The Implications of Handwashing and Skin Hygiene on Infectious Disease Dynamics: The African Scenario

Abstract

Infectious diseases are largely preventable, yet they continue to pose a significant threat to public health, particularly among vulnerable populations in developing countries. Basic hygiene practices, especially hand and skin hygiene, have been shown to significantly reduce the risk of the cross-transmission of infections, including those caused by multi-drug-resistant organisms. In light of the growing global concern about antimicrobial resistance, there is an urgent need to review and reinforce these practices. This study provides a general overview of the role that hand hygiene practices play in decreasing infectious diseases by conducting a comprehensive review. Multiple online databases, including Google Scholar, Scopus, and Web of Science, were searched using relevant keywords such as “hygiene practices”, “infectious diseases”, “public health”, “Africa”, and “sanitation”. After filtering the search results for relevancy, selected studies were narratively synthesized to present the latest data on hand hygiene and its impact on infectious diseases. Strengthening hand and skin hygiene, along with environmental sanitation and preventive measures, can help reduce the spread of nosocomial infections. By emphasizing the importance of these fundamental hygiene practices, particularly in regions where the burden of infectious diseases is highest, the development of antibiotic-resistant diseases can be prevented, improving patient safety, and enhancing public health outcomes. Adopting comprehensive hygiene policies, including regular handwashing, is crucial for reducing the prevalence of infectious diseases and improving health outcomes in developing countries.

1. Introduction

Handwashing is a basic yet powerful hygiene practice that aids in preventing the transmission of infectious agents or pathogens that lead to outbreaks of diseases [1]. To get rid of contaminants and pathogens, it entails cleaning the palms with detergent soap and water [2]. Hand hygiene is considered one of the best practices in promoting public health and hygiene in African countries [3], and in many countries throughout the world, handwashing compliance is acknowledged as an efficient and care-related technique [4]. Hand disinfection is achieved using soap and water, and this reduces the risk of infection associated with the skin from spreading within the population [3]. However, the application of alcohol-based hand disinfectants is high in hospital settings to strengthen hand hygiene. The use of alcohol-based disinfectants has increased the rate of compliance and they are more acceptable and effective than washing hands [5]. Patient safety is of the utmost importance in healthcare settings, and one of the greatest ways to protect oneself is to practice basic hand hygiene. This is why healthcare workers must adhere to the right procedure and employ the right technique [6], as infection control with efficient and effective hand decontamination is especially important in the perioperative setting [7]. Furthermore, it is vital to highlight the importance of handwashing, which is a fundamental aspect of hygiene to prevent infection. Maintaining personal hygiene and clothing hygiene is also important for enhancing general health and well-being [8].

Due to the rapid spread of the COVID-19 pandemic, it has placed a substantial strain on healthcare systems [9]. During the era of COVID-19, flu outbreaks and gastrointestinal infections were managed more effectively through handwashing, which helped reduce the spread of infectious diseases. People were strongly encouraged to wear masks, maintain social distancing, and regularly wash their hands in settings such as homes, schools, and hospitals. Several research studies have established a link between enhanced hand hygiene practices and a decrease in influenza-like illnesses. As noted by [4], there is evidence that the incidence of influenza-like illness can be lowered by receiving an annual flu vaccine, and washing hands with soap for at least 15 s after using the restroom, and before and after handshakes or meals.

Handwashing is recommended in certain situations to maintain hygiene and prevent the spread of infectious diseases. Guidelines suggest washing hands after using the restroom and before eating or preparing food to reduce the risk of diarrheal-related infections [10]. Inadequate hygiene practices among food handlers can result in outbreaks of food-borne diseases [11]. Additionally, to prevent healthcare-associated infections (HAIs) in both patients and healthcare workers, proper handwashing is essential in healthcare settings, particularly before and after patient interactions [7].

This paper explores the vital role of hygiene practices in preventing infectious diseases, with a special emphasis on the African setting. While the article centers on Africa, it also acknowledges that studies from other parts of the world offer important insights into the effectiveness of hygiene measures. These international perspectives can help shape local strategies and inform policy development.

1.1. Methodology

This study provides a general overview of the role that hand hygiene practices play in decreasing infectious diseases. Multiple online databases, including Google Scholar, Scopus, and Web of Science, were searched extensively for relevant material using keywords including “hygiene practices”, “infectious diseases”, “public health”, “Africa”, and “sanitation”. Included were pertinent reviews and studies that have been published. After the search results were filtered for relevancy, a selection of studies was examined and narratively synthesized to give an overview of the most recent data on hand hygiene practices and the link to infectious diseases.

1.2. History: Timeline of Handwashing Practice

In the early days of medicine, poor hand hygiene contributed to high mortality rates in hospitals because the link between disease transmission and hand hygiene was not well understood at the time [12]. Physician Ignaz Semmelweis made a significant discovery when he found out that maternal mortality in hospitals due to puerperal fever is associated with inadequate hand hygiene and washing following autopsies by healthcare workers [13,14]. These findings contributed to the reduction in the death rate; therefore, this demonstrates that handwashing and hygiene are essential in maintaining general body health. Over the years, the term surrounding handwashing evolved. Formerly mainly called “handwashing”, the term has evolved to encompass a variety of methods, including surgical scrubbing, disinfection, and handwashing [15]. Thereby, transformation increases the comprehension of the importance of hygiene practice in the prevention and control of infectious diseases.

Moreover, proper handwashing can decrease the risk of diseases affecting the respiratory system and gastrointestinal infections by 20% and 30%, respectively, according to the Centre for Disease Control and Prevention. Previously, handwashing was not primarily considered a disease-prevention strategy but rather was linked to religious rites [16,17]. Roman tradition reinforced the value of handwashing by prohibiting dirty hands from touching holy places or sacred objects [12]. The belief that dirty hands may attract demons is another example of how hygiene was perceived from a spiritual rather than a biological perspective in Jewish culture [12].

Despite the well-recognized importance of hand hygiene, access to basic handwashing facilities remains a significant global challenge. As of 2021, around 2.3 billion people still lacked access to essential resources for proper handwashing [17]. Global initiatives, such as “Hand Hygiene for All” and World Hand Hygiene Day, are actively working to address this critical gap [18].

Early in the 20th century, healthcare professionals started to regularly advise patients about handwashing and hygiene [19]. By the mid-20th century, infection control in hospitals worldwide had become critical. With the acceptance of germ theory and the development of more effective antiseptics, healthcare institutions implemented strict hand hygiene policies. These guidelines require staff to wash their hands frequently, particularly before and after patient contact [20].

Since then, hand hygiene has gained widespread acceptance as being crucial to infection prevention and patient safety. In the aftermath of the COVID-19 pandemic in 2020, hand hygiene has once again emerged as a crucial preventive measure against viral transmission [21]. Public health agencies and organizations emphasized the importance of handwashing and using hand sanitizers during the outbreak to help prevent the spread of COVID-19.

1.3. Normal Flora of the Skin and Hand

The genetic material and bacteria throughout the human body are collectively referred to as the microflora, which are about a trillion in the number living in different areas or organs of the body with a surface area of approximately 2 m². Nevertheless, the overall surface area in contact with the skin microbial community increases dramatically to at least 30 m² when appendages are included [22]. The skin, as the principal physical barrier against external hazards, is home to a collection of microorganisms called the skin microbiota, or normal flora. These normal flora develop gradually after birth, although the stable microbial populations established as a result of this process comprise the adult microbiota. However, hygiene practices and other factors like age and environment influence its makeup and composition. Therefore, it is vital to protect the skin from pathogenic microorganisms and other harmful external factors to maintain its integrity and overall health. Fully comprehending the skin structure, its microbial community, and its implications for hygiene and health is essential for implementing optimal hygiene standards, especially in areas with little or no resources in Africa. This is because skin health is greatly dependent on the skin’s normal flora, which also affects the immune system and general physiology [23]. Certain factors, like changes in anatomical structures and physical factors like humidity and temperature, affect the several microbial habitats on the skin. The quantity of bacteria on the skin remains constant, while the amount of colonization and the survival of those bacteria are influenced by the type of environment to which the skin is exposed in addition to the skin’s inherent and species-specific bactericidal action [23].

The microbiota exist in two groups: The resident microbes are stable microbial communities on the skin; they can establish themselves after disturbance or stress by external factors. This group of microbiota is the commensal microorganisms; that is, they are non-pathogenic, do not cause harm to the host, and offer protection to the host. Some of these organisms are Staphylococcus epidermidis, which is the dominant species in this group (90%); others are Micrococci, Corynebacteria, Micrococcus luteus, Propionibacteria, and Anaerobic cocci [23]. The second group of microbiota is the transient microbes such as Klebsiella, Escherichia coli (E. coli), Staphylococcus aureus (S. aureus), and various enterobacteria. These bacteria originate from the environment, and they are Gram-negative and live for a short time (hours to days), specifically on hands and skin. Actinobacter spp. can also be found in healthy individuals, especially in wet intertriginous areas [23]. The resident microbes are more diverse than transient microbes. Therefore, they may contact the outer layer of the skin from the environment, from another person, or via the gastrointestinal tract, and if the skin is not properly washed and disinfected after introducing the organisms, they could reside there for a long time [24]. According to studies on fungal communities, the most common group of fungal organisms on healthy human skin is Malassezia, such as Malassezia globosa, Malassezia restricta, and Malassezia sympodialis [25]. Others are Rhodotorula, Epicoccum, and Aspergillus [26].

However, factors like environment, age, health status, and nutritional state affect the skin microbiome. The resident and transient microbes are not pathogenic under normal conditions provided that proper hygiene is practiced and the normal resident flora, immune responses, and skin barrier function remain intact [27]. However, if there is a disruption where these microbial populations can colonize, multiply, and lead to disease conditions, frequent handwashing and disinfection, the skin’s protective role as a mechanical barrier provided by intact skin, desiccation that dries out some invasive bacteria, the presence of fatty acids on the skin that inhibit numerous bacteria, and the antimicrobial substances produced by the skin’s native flora restrict the survival and growth of these organisms [28].

1.4. Pathogen Colonization of Hand and Skin, and Association with Disease Transmission

The skin microflora support the immune system in protecting the skin’s health. However, a condition known as dysbiosis influences the microflora to cause certain skin disorders and also makes the non-pathogenic microorganisms pathogenic, leading to disease [29]. Some of these skin conditions are acne, dandruff, and atopic dermatitis, which are associated with changes or alterations in the skin microflora [30]. Conditions like Seborrheic dermatitis and dandruff are caused by yeast infection known as Malassezia, which is a non-pathogenic fungus on the skin [31]. Psoriasis patients’ microbiomes had significantly fewer Cutibacterium and more Streptococcus and Malassezia species than those of healthy individuals [32]. When compared to healthy controls, it was discovered that the unaffected skin microbiome of people with ichthyosis vulgaris and a filaggrin deficiency was predominantly composed of Gram-positive anaerobic cocci. According to this, a malfunctioning stratum corneum may be the origin of the dysbiosis associated with eczema, altering the microbiota of the skin [33]. It has been established that skin-colonizing microbes influence both the healing of chronic wounds, which are common in populations with high rates of diabetes, obesity, and aging, as well as the healing of conventional skin disorders. For instance, the part that bacteria play in the overall picture of diabetic foot ulcers (DFUs) has been the subject of much investigation. Shallower and shorter-lasting ulcers were associated with increased levels of S. aureus, whereas deeper and longer-lasting ulcers demonstrated greater microbial diversity and a higher relative abundance of anaerobic bacteria and Gram-negative Proteobacteria spp. [34].

Although opportunistic microorganisms are frequently detected in skin-associated phyla, these microbes are present in individuals with primary immunodeficiency. Skin was colonized with less Corynebacterium spp. and more Acinetobacter spp., a kind of Gram-negative bacteria, than the levels found in healthy controls [35]. Because S. aureus is linked to atopic dermatitis, other skin problems, and bloodstream infections, a lot of research has been performed on the bacteria, its toxins, its immune system, and its capacity to cause or aggravate diseases. When exposed to lipoteichoic acid, a component of the S. aureus cell wall, T cells, did not proliferate or produce cytokines [36], indicating that S. aureus compounds can both momentarily paralyze and activate the immune system. Besides targeting immune cells, S. aureus has also been found to enhance adipocyte proliferation and boost the host’s production of the antimicrobial peptide cathelicidin [37].

Alterations in cutaneous microbiological communities, marked by an increase in the normal flora or commensal organisms, occurred before the emergence of features related to atopic dermatitis [37]. To survive on the skin, Staphylococcus species have evolved a variety of adaptations. These include the ability to produce adherents, which help with skin attachment, and proteases, which release nutrients from the stratum corneum to aid in colonization [38]. Additionally, they are halotolerant, meaning that they can withstand the elevated salinity of sweat and use the urea found in perspiration as a source of nitrogen [39].

1.5. Impact of Hand and Skin Hygiene on Specific Infectious Diseases

To control the spread of pathogens and prevent the onset of infectious diseases, it is essential to maintain proper hand and skin hygiene. Whether the source of the infection is a virus, bacteria, protozoa, or a fungus, contact with contaminated surfaces can spread an array of diseases. Breaking the chain of transmission requires maintaining proper hygiene, particularly in locations where there is a high risk of disease transmission, such as hospitals, schools, prisons, and camps for internally displaced people (IDPs). Good hand hygiene is essential for preventing the spread of viruses, including influenza, coronaviruses (such as SARS-CoV-2), norovirus, hepatitis A, and enteroviruses. These viruses are mostly transmitted by respiratory droplets, contaminated surfaces, and direct contact between individuals [40,41]. Handwashing reduces the risk of infection by eliminating virus particles from hands and preventing self-inoculation through the mouth, nose, or eyes [42]. According to research, routine handwashing dramatically lowers the number of influenza cases [43], particularly during flu seasons and pandemics.

Two-thirds of research suggested that hand hygiene successfully reduces influenza infection, according to a systematic review [44]. Hand hygiene practices, including washing hands with soap and water or using alcohol-based sanitizers, have been proven to significantly decrease the amount of the virus on hands and prevent the transmission of SARS-CoV-2 during the COVID-19 pandemic [22,45]. It emphasized the significance of handwashing even more. Norovirus is a frequent cause of gastroenteritis and spreads swiftly in confined spaces like prisons, schools, and cruise ships [46]. Although norovirus is resistant to alcohol, studies show that handwashing with soap and water is more effective against the virus than alcohol-based hand sanitizers [47]. This emphasizes the critical role of proper hygiene in controlling outbreaks. In contrast, viruses like enteroviruses and hepatitis A, which are spread through the fecal–oral route and have been linked to fewer outbreaks, require enhanced hand cleanliness [48,49]. This issue is particularly prevalent in areas with poor sanitation. Thus, promoting regular handwashing with soap and water is a simple yet highly effective public health measure that significantly reduces the spread of viruses. This underscores the importance of hand hygiene as a primary defense against viral infections during epidemics and pandemics.

Because of their propensity for rapid transmission and substantial morbidity, bacterial infections—including those caused by S. aureus, Salmonella, E. coli, and Clostridium difficile (C. diff.)—are serious public health concerns. Because of its resistance to antibiotics, Staphylococcus aureus, especially methicillin-resistant S. aureus (MRSA), frequently colonizes the skin and nasal passages and presents a risk in healthcare settings [50,51]. Since research has indicated that healthcare personnel may carry the bacteria on their hands and so expose patients to it, hand cleanliness is essential in minimizing the spread of S. aureus [52]. The general public and food handlers must practice basic hand hygiene to prevent outbreaks, as contaminated food and water are the main ways that Salmonella and E. coli spread [53]. Good hand hygiene is essential to prevent the cross-contamination of food, which can cause severe gastroenteritis and other significant health problems. Because C. diff., a prominent cause of gastrointestinal infections associated with healthcare, spreads by spores resistant to alcohol-based sanitizers, handwashing with soap and water is essential [54].

Among the main threats to public health linked with protozoan infections include Giardia lamblia, Cryptosporidium spp., and Entamoeba histolytica (E. histolytica) infections, especially in places with inadequate sanitation and water quality [55]. Maintaining proper hand hygiene is essential for prevention, as parasites are primarily transmitted through contaminated food, water, and human contact. Research has demonstrated that improved handwashing practices significantly reduce the incidence of these diseases. For example, a study conducted in rural Bangladesh found that individual handwashing interventions could prevent 25–30% of Giardia infections [56]. Other studies have highlighted the importance of hygiene in reducing the risk of diarrhea [57,58].

Fungal infections caused by dermatophytes, such as ringworm and athlete’s foot, as well as those caused by Candida species, are common skin conditions that spread through contact with infected individuals or contaminated surfaces. While Candida species can cause opportunistic infections, particularly in people with compromised immune systems, dermatophytes thrive in communal settings like gyms, swimming pools, and bathrooms [59,60]. Research indicates that educating individuals about basic hygiene practices—such as keeping personal items separate and washing their hands and feet after using public restrooms—can significantly lower the risk of acquiring these infections [61].

Therefore, preventing the transmission of infectious diseases necessitates strict hand and skin hygiene. Implementing proper hygiene practices can help curb disease transmission and enhance public health, particularly in high-risk areas and among vulnerable populations.

1.6. Skin and Hand Hygiene in Healthcare Settings: Impact on Nosocomial Infections

Hand hygiene is essential for ensuring patient safety and preventing HAIs in hospital environments [20]. These infections frequently arise from poor hygiene measures among healthcare personnel and can cause greater morbidity, longer stays in hospitals, and death. Since viruses are often transmitted by touch directly or the hands of healthcare personnel, hand hygiene is an important preventive measure against HAIs. Maintaining good hand sanitation greatly lowers the risk of infection, safeguarding both patients and medical personnel [62]. As healthcare workers (HCWs) are the primary transmitters of healthcare-associated infections (HAIs) via their hands [63], maintaining proper hand hygiene is vital for infection control. Healthcare personnel can spread HAIs in various ways, with direct patient contact being a significant method, allowing germs to be transferred between the worker’s hands and the patient or vice versa [64].

Furthermore, a variety of surfaces in hospital settings may be habitats to infectious agents [65]. They often interact with potentially contaminated surfaces of medical equipment, increasing the risk that, without proper hand sanitization, infectious pathogens may be transmitted to patients. Moreover, inappropriate use or neglect to replace gloves between patients can lead to cross-contamination [66]. Research revealed that hands are the main way that pathogens spread in healthcare environments [67,68], and that hand-to-surface exposures involving HCWs’ hands occur often when managing infections or diseases [69,70]. Numerous nosocomial diseases are linked to poor hand hygiene practices. When microorganisms enter the bloodstream, usually through invasive devices like central lines, bloodstream infections can happen [71].

This is because improper hand hygiene during the installation or maintenance of these devices can result in infections. Furthermore, if hands are not cleaned properly during catheter insertion, infections such as urinary tract infections may arise [72], which could introduce bacteria into the urinary system. Patients on mechanical ventilation are at risk of developing ventilator-associated pneumonia [73], and healthcare personnel who do not practice proper hand hygiene may inadvertently spread respiratory infections and increase the risk of contracting one themselves [74]. Because bacteria can spread from the surgical team’s hands to the surgical site, surgical site infections can happen at the location of a surgical procedure. It is the most frequent nosocomial infection among surgical patients [75], making up 15% of all nosocomial infections [76]. Numerous studies have emphasized the critical role of hand hygiene in decreasing healthcare-associated infections, showing that enhanced compliance with handwashing practices has resulted in substantial reductions in infection rates. For instance, one study demonstrated that the adoption of the WHO’s “My Five Moments for Hand Hygiene” approach significantly improved healthcare workers’ adherence, leading to a 30% decrease in nosocomial infections over six months in a large hospital [77]. Furthermore, research conducted after implementing rigorous hand hygiene protocols found that the incidence of hospital-acquired MRSA cases dropped from 1.9% to 0.9% [78]. Another investigation revealed a 66% increase in compliance following the launch of a multimodal hand hygiene promotion strategy at a Swiss hospital [79]. This increase in adherence correlated with a 50% decline in nosocomial infections, particularly in the spread of methicillin-resistant Staphylococcus aureus (MRSA) and related infections, highlighting that organized cleanliness initiatives can significantly reduce infection rates [80].

2. Implications for Practice

To successfully lower HAIs, hygiene practices should be implemented in clinical settings like hospitals and clinics by using the WHO’s multimodal hand hygiene improvement plan [81]. The “My 5 Moments for Hand Hygiene” method [15], which highlights important periods for handwashing, such as before patient contact and after exposure to body fluids, is one of the strategies used to train healthcare workers. Moreover, healthcare personnel must receive instructions on proper hand hygiene. Although studies show that employees frequently have a good level of awareness of hand hygiene, real compliance may be low in the absence of frequent training and reminders. For example, a Nigerian study found that even though 63% of healthcare professionals had received training, there were significant differences in compliance based on the precise times when hand hygiene was practiced [82]. To make sure that staff can apply these techniques effectively, training programs should include continual assessments and hands-on demonstrations. Furthermore, community-based initiatives might be crucial in encouraging hand hygiene in homes, marketplaces, and educational institutions. One of the initiatives could involve workshops that educate families on the importance of handwashing, especially before meals and after using the restroom. Collaborating with non-profits and local health departments can further enhance these efforts. In underserved communities, these partnerships can assist in providing essential supplies such as soap and hand sanitizers, ensuring that community members have the necessary resources to maintain proper hygiene practices.

3. Discussion

Enhancing hand hygiene practices can potentially lessen the burden of disease and the related healthcare costs of HAIs. There may be fewer infectious illness outbreaks as a result of improved hygiene habits. Nonetheless, several obstacles prevent many African tribes from practicing good hand hygiene. Progress can be impeded by various factors, including time constraints, insufficient resources in clinical settings, limited education and training, and restricted access to clean water. To overcome these challenges and prevent disease outbreaks while enhancing public health, timely interventions are essential. Moreover, there is a notable gap in current research regarding the effectiveness of various hand hygiene solutions in different contexts.

Further study efforts need to investigate the enduring effects of educational interventions on the alteration of community behavior concerning hygiene practices. Furthermore, a comparative examination of hand hygiene methods in different countries may reveal effective strategies that could be used in Africa. Strong public health policies and training activities are common in nations with high compliance rates. These policies support cleanliness initiatives.

4. Recommendations

4.1. Impact on Infection Prevention and Control

Handwashing and skin hygiene are essential components of infection prevention and control, playing a vital role in reducing the transmission of pathogens. Research has shown that proper hand hygiene significantly decreases the risk of infections. Statistics highlight the effectiveness of handwashing in controlling infections. For instance, one study revealed that antiseptic handwashing lowered the transmission rate of Staphylococcus aureus from 43% to 14% when healthcare workers practiced appropriate hand hygiene before patient interactions [83]. Additionally, in a clinical setting, 92% of infants cared for by nurses with unwashed hands became colonized with S. aureus, compared to just 53% when nurses followed hand hygiene protocols [83]. These results illustrate the direct effect of handwashing on infection rates.

Hand and skin hygiene are particularly essential for reducing the risk of infections acquired in hospitals. Pathogens contracted by coming into contact with infected surfaces or people are reduced in their ability to multiply [20]. Improved hand hygiene habits have been associated with lower rates of HAIs, which further emphasizes the importance of skin hygiene in infection prevention. For instance, research has demonstrated that healthcare workers’ rates of methicillin-resistant Staphylococcus aureus (MRSA) have significantly decreased as a result of greater adherence to hand hygiene guidelines [84]. Additionally, adherence to hand hygiene practices significantly decreased the acquisition of pathogens on hands, which in turn decreased infection rates in hospital settings, according to a comprehensive review [85]. Several steps are recommended to maximize the anti-infection benefits of handwashing and skin care. Individuals ought to scrub their hands with soap and clean water for at least 20 s, the CDC recommends. When soap is unavailable, an alcohol-based hand sanitizer containing at least 60% alcohol can be used effectively. Key moments for handwashing include before preparing food, after using the restroom, after caring for someone who is ill, and after handling animals or waste. Finally, educational campaigns are vital for raising awareness about the importance of hand hygiene. Developing educational materials and initiatives in various settings can significantly enhance community understanding and compliance with these essential practices.

4.2. Antimicrobial Resistance (AMR)

Grasping the connection between hygiene practices and the emergence of antimicrobial resistance (AMR) is crucial for comprehending how infections spread and evolve. Good hygiene, especially hand hygiene, significantly helps prevent the transmission of pathogens, including antibiotic-resistant strains [86]. When hygiene standards are lacking, the risk of infections rises, leading to increased antibiotic usage. This higher usage, in turn, places selective pressure on bacteria, encouraging the development of resistance. Effective handwashing can prevent up to 25% of diarrheal episodes and reduce respiratory infections by 6–44%. By decreasing the need for antibiotics, proper hygiene practices help alleviate the selective pressure that drives the evolution of resistant bacteria [87]. A mathematical model further demonstrates that improved hygiene levels can lessen the impact of antibiotic use on resistance evolution by limiting the spread of resistant strains within populations [87]. Inadequate sanitation and personal hygiene lead to higher infection rates, resulting in more antibiotic prescriptions [86]. This cycle perpetuates the development and spread of resistant bacterial strains.

Integrating hygiene practices into national and international strategies is essential for the effective prevention and control of AMR. These strategies include implementing hygiene practices in institutions like schools, prisons, and internally displaced people’s camps to lower the risk of infection on frequently touched surfaces. Therefore, it is important to continue public sensitization on the role of hands and skin hygiene in the prevention of infections and in decreasing the use of antibiotics, which focuses on proper handwashing and sanitation procedures. Moreover, the use of antibiotics and the risk of infection can be reduced by investing in water, sanitation, and hygiene (WASH) infrastructure to provide access to clean water and sanitary facilities, especially in resource-limited settings or communities. Strategies for strengthening hand and skin hygiene should be included in the public health action plans tackling antimicrobial resistance. Also, putting in place systems to track how well hygiene initiatives reduce infection rates and the incidence of AMR will guarantee ongoing advancements in public health tactics.

4.3. Cost Analysis of Infectious Diseases Due to Poor Hygiene

Poor hand and skin hygiene practices are associated with a high prevalence of infectious diseases, leading to significant economic loss and burdens. For instance, about $4.5 billion is lost every year in Nigeria due to nosocomial infections associated with WASH. This amount includes direct healthcare costs, mortality, and productivity loss of about $606 million, $3.6 billion, and $257 million respectively. This led to an overall economic loss of 0.94% of its Gross Domestic Product (GDP) in the year 2022 due to nosocomial infections [88]. Therefore, improving hand and skin hygiene can yield a significant economic benefit by lowering the risk of infectious disease transmission as well as the healthcare cost associated with it. Interestingly, a Community-Led Total Sanitation (CLTS) initiative was implemented in Ghana and it has produced a very cost-effective result of a proportion of about $106.42 per individual for enhanced sanitation [89].

4.4. Pandemic Preparedness and Response

To prevent the transmission of pathogens, maintaining hygiene is important for limiting pandemics and outbreaks of infectious diseases in a population. To limit the transmission of diseases, effective hygiene measures, such as respiratory hygiene, surface disinfection, and handwashing, are vital, as seen during the COVID-19 pandemic. Strict sanitation guidelines during outbreaks help protect vulnerable groups, significantly decrease infection rates, and reduce the burden on healthcare systems.

Response plans require robust hygiene practices to improve pandemic preparation. This involves developing comprehensive hygiene education programs that instruct communities about good hygiene habits, funding WASH infrastructure to guarantee access to potable water, and implementing behavior change initiatives into action that encourage uniform hygiene in several settings. Essential steps also include creating regulations that require hygienic standards in public areas and healthcare facilities, putting in place monitoring systems to gauge compliance, and encouraging cooperation with community organizations, NGOs, and municipalities. Communities can greatly increase their resistance to infectious diseases and safeguard public health by giving hygiene priority in pandemic preparedness.

4.5. Enhancing Research Initiatives on Hygiene Practices

Research efforts in the area of hygiene practices are essential in understanding the infectious disease dynamics associated with hygiene especially in low- and middle-income countries and communities that are resource-limited where significant disparities exist [67,90,91,92]. There is a need to focus on studies that target interventions, which may result in a sustainable systematic improvement in hygiene practices. The studies should assess the impact of preventive measures, compliance, and disease transmission dynamics as well as evaluate the effectiveness of hand sanitizers and reagents. A study revealed that only 27% of hand sanitizers were effective in eliminating pathogens from hands and contact surfaces. Therefore, there is a need for more studies to increase access to and availability of high-quality hygiene products [93].

Moreover, effective research methodologies are essential to understanding the challenges related to the adoption and implementation of hygiene practices. A separate study conducted in Kenya [94] demonstrated that including hygiene promotion did not significantly enhance adoption rates.

While several studies have been conducted on health hygiene education and training, the WHO has identified performance feedback and hand hygiene training as the areas of greatest priority for healthcare workers. This research takes into account baseline adherence, organizational structure, and the knowledge and skills of healthcare workers when assessing the impact of these interventions on compliance [95]. National, regional, and continental initiatives should support the design and customization of research to address these important areas. Apart from the aforementioned research priorities as indicated by the World Health Organization, a recent study examined research priorities concerning water, sanitation, and hygiene (WASH) in humanitarian crises. The study identified multiple research focus areas that intersect with the identification, development, characterization, and provision of WASH practices and implementations [96]. Furthermore, research at the interface between humans and animals, where there is a chance of disease transmission to humans, needs to be prioritized to better understand the behaviors and practices that affect hygiene practices and their implementation, as well as food safety and hygiene research aimed at identifying risk factors [97,98,99]. Taken together, these efforts and resources from both local and international sources will greatly advance our knowledge of and ability to implement better hygiene practices in Africa.

4.6. Education and Hygiene Promotion

Improving hygiene practices and preventing disease can be accomplished through education and the promotion of effective hygiene behaviors [100,101]. For example, the World Health Organization (WHO) Guidelines on Hand Hygiene in Health Care highlight that education is vital for successfully enhancing hand hygiene, alongside other factors [15]. These educational initiatives should target both the general public and healthcare professionals [102,103]. This is essential because research indicates that hygiene practices vary significantly among different socioeconomic groups [104,105], necessitating that hygiene education programs be tailored effectively to address these disparities. To promote the adoption of the WHO’s multimodal hand hygiene improvement strategy, healthcare workers should receive continuous education. Moreover, formal hygiene education models should be integrated into the training of medical and health-related students to foster adherence before they enter healthcare settings [102,106,107]. Public hygiene education should emphasize critical moments for handwashing, such as before meals, after using the restroom, after contact with feces, and during disease outbreaks [108]. Additionally, using influential figures and media platforms can further amplify hand hygiene messages in an engaging and accessible manner, ensuring greater public awareness and acceptance [11,109,110].

Educational components are a persistent feature of successful hand hygiene programs [111]. Programs that focus only on teaching, however, may only have temporary effects. Extended benefits can be achieved by a multimodal approach that integrates behavior-modifying methods with education for lasting development. A series of actions intended to improve behavior toward the adoption and maintenance of sanitary habits is referred to as hygiene promotion [112]. Numerous studies conducted both inside and outside of Africa have demonstrated the positive impact of health promotion interventions on the adoption of better hygiene practices and the decline in disease incidence across various demographic groups [11,94,101,103,113,114]. The establishment of more toilets and bathroom facilities and the provision of soap, water treatment techniques, and handwashing stations in homes, hospitals, school communities, and public areas are a few of these health promotion initiatives. Hygiene education and extension programs are also included.

4.7. Government Policy and Policy Implementation

To improve hygiene practices and their implementation globally, the WHO has been at the forefront of development and driving strategic policies [15,90,115]. With the creation of the African Sanitation Policy Guidelines in 2021, there has been progress made at the continental level in creating policy roadmaps to improve WASH in Africa. Despite this significant advancement in policy development, there is still a significant implementation gap. About three out of five Africans still do not have access to WASH, and there is a significant difference in the way WASH is implemented in urban and rural areas, according to current data on the progress made in this area [105,115]. Transforming these policy frameworks into practical action in the majority of countries is currently a difficulty. Governments at the national and local levels need to allocate resources and guarantee uniform policy execution to enforce cleanliness standards with greater severity. Important policy initiatives should focus on increasing capacity, fortifying public–private partnerships to boost involvement in promoting hygienic practices, encouraging active research that provides solid sector-specific data to support budget and implementation, and encouraging the production of WASH equipment locally, which would encourage a rise in the adoption of hygienic practices [92,116].

Additionally, improved sanitation regulations in food sectors and healthcare facilities are essential to minimize foodborne diseases and HAIs [90,117,118]. With a greater emphasis on rural areas, public health regulations should be modified to promote hygienic infrastructure and education initiatives in both urban and rural areas [119,120,121]. Improving relationships, funding, and technical support amongst African member states and institutions can help improve the implementation of hygienic policies [122,123,124]. African nations need to give priority to improving cleanliness, both in terms of policy and in terms of actual, hands-on execution.

4.8. Zoonoses and Responsible Pet Ownership

One of the most important ways to prevent zoonotic diseases—diseases that spread from animals to people—is through good hygiene [99,125,126,127]. Since few studies have examined this crucial area, more attention needs to be paid to sanitation and hygiene at the animal–human interface in Africa. To address potential zoonotic disease risks resulting from intimate encounters between humans and animals, particularly in disadvantaged communities, better research and interventions are needed [126,128]. To provide clear guidelines on hygienic standards and strategies at the animal–human interaction interface, veterinarians and public health authorities need to work together more effectively. This is especially important when managing pets or livestock that may carry infectious agents like bacteria or parasites [96,126,127]. In addition to promoting ethical pet ownership through awareness campaigns, public health campaigns targeting zoonoses should stress the significance of washing hands after getting into contact with animals [129,130,131]. To encourage healthier living circumstances and stop the spread of diseases from animals to people, pet owners must receive hygiene education [97,130,132]. Pet owners must guarantee food safety, clean pet surroundings, and routine veterinarian treatment because improper management of pet food, waste, and living areas can raise the risk of illnesses for both humans and pets [97].

4.9. Technological Innovations in Promoting Hygiene

Improved hand and skin hygiene practices can now be achieved with the aid of technology. Hygiene awareness and compliance are aimed to be promoted by several developments, such as automated systems, sensors, and mobile applications. The way individuals monitor their skin health and practice cleanliness has changed significantly, especially due to mobile applications. Technology has a significant impact on awareness and compliance. Technological advancements, via a variety of methods, can dramatically improve adherence to hygiene measures. For instance, individuals can more easily adopt good hygiene practices due to the information that mobile apps make accessible and individualized recommendations and reminders. In this regard, educational platforms are also quite important. A lot of applications offer useful information about skin health and good hygiene habits. These tools aid users in appreciating the significance of practicing proper hygiene. The effectiveness of technology-based hygiene initiatives is illustrated by various case studies. Numerous mobile applications were developed to promote hand hygiene in response to the COVID-19 pandemic. During this critical time, these applications played a vital role in encouraging individuals to maintain proper handwashing practices.

The “Wash Your Hands” app, for example, promoted user compliance by offering instructional videos and reminders on proper handwashing practices. By leveraging these technological innovations, public health initiatives can effectively promote better hygiene practices, enhance compliance among individuals, and ultimately contribute to improved health outcomes across communities.

5. Conclusions

In conclusion, the act of handwashing and upholding skin hygiene is crucial in managing the spread of infectious diseases throughout Africa. This work points out the significance of these practices in mitigating the spread of pathogens and in lowering the global toll of diseases like respiratory infections, cholera, foodborne infections, and other infections linked to healthcare. Although the advantages have been demonstrated, there are still major obstacles, such as cultural norms, restricted access to resources, and low public awareness. To build a healthier future, collaboration between local communities, healthcare workers, and the government is needed to strengthen effective hand and skin hygiene practices. Measures to guarantee access to clean water and sanitary facilities, public health campaigns, and educational initiatives can help achieve this. Additionally, funding research in this sector is essential in comprehending hygiene practices and their consequences. Through these, the incidence of infectious diseases will be reduced significantly and health outcomes will improve across Africa.