Hygiene - Introduction

1. Hygiene - Introduction ENVR 890 Mark D. Sobsey Spring, 2007

2. Hygiene Promotion: One of the Big Five to Reduce Diarrheal Disease

3. Hygiene: The Importance and Impact of Handwashing • Handwashing with soap and water after contact with fecal material can reduce diarrheal diseases by 42%% or more • Curtis, V and S. Cairncross (2003) Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. Lancet Infect Dis. 2003 May;3(5):275-81.

4. Washing Hands • One of the most effective behaviors to prevent diarrhoea, roundworm and whipworm. • Rarely done at the most crucial times and rarely done most effectively (with soap). (Is soap really needed?) • Hands get most dangerously contaminated fron human faces and soil (possibly containing worm eggs). • Crucial times for handwashing to reduce transmissions are: • after defecation and after contact with children’s faeces • before handling food and after handling high risk food such as raw meat • before eating and before feeding children • before handling water. • Effective handwashing requires thorough rubbing of the hands while using soap and sufficient water to rinse it off. • If soap is not available, ash or earth is nearly as effective • Water alone is effective, especially of water is clean

5. Cleaning fingernails • Closely related to handwashing. • Handwashing does not ensure fingernails get cleaned • Clean fingernails are particularly important when food is consumed or fed to infants using fingers • Clean fingernails have an aesthetic value • Handwashing and cleaning fingernails also play a role in the prevention of eye and skin infections, such as scabies.  • When wiping infected eyes or scratching itching infected skin, bacteria or mites can settle on fingers and hence be transmitted. •  Keeping fingernails clean requires them to be kept short and brushed regularly.

6. Washing the body (bathing) • Important for preventing skin infections like scabies (caused by small mites living under the skin), and ringworm (a fungal infection). • Also louse-borne typhus and louse-borne relapsing fever are controlled with regular washing of the body and clothes. • Washing is best done using running water and soap • Special attention needs to go to folds of the skin as well as to skin between fingers and toes.

7. Washing the face • Has an important role in the prevention of eye-infections • Hygiene related eye infections are conjunctivitis and trachoma • More frequent washing of the face and few flies sitting on eyes reduces the incidence of trachoma • Washing the face regularly removes infectious discharge from the eyes. • This prevents flies from being attracted to the infected eyes, thus becoming transmission agents. • Removing eye discharge using bare fingers or a cloth, causes bacteria to be picked up on the fingers or cloth and transmitted to anything else that they touch.

8. Washing clothes and bedding • Major preventive measures to reduce transmission of scabies and louse-borne typhus and relapsing fever. • Touching clothes or bedclothes of a person infected with scabies or ringworm can easily cause spread and further infection of others • Lice, which may spread typhus or relapsing fever, hide in seams of clothes and bedclothes • Washing removes them • Communal use of clothes and bedclothes should be avoided

9. Introduction and Issues • The most important lesson learned from water and sanitation programmes: • water and sanitation facilities on their own do not result in improved health. • Access to improved facilities is crucial, but… • Correct use of water and sanitation facilities is what leads to a reduction in disease • Correct use requires personal, community and institutional actions • actions depend on behaviors

10. Hygiene and Behavior • Hygiene is a key factor in reducing risk of diarrheal and other sanitation-related diseases • People and communities can protect themselves from diarrhea and other infectious diseases they make changes in hygiene behavior • Making behavior changes requires actions • These behavior change actions will occur only if people are informed • They need information about how and why certain personal and community behaviors will reduce disease transmission risks • They need encouragement to make positive changes in their hygiene behavior. • Hygiene education is essential to achieve hygiene behavior change.

11. UNICEF Hygiene Improvement Framework

12. Access to Facilities • Implement and promote a package of appropriate, low-cost sanitation, water and hand washing facilities • Introduce basic technologies that may be upgraded when families and communities can afford to do so

13. Hygiene Awareness and Promotion • Focus on behavior change by communicating key hygiene practices like hand washing. • Encourage children, youth and mothers to be agents of change in their families and communities • Implement through initiatives such as lifeskills training programs, curriculum development and integrated sanitation and hygiene education in schools, and maternal and child health education

14. Enabling Environments(and Institutions) • Promote hygiene continuously at all levels • Village household • Village or community • District, province, canton, etc • Nationally • Regionally • Globally • Developing national policies is critical • UNICEF focuses on promoting community-managed systems that are affordable and easy to maintain. • Equip communities with the knowledge and skills to effectively manage their own facilities • Encourage communities to demand high-quality service from duty-bearers in government, civil society and the private sector

15. Enabling Conditions • The most obvious enabling condition for personal hygiene is the availability of water. • However, for behavioral change to occur and be sustained there is a need to continue hygiene promotionuntil the new behavior has become entrenched

16. Hygiene Promotion Key Principles • Target a small number of risk practices • Target specific audiences • Identify the motives for changed behavior • Hygiene messages need to be positive • Identify appropriate channels of communication • Decide on a cost-effective mix of channels • Hygiene promotion needs to be carefully planned, executed, monitored and evaluated.

17. Hygiene Promotion: Target Practices Having a Positive Health Impact The Big 3: • Handwashing with soap (HWWS) • Removal of stools (feces) from the household environment • Home treatment and safe storage of drinking water Others: • Safe disposal of children's stools • Safe handling of weaning food

18. Identifying Behavioral Domains for Hygiene Five Behavioral Domains (Boot and Cairncross, 1993) • Disposal of human faeces • Use and protection of water sources • Water and personal hygiene • Food hygiene • Domestic and environmental hygiene • Personal Hygiene Behaviors: • Washing of hands / cleaning of nails • Washing of face • Body wash / bathing • Hygiene after defecation • Washing and use of clothes, towels and bedding

19. Personal Hygiene Measures(Benenson, 1990) • washing hands in soap and water immediately after fecacation/urination and always before handling food or eating  • keeping hands and unclean articles, or articles that have been used for toilet purposes by others, away from the mouth, nose eyes, ears, genitalia, and wounds • avoiding the use of common or unclean eating utensils, drinking cups, towels, handkerchiefs, combs, hairbrushes and pipes • avoiding exposure of other persons to spray from the nose and mouth as in coughing, sneezing, laughing or talking • washing hands thoroughly after handling a patient or his/her belongings and  • keeping the body clean by sufficiently frequent soap and water baths.

20. Hygiene Promotion for Children • Most hygiene promotion is developed for adults • Young children do not possess the same skills, knowledge and ability to learn complex concepts as older children (or adults), and they learn differently • Children learn through: • Helping (e.g., with chores) • Playing • Being creative • Dealing with others (interaction and communication) • Playing • Exercising

21. Hygiene promotion in Schools • School sanitation and hygiene education (SSHE) • Combination of hardware and software components to produce a healthy school environment and to develop or support safe hygiene behaviors. • The hardware components: • drinking water • hand washing • excreta disposal • solid waste disposal facilities in and around the school compound. • Software components: activities that promote conditions at school and practices of school staff and children that help to prevent water and sanitation-related diseases and parasites

22. Benefits of School Hygiene and Sanitation • Effective learning: Children perform better when they function in a hygienic and clean environment. • Increases enrolment of girls: The lack of private sanitary facilities for girls can discourage parents from sending girls to school and contributes to the drop out of girls, particularly at puberty. • Reduces incidence of disease and worm infections: If school sanitation and hygiene facilities are absent, or are badly maintained and used, schools become health hazards. • Environmental cleanliness: Presence and proper use of facilities prevents pollution of the environment and limit health hazards for the community at large. • Implementing children’s rights: Children have the right to be as healthy and happy as possible. Being clean, healthy and having clean water and proper sanitation facilities contribute to a happy childhood.

23. Issues in School Hygiene Education • Developing and producing teaching materials: • hygiene education materials which can be reproduced on a large scale, so that they are not too costly and allow for easy adaptation to local circumstances. • Basic insights into the more technical aspects of sanitation facilities at the school: • Teacher training on how sanitary facilities work in practice which includes the construction, operational and maintenance aspects. • Organizational issues of sanitary facilities: • Includes ways to monitor behavioral changes. • Focusing of teacher training: • How to use the materials of SSHE; • how to organize/implement a SSHE programme • How to plan for the replacement of facilities. • Outreach programs to the community: • To gain community support • To ensure that the learned behaviour can also be practiced at home. • Focusing on monitoring: • Evaluation and documentation of SSHE experiences for teachers in schools around the world.

24. School Hygiene Program Strategy • Striving for a common goal, common purpose, common policy and common planning • Focusing on the child as the key resource • Focusing on schools as the knowledge centre • Focusing on education for behavior change • Acknowledging the teacher as the facilitator • Concentrating on result oriented/effective delivery system • Recognizing that the community is an equal partner

25. Five Fallacies about Hygiene Promotion • Fallacy No. 1. Behaviour change is easy. • Fallacy No. 2. Knowledge change=behaviour change. • Fallacy No. 3. Experts know how to change behavior. • Fallacy No. 4. A whole variety of hygiene practices should be encouraged. • Fallacy No. 5. Hygiene promotion is a cheap add-on to water programmes.

26. Lessons from Marketing and Private Industry: Public-Private Partnerships • Private Industry is very successful at changing behavior • Its survival may depend on it! • Soap companies have got soap into almost every household in the world. • They can thus be useful partners in promoting HWWS. • Knowledge sharing between public and private sectors has created a Global Public-Private Partnership for Handwashing. • Several country programmes are underway • Successful experiences have now been collated into the Handwashing Handbook • (Scott et al, (2005), a practical guide to handwashing promotion at the national level.  

27. Understanding Consumer Behavior: A Key Principle • Base handwash promotion programs on an understanding of consumer behavior • First stage: conduct comprehensive formative or ‘consumer’ research (see Fig) to answer four essential questions: • What are the risk practices? • Who carries out the risk practices? • What drivers, habits and/or environment can change behaviour? • How do people communicate? • Next: Use the answers to design an appropriately targeted promotion campaign.

28. Hygiene Improvement Framework