EIACP Programme Centre on Hygiene, Sanitation, Sewage Treatment Systems and Technology

Good hygiene is an important barrier to many infectious diseases, including the faecal–oral diseases, and it promotes better health and well-being. To achieve the greatest health benefits, improvements in hygiene should be made concurrently with improvements in the water supply and sanitation, and be integrated with other interventions, such as improving nutrition and increasing incomes. The next sections discuss how to improve personal and community hygiene practices that help to prevent the spread of faecal–oral diseases.

Personal hygiene involves those practices performed by an individual to care for one's bodily health and well being, through cleanliness. Motivations for personal hygiene practice include reduction of personal illness, healing from personal illness, optimal health and sense of well being, social acceptance and prevention of spread of illness to others. What is considered proper personal hygiene can be cultural-specific and may change over time. In some cultures removal of body hair is considered proper hygiene. Other practices that are generally considered proper hygiene include bathing regularly, washing hands regularly and especially before handling food, washing scalp hair, keeping hair short or removing hair, wearing clean clothing, brushing one's teeth, cutting finger nails, besides other practices. Some practices are gender-specific, such as by a woman during her menstrual cycle. People tend to develop a routine for attending to their personal hygiene needs. Other personal hygienic practices would include covering one's mouth when coughing, disposal of soiled tissues appropriately, making sure toilets are clean, and making sure food handling areas are clean, besides other practices. Some cultures do not kiss or shake hands to reduce transmission of bacteria by contact.

Personal grooming extends personal hygiene as it pertains to the maintenance of a good personal and public appearance, which need not necessarily be hygienic. It may involve, for example, using deodorants or perfume, shaving, or combing, besides other practices.

Domestic hygiene: domestic hygiene (sanitary preparation of food, cleanliness, and ventilation) means cleanliness in your home whereas personal hygiene (proper living habits, cleanliness of body and clothing, healthful diet, a balanced regimen of rest and exercise) means cleanliness of your person or your body.

Domestic hygiene activities include all the work which is done to keep the house and people's clothes and bedding clean. These jobs include sweeping and washing floors, cleaning the toilet, washing clothes and bedding, and washing dishes and cooking utensils after meals. It is important that the house be kept clean so that it is a healthy place. If the house and everything in it are not cleaned often, moisture and dirt gather and it becomes an ideal place for germs, parasites and vectors (disease-carrying animals) to breed and multiply. These germs can cause the people living in the house to get sick.

Toilet to be healthy places :

Toilet need to be cleaned regularly just as it is a part of a house. If it get dirty and surfaces become contaminated with germs, people could get sick.

•   make sure there is always toilet paper in the toilets
•   clean the toilets, showers, basins and tubs once a day, and more often if they get very dirty
•  &hose or sweep the floors regularly

Protecting food from contamination

Correct food handling practice and food storage helps prevent bacteria from contaminating and multiplying on foods. The following action needs to be taken to prevent bacterial contamination:

• Protect food from contamination – handle food properly
• Prevent bacteria from multiplying
• Destroy germs on/in food.
• Food poisoning bacteria come from people’s bodies, sneezes, coughs, high risk foods, insects, rodents, pets, toilets and dust particles in the air
• Bacteria can get on to the food they are handling, for example, from cross contamination and contaminated hands and clothing
• &The correct cooking and storage temperatures which prevent bacteria multiplying 

Correct food handling :

Always wash hands with soap and warm water before handling food. Wet the hands before applying the soap. Make sure you rub in between fingers and on the front and backs of hands. Remember to clean under fingernails. Rubbing with soap loosens bacteria. They must be rinsed off with water.

Always wash hands with soap and warm water after going to the toilet or touching any parts of the body, such as the skin or nose.

If sneezing, turn away from the food and use a tissue

Always clean and sanitize utensils and benches

Insects, rats, mice and other pests cannot get into the food preparation area

Pets must never be allowed into a shop or community kitchen

Dispose of rubbish regularly and correctly

Make sure the floors, walls, window sills and all fixtures in the food preparation area are regularly and properly cleaned

Water contamination and disease

Water is one of the most important substances on earth. All plants and animals must have water to survive. If there was no water there would be no life on earth.

Disease-causing germs and chemicals can find their way into water supplies. When this happens the water becomes polluted or contaminated and when people drink it or come in contact with it in other ways they can become very sick.

Apart from drinking it to survive, people have many other uses for water. These include:

• cooking
• washing their bodies
• washing clothes
• washing cooking and eating utensils; such as billies, saucepans, crockery and cutlery
• keeping houses and communities clean
• recreation; such as swimming pools

The most effective way to fight diarrhea among young children is to target improvements in the three areas of better water quality, improve sanitation, and lower levels of anemia among women. The benefits of good domestic hygiene – in particular, mothers washing their hands with soap before feeding their children – were at least as large as those from improvements in the quality of drinking water.

The human body can provide places for disease-causing germs and parasites to grow and multiply. These places include the skin and in and around the openings to the body. It is less likely that germs and parasites will get inside the body if people have good personal hygiene habits.

Personal hygiene habits include:

• Washing the body helps keep it free of disease-causing germs
• Cleaning teeth helps keep gums and teeth healthy.
• Washing hands after going to the toilet helps stop the spread of germs.
• Washing hands before preparing food helps keep germs out of our bodies.
• Washing hands before eating food helps stop germs getting into our bodies
• Washing clothes helps keep them free of disease-causing germs.
• Hanging clothes in the sun helps to kill some disease-causing germs and parasites.
• Covering the nose and mouth when sneezing helps stop the spread of germs.

Germs on the skin surface, particularly the hands, can be transferred on to another person, either by direct contact or via surfaces, and can cause infection in that person. Hand washing is key to preventing spread of infection (usually called cross infection) from a source to another person, or to food or water.

COMPONENTS OF PERSONAL HYGIENE

Body hygiene (skin care): The body has nearly two million sweat glands. Moistened and dried sweat and dead skin cells all together make dirt that sticks on to the skin and the surface of underclothes. The action of bacteria decomposes the sweat, thereby generating bad odour and irritating the skin.

Oral hygiene (oral care): The mouth is the area of the body most prone to collecting harmful bacteria and generating infections. Our mouth mechanically breaks food into pieces. This process leaves food particles (food debris) that stick to the surface of our gums and teeth. Our mouth cavity is full of bacteria and is a good environment for bacterial growth.

Mouth cleaning:

• Rinse the mouth after each meal.
• Brush your teeth with a fluoride-containing toothpaste twice a day – before breakfast and before you go to bed. Cleaning the mouth with twigs is possible if done carefully.
• During the day, fill your mouth with water and swish it around to get rid of anything sticking to your teeth.
• In addition to regular brushing, it is advisable to floss your teeth at least once a day, usually before you go to bed.

Hand washing: The cleanliness of our hands is very important in all our daily activities. In our normal activities our hands frequently get dirty. There are many situations in which microorganisms are likely to attach to our hands along with the dirt. There are many communicable diseases that follow the route of faeco-oral transmission. Hand hygiene plays a critically important role in preventing this transmission.

 Hand washing technique:

• First wet your hands with clean water and lather with a bar of soap.
• Next rub your hands together vigorously and scrub all surfaces up to your wrists.
• Clean under your fingernails.
• Continue for 15–30 seconds or about the length of a little tune (for example, the ‘Happy Birthday’ song). It is the soap combined with the scrubbing action that helps dislodge and remove germs.
• Rinse your hands well with clean running water (pour from a jug or tap).
• Dry your hands in the air to avoid recontamination on a dirty towel – do not touch anything until your hands are dry.
• Wood ash will also rub off any dirt and smells. The slight irritation you feel when you wash your hands with ash shows the cleansing power of ash.
• Local seeds such as indod (Lemma’s plant), which are known to be good cleaning agents, can also be used for regular hand washing.
• Clean sand with water can be used for hand washing to help to rub off dirt.

Face hygiene: Our face reveals our daily practice of personal hygiene. Face hygiene includes all parts of the face. A person should wash their face every morning in order to remove all dirt that they have come in contact with during the course of the day. This will keep your face clean all day. Children are advised to wash their face frequently. Never share your face towel with others.

Fingernail and toenail hygiene (nail care): A nail is hard tissue that constantly grows. Long fingernails tend to accumulate or trap dirt on the underside. The dirt could be as a result of defecation or touching infected and contaminated surfaces. Keeping nails trimmed and in good shape weekly is important in maintaining good health.

Ear hygiene: Ear wax accumulates in the ear canal that leads from the outer ear to the ear drum. As the secretion comes out of the ear it collects dust particles from the air. Daily washing with soap and water is enough to keep the outer ear clean. Do not reach farther than you can with your little finger into your ear. Putting in hairpins, safety pins or blunt-edged things for cleaning purposes might harm the ear.

Hair hygiene (hair care): Poor hair hygiene could cause dandruff and skin infections such as Tinea capitis. Dandruff is dead skin on the scalp that comes off in tiny flakes when sebaceous glands produce too much oil and accumulates on the scalp.

The recommended procedures for cleaning the hair are:

•  Use clean water to wash your hair regularly (at least twice weekly, preferably once every other day) with body soap or shampoo, whichever is available.
• Massage your scalp well. This will remove dead skin cells, excess oil and dirt.
• Rinse well with clear water.
• Conditioner is helpful if you have longer hair as it makes the hair smoother and easier to comb, but hair doesn’t need to have conditioner.
• Use a wide toothed comb for wet hair as it is easier to pull through.
• Dry the hair and the head with a clean towel. Never share a towel with someone else.
• Comb the hair to look beautiful for the day. 

Foot hygiene (foot care): We spend a lot of time on our feet. Our feet sweat as we walk day and night and the sweat accumulates on all foot surfaces and between the toes. The sweat may stain the shoes and can produce an awful odour. As well as bacteria, sweat also encourages fungal growth between the toes. Foot hygiene is also important in the treatment of podoconiosis, sometimes known as mossy foot. This disease causes swelling in the feet and lower legs and is common in certain parts of Ethiopia.

Armpit and bottom hygiene: These are body parts that easily get sweaty and where ventilation is very poor. After puberty, our sweat gains a specific and unpleasant odour which may be offensive to others. The armpits and the bottom should be washed daily.

Anal cleansing is the hygienic practice of cleaning the anus after defecation. The anus and buttocks may be cleansed with clean toilet paper or similar paper products. Water may be used. Hands must be washed with soap afterwards. The use of rags, leaves, stones, corn cobs, or sticks must be discouraged as these materials can damage the skin.

Clothes hygiene: We usually have two layers of clothing. The internal layer is underwear (or underclothes) such as pants, vest and T-shirt. These are right next to our skin and collect sweat and dead skin cells, which can stain the cloth. Bacteria love to grow on this dirt and produce a bad smell in addition to the specific odour of the sweat. Underwear must be washed more frequently than the outer layer of clothing. Clothes hygiene is an important aspect of one’s dignity. Changing used clothes for clean ones every day is recommended.

Diseases in Indigenous communities caused by germs and parasites resulting from inadequate domestic and personal hygiene

Poor domestic and personal hygiene practices can help the transmission of disease-causing germs: There are many sicknesses which can be caused by inadequate (poor) domestic or personal hygiene.

• Directly by the faecal-oral route, or by person to person or pet to person contact
• Indirectly by vectors coming into contact with people or their food, people breathing in airborne droplets of moisture which contain germs or eating contaminated food.
  

Signs of poor domestic hygiene include:

• not cleaning the toilet
• not getting rid of rubbish
• not washing clothes and bedding frequently
• not storing food properly
  

Signs of poor personal hygiene include:

• not washing hands
• not showering
• not washing hair

Bacterial

• Food poisoning
• Gastroenteritis
• Diarrhea caused by Campylobacter
• Pneumonia
• Trachoma
• Skin infections

Viral

• Hepatitis A
• Gastroenteritis
• Colds and flu

Parasitic

• Giardiasis
• Scabies infection
• Pediculosis (head lice infection)
• Hookworm infection
• Threadworm infection
• Roundworm infection (strongyloides)

Promote hand hygiene to save lives and combat COVID-19

Promoting good hand hygiene is one of the most basic yet powerful tools that Member States of the WHO South-East Asia Region must continue to leverage to reduce the spread of COVID-19. All Member States should urgently provide universal access to public hand hygiene stations as they embark on the next phase of the pandemic response, including at the entrance to every public or private commercial building and at all transport locations, especially major bus and train stations, airports and seaports. Regular and thorough hand-washing with soap or use of an alcohol-based rub are critical measures each of us can take to protect ourselves, each other and those who care for us: health workers.

As the world marks the annual WHO “SAVE LIVES: Clean Your Hands” campaign on 5 May, which is also the International Day of the Midwife, it is imperative that Member States continue to enhance hand hygiene in health care. Based on WHO/UNICEF Joint Monitoring Programme global estimates, 35% of health facilities in the Region lack functional hand hygiene facilities at points of care and toilets. Effective infection prevention and control measures, including hand hygiene, are crucial to ensuring health facilities do not become hubs of COVID-19 transmission, and to reducing health care-associated infections from other pathogens, which account for an estimated 8 million deaths globally each year. Nurses and midwives in particular must be provided the resources and training required to implement good hand hygiene practices to respond to the pandemic and to safely maintain essential services.

There are several opportunities for Member States and health leaders in the Region to immediately scale up their support to nurses, midwives and other frontline responders to deliver clean care, for which they have WHO’s full technical and operational assistance.

First, all public and private health facilities should make functional hand hygiene stations readily accessible. Facility administrators should position hand hygiene stations at all points of care, in areas where personal protective equipment is put on or removed, where health care waste is handled, and within 5 metres of toilets. Hand hygiene stations must also be accessible at health facility entries and exits, and in waiting and dining rooms and other public areas.

Second, all health facilities should establish or strengthen hand hygiene improvement strategies. Facility administrators should provide refresher training on hand hygiene to nurses, midwives and other health workers. They should procure adequate quantities of good quality hand hygiene supplies. All staff must be encouraged to adhere to the “five moments for hand hygiene”, which are vital to protecting patient safety.

And third, health facility leaders should make hand hygiene a key quality monitoring indicator. Compliance with hand hygiene standards should be a core part of every health facility’s infection control regimen, with areas of risk identified and solutions found as a matter of priority. As part of this, all health facilities should sign up to and fully implement WHO’s global “SAVE LIVES: Clean Your Hands” campaign.

In this International Year of the Nurse and the Midwife, Member States in the Region must continue to support and strengthen the ability of nurses, midwives and other frontline responders to combat COVID-19, while also empowering the public to stop the spread and reduce the strain on health services. We are in this together and must get through it together. The health and well-being of the Region’s near 2 billion people is in all of our hands

Source:WHO, Updated on 8th Dec, 2020