Handwashing Facts

Key facts

People often get sick when they make contact with germs from feces (poop) on their hands

Feces (poop) from people or animals is an important source of germs like Salmonella, E. coli O157, and norovirus that cause diarrhea, and it can spread some respiratory infections like adenovirus and hand-foot-mouth disease. These kinds of germs can get onto hands after people use the toilet or change a diaper, but also in less obvious ways, like after handling raw meats that have invisible amounts of animal poop on them. A single gram of human feces—which is about the weight of a paper clip—can contain one trillion germs. Germs can also get onto hands if people touch any object that has germs on it because someone coughed or sneezed on it or was touched by some other contaminated object. When these germs get onto hands and are not washed off, they can be passed from person to person and make people sick.

Washing hands prevents illnesses and spread of infections to others

Handwashing with soap removes germs from hands. This helps prevent infections because:

• People frequently touch their eyes, nose, and mouth without even realizing it. Germs can get into the body through the eyes, nose and mouth and make us sick.
• Germs from unwashed hands can get into foods and drinks while people prepare or consume them. Germs can multiply in some types of foods or drinks, under certain conditions, and make people sick.
• Germs from unwashed hands can be transferred to other objects, like handrails, tabletops, or toys, and then transferred to another person's hands.

Teaching people about handwashing helps them and their communities stay healthy. Handwashing education in the community:

• Reduces the number of people who get sick with diarrhea by 23-40%
• Reduces diarrheal illness in people with weakened immune systems by 58%
• Reduces respiratory illnesses, like colds, in the general population by 16-21%
• Reduces absenteeism due to gastrointestinal illness in schoolchildren by 29-57%

Not washing hands harms children around the world

About 1.8 million children under the age of 5 die each year from diarrheal diseases and pneumonia, the top two killers of young children around the world.

• Handwashing with soap could protect about 1 out of every 3 young children who get sick with diarrhea, and almost 1 out of 5 young children with respiratory infections like pneumonia.
• Although people around the world clean their hands with water, very few use soap to wash their hands. Washing hands with soap removes germs much more effectively.
• Handwashing education and access to soap in schools can help improve attendance.
• Good handwashing early in life may help improve child development in some settings.
• Estimated global rates of handwashing after using the toilet are only 19%.

Handwashing helps battle the rise in antibiotic resistance

Preventing sickness reduces the amount of antibiotics people use and the likelihood that antibiotic resistance will develop. Handwashing can prevent about 30% of diarrhea-related sicknesses and about 20% of respiratory infections (e.g., colds). Antibiotics often are prescribed unnecessarily for these health issues. Reducing the number of these infections by washing hands frequently helps prevent the overuse of antibiotics—the single most important factor leading to antibiotic resistance around the world. Handwashing can also prevent people from getting sick with germs that are already resistant to antibiotics and that can be difficult to treat.

Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap

Why? Because hands could become re-contaminated if placed in a basin of standing water that has been contaminated through previous use, clean running water should be used. However, washing with non-potable water when necessary may still improve health. The temperature of the water does not appear to affect germ removal; however, warmer water may cause more skin irritation and is more environmentally costly.

Turning off the faucet after wetting hands saves water, and there are few data to prove whether significant numbers of germs are transferred between hands and the faucet.

Using soap to wash hands is more effective than using water alone because the surfactants in soap lift soil and microbes from skin, and people tend to scrub hands more thoroughly when using soap, which further removes germs.

To date, studies have shown that there is no added health benefit for consumers (this does not include professionals in the healthcare setting) using soaps containing antibacterial ingredients compared with using plain soap. As a result, FDA issued a final rule in September 2016 that 19 ingredients in common "antibacterial" soaps, including triclosan, were no more effective than non-antibacterial soap and water and thus these products are no longer able to be marketed to the general public. This rule does not affect hand sanitizers, wipes, or antibacterial products used in healthcare settings.

Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and under your nails.

Why? Lathering and scrubbing hands creates friction, which helps lift dirt, grease, and microbes from skin. Microbes are present on all surfaces of the hand, often in particularly high concentration under the nails, so the entire hand should be scrubbed.

Scrubbing your hands for at least 20 seconds removes more germs from hands than washing for shorter periods

Why? Determining the optimal length of time for handwashing is difficult because few studies about the health impacts of altering handwashing times have been done. Of those that exist, nearly all have measured reductions in overall numbers of microbes, only a small proportion of which can cause illness, and have not measured impacts on health. Solely reducing numbers of microbes on hands is not necessarily linked to better health. The optimal length of time for handwashing is also likely to depend on many factors, including the type and amount of soil on the hands and the setting of the person washing hands. For example, surgeons are likely to come into contact with disease-causing germs and risk spreading serious infections to vulnerable patients, so they may need to wash hands longer than someone preparing their own lunch at home. Nonetheless, evidence suggests that washing hands for about 15-30 seconds removes more germs from hands than washing for shorter periods.

Accordingly, many countries and global organizations have adopted recommendations to wash hands for about 20 seconds (some recommend an additional 20-30 seconds for drying):

• The Benefits of Hand Washing
• New Zealand. Step-by-Step Guide to Hand Washing
• The Global Handwashing Partnership. Why Handwashing?
• World Health Organization. Guidelines on Hygiene in Health Care: A Summary

Rinsing your hands well under clean, running water helps remove soap

Why? Soap and friction help lift dirt, grease, and microbes—including disease-causing germs—from skin so they can then be rinsed off of hands. Rinsing the soap away also minimizes skin irritation. Because hands could become re-contaminated if rinsed in a basin of standing water that has been contaminated through previous use, clean running water should be used. While some recommendations include using a paper towel to turn off the faucet after hands have been rinsed, this practice leads to increased use of water and paper towels, and there are no studies to show that it improves health.

Your hands should be as dry as possible after handwashing

Why? Germs can be transferred more easily to and from wet hands; therefore, hands should be dried after washing. However, the best way to dry hands remains unclear because few studies about hand drying exist, and the results of these studies conflict. Additionally, most of these studies compare overall concentrations of microbes, not just disease-causing germs, on hands following different hand-drying methods. Nonetheless, studies suggest that using a clean towel or air-drying hands are best.