As Covid-19 dissipates, what lessons in hand hygiene can we take going forward?

During the recently concluded 18th National Dialogue Council (Umushyikirano), much was discussed about health and hygiene in Rwanda. The Minister of Health reminded the country that the correlation between health and hygiene in Rwanda is strong and significant. Poor hygiene practices can lead to the spread of diseases, infections, and illnesses, which can have a negative impact on individual and public health. Poor sanitation is a strong and major contributor to poor hygiene and health outcomes. Improving hygiene practices, including hand-washing, proper waste disposal, and access to clean water and sanitation facilities, can have a significant positive impact on health outcomes. We are also aware that there are several simple and cheap community-led public health interventions such as hand washing, provision of safe and clean water, community education, and awareness that can be implemented at a low cost and have a significant impact on improving hygiene and health outcomes Similar to other low-and-middle-income countries, the Government of Rwanda identified many cost-effective public interventions to respond to Covid-19. Although social life saw many restrictive interventions that may have had extensive consequences on the daily lives of many, other simple interventions were also promoted. One of the key interventions during the Covid-19 response was hand hygiene. Regular hand hygiene, including washing hands with soap and water or using an alcohol-based hand sanitiser helped reduce the spread of Covid-19. The World Health Organization recommended washing hands frequently with soap and water for at least 20 seconds, particularly before eating, after using the toilet, and after being in a public place. This was a cheap but powerful intervention. Although the virus continues to circulate, there has been a marked reduction in the number of cases in recent times and life seems to return to normal for many. But as masks come off, schools, businesses, and other institutions reopen, and travel resumes, we should expect a resurgence of certain old Pre-Covid-19 unhygienic habits in the community. As people become more complacent or tired of pandemic precautions, the importance of hand hygiene may suffer. It’s important for the community to remember that hand washing is a critical component in preventing the spread of disease, and not just Covid-19. Despite the closing window on the Covid-19 pandemic where people may inadvertently become complacent, Rwanda could take many lessons going forward and use the existing Covid-19 infrastructure and strategies to go within and beyond the pandemic. There is a lot of empirical evidence that shows improved hand hygiene practices during the pandemic likely led to a decrease in other diseases as well. Many infectious diseases like diarrhoeal diseases especially in children, common cold flu, skin infections, and others are transmitted when people touch contaminated surfaces, and regular hand washing is a simple answer to that. Rwanda can have a sustainable hand-washing culture by learning from the pandemic. The pandemic has highlighted the importance of hand hygiene as a key measure to prevent the spread of infectious diseases, including Covid-19. We should aim to build on the awareness and habits developed during the pandemic to create a culture of hand washing that is sustained beyond the pandemic. We have an opportunity to maintain and use existing hand-washing facilities that were present in the community. Regular maintenance and cleaning of these hand-washing facilities will help ensure they remain functional and attractive to Rwandans. Governments and other organisations can invest in ongoing maintenance programmes to keep facilities in good condition. More importantly, we should look towards continued local ownership of these facilities and ensure they are well-maintained and used. Schools, small businesses, places of prayer, workplaces, and all other public places that already have these permanent structures should ensure that washing remains a regular part of daily lives as it has been in the past two years. Currently, there is a worrying trend that shows that sanitising and handwashing in public places are soon to be things of the past. One can clearly see the kandagira ukarabe (foot pump sink) is now dry, dusty, and abandoned. All the once shiny new sinks that sprouted everywhere are coated in dust showing their use is now sporadic or they are no longer in use. Our great practice of hand washing is dying! We are missing out on this life-saving opportunity. Dr Vincent Mutabazi is an applied epidemiologist. Twitter: @VkneeM

Opinions

As Covid-19 dissipates, what lessons in hand hygiene can we take going forward?