Volume 100, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Handwashing with soap reduces the transmission of diarrheal pathogens, but access to hand-washing facilities, water, and soap in humanitarian emergencies is limited. The SuperTowel (ST) is a fabric treated with permanent antimicrobial bonding and has been designed as a soap alternative in emergency situations. The aim of this study was to test the efficacy of the ST as a hand-cleaning product. Two sets of laboratory tests, with 16 volunteers in each, were conducted to test the efficacy of different prototypes of the ST. Volunteers pre-contaminated their hands with nonpathogenic . Comparisons were made between hand cleaning with the ST and handwashing with the reference soap, using a crossover design. Participants also completed a questionnaire about product perceptions. Three of the prototypes of the ST were more efficacious at removing from pre-contaminated hands than handwashing with soap (mean log reduction of 4.11 ± 0.47 for ST1, 3.84 ± 0.61 for ST2, and 3.71 ± 0.67 for ST3 versus 3.01 ± 0.63 for soap [ < 0.001, = 0.002, and = 0.005, respectively]). The ST prototypes used less water than handwashing with soap, were well accepted, and were considered preferable in communal settings. The ST has the potential to be a suitable complementary hand-cleaning product for humanitarian emergencies.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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  1. Checchi F, Gayer M, Freeman Grais R, Mills EJ, , 2007. Public Health in Crisis Affected Populations: A Practical Guide for Decision-Makers. London, United Kingdom: Humanitarian Practice Network, Overseas Development Institute. [Google Scholar]
  2. Connolly M, Gayer M, Ryan MJ, Salama P, Spiegel P, Heymann DL, , 2004. Communicable diseases in complex emergencies: impact and challenges. Lancet 364: 19741983. [Google Scholar]
  3. Cairncross S, Hunt C, Boisson S, Bostoen K, Curtis V, Fung IC, Schmidt WP, , 2010. Water, sanitation and hygiene for the prevention of diarrhoea. Int J Epidemiol 39 (Suppl 1): i193i205. [Google Scholar]
  4. Rabie T, Curtis V, , 2006. Handwashing and risk of respiratory infections: a quantitative systematic review. Trop Med Int Health 11: 258267. [Google Scholar]
  5. Phillips RM, Vujcic J, Boscoe A, Handzel T, Aninyasi M, Cookson ST, Blanton C, Blum LS, Ram PK, , 2015. Soap is not enough: handwashing practices and knowledge in refugee camps, Maban county, South Sudan. Confl Health 9: 39. [Google Scholar]
  6. Biran A, Schmidt WP, Zeleke L, Emukule H, Khay H, Parker J, Peprah D, , 2012. Hygiene and sanitation practices amongst residents of three long-term refugee camps in Thailand, Ethiopia and Kenya. Trop Med Int Health 17: 11331141. [Google Scholar]
  7. Aunger R, Schmidt WP, Ranpura A, Coombes Y, Maina PM, Matiko CN, Curtis V, , 2010. Three kinds of psychological determinants for hand-washing behaviour in Kenya. Soc Sci Med 70: 383391. [Google Scholar]
  8. Hoque BA, Mahalanabis D, Pelto B, Alam MJ, , 1995. Research methodology for developing efficient handwashing options: an example from Bangladesh. J Trop Med Hyg 98: 469475. [Google Scholar]
  9. Hirai M, Graham JP, Mattson KD, Kelsey A, Mukherji S, Cronin AA, , 2016. Exploring determinants of handwashing with soap in Indonesia: a quantitative analysis. Int J Environ Res Public Health 13: E868. [Google Scholar]
  10. The Sphere Project, 2004. Sphere Handbook, Vol. 2005, Revised edition. Geneva, Switzerland: The Sphere Project. [Google Scholar]
  11. UNHCR Global, 2017. Trends: Forced Displacement in 2016. Geneva, Switzerland: UNHCR. [Google Scholar]
  12. Blum LS, Yemweni A, Trinies V, Kambere M, Tolani F, Allen JV, Handzel T, Cookson S, Ram PK, , 2017. A qualitative assessment of motivators and barriers to handwashing behaviors in an emergency setting in North Kivu, Democratic Republic of Congo. Am J Trop Med Hyg 97 (5 Suppl 1): 401402. [Google Scholar]
  13. Poucher WA, , 1991. Poucher’s Perfumes, Cosmetics and Soaps, Vol. 1, 9th edition. London, United Kingdom: Chapman & Hall. [Google Scholar]
  14. TÜV Rheinland, 2016. Bioefficacy of the Antimicrobial Bonding Treatment as Applied to the SafePad. India: RealRelief Website. [Google Scholar]
  15. Gibson KE, Crandall PG, Ricke SC, , 2012. Removal and transfer of viruses on food contact surfaces by cleaning cloths. Appl Environ Microbiol 78: 30373044. [Google Scholar]
  16. Lin CM, Wu FM, Kim HK, Doyle MP, Michael BS, Williams LK, , 2003. A comparison of hand washing techniques to remove Escherichia coli and caliciviruses under natural or artificial fingernails. J Food Prot 66: 22962301. [Google Scholar]
  17. McGinley KJ, Larson EL, Leyden JJ, , 1988. Composition and density of microflora in the subungual space of the hand. J Clin Microbiol 26: 950953. [Google Scholar]
  18. Friedrich MN, Julian TR, Kappler A, Nhiwatiwa T, Mosler HJ, , 2017. Handwashing, but how? Microbial effectiveness of existing handwashing practices in high-density suburbs of Harare, Zimbabwe. Am J Infect Control 45: 228233. [Google Scholar]
  19. European Committee for Standardization, 1997. EN1499: Chemical Disinfectants and Antiseptics. Hygienic Hand Wash. Test Method and Requirements. Brussels: Comite Europe en de Normalisation. [Google Scholar]
  20. Trick WE, Vernon MO, Hayes RA, Nathan C, Rice TW, Peterson BJ, Segreti J, Welbel SF, Solomon SL, Weinstein RA, , 2003. Impact of ring wearing on hand contamination and comparison of hand hygiene agents in a hospital. Clin Infect Dis 36: 13831390. [Google Scholar]
  21. Alur AA, Rane MJ, Scheetz JP, Lorenz DJ, Gettleman L, , 2009. Simulated microbe removal around finger rings using different hand sanitation methods. Int J Oral Sci 1: 136142. [Google Scholar]
  22. Miles AA, Misra SS, Irwin JO, , 1938. The estimation of the bactericidal power of the blood. J Hyg (Lond) 38:732749. [Google Scholar]
  23. World Health Organisation, 2009. Hand Hygiene: Why, How & When? Geneva, Switzerland: WHO. [Google Scholar]
  24. Nilsen SK, Dahl I, Jørgensen O, Schneider T, , 2002. Micro-fibre and ultra-micro-fibre cloths, their physical characteristics, cleaning effect, abrasion on surfaces, friction, and wear resistance. Build Environ 37: 13731378. [Google Scholar]
  25. Kampf AK, Kramer A, , 2004. Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs. Clin Microbiol Rev 17: 863893. [Google Scholar]
  26. Torondel B, Opare D, Brandberg B, Cobb E, Cairncross S, , 2014. Efficacy of Moringa oleifera leaf powder as a hand-washing product: a crossover controlled study among healthy volunteers. BMC Complement Altern Med 14: 57. [Google Scholar]
  27. Rotter M, Mayhall CG, , 1999. Hand washing and hand disinfection. , ed. Hospital Epidemiology and Infection Control, 2nd edition. Philadelphia, PA: Lippincott Williams & Wilkins, 13391355. [Google Scholar]
  28. Larson EL, , 1995. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 23: 251269. [Google Scholar]
  29. Garbutt C, Simmons G, Patrick D, Miller T, , 2007. The public hand hygiene practices of New Zealanders: a national survey. N Z Med J 120: U2810. [Google Scholar]
  30. Mazure CM, Jones DP, , 2015. Twenty years and still counting: including women as participants and studying sex and gender in biomedical research. BMC Womens Health 15: 94. [Google Scholar]
  31. Institute of Medicine (US), Committee on Ethical and Legal Issues Relating to the Inclusion of Women in Clinical Studies Mastroianni AC, Faden R, Federman D, , 1994. Women’s participation in clinical studies. , eds. Women and Health Research: Ethical and Legal Issues of Including Women in Clinical Studies, Vol. 1. Washington, DC: National Academies Press (US). [Google Scholar]
  32. Yalcin SS, Yalcin S, Altin S, , 2004. Hand washing and adolescents. A study from seven schools in Konya, Turkey. Int J Adolesc Med Health 16: 371376. [Google Scholar]
  33. Anderson JL, Warren CA, Perez E, Louis RI, Phillips S, Wheeler J, Cole M, Misra R, , 2008. Gender and ethnic differences in hand hygiene practices among college students. Am J Infect Control 36: 361368. [Google Scholar]
  34. Mariwah S, Hampshire K, Kasim A, , 2012. The impact of gender and physical environment on the handwashing behaviour of university students in Ghana. Trop Med Int Health 17: 447454. [Google Scholar]
  35. Tao SY, Cheng YL, Lu Y, Hu YH, Chen DF, , 2013. Handwashing behaviour among Chinese adults: a cross-sectional study in five provinces. Public Health 127: 620628. [Google Scholar]
  36. To KG, Lee JK, Nam YS, Trinh OT, Van Do D, , 2016. Hand washing behavior and associated factors in Vietnam based on the multiple indicator cluster survey, 2010–2011. Glob Health Action 9: 29207. [Google Scholar]
  37. Tran D, Phongsavan P, Bauman AE, Havea D, Galea G, , 2006. Hygiene behaviour of adolescents in the Pacific: associations with socio-demographic, health behaviour and school environment. Asia Pac J Public Health 18: 311. [Google Scholar]
  38. Pengpid S, Peltzer K, , 2012. Hygiene behaviour and health attitudes in African countries. Curr Opin Psychiatry 25: 149154. [Google Scholar]
  39. Pengpid S, Peltzer K, , 2011. Hygiene behaviour and associated factors among in-school adolescents in nine African countries. Int J Behav Med 18: 150159. [Google Scholar]
  40. Abad FX, Pintó RM, Bosch A, , 1994. Survival of enteric viruses on environmental fomites. Appl Environ Microbiol 60: 37043710. [Google Scholar]
  41. Barclay L, Park GW, Vega E, Hall A, Parashar U, Vinjé J, Lopman B, , 2014. Infection control for norovirus. Clin Microbiol Infect 20: 731740. [Google Scholar]
  42. Balsells E, Filipescu T, Kyaw MH, Wiuff C, Campbell H, Nair H, , 2016. Infection prevention and control of Clostridium difficile: a global review of guidelines, strategies, and recommendations. J Glob Health 6: 020410. [Google Scholar]

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  • Received : 26 Oct 2018
  • Accepted : 12 Feb 2019
  • Published online : 11 Mar 2019

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