Involving Children For Hand Washing Behavior Change: Repeated Message Delivery to Foster Action

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Chapter 2.1.4, Hand washing Practice:

A lot of researches conducted starting in the 20th to evaluate the effectiveness of soaps and other detergents. For instance, a study by Norton (1922) was done in the examination of 12 different samples of toilet type to the most expensive so-called germicidal or antiseptic soap.
In the experiment hands were washed by different soaps in sterile water at C and then rinsed. From the 12 wash water plate culture result indicated that ordinary toilet soap removes the largest number of bacteria from skin. Borges et al., (2007) however emphasized that washing with waster and soap was effective in reducing the hand contamination only for healthy hands not for damaged hands. In another evaluation study done on 1932 subjects by Chamorey et al.,(2010) where individual and environmental risk factors( age, sex, use of a protective agent, constitutional factors, personal factors, and a number of consecutive working days) of whether that disinfection with an alcohol-base hand rub better tolerated than classic hand washing with mild soap and water. The result shows that traditional hand washing with soap is a risk factor for dryness and irritation, whereas use of alcohol to wash cause no skin deterioration and might have protective effect, particularly in intensive use. This result faced strong argument by many researchers.
According to Wijk, Christine, Murre, and Tineke (1993), hand washing is only effective when hands are rubbed sufficiently and preferably with cleaning agents like soap, ash, soil or certain types of leaves. Just pouring water over hands, as is sometimes done, is not effective in removing pathogens. In this regard, Ejemot et al., (2008) mentioned washing with soap and water not only removes pathogens mechanically, but may also chemically kill contaminating and colonizing flora making hand washing more effective as verified by Han(1998),Shahid(1996), and Rotter(1999) independent research. Regarding the use of water Ejemot suggested washing hands with soap under running water or large quantities of water with vigorous rubbing was found to be more effective than several members of a household dipping their hands in the same bowl of water (often without soap) identified by Kaltenthaler (1991) research. Furthermore, as Bloomfield et al., (2009) suggested that the use of rubbing agent is important and the nature of the agent is a less important factor. Their research indicated that the key component of the hand washing process is the mechanical rubbing of the hands and that soap is more effective than soil and ash because soap users tend to rub their hands more and use more water to rinse away the soapy feeling on their hands.
In many part of the world ash and mud are used for hygiene purpose including for hand washing. Bloomfield et al., (2009) mentioned that wood ash, when freshly produced through the burning of wood, must be sterile. However, where ash is allowed to accumulate either in, or in the vicinity of the home, it has the potential to become contaminated with pathogens, either from human or animal feces or from waste water discarded around the home. There is however no data to show whether and to what extent as, use of contaminated soil, mud or ash for hand washing, may be a source of microbial infection or potential toxic effect. Bloomfield et al., (2009) quoting Hoque and Briend a 1991 evaluation study mentioned the relative efficiency of hand washing using ash, soap, mud or plain water, in group of 20 women living in slum of Dakar in Bangladesh. Each woman washed her hands using of the washing agents and the efficiency of the process was assessed by comparing fecal Cliform (a type of Bacteria) counts from post washing hand samples. Result showed that, for 60 %( 12) of women who did not wash their hands, the hands were contaminated with fecal Coliforms. The proportion of positive counts was similar for ash and mud 40%(4), with water 40%(8) and with Ash 15%(3) where none of these differences were statistically significantly(p-value <0.01) from each other. In 1995 Holque et al., as cited in Bloomfield reported a study of women in rural Bangladesh evaluating the different hand washing process indicated that of 90 subjects observed wash their hands after defecation, 38% used mud, 2% used ash, 19% used soap, and 41% used water only without a rubbing agent. In another research presented in South Asia Hygiene Practioners' Workshop 1-4 February 2010 Danquah (2010) mentioned the use of ash greater than 66% of the time during the observation period was 9% and 14% respectively after cleaning child anus and after defecation.
In many observational researches measuring and interpretation of hand washing practice is a problem. But Larson and Lusk (1985) presented two models. In one tested model of hand washing interpretation and scoring to make consistent and reproducible result a series of test. In this model vigorous frictions was defined as increasing visible movement of both arms up to the elbow and an audible sound of rubbing (unless the flow of water was too loud to allow one to hear the sound). Minimal friction was defined as an absence of rubbing of hands together the soap was applied. But this model has got difficulty in many ways. Do you to this fact they developed the second more comprehensive model. To demonstrate accurately and in reliable ways of evaluation the second tool is better because it includes all the 7 minor details which are described, Larson and Lusk (1985) are soap, splashing, friction (rubbing), surface covered, hand position, rinse, and drying (Table in Annex 4).