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Ecotoxicology and Human Environmental Health
Safely-Managed Hygiene: A Risk-Based Assessment of Handwashing Water Quality Matthew E. Verbyla, Ana K. Pitol, Tala Navab-Daneshmand, Sara J Marks, and Timothy R Julian Environ. Sci. Technol., Just Accepted Manuscript • Publication Date (Web): 28 Jan 2019 Downloaded from http://pubs.acs.org on January 28, 2019
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Environmental Science & Technology
Safely-Managed Hygiene: A Risk-Based Assessment of Handwashing Water Quality Matthew E. Verbylaa, Ana K. Pitolb,c, Tala Navab-Daneshmandd, Sara J. Marksc, Timothy R. Julian*,c,e,f a
Laboratory of Environmental Chemistry, School of Architecture, Civil and Environmental Engineering (ENAC), École Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland; Current: Department of Civil, Construction and Environmental Engineering, San Diego State University, CA, 92182, USA
b
Laboratory of Environmental Chemistry, School of Architecture, Civil and Environmental Engineering (ENAC), École Polytechnique Fédérale de Lausanne (EPFL), CH-1015 Lausanne, Switzerland
c Eawag,
Swiss Federal Institute of Aquatic Science and Technology, CH-8600 Dübendorf, Switzerland
d School
of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, OR, 97331, USA
e Swiss f
Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland
University of Basel, P.O. Box, CH-4003 Basel, Switzerland
*Correspondence to Timothy R. Julian(Dept. of Environmental Microbiology, Eawag, Überlandstrasse 133, CH-8600 Dübendorf, Switzerland; email:
[email protected], phone: +41 58 765 5632)
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ABSTRACT
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Sustainable Development Goal (SDG) Indicator 6.2.1 requires household handwashing facilities
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to have soap and water, but there are no guidelines for handwashing water quality. In contrast,
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drinking water quality guidelines are defined: water must be “free from contamination” to be
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defined as “safely-managed” (SDG Indicator 6.1.1). . We modeled the hypothesized mechanism
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of infection due to contaminated handwashing water to inform risk-based guidelines for microbial
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quality of handwashing water. We defined two scenarios that should not occur: 1) if handwashing
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caused fecal contamination – indicated using Escherichia coli - on a person’s hands to increase,
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rather than decrease; and 2) if hand-to-mouth contacts following handwashing caused an infection
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risk greater than an acceptable threshold. We found water containing 99% probability. However,
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for the annual probability of infection to be
