In developing country people wash their hands to depending to their meals whether two or three but not with soap also in the toilet wash their hands without soap but also after closing the door they don't wash their hands.

Dear Elisabeth,

Thank you for the kind reply and thoughts!

I am sure you are right, handwashing behaviour will vary substantially by person and group!

I was hoping to collate enough information to inform a mini meta-review on the topic. I wanted to try and estimate a global distribution by combining all of the point estimates, and then I could (maybe) try to tease out the main factors that might matter (like male/female, child in the home, etc.). Unfortunately, there isn't that much data on how many times per day. other indicators are much more common (like whether or not people wash their hands at one of the critical periods). That data might be helpful in trying to tease out factors that influence handwashing, but is not so helpful in trying to find a global frequency estimate.

I'll take a look at the handwashing wiki, thanks for thinking about that!

All the best,
Tim

Dear Mohammad,

Thank you for the kind reply! These are great references for informing how often people should wash their hands. I am also looking for primary data on estimates of how often people actually do wash their hands. I've managed to find a few, but was hoping for enough to inform fitting a distribution.

Thanks, again!
tim

Hi F.H. Mugal,

Thank you so much for your kind reply, it was very helpful. From the papers I referenced:

• Davis et al. (2011): female head of household with children under five in periurban Dar es Saleem was mean 3.78 and sd 1.35
• Lau et al. (2004): Hong Kong telephone survey of probable SARS case-patients and general population showed 18% washed hands more than 10 times per day, the control was 33% washed hands more than 10 times per day
• Pickering et al. (2011): female caretakes of children under five, a mean, sd, median (4.4, 4.3, 3) reported handwashing with soap per day
• Greywater Technology Testing Protocol (2008) assumed 5 handwashing per day at home in Australia, but provided no references.

I think you are certainly correct it will vary substantially by person and site and context. I was hoping to get enough data to inform a distribution so that we could understand generally. But I was surprised by the lack of data on what I think is an important topic.

I also agree with your statement on the importance of handwashing effectiveness. We published something that supports that by showing that cleaning under fingernails, cleaning fingertips, and drying all impact microbial contamination on hands. You can find it here (there's a paywall, but i'm happy to send directly to people if they'd like a copy): www.ajicjournal.org/article/S0196-6553(16)30793-3/pdf

Thanks, again!

It is not only the question of how many times people wash their hands each day (though this varies from country to country - urban and rural areas; affluent and poor people), it is also the question of hygiene of hands after cleaning.

The attached paper: A large-scale assessment of hand hygiene quality and the effectiveness of the “WHO 6-steps” - says:

A hand hygiene education and assessment program targeted 5200 clinical staff over 7 days at the National University Hospital, Singapore. Participants in small groups were guided by professional trainers through 5 educational stations, which included technique-training and UV light assessment supported by digital photography of hands. Objective criteria for satisfactory hand hygiene quality were defined a priori. The database of images created during the assessment program was analyzed subsequently. Patterns of poor hand hygiene quality were identified and linked to staff demographic.

Despite the assessment taking place immediately after the training, only 72% of staff achieved satisfactory coverage. Failure to adequately clean the dorsal and palmar aspects of the hand occurred in 24% and 18% of the instances, respectively. Fingertips were missed by 3.5% of subjects. The analysis based on 4642 records showed that nurses performed best (77% pass), and women performed better than men (75% vs. 62%, p < 0.001). Further risk indicators have been identified regarding age and occupation.

Ongoing education and training has a vital role in improving hand hygiene compliance and technique of clinical staff. Identification of typical sites of failure can help to develop improved training.

F H Mughal

Dear Mr.Tim

WHO and CDC as the two professional institutes have recommended for hand washing WHO focus on health care professional , but CDC as general rule for daily life and diseases preventing .

When & How to Wash Your Hands(CDC)
www.cdc.gov/handwashing/when-how-handwashing.html

Clean hands protect against infection(WHO)
www.who.int/gpsc/clean_hands_protection/en/

In daily life this is the best washing hand befor leave any duty and when come to home but in
Sanitation process as studying or operational from this point of view sanitation is the process has many health risks because of pollution and various infections ,safety issue must be consider in using safety and protection such using of personal protective Equipment (PPE) and frequently washing hand and hygiene.

Mohammad.

Dear Tim,

I think it is impossible to come up with an "average" figure on that. You'd probably have to group it by type of person, age, gender, profession, whether they have children or not etc.

When I look at my own handwashing behavior: While I had babies or children at home I washed my hands much more often then before having children. Once the children are older again, it reduces.
The handwashing is related to changing their nappies and food preparation. I had to wash my hands so often during those years that I started to wear those latex gloves because my skin was getting too dry from all the hand washing.

It is probably a fair guess that women on average wash their hands more often then men per day. E.g. on days of menstruation a woman would have to wash her hands when doing her menstrual hygiene related tasks.

Please do tell us more about the broader research project that this question is embedded into? What are your research hypotheses?

Regards,
Elisabeth

P.S. If you are a bit of a handwashing expert, can you help improve the Wikipedia article on handwashing?: en.wikipedia.org/wiki/Hand_washing
e.g. you might like to ensure that the right references are cited.

Dear Mr. Tim,

What those papers you have referred to say?

Please have a look at this Pakistan paper:
fuuast.edu.pk/biology%20journal/images/p...ACHI,%20PAKISTAN.pdf

The abstract says:
Survey has highlighted the significance of hand washing and also indicated the knowledge and practices among 250 mothers between the age group 22-35 in belong to Karachi, the cosmopolitan city of Pakistan by direct filling of questionnaire and short interviews. The results of the survey indicated that 24% were also not aware that gastroenteritis and diaherral diseases can be transmitted to their kids due to their improper hand washing practices. Similarly, about 6% were reported of washing hands frequently each day and 72% spend hardly less than a minute in this activity. In addition to this, among interviewed mothers 60% responded washing hands with soap as compared to the 32% and 40% wash with some detergents and plain water respectively. Moreover, 56% mothers were found to have long nails and about 40% of them had dirt in them. In interview, 16% were found only educating their kids about hand washing procedures and 72% of the mothers were in favour of introducing a course of hand hygiene for school going kids

Regards,

F H Mughal

Hi!

Does anyone know of any references for the number of times per day people from low and middle income countries wash their hands? I have found a lot of references for prevalence rates at critical times, but very few on number of times per day. So far, I only know about Davis et al. (2011) and Pickering et al. (2011) for women in Tanzania, and Lau et al. (2004) for SARS patients in Hong Kong. Any help is appreciated!

Thanks,
Tim