HANDWASHING : Timeless Wisdom - A Healthy Habit

1. HANDWASHING : Timeless Wisdom -A Healthy Habit Dr. Ritvik Dr. Chandrakant S. Pandav National President, Indian Public Health Association Professor and Head, Centre for Community Medicine All India Institute of Medical Sciences

2. Ancient Wisdom Regarding post defecation cleaning Vishnu Purana, a religious Hindu text, lays down the rules as thus: एका लिङ्गे गुदे तिस्त्रो दश वामकरे नृप | हस्तद्वये च सप्त स्युर्मदश्शौचोपपादिका: || १८ (तृतीय अंश अध्याय ग्यारह)

3. Ancient Wisdom “After defecation : • The generative organ is to be washed once, • The anus is to be washed three times, • The left hand to be washed ten times and • The right hand to be washed seven times. • Both feet are to be cleaned three times. • Fist full of earth is to be used for washing before use of water. • The water utensil is to be washed too” Source: Sulabh International Museum of Toilets

4. Semmelweis Ignac – 1847 (01/07/1818 – 13/08/1865) Hungarian Physician

5. Autopsy Room Autopsy Room Wash hands Chlorinate Solution Delivery Room Delivery Room “Childbed fever” Maternal Mortality : 2% Maternal Mortality : 18%

6. Hand Hygiene In Fecal Oral Transmission Fingers HANDWASHING Flies Feces Foods Host Fomites Fluids

8. Six Honest Serving - Men I KEEP six honest serving-men(They taught me all I knew);Their names are What and Why and When and How and Where and Who Rudyard Kipling (The Elephant's Child)

9. Why Wash Hands ? Reduces Diarrhoea • Hand washing with soap : • Reduces risk of diarrhoeal diseases by 42-47% • No of diarrhoea deaths that could be averted 1.1 million • Hand washing by mothers : • Lowers incidence of childhood diarrhoea

10. Why Wash Hands ? Reduces ARI • Viruses like adenovirus, corona virus, Asian flu virus • Transmitted by faecal-oral route too and hands act as vectors in spreading them • Hand washing • Reduces ARI Risk Reduction: 6% to 44%

12. Why wash hands? • Reduced Diarrhoea • Reduced ARI 42% to 47% 6% to 44%

13. When to Wash Hands? • A study from Peru observed that : - Number of times hands were washed per day - More important than the reasons for it, - Whether before cooking or eating, or after defecation

14. What Material Should Be Used For Hand Washing? • All washing agents including plain water • Effective in reducing bacterial counts from hands. • Physical action of scrubbing, washing and • Drying on a paper towel was more important

15. WhatMaterial Should Be Used For Hand Washing? Bangladesh and Pakistan study : • Soap • Ash • Clean Mud • Were more or less equally effective in reducing faecal coliform hand contamination

16. How Should One Wash Hands? • Rubbing of hands (6 times or more), • Rinsing with safer water • Drying with clean cloth or paper towel • For at least 15 to 30 seconds

17. Areas of Hands Requiring Special Attention

19. Drying Hands After Hand Wash • Handkerchief / cloth used to dry hands • Can be a source of re-infection • Air drying with hot air blower • Has been shown to increase hand contamination

20. Where to Wash Hands • Often resources like water and soap are limited especially in schools or sometimes even at homes • But once you have the habit ingrained you will almost always successfully seek and find the resources

21. Who Should Wash Hands • WE ALL • WE ALL are at Risk • Clean appearing hands need not be free of Germs

22. IPHA –Lifebuoy : “What is on My Hands Study” • A pilot study to look at hand hygiene status of school children • Indian Public Health Association (IPHA) and Lifebuoy • One school each in Kolkata and Bangalore • About 100 students in each school, Aged 10-14 years • Conducted in September – October 2010

23. What is on My Hands Study: Findings

24. What is on My Hands Study: Findings

25. What is on My Hands Study: Findings

26. What is on My Hands Study: Findings

27. What is on My Hands Study: Findings

28. What is on My Hands Study: Findings • Use of soap more frequent during hand washing • Before dinner (at home) than Before lunch (at school) • Plausible reason : poor availability of soap at school

29. What is on My Hands Study: Findings

30. What is on My Hands Study: Findings

31. Public Private Parternship • Collaboration between Lifebuoy with Public Health institutions and Government to promote hand hygiene • Once adapted by people in their daily lives it will not only control spread of life threatening diseases contribute towards meeting the Millennium Development (Goal 4), To reduce Child Mortality

32. Fact File - 1 • Clean hands save lives! • Handwashing with soap is among the most effectiveandinexpensive ways to prevent diarrhoeal diseases and pneumonia, which together are responsible for the majority of child deaths (36%)

33. Fact File - 2 • Every year, > 3.5 million children globally do not live to celebrate their 5th birthday because of diarrhoea and pneumonia • Diarrhoeal diseases kill more < 5 yrs five children than Malaria and HIV AIDS combined

34. Hand Washing Before Prayers • Before entering places of worship provision of water in form of Taps is usual to enable hand washing • For Hindus Hand washing a must before offering Prayers • In Islam a particular sequence for washing of hands is prescribed before offering prayers

35. When you wash hands before offering Prayers Then, Why not wash hands before eating Meals?

36. When you wash your hands before Prayers You wash off Enmity Join Clean Hands For an Integrated  and Healthy India

37. Take Home Messages

38. Six Honest Serving - Men I KEEP six honest serving-men(They taught me all I knew);Their names are What and Why and When and How and Where and Who Rudyard Kipling (The Elephant's Child)

39. Take Home Messages-1 • WHO: We All • WHY: Keeps Us Healthy and Disease Free • WHEN: As Often as You Can • WHERE: Every Where • HOW: Follow the Steps of Hand Washing • WHAT: Use Soap and Water

40. Take Home Messages-2 • Hand washing is MOST important habit to inculcate for health as well as social reasons • Hand washing and personal hygiene is timeless wisdom • Despite appearing simple, it is a complex behaviour • With a little effort it can easily be imbibed by anyone at any age • Handwashing : Timeless wisdom - A Healthy Habit

41. Take Home Messages-3 • Contrary to the existing belief • No need to wash hands for extended duration of 1 to 2 minutes • Hand washing for 15 to 30 seconds is enough • Particularly important in infection prevention strategies in relation to: • Care of infants and children • Care of sick patients • Food handlers • Domestic work

42. Take Home Messages-4 • Wash your hands • After you use a restroom • Before and after you eat • Before you touch your eyes, nose or mouth • Before and after you prepare food, and after you handle meat or fish, • Before moving on to other food items • After you change a diaper • After you pet a dog, cat or other animal • After you touch plants or soil • After you visit a hospital or nursing home • After you come in contact with any body fluids or touch items that may have come in contact with body fluids

43. Global Handwashing Day! 15th October Sachin Tendulkar – Brand Ambassador

44. All India Institute of Medical Sciences, New Delhi Thank You