Dear SuSanA WG 8 members,

Global Handwashing Day 2020 is commemorated on October 15th.  This year's theme is "Hand Hygiene for All".  This can be particularly difficult to manage in humanitarian situations. 

Below you find a curated list of studies and resources on handwashing in humanitarian situations. You can contribute to the listing by adding related documents to the listing on the google shared document mentioned at the top of the list, which was kindly developed by Dan Campbell of the USAID Water Communications and Knowledge Management (CKM) Project. 

With kind regards,

Arno Coerver, WG 8

  docs.google.com/document/d/1NTOKorOO0GJH...BE4mCX7XAwaLioI/edit A Bibliography on Handwashingin Humanitarian Situations as a Contribution to Global Handwashing Day 2020
(September 2, 2020 update) Handwashing andHumanitarian Situations 

TheDeterminants of Handwashing Behaviour Among Internally Displaced Women in Two
Camps in the Kurdistan Region of Iraq .PLoS One, May 2020. Handwashing programs should seek to improve theconvenience and quality of handwashing facilities, create cues to trigger
handwashing behavior, and increase perceived risk. 

Interim Guidance on Public Health and Social Measures forCOVID-19 Preparedness and Response Operations in Low Capacity and Humanitarian
Settings. Interagency StandingCommittee. May 2020. This interim guidance outlines how public health andsocial measures, including availability of handwashing supplies, can be adapted
in low capacity and humanitarian settings. 

Barriers and motivators to participation in handwashingpromotion programs at household level among refugees in Rhino Settlement, Arua
District, Uganda . CogentMedicine. May 2020. Participation in handwashing promotion programs was low
among the refugees. There is need for relevant stakeholders to come up with
interventions to increase participation among the refugees while taking into
consideration the potential barriers and motivators to their participation as
identified by this study. 

Access to Functional Handwashing Facilities and Associated Factors Among South
Sudanese Refugees in Rhino Camp Settlement, Northwestern Uganda . Journal of Environmental and Public Health,March 2020. Hand hygiene in refugee camp settlements remains an important
measure against diarrheal infections. Handwashing with soap and water is an
effective way of preventing such diseases. Despite this knowledge, information
is limited about access to functional handwashing facilities in these settings. 

ChildHandwashing in an Internally Displaced Persons Camp in Northern Iraq: A
Qualitative Multi-Method Exploration of Motivational Drivers and Other
Handwashing Determinants . PLoSOne, February 2020. Provision of soap and water alone is not sufficient to encourage children to practice handwashing with soap in a humanitarian context.
The authors’ findings suggest that equal consideration should be given to the
quality and location of handwashing materials and facilities and that social
norms could be leveraged to promote and enhance child handwashing.

Programmatic implications for promotion of handwashingbehavior in an internally displaced persons camp in North Kivu, Democratic
Republic of Congo . Conflict and Health, November 2019. Compared to non-emergency contexts, illness-based messages may
be more effective in emergency settings where disease poses a current and
ongoing threat.

Handwashing Behaviour Change: Research on the Frontlines .GHP, October 2019. The first pilot study aims to investigate if the use of
guiding stories could act as an emotional motivator to change behaviour, an
approach that has been proven to be effective in non-emergency settings. The
second pilot study explores additions to the handwashing station, such as a
mirror or a nicer type of soap to determine if they can make handwashing more
desirable and more likely to be practiced.

Designing an adaptable handwashing facility foremergencies . GHP, October 2019.Handwashing facilities are not just about reducing disease transmission. If
designed well, a handwashing facility can cue behavior and promote dignity and
self-worth in situations that are often traumatic and unpleasant.

Could the Supertowel be used as an alternative handcleaning product for emergencies? An acceptability and feasibility study in a
refugee camp in Ethiopia . PLoS One, May2019. The Supertowel was found to be an acceptable and useful hand-cleaning
product that could complement soap use in crisis contexts.

Efficacy of the SuperTowel®: An Alternative Hand-washingProduct for Humanitarian Emergencies .American Society of Tropical Medicine and Hygiene, May 2019. These studies have
demonstrated that under controlled conditions, the microfiber prototypes of the
SuperTowel were more efficacious at removing nonpathogenic E. coli from
pre-contaminated hands than handwashing with soap.

Child's play: Harnessing play and curiosity motives to improve child handwashing in a humanitarian setting . International Journal of Hygiene and Environmental Health, March 2019. We show that distributing soaps with toys embedded inside,
in a rapidly deployable intervention, can improve child handwashing behavior in
a humanitarian emergency context.

Handwashing andCOVID-19

USAID Water, Sanitation and Hygiene (WASH): StrategicApproach to COVID-19 Response . USAID, April2020. USAID’s priorities for COVID-19 responses in complex emergencies are to
mitigate widespread transmission of COVID-19, address public health
consequences, and maintain essential WASH and health services for crisis
affected populations

Summary report on handwashing and COVID-19 . COVID-19 Hygiene Hub, August 2020. To understand whyhandwashing is so effective in killing and removing SARS-CoV-2 it is necessary
to understand how soap works at a microscopic level.

Five ideas for handwashing promotion during the 1st phaseof COVID-19 response . COVID-19 HygieneHub, August 2020. Here we provide some practical tips for how to encourage
community-level handwashing behavior with the aim of controlling and preventing
the spread of COVID-19.

Can ash be used for handwashing? COVID-19 Hygiene Hub, August 2020. There is no evidence onthe effectiveness of ash for removing or killing SARS-CoV-2. Evidence on the
effectiveness of ash in general is poor. Where there are no other options,
handwashing with ash should be encouraged as it is likely to be more effective
than handwashing with water alone.

BeyondHandwashing: Water Insecurity Undermines COVID-19 Response in Developing Areas . Journal of Global Health, June 2020. Thisarticle explores the wide-ranging ways in which water insecurity impedes
COVID-19 control strategies beyond simply limiting handwashing, especially in
high-density urban areas. 

Beyond Raising Awareness: Promoting Handwashing in Nepal Amid the COVID-19 Crisis . WorldBank, May 2020. This report proposes a framework for policy actions to effectively promote handwashing in Nepal amid COVID-19. Raising awareness about
proper handwashing is the cheapest, easiest, and most important way to prevent
the spread of the coronavirus, but it is far from sufficient in Nepal. 

UNICEF Fact Sheet: Handwashing Stations and Supplies for the COVID-19 response . UNICEF,May 2020. The design of the tap is essential to limit cross-contamination
between hand washers and with 1 m distance between users should be given a
primary consideration in the context of the Covid-19 response. 

‘How to’ Brief: Communicating for Hand Hygiene duringCOVID-19 . GHP, May 2020.This brief provides suggestions for crisis planning and risk communication
particular to hand hygiene and related issues for COVID-19. 

Pedal Operated Handwashing Station Responding COVID-19 Pandemic . WaterAid Bangladesh, May 2020. In response toCOVID-19, WaterAid Bangladesh has demonstrated different handwashing options
including pedal-operated handwashing stations, which help sanitize hands
without physically touching the water tap and soapy water or other liquid soap
dispensers, there by limiting potential for contamination at public and common
places. 

Inequalities in Access to Water and Soap Matter for the COVID-19 Response in Sub-Saharan
Africa . International Journal for Equity in Health, June 2020. This article argues interventions such as mass distribution of soap and ensuring access to clean water, along with other
preventive strategies, should be scaled up to reach the most vulnerable
populations. 

GlobalAccess to Handwashing: Implications for COVID-19 Control in Low-Income
Countries . EnvironmentalHealth Perspectives, May 2020. Handwashing is a key component of guidanceto reduce transmission of COVID-19. This article found more than 50 percent of
the population in sub-Saharan Africa and Oceania were without access to
handwashing in 2019, and in eight countries, 50 million or more persons lacked
access. 

Handwashing Stations and Supplies for the COVID-19Response . UNICEF, May2020. This document provides an overview of available handwashing station
designs for policymakers, implementers, and procurement officers.

COVID-19 Action Toolkit: Handwashing and OtherPreventative Measures . BusinessFights Poverty, May 2020. This action toolkit provides guidance on whatbusinesses can do immediately and in the longer term to increase awareness of
and access to handwashing and other preventative measures. 

COVID-19 Handwashing with Soap Facilities: Compendium ofIndicative Layouts, Designs and Cost Estimates . UNICEF, May 2020. This document provides detailsof different handwashing station designs and their estimated costs. 

How Long Should Hands Be Washed? COVID-19 Hygiene Hub, June 2019. This documentgives guidance on the suggested duration of handwashing: given that COVID-19
can transmit via surfaces as well as respiratory droplets, it is important that
hands are washed at additional and different times than what would normally be
recommended for the control of diarrheal diseases. 

Potential Utilities of Mask-Wearing and Instant Hand Hygiene for Fighting SARS-CoV-2. Journal of Medical Virology. March 2020.Mask-wearing and handwashing can slow the spread of the virus, but mask
shortages and timely handwashing is often impossible. This efficacy study
evaluates three types of masks and instant hand wiping using the avian
influenza virus to stand in for the coronavirus. 

Websites 

COVID-19Hygiene Hub - The COVID-19Hygiene Hub is a free service that supports actors in low- and middle-income
countries (LMICs) to rapidly design evidence-based hygiene interventions to
combat the coronavirus. 

Globalwaters.org – The USAID Globalwaters.org website has information on handwashing research and collections ofresources on Emergency WASH and WASH& COVID-19 .   

GlobalHandwashing Partnership (GHP) –GHP is a coalition of international stakeholders who work explicitly to promote
handwashing with soap and recognize hygiene as a pillar of international
development and public health.  

Dan Campbell
Knowledge Creation/WASH Specialist, ECODIT│ www.ecodit.com
USAID Water Communications and Knowledge Management (CKM) Project