“Wash Your Damn Hands”: Field Hygiene and Sanitation – Part Two, by LiquoredRabbit

If you missed Part One in the series, you can view it by clicking here.

Fun Fact:

In 1847 Ignaz Semmelweis, aka “The Father of Handwashing,” found that washing hands in a chlorinated lime solution helped to reduce mortality rates within his maternity ward from 18% to less than 1%. These findings were outright rejected by the current physicians of the time. He was eventually sent off to a sanitarium after causing a lot of friction within the medical community. Upon his death within the facility, an autopsy showed he died from the same disease that hand washing would have stopped.

What does it do?

Throughout our lives, we have been harassed about washing our hands. From the grade-school teacher asking if you counted to 20 while you washed, to the OSHA posters that are on every vertical surface imaginable, we are constantly reminded of this simple task all day. Hell, sometimes it seems like we are supposed to wash our hands, before washing our hands. The biggest reason is because of how highly effective handwashing is when removing sources of infection and chemical irritants from the skin. As we go through our day, we never fully consider how many things we directly contact, and each time we do, we leave some remnants behind from where we have been. This is no different in the field environment, passing around plates at the table or camp cups, even using the same hand tools can cause transmission of microbes or irritants from one person to another. The main question to ask is “If this is so important now, with all the resources we have, how much more important is it when all those resources are no longer available.” Washing your hands exponentially becomes more important as it is the main stopgap in preventing many further medical issues while using the least amount of resources possible. Sometimes if you know you have handled chemicals or been exposed to an environmental irritant it’s good to clean off even before using the latrine. I had an instance where a couple of people had a lapse of judgment while clearing some brush. After being told, “You’ll need to wash up before doing anything, even hitting the latrine,” was met with “We aren’t idiots, we got this.” All in all, that lead them back for an evaluation for getting poison ivy all over, even in those delicate parts. Those guys were out for about 10 days and used up all the Calamine lotion I had in stock. Luckily, I had a great supply chain to send me more.

Why does it work?

Washing relies on the friction of scrubbing to remove the microbes and irritants from your hands. Soap aids in the process by breaking the surface tension of the water allowing dirt, grime, and oils to be removed easier than just water alone. Water by itself can be used, but with reduced effectiveness and it will not remove oils effectively at all.

Some factors that have not shown any notable change in effectiveness are the temperature of the water, the amount of soap used, and the use of antibacterial soap. The temperature of the water only seemed to influence how dry the skin was, as the temperature increased, so did the damage to the hands. If your hands do feel dry, using lotion is encouraged to prevent damage to the skin and reduce the risk of small open wounds that may result from dryness. Testing also found that any amount of soap used resulted in the same amount of positive effectiveness from just under a couple of drops (0.5ml), to almost a palm full (2ml). So there is no need to waste extra resources. Finally, the use of anti-bacterial soap is no better than any other soap and may have negative effects by disrupting the natural good bacteria that help to defend you. Its gross overuse has also been connected to a rise in antibiotic-resistant bacteria, so it’s better to just use the regular stuff, or maybe even splurge a little for the extra boujee soap with lotion in it, no problems with that either.

The cleanliness of the water does have a strong effect on how effective handwashing is. Clean drinking water will always provide the best results, but if water resources are low an effective substitute can be to use gray water. This is water that has been previously used, for example in a sink or a shower but the water does not contain any harsh chemicals or excrement. Though this is only advised in dire straits it is better than nothing, but it will never be as effective as using potable drinking water.

The last main and largest factor is that washing is still the personal responsibility of the individual, no one is going to/ can do it for you, plus that’s creepy as hell. Do your whole camp a favor, be an adult and just wash your damn hands.

Does Hand Sanitizer do anything?

Yes, and it has its place when trying to keep a camp clean and healthy. It does a good job of killing many types of microbes from your hands, but it doesn’t kill everything. Also, it does have some other limitations that make it less effective than conventional handwashing. Specifically, it only kills the germs, but does not remove them like washing does, so the dead microbes are still there. That doesn’t mean it is not a decent fill-in as it uses no water, and as long as the alcohol content is above 60% the solution will work as intended. It is also convenient, as most containers are small pocket-sized ones that can be used often.  So though hand sanitizer does have some limitations it is a good fill-in if water resources may get low.

What types of handwashing stations are available?

Just like many things in field sanitation, there are endless ways to set up appropriate facilities. The main things to keep in mind are the initial placement, where the wastewater will go, and the ease of use.

Going back to our story about John, there are two main points of correction when talking about his handwashing regiment. One, of course, deciding not to wash due to the station not having any water. While the other correction is that there should have been a handwash station at the latrine as well. This change would have limited most microbe transmissions as people would have the opportunity to wash before even leaving the latrine area, because of the convenient placement of the facility. The locations that would make the most difference would be:

1. Right outside the latrine/urinal,
2. Where any meals are served,
3. Where any food is prepared or cooked.

Granted having more facilities in more locations is good, but there is a diminishing return, which depends on the resources and manpower available to construct and continuously maintain them. While looking for the right locations keep in mind that the wastewater will have to go somewhere as well. In this example, porous soil is right under the station which helps drain away the used water. In other instances, it might need to be moved to the appropriate drainage area. Make sure that your drainage/ soakage pit should not be near any sources of water  This can be done manually emptied via a bucket or a hose routed to the drainage area. Just don’t forget that if it must be manually emptied that’s one more job that needs to be done around the camp, so if resources allow make it easier on yourselves and try to eliminate that responsibility with some clever engineering.

For additional planning purposes, you need to think of how much water will be used. A good place to start using 1.5 cups per wash, with a minimum of 5 washes per day, per person. So that would be just under ½ a gallon (0.47gal) a day per person. Some ways to lower the amount of water used is by using a narrower spout and turning the water off while lathering. You will need enough per-use to initially wet your hands, and fully rinse them so don’t make the amount too small.

I have included many other designs that might help to get some ideas. Just remember there are a ton of ways to do this, so keep an open mind and don’t use too many resources to build these. They need to be simple to use, dispense the right amount of water needed, and the wastewater needs to have a place to go. With these simple requirements, these wash stations are the first big step in keeping disease away from your camp.

Citations:

Burton, M., Cobb, E., Donachie, P., Judah, G., Curtis, V., & Schmidt, W.-P. (2011). The effect of handwashing with water or soap on bacterial contamination of hands. International Journal of Environmental Research and Public Health, 8(1), 97–104. https://doi.org/10.3390/ijerph8010097

Deborah, Bensen. (2023, February 13). What is a tippy tap hand washing device? : Healing waters. Healing Waters International. https://healingwaters.org/what-is-a-tippy-tap-hand-washing-device/

Gordis L. (2014) The epidemiological approach to disease and intervention. In: Gordis L, editor. Epidemiology, 5th edn. Saunders: Elsevier.

Headquarters, Dept. of the Army (2023) Army Water Planning Guide

Headquarters, Dept. of the Army (2014, April) Unit Field Sanitation Teams ATP 4-15.12

Headquarters, Dept. of the Army (2000) Preventive medicine services FM4-02.17

Mayo Foundation for Medical Education and Research. (2021, December 10). The right way to wash your hands. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/hand-washing/art-20046253

Petruzzello, M. (Invalid Date). How Does Soap Work? Encyclopedia Britannica. https://www.britannica.com/story/how-does-soap-work

Yu, J. J., Manus, M. B., Mueller, O., Windsor, S. C., Horvath, J. E., & Nunn, C. L. (2018). Antibacterial soap use impacts skin microbial communities in rural Madagascar. PLOS ONE, 13(8). https://doi.org/10.1371/journal.pone.0199899

Zoltán, I. (Invalid Date). Ignaz Semmelweis. Encyclopedia Britannica. https://www.britannica.com/biography/Ignaz-Semmelweis