Handwashing, but how? Microbial effectiveness of existing handwashing practices in high-density suburbs of Harare, Zimbabwe.
BACKGROUND
Consistent domestic hand hygiene can reduce diarrhea-related morbidity and mortality and the spread of other communicable diseases. However, it remains uncertain which technique of handwashing is most effective and practicable during everyday life. The goal of this study is to determine how the handwashing technique, as performed in the daily life by the participants of this case study in Harare, Zimbabwe, influences microbial handwashing effectiveness.


METHODS
Handwashing technique of 173 primary caregivers was observed in their homes and hand rinse samples were collected before and after handwashing. Samples were analyzed for Escherichia coli and total coliform concentrations. Generalized linear models were used to predict fecal hand contamination after washing from observed handwashing technique.


RESULTS
Cleaning under fingernails, scrubbing the fingertips, using soap, and drying hands through rubbing on clothes or a clean towel statistically significantly reduced E coli contamination of hands after washing. Tap use, scrubbing fingertips, and rubbing hands on clothes to dry them statistically significantly reduced total coliform contamination.


CONCLUSIONS
Recommendations for effective and practicable domestic handwashing in Harare, Zimbabwe, should include performing specific handscrubbing steps (ie, cleaning under the fingernails and rubbing the fingertips), and soap and tap use. This calls for further research to develop behavior change interventions that explicitly promote effective handwashing technique at critical times.
Department of Environmental Social Sciences, Swiss Federal Institute of Aquatic Science and Technology (Eawag), Dübendorf, Switzerland. Electronic address: max.friedrich@eawag.ch.
Max N D
MN
Friedrich
Department of Environmental Microbiology, Swiss Federal Institute of Aquatic Science and Technology (Eawag), Dübendorf, Switzerland.
Timothy R
TR
Julian
Center for Applied Geoscience, University of Tübingen, Tübingen, Germany.
Andreas
A
Kappler
Department of Biology, University of Zimbabwe, Mount Pleasant, Harare, Zimbabwe.
Tamuka
T
Nhiwatiwa
Department of Environmental Social Sciences, Swiss Federal Institute of Aquatic Science and Technology (Eawag), Dübendorf, Switzerland.
Hans-Joachim
HJ
Mosler
D000328:Adult; D058491:Bacterial Load; D004755:Enterobacteriaceae / Q000302:isolation & purification*; D004926:Escherichia coli / Q000302:isolation & purification*; D005191:Family Characteristics; D005192:Family Health; D005260:Female; D006225:Hand / Q000382:microbiology*; D006235:Hand Disinfection / Q000379:methods*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013383:Suburban Population; D015030:Zimbabwe
Diarrhea; Efficacy; Procedure; Recommendation; Steps