Objective: A handwashing program is a cost-effective, life-saving public health intervention that can help decrease the incidence of various communicable diseases in developing nations. Unfortunately, handwashing interventions in impoverished communities are often hindered by the unilateral promotion of official handwashing guidelines, which are inappropriate for these communities since they assume soap, clean water and towels are readily available. Methods: Current handwashing recommendations and their applicability to hygiene interventions in developing nations are discussed. Results to Date: This paper presents a novel handwashing ladder which emphasizes that access to the physical resources of soap, water and towels should be addressed in hygiene interventions. Some examples of how to use this ladder to more sustainably move a population towards best known handwashing practices are also presented. Conclusions: This handwashing ladder allows for more sustainable progress in hygiene within a community than previous guidelines, since progress can be made incrementally, and, in many cases, on one individual aspect of the handwashing process at a time.
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