Hand-hygiene mitigation strategies against global disease spreading through the air transportation network

Christos Nicolaides; Demetris Avraam; Luis Cueto-Felgueroso; Marta C. González; Ruben Juanes

To derive an approximation of the status quo level of hand cleanliness (i.e. the percentage of people with cleaned hands) in the population of an airport at any given moment, we simulate a close population following some assumptions derived from the literature. We use data from a survey performed by the American Society for Microbiology 38 which revealed that 30% of travelers do not wash their hands after using public toilets at airports, denoting that the rest 70% are compliers with hand washing. Following a study in a college town environment, we consider that only the 67% of the compliers wash their hands properly (i.e. with water and soap and for the recommended by CDC duration of time 39 ), while the rest 33% are wetting their hands quickly and/or without soap 40 . Therefore, we assume that in an airport population of N individuals only the 70% · 67% = 49.6% of N are compliers with effective hand washing. Furthermore, we assume that each individual wash their hands on average between 4-10 times per day 41 which means that in a 24-hour timeframe one event of hand washing takes place every 2.5-6 hours. We assume that the frequency of hand washing follows a normal distribution with mean equal to 4.5 hours and standard deviation equal to 1 hour. We also consider that the duration of cleanliness of hands after hand washing follows an exponential distribution with mean value equal to 1.5 hours.