Water Loss During the Handwashing During Covid-19 Pandemic in Bangladesh

Hand washing is an important measure of public health to prevent COVID-19 pandemic from speared. But the increase in hand washing causes tremendous pressure on overstretched water resources, as the loss of water during handwashing increases. As there is no previous study to evaluate water loss during hand washing, the study aimed to determine the water loss during the COVID-19 pandemic during hand washing. Sociodemographic data were collected using a web based survey tool and an experiment was conducted to estimate the amount of water wasted during hand washing. 77.9% of participants washed their hands regularly after returning home from outside. 4 of the 7 participants generally did not turn off their tap when washing their hands.A single participant, who kept their tap on throughout the hand washing process, wasted approximately 14.88 L of water per day. The loss of water during hand washing is an alarming but less attentional issue. Hand washing is necessary during the COVID-19 situation, but behavioral adjustments are required to shut down the faucet at times when water is not being used.


Introduction
Hand hygiene is often considered the synonymous of handwashing which is the single most important factor in preventing nosocomial infections by preventing contact and fecal-oral transmission of pathogens (Widmer 2000; Boyce and Pittet 2002). Hand hygiene is an important public health measure (Burton et al. 2011;Tao et al. 2013) and it has long been recognized to be a convenient, effective, and also cost-effective means of preventing infectious diseases (Tao et al. 2013). During the COVID-19 pandemic, frequent handwashing with soap and water was considered as one of the most effective actions to reduce the spread to infection (CDC 2020; UNICEF 2020; WHO 2020).In addition to that, WHO and UNICEF also recommended to switch the faucet/tap off whiling while lathering hand with soap and scrubbing for at least 20 seconds to prevent the water loss.
Evidence suggests that the frequency of handwashing increased during a pandemic situation (Park et al. 2010). The outbreak of Ebola in West Africa in 2014-16 has also raised the demand for clean water for prevention and treatment (Conversation 2020). Therefore, the frequency of handwashing has also reported being increased during the co-current COVID-19 pandemic. The water demand raised by 20 to 25% in India during this COVID-19 pandemic due to the tap open during handwashing (Rohilla 2020). In addition, a water sector o cial in Jordan, recently claimed that water demand has increased by 40% after the government ordered people to stay home as part of a nationwide curfew (Conversation 2020). Hence, this increased demand of water poses another thinkable problem of water loss during hand washing.
This increase in demand will bring tremendous pressure on overstretched water resources to ll existing shortages in the water supply. This situation will be further worsened in summer when sources of water supply run dry. Although the loss of water during hand washing is a serious issue, there is no previous study to evaluate water loss during hand washing globally. Therefore, the aim of the study was to determine the water loss during handwashing during the COVID-19 pandemic.

Setting and participants
A prospective cross-sectional web-based survey was conducted among the general population of Bangladesh to assess handwashing practices from May to June 2020. As a community-based national sampling survey during this time was not feasible, data was collected through online. The authors distributed the survey link in all divisions of Bangladesh via social media using snowball sampling. To improve the participation rate, reminder requests were sent at 2-week intervals for a total of three times.
The survey questionnaire was sent to 1100 participants and 990 of them from almost all the divisions of the country aged between 18 to 47 years completed the questionnaire. Eligibility criteria included the ability to read Bangla and residence in Bangladesh.

Data collection
A survey tool was developed considering the pattern of handwashing practice and facility during the COVID-19 pandemic. The survey consisted of 13-close ended queries, which took about 3-4 minutes to nish. Sociodemographic data were collected on age, gender, educational status, location of residence. Besides, the survey included questions on the frequency of handwashing, duration of lathering hand with soap and, scrubbing, whether they keep their faucet on during the lathering and scrubbing time.
The survey tool was piloted with a small online user group to test its clarity. The survey included a short overview of the study context, purpose, procedures, con dentiality agreement, and consent. This study complied with the most recent revision of the Helsinki Declaration (Williams 2008) and followed the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) guidelines (Eysenbach 2004).
Descriptive statistics were performed to de ne the fundamental characteristics of the data in the participants.

Procedure
The average duration of lathering hand with soap and scrubbing was 17.95 seconds among the participants who usually keep their tap on throughout the handwashing process. An experiment was designed to estimate the amount of water wasted during that time. We invited 567 participants who did

Results And Discussion
Demographic information Table 1 represents the characteristics of the participants. Of the 990 participants, 64.7% were female, 78.4% were a student. The majority of the participant has completed their graduation (63.1%). Although most of the respondents were from the Dhaka division (39.5%), respondents from all 8 divisions of the country participated in the study. participant. Then if we calculate this water loss for 567 participants, it will be a huge amount of (8437 L) of water loss per day where we had only 990 participants.

Limitation
The speed of the tap was set by the judgment of the experimenter. Therefore, the number of participants for the experiment is not so big. However, it still gives a reasonable representation.

Conclusion
A great number of people keep their faucet on during lathering hands with soap and scrubbing, thus wasting a considerable amount of water. One of the rst things that we need to address is to reduce the amount of water coming out of the tap every minute. That would save some water at least without relying on individual behaviors. It is also recommended to use push taps that automatically switch off after a period or sensor taps that are programmed to automatically turn on when hands are under the spout and immediately stop when the hands are taken away from the tap. Furthermore, behavioral change interventions are needed to aware people to shut off the faucet at periods when water is not being used.

Declarations
Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Competing interest
The authors declare that they have no competing interests