Efficacy of Waterless Hand Hygiene Compared with Handwashing with Soap: A Field Study in Dar es Salaam, Tanzania

Amy J. Pickering Emmett Interdisciplinary Program in Environment and Resources, School of Earth Sciences and Civil and Environmental Engineering, and Woods Institute for the Environment, Stanford University, Stanford, California; Population Services International, Dar es Salaam, Tanzania

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Alexandria B. Boehm Emmett Interdisciplinary Program in Environment and Resources, School of Earth Sciences and Civil and Environmental Engineering, and Woods Institute for the Environment, Stanford University, Stanford, California; Population Services International, Dar es Salaam, Tanzania

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Mathew Mwanjali Emmett Interdisciplinary Program in Environment and Resources, School of Earth Sciences and Civil and Environmental Engineering, and Woods Institute for the Environment, Stanford University, Stanford, California; Population Services International, Dar es Salaam, Tanzania

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Jennifer Davis Emmett Interdisciplinary Program in Environment and Resources, School of Earth Sciences and Civil and Environmental Engineering, and Woods Institute for the Environment, Stanford University, Stanford, California; Population Services International, Dar es Salaam, Tanzania

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Effective handwashing with soap requires reliable access to water supplies. However, more than three billion persons do not have household-level access to piped water. This research addresses the challenge of improving hand hygiene within water-constrained environments. The antimicrobial efficacy of alcohol-based hand sanitizer, a waterless hand hygiene product, was evaluated and compared with handwashing with soap and water in field conditions in Dar es Salaam, Tanzania. Hand sanitizer use by mothers resulted in 0.66 and 0.64 log reductions per hand of Escherichia coli and fecal streptococci, respectively. In comparison, handwashing with soap resulted in 0.50 and 0.25 log reductions per hand of E. coli and fecal streptococci, respectively. Hand sanitizer was significantly better than handwashing with respect to reduction in levels of fecal streptococci (P = 0.01). The feasibility and health impacts of promoting hand sanitizer as an alternative hand hygiene option for water-constrained environments should be assessed.

Author Notes

*Address correspondence to Jennifer Davis, The Jerry Yang and Akiko Yamazaki Environment and Energy Building, Stanford University, 473 Via Ortega, Room 255, MC 4020, Stanford, CA 94305. E-mail: jennadavis@stanford.edu

Financial support: This study was supported by the American Public Health Association International Health Section Award Program (sponsored by the Colgate-Palmolive Company, 2008). GOJO Industries supplied the hand sanitizer product tested in this investigation.

Authors' addresses: Amy J. Pickering, Alexandria B. Boehm, and Jennifer Davis, The Jerry Yang and Akiko Yamazaki Environment and Energy Building, Stanford University, Stanford, CA, E-mails: amyjanel@stanford.edu, aboehm@stanford.edu, and jennadavis@stanford.edu. Mathew Mwanjali, Population Services International, Dar es Salaam, Tanzania, E-mail: mmwanjali@psi.or.tz.

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