Objectives
  More than half of those living in developing countries do not have piped water in their homes. Although handwashing is effective for the elimination of microbes from the surface of the palms, thereby preventing the transmission of infectious diseases, the effect of using poor-quality water for handwashing is unclear. This study measured the water quality and the bacteria count on the hands of preschool children in Kathmandu, Nepal.
Methods
  Sixty-two children were asked to follow their normal handwashing technique, and the counts of 3 microbial bacteria—viable bacteria, Escherichia coli, and total coliforms—were measured in the water source and on the children’s palms. Microbial samples from the children’s palms were collected before and after handwashing. The Wilcoxon signed-rank test was used to compare the number of bacteria on the palms before and after handwashing.
Results
  The children washed their hands with a low volume of stored water without soap. Viable bacteria, E. coli, and total coliforms were detected in the water source. The number of viable bacteria and total coliforms on the palms increased after handwashing. In contrast, the numbers of E. coli colonies did not change after handwashing.
Conclusion
  Handwashing with poor quality of water did not have effect on removal of bacteria from hands. In areas with limited water sources, intervention for handwashing requires strategies for not only promoting hygiene behaviors also water storage management.