Proper hand-washing is one of the most effective strategies to prevent the spread of microbial infections and illness. For instance, practicing good hand-washing habits with soap and water can reduce the occurrence of diarrhea by almost 50 percent. Common diarrheal diseases such as cholera, typhoid, intestinal worms and Shigella are the leading cause of death of children five years and younger worldwide.
Tips for Teaching Hand-Washing Concepts and Practices in Central American
Health professionals with experience working in Central America have found the following approaches to teaching hand-washing practices to be effective:
- Using brief and simple education tools with plenty of illustrations: Due to minimal literacy among this population, text should be limited on health education materials.
- Providing interactive demonstrations: A hands-on demonstration on how to correctly construct a hand-washing system and correctly wash hands will enhance the learning experience.
Explaining How Germs Can Lead to Disease
Another important aspect of hand-washing education is the concept of germs and their relationship to disease. Parents don't want their children to get sick but often lack understanding of what germs are and how they can cause disease. In remote areas, diseases may be attributed to spirits and magic spells. Health educators should assess local beliefs related to causes of illness. Any hand-washing education needs to incorporate basic information about the existence of germs, how they cause diseases and how to control them.
Steps to Improve Hand-Washing Methods and Systems in Central America
The Centers for Disease Control and Prevention recommends the following method for washing hands:
- Wet hands with clean, running water (warm or cold), turn off the tap and apply soap.
- Lather hands by rubbing them together with the soap. Lathering the backs of hands, between fingers and under nails.
- Scrub hands for at least 20 seconds.
- Rinse hands well under clean, running water.
- Dry hands using a clean towel or air-dry them.
Putting this into practice in Central America often entails modifications in places where hand-washing is done using bowls to scoop water from cisterns or buckets. If hand-washing is done with bowls, cisterns and buckets, here are steps to make the process safer and more sanitary:
- Scoop water from cistern or bucket with a bowl and pour over one hand, using this water to wet both hands.
- Lather hands by rubbing together using soap, being sure to lather the backs of hands, between fingers and under nails. If no soap is available, remember that scrubbing also plays a role in dislodging germs and should be done regardless.
- Rinse hands in the bowl and discard the water. If other people are available, as in a school or food service environment, have another person pour water over lathered hands to rinse (instead of rinsing hands in the bowl).
- Be sure to have a second bucket or a catch basin to capture the waste water if a wash station isn't available. Discard waste water in a drainage system or pour into a garden, latrine or into greenery where it will not create a mosquito-breeding mud puddle.
- If possible, hang a clean towel by the hand-washing station. If this isn't possible, include information on how to air-dry as part of instruction. Otherwise, children may dry their clean hands on their dirty clothing.
There may also be an opportunity to create a hand-washing station even in a community with limited resources. The CDC provides instructions on how to create a "Tippy Tap", a homemade hand-washing station made using commonly available materials in areas with limited piped water. The CDC also provides additional information about safe water systems.
Understanding Barriers to Clean Water and Soap
Without clean water, it's difficult to achieve proper hygiene. The less clean water available, the less likely it is that communities and households will practice good hygiene. However, evidence indicates that using unsafe water to clean hands still reduces the spread of disease and is more effective at reducing the spread of pathogens than not washing hands at all.
Limited access to soap may be another barrier to proper hand-washing in Central America. Health educators should educate community members on the benefits of using soap to wash hands and encourage them to use it, if available.
Improving Access to Hand-Washing Stations
The location of hand-washing stations can affect hand-washing frequency. A goal of hand-washing promotion should be to have a child-accessible hand-washing station in every home and by every latrine. Schools should have functional hand-washing stations outside the banks of latrines.
Communities need to determine whose responsibility it is to ensure these stations are functional with daily fresh water. Where community feeding centers provide meals for children, an adult staff member or volunteer should be in charge of hand-washing stations and all children should be required to wash before eating. Hand-washing will only occur where there are hand-washing facilities and someone in charge of ensuring there is fresh water and other required supplies.
- Cairncross S, Valdmanis V. Water Supply, Sanitation, And Hygiene Promotion. In: Jamison D, ed. Disease Control Priorities in Developing Countries 2nd edition. Washington DC. World Bank. 2006.
- Center for Disease Control and Prevention. Hygiene Challenges and Resources in Lower Income Countries. 2015. Accessed February 5, 2016.
- Center for Disease Control and Prevention. Show me the Science – How to Wash Your Hands. 2015. Accessed February 5, 2016.
- Global Public-Private Partnership for Hand-washing Initiative. The Handwashing Handbook. Washington DC. The World Bank. Accessed February 5, 2016.
- UNICEF. The Importance of Hygiene. UNICEF. 2003. Accessed February 5, 2016.