Washing Without a Sink

To the Editor:

The recommendation from the Centers for Disease Control and Prevention that everyone wash their hands frequently is now common knowledge, but this task is not easily accomplished for those experiencing homelessness. As COVID-19 spread worldwide, a team of students from Street Medicine Detroit and Detroit Street Care—student-led organizations that focus on the health of individuals experiencing homelessness—became concerned about our patients’ ability to wash their hands. Businesses and public facilities shut down, soup kitchens operated on limited schedules, and most shelters adopted a policy of “no one in, no one out.” The limited access to hand hygiene among the homeless left this already vulnerable population with little control over the spread of COVID-19.

Our team explored hand hygiene solutions and was inspired by an online tutorial on how to create field hand washing stations. They are easy to assemble and consist of: a 5-gallon bucket with a spigot drilled into its side functioning as a basin and faucet, hosiery containing antibacterial bar soap, a spray bottle of diluted bleach solution, and a base. We received donations from local stores to construct 6 stations. With input from our preceptor and local social service providers, we chose key locations for the stations: 2 at soup kitchens and 1 in a homeless encampment. Encampment residents then requested an additional 3.

During the Spring and Summer of 2020, we refilled and sanitized the stations twice weekly, which also provided us with an opportunity to learn from the homeless population. We saw excitement, heard gratitude, and witnessed increased hand hygiene from those who are medically disenfranchised. While simple, the stations required relationship building to be effective. One station went unused for 2 weeks. We used the teach-back method to show an affable, older gentleman proper hand hygiene using the station. His face brightened as he turned the spigot and warm water poured out. He exclaimed, “I’m going to tell everyone about these stations!” When we returned, the water basin was empty, and a personal bar of soap was placed neatly nearby. This experience demonstrated the power of community engagement to build trust and affect personal health behaviors.

Our team has now expanded to include additional student volunteers who have continued to maintain the stations. We received inquiries from health professions students from across the country asking for instructions on how to construct their own stations. We also communicated with city officials to expand the program and improve its sustainability.

These stations were an interdisciplinary community effort that have become integral to health maintenance for some individuals experiencing homelessness in Detroit. We hope this initiative will spark a conversation on social determinants of health and patient empowerment.