Hand hygiene is one of the simplest yet most effective ways to prevent infections. However, a systematic review published in BMJ Global Health has revealed that the lack of soap remains the most common barrier to effective handwashing across community settings.
The review found that physical barriers, such as soap and water shortages, were the most frequently reported challenges. Lack of motivation also emerged as a key issue, with many people not considering hand hygiene a priority or failing to make it a consistent habit.
Missing resources and overlooked barriers
Although many public health initiatives have tried to promote hand hygiene, the study highlighted that most interventions fail to address the root problems. Programs often focus on education or motivation without ensuring the basic resources—such as soap, clean water, and proper facilities—are in place.
“If critical hand hygiene components are missing, interventions based only on motivation, social pressure, or knowledge should be reconsidered,” the authors stressed.
The review is part of a special supplement of five systematic studies that informed new World Health Organization (WHO) and UNICEF guidelines on community hand hygiene, set to launch on October 15, Global Handwashing Day.
Gaps in knowledge and practice
One review found that while many studies assessed bacteria reduction through handwashing, only 4% focused on viruses like influenza, HIV, respiratory syncytial virus, and coronaviruses. Even fewer looked at other pathogens, including fungi and protozoa.
Knowledge gaps also persist around the use of soap alternatives such as ash and sand, optimal drying methods, and the risks posed by contaminated water.
The authors concluded that more research is urgently needed to strengthen recommendations for handwashing methods, particularly in light of viral pandemics and resource-limited environments.
Why hand hygiene matters more than ever
Joanna Esteves Mills of WHO’s Water, Sanitation, Hygiene and Health Unit provided insights in a linked commentary. She emphasized the broader impact of hand hygiene. She noted that it not only protects health but also reduces strain on health systems. This reduction lowers reliance on antibiotics. It also helps curb antimicrobial resistance.
Despite global recognition of its importance, progress has lagged. Between 2015 and 2024, around 1.6 billion people gained access to basic handwashing facilities. Yet, in 2024, 1.7 billion people still lacked soap and water at home, and 611 million had no handwashing facility at all, according to WHO and UNICEF figures.
Each year, 740,000 people die from diarrhoea or acute respiratory infections that could have been prevented through simple handwashing. Achieving universal access by 2030 would require doubling the current rate of progress worldwide. The rate of progress needs even greater acceleration in low-income and fragile countries.
Three core principles for lasting change
Evidence from all five systematic reviews highlights three fundamental principles for sustainable hand hygiene:
- Reliable access to soap, water, or alcohol-based sanitisers as a minimum requirement.
- Clear understanding of why, when, and how to wash hands.
- An enabling environment that encourages hand hygiene through convenient, attractive, and socially supported facilities.
Breaking the cycle of neglect
Mills warned that governments often mobilise quickly during outbreaks. However, they tend to cut budgets once the crisis passes. They also deprioritise hand hygiene. This “cycle of panic and neglect” leaves communities vulnerable.
To break the cycle, experts argue that governments must embed hand hygiene financing into annual health budgets. They should invest in water supply infrastructure. Additionally, they need to strengthen systems that link handwashing to wider health initiatives.
“Although cost-effective and relatively simple, hand hygiene interventions are not always low-cost,” Mills noted. “Most importantly, political leadership requires sufficient investment to deliver change.”
