Acceptability and effectiveness of a Supertowel intervention for handwashing in a humanitarian setting in Northeast Nigeria

Water, sanitation, and hygiene (WASH) interventions are critical to reduce disease transmission and ensure dignity in humanitarian emergencies. The Supertowel is a microfiber towel embedded with quaternary ammonium compounds, intended for handwashing in areas without soap and water. Previous laboratory research has found that the Supertowel removes bacteria. To fill gaps in real-world effectiveness, Supertowels were distributed in conflict-affected Nigeria. Household surveys, structured observations, focus group discussions, and laboratory testing of used Supertowels were conducted for one year post-distribution in intervention and control camps. Supertowel intervention households were more likely to have soap during monthly follow-up visits (p < 0.001), and 28–59% had a damp Supertowel (an indicator of recent use). During observations, 55–60% of intervention households used Supertowels, with most uses at non-critical times (61%) by female heads of household. Focus group participants appreciated the ease of use and water conservation of the Supertowel, noted the Supertowel can be easily lost and is not locally available, and recommended increasing its size, available colors, and including a clip/band for transportation and storage. In the laboratory, the surface disinfection efficacy of the Supertowel dropped over twelve months, from 2.5-4.0 log reduction value (LRV) to +0.1- + 0.6 LRV growth of Staphylococcus aureus, Klebsiella pneumoniae, and Vibrio cholerae . Additionally, during handwashing laboratory trials, used Supertowels removed 3.03 LRV Escherichia coli from hands. Further research is needed on Supertowel lifespan in real-world settings and effectiveness against viral pathogens. Overall, when handwashing with soap is not feasible, the Supertowel can potentially be an acceptable and efficacious short-term humanitarian handwashing innovation.