Ansari SA, Springthorpe VS, Sattar SA, Rivard S, Rahman M, 1991. Potential role of hands in the spread of respiratory viral infections: studies with human parainfluenza virus 3 and rhinovirus 14. J Clin Microbiol 29: 2115–2119.
WHO , 2020. The Top 10 Causes of Death. Available at: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death. Accessed April 26, 2022.
Boone SA, Gerba CP, 2007. Significance of fomites in the spread of respiratory and enteric viral disease. Appl Environ Microbiol 73: 1687–1696.
Aiello AE, Coulborn RM, Perez V, Larson EL, 2008. Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis. Am J Public Health 98: 1372–1381.
Rabie T, Curtis V, 2006. Handwashing and risk of respiratory infections: a quantitative systematic review. Trop Med Int Health 11: 258–267.
WHO Handwashing an Effective Tool to Prevent COVID-19, Other Diseases. Available at: https://www.who.int/southeastasia/news/detail/15-10-2020-handwashing-an-effective-tool-to-prevent-covid-19-other-diseases. Accessed February 3, 2022.
CDC , 2022. How to Protect Yourself and Others. Available at: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html. Accessed February 3, 2022.
WHO World Hand Hygiene Day. Available at: https://www.who.int/campaigns/world-hand-hygiene-day. Accessed May 11, 2022.
WHO Handwashing and Handwashing Alternatives. COVID-19 in the Philippines. Available at: https://www.who.int/philippines/emergencies/covid-19-response-in-the-philippines/information/handwashing. Accessed February 16, 2022.
Nath KJ, Bloomfield SF, 2009. Use of Ash and Mud for Handwashing in Low Income Communities. International Scientific Forum on Home Hygiene. Available at: https://www.ifh-homehygiene.org/review-best-practice/use-ash-and-mud-handwashing-low-income-communities. Accessed February 13, 2022.
Nizame FA, Nasreen S, Halder AK, Arman S, Winch PJ, Unicomb L, Luby SP, 2015. Observed practices and perceived advantages of different hand cleansing agents in rural Bangladesh: ash, soil, and soap. Am J Trop Med Hyg 92: 1111–1116.
Kivuti-Bitok LW, Chepchirchir A, Waithaka P, Ngune I, 2020. Dry taps? A synthesis of alternative “wash” methods in the absence of water and sanitizers in the prevention of coronavirus in low-resource settings. J Prim Care Community Health 11: 2150132720936858.
Anuradha P, Devi PY, Prakash MS, 1999. Effect of handwashing agents on bacterial contamination. Indian J Pediatr 66: 7–10.
Hoque BA, Mahalanabis D, Alam MJ, Islam MS, 1995. Post-defecation handwashing in Bangladesh: practice and efficiency perspectives. Public Health 109: 15–24.
Paludan-Müller AS, Boesen K, Klerings I, Jørgensen KJ, Munkholm K, 2020. Hand cleaning with ash for reducing the spread of viral and bacterial infections: a rapid review. Cochrane Database Syst Rev 2020: CD013597.
Ijaz MK, Nims RW, de Szalay S, Rubino JR, 2021. Soap, water, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): an ancient handwashing strategy for preventing dissemination of a novel virus. PeerJ 9: e12041.
U.S. FDA , 2015. Safety and Effectiveness of Health Care Antiseptics; Topical Antimicrobial Drug Products for Over-the-Counter Human Use; Proposed Amendment of the Tentative Final Monograph; Reopening of Administrative Record. Federal Register. Available at: https://www.federalregister.gov/documents/2015/05/01/2015-10174/safety-and-effectiveness-of-health-care-antiseptics-topical-antimicrobial-drug-products-for. Accessed April 10, 2022.
Jensen DA, Macinga DR, Shumaker DJ, Bellino R, Arbogast JW, Schaffner DW, 2017. Quantifying the effects of water temperature, soap volume, lather time, and antimicrobial soap as variables in the removal of Escherichia coli ATCC 11229 from hands. J Food Prot 80: 1022–1031.
Wolfe MK, Gallandat K, Daniels K, Desmarais AM, Scheinman P, Lantagne D, 2017. Handwashing and Ebola virus disease outbreaks: a randomized comparison of soap, hand sanitizer, and 0.05% chlorine solutions on the inactivation and removal of model organisms Phi6 and E. coli from hands and persistence in rinse water. PLoS One 12: e0172734.
Tuladhar E, Hazeleger WC, Koopmans M, Zwietering MH, Duizer E, Beumer RR, 2015. Reducing viral contamination from finger pads: handwashing is more effective than alcohol-based hand disinfectants. J Hosp Infect 90: 226–234.
Grayson ML, Melvani S, Druce J, Barr IG, Ballard SA, Johnson PDR, Mastorakos T, Birch C, 2009. Efficacy of soap and water and alcohol‐based hand‐rub preparations against live H1N1 influenza virus on the hands of human volunteers. Clin Infect Dis 48: 285–291.
Ansari SA, Sattar SA, Springthorpe VS, Wells GA, Tostowaryk W, 1989. In vivo protocol for testing efficacy of hand-washing agents against viruses and bacteria: experiments with rotavirus and Escherichia coli. Appl Environ Microbiol 55: 3113–3118.
Burton M, Cobb E, Donachie P, Judah G, Curtis V, Schmidt W-P, 2011. The effect of handwashing with water or soap on bacterial contamination of hands. Int J Environ Res Public Health 8: 97–104.
NASA Anthropometry and Biomechanics. Man-Systems Integration Standards. Available at: https://msis.jsc.nasa.gov/sections/section03.htm. Accessed February 28, 2022.
Water Resources City of Palo Alto. Available at: https://www.cityofpaloalto.org/Departments/Utilities/Utilities-Services-Safety/Water-Resources. Accessed January 18, 2022.
Baker KK et al., 2014. Association between moderate-to-severe diarrhea in young children in the Global Enteric Multicenter Study (GEMS) and types of handwashing materials used by caretakers in Mirzapur, Bangladesh. Am J Trop Med Hyg 91: 181–189.
Anderson CE, Boehm AB, 2021. Transfer rate of enveloped and nonenveloped viruses between fingerpads and surfaces. Appl Environ Microbiol 87: e01215-21.
Julian TR, Leckie JO, Boehm AB, 2010. Virus transfer between fingerpads and fomites. J Appl Microbiol 109: 1868–1874.
. U.S. Environmental Protection Agency , 2001. Method 1602: Male-Specific (F+) and Somatic Coliphage in Water by Single Agar Layer (SAL) Procedure EPA 821-R-01-029. Washington, DC: Office of Water, Engineering and Analysis Division.
Pitol AK, Bischel HN, Boehm AB, Kohn T, Julian TR, 2018. Transfer of enteric viruses adenovirus and coxsackievirus and bacteriophage MS2 from liquid to human skin. Appl Environ Microbiol 84: e01809-18.
Sickbertbennett E, Weber D, Gergenteague M, Sobsey M, Samsa G, Rutala W, 2005. Comparative efficacy of hand hygiene agents in the reduction of bacteria and viruses. Am J Infect Control 33: 67–77.
Halliday E, Gast RJ, 2011. Bacteria in beach sands: an emerging challenge in protecting coastal water quality and bather health. Environ Sci Technol 45: 370–379.
Solo-Gabriele HM et al., 2016. Beach sand and the potential for infectious disease transmission: observations and recommendations. J Mar Biol Assoc U K 96: 101–120.
Chamorey E et al., 2011. A prospective multicenter study evaluating skin tolerance to standard hand hygiene techniques. Am J Infect Control 39: 6–13.
Davies J, 1993. Preliminary study of test methods to assess the virucidal activity of skin disinfectants using poliovirus and bacteriophages. J Hosp Infect 25: 125–131.
Iqbal Q, Lubeck-Schricker M, Wells E, Wolfe MK, Lantagne D, 2016. Shelf-life of chlorine solutions recommended in Ebola virus disease response. PLoS One 11: e0156136.
Trevett AF, Carter RC, Tyrrel SF, 2004. Water quality deterioration: a study of household drinking water quality in rural Honduras. Int J Environ Health Res 14: 273–283.
|Past two years||Past Year||Past 30 Days|
|Full Text Views||69||69||2|
The WHO recommends handwashing with soap and water for 20–40 seconds. In settings where soap is not available, ash or sand is used for handwashing, yet their efficacy as handwashing materials is underresearched. The purpose of this study was to quantify the removal of viruses using ash and sand as handwashing agents, and compare their efficacy to commonly recommended handwashing methods. We performed a volunteer study to estimate the log reduction value (LRV) of model viruses Phi6 and MS2 on hands after six handwashing conditions: two handwashing agents (ash and water, and sand and water) with two time points (5 and 20 seconds), and two handwashing agents (soap and water, and water only) with one time point (20 seconds). Plaque assays were used to measure infectious virus reduction. Handwashing with any of the handwashing agents for 20 seconds resulted in a greater LRV than the 2-log reduction U.S. Food and Drug Administration criteria for both viruses. Soap and water resulted in a significantly greater LRV (2.7–4.8) than washing with ash and water (2.0–2.8) or sand and water (1.8–2.7) for 5 seconds for both viruses, and water only resulted in a significantly higher LRV (2.8) than all ash (2.0–2.6) and sand (1.8–2.4) conditions for MS2 only. These results suggest that using ash or sand as handwashing agents can be efficacious in reducing viruses but may be less efficacious than soap, especially when used for shorter durations. Further research should investigate the use of ash and sand as handwashing agents in real-world settings.
Financial support: This study was made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents are the responsibility of the coauthors and do not necessarily reflect the views of the USAID or the United States Government.
Data availability: Zambrana W, Tong J, Anderson C, Boehm A, Wolfe M, 2022. Data on quantifying the viral reduction achieved using ash and sand as handwashing agents. Stanford Digital Repository. Available at: https://purl.stanford.edu/bb708mf8734.
Authors’ addresses: Winnie Zambrana, Jingyan Tong, Claire E. Anderson, and Alexandria B. Boehm, Department of Civil and Environmental Engineering, Stanford University, Stanford, CA, E-mails: firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, and email@example.com. Marlene K. Wolfe, Department of Civil and Environmental Engineering, Stanford University, Stanford, CA, and Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, E-mail: firstname.lastname@example.org.