Hand hygiene in public places: why antiseptics are essential

12 May 2020

Dangerous disease-causing pathogens are everywhere. They can remain on a variety of surfaces for long periods of time, easily find their way onto a person’s hands, and then into their body. 

An effective safeguard against the spread of viruses and infections is the thorough washing of hands with soap and water, or using antiseptics containing at least 60% alcohol.

Hand hygiene in public places: why antiseptics are essential | ARC.UA
Hand hygiene in public places: why antiseptics are essential | ARC.UA

The COVID-19 pandemic has resulted in the topics of viruses and infections, as well as the consequences of their spread and protection against them, becoming a top priority for the medical community, national governments and the public. Consequently, providing unfettered access to soap and water, as well as to other means of hand hygiene such as antiseptics, is critically important in the current realities of life. Why?

Dangerous disease-causing pathogens are everywhere. They can remain on various surfaces for long periods of time, easily find their way onto a person’s hands, and then into their body. An effective safeguard against the spread of viruses and infections is the thorough washing of hands with soap and water or using antiseptics with at least 60% alcohol. Hand-washing is the most straightforward and economically feasible measure to prevent the spread of dangerous pathogens and significantly reduces the probability of spreading infectious diseases.[1]

There are several differences between washing hands with soap and water and using an antiseptic. Soap and water (with frequent, thorough and extended washing) destroy and literally wash dangerous pathogens off the hands by damaging the membranes of bacteria and viruses. Antiseptics, on the other hand, destroy certain pathogens but do not remove the “dirt” that can be washed away by soap and water. And antiseptics are less effective when used on sweaty hands. Thus, washing with soap and water is preferred. However, if there is no access to soap and water, then alcohol-based antiseptics can be used.[2]

Evidence.

Numerous studies have shown that handwashing can prevent the spread of dangerous diseases and even save lives. Maintaining adequate hand hygiene helps reduce respiratory disease rates: one study showed cases of infection fell by 15-20%.[3] The results of eight other studies revealed that hand washing reduces the risks of respiratory infection by approximately 16%.[4]
A meta-analysis of four databases, published from January 1960 to May 2007, shows that improving access to hand hygiene led to lower rates of gastrointestinal and respiratory diseases by 31% and 21% respectively.[5]

The Journal of Occupational and Environmental Medicine published the results of a randomized controlled study that showed that daily use of sanitizers in office settings led to a decrease in sickness among workers by 20%.[6]

Several studies show the correlation between handwashing and the reduction of death rates from different illnesses. Handwashing can lead to reductions of up to 50% in deaths from intestinal infections,[7] and up to 16% from respiratory infections.[8]  The use of antiseptics in schools led to a 19.8% decrease in student absences due to infectious illnesses, according to a study conducted in 16 primary schools with 6,000 students.[9]

The need to disinfect hands and provide access to antiseptics has been shown to be extremely important and effective. Authoritative organizations such as the World Health Organization and the US Centers for Disease Control and Prevention are constantly stressing the importance of regular handwashing (or using an alcohol-based disinfectant with at least 60% alcohol, if handwashing with soap and water is not possible), as a measure to combat the spread of the SARS-CoV-2 virus and other infections.[10]

Thus, the proper maintenance of hand hygiene is an important public health intervention that can combat the spread of viruses and infections and significantly reduce illness rates among the population.

The current situation in Ukraine.

In Ukraine, millions of people use public transportation, as well as government and retail services every day (when quarantine restrictions are not in place}. They touch doors and door handles in public places and pay for transit fares and goods with cash. Given the current realities of the spread of the SARS CoV-2 virus and the plans to ease quarantine measures on May 11, 2020, these are the places that will become most conducive for transmission of disease-causing pathogens, including the SARS-CoV-2 virus.

In order to prevent viral transmission, it is necessary to abide by several rules: physical distancing, coughing and sneezing etiquette, avoiding face touching (eyes, nose, mouth) with dirty hands and maintaining proper hand hygiene. In terms of the latter, if there is no opportunity to wash hands with soap and water, antiseptics can be used. [11]

There are public spaces where people tend to congregate and accessing soap and water are impractical. One solution to this challenge is the installation of alcohol-based antiseptic dispensers that can be used by the public.

Providing access to antiseptics in public places (inside public transport, government offices, educational and cultural institutions) is a vital public health issue. Local governments should be the agents of change in implementing this practice. Other countries have already put in place such measures in public places, including subways.

Examples.

Helsinki’s urban area has a population of nearly 1.3 million. There, the city government began installing hand-sanitizing stations with antiseptics in the city’s subway stations. About half of the planned sanitizers have already been installed. This was done after the Finnish Institute for Health and Welfare published a recommendation on April 15 to make hand disinfecting accessible in those places where handwashing is impossible, including subway stations and surface public transit.[12]

Montreal (population 1.6 million) announced plans to install 224 “touchless hand” sanitizer stations at subway station entrances by mid-May. [13]

The city of Kyiv can adapt similar measures by installing antiseptic stations at several metro stations to start, including the major transfer stations and those stations that see the greatest number of passengers.

Calculating requirements.

According to Kyiv Metro, the number of passengers using the highest volume stations in 2019 were: Academmistechko (21.3 million), Minska (17 million), Poznyaky (14.8 million), and  Lukyanivska (14 million). In 2019, the Kyiv Metro transported 495,300,000 passengers.[14]

In order to calculate how much sanitizer would be required for one subway station per month, let us take Minska as an example. Last year, this station saw 17 million passengers, or 1.4 million riders every month.

In its recommendations, the Public Health Center of the Ministry of Health of Ukraine states that antiseptic should be used to cover the entire surface skin of the hands. This requires 3 ml of liquid.[15] Therefore, 1.4 million people would require 4,200 liters of antiseptic every month. However, not every single passenger will use the antiseptic, so the actual volume could be determined after the initiative is launched and use was measured.

Dispensers are used to facilitate the use of sanitizers. Depending on where they will be used, the dispensers can be wall-mounted and floor-mounted (for use in the metro or public places) or tabletop (if used at home or in offices).

Ukrainian antiseptic manufacturers can be engaged to supply the required volume of antiseptic. In the early days of the pandemic, there was a significant deficit of disinfectants across the country that led to their inflated prices. As time passed, Ukrainian manufacturers began producing antiseptics that corresponded in quality and quantities to satisfy the country’s requirements.

There are at least 10 companies producing disinfecting agents in Ukraine. In addition, there are numerous companies that distribute already produced antiseptics. This capacity is more than enough to begin installing antiseptic stations in several Kyiv Metro stations. The manufacturers should be actively engaged to support the initiative.

Corporate Social Responsibility and logistical issues.

The practice of installing antiseptic stations in public places and other measures aimed at preventing the spread of the SARS-CoV-2 virus are being implemented locally across Ukraine. This is occurring primarily through the participation of socially- responsible businesses.
These practices have been put in place by the food delivery services such as “UberEats” and “Glovo” who have implemented “contact-free delivery” where the food a customer has ordered is left by the customer’s door. The delivery people do not enter the customer’s apartment or house, nor do they hand the order directly to the customer.

“Nova poshta” has put clear floor markings inside their branches and by doorways to ensure social distancing between clients standing in line. All of the branches also have antiseptic stations at their entrances.

The “Silpo” supermarket chain also has markings and antiseptics available in addition to on-line ordering and pick up services.

There are many such examples in Kyiv, as well as in the regions. Responsible businesses could share their experience of introducing various initiatives with local governments and other interested businesses.

After the installation of antiseptic stations in the Kyiv Metro, this practice can be implemented in other public places. For example, antiseptic dispensers can be installed inside public transit (buses, trolleybuses and streetcars) and inside government buildings (such as the “CNAP” administrative services centers), and educational and cultural institutions.

The question of logistics for resupply of antiseptics can be solved through already existing business models. The delivery of drinking water is a very well-developed service in Ukraine, especially within larger cities. The owners of water delivery services can look at expanding their service to deliver resupply of antiseptics to government and private institutions. These companies have the personnel, technical abilities and established logistical capacity to introduce the delivery of antiseptics to locations where they will be used in high volumes, in parallel with the delivery of drinking water. 

Informational support.

Simply installing antiseptic stations in public places where handwashing with soap and water is unavailable will not be enough. The public needs to be taught how to properly use them and how to maintain basic hand hygiene.  Thus, informational campaigns and joint projects with civil society and businesses should be conducted.

Any antiseptic stations installed in public spaces should be accompanied by informational materials (e.g. posters, pamphlets) with instructions on the proper use and importance of antiseptics.

An example of a successful public education campaign was the US national information campaign “Life is Better with Clean Hands”. It was developed to motivate teenagers to wash their hands more often, and to make the habit of handwashing an integral part of their daily lives. The campaign created print and audiovisual materials for distribution in public places, social networks, television, and radio.[16]

Similar campaigns do not necessarily have to be at the national level. Local initiatives and socially-responsible businesses could introduce hand hygiene measures and educational campaigns for their communities and employees.

Conclusion.

Local governmental bodies should consider the fact that the threats posed by viruses and infectious diseases will not disappear with the lifting of the quarantine. They must take action to create a new culture of protecting the public by providing access to hand hygiene in places where people regularly congregate. Hence, the initiative of installing antiseptic stations in the Kyiv Metro is both timely and relevant.  If implemented correctly, this initiative can set a precedent to follow for local governments throughout Ukraine’s regions.

The measures for ensuring the maintenance of access to hand hygiene need to be planned out and implemented on a permanent basis. In addition to procurement and installation, the continuous education of the public should be a priority. The application of this and similar measures by local government and responsible businesses will send a signal that the safety of Ukrainians is a priority for those institutions.


Arc.ua has initiated a petition on the website of the Kyiv City State Administration so that the idea of installing antiseptic stations in the Kyiv Metro becomes a reality. It can be signed by following this link


Main ideas: 

  1. Frequent, thorough, and extended washing of hands with soap and water is the most effective, economically viable, and straightforward way to prevent the spread of dangerous disease pathogens.

  2. If there is no access to soap and water, hand hygiene can be maintained with alcohol-based antiseptics that contain at least 60% alcohol.

  3. In places of large concentrations of people, when soap and water are not accessible, one solution is the installation of alcohol-based antiseptic dispensers. The Kyiv Metro is one such public place.

  4. Using the Kyiv Metro’s ridership statistics, the numbers of antiseptic dispensers and volumes of antiseptics can be calculated for every subway station. 

  5. There are at least 10 companies that manufacture disinfectants in Ukraine. Their capacity is more than sufficient to satisfy demand. These manufacturers should be engaged to participate in this initiative. 

  6. It is not enough to simply install antiseptic stations in public places; people need to be taught how to properly use them. Conducting a public education campaign is necessary.

Endnotes:

[1] Purva Mathur. Hand hygiene: Back to the basics of infection control
[Indian Journal of Medical Research]
[https://cutt.ly/iyjJR2P]

[2] Hand Sanitizer Use Out and About
[Centers for Disease Control and Prevention]
[https://cutt.ly/tyjSFg9]

[3] German Lopez, Julia Belluz. Wash your damn hands.
[Vox Contribute]
[https://cutt.ly/qya37WE]

[4] Tamer Rabie, Valerie Curtis. Handwashing and risk of respiratory infections: a quantitative systematic review.
[Tropical Medicine International Health. Wiley online library]
[https://cutt.ly/Zya8iQg]

[5] Alison E.Aiello, Rebecca M.Coulborn, Vanessa Perez, Elaine L.Larson. Effect of Hand Hygiene on Infectious Disease Risk in the Community Setting: A Meta-Analysis.
[American Journal of Public Health]
[https://cutt.ly/5yjZcoi]

[6] Arbogast, James W.; Moore-Schiltz, Laura; Jarvis, William R.; Harpster-Hagen, Amanda; Hughes, Jillian; Parker, Albert. Impact of a Comprehensive Workplace Hand Hygiene Program on Employer Health Care Insurance Claims and Costs, Absenteeism, and Employee Perceptions and Practices
[Journal of Occupational and Environmental Medicine]
[https://cutt.ly/yyaMLnm]

[7] Val Curtis, Sandy Cairncross. Effect of washing hands with soap on diarrhea risk in the community: a systematic review
[The Lancet Infectious Diseases].
[https://cutt.ly/FyjXgpw]

[8] Tamer Rabie, Valerie Curtis. Handwashing and risk of respiratory infections: a quantitative systematic review.
[Tropical Medicine International Health. Wiley online library]
[https://cutt.ly/Zya8iQg]

[9] Hammond B, Ali Y, Fendler E, Dolan M, Donovan S. Effect of hand sanitizer use on elementary school absenteeism.
[American Journal of Infection Control]
[https://cutt.ly/Xyhfyu9]

[10] Show Me the Science – When & How to Use Hand Sanitizer in Community Settings
[Centers for Disease Control and Prevention]
[https://cutt.ly/kya3gNj]

[11] Kwok YL, Gralton J, McLaws ML. Face touching: a frequent habit that has implications for hand hygiene
[American Journal of Infection Control].
[https://cutt.ly/4yjJFA1]

[12] Hand sanitizer dispensers installed at metro stations – people encouraged to bring their own as well
[Helsinki Region Transport]
[https://cutt.ly/4yaBLVV]

[13] Tyler Jadah. STM to install over 220 touchless hand sanitizers at station entrances
[Daily Hive]
[https://cutt.ly/iyaBXnh]

[14] U metro proyikhalosia mayzhe pivmilyarda pasazhyriv
[Kyivskyy metropoliten]
[https://cutt.ly/zyha3C3]

[15] Novyy coronavirus: shliakhy peredavannya i varianty zakhystu
[Tsentr hromadskoho zdorovya MOZ Ukrayiny]
[https://cutt.ly/WyaB3YR]

[16] Life is Better with Clean Hands
[Centers for Disease Control and Preventions]
[https://cutt.ly/Gya55CM]

Brief developed by:

Ivanna Pavliuk, Iryna Yurchenko, Marko Suprun, Ulana Suprun, Diana Rusnak, Stanislav Hreshchyshyn, Pavlo Kovtoniuk, Volodymyr Kurpita

Translated from the Ukrainian language original by Stephen Bandera