Is the Supertowel efficacious against viruses?add
In theory, the antimicrobial treatment on the Supertowel, is efficacious against incapsulated or enveloped viruses5 such as SARS CoV-2. Recent studies at Tufts University have investigated the virucidal efficacy of Supertowel after 15 min of contact time. Results are preliminary and unpublished, but it seems that the Supertowel and the other antimicrobial surface tested, are ineffective at killing SARS-CoV-2. On-going studies at Stanford University, is elaborating on the tests performed by Tufts and further investigating whether the Supertowel is indeed efficacious against SARS CoV-2 in practical application.
How long does the Supertowel last for?add
We estimate that a Supertowel will last for 12 months, but it is highly dependent on the intensity of use. This estimate is based on two studies:
Replacing Supertowel after 6-12 months is likely to be necessary as by this time, they may be visually dirty or torn and this could affect the desirability and use of the product
How much time does it take to effectively clean hands with the Supertowel?add
We have performed several laboratory-based studies to assess the efficacy of the Supertowel when used for different durations. Just like handwashing with soap, the Supertowel will be more effective the longer it is used for. In general, we would recommend hand cleaning with the Supertowel for 30 seconds. When used for 60 seconds we typically see a log10 reduction in pathogens of 4.11, when used for 30 seconds we see a log10 reduction of 3.50 and when used for 15 seconds we see a log10 reduction of 2.71. These tests were based on non-pathogenic E. coli4,7.
Is the Supertowel as effective as soap?add
Our laboratory studies have shown that the Supertowel is more effective at removing non-pathogenic E. coli from the hands of volunteers than soap and water. These results are based on the European Standard (EN 1499) for testing hand cleaning products and are true when hand cleaning with soap or the Supertowel is practiced for 60 seconds or 30 seconds4,7. However, when explaining the efficacy of the product to populations we recommend that you say that the Supertowel is as effective as hand washing with soap and should be considered as an alternative when soap and water are scarce. The Supertowel is not designed to be completely replacing soap and it is important that people understand that handwashing with soap remains one of the most effective ways to reduce disease transmission.
Can the Supertowel be used for personal hygiene or cleaning surfaces?add
Yes. In fact, our research with displaced populations in Ethiopia8 and Nigeria have indicated that the multi-purpose nature of the Supertowel is seen as a key advantage by populations. In addition to hand cleaning, the Supertowel can be used to clean faces or bodies or surfaces (e.g. kitchen surfaces, or frequently touched surfaces mobile phones, doorknobs, water taps etc.). The Supertowel will use the same two mechanisms of action described above to remove and then kill pathogens on these surfaces. In studies so far, the use of the Supertowel for other types of cleaning has not prevented people from using it for handwashing.
Can the Supertowel be used for water purification?add
The Supertowel was always designed to be a hand cleaning product. However, while testing the product in a refugee camp in Ethiopia8, some of our participants asked if it might also work to treat water. Following this we conducted a preliminary laboratory test where contaminated water was poured through the Supertowel either as is or folded to allow the water to pass through two layers of Supertowel fabric. The test showed a very effective bacteria reduction in water contaminated with E. coli, P. aeruginosa and V. cholerae9. In all cases the reduction was > 99,999%, only E. coli needed the Supertowel to be folded. Further testing would be needed prior to recommending its use for water filtration.
Is the Supertowel an acceptable and feasible alternative to handwashing with soap?add
To date our research indicates that the Supertowel is generally acceptable to people of different ages, abilities, ethnicities, and religions. It is also considered to be a feasible product for use in humanitarian crises and contexts where regular handwashing is challenging to practice.
This conclusion is based on research in a refugee camp in Ethiopia, an IDP camp in Nigeria as well as increasing demand for the product in high-income settings. The study in Ethiopia8 was specifically designed to understand the acceptability of the product. We distributed 123 Supertowel, one for each member of 19 households, except babies (approx. <2 years of age). We interviewed each family three times over the course of 14 days about their experiences of using the Supertowel. At the same time, we conducted focus group discussions with people who had not received the Supertowel and in these we asked participants to rate the Supertowel and a range of locally available soap products against a range of criteria. From this research we learned that the participants:
The work in Nigeria is ongoing but indicates similar levels of acceptability as in Ethiopia. For more information on the acceptability of the Supertowel read the research study8 done by the London School of Hygiene and Tropical Medicine in partnership with the Danish Refugee Council.
Does the Supertowel improve the frequency of hand cleaning?add
The studies to understand the effect of Supertowel on handwashing behaviour performed so far look promising. Below we indicate some of what we know:
Does the Supertowel reduce the use of soap?add
Handwashing is often not a priority use of soap in settings where soap is a scarce commodity. Instead, soap is prioritized for tasks like bathing, laundry and dishes. Our research indicates that the Supertowel may help families to prioritize soap across their hygiene needs by providing an alternative way of hand cleaning. We know this based on the ongoing operational research in Nigeria. Here they distributed Supertowel to each household through routine hygiene kit distributions. In the two intervention areas, households received the Supertowel in addition to standard amounts of soap. In the control area they received only the standard amount of soap. Initial results indicate that the households in the control area ran out of soap within the first month following distribution, while the households in the intervention arm continued to have a supply of soap for other household tasks for at least three months after distribution.
Is the Supertowel intuitive to use?add
At the moment, it is not always obvious when a person first encounters the Supertowel that it is a product for hand cleaning. This became clear in focus group discussions in Ethiopia when we asked participants who knew nothing about the product to guess what it was used for and how it was supposed to be used. We showed some simple pictograms to the participants (see Figure 5) after which they understood what the Supertowel was to be used for. We have been working with the Royal College of Art to adjust the design of the Supertowel and to develop guidance on its use which can be understood even with limited literacy.
Is there any standard communications package about the Supertowel?add
Yes. We have designed a package that can be used by frontline staff (e.g. Hygiene Promoters). The package includes a fold out poster and a set of activities that are designed to be done in small groups (e.g. by bringing neighbouring households together, or gathering small groups at the distribution point).
The communications package was co-created with the London School of Hygiene and Tropical Medicine and the Royal College of Art. It is available free of charge in an electronic version by contacting Real Relief.
How should the Supertowel be distributed?add
We recommend that one Supertowel is given to all household members above the age of 2. The rationale behind not including children under the age of two is that children of this age typically require their parents support to clean their hands and are therefore likely to share a Supertowel. To facilitate distribution, it is necessary to have an indication of the number of people per household in advance.
Supertowel can be distributed as a separate item or as part of hygiene kits. At the point of distribution, it is essential that populations receive an explanation of the product, how it works and how to use it (e.g. through the communications package). The Supertowel is not designed to fully replace soap. Even if the Supertowel is used for most hand hygiene tasks, soap is still critical for other household tasks and hygiene behaviours.
How much does Supertowel cost?add
The nominal cost of the Supertowel is relatively easy to calculate. When procured in bulk (<20,000 pcs) and for the purposes of humanitarian use, the price of the Supertowel is 50 US$ cents. This does not include freight however, so depending on destination another 10 to 20 cents would be added before the Supertowel is on ground. The actual low procurement cost is however only a part of the cost savings that is offered by Supertowel. The savings on distribution cost is probably the bigger part. It is however almost impossible to estimate this cost on a general basis. The cost savings towards soap is best illustrated with an example:
The Sphere standards state that each person needs to access to 250 grams of soap for bathing per person per month and 200 grams of soap for laundry per person per month. They do not actually specific mention handwashing soap per person but just that soap should be provided at the handwashing station (one station per shared toilet or one per household). So, under a set of typical assumptions, in practice this would mean that the cost per household per month of providing soap for handwashing ranges between $2 and $9. In comparison the cost per Supertowel in the first month costs $2.50 per household.
Over a year of displacement and in camp of 1000 families (approx. 5000 people) this would mean handwashing soap costs would be $24,000 (based on cheapest estimate) and Supertowel costs would be $5000. This does not include distribution costs.
Health and hygiene:
Supertowel was originally presented as a proposal to the challenge #ReimagineSoap by the Humanitarian Innovation Fund (HIF).
A subsequent project was funded by the HIF, where handwashing with the Supertowel was compared in the lab to water and soap. Following a successful outcome, a user acceptance field study was conducted under the same grant in a refugee camp in Ethiopia.
A production scale-up project, where the production method for Supertowel was developed, was also funded by the HIF. The project successfully established a supply chain that can provide Supertowel at the right quality, quantity and price.
Supertowel has furthermore received funding from USAID OFDA for extended laboratory studies, where handwashing with Supertowel is compared again to handwashing with soap and water, but under more realistic conditions, i.e shorter time, less water, contaminated water source and visibly dirty.
The Supertowel™ project is supported by Elhra's Humanitarian Innovation Fund programme, a grant making facility supporting organisations and individuals to identify, nuture and share innovative and scalable solutions to the most pressing challenges facing effective humanitarian assistance. The HIF is funded by aid from the UK Government. Visit www.elrha.org for more information about Elrha's work to improve humanitarian outcomes through research, innovation and partnership.
This research was made possible by the generous support of the American people thorugh the United States Agency for international development (USAID). The contents are the responsibility of the authors of the paper and do not necessarily reflect the views of USAID or the United States government.
Links to peer reviewed scientific papers: