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The curious culture of handwashing around the world

Photo shows handwashing or bathing

In the western world, we take for granted access to soap and the hygiene education responsible for our daily handwashing regime. A combination of globalisation and healthcare are driving the interest in handwashing culture around the world, with encouragement to adopt the western approach, especially in food handling and healthcare.

Regular handwashing with soap is promoted as an effective approach to disease prevention. There’s even a day devoted to it! Global Handwashing Day was set up in 2008 at the annual World Water Week in Stockholm. The Global Public-Private Partnership for Handwashing with Soap (PPPHW) established Global Handwashing Day to promote a global and local vision of handwashing with soap. The campaign was initiated to help reduce child mortality rates and related respiratory and diarrhoeal diseases.

Suitably equipped bathrooms and running water are things we in the Western World take for granted. With many of his youthful years spent travelling the continents, author Mike James is all too aware of the varying levels of sanitation and cultural solutions. Working with information available with the Bathroom Discount Centre, he was curious to know more about handwashing traditions from around the world and has delved deep enough to put together some of the most interesting facts. And it’s not all about hand hygiene. There are many religious and cultural issues entrenched in handwashing traditions from all corners of the globe. It’s a fascinating topic.

Globalisation, healthcare and hand hygiene

There’s a complex association between religion, culture and healthcare, and population movement is having a huge impact on our approach to healthcare in the Western hemisphere. Unicultural care is now no longer applicable in many countries, and cultural awareness has become a crucial aspect of implementing good clinical practice.

According to a patient safety leaflet by the World Health Organisation (WHO), thousands of people around the world die every day from infections acquired through healthcare. It’s the reason the global handwashing campaign was started. It’s not as straightforward though as it first appears. Many cultural and religious traditions involve handwashing rituals, so it’s easy to see why implementing handwashing techniques purely for hygiene and disease prevention may be meeting some resistance.

Generally, handwashing can be practised for hygienic reasons, religious rituals or symbolic beliefs. According to a 2008 study conducted by the WHO, hand hygiene is strongly influenced by religious faith and potentially affects compliance.

The religious and cultural aspects of hand hygiene

If we are to adopt a universal approach to healthcare hygiene, handwashing customs need to transcend religion, culture and place. The evidence overwhelmingly supports the need for hand hygiene amongst healthcare workers whatever their environment, religion or cultural background. But, the issue of implementing hand hygiene into some religious and cultural societies needs sensitive consideration.

Hand hygiene in the foodservice industry is also of paramount importance. Regular handwashing is the most effective defence against the spread of foodborne illness.

As recommended by the World Health Organisation, strategies for hand hygiene need to take into consideration religious and cultural issues. WHO argues “it is clear that cultural – and to some extent, religious – factors strongly influence attitudes to inherent community handwashing which, according to behavioural theories are likely to have an impact on compliance with hand cleansing during health care.”

Alcohol-based rubs are the norm in the Western world, but alcohol is a potential problem for some faiths. Although the Qur’an (the holy text of Muslims) forbids the use of alcohol, it permits the use of any manmade substance to help in illness or to improve health. This includes the use of alcohol for disinfection.

Judaism and handwashing

In Temple times the washing of hands was adopted as a ritual before going to the altar to offer a sacrifice. It was symbolic of washing away impurity. When the Temple was destroyed, the table in the home became symbolic of the altar and bread became symbolic of the sacrifice offered at the altar. The practice of washing hands became a ritual. This ritual washing is not actually an act of physical cleanliness and is only required before a meal at which bread is eaten.

Islam, the Qur'an and handwashing

Islam places great emphasis on spiritual and physical cleanliness and purification. The Qur'an offers specific advice on how and when hand cleansing should occur, including prior to prayer (five times a day), before and after eating, after using the toilet, after touching a dog, a cadaver or shoes, and after touching anything that is soiled. If there is no water available, then the Qur’an permits cleansing with clean earth.

The ritual washing before prayer is called Wudhu. It involves washing of the hands, mouth, nasal passage, face forearms and feet, and wiping the head and beard. Ghusi is ritual bathing. Clean, soap-free water must run all over the body. It is an immediate obligation following sexual discharge, menstrual discharge, after contact with a dog’s saliva or touching a wet dog’s coat.

Culture and ancient tradition in some African countries

In some West African countries, hand hygiene is practised in accordance with ancient traditions. Hands must be washed before anything is raised to one’s lips. It is also customary to leave a bowl of water with special leaves outside the house, allowing visitors to wash their hands and face before any enquiry is made about the reason they are visiting.

Handwashing is a fascinating and complex tradition, not just attributable to personal hygiene and as a means of preventing the spread of disease. There are many traditions all over the world that incorporate handwashing as ritual, respectful custom and as a result of ancient practices.

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