Hand safety Research

Hand washing

Hand washing is a benefit and it one of the most cost Effective investments in public health, and the economic benefit from handwashing it isn’t a hard thing to do. Handwashing halts the spread of infection and is effective in preventing the spread of some diseases.

The main factor I noticed when it came to hand washing is that shocking people is more effective at increasing handwashing behaviour than the repeated attempt of reminder posters that everyone ignores. People sometimes think they know when they need to wash there hands however there may be a time when people don’t think they need to as they forget they’ve just touched there hair or phones. We all wash our hand once and think that’s enough.

A modest measure—with significant effects


Hospital-acquired infection damages patients prolong hospital stays, consumes scarce hospital resources, and thus presents a significant challenge for clinical governance. In a seminal intervention study 150 years ago Semmelweis insisted that doctors performing necropsies washed their hands before delivering babies, so reducing mortality due to streptococcal puerperal sepsis from 22% to 3%. Many studies since have confirmed that doctors decontaminating their hands between seeing patients can reduce hospital infection rates. Nevertheless, healthcare workers still fail to wash their hands and fail to appreciate the importance of doing so. This month the Department of Health has had another attempt at reminding them by sending a document and health circular to all NHS chief executives, public health directors, and microbiologists in England. The failure of healthcare workers to decontaminate their hands reflects the fundamentals of attitudes, beliefs, and behaviour, and there are no simple solutions. Many attempts have been made to improve handwashing compliance through education, and indeed elementary hygiene practice should be taught explicitly in medical schools. Principles taught in the lecture theatre can be reinforced by experiential learning, such as demonstrating the need for proper hand washing technique by showing microbial growth from unwashed hands and by using fluorescent oil-based dyes to illustrate the effectiveness of hand washing. Such methods increase personal impact, but, though they may temporarily improve compliance, behavioural changes tend not to be maintained.

Food standard agency 

Supporting Strategic Plan

Our supporting strategic plan sets out proposed approaches to ensure that consumers are consistently protected, informed and empowered. These approaches include

  • using science, evidence and information both to tackle the challenges of today, and to identify and contribute to addressing emerging risks for the future
  • using legislative and non-legislative tools highly effectively to protect consumer interests and deliver consumer benefits – influencing business behaviour in the interests of consumers being genuinely open and engaging, finding ways to empower consumers
  • both in our policy-making and delivery, and in their relationship with the food industry
  • Food companies have a food hygiene rating should food handler have one too.


Hand washing can help prevent the spread of infection

“Doctors and nurses should do more to stop hospital patients developing infections, an NHS watchdog says,” BBC News reports.

The National Institute for Health and Care Excellence (NICE) has highlighted how necessary hygiene protocols, such as hand washing, may be overlooked by some health professionals, which may threaten patient safety.

NICE points out that one in 16 people being treated on the NHS picks up.

“It is unacceptable that infection rates are still so high within the NHS,” said Professor Gillian Leng, director of Health and Social Care at NICE. “Infections are a costly and avoidable burden. They hinder a patient’s recovery, can make underlying conditions worse, and reduce the quality of life.”

Of remaining entries that attempted hand-hygiene practices findings determined:
• Only 2% of attempts were compliant with the company procedure.
• 22% of attempts failed to use soap to wash hands.
• Only 45% of attempts wetted hands with water before applying soap.
• Only 42% of attempts included the use of sanitizers.
• On 13 occasions (2% of attempts), staff were observed failing to implement a hand washing/drying attempts and used hand sanitiser only before entering production. Consequently, the majority (98%) of hand decontamination attempts implemented before entering production were not compliant with the company hand hygiene procedure.


Hand Hygiene: NHS

The data on this issue is scary. The 2011 prevalence survey showed that 6.4% of hospital patients—one in every 16—contracted an infection while in the hospital. Imagine going to a restaurant where one in 16 customers was made ill by the food. No one would go back again; we would not allow it to stay open. But that is what the data showed for our hospitals five years ago. We should not be willing to accept that.

Infections contracted in hospitals affect 300,000 patients every year and cause 5,000 deaths. They have a dramatic impact on those individuals and a significant impact on the NHS because patients who contract such infections remain in hospital on average two and a half times longer than patients who do not. They spend an average of 11, and a maximum of 25, extra days in the hospital at an estimated cost of about £1 billion a year. It is estimated that 30% of such infections can be avoided simply by better applying the existing rules and practices.

The NHS must improve its performance on this fundamental issue. We should not be willing to accept that level of unnecessary infection. I am not saying that such infections are caused by people deliberately not washing their hands enough. They probably do not realise what they are doing, and their behaviour is not corrected. I suspect that most people in the NHS do not realise how many times they should wash their hands when they see a patient and do not know that they are not doing all they can. I am sure most people are incredibly keen to do everything they can to fix this problem and prevent such infections. We must look at what more we can do to put systems in place and enforce them. We should give people support, training, peer pressure and peer reviews to ensure it is happening, rather than blame individuals. This issue will become increasingly important as the problem of antimicrobial resistance grows. We cannot rely on antibiotics to fix such infections and tackle the problem, so it is essential that we stop the infections in the first place and prevent the situation from getting worse.

I want to talk about the existing hand-washing rules, the systems for monitoring them and why they do not work. I will look at some things that can be done to improve the situation. I hope the Minister will accept that I do not intend these ideas to be controversial or costly; they are ways of enforcing the rules that are already in place and of using the existing systems.

Reverse Psychology

I’ve been thinking about how I could use this brief and use reverse Psychology to make the food handler listen more and make it more effective. Having something that questions whether you’ve washed your hand can be useful.

This article assesses the effectiveness of The Great WASH Yatra handwashing awareness-raising campaign in India on changing visitors’ intention to wash hands with soap after using the toilet and the underlying behavioural determinants. Interviews based on the RANAS (Risk, Attitudes, Norms, Abilities, Self-regulation) model of behaviour change were conducted with 687 visitors before and after their visit to the campaign. Data showed that a campaign visit had little effect on the intention to wash hands with soap, even when comparing visitors who had actively participated in handwashing games with those who had not. After a campaign visit, knowledge about the benefits of washing hands had increased by almost half a standard deviation. A multiple linear regression analysis revealed that when considering all behavioural determinants change scores simultaneously, they were able to explain 57% of the variance in the intention change score. These findings suggest that substantively changing behaviour requires more than improving knowledge and emphasizing the importance of washing hands. Identifying the crucial behavioural determinants for handwashing may be an essential first step in planning effective large-scale promotion programmes.

The Great WASH Yatra campaign

TGWY was a travelling campaign engaging visitors in the issues of sanitation and hygiene in a playful and carnival-style atmosphere on a 7000 m² area. The campaign was jointly managed by WASH United gGmbH and Quicksand, a Delhi based multi-disciplinary innovation consultancy. TGWY had two principal goals: promoting life-saving handwashing behaviour and toilet usage. A set of interactive educational games and activities were developed, inspired by cricket, Bollywood song and dance, parlour games and popular Indian TV formats. Song, dance, theatre, art, and games themed and aligned around a unique narrative involving hygiene heroes and spreading the message of clean water and sanitation for all. The game zone comprised nearly 20 games that were housed in custom-designed stalls, arcade-like settings or outdoors. Each game was designed to communicate one or more of the core messages: the necessity of using toilets and the necessity of washing hands with soap. The core message of about half of the activities was to discourage open defecation and promote the usage of toilets. Because the focus of the present evaluation study was solely on the promotion of handwashing behaviour, only games and activities targeted at increasing handwashing rates were included in the analyses. Handwashing games and activities were such as the Clean Hands Challenge , where germ targets are marked out on a sizeable hand-shaped cut-out and act as targets which players have to successfully hit with a wet soapy sponge or the Soap Lab where participants dip their hands into coloured chalk and then wash hands once with water only and once with soap and water in order to see for themselves the importance of soap for removing all of the chalk.

Survey procedures and study areas

Data were collected over a 5-week period, from October 14 through 19 November 2012, within five stations of TGWY using structured interviews using a standardized, pre-coded and pre-tested questionnaire administered in paper-and-pencil. The same visitors were interviewed before and after their visit to TGWY. Selection criteria were that respondents were at least 16 years of age, that they intended to visit TGWY immediately after the first interview (pre-interview), and that they were committed to giving a second interview (post-interview) after their visit. Each interview lasted between 10 and 15 min. Interviewers were instructed to recruit participants from both genders equally if possible. Each respondent who participated in both the pre- and the post-interview received three bars of soap as an incentive. Seven interviewers with a Master’s degree in social sciences or humanities were recruited and received training in the objectives and methodology of the survey, in the theoretical background of the questionnaire and in the procedures and interpersonal communication in the field. The interviewers familiarized themselves with the questionnaire by reviewing the purpose for each item and by conducting role-plays and mock interviews on how to administer the questionnaire and record responses. The study was conducted in strict compliance with the ethical principles of the American Psychological Association (APA) and the Declaration of Helsinki. The study protocol was approved by the ethical review committee of the Faculty of Arts of the University of Zurich and by the Indian Ministry of Drinking Water and Sanitation.


A total of 1005 visitors were invited to participate in the study. One hundred and seventy-six visitors did not want to be interviewed for the pre-interview and 142 of the visitors who had participated in the pre-interview did not want to be interviewed again for the post-interview, resulting in 687 matching pre- and post-interviews. The sample consisted of 59.4% male and 40.6% female respondents. The age of the respondents ranged between 16 and 84 years, with a median age of 32.8 years (SD = 12.4). Twenty-two per cent of the interviewees had never attended school, 3.5% had completed 1–4 years of schooling, 19.3% had completed 5–8 years, 29.7% had completed 10–12 years and 25.6% had completed a secondary school degree or higher. The majority were Hindus (88.2%), followed by Muslims (11.6%). Seventy-seven per cent of the respondents were married and 22.7% were single. On average, visitors spent 41 min at TGWY event. The time spent at the event did not differ between participants and non-participants and did not affect the changes in the behavioural determinants or in their intention to wash hands.


The questionnaire was developed from previous instruments used in studies on handwashing practices and water consumption in developing countries [ 20–22 ]. All English items were translated into Hindi and retranslated to ensure the meaning of the questions was accurate. The pre-visit questionnaire included structured items addressing the intention to wash hands with soap, the behavioural determinants of the RANAS model, and socio-demographic characteristics. Example items for the behavioural determinants are displayed in Table I. Five-point unipolar items (from 1 to 5) were used to measure the behavioural determinants (e.g. 1 = ‘not at all’ and 5 = ‘very much’). Two items (the effective belief liking and the injunctive norm) were originally assessed on a 9-point scale with bipolar verbal descriptors at each end of the scale (e.g. 1 = ‘dislike it very much’ and 9 = ‘like it very much’). It was decided to reduce the 9-point scale to a 5-point scale by combining the descriptions of former scores of 1 through 5, because <5% of respondents had used this half of the scale. If multiple items were used to measure a behavioural determinant, the items were averaged to build scales. A single question was used to quantify the intention to wash hands with soap (‘How strongly do you intend to always wash hands with soap and water after using the toilet?’). Response options were rated on 5-point scales, with one representing ‘not at all strongly’ and five representing ‘very strongly’. During the administration of the post-questionnaire, items on the intention to wash hands with soap and on the behavioural determinants were administered a second time. Also, visitors were asked in which handwashing game or activity they had actively participated in.

Data analysis

We used Paired Student’s t-tests to compare pre- and post-visit scores in intention and the behavioural determinants. Two-way repeated measures analyses of variance were used to determine if there were any significant differences from pre- to post-visit in the behavioural determinants and in the intention to wash hands with soap among handwashing games participants and non-participants. Change scores for all behavioural determinants and for the intention to wash hands with soap were calculated to reflect differences from pre- to post-visit. A forced-entry multiple linear regression analysis using change scores was carried out to explore the relationship between changes in the behavioural determinants and changes in the intention for washing hands with soap.