WASHplus Weekly: Focus on Hygiene

WASHplus Weekly – Issue 190| May 8, 2015 | Focus on Hygiene

This issue focuses on hygiene advocacy, hygiene promotion, and hygiene in emergency settings. Included are webinars; a toolkit; a literature review from the Global Public-Private Partnership for Handwashing; a blog post by Orlando Hernandez, USAID/WASHplus project; IRC and BRAC reports on handwashing promotion; World Health Organization (WHO) hygiene guidelines for Ebola and other emergencies; and other studies and resources. WASHPlus_HTMLbanner_weekly_600x159


Healing Hands: The Role of Hand Hygiene in Healthcare Globally. May 2015. Global Public-Private Partnership for Handwashing (PPPHW). Link
PPPHW hosted this webinar to discuss the importance of hand hygiene in health care, the challenges of achieving good hand hygiene, and lessons for improving hand hygiene in health care settings. The speakers included Benedetta Allegranzi, the WHO’s Lead for the Clean Care is Safer Care program, Cyrus Engineer, director of the Healthcare Management Program at Towson University, and Robert Aunger from the London School of Hygiene and Tropical Medicine.

Handwashing and Global Food Hygiene: A World Health Day Webinar. April 2015. PPPHW. Link
This webinar explores why food hygiene matters for child health in the global context. It includes a case study from the London School of Hygiene and Tropical Medicine about a creative food and handwashing behavior change intervention in Nepal; WASHplus’s Julia Rosenbaum talks about small doable actions; and UNICEF discusses the successes and challenges associated with its group handwashing and mid-day meal program in India.


Hygiene Advocacy Toolkit, 2015. PPPHW. Link
Developed by PPPHW, in cooperation with the UNICEF/WHO Joint Monitoring Programme’s Advocacy and Communications Group, this hygiene advocacy toolkit is an evidence-based resource that outlines why hygiene must be a priority in the post-2015 development agenda and beyond. The role of hygiene in the global development agenda is misunderstood. This toolkit seeks to address any confusion and provide the necessary facts and talking points to successfully advocate for the inclusion of hygiene in the Post-2015 Sustainable Development Goals.

Community Handwashing Guide: Utilizing Available Resources to Initiate a Handwashing InterventionWorld Med Health Policy, Mar 2014. MP Sandhu. Link (The full text of this article can be downloaded free of charge through May 2015.)
In this article, the current handwashing recommendations and their applicability to hygiene interventions in developing nations were examined. The results of this review suggested that a new handwashing paradigm is needed to address the varying resources available for hand hygiene. Thus, a novel community handwashing guide was developed. This guide emphasizes the importance of increasing access to physical handwashing resources in developing communities, and can be applied to communities regardless of their socioeconomic status. The community handwashing guide promotes sustainable, incremental improvements in hygiene within a community, and is a more feasible approach than previous recommendations.


Handwashing Research Summary: What We Learned about Handwashing in the First Quarter of 2015.  L McCay, PPPHW. Link
Between January and March 2015, 16 relevant peer-reviewed handwashing studies were published. This review discusses studies on the benefits of handwashing, measurement of handwashing behavior, handwashing “hardware,” and other topics.

Improving Household Food Hygiene in a Development Context, 2015. M Woldt, FANTA. Link
This literature review presents information on foodborne disease and key areas and considerations at the household level to reduce foodborne contaminants in developing countries. Recommendations on potential programmatic and research activities related to foodborne disease are also included.


Hygiene Promotion: The Backbone of BRAC WASH, 2015. A Biswas. Link
Hygiene promotion is most successful when it targets a few behaviors that have the greatest potential for impact. Because hygiene is personal, changing hygiene behavior is complex and requires skill and care. The BRAC WASH program uses multiple approaches with a persistent long-term strategy to encourage people to adopt safe hygiene practices and behaviors to prevent diarrheal and other infectious diseases.

Implementing Effective Hygiene Promotion: Lessons from the Process Evaluation of an Intervention to Promote Handwashing with Soap in Rural India. BMC Pub Health, Nov 2014. D Rajaraman. Link
An intervention trial of the SuperAmma village-level intervention to promote handwashing with soap (HWWS) in rural India demonstrated substantial increases in HWWS amongst the target population. Researchers carried out a process evaluation to assess the implementation of the intervention and the evidence that it had changed the perceived benefits and social norms associated with HWWS. The evaluation also aimed to inform the design of a streamlined shorter intervention and estimate scale-up costs.

Managing Hygiene Promotion in WASH Programmes, 2014. WEDC. Link
A number of studies have suggested that the impact of hygiene practices on sanitation-related disease could be as great as that of the actual provision of sanitation facilities. Effective hygiene promotion is widely believed to be one of the most valuable tools to change people’s behavior, which in turn can protect them from diarrheal diseases. It can also be a helpful way to encourage participation and empower communities. Despite the acceptance of its importance, hygiene promotion is often given far less emphasis than traditional water supply and sanitation activities in development settings. This guide is designed to help address this issue.

Liberia: National Guidelines on Hygiene Promotion, 2014. Ministry of Health and Social Welfare. Link
The National Guidelines on Hygiene Promotion establish a framework that seeks to ensure that advocacy and communication on appropriate hygiene behavior reaches all Liberians by 2017. These guidelines articulate the objective of the Government of Liberia in hygiene promotion and clarify the roles and responsibilities of the many stakeholders involved. These guidelines aim for a sustainable and scalable approach and generate ownership among its beneficiaries.

The Neglect of Hygiene Promotion in Developing Countries, as Shown by the Global Analysis and Assessment of Sanitation and Drinking-Water Survey. Jnl Water, San Hyg Devel, 4(2) 2014. A Jiménez. Abstract
This paper analyzes the data on hygiene promotion that were collected for the 2012 edition but not included in the report. Despite the limitations of the information, this is the best picture available of the global status of hygiene promotion in developing countries. Results show the low priority given to hygiene when it comes to implementation.


Behavioral Challenges and Potential Solutions to Reach Universal Sanitation Coverage. Sanitation and Water for All, April 2015. O Hernandez, USAID/WASHplus and FHI 360. Link
Behavior change specialists rely on frameworks to dissect a problem and define a strategy to address it. The Water Improvement Framework, previously named the Hygiene Improvement Framework developed in connection to USAID WASH projects some 15 years ago, is one such framework.

Bangladesh National Hygiene Baseline Survey: Preliminary Report, 2014. L Unicomb, ICDDR,B. Link
The government of Bangladesh has a commitment to ensure a safe environment through the promotion of personal hygiene practices. However, there is a lack of baseline information on hygiene practices among different segments of the population and regions. The overall objective of this national hygiene survey is to establish a nationally representative baseline status of hygiene situations related to knowledge, facilities, and practices in the area of water, sanitation, and hygiene.

Geophagy is Associated with Environmental Enteropathy and Stunting in Children in Rural Bangladesh. Am Jnl Trop Med Hyg, April 2015. C George. Abstract
There is a growing body of literature indicating an association between stunting and environmental enteropathy (EE), a disorder thought to be caused by repeated exposures to enteric pathogens. To investigate the relationship among exposure to enteric pathogen through geophagy, consumption of soil, EE, and stunting, the authors conducted a prospective cohort study of 216 children under 5 years of age in Bangladesh. Findings suggest that geophagy may be an important unrecognized risk factor for EE and stunting.

Value for Money Study on Sanitation, Hygiene Education and Water Supply in Bangladesh (SHEWA-B) Programme Interventions, 2015. A Barkat. Link
Primary data collected through household surveys in 2013 suggest that (reported) handwashing practice with soap/ash after defecation has increased from 54 percent at baseline to 95 percent. Washing hands before eating increased to 41 percent from 22 percent since the baseline. When asked to recall hygiene behaviors they learned through the intervention (unprompted), all the respondents could recall at least one, and nearly 95 percent could recall three or more hygiene behaviors.

Empowerment in Action: Savings Groups Improving Community Water, Sanitation, and Hygiene Services. Enterprise Development Microfinance, March 2015. K DeVries. Link
Savings groups (SGs) combined with social empowerment strategies can be used to engage communities meaningfully in addressing development challenges such as access to clean water and a functioning latrine. As participants in Project Concern International’s SG initiative entitled Women Empowered, women have independently identified WASH needs in their communities and have organized and carried out collective actions to improve their situation. This paper highlights results from a qualitative study in which Project Concern International looked at SGs within two international development programs in urban and rural Guatemala.

How Recycled Bars of Soap Could Help Prevent Illnesses in Developing Countries.Huffington Post, April 2015. B Skoloff. Link
Clean the World began about seven years ago as a tiny operation with a few friends and family in a single-car garage in Orlando, Florida, where they used meat grinders, potato peelers, and cookers to recycle used soap into fresh bars. It has since grown to include industrial recycling facilities in Las Vegas, Orlando, and Hong Kong, cities where hotels are plentiful and used bars of soap can be gathered easily by the thousands.

WaterAid Hygiene Resources. WaterAid. Link
This webpage has link to WaterAid’s Hygiene Framework and other hygiene-related publications.


Strategies & Challenges to Handwashing Promotion in Humanitarian Emergencies, 2014. J Vujic. Link
Relatively little information has been published in the peer-reviewed literature on handwashing behavior among those affected by a humanitarian emergency or on the behavioral effects of routinely applied hygiene promotion strategies in humanitarian emergencies. The international and nongovernmental organizations that provide WASH services to internally displaced and refugee populations in humanitarian emergencies have an abundance of field experience and expertise, institutional memory on the nature of handwashing promotion employed in emergency settings, and access to unpublished information on evaluations of handwashing promotion in the emergency context.

WASH Tools for Implementers Responding to the Nepali Earthquake, 2015. PPPHW.Link
As the international community attempts to help Nepal recover from a recent deadly earthquake, many organizations are working on response efforts. For those working on WASH in Nepal, PPPHW has links to documents which might be useful in coordinating WASH efforts.

Ebola Virus Disease: Key Questions and Answers Concerning Water, Sanitation and Hygiene, 2014. WHO; UNICEF. Link
Best WASH practices, particularly handwashing with soap, should be strictly applied and maintained as these form an important additional barrier to Ebola virus transmission, and to the transmission of infectious diseases in general. All human excreta must be contained in a way that separates it from human contact—at a minimum covered with soil—pending construction of latrines.

Checklist for Terminal Cleaning and Decontamination of Ebola Care Facilities, 2015. WHO. Link
This checklist includes the necessary steps for terminal waste management, cleaning, and decontamination processes.

Manual for the Care and Management of Patients in Ebola Care Units/Community Care Centres: Interim Emergency Guidance, 2015. WHO. Link
This manual provides guidance on best practices to be followed in Ebola Care Units/Community Care Centers. It is intended for health aid workers (including junior nurses and community health care workers) and others providing care for patients in these units. While the focus is on the care and management of patients with Ebola, the care of patients with other causes of fever is also described.
WASHplus Weeklies highlight topics such as Urban WASH, Household Air Pollution, Innovation, Household Water Treatment and Storage, Handwashing, Integration, and more. If you would like to feature your organization’s materials in upcoming issues, please send them to Dan Campbell, WASHplus Knowledge Resources Specialist, at dacampbell@fhi360.org.

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