Traditional Handwashing Research Articles

Analisis Fasilitas Cuci Tangan Pasar Tradisional di Kecamatan Klungkung pada Masa Pandemi COVID-19

Background: Hand washing facilities are one of the facilities that must be provided in public facilities such as markets to prevent the spread of the COVID-19 virus. The use of public hand hygiene facilities is required before passing through entrances and locations that are easily accessible in crowded areas so that people and traders can easily wash their hands during the COVID-19 pandemic. Purpose:To find out the description of traditional market hand washing facilities in Klungkung District during the COVID-19 pandemic. Method: The research design used in this study is a descriptive study with a cross-sectional approach which was carried out on April 30 - May 1, 2021. The population in this study were all hand washing facilities at traditional markets in Klungkung District. The sampling technique used is non-probability sampling. Data collection tools used in the form of observation sheets. Data analysis using univariate analysis. Results:The results showed that most of the traditional market hand washing facilities were in sufficient condition as many as 4 markets (57.1%) and were in good condition as many as 3 schools (42.9%). Conclusion: It is recommended to all market managers to continue to pay attention to the availability of components of hand washing facilities complete with clean conditions to prevent the chain of disease transmission during the COVID-19 pandemic.

Investigating particulate production in the operating suite following the use of waterless alcohol based dry scrub versus traditional hand washing and drying with commonly used surgical towels: An experimental study

An often-overlooked item that could cause contamination in the operating suite are the towels used for hand drying following surgical scrub. The purpose of this current study was to determine if there was a difference in the particulate count from different hand drying methods following surgical hand preparation. Three simulated hand drying groups were established: disposable sterilized surgical towels, reusable sterilized surgical towels, and a waterless alcohol-based dry rub. Particle size measurements of 0.3 µm, 5.0 µm, and 10.0 µm were collected at time zero and repeated every minute for 5 minutes for a total of 10 trials each. Both the reusable and disposable towels produced significantly more particle matter in all size groups compared to the alcohol scrub control group. A comparison analysis and ANOVA testing demonstrated that alcohol dry scrub produced significantly fewer particles compared to both the disposable blue towels (P < .01) and the reusable green towels (P < 0.01). Disposable towels produced significantly more particles in the 0.3 µm count compared to reusable towels (P < .05). An alcohol-based dry rub without using a towel yielded the lowest amount of particulate formation in this experimental model, while reusable surgical towels produced the highest number of particles. Level II Experimental Study.

Perception, Patterns and Facts: A Study Based on Hand Hygiene among Pharmacy Clerkship Students during COVID-19 Epidemic in Karachi

Aims: The objective of the study is to explore the knowledge and attitude towards hand hygiene practices among 4th year and 5th year clerkship pharmacy students in a private medical university in Karachi, Pakistan.&#x0D; Methodology: A cross- sectional study was conducted for the period of 2 months (November 2020- December, 2020). A well-structured questionnaire was developed to determine the current habit of students’ hand hygiene. The statistical data assimilation recorded through SPSS version 20 to integrate numerical significance.&#x0D; Results: Questionnaire was distributed to 193 students out of which, one hundred Eighty (n=180/193) students participated in this study (response rate 93.26%. Although the majority of students had a fair knowledge of hand hygiene practices, a number of them had few misconceptions. The hand sanitizing practices while encountering patient or prior to patient’s contact showed the 88.3% correct answers. In our study the 75% of participants correctly answered that “traditional hand washing (apply enough soap to cover and rub hands and clean in between the fingers using water) can help stop picking up infections and spreading them to others.” The current study showed that 82.2 percent Healthcare providers are educating patients and their families about hand hygiene and its importance, the 23.3% negative response was collected in context to inspected the particular World Health Organization (WHO) and center of disease control (CDC)rules for hand cleanliness.&#x0D; Conclusion: The current study showed that students had adequate knowledge regarding the importance of hand hygiene. However, there were few students who had inadequate knowledge related to WHO and CDC rules for hand cleanliness which can improve by providing appropriate education and guidance.

Child's play: Harnessing play and curiosity motives to improve child handwashing in a humanitarian setting.

In humanitarian emergency settings there is need for low cost and rapidly deployable interventions to protect vulnerable children, in- and out-of-school, from diarrhoeal diseases. Handwashing with soap can greatly reduce diarrhoea but interventions specifically targeting children's handwashing behaviour in humanitarian settings have not been tested. Traditional children's handwashing promotion interventions have been school-focused, resource-intensive and reliant on health-based messaging. However, recent research from non-humanitarian settings and targeting adults suggests that theory-based behaviour change interventions targeting specific motives may be more effective than traditional handwashing interventions. In this proof-of-concept study we test, for the first time, the distribution of a modified soap bar, designed to appeal to the motives of play and curiosity, in a household-level, rapidly deployable, handwashing promotion intervention for older children in a humanitarian setting - an internally displaced persons camp in Iraqi Kurdistan. Out of five total blocks within the camp, one was assigned to intervention and one to control. 40 households from each assigned block were then randomly chosen for inclusion in the study and the practice of handwashing with soap at key times was measured at baseline and four weeks after intervention delivery. Children in intervention households received transparent soaps with embedded toys, delivered within a short, fun, and interactive household session with minimal, non-health-based, messaging. The control group received plain soap delivered in a short standard, health-based, hygiene promotion session. At the 4-week follow-up, children in the intervention group were 4 times more likely to wash their hands with soap after key handwashing occasions than expected in the counterfactual (if there had been no intervention) based on the comparison to children in the control group (adjusted RR = 3.94, 95% CI 1.59-9.79). We show that distributing soaps with toys embedded inside, in a rapidly deployable intervention, can improve child handwashing behaviour in a humanitarian emergency context. Further studies are needed to determine the longer-term behavioural and health impact of such an intervention when delivered at a greater scale in a humanitarian context.

Behavior Change without Behavior Change Communication: Nudging Handwashing among Primary School Students in Bangladesh.

Behavior change communication for improving handwashing with soap can be labor and resource intensive, yet quality results are difficult to achieve. Nudges are environmental cues engaging unconscious decision-making processes to prompt behavior change. In this proof-of-concept study, we developed an inexpensive set of nudges to encourage handwashing with soap after toilet use in two primary schools in rural Bangladesh. We completed direct observation of behaviors at baseline, after providing traditional handwashing infrastructure, and at multiple time periods following targeted handwashing nudges (1 day, 2 weeks, and 6 weeks). No additional handwashing education or motivational messages were completed. Handwashing with soap among school children was low at baseline (4%), increasing to 68% the day after nudges were completed and 74% at both 2 weeks and 6 weeks post intervention. Results indicate that nudge-based interventions have the potential to improve handwashing with soap among school-aged children in Bangladesh and specific areas of further inquiry are discussed.

Hand Hygiene: Knowledge and Attitudes of Fourth-Year Clerkship Medical Students at Alfaisal University, College of Medicine, Riyadh, Saudi Arabia.

Introduction: Little is known about the clerkship (clinical) medical students’ knowledge of hand hygiene as the single most important precautionary measure to reduce nosocomial healthcare-associated infections. The aim of this study is to explore the knowledge of, and attitudes towards, hand hygiene practices among fourth-year clerkship medical students at Alfaisal University, College of Medicine, Riyadh, Saudi Arabia.Materials and Methods: A cross-sectional, paper-based, Yes/No formatted questionnaire was administered to explore the students’ knowledge of, and attitudes towards, hand hygiene practices. Data were decoded in Microsoft Excel sheet and presented as numbers and percentages.Results: One hundred and eleven students (n=111/147) participated in the questionnaire (response rate: 76%). Although the majority of students had a fair knowledge of hand hygiene practices, a number of them had some misconceptions. Only 14% of students correctly agreed to the statement: "Traditional hand washing (water, plus regular soap) decreases the number of germs." Furthermore, only 32% of students correctly answered that "hand washing with a regular soap, instead of an antiseptic soap, is better in limiting the transmission of clostridium difficile infections". Almost all students (93%) agreed to the importance of hand hygiene education in medical curricula and its awareness in healthcare centers. Despite the importance of hand hygiene, only 13% of students reviewed the respective WHO and CDC guidelines before starting their clinical training in the teaching hospital.Discussion: The students’ inadequate knowledge about hand hygiene needs to be enriched by well-structured curricular and extra-curricular programs as well as more positive attitudes by healthcare workers.

Diarrhea at the Hajj and Umrah.

This systematic review aims to summarize the incidence and etiology of diarrheal illness among pilgrims attending the Hajj and Umrah. Gastroenteritis and diarrhea have been potential threats during previous Hajj pilgrimages. The last cases of Hajj related cholera were reported in 1989. Currently, respiratory tract infections account for the majority of health problems during the Hajj. This shift in epidemiology reflects the improvement of sanitary conditions in Saudi Arabia in general, and at religious sites in particular. Nevertheless, gastrointestinal diseases, food-poisoning outbreaks, and diarrhea continue to occur among pilgrims. Available studies about diarrhea among Hajj pilgrims indicate a mean prevalence of 2% with the highest prevalence of 23% among a group of French pilgrims in 2013. There is an obvious lack of information about the etiology of diarrheal disease at the Hajj. Further studies addressing this issue in hospitalized patients as well as prospective cohort studies would be of interest. During the Hajj, hand washing is regularly carried out by pilgrims under a ritual purification, often called ablution. We recommend implementation of effective hand hygiene practices focusing on the regular use of alcohol-based hand rubs, as they require less time than traditional hand washing, act more rapidly, and contribute to sustained improvement in compliance associated with decreased infection rates.

Redesigning a large school-based clinical trial in response to changes in community practice.

Background Asthma exacerbations are seasonal with the greatest risk in elementary-age students occurring shortly after returning to school following summer break. Recent research suggests that this seasonality in children is primarily related to viral respiratory tract infections. Regular hand washing is the most effective method to prevent the spread of viral respiratory infections; unfortunately, achieving hand washing recommendations in schools is difficult. Therefore, we designed a study to evaluate the effect of hand sanitizer use in elementary schools on exacerbations among children with asthma. Purpose To describe the process of redesigning the trial in response to changes in the safety profile of the hand sanitizer as well as changes in hand hygiene practice in the schools. Methods The original trial was a randomized, longitudinal, subject-blinded, placebo-controlled, community-based crossover trial. The primary aim was to evaluate the incremental effectiveness of hand sanitizer use in addition to usual hand hygiene practices to decrease asthma exacerbations in elementary-age children. Three events occurred that required major modifications to the original study protocol: (1) safety concerns arose regarding the hand sanitizer’s active ingredient; (2) no substitute placebo hand sanitizer was available; and (3) community preferences changed regarding hand hygiene practices in the schools. Results The revised protocol is a randomized, longitudinal, community-based crossover trial. The primary aim is to evaluate the incremental effectiveness of a two-step hand hygiene process (hand hygiene education plus institutionally provided alcohol-based hand sanitizer) versus usual care to decrease asthma exacerbations. Enrollment was completed in May 2009 with 527 students from 30 schools. The intervention began in August 2009 and will continue through May 2011. Study results should be available at the end of 2011. Limitations The changed design does not allow us to directly measure the effectiveness of hand sanitizer use as a supplement to traditional hand washing practices. Conclusions The need to balance a rigorous study design with one that is acceptable to the community requires investigators to be actively involved with community collaborators and able to adapt study protocols to fit changing community practices.

Étude des facteurs de risque de sécheresse et d’irritation des mains du personnel dans neuf établissements de soins

Objective We performed a prospective multicenter study to assess dryness and irritation of hands of staff in care facilities, and to show that disinfection with alcohol-based hand rub is better tolerated than classic hand washing with mild soap. Method Dryness and irritation were self-evaluated by volunteers and hetero-evaluated by a team of investigators. The study took into account most of the individual and environmental risk factors of dryness and irritation (season, age, gender, use of protective agent, constitutional, personal and external factors, institution, function, number of consecutive working days). Results The results from the 1932 assessments collected showed that traditional hand washing was a risk factor for dryness or irritation, while alcohol-based hand rubs caused no skin deterioration and had a protective effect even when used intensively. Comment These results should help to fight non-adherence to the use of alcohol-based hand rubs.

A prospective multicenter study evaluating skin tolerance to standard hand hygiene techniques

We performed a prospective multicenter study to assess the dryness and irritation of the hands in health care facilities, and to evaluate whether that disinfection with an alcohol-based hand rub (ABHR) is better tolerated than classic handwashing with mild soap and water. Our study was conducted in 9 sites in the summer and winter. A team of investigators evaluated dryness and irritation. This study takes into account most of the individual and environmental risk factors (age, sex, use of a protective agent, constitutional factors, personal factors, external factors, institution, function, and number of consecutive working days). The results from the 1932 assessments collected show that traditional handwashing is a risk factor for dryness and irritation, whereas the use of ABHR causes no skin deterioration and might have a protective effect, particularly in intensive use. These results provide a strong argument to counter the rear-guard resistance to the use of ABHRs.

Hand hygiene practices in adult versus pediatric intensive care units at a university hospital before and after intervention

Observations of hand hygiene practices of the health care workers (HCWs) were carried out at a tertiary care center by a single observer in all adult and pediatric intensive care units (ICUs) before and after educational programs. Access to alcohol-based hand rub was also increased. A survey of HCWs was carried out to determine knowledge of hand hygiene. Before interventions, mean adherence to hand hygiene in all ICUs was 54% with significant difference between adult and pediatric ICUs (p<.0001) (35% vs 90%, respectively). Traditional handwashing versus alcohol-based hand rub use was 72% versus 28%, respectively. Following the interventions, there was a significant increase (p<.0001) in hand hygiene adherence in adult ICUs (81%). 46% of survey respondents believed that alcohol-based hand rub could not be used for methicillin resistant Staphylococcus aureus infection and 21% believed that alcohol-based hand rub could be used if hands were soiled. Overall, adherence to hand hygiene in adult ICUs improved with institution of an educational program and increase in accessibility of alcohol-based hand rub. There was a statistically significant increase in the frequency of alcohol-based hand rub use; however, traditional handwashing was still preferred. The survey of HCWs revealed gaps in knowledge regarding methods of hand hygiene.

Cost Analysis of Hand Hygiene Using Antimicrobial Soap and Water Versus an Alcohol-Based Hand Rub

Proper hand hygiene is acknowledged as the most critical element of an adequate infection control program in the oral healthcare setting. However, adherence to proper hand hygiene protocols is often lacking. Poor compliance with hand hygiene protocols has been attributed to such factors as lack of time, hand irritation, hand dryness, forgetfulness, skepticism over importance, understaffing, perceived low risk of cross-infection, inconvenience, and the belief gloves alone offer protection. In the medical environment the use of alcohol-based hand rubs now represent the preferred method of performing hand hygiene when delivering non-surgical care. In this study we compared the costs associated with traditional hand washing against an alcohol-based hand rub protocol in the dental setting. The results indicate an alcohol-based hand rub protocol is less costly and less time consuming when compared to traditional handwashing in the dental setting, creating a new paradigm for hand hygiene in the dental office.

Effect of Antiseptic Handwashing vs Alcohol Sanitizer on Health Care–Associated Infections in Neonatal Intensive Care Units

The Centers for Disease Control and Prevention, Atlanta, Ga, recommend use of waterless alcohol hand products in lieu of traditional handwashing for patient care, but there are few data demonstrating the impact of this recommendation on health care-associated infections. To compare the effect of 2 hand hygiene regimens on infection rates and skin condition and microbial counts of nurses' hands in neonatal intensive care units. Clinical trial using a crossover design in 2 neonatal intensive care units in Manhattan, NY, from March 1, 2001, to January 31, 2003, including 2932 neonatal hospital admissions (51 760 patient days) and 119 nurse participants. Two hand hygiene products were tested: a traditional antiseptic handwash and an alcohol hand sanitizer. Each product was used for 11 consecutive months in each neonatal intensive care unit in random order. After adjusting for study site, birth weight, surgery, and follow-up time, there were no significant differences in neonatal infections between the 2 products; odds ratios for alcohol compared with handwashing were 0.98 (95% confidence interval [CI], 0.77-1.25) for any infection, 0.99 (95% CI, 0.77-1.33) for bloodstream infections, 1.61 (95% CI, 0.57-5.54) for pneumonia, 1.78 (95% CI, 0.94-3.37) for skin and soft tissue infections, and 1.26 (95% CI, 0.42-3.76) for central nervous system infections. The skin condition of participating nurses was significantly improved during the alcohol phase (P = .02 and P = .049 for observer and self-assessments, respectively), but there were no significant differences in mean microbial counts on nurses' hands (3.21 and 3.11 log(10) colony-forming units for handwashing and alcohol, respectively; P = .38). Infection rates and microbial counts on nurses' hands were equivalent during handwashing and alcohol phases, and nurses' skin condition was improved using alcohol. However, assessing the impact on infection rates of a single intervention is challenging because of multiple contributory factors such as patient risk, unit design, and staff behavior. Other practices such as frequency and quality of hand hygiene are likely to be as important as product in reducing risk of cross-transmission.

Cost analysis of hand hygiene using antimicrobial soap and water versus an alcohol-based hand rub

Proper hand hygiene is acknowledged as the most critical element of an adequate infection control program in the oral healthcare setting. However, adherence to proper hand hygiene protocols is often lacking. Poor compliance with hand hygiene protocols has been attributed to such factors as lack of time, hand irritation, hand dryness, forgetfulness, skepticism over importance, understaffing, perceived low risk of cross-infection, inconvenience, and the belief gloves alone offer protection. In the medical environment the use of alcohol-based hand rubs now represent the preferred method of performing hand hygiene when delivering non-surgical care. In this study we compared the costs associated with traditional hand washing against an alcohol-based hand rub protocol in the dental setting. The results indicate an alcohol-based hand rub protocol is less costly and less time consuming when compared to traditional handwashing in the dental setting, creating a new paradigm for hand hygiene in the dental office.

Alcohol Hand Rub As Effective As Traditional Surgical Scrub and Better Tolerated

Infectious Diseases| December 01 2002 Alcohol Hand Rub As Effective As Traditional Surgical Scrub and Better Tolerated AAP Grand Rounds (2002) 8 (6): 65–66. https://doi.org/10.1542/gr.8-6-65 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Alcohol Hand Rub As Effective As Traditional Surgical Scrub and Better Tolerated. AAP Grand Rounds December 2002; 8 (6): 65–66. https://doi.org/10.1542/gr.8-6-65 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: ethanol, hand, surgical scrub, acute aortic syndrome, anabolic steroids Source: Parienti JJ, Pascal T, Heller R, et al. Hand-rubbing with an aqueous alcoholic solution versus traditional hand-scrubbing and 30-day surgical site infection rates. JAMA. 2002;288:722–727. To compare the effectiveness of 2 hand-cleansing protocols in preventing surgical site infections (SSI), these investigators from a French multisite collaboration performed a randomized trial using a multiple-service crossover experimental design that alternated protocols monthly for 16 months. The study involved 4,387 patients on 6 surgical services (3 teaching, 3 nonteaching). All patients treated by the surgical services were eligible for study. Patients in contaminated or dirty procedures were excluded, as were patients who underwent a second operation within 15 days of the first. The experimental method involved hand-rubbing for a total of at least 5 minutes with 75% aqueous alcoholic solution (AAS) containing propanol-1, propanol-2, and mecetronium etilsulfate (Sterillium). Prior to the first procedure of the day or if their hands were visibly soiled, the AAS group scrubbed their hands for 1 minute with nonantiseptic soap. The control method involved at least 5 minutes of systematic hand-scrubbing with standard 4% providone iodine (Betadine) or 4% chlorhexidine (Hibiscrub). The primary outcome measure was the difference in the 30-day SSI rate between the hand-rubbing and hand-scrubbing groups. Surgical team compliance and tolerance to the agents were also evaluated. The nosocomial SSI rates were similar between the 2 protocols: 53 of 2,135 (2.48%) developed SSI in the hand-scrubbing protocol and 55 of 2,252 (2.44%) in the hand-rubbing protocol. Compliance with the duration of hand hygiene was poor in both protocols but was significantly better in the hand-rubbing group compared with the hand-scrubbing group (44% versus 28%; P=.008). Skin irritation and dryness were found to increase during hand-scrubbing months and decrease during hand-rubbing months. The authors concluded that hand-rubbing with AAS (preceded by a nonantiseptic hand wash) was equivalent to hand-scrubbing in preventing SSI and noted that hand-rubbing with AAS improved compliance with and tolerance to hand antisepsis protocols. Perhaps because of the awareness of increasing antimicrobial resistance and a perception by some that nosocomial infection rates are a proxy for quality, more attention is being paid to basic hygiene and other cost-effective methods, such as hand cleansing, to prevent the spread of communicable illness.1 Very poor compliance with proper hand hygiene remains a concern for all health care facilities.2 Even though the hand washing procedures in an office or clinic differ from those in the operating suite, the basic principles are those first advocated by Semmelweis,3 and this study offers practical insights for the busy pediatrician. The above study’s results would suggest that prudent clinicians should start each session with a 1-minute nonantiseptic hand wash before the first patient (to be repeated if the hands become soiled) followed by hand-rubbing with AAS between patients. As has been shown before, AAS—which is available in various brands as a gel, foam or liquid—is at least as effective as traditional hand washing, with less skin irritation and improved compliance.4... You do not currently have access to this content.

Purification and glycosylation analysis of an acidic pectin methylesterase in jelly fig (Ficus awkeotsang) achenes.

An acidic pectin methylesterase (PME) is responsible for the gelation of water extract from jelly fig (Ficus awkeotasang) achenes. A new, fast and efficient, method has been developed to purify this acidic PME. The method includes preparing jelly curd by traditional hand washing, extracting proteins from the curd, and separating PME by anion-exchanger. The purified PME exists as a monomer of 38 kDa determined by gel filtration, and exerts enzymatic activity over a broad pH range, particularly in acidic environments where most known PME enzymes from various species are inactivated. Chemical staining and enzymatic cleavage suggest that the jelly fig PME is an N-linked glycoprotein. Fluorophore-assisted carbohydrate electrophoresis reveals that the polysaccharide of this glycoprotein putatively consists of 22 hexoses including 16 mannose, 4 N-acetylglucosamine, and 2 galactose residues.

Compliance with hand disinfection and its impact on hospital-acquired infections

Hand hygiene prevents cross-infection in hospitals, but adherence to guidelines is poor among healthcare workers. Although some interventions to improve compliance have been successful, none had achieved lasting improvement until very recently. Reasons for non-compliance with recommendations occur at individual, group and institutional levels. The complexity of the process of behavioural change would suggest that the application of multimodal, multidisciplinary strategies are necessary. Both easy access to hand hygiene in a timely fashion and skin protection appear necessary prerequisites for satisfactory hand hygiene behaviour. Alcohol-based hand-rub may be superior to traditional handwashing as it requires less time, acts faster, irritates hands less often, and recently proved significantly to contribute to sustained improvement in compliance associated with decreased infection rates. This paper reviews barriers to appropriate hand hygiene and describes the results of the first successful experience of sustained hand hygiene promotion and its effectiveness on hospital-acquired infection.

Improving adherence to hand hygiene practice: a multidisciplinary approach.

Hand hygiene prevents cross-infection in hospitals, but health-care workers' adherence to guidelines is poor. Easy, timely access to both hand hygiene and skin protection is necessary for satisfactory hand hygiene behavior. Alcohol- based hand rubs may be better than traditional handwashing as they require less time, act faster, are less irritating, and contribute to sustained improvement in compliance associated with decreased infection rates. This article reviews barriers to appropriate hand hygiene and risk factors for noncompliance and proposes strategies for promoting hand hygiene.

Post-defecation handwashing in bangladesh: Practiceand efficiency perspectives

Inadequate handwashing after defecation and anal cleaning practices in the Indian subcontinent is an important source of faeco-oral transmission of enteric diseases. To better understand the process as traditionally practised, 90 women in semi-rural Bangladesh were observed washing hands after defecation. Several components of handwashing practices were identified: the cleaning agent, using left or both hands; frequency of rubbing hands, type and amount of water used to wash, and the drying of hands on the wearer's clothes. A subsequent experiment was conducted to assess the effect of currently practised handwashing and drying according to standardised procedure on faecal coliform count of hands. As a rubbing agent, soil was commonly used (40%); soap was used by 19% and was reported unaffordable by about 81% of the non-users. Good handwashing behaviour was positively associated with better social and economic indicators including education of the women observed. Both hands were unacceptably contaminated after traditional handwashing (the geometric mean count of left was 1,995 and right hand was 1,318 faecal coliform units/hand). After standardising the observed components of handwashing procedures the use of any rubbing agent, i.e. soil, ash or soap, produced similar acceptable cleaning. Use of a rubbing agent (e.g. soil, ash or soap), more rubbing (i.e. six times), rinsing with safer water (e.g. 2 litres of tubewell water) and drying with a clean cloth or in the air produced acceptable bacteriological results. Components of traditional handwashing practices were defined through careful observation, and experiments on handwashing with standardised components showed that efficient and affordable options for handwashing can be developed; this knowledge should be helpful in disease control programmes.