Awareness survey
The average daily frequencies of handwashing with soap or hand sanitizer among adults were 6.6, 6.8, and 5.0 in 2014, 2013, and 2011, respectively. Among students, these frequencies were 5.2 and 4.7 in 2014 and 2013, respectively. The average overall daily handwashing frequencies in 2014 and 2013 were 9.8 and 10.3, and 8.3 and 7.5 for adults and students, respectively.
Most frequently, adults spent 21 seconds or longer (48.6%) per handwashing, followed by 6 to 10 seconds (23.2%). Similarly, 34.2% and 24.8% of students washed their hands for 21 seconds or longer and 6 to 10 seconds, respectively. The parts of the hand washed during handwashing were also surveyed. For adults, palms (99.7%) and backs (98.4%) both exceeded 95% in 2014, similar to 2013 (99.6% and 96.5%) and 2011 (99.3% and 96.7%), followed by fingers (84.9%) and the spaces between (79.4%).
Adult and student respondents reported similar rates of handwashing with soap (75.1% and 71.3%, respectively).
The highest proportion of adult participants reported experiencing colds (25.9%) and diarrhea (23.1%). They also reported eye infections (4.3%) and food poisoning (1.8%). The highest proportion of students reported colds (53.1%), followed by diarrhea (24.1%), eye infections (5.1%), and food poisoning (2.3%) (
Table 1) [
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Analysis of home handwashing habits revealed that “after bathroom use” was most common (88.0%) among adults, followed by “before eating” (71.9%) and “before preparing food” (70.2%). Among students, “before preparing food” (89.1%) was most common, followed by “after bathroom use” (86.1%) and “before eating“ (58.7%).
Among daily activities involving potential sources of infection, adult participants washed their hands more frequently “after waste disposal” (87.1%) and “after cleaning” (80.0%), and less frequently “after touching money” (18.1%) and “after coughing and sneezing” (17.6%). Student participants washed their hands more frequently “after cleaning” (79.5%) and “after waste disposal” (78.2%), and less frequently “after nosing or touching the nose” (27.3%) and “after touching money” (24.7%).
The reported frequency of handwashing among adults “after using public restrooms” was 88.0%, followed by “when returning home” (78.1%), “before eating in restaurant” (57.1%), and “use of wet towel before eating” (56.2%). The handwashing frequencies among students were “after using public restrooms” (86.2%), “when returning home” (70.6%), “before eating in a restaurant” (60.8%), and “use of wet towel before eating” (27.0%) (
Table 2) [
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The results of the awareness survey revealed that 90.1% and 92.3% of adult and student respondents, respectively, were aware that handwashing helps prevent infectious diseases. Adults did not wash their hands for the following reasons: “no habit yet” (31.4%), “no place to wash” (24.7%), and “cumbersome” (23.4%). Students reported “cumbersome” (35.7%) and “no habit yet” (22.9%) as the main reasons, followed by “no place to wash” (4.9%).
Most adults (59.1%) and students (65.2%) reported washing their hands more often during domestic or international pandemic outbreaks.
When asked whether public restrooms have good handwashing conditions, 29.8% of adults responded that they were “not sufficient”. The proportion of “not sufficient” responses in 2014 was lower than in 2011 (48.2%) and 2013 (31.4%); in contrast, student opinions of the conditions in public restrooms did not improve over time (48.2%, 45.3%, and 45.0% in 2011, 2013, and 2014, respectively) (
Table 3) [
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Results of the survey on exposure to education on correct handwashing behaviors over the previous year revealed that only 12.9% of adults reported having experienced handwashing-related education, whereas 40.6% of students had participated in handwashing education programs. Compared to 2013, adults showed a negligible increase and students a slight decrease in exposure (12.8% and 41.6%, respectively).
Adults reported an average of 2.5 handwashing-related educational experiences (n=647) in the previous year. The largest proportion (47.5%) had participated in handwashing education sessions only once, and 3.6% had experienced educational programs four times. In comparison, students (n=365) participated in an average of 1.7 handwashing educational experiences in the previous year, with “once” the most frequent response (57.0%). The most common session duration among adults and students were “<10 minutes” (51.3%) and “30 to 60 minutes”(43.6%), respectively.
The most common method of adult education was “lecture” (40.0%), followed by “audio-visual media such as video” (30.0%), “pamphlets such as community notice” (16.8%), and “practice” (12.7%). Students were most often exposed to “audio-visual media” (38.4%), “lecture” (29.0%), and “practice” (8.2%).
While 95.2% of adults and 93.2% of students felt that handwashing education was necessary in 2013, only 80.6% and 77.7%, respectively, found the handwashing education programs necessary in 2014.
More than half of the adults (57.1%; n=2,863) reported seeing Ads or pamphlets about correct handwashing. Similarly, 56.6% of students (n=509) reported seeing promotional material. Adults most frequently encountered Ads via “terrestrial TV” (47.7%), followed by “community health center and hospital plasma display panel (PDP)” (31.9%). Students mostly encountered Ads/pamphlets via “community health center and hospital PDP” (37.7%) and “terrestrial TV” (37.5%).
When asked whether the contents of the Ads/pamphlets were easy to understand, 94.1% of adults answered affirmatively, versus 3.5% who answered negatively, compared to 94.5% and 5.5% in 2013. Among students, 91.4% reported finding the contents easy to understand. Regarding their reactions to the Ads/pamphlets they had seen, 84.0% of adults reported that the Ads/pamphlets led them to consider behavioral changes including handwashing habits in 2014, a slight increase compared to 2013 (83.5%). 76.2% of students indicated that they would consider behavioral changes including handwashing after seeing the Ads/pamphlets.
Most adults (90.2%) reported having learned to wash their hands correctly after seeing the Ads/pamphlets, compared to 7.8% who did not, a slight increase from 2013 (88.5%). Nearly nine in 10 students (87.6%) answered affirmatively, vs. 9.6% who did not (
Table 4) [
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Observational survey
Handwashing was observed in 29.5% of individuals after using the restroom, increases of 6.0% and 10.4% from 2013 (23.5%) and 2011 (19.1%), respectively. The highest percentage of handwashing was observed in 2009, a year with an outbreak of a novel influenza strain. Handwashing after restroom use decreased from 72.6% in 2013 to 71.4% in 2014, but handwashing with soap increased from 32.3% to 41.3%. Females washed their hands more often than males (76.6% vs. 66.2% in 2014, 81.4% vs. 63.8% in 2013, and 69.2% vs. 45.9% in 2011).
The duration of handwashing was 1 to 5 seconds in 39.0% of observed individuals, 6 to 10 seconds in 33.1%, 11 to 15 seconds for 12.9%, 16 to 20 seconds in 7.4%, and ≥21 seconds in 7.6%. The average duration increased slightly from 8 seconds in 2013 to 9 seconds in 2014.
Almost all restroom users (99.4%) turned off the faucet with their bare hands, while 0.1% used a paper towel. After handwashing, hand dryers were used most frequently (23.4%), followed by paper towels (16.3%) and personal handkerchiefs (2.9%) (
Table 5) [
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