Who Washed Their Hands During COVID-19? A June 2020 Survey of 4,817 U.S. Adults

Washing hands with soap and water — or, when that isn't available, using a hand sanitizer with at least 60% alcohol — is one of several key measures recommended to slow the spread of SARS-CoV-2, the virus that causes COVID-19. Earlier studies had looked at who washed their hands during the pandemic; less was known about who used sanitizer, or how people's experiences and beliefs shaped both habits.

An internet survey of U.S. adults during June 24–30, 2020 asked how often, in the past week, people had washed or sanitized their hands after touching high-touch public surfaces such as shopping carts, gas pumps and ATMs.

The headline

Of 4,817 adults who had been out in public that week, 85.2% always or often cleaned their hands afterward in at least one way:

Who did it less

Frequency rose with age, and with concern. Frequent sanitizer use was also higher among people with a 2019 household income of $100,000 or more (72.6%) than below $25,000 (62.5%).

What predicted it, all else equal

Adjusting for gender, age, race and ethnicity, income, region, rural or urban residence, knowing someone with COVID-19, and concern about infection, the odds of washing hands more often were:

Adjusted odds of more frequent handwashing, by respondent characteristics. CDC

The pattern for hand sanitizer was much the same, with two additions:

• a household income of $25,000–$49,999, compared with under $25,000: 30% higher odds (aOR 1.30; 95% CI 1.04–1.64);
• knowing someone hospitalized for or killed by COVID-19: 28% higher odds (aOR 1.28; 95% CI 1.04–1.59).

Adjusted odds of more frequent hand sanitizer use. CDC

Making sense of it

Men and young adults cleaned their hands less often, as in earlier pandemics and earlier in this one. One earlier COVID-19 study found Hispanic adults washed their hands more often than White adults; this one found no difference once concern about infection was taken into account.

Risk perception seems to matter. In past respiratory pandemics, general concern, feeling susceptible and seeing the illness as severe all went with more hygiene, and during this one, higher perceived risk has gone with more handwashing — and with distancing, avoiding handshakes and crowds, and wearing cloth masks. Other research during the pandemic found younger people and men perceived less risk, which may partly explain the gaps, though this survey did not test that. There is some evidence that U.S. adults underestimated their own risk of becoming ill.

Lower income went with less sanitizer use, which may reflect access: hand sanitizer was at times hard to find during the pandemic, rising prices may put it out of reach, and higher income and access to handwashing facilities have been tied to better hand hygiene before.

What the authors recommend

• Keep promoting hand hygiene, tailored to men and young adults.
• Address how people see their COVID-19 risk — which could also encourage masks and distancing.
• Put soap and sanitizer where people are: visible signs and contactless dispensers in public places — the middle of a lobby or market, beside or built into gas pumps — to close gaps in access.

Hand hygiene is one part of a wider approach that also includes wearing face masks and staying at least 6 feet from others.

About the survey

• Run by Qualtrics for The COVID-19 Outbreak Public Evaluation (COPE) Initiative. Of 9,896 eligible adults, 5,412 (54.7%) completed it: 3,683 first-time respondents and 1,729 re-contacted from an April 2–8, 2020 round.
• 5,000 gave complete answers; the 4,817 of them who had been in public the previous week were analysed.
• Quota sampling and weighting were used to make the sample more representative of U.S. adults (2010 Census estimates) by gender, age and race/ethnicity. Monash University's human research ethics committee approved the protocol, and CDC reviewed it.

Limits. Answers are self-reported and may overstate hand hygiene; weighting may not remove nonresponse bias. The model assumes proportional odds, an assumption often violated, though models without it gave similar results. An internet sample may not represent the 2020 population by income, education and access to technology. The survey covered only public surfaces — not homes or workplaces — did not count how often people touched them, and did not ask whether soap, water or sanitizer were available.

Sources

Based on Czeisler MÉ, Garcia-Williams AG, Molinari NA, et al., "Demographic Characteristics, Experiences, and Beliefs Associated with Hand Hygiene Among Adults During the COVID-19 Pandemic — United States, June 24–30, 2020," MMWR volume 69, number 41, Centers for Disease Control and Prevention, with authors from CDC, Monash University, Brigham and Women's Hospital, Harvard Medical School, Austin Health and the University of Melbourne; a work of the United States government in the public domain.