Christensen 1

Christy Christensen
Evelyn Galvez
Biology 1615
14 November 2014
Title. Efficacy of waterless hand hygiene compared with handwashing with soap: a field
study in Dar es Salaam, Tanzania
Introduction. This research addressed the difficulties in improving hand cleanliness in
populations that lack sufficient water availability to maintain hygiene. For handwashing to be
effective using soap, it requires dependable availability from water supplies. Pickering claims:
more than three billion persons do not have household-level access to piped water. The
research was conducted to influence awareness surrounding beneficial health impacts of
promoting hand sanitizer usage. Pathogens transmitted via the hands; through direct personal
contact or indirect contact (i.e.: touching surfaces or preparing food) cause illnesses. Diarrhea
and respiratory diseases are two of the most common afflictions transmitted via the fecal-oral
route. Having clean hands before preparing food, prior to eating or feeding a child, after
elimination or cleaning up a soiled child is essential to hygiene success and would potentially
reduce child mortality rates. Pickering purports; A review of handwahing behavior research
from 11 countries found that only 17% of child caretakers wash their hands with soap after using
the toilet. Researchers in this study hypothesize that although handwashing with soap is argued
to be the best intervention for diarrhea, identifying alternative hand hygiene methods for
environments with limited supply of water may be a critical step for reducing global child
mortality.

Christensen 2
Materials and methods. Fecal indicator bacteria (FIB) on hands was quantitatively measured to
provide data for the study. Although these FIB (E. coli, fecal streptococci and fecal coliforms)
organisms are not pathogens, they are used to indicate fecal contamination. 53 pupils and 9
teachers were selected from six secondary schools to participate in the research. Additionally, 10
nurses and 127 mothers from a health clinic took part. 33 out of the total 204 subjects were
assigned to the control group. Control participants hands were sampled separately to capture
baseline bacteria levels. Two types of efficacy tests were performed on the remaining
respondents; 118 were assigned to hand sanitizer study and 53 to the handwashing study. Both
sanitizer and handwashing tests were performed by obtaining hand rinse samples prior to and
after proper use of the hand hygiene agent. One hand at a time was randomly sampled with the
same hand never being sampled twice. The opposite hand was sampled after respective hygiene
procedures. Proper hand hygiene procedures were ensured by educating participants through oral
instruction as well as diagrams to demonstrate. Hand rinse samples were processed within four
hours of collection and kept on ice to then analyze for concentrations of E.coli and fecal
streptococci. Eventually, data was collected from all participants to gain user perceptions
concerning hand sanitizer usage. This was done by allowing them to use the hand sanitizer after
data collection from completed control test or handwashing efficacy tests.
Results. Hand sanitizers proved to be notably more effective than the soap and water method.
Sanitizer worked as well or better at reducing E.coli and fecal streptococci concentrations on
hands. Even so, effectiveness of hand sanitizer in this study may have shown lower than other
studies due to factors including concentration, period of time and amount of sanitizer used. 97%
of participants had never seen hand sanitizer before in Tanzania yet 94% reported they would use
it in their home.

Christensen 3

Discussion. Hand hygiene behavior was recorded with data being collected by questioning
respondents. Reasons reported for inadequate hygiene included; not a habit, soap is not available,
not enough time, and soap is not needed for cleaning hands. Use of hand sanitizer is less time
consuming than washing with water and soap. Additionally there is no need to dry hands and risk
touching a surface that is possibly contaminated.
Conclusion. Promoting hand sanitizer as an alternative to handwashing with soap in populations
with limited water supply should be assessed due to the feasibility and health impacts.

Bibliography. Pickering, A. J., A. B. Boehm, M. Mwanjali, and J. Davis. "Efficacy of

Waterless Hand Hygiene Compared with Handwashing with Soap: A Field Study in Dar Es
Salaam, Tanzania." American Journal of Tropical Medicine and Hygiene 82.2 (2010): 270-78.
Web.