1.

Identify a core problem (this may involve considerable trial and error before settling on
one).
2. Determine which problems are Causes and which are Effects/Symptoms.
3. Arrange in hierarchy both Causes and Effects
1. PROBLEM: Lack of Motivation to sanitize hands.
2. CAUSES: Laziness, Lack of knowledge on the benefits of having clean hands and the effects
of not having clean hands. Time consuming, inconvenient, lack of incentive (lacks fun factor)
3. SYMPTOMS:
Vomiting, sore stomach, nausea, Salmonella poisoning, Campylobacter infection, MRSA,
diarrhoea, sickness, common cold, impetigo, food poisoning, the transmission of
gastrointestinal diseases.
When you are talking about evidence just say where it came from and yes, a reference
list at the end is necessary.
How important is the problem
Width How many people does this problem effect?
A lack of hygiene can lead to many symptoms as discussed.
Depth How severe this problem. How bad can it get if you dont address this problem today?
Problem Statement: An interesting problem is clearly described. Solving this problem will make the
world a better place. The problem is backed up with strong references.
Problem Tree: A clear and comprehensive problem tree that includes the problem, and provides
convincing symptoms and causes.
The width and depth are insightfully discussed.













3 minutes dialogue:

Have you washed your hands lately?

Keeping your hands clean helps to prevent the transmission of gastrointestinal infections:
(diarrhoea, vomiting, food poisoning,), influenza (flu), hepatitis A and the spread of MRSA.
1) The Better Health Channel (BHC). (2013). Handwashing - why it's important. Retrieved from
http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/handwashing_why_it's_im
portant
Simply put these diseases
Despite these symptoms, 15 % of Men and 7% of Women dont wash their hands after the use of a
toilet at all. Of those who do wash their hands, only 5% of them wash their hands properly.
Just 1 in 20 (5%) wash their hands properly. The remainder are either doing it incorrectly or not
doing it all 10% do not bother.
Most people are only washing their hands for six seconds when they should be spending three times
that amount of time on the task.
Taking these statistics into account the average person's hands carry at least 3,000 different bacteria
belonging to more than 100 species, according to US researchers at the University of Colorado
Boulder.
2) BBC News Magazine. (2012). Handwashing: Why are the British so bad at washing their
hands? Retrieved from http://www.bbc.com/news/magazine-19834975
3) MichiganStateU (June 7 2013). Eww! Only 5 percent of us wash hands correctly. Retrieved
March 31 2014, from http://www.youtube.com/watch?v=PT45b7NLYCQ

Faecal matter can be found on just 25% of our hands, new research suggests. In some cases the
quantity of germs is equivalent to the number in a dirty toilet bowl. So, as you shake that persons
hand just think of wiping a wet and disgusting toilet bowl.

So what are the causes of bad hand hygiene?
Laziness or a lack of awareness are obvious causes but there is also something known as
subconscious automatic behaviour (Dr Val Curtis, director of the Hygiene Centre at LSHTM) in which
we simply dont think about what were doing.

As the most cost-effective intervention for the worldwide control of disease, hand washing could
save more than a million lives a year from diarrhoeal diseases and prevent respiratory infections,
one of the biggest causes of child mortality in developing countries. (United Nations).
"People often genuinely think they've washed their hands after going to the toilet when they
haven't. People think their behaviour is under conscious control, but often it's not. They are
mindlessly doing things."
So, whats the solution?
How can we get people to realise the significance of not washing their hands whilst effectively
providing incentive to rid themselves of laziness or subconscious control. How can we push home
the reality of bad hand hygiene in which 1 in 6 mobile phones is contaminated with faecal matter?
4) Metro.co.uk. (2013). Be HonestDo you wash your hands after you go to the toilet?
Retrieved from http://metro.co.uk/2013/06/18/be-honest-do-you-wash-your-hands-after-
you-go-to-the-toilet-3844526/
The need for convenience can be found in the ease of use of alcohol based sanitizers. Quick, easy,
and effective, a waterless alcohol gel hand sanitizer solves the issue of insufficient logistics, time and
facilities.
Effectiveness is solved by the fact that Alcohol sanitizers eliminate more germs than soap and water,
according to more than 20 studies cited by the CDC (Centre for disease control and prevention). The
use of an alcohol-based hand sanitizer reduces infection rates by 30%.
5) Consumer Search. (2011). Hand Sanitizer: Myths and Facts. Retrieved from
http://www.consumersearch.com/hand-sanitizers/hand-sanitizer-myths-and-facts

6) Hammond, Y Ali, E Fendler, M Dolan, S. Donovan. (2000). Effect of hand sanitizer use on
elementary school absenteeism. 28 (2000), pp. 340346). Retrieved from
http://www.sciencedirect.com.ezproxy.auckland.ac.nz/science/article/pii/S0196655302482
156
How can we motivate people to use hand sanitizers and understand the need for cleanliness.
Through the use of FUN FACTOR of course.

So, it works like this.. Incentivised by the chance to win food vouchers, participants not only learn
the perks of clean hand hygiene but also discover that sanitizing your hands is not so tedious after
all.

























































http://www.cdc.gov/healthywater/pdf/hygiene/hwcorporate.pdf



A number of infectious diseases can be spread from one person to another by contaminated
hands, particularly gastrointestinal infections, influenza and hepatitis A. Washing your hands
properly can help prevent the spread of the organisms that cause these diseases.

Some forms of gastroenteritis can cause serious complications, especially for young children,
the elderly, or those with a weakened immune system
http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/handwashing_why_it's_im
portant

http://www.youtube.com/watch?v=PT45b7NLYCQ : Only 5% of people wash their hands
properly Michigan State University.

ABC News. (Feb 5, 2013). Hand Sanitizers and Soaps Put to the Test. Retrieved March 31 2014, from
http://www.youtube.com/watch?v=OMZZIlkkPZg

BBC News: Faecal matter can be found on just over a quarter of our hands, new research suggests. In
some cases the quantity of germs is equivalent to the number in a dirty toilet bowl.

Even when faced with a serious health threat, many still don't bother. More newly published
findings, this time from an international study by Harvard University, suggest only 53% of people
washed their hands more frequently during the 2009 swine flu pandemic.

They're wrong of course. The average person's hands probably carry at least 3,000 different bacteria
belonging to more than 100 species, according to US researchers at the University of Colorado
Boulder.

Sometimes bad hygiene is not down to laziness or a lack of awareness. Automatic behaviour is often
subconscious and we simply don't think about what we're doing, says Dr Val Curtis, director of the
Hygiene Centre at LSHTM.
"People often genuinely think they've washed their hands after going to the toilet when they
haven't. People think their behaviour is under conscious control, but often it's not. They are
mindlessly doing things."
The UN says washing hands is the most cost-effective intervention for the worldwide control of
disease. It estimates hand washing could save more than a million lives a year from diarrhoeal
diseases and prevent respiratory infections, one of the biggest causes of child mortality in
developing countries.
But one tactic that has been shown to work in the UK is shaming people into doing it. The study
conducted in service stations toilets found more people washed their hands when signs were put up
asking: "Is the person next to you washing their hands?"
"It makes people conscious of what others are doing around them and someone might be looking at
them, they get embarrassed," says Dr Ackerley. "Social pressure is a powerful tool.
"There are more notices in US toilets. I remember one that said, 'no poo poo fingers'. That was
probably very effective."
Dr Cutler agrees. "People obviously lie about washing their hands because they're embarrassed to
admit the truth. Get them to feel embarrassed at the sink and they are more likely wash their
hands," he says.
So remember, no poo poo fingers from now on.
http://www.bbc.com/news/magazine-19834975




Research showing that alcohol-based sanitizers can reduce overall rates of GI infections, cut the
number of days kids stay home sick from school, and lower illnesses among college students living
in dorms.

If your hands are visibly dirt-free but germ-ridden, an alcohol hand sanitizer is a smart way to go,
because these products eliminate more germs than soap and water, according to more than 20
studies cited by the CDC. http://www.consumersearch.com/hand-sanitizers/hand-sanitizer-myths-
and-facts
CDC experts say alcohol-based hand sanitizers are gentler on skin than soap and water. For example,
in a Brown University study, subjects washed their hands with soap and water for two weeks, then
used only an alcohol sanitizer for the same amount of time. In the end, subjects reported that their
hands looked and felt drier when washed with soap and water. Final tests confirmed that the level of
moisture in their skin fell measurably after these rinses, while the hand sanitizer did not affect skin.

Elementary School Study
A study by the Research Division of Woodward Laboratories in Los Alamitos, California, found that
using alcohol-free hand sanitizer reduced illness and absentee days in elementary school students.
All 420 students in the study heard a lesson on germs and the importance of hand washing. Students
were divided into two groups and instructed to continue normal hand washing. However, the
treatment group was also instructed to use hand sanitizer after using the bathroom, after coming
into the classroom and before eating. Compared with the control group, the treatment group had
41.9 percent fewer illness-related absent days during the 10-week study.

Allison Aiello, PhD, associate professor of epidemiology at University of Michigan. Alcohol-based
sanitizer with 60% concentration is very effective at killing a wide range of bacteria and viruses on
the handsand the product of choice in the hospital setting based on rigorous randomized
intervention studies. http://health.yahoo.net/experts/dayinhealth/hand-sanitizers-healthy-or-hype
Does Hand Sanitizer really work? http://www.youtube.com/watch?v=f6J4iPdrEIY
Handwashing practices are extremely difficult to perform in some classroom situations because of
simple logistics, time constraints, and the lack of facilities. In these latter situations, a waterless
alcohol gel hand sanitizer provides a hand hygiene alternative that is quick, easy, and effective. The
objective of this study was to determine the effectiveness of the use of an alcohol gel hand sanitizer
in the classroom as a hand hygiene methodology to decrease illness-related absenteeism among
students. A waterless alcohol gel hand sanitizer was used in this study as a supplement to existing
handwashing with soap and water.
http://www.sciencedirect.com.ezproxy.auckland.ac.nz/science/article/pii/S0196655300840109
Use of waterless alcohol-based hand sanitizers instead of soap-and-water handwashing has been
demonstrated to overcome these barriers to compliance.11
,
12
,
13
,
14
,
15
and
16 These products,
generally containing 60% to 70% ethanol or isopropanol, are one of the most effective agents for
reducing the number of viable pathogens on the hands,18
,
19
,
20
and
21 including under artificial
fingernails.
22
Hand disinfection with a well-formulated alcohol gel hand sanitizer containing
emollients has been shown to cause less skin irritation and dryness of the hands of nurses than has
soap and water.
12
Introduction of easily accessible dispensers with an alcohol-based waterless
handwashing antiseptic also has been demonstrated to lead to significantly greater hand hygiene
rates among health care workers.
8
Improving health care workers' compliance with recommended
hand hygiene measures can reduce transmission of pathogens16
and
17 and result in decreased
infection rates.
17
A recent study
29
in an extended care facility demonstrated that the use of an
alcohol-based hand sanitizer reduced the infection rates by 30%. The objective of this study was to
assess the effect of the use of an alcohol hand sanitizer by caregivers on infection rates and types in
an acute care facility.
http://www.sciencedirect.com.ezproxy.auckland.ac.nz/science/article/pii/S0196655302482156
Information on this problem:
The latest statistics on handwashing or the lack of it are even more damning. Research from
Michigan State University, published last week, showed that 95 per cent of us dont know how to
clean our hands in the correct fashion.
The study, which examined the bathroom habits of more than 3,700 people in public toilets in the
US, found that just 1 in 20 is washing properly. The remainder are either doing it incorrectly or not
doing it all 1 in 10 did not bother.
Most people are only washing their hands for six seconds when they should be spending three times
that amount of time on the task.
Health experts warn that failing to wash our hands properly can lead to diarrhoea, vomiting, food
poisoning, flu and the spread of MRSA.
Newspaper Article: http://metro.co.uk/2013/06/18/be-honest-do-you-wash-your-hands-after-you-
go-to-the-toilet-3844526/
Clean Hands save lives: http://www.cdc.gov/handwashing/publications-data-stats.html















Hand Washing alert:
https://www.google.com/patents/US4896144?dq=ininventor:%22Naomi+C.+Bogstad%22&hl=e
n&sa=X&ei=L7QsU7e8O-K5iQejrYCQCg&ved=0CDYQ6AEwAA

Studies indicating success of electronic monitoring:
http://journals.lww.com.ezproxy.auckland.ac.nz/ccmjournal/Abstract/2004/02000/Electronic_monit
oring_and_voice_prompts_improve.5.aspx
Child centres: http://aje.oxfordjournals.org.ezproxy.auckland.ac.nz/content/113/4/445.short
http://www.amsciepub.com.ezproxy.auckland.ac.nz/doi/abs/10.2466/pms.1989.69.3.733?journalCo
de=pms
Semester One Test : https://www.youtube.com/watch?v=Nsk_vXRVOi8#t=88





Yellow highlighting = Used!!