Hand washing is the single most effective and inexpensive way to prevent diarrhea and acute respiratory infections, as automatic behavior performed in homes, schools, and communities worldwide [1]. A simple and proper method of washing hands is found to eliminate over 90% of infections. On October 2, 2014 Indian public received a shocker “Launch of Swachh Bharat Abhiyaan” by none less than the prime minister of India, to fulfil Mahatma Gandhi’s vision of “Clean India” and invited many public figures to contribute to this national campaign. Amongst these included cleaning the environment, construction of pubic latrines and hand hygiene to name a few [2]. Many of these practices look very simply yet are of major importance and ultimate to improve the healthcare in India [3]. 

The Global Hand washing Day took place for the first time on October 15, 2008, the date appointed by UN General Assembly in accordance with year 2008 as the International Year of Sanitation. An ounce of prevention is worth a pound of cure. Thus, this study was carried out to see the perception and practices of handwashing in a hilly city of Shimla.

Objective of the study is to assess the perception and practices of handwashing in Shimla city.

Study Population

Population residing in all 34 wards under Municipal corporation area of Shimla City.

Sample Size

Sampling unit was households in the Municipal corporation area of Shimla city. Sample size is estimated to be 640 expecting 50% of households having adequate knowledge of WASH and solid waste management with 95% level of confidence, design effect 1.5 and 5% confidence interval and non-response rate of 5%. 

Sampling Design

Stratified random Sampling was done for the selection of Households for survey. We equally   divided   the   household in all 34 wards of Shimla city. (18-19 households per municipal ward in Shimla city). First household of the ward was selected randomly and then every 10th household was selected to complete the sample size in the respective ward. An effort was made to have a balance of males and females, as well as to involve some younger persons as respondents, but this was dependent on cultural and other sensitivities when the household members are approached

Data Collection

The data collectors obtained consent from the head of Family and Pretested Standardized Questionnaire administered in every selected household, and the respondents (who willing to participate) were asked questions regarding handwashing perception and practices. Only one adult member per household was selected for data collection.

        The data was collected to obtain information on following parameters;

• Socio demographic profile 

• Perception and knowledge about hand washing

• Practices about handwashing

Inclusion Criteria

Any adult person (only One per household) in selected household who was willing to participate in the study and had given consent.

Exclusion Criteria

Person who didn’t give consent and decline to answer the questions was excluded from the study

In the present study the A total of 640 households were selected for the survey. 

8-25 households per ward according to the population and further   consent   given     by    the    people  in   that ward.

Figure 1: Perceptions regarding handwashing

In the study maximum 71.7% respondents were females, 97% were Hindus, 93.1% were literate and 37.7% were employed or working.

Perception of handwashing was regarded as very important by 76% of the respondents and 21% regarded it as important and only 3% regarded it as slightly important (Table and Figure 1).

Regarding practices of handwashing 97.8% respondents wash their hands 5 or more times in a day, 79.22 % respondents used water and soap for hand washing, 75.6% used clean towel after handwashing,74.7% spent 15-20 second for hand wash, 70.9% own a sanitizer, 18.8% respondent sometimes running out of water for handwash (Table 2).

Table 1: Perception about Hand-washing (n=640)

Table2: Hand washing practices in households (n=640)

In this study it was found that majority considered hand washing as very important mean to maintain hygiene and curb diseases. 

Hand washing practices in our study were similar to the public hand hygiene practices of New Zealanders: a national survey  in which Soap was used by 71.6%for hand washing and, in our study, it was 79 %.

As for hand washing practices are concerned most people (80%) in the study area use water and soap for hand washing 9 % wash hands with only water and only 0.5% use ash with water. Similar hand washing practices are being followed in other parts of the country as seen in study by Ray et al. [4]. on Hand washing practices in and around Kolkata west Bengal respondents interviewed practiced hand washing after defecation either with soap (59%) or with plain water, ash & mud. Another study named Hand Washing Practices in Two Communities of Two States of Eastern India also found similar hand washing practices which included washing hands with soap, mud and ash. The study also pointed out that majority washed hands for time period well below than the recommended 30 seconds. In our study nearly 74% of the respondents practiced hand washing for the recommended duration of 15-30 sec.

Regarding frequency of hand washing 97% of respondents washed their hands 5 to more than 5 times in a day. In a study conducted Beale et al.  [5] all on hand hygiene practices and COVID-19 infection also found that moderate-frequency handwashing (6-10 times per day) predicted a lower personal risk of infection. It was also seen among the study participants that nearly 70% owned a hand sanitizer. Therefore, practices in the study area are good enough to lower risk of infection. 

In this study we found that hand washing was practiced by all respondents with good practices in terms of duration followed by majority of the city’s residents. Such practices need to be inculcated in communities to prevent spread of diseases and in turn lead to a healthy community.

1. "Hand hygiene and swachh Bharat abhiyaan." Greater Kashmir, 2020, https://www.greaterkashmir.com/news /gk-magazine/hand-hygiene-and-swachh-bharat-abhiy aan/. Accessed 6 Nov. 2020.

2. Garbutt, C. et al.  "The public hand hygiene practices of new zealanders: A national survey." New Zealand Medical Journal, vol. 120, no. 1265, 2007, U2810. PMID: 18264189.

3. Ray, S.K. et al.  "Hand washing practices in urban and rural communities in and around Kolkata, West Bengal." Indian Journal of Public Health, vol. 53, no. 3, 2009, pp. 192–195.

4. Ray, S. et al.  "Hand washing practices in two communities of two states of Eastern India: An intervention study." Indian Journal of Public Health, vol. 54, no. 3, 2010, pp. 126.

5. Beale, S. et al. "Hand hygiene practices and the risk of human coronavirus infections in a UK community cohort." Wellcome Open Research, vol. 5, 2020, pp. 98.