImmunologyandChairmanHospitalInfectionControl

committee,PushpanjaliCrosslayHospital,vaishali,India

ProfessorBarryschoub,executiveDirector,national•

InstituteforCommunicableDiseases,Johannesburg,

southafrica

ProfessorCarlosignorelli,vice-PresidentoftheItalian•

societyofHygiene,PreventativemedicineandPublic

Health(sltl),Italy

Drrhondastuart,InfectiousDiseasePhysician,monash•

medicalCenter,victoria,australia

ProfessorPhilipmtierno,DirectorClinicalmicrobiology•

andImmunology,newyorkuniversitylangonemedical

Center,ClinicalProfessorofmicrobiologyandPathology,

newyorkuniversityschoolofmedicine,usa

WeBSITeS

InternationalscientificForumonHomeHygiene(IFH):•

www.ifh-homehygiene.org

worldHealthorganisation(wHo): •

www.who.int

europeanFoodsafetyauthority: •

www.efsa.europa.eu

CentersforDiseaseControlandPrevention(CDC): •

www.cdc.gov/

HygieneCouncil: •

www.hygienecouncil.com

ReCkITT BeNCkISeR INfoRMATIoN

lizol:www.lizol.co.in•

Dettol:www.dettol.co.in•

reckittBenckiser:www.reckittbenckiser.com•

RefeReNCeS

vongottberga,klugmankP,CohenCetal.emergence1.

oflevofloxacin-non-susceptiblestreptococcuspneumonia

andtreatmentformultidrug-resistanttuberculosisinchildren

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lancet 2008;371:1108-13.

kiszewskia,JohnsB,schapiraaetal.estimatedglobal2.

resourcesneededtoattaininternationalmalariacontrolgoals.

Bulletin of the World health organisation2007;85(8):623-30.

southafricaneveryDeathCountswritinggroup.everydeath3.

counts:useofmortalityauditdatafordecisionmakingtosave

thelivesofmothers,babies,andchildreninsouthafrica.

lancet2008;371:1294-1304.

HanDHygIeneIntHeHomeanDCommunIty:IFH4.

briefingdocumentforhealthprofessionals,July2007.

Supported by Dettol – Leaders in Hygiene