Clean Hands (and More!) in the Time of COVID-19

Five ways USAID supports good water, sanitation, and hygiene practices in health care facilities

A third year midwifery student taking part in a practical training session on proper handwashing at the Korle Bu Nursing and Midwifery Training School in Accra, Ghana. / Kate Holt, JHPIEGO/MCSP

When the novel coronavirus emerged as a global pandemic, handwashing entered the spotlight as an important way to limit the spread of infectious disease.

Around the world, one of the main pieces of advice to prevent the spread of COVID-19 is the same: Wash your hands!

Proper handwashing with soap and water represents the first layer of defense against COVID-19 and other infectious diseases. But many places around the world cannot practice this behavior due to a lack of access to safe water, sanitation, and hygiene (WASH) resources. Health care workers, families, and students cannot practice safe handwashing due to shortages of running water or soap in homes, health care facilities, and schools.

Dr. Mboahangy Ramanantsoa (right) is holding a training session in Madagascar for infection prevention control, including proper handwashing techniques. / Karen Kasmauski, MCSP

It is critical for frontline health workers and facilities to have access to safe water and soap in order to deliver high quality care.

Globally, 42 percent of health care facilities do not have access to handwashing resources, and one in four health care facilities lack basic water services — impacting 2 billion people.

Health care facilities without clean water access are more likely to contribute to the spread of infectious diseases, including higher numbers of infections from childbirth and other essential care procedures. Patients are also less likely to seek care at a health facility if they feel the environment is unsafe due to a lack of WASH services.

USAID provides access to clean and reliable water in health care facilities to ensure safe and sanitary conditions for families and communities seeking care, while also educating them about the role of handwashing in limiting the spread of infectious disease.

As part of the Agency’s ongoing response to COVID-19 globally, USAID is supporting infection prevention and handwashing training for nearly 24,000 health workers in 1,540 health care facilities across 40 countries.

Here are five ways USAID has pivoted its work to improve handwashing during COVID-19.

1. Assessing Infection Prevention Readiness and Handwashing Capabilities

To better understand the WASH needs of each facility, USAID conducts infection prevention control readiness assessments using scorecard tools and audits. / Kate Holt for JHPIEGO/MCSP

USAID supports WASH in health care facilities by conducting infection prevention control readiness assessments that use scorecard tools and audits to better understand the unique needs of each facility. Quarterly hygiene audits and scorecard assessments are integrated into other health facility quality improvement activities and help monitor progress on water, sanitation, hygiene, and infection prevention and control at health facilities.

In northern Uganda, USAID conducted infection prevention readiness assessments and found a need for increased training on proper WASH practices for health care facility staff. As a result of increased WASH training for staff, infection prevention readiness scores improved in outpatient departments in 58 facilities.

2. Identifying “COVID-19 Champions” to Engage Community Members

Participants of a WASH training in Kenya for a project that increases access to water and sanitation services for over one million Kenyans. / USAID/Kenya, KIWASH

Community engagement is critical for widespread behavior change. Through training programs, USAID identifies health care staff that can engage community members and effectively communicate the importance of proper hand hygiene through handwashing with soap or use of alcohol-based hand sanitizer to limit the spread of COVID-19.

In Kenya, USAID partners identify “COVID-19 Champions” through a training of trainers program. COVID-19 Champions increase awareness of infection prevention measures against COVID-19 and engage community members in health facilities on the importance of hand hygiene by disseminating handwashing guidelines and outreach materials.

3. Installing Handwashing Stations at Health Care Facilities

Bimala Chaudhary washes her hands in Nepal. / Dave Cooper for USAID

USAID works with local private sector organizations to install handwashing stations at critical points of care.

In response to COVID-19 and with USAID support, local committees in Nepal installed water drums and handwashing stations at health posts for patients to effectively wash hands with soap and water before entering. In addition, USAID built fully functioning water supply systems in 57 health posts across Nepal to assist health workers and patients in limiting the spread of infectious diseases through proper handwashing.

4. Training Health Workers on Handwashing for Infection Prevention Control

In Senegal, health facility staff are trained in proper WASH techniques to prevent the spread of infectious disease. / Oliver Subasinghe, USAID

USAID provides training to local health workers on infection prevention control against COVID-19, including proper handwashing with soap and water at critical points of care.

In Senegal, USAID supports the National Hygiene Service to conduct infection prevention control activities in all 14 regions of the country through regional hygiene brigades. Since the launch of COVID-19 response activities, 447 hygiene officers and 549 community health workers were trained in basic infection prevention control and good WASH practices.

5. Communicating the Importance of Handwashing to Prevent COVID-19

To reduce the transmission of disease, health care workers at a clinic in Haiti have adopted proper handwashing techniques. / Karen Kasmauski/MCSP and Jhpiego

Since the start of the pandemic, USAID has rapidly and widely communicated COVID-19 infection prevention messages widely through various local channels, including social media, radio advertisements, posters, and brochures explaining the importance of handwashing in local languages.

In Haiti, USAID has been closely collaborating with in-country partners and the Haitian Ministry of Health to print and distribute 500,000 leaflets, 250,000 brochures, and 100,000 posters to raise awareness on COVID-19 and infection prevention measures, such as handwashing at critical times. Through these efforts, more than 1.4 million people in Haiti have received messages on handwashing since the start of the Pandemic.

Moving forward, there needs to be coordination and commitment across governments, private sector organizations, donors, civil society, faith-based organizations, and the health care sector to ensure continuous and sustainable water access in health care facilities. USAID is also working to improve WASH access for households, schools, and businesses. Since 2008, USAID’s partnerships have resulted in more than 53 million people gaining access to an improved water service.

Handwashing is one of the best ways to limit the spread of infectious diseases. USAID’s investments in handwashing strengthens the capacity of countries to reduce the spread of COVID-19 and move towards widespread and sustained good hygiene practices. Two clean thumbs up to that!

About the Authors

Stephanie Mork is a Communications Consultant in USAID’s Bureau for Global Health. Sydney Perlotto is a Communications Analyst in USAID’s Bureau for Global Health.