WHO Guidelines on Hand Hygiene in Health Care - Safe Care ...

<strong>WHO</strong> GUIDELINES ON HAND HYGIENE IN HEALTH CARE
17.
Religious and cultural aspects of hand hygiene
There are several reasons why religious and cultural issues should be considered when dealing with the topic
of hand hygiene and planning a strategy to promote it in health-care settings. The most important is that these
<strong>Guidelines</strong>, issued as a <strong>WHO</strong> document, are intended to be disseminated all over the world and in settings
where very different cultural and religious beliefs may strongly influence their implementation. Furthermore, the
guidelines consider new aspects of hand hygiene promotion, including behavioural and transcultural issues.
Within this framework, a <strong>WHO</strong> Task Force on Religious and Cultural Aspects of Hand Hygiene was created to
explore the potential influence of transcultural and religious factors on attitudes towards hand hygiene practices
among HCWs and to identify some possible solutions for integrating these factors into the hand hygiene
improvement strategy. This section reflects the findings of the Task Force.
In view of the vast number of religious faiths worldwide, only the
most widely represented have been taken into consideration
(Figure I.17.1). 760 For this reason, this section is by no means
exhaustive. Some ethno-religious aspects such as the followers
of local, tribal, animistic or shamanistic religions were also
considered.
Philanthropy, generally inherent in any faith, has often been the
motivation for establishing a relationship between the mystery
of life and death, medicine, and health care. This predisposition
has often led to the establishment of health-care institutions
under religious affiliations. Faith and medicine have always
been integrated into the healing process as many priests,
monks, theologians and others inspired by religious motivations
studied, researched, and practised medicine. In general,
religious faith has often represented an outstanding contribution
to highlighting the ethical implications of health care and to
focusing the attention of health-care providers on both the
physical and spiritual natures of human beings.
Well-known examples already exist, however, of health
interventions where the religious point of view had a critical
impact on implementation or even interfered with it. 761,762
Research has already been conducted into religious and
cultural factors influencing health-care delivery, but mostly in
the field of mental health or in countries with a high influx of
immigrants where unicultural care is no longer appropriate. 49,763
In a recent world conference on tobacco use, the role of
religion in determining health beliefs and behaviours was
raised; it was considered to be a potentially strong motivating
factor to promote tobacco control interventions. 764 A recent
review enumerates various potential positive effects of religion
on health, as demonstrated by studies showing its impact
on disease morbidity and mortality, behaviour, and lifestyles
as well as on the capacity to cope with medical problems. 765
Beyond these particular examples, the complex association
between religion, culture, and health, in particular hand hygiene
practices among HCWs, still remains an essentially unexplored,
speculative area.
In the increasingly multicultural, globalized community that is
health-care provision today, cultural awareness has never been
more crucial for implementing good clinical practice in keeping
with scientific developments. Immigration and travel are more
common and extensive than ever before as a result of the
geopolitically active forces of migration, asylum-seeking and, in
Europe, the existence of a broad, borderless multi-state Union.
With the increasingly diverse populations accompanying these
changes, very diverse cultural beliefs are also more prevalent
than ever. This evolving cultural topography demands new,
rapidly acquired knowledge and highly sensitive, informed
insights of these differences, not only among patients but also
among HCWs who are subject to the same global forces.
It is clear that cultural – and to some extent, religious – factors
strongly influence attitudes to inherent community handwashing
which, according to behavioural theories (see Part I, Section
18), are likely to have an impact on compliance with hand
cleansing during health care.
In general, the degree of HCWs’ compliance with hand hygiene
as a fundamental infection control measure in a public health
perspective may depend on their belonging to a communityoriented,
rather than an individual-oriented society. The
existence of a wide awareness of everyone’s contribution to the
common good, such as health of the community, may certainly
foster HCWs’ propensity to adopt good hand hygiene habits.
For instance, hand cleansing as a measure of preventing the
spread of disease is clearly in harmony with the fundamental
Hindu value of non-injury to others (ahimsa) and care for their
well-being (daya).
Another interesting aspect may be to evaluate optional methods
of hand cleansing which exist in some cultures according to
deep-seated beliefs or available resources. As an example, in
the Hindu culture, hands are rubbed vigorously with ash or mud
and then rinsed with water. The belief behind this practice is that
soap should not be used as it contains animal fat. If water is not
available, other substances such as sand are used to rub the
hands. In a scientific study performed in Bangladesh to assess
faecal coliform counts from post-cleansing hand samples,
hand cleansing with mud and ash was demonstrated to be as
efficient as with soap. 766
In addition to these general considerations, some specific
issues to be investigated in a transcultural and transreligious
context are discussed.
Based on a review of the literature and the consultation of
religious authorities, the most important topics identified were
the importance of hand hygiene in different religions, hand
gestures in different religions and cultures, the interpretation
of the concept of “visibly dirty hands”, and the use of alcoholbased
handrubs and alcohol prohibition by some religions.
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