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More than 50 million people in India do not have access to effective handwashing, putting them at a greater risk of acquiring and transmitting the novel coronavirus, according to a study.

Researchers from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in the US found that without access to soap and clean water, over 2 billion people in low- and middle-income nations -- a quarter of the world's population -- have a greater likelihood of transmitting the coronavirus than those in wealthy countries.

According to the study, published in the journal Environmental Health Perspectives, more than 50 per cent of the people in sub-Saharan Africa and Oceania lacked access to effective handwashing.

"Handwashing is one of the key measures to prevent COVID transmission, yet it is distressing that access is unavailable in many countries that also have limited health care capacity," said Michael Brauer, a professor at IHME.

The study found that in 46 countries, more than half of people lacked access to soap and clean water.

In India, Pakistan, China, Bangladesh, Nigeria, Ethiopia, Democratic Republic of the Congo, and Indonesia, more than 50 million persons in each country were estimated to be without handwashing access, according to the study.

"Temporary fixes, such as hand sanitizer or water trucks, are just that -- temporary fixes," Brauer said.

"But implementing long-term solutions is needed to protect against COVID and the more than 700,000 deaths each year due to poor handwashing access," Brauer said.

He noted that even with 25 per cent of the world's population lacking access to effective handwashing facilities, there have been "substantial improvements in many countries" between 1990 and 2019.

Those countries include Saudi Arabia, Morocco, Nepal, and Tanzania, which have improved their nations' sanitation, the researchers said.

The study does not estimate access to handwashing facilities in non-household settings such as schools, workplaces, health care facilities, and other public locations such as markets.

Earlier this month, the World Health Organization predicted 190,000 people in Africa could die of COVID-19 in the first year of the pandemic, and that upward of 44 million of the continent's 1.3 billion people could be infected with the coronavirus, the researchers said. 

New Delhi, May 15: A group of doctors from the AIIMS, Raipur has recommended restrictions on the use of mobile phones in healthcare institutions amid the COVID-19 pandemic, warning that such devices can be a potential carrier of the virus and lead to infection among healthcare workers.

In a commentary published in the BMJ Global Health journal, the doctors stated that mobile phone surfaces are a peculiar 'high-risk' surface, which can directly come in contact with the face or mouth, even if hands are properly washed and one study indicates that some healthcare workers use phones every 15 minutes to two hours.

Though there have been many significant guidelines from various health organisations like the WHO and CDC focusing on prevention and control of disease, the commentary highlighted "there is no mention of or focus on mobile phones in these guidelines, including the WHO infection control and prevention guidelines, which recommends the use of handwashing".

In healthcare facilities, phones are used to communicate with other health care workers, look up recent medical guidelines, research drug interactions, understand adverse events and side effects, conduct telemedicine appointments and track patients among others, stated the document.

The document has been authored by Dr Vineet Kumar Pathak, Dr Sunil Kumar Panigrahi, Dr M Mohan Kumar, Dr Utsav Raj and Dr Karpaga Priya P from the Department of Community and Family Medicine.

"In their tendency to come in direct contact with the face, nose or eyes in healthcare settings, mobile phones are perhaps second only to masks, caps or goggles," the authors said.

"However, they are neither disposable nor washable like these other three, thus warranting disinfection. Mobile phones can effectively negate hand hygiene... There is growing evidence that mobile phones are a potential vector for pathogenic organisms," they said.

It is the need of the hour to address proper hygienic use of mobile phones in healthcare settings. In a study in India, almost 100 per cent of health workers of a tertiary care hospital used mobile phones in the hospital, but only 10 per cent of them had at any time wiped their mobile phones clean, the commentary published on April 22 said.

"The safest thing to do is to consider your phone as an extension of your hand, so remember you are transferring whatever is on your phone to your hand," Dr Pathak said.

Amidst the ongoing pandemic, two biggest mobile phone companies have uploaded their user support guidelines, saying that 70 pc isopropyl alcohol or Clorox Disinfecting Wipes can be used to gently wipe the exterior surface of phones in switched-off mode.

However, in doing so, the use of bleach or entry of moisture through any of the openings must be avoided, and any harsh chemical may damage the oleophobic screen, leading to damage in the touch screen sensitivity of the phone, the article stated.

Mobile phones are one of the most highly touched surfaces according to the Centers for Disease Control and Prevention (CDC), along with counters, tabletops, doorknobs, bathroom fixtures, toilets, keyboards, tablets and bedside tables.

The doctors recommended restriction on mobile phone usage in healthcare settings like hospital wards, ICUs and operation theatres, while advocating the use of headphones to prevent contact with the face while talking.

There should be no sharing of mobile phones, headphones or headsets of any kind. In addition, where available, the use of interdepartmental intercom facility may be promoted.

"Although hand hygiene and mobile phone use by a person are not mutually exclusive, it is high time to acknowledge the potential role of mobile phones in disease transmission cascade and to take evidence-based appropriate actions. This is especially important, given the ongoing COVID-19 pandemic," the authors said.

They said it is necessary for government agencies and the WHO to generate public awareness and to formulate suitable information, education and communication material on mobile phone hygiene, especially in healthcare settings.

AIIMS, New Delhi, Resident Doctors' Association (RDA) General Secretary, Dr Srinivas Rajkumar T said even outside health care settings, people should pay special attention to the usage of mobile phones as they carry them to all places.

"Phone and computer peripherals like keyboard, mouse, etc. should be covered with transparent plastic covers which can be cleaned without interfering with their function. Cleaning hands by soap or alcohol-based hand sanitizer before and after contact with phone and between contact with other surfaces can decrease the risk of potential transmission.

"Using a handsfree headset, dedicated operator/assistant per ward handling the communication via common line in hospitals while on duty can enable communication without compromising safety," Dr Srinivas said.