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The current consensus I am hearing on the email chains and from the meetings at UNC Water and Health Conference and guidance from WHO is to recommend soap or hand sanitizer as they are more effective than chlorine solutions for hand washing because of the chlorine demand of the organic material in your hands that exerts chlorine demand and degrades the chlorine concentration, and chlorine can damage hands and cause breaks in skin, which can lead to increased transmission. There is also the risk of Ebola in the water that has been used for hand washing (particularly if this is in an open bucket). The general consensus I am hearing is:

• Use soap/hand sanitizer preferentially
• Use chlorine solution for hand washing only when it’s culturally demanded at a 0.5% solution
• Think about treating the hand washing water with chlorine if stored in an open bucket to reduce transmission risk.

If you are using chlorine solution for handwashing (because it is socially accepted, or for whatever reason) it is recommended 0.5%. This can be made with sodium hypochlorite (liquid) - there is liquid available in Liberia from Manco and Operation Blessing. It can also be diluted from HTH or NaDCC powder. 0.5% sodium hypochlorite / HTH solution degrades 50% in 4-6 weeks at temps in the affected countries at unstabilized pH (generally around 7 if unstabilized); if stabilized to pH>11 with sodium hydroxide then 0.5% solution lasts 24 months. It appears that NaDCC degrades faster (within a few days if unstabilized) in aqueous solution, although more research is needed on this.

In any case, due to the degradation issue of chlorine, it is safest to make solution fresh every day for handwashing.

The current consensus I am hearing on the email chains and from the meetings at UNC Water and Health Conference and guidance from WHO is to recommend soap or hand sanitizer as they are more effective than chlorine solutions for hand washing because of the chlorine demand of the organic material in your hands that exerts chlorine demand and degrades the chlorine concentration, and chlorine can damage hands and cause breaks in skin, which can lead to increased transmission. There is also the risk of Ebola in the water that has been used for hand washing (particularly if this is in an open bucket). The general consensus I am hearing is:

• Use soap/hand sanitizer preferentially
• Use chlorine solution for hand washing only when it’s culturally demanded at a 0.5% 0.05% solution
• Think about treating the hand washing water with chlorine if stored in an open bucket to reduce transmission risk.

If you are using chlorine solution for handwashing (because it is socially accepted, or for whatever reason) it is recommended 0.5%. 0.05%. This can be made with sodium hypochlorite (liquid) - there is liquid available in Liberia from Manco and Operation Blessing. It can also be diluted from HTH or NaDCC powder. 0.5% 0.05% sodium hypochlorite / HTH solution degrades 50% in 4-6 weeks at temps in the affected countries at unstabilized pH (generally around 7 if unstabilized); if stabilized to pH>11 with sodium hydroxide then 0.5% 0.05% solution lasts 24 months. It appears that NaDCC degrades faster (within a few days if unstabilized) in aqueous solution, although more research is needed on this.

In any case, due to the degradation issue of chlorine, it is safest to make solution fresh every day for handwashing.