Personal controls: General recommendations for hand hygiene in markets
Clean hands frequently. Hand hygiene is a critical way that people can stop the spread of COVID-19. In markets, customers and vendors should clean hands upon entry and exit, before and after each transaction, and after blowing their nose, sneezing, or coughing, in addition to other key times. image icon[37 pages]external icon
Types of hand hygiene:
Handwashing with soap and water. Soap and water are available in most contexts and are effective against coronaviruses. The cleanest water available should be used for handwashing, and all types of soap (bar soap, liquid soap, and powder soap) are effective at removing COVID-19. Hands should be scrubbed with soap and water for at least 20 seconds and dried using single-use hand drying materials when available, or air dried.
Soapy water (a mix of water and either powdered or liquid soap) can also be used. To prepare, mix enough soap with water so that you can create a lather when rubbing hands together. When using soapy water, a separate handwashing station of rinse water next to the soapy water station will also be needed. Alternatively, soapy water can be provided in a bottle or other closed container next to a handwashing station of plain water.
Instructions for making soapy water can be found on page 25 of this document pdf icon[39 pages]external icon.
Cleaning with alcohol-based hand rub. If hands are not visibly dirty, hand rub with at least 60% alcohol content can be used against coronaviruses as an alternative to washing hands with soap and water. To use, rub hands together until they feel dry.
If soap and water or alcohol-based hand rub are unavailable or infeasible, handwashing with 0.05% chlorine solution can be considered as a temporary option. The solution should be refreshed daily and made using the below instructions. Users should exercise caution to avoid getting the solution in their eyes or mouth.
[% chlorine in liquid bleach ∕ % chlorine desired] – 1 = Total parts of water for each part bleach
Administrative and engineering controls: Possibilities for markets
- Ensure widespread access to hand hygiene facilities by placing hand hygiene stations (handwashing stations or alcohol-based hand sanitizer dispensers) at entrances, exits, and throughout the market, including within 5 meters of toilets if any are present at the market. Hand hygiene can be made obligatory upon entry and exit of the market. Hand hygiene stations should be obviously placed so that they are hard to avoid. Vendors and customers should have easy access to handwashing facilities (ideally one per vendor or group of vendors, depending on the layout).Handwashing stations should follow these pdf icon[5 pages]external icon hand hygiene behavior change principles. More information on different handwashing station designs is available here pdf icon[39 pages]external icon. In particular, handwashing stations should: 1) Allow users to scrub their hands under a stream of running water; 2) Secure provided soap (either a cage, rope, or other device); 3)Have a place to catch used water; 4)Provide single-use hand drying materials whenever possible; 5) Provide a waste bin to collect single-use hand drying materials (when applicable).
- The installation, supervision, and regular refilling should be the responsibility of local public health authorities but can be delegated to building / market managers.3
- If using 0.05% chlorine solution, provide those doing the mixing with personal protective equipment (thick gloves, thick aprons, and closed shoes).
Materials, activities, and personnel needed for implementation
- Handwashing stations or alcohol-based hand sanitizer dispensers.
- Daily access to water (or alcohol-based hand rub) to refill hand hygiene stations and a consistent supply of soap.
- Market staff to check on hand hygiene stations regularly and refill when necessary.
- Market staff to enforce hand hygiene practice upon entry and exit to the market.
- Signs and/or audio messages within the market prompting customers to practice hand hygiene. Messaging should include information about when to practice hand hygiene as well as how.
- Personal protective equipment (rubber gloves, thick aprons, and closed shoes) if using 0.05% chlorine solution.
- Locked location for storing handwashing stations or alcohol-based hand sanitizer dispensers overnight.
Considerations and challenges for implementation
Continuous oversight will be required to ensure that hand hygiene stations are refilled regularly, which may be difficult without clear management structures.
If water supply is not available on site, it will be more challenging and costly to regularly refill handwashing stations.
There will be costs associated with purchasing the handwashing stations or alcohol-based hand sanitizer dispensers, refilling water and soap (or sanitizer), personal protective equipment (if needed) developing and printing communications materials, and possibly paying staff to refill and reinforce use of hand hygiene stations upon entry and exit.
There could be supply chain constraints on soap and alcohol-based hand sanitizer if demand increases as COVID-19 spreads. Single-use hand drying materials (such as paper towels) are often unavailable.
If using 0.05% chlorine solution, those mixing the solution should be adequately protected by wearing rubber gloves, thick aprons, and closed shoes during the mixing process because of potential skin and inhalation hazards. They should also be trained on how to mix chlorine solution.
If no thick gloves are available, any kind of gloves can be used. Those mixing should remove gloves and wash hands immediately after mixing. If no aprons are available, cleaners can wear protective clothing (such as long pants and long-sleeved shirts) and launder after use.