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1. Setting the Hand Hygiene Standards
• Practical recommendations from the Hygiene Council
to help improve hand hygiene standards
• Findings of the 2009 International consumer survey
Supported by Dettol – Leaders in Hygiene

3. Introduction
why is it so important
to improve hygiene?
The global increase in infection due to bacteria,
viruses, fungi, prions, or parasites is evident in all
nations. Western developed nations have seen an
increase in hospital acquired infection and antibiotic
resistant strains of bacteria, while some developing
nations have seen increases in resistant tuberculosis1
and in malaria.2
Regardless of geographical location, many infectious
diseases can be prevented or contained through
good hygiene practice and education. Whether this is
to ensure that stored water is covered to reduce the
spread of dengue or malaria, that purifying tablets
are used for drinking water, that the mouth is covered
when coughing, or simple effective hand washing
when running water is available.
Prevention is better than cure.
Childhood infections
Pneumonia, diarrhoea, and
HIV/AIDS each account
for approximately 30% of
child deaths in developing
nations, particularly Africa.3
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Hygiene Council 3

5. Introduction
the Hygiene Council
The Hygiene Council is a group of leading global experts in the fields of
microbiology, virology, infectious disease, immunology, and public health.
The Council reviews current infectious disease threats to society and formulates
realistic recommendations on simple hygiene measures to help the public improve
levels of hygiene in the home and community and in turn help to prevent the spread
of all kinds of infections.
This year, the Hygiene Council, responding to consumer confusion about how best
to be hygienically safe during the spread of infectious diseases, has come up with a
set of practical recommendations to help all of us practice good hand hygiene. By
translating science into practice, everyone can have a clear idea of best practice.
From left to right:
Back Row: Professor Exner (GERMANY), Joe Rubino (DIRECTOR, R&D LABS),
Dr Letlape (SOUTH AFRICA), Philippe Gaertner (FRANCE)
Middle Row: Dr Lee (MALAYSIA), Professor Signorelli (ITALY), Professor Schoub (SOUTH AFRICA)
Front Row: Professor Tierno (USA), Professor Oxford (UK),
Dr Narendra Saini (INDIA), Dr Low (CANADA)
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Hygiene Council 5

6. Did you know?
The hands are one of
the most important
causes of cross
contamination and
cross infection in
the home.
HygieneStandardsHandwashing–Yourfirstlineofdefence

7. Handwashing
your first line of defence
“After hand washing with soap, hands should
be thoroughly dried on a clean dry towel”
HANDWASHING
WHY is hand washing so important?
The hands are one of the most important causes of cross contamination,
and the spread of flu.
WHEN should you wash your hands?
Before...
Eating or before feeding children•
Applying contact lenses•
Giving any medication or first aid•
After...
Coughing, sneezing or blowing and scratching the nose•
Touching frequently touched surfaces and objects•
Using the toilet or changing a child’s nappy•
Handling pets and domestic animals•
Before and after...
Handling raw food•
Tending to someone who is sick•
And whenever...
Hands appear dirty•
HOW should hands be washed?
Where soap and clean water are available, follow the six-step•
hand washing process - See next page »
Where soap and clean water are not available, alcohol-based•
hand rubs can be used to kill germs on the hands, but not if
the hands are visibly dirty as these products don’t clean
HygieneStandardsHandwashing–Yourfirstlineofdefence
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Hygiene Council 7

8. “Only 42% people in India
believe that hand
washing is the most
effective way to prevent
the spread of flu”
HygieneStandardsHandwashing–Yourfirstlineofdefence

9. The 2009 Global Survey found that:
• Only 42% people in India believe that hand washing is the
most effective way to prevent the spread of flu
• 29% of people in India might not wash their hands
properly after coughing or sneezing
• 70% of Indians don’t wash their hands for the
recommended duration (at least 20 seconds)
Wet hands and apply soap. Rub palms together until soap is bubbly1.
Rub each palm over the back of the other hand2.
Rub between your fingers on each hand3.
Rub backs of fingers (interlocked)4.
Rub around each of your thumbs5.
Rub both palms with finger tips then rinse and dry your hands6.
The six-step process to washing your hands
HANDWASHING
HygieneStandardsHandwashing–Yourfirstlineofdefence
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11. HygieneStandardsHandwashing–Yourfirstlineofdefence
2009 International
Consumer Survey
Overview
An International Consumer Survey has been carried out by the Hygiene
Council in order to identify and assess worldwide and country-specific
public behaviours, attitudes and opinions towards hygiene. The survey
provides an insight into current beliefs and affords the Council the
ability to identify trends and shifts in consumer attitudes over time.
Survey Method
The survey was conducted on behalf of the Hygiene Council by Taylor
Nelson Sofres (TNS) Market Research Company between February and
April 2009. A survey was carried out in 8 countries; Australia, Germany,
India, Malaysia, Saudi Arabia, South Africa, UK and USA.
Respondents in all countries were asked questions to allow for
worldwide analysis and cross-country comparisons. Each country was
then asked a series of locally relevant questions.
Results
The global survey questions with key findings are:
surveyHygiene StandardS
Hygiene Council 11

12. survey
Q. Which of the following measures do you think is the
most effective way to help protect against catching a
cold or flu?
*calculated from weighted base figure
Only 42% of Indians• feel that washing hands regularly is an effective way to
help protect against catching a cold or flu.
Only 26% of Indians• feel that covering your nose and mouth while sneezing is
an effective way to help protect against catching a cold or flu.
Country Wash hands Cover your Avoid public Disinfect Avoid being None of Don’t know/
regularly nose and places / surfaces you near animals / these Refused
mouth when transport frequently birds
sneezing touch
Australia 46% 16% 12% 7% 0% 15% 5%
Germany 60% 8% 17% 5% 1% 8% 2%
Great Britain 46% 27% 11% 10% 0% 5% 1%
India 42% 26% 10% 13% 5% 5% 0%
Malaysia 21% 30% 17% 14% 14% 2% 2%
Saudi Arabia 20% 42% 15% 14% 8% 1% 0%
South Africa 53% 16% 3% 13% 5% 7% 4%
USA 79% 9% 3% 4% 1% 2% 1%
Total Avg* 45% 22% 10% 10% 5% 6% 2%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Wash hands
regularly
Cover your nose
and mouth when
sneezing
Avoid public
places /
transport
Disinfect
surfaces you
frequently touch
Avoid being near
animals / birds
None of these Don't know /
Refused
Australia Germany Great Britain India Malaysia Saudi Arabia South Africa USA
HygieneStandardsHandwashing–Yourfirstlineofdefence
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12 Hygiene Council

13. survey
Q. On which of the following occasions might you not
wash your hands properly?
70% of people in India might not wash their hands after touching commonly•
touched surfaces.
29% of people in India might not wash their hands after coughing or sneezing.•
Country After touching After Before Before After using None of Don’t know /
commonly Sneezing / cooking / eating the toilet these Refused
touched coughing serving food
surfaces like
a remote /
phone etc.
India 70% 29% 7% 5% 5% 15% 1%
0%
10%
20%
30%
40%
50%
60%
70%
80%
After touching
commonly
touched surfaces
like a remote /
phone etc.
After sneezing /
coughing
Before cooking /
serving food
Before eating After using the
toilet
None of these Don't know /
Refused
India
HygieneStandardsHandwashing–Yourfirstlineofdefence
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14. Q. On average, how long do you take to wash your
hands?
70% of people in India do not wash their hands for the recommended•
duration (at least 20 seconds).
Country Upt to 5 5 – 10 10 – 20 20 – 30 30 Don’t wash Don’t know /
seconds seconds seconds seconds seconds + hands at all Refused
India 8% 33% 29% 10% 19% 0% 1%
survey
0%
5%
10%
15%
20%
25%
30%
35%
Up to 5 seconds 5-10 seconds 10-20 seconds 20-30 seconds 30 seconds + Don't wash hands
at all
Don't know /
Refused
India
HygieneStandardsHandwashing–Yourfirstlineofdefence
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14 Hygiene Council

15. survey
Q. Of the following options, which do you feel is the
most effective way to prevent the spread of germs in
the home?
*calculated from weighted base figure
Only 44% of people in India believe ‘washing hands regularly’ is the most•
effective way to prevent the spread of germs in the home, with regular surface
disinfection (31%) the next priority
Country Wash hands Surface Prevent Avoid kissing or Disinfect None of Don’t know/
regularly disinfection on animals from close physical the these Refused
a regular entering the contact with laundry
basis house family & friends
Australia 53% 36% 2% 2% 1% 4% 2%
Germany 55% 27% 6% 5% 2% 5% 1%
UK 51% 40% 3% 2% 2% 1% 1%
India 44% 31% 10% 3% 8% 4% 0%
Malaysia 31% 31% 21% 4% 11% 1% 1%
Saudi Arabia 16% 43% 30% 3% 7% 0% 0%
South Africa 56% 24% 10% 4% 1% 2% 3%
USA 65% 25% 3% 2% 1% 2% 2%
Total Avg* 47% 31% 11% 3% 4% 2% 1%
0%
10%
20%
30%
40%
50%
60%
70%
Wash hands
regularly
Surface
disinfection on a
regular basis
Prevent animals
from entering the
house
Avoid kissing or
close physical
contact with family
and friends
Disinfect the
laundry
None of these Don't know /
Refused
Australia Germany Great Britain India Malaysia Saudi Arabia South Africa USA
HygieneStandardsHandwashing–Yourfirstlineofdefence
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16. survey
Q. When you clean your hands, which of the following
do you usually use…?
*calculated from weighted base figure
9% of people in India wash their hands with running water only.•
Country Runnign water Running Running Hand Hand None of Don’t know/
and antibact- water and water sanitizer wipes these Refused
erial liquid regular only only only
hand soap soap
Australia 39% 52% 4% 3% 0% 1% 1%
Germany 8% 90% 1% 1% 0% 0% 0%
Great Britain 52% 43% 2% 1% 0% 1% 0%
India 45% 43% 9% 2% 2% 0% 0%
Malaysia 33% 53% 12% 1% 1% 0% 0%
Saudi Arabia 38% 54% 2% 5% 1% 0% 0%
South Africa 22% 60% 15% 2% 0% 1% 0%
USA 48% 45% 2% 3% 0% 1% 1%
Total Avg* 34% 55% 7% 2% 1% 0% 0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Running water
and antibacterial
liquid hand soap
Running water
and regular hand
soap
Running water
only
Hand sanitizer
only
Hand wipes only None of these Don't know /
Refused
Australia Germany Great Britain India Malaysia Saudi Arabia South Africa USA
HygieneStandardsHandwashing–Yourfirstlineofdefence
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16 Hygiene Council

17. survey
Q. On which of the following occasions’ might your
children not wash their hands?
59% of people in India admit that their children might not wash their hands•
during in between meal snacking.
Country Before Before Before In between Don’t know/
breakfast Lunch Dinner meal snacking Refused
India 14% 16% 11% 59% 33%
0%
10%
20%
30%
40%
50%
60%
70%
Before breakfast Before lunch Before dinner In between meal snacking Don't know / Refused
India
HygieneStandardsHandwashing–Yourfirstlineofdefence
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Hygiene Council 17

18. Hygiene Council Members
CHAIR: Professor John Oxford, Professor of Virology at St•
Barts and The London School of Medicine and
Dentistry, UK
Professor Martin Exner, Managing Director, Institute of•
Hygiene and Public Health, University of Bonn, Germany
Dr Christopher Lee, Consultant Physician Infectious•
Diseases, Sungai Buloh Hospital, Malaysia
Dr Kgosi Letlape, Immediate past President of the World•
Medical Association (WMA), South Africa
Dr Donald Low, Microbiologist-in-Chief at Toronto•
Medical Laboratories/Mount Sinai Hospital, Canada
Professor Tariq Ahmed Madani, Professor of Internal•
Medicine and Infectious Diseases, Faculty of Medicine,
King Abdulaziz University, Jeddah, Advisor to the Minister
of Health, Ministry of Health, Riyadh, Saudi Arabia
Dr Sandip K Ray, Secretary General, Indian Public Health•
Association, India
Joe Rubino, Director Shared Services, R&D Laboratories,•
Reckitt Benckiser
Dr Narendra Saini, Head of Department Microbiology &•
Immunology and Chairman Hospital Infection Control
committee, Pushpanjali Crosslay Hospital, Vaishali, India
Professor Barry Schoub, Executive Director, National•
Institute for Communicable Diseases, Johannesburg,
South Africa
Professor Carlo Signorelli, Vice-President of the Italian•
Society of Hygiene, Preventative Medicine and Public
Health (Sltl), Italy
Dr Rhonda Stuart, Infectious Disease Physician, Monash•
Medical Center, Victoria, Australia
Professor Philip M Tierno, Director Clinical Microbiology•
and Immunology, New York University Langone Medical
Center, Clinical Professor of Microbiology and Pathology,
New York University School of Medicine, USA
Websites
International Scientific Forum on Home Hygiene (IFH): •
www.ifh-homehygiene.org
World Health Organisation (WHO):•
www.who.int
European Food Safety Authority:•
www.efsa.europa.eu
Centers for Disease Control and Prevention (CDC):•
www.cdc.gov/
Hygiene Council:•
www.hygienecouncil.com
Reckitt Benckiser Information
Lizol: www.lizol.co.in•
Dettol: www.dettol.co.in•
Reckitt Benckiser: www.reckittbenckiser.com•
References
Von Gottberg A, Klugman KP, Cohen C et al. Emergence 1.
of levofloxacin-non-susceptible streptococcus pneumonia
and treatment for multidrug-resistant tuberculosis in children
in South Africa: a cohort observational surveillance study.
Lancet 2008;371:1108-13.
Kiszewski A, Johns B, Schapira A et al. Estimated global 2.
resources needed to attain international malaria control goals.
Bulletin of the World Health Organisation 2007;85(8):623-30.
South African Every Death Counts Writing Group. Every death 3.
counts: use of mortality audit data for decision making to save
the lives of mothers, babies, and children in South Africa.
Lancet 2008; 371:1294-1304.
HAND HYGIENE IN THE HOME AND COMMUNITY: IFH 4.
briefing document for health professionals, July 2007.

20. Supported by Dettol – Leaders in Hygiene