The copyright of featured pic belong Hossam all line, Flickr

Hand hygiene, once considered a simple act of cleanliness, has taken on profound cultural significance in the Middle East. This region, known for its rich history and diverse traditions, has seen a transformation in its approach to personal hygiene, especially in recent years. The cultural impact of hand hygiene in the Middle East is a fascinating phenomenon that reflects both tradition and modernity.

In the Middle East, tradition and religion play a vital role in daily life. Islamic culture, which is predominant in the region, emphasizes cleanliness as a fundamental aspect of faith. The practice of “Wudu” (ritual washing) before prayer is a prime example. This tradition involves cleansing the hands and other body parts, reinforcing the importance of hand hygiene. As a result, hand hygiene is deeply ingrained in Middle Eastern culture, aligning it with religious values.

In recent years, globalization and advancements in healthcare have introduced modern hand hygiene practices to the Middle East. With the global spread of infectious diseases, such as COVID-19, hand hygiene has gained even more prominence. Hand sanitizers, antibacterial soaps, and sanitizing stations have become ubiquitous in public spaces, reflecting the region’s embrace of modern hygiene methods.

To summarise, the cultural impact of hand hygiene in the Middle East is a dynamic fusion of tradition and modernity. While rooted in religious and traditional practices, the region has embraced contemporary hygiene measures as a response to global health challenges. This cultural shift has not only improved public health but also stimulated economic growth and redefined social interactions. Hand hygiene is a testament to the Middle East’s ability to adapt and thrive in a changing world while preserving its rich cultural heritage.

In this article, we explore and understand two important perspectives about the cultural impact of hand hygiene in the middle east.

Bassel Molaeb, Healthcare Advisor, Trainer & Infection Prevention and Control Consultant, The Compass Health Consultancy

The majority of germs that cause serious infections in humans are transmitted by people’s actions. Hand Hygiene is one of the best ways to remove germs, avoid getting sick, and prevent the spread of germs to others. Whether you are at home, at work, travelling, or out in the community,

Hand hygiene through handwashing with soap and water or hand rubbing using alcohol-based hand rubs can protect you and your family. Hand hygiene is a crucial practice that has gained significant attention worldwide, especially in the wake of global health crises such as the COVID-19 pandemic.

While hand hygiene is considered a universal practice, its cultural impact can vary across different regions. In this article, we will explore the cultural impact of hand hygiene in the Middle East, shedding light on the region’s traditions, beliefs, and practices related to cleanliness and hygiene.

The importance of cleanliness and purification

Cleanliness holds great significance in Middle Eastern cultures. Islamic traditions, which form a significant part of the region’s cultural fabric, emphasise the importance of cleanliness and purification. Muslims are required to perform ablution (wudu) before prayer, which involves washing the hands, face, and feet. This ritual cleansing underscores the significance of hand hygiene in the daily lives of Middle Easterners.

Traditional practices and rituals

The Middle East has a rich history of traditional practices and rituals that involve hand hygiene. For instance, the Hammam, a traditional Turkish bath, is a communal bathing experience that involves cleansing the body thoroughly, including the hands. The Hammam not only serves as a hygienic practice but also as a social gathering, promoting community bonding and relaxation.

Cultural significance of hospitality

Hospitality is highly valued in Middle Eastern cultures. Guests are warmly welcomed and treated with utmost respect. Hand hygiene plays a crucial role in this aspect of Middle Eastern culture. It is customary for hosts to offer guests water or scented rosewater to wash their hands upon arrival.

This gesture reflects the host’s commitment to cleanliness and ensures that guests feel comfortable and well taken care of.

Traditional food practices

Middle Eastern cuisine is renowned for its rich flavours and diverse dishes. Traditional food practices also emphasise the importance of hand hygiene. For example, the art of eating with one’s hands is prevalent in Arab and Lebanese cultures. Before indulging in a communal meal, participants often cleanse their hands thoroughly, ensuring that they can enjoy the food without compromising hygiene.

Adaptation to modern hygiene practices

While traditional practices continue to have cultural significance in the Middle East, the region has also adapted to modern hand hygiene practices. In recent years, there has been a growing emphasis on public health and hygiene education, particularly in urban areas. Hand sanitizers, handwashing stations, and hygiene campaigns have become more prevalent, especially in public spaces such as malls, airports, and hospitals.

Impact of COVID-19

The COVID-19 pandemic has had a profound impact on hand hygiene practices in the Middle East.

Health authorities have encouraged and enforced strict hand hygiene measures to curb the spread of the virus. The pandemic has also led to an increased awareness of hand hygiene among the general population, with individuals adopting practices such as frequent handwashing, using hand sanitizers, and avoiding handshakes.

Hand Hygiene in healthcare settings

Contaminated hands of healthcare providers are a primary source of pathogenic spread. Proper hand hygiene decreases the proliferation of microorganisms, thus reducing infection risk and overall healthcare costs, length of stays, and ultimately, reimbursement. According to the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), hand hygiene is the single most important practice in the reduction of the transmission of infection in healthcare settings. This activity illustrates the importance of hand hygiene and highlights the importance of the interprofessional team in educating patients about preventing infections and improving outcomes by remembering to wash hands frequently.

Hand hygiene has deep cultural roots in the Middle East, intertwining with religious traditions, hospitality customs, and traditional practices. The cultural impact of hand hygiene in the Middle East showcases the region’s commitment to cleanliness, public health, and the well-being of its communities. By understanding and respecting cultural nuances, effective hand hygiene campaigns can be tailored to resonate with Middle Eastern societies, promoting health and hygiene while honoring local traditions.

Michael Rollins, Consultant Healthcare Environment Infection Prevention Specialist.

Hand hygiene is widely recognised as the most important Infection Prevention Intervention to reduce Healthcare Associated Infections (HAI) within the healthcare setting.

The World Health Organisation (WHO) Guidelines on hand hygiene in healthcare involve a multi-modal approach including hand washing with soap and water, and the use of alcohol-based handrub at point of care, in compliance with the WHO 5 Moments of Hand Hygiene.

In considering ‘culture’ as an influence on compliance with hand hygiene, some community cultures and religious factors may influence personal attitude to compliance with Global Patient Safety Guidelines presented by the WHO. Soaps which contain animal fat and hand rubs containing alcohol are two examples.

Access to clean water

In some low- resource countries access to clean water and the restricted availability of water may inhibit hand washing but alternates within these cultures successfully employed. Traditional methods and under the guidance of the WHO, formulation and manufacture to alcohol-based handrub locally.

Religious influence

The Islamic tradition poses the toughest challenge to alcohol use. However, any substance that man can manufacture or develop in order to alleviate illness or aid better health is permitted by the Qur’an and this includes alcohol used as a medical agent.

The Kingdom of Saudi Arabia was a founding signatory to the Global Patient Safety Challenge, working in partnership with the World Alliance for Patient Safety in 2005. The initial challenge focussed on the challenges of ‘Clean Care is Safer Care’ and ‘Safe Surgery Saves Lives’.

To understand Muslim Healthcare workers attitudes to alcohol-based hand cleansers in an Islamic Country, King Abdul Aziz Medical City (KAAMC) initiated in 2003 the policy of using alcohol-based handrub and actively encouraged compliance in the interests of Infection of Infection prevention and control and Patient Safety. Interestingly, no difficulties or reluctance from healthcare workers was encountered in this early adoption of the alcohol-based hand hygiene measures.

In 2005 the Saudi Ministry of Health pledged its commitment to the WHO Global Patient Safety Challenge and most hospitals across the Kingdom joined the National campaign implementing the WHO multi-modal hand hygiene improvement strategy centred on the use of alcohol-based handrub at point of care. IN 2007, the WHO evaluated the response to adoption of the Guidelines and results indicated a very strong adoption of the strategy including a preference for hand rubbing instead of handwashing, which has led to a significant increase of hand hygiene compliance among healthcare workers and a reduction of HAI rates within Intensive Care Units.

The positive shift from hand washing to the more frequent use of alcohol-based hand rub did not come without consequences. Hand washing with soap and water benefits from the added element of mechanical action of running water to wash and remove soil from the hands. Hand cleansing using alcohol-based hand rub requires competency of hand hygiene cleansing technique to be fully effective.

Research at Widmer

Following the publication of the 2004 hand hygiene guidance by the Centres for Disease Control (CDC), promoting the use of alcohol-based handrub at point of care, researchers Widmer et al identified that technique was not specifically addressed. Consequently, Widmer proceeded to evaluate the influence of technique on the efficacy of the alcohol-based handrub.

60 Professional Infection Control Professionals and epidemiologists participated in the study. 63% of the participants had worked in Infection Control for more than 10 years. A fluorescent dye marker as a visualisation test and microbiological samples pre and post the hand cleansing procedure was undertaken by all participants. 66% of all participants had detectable bacteria after anti-sepsis.

The conclusion was that technique is of crucial importance in hand anti-sepsis. Significantly, major deficiencies were detected amongst even highly trained healthcare workers. The study clearly highlighted the need for competency-based training in handrub technique.

The current WHO hand wash technique is based on the European Standard EN1500 which involves six distinct steps or poses. The correct performance of this technique results in optimal coverage of the alcohol-based handrub when compared with incomplete actions or poor technique.

Dr Gerry Lacey, Director of strategic Innovation at the school of Computer Science at Trinity College Dublin, conceived the concept of automated teaching technology for hand hygiene technique and initiated the Surewash R&D Project. Dr Lacey identified that emerging technology in computerised image processing and augmented reality technology developed in the gaming industry could be applied to the interactive training of healthcare workers in the correct hand hygiene technique. Using sophisticated gesture recognition software, the interactive gaming technology engages with the user on a one-to-one basis providing instant feedback on the accuracy of the user’s technique, guiding the user with visual prompts and immediate measurement of the user’s response. The personalised interactive teaching improves cognitive behaviour and through repetitive practice development of muscle memory and ‘unconscious competence’ meaning that the correct technique is used every time without having to consciously think about the technique.

Returning to the question of Cultural Impact of Hand Hygiene, the case can be presented that we should focus on and nurture a ‘Universal Culture of Patient Safety’ orientation, always providing safe care within the healing environment.

A culture of constant quality improvement, technological advances and skills development practiced consistently produce remarkable results.