Just over 21 percent of people in Japan are washing or sanitizing their hands appropriately amid the novel coronavirus pandemic, according to an online survey by a team drawn from Tokyo Medical University and other institutions.

The survey was conducted in June, after a decline in the daily number of COVID-19 infections and the lifting of the first coronavirus state of emergency in late May. The research was published in the Japanese Journal of Infectious Diseases in late December.

Students wash their hands at their elementary school in Shizuoka, central Japan, on March 16, 2020, amid the spread of the new coronavirus. (Kyodo) ==Kyodo

Masaki Machida, a research associate in Tokyo Medical University's Department of Preventive Medicine and Public Health, who led the research, said people may have improved their hygiene because alcohol hand sanitizers had been placed at numerous locations since the start of the pandemic.

"But attention to preventing infection may have diminished among some people due to coronavirus fatigue. It is important to continue encouraging hand hygiene," Machida said.

In the survey, respondents were asked if they washed their hands with soap or used alcohol hand sanitizers in five situations -- before eating food, after returning from public places, after going to the toilet, after touching something outside, and after blowing their nose, coughing or sneezing.

Of the respondents, 76.4 percent replied that they "always" cleaned their hands after returning from public places, followed by 68.1 percent who did so after going to the toilet. Only 30.2 percent did so after blowing their nose, coughing or sneezing, the lowest figure for the five situations.

The survey found only 21.1 percent of respondents always washed their hands or used alcohol hand sanitizers in all five situations and that individuals in this group cleaned their hands at least 11 times per day.

Practicing hand hygiene 11 times or more per day can indicate that a person cleans their hands in all five situations, the report said.

Machida noted that individuals who eat three meals and go to the toilet three times per day should wash their hands six times.

"That said, if you wash hands 10 times or fewer, it is highly likely that you have missed some chances to wash your hands," he said, adding such people need to review their hand hygiene.

The report also said if the pandemic worsens, it would require more rigorous education and an assessment of preventive actions, including setting the hand-washing standard at 16 times or more.

With the number of infections running high in Tokyo and surrounding areas, Machida believes people in the region may need to adopt the higher standard, while making allowances for those who do not go outside often or whose skin is dry and sensitive.

He also noted the importance of hand hygiene when taking care of sick people, at a time when coronavirus transmission between family members has been rising.

The online survey received responses from 2,149 people aged between 20 and 79 in the Kanto region centering on Tokyo.