Innovative Practices in Health and Hygiene

1. Innovative Practices in Health and Hygiene Dr. Sudha Sinha, MD Assistant Professor, Medical Oncology MNJ Institute of Oncology and Regional Cancer Center Hyderabad

2. Hygiene Set of practices performed for preservation of health

3. Types of Hygiene • Personal • Oral Hygiene • Respiratory Hygiene • Body Hygiene • Menstrual Hygiene • Home Hygiene • Kitchen Hygiene • Bathroom Hygiene

4. Types of Hygiene • Community Hygiene • Clean Water • Sanitation • Garbage disposal • Bathrooms • Sewage • Institutional Hygiene Eg: Hospitals • Waste Segregation • Waste management • Provision of Clean water and bathrooms

5. Poor Hygiene - Consequences • Diarrhea • Poor water and sanitation facilities • Poor hand washing • 1.12 crore cases of acute diarrhea in year 2008 • 1600 deaths per day from diarrhea every DAY in India – most of them in children • Completely preventable • Hepatitis A • Poor food and water hygiene • Poor handwashing • Endemic in India

6. Poor Hygiene - Consequences Typhoid fever • Bacterial infection caused by ingesting contaminated food or water. • Symptoms are characterized by headaches, nausea and loss of appetite. • About 12 million people are affected by typhoid every year Cholera • acute bacterial infection of the intestinal tract. • severe attacks of diarrhoea that, without treatment, can quickly lead to acute dehydration and death • underreported

7. Poor Hygiene - Consequences Mosquito Borne diseases • Malaria, Dengue, Japanese Encephalitis • Mosquito Bite • Open Drains • Stagnant Water • Uncovered Water Tanks

8. Poor Hygiene Trachoma • eye infection • poor hygiene caused by lack of adequate water supplies and unsafe environmental sanitation conditions. • 6 million people are blind today because of trachoma. • Women two to three times more than men. • Children are also especially susceptible

9. Trachoma – various stages

10. Poor Hygiene - Consequences Intestinal Worms • Oral Fecal Route Spread • Eating contaminated food • Contact with soil contaminated with human feces of a contaminated person • Children are most affected

11. Poor Hygiene – Long Term Consequences • Malnutrition • Anemia • Stunted Growth • Blindness

12. Poor Hygiene – Broader Issues • Decreased Cognitive Development • Decreased Performance in School • Decreased Productivity

13. Poor Hygiene – Broader Issues • Girl Child • Increased School Drop out rates • Increased risk of Urinary Tract Infections • ? Increased risk of Cancers (Cervix)

14. Poor Hygiene • A Strain on the Family • Loss of Livelihood • Expenses • Loans • A Strain on the Public Health System

15. Will Improving Hygiene Help • Washing hands decreases diarrhea by 33% • Adequate water supply reduce trachoma by 25% • Reduce schistosomiasis by 77 % • Cholera can be prevented by access to safe drinking water, sanitation and good hygiene behaviour (including food hygiene).

16. Diarrhoeal disease reduction from drinking water and sanitation improvements Reduction (%) Source: Fewtrell L et al. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis.Lancet Infectious Diseases, 2005 Intervention

17. Introduction of Municipal Water Treatment in the United States

18. Introduction of Municipal Water Treatment in the United States

19. WSH = a motor for development • Improved water supply • Safe water resources • Universal access • Time, financial savings • Averted disease costs • Healthy populations Development

20. UNICEF Hygiene Improvement Framework

21. 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

22. 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 • Good Hygiene is not just a personal issue

23. Hygiene and Behavior • Behaviorchange 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.

24. 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

25. Enabling Conditions • However, for behavioral change to occur and be sustained there is a need to continue hygiene promotionuntil the new behavior has become entrenched

26. Enabling Environments(and Institutions) Promote hygiene continuously at all levels • Village household • Village or community • District, province, canton, etc • Nationally • Regionally • Globally

27. 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

28. 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

29. 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.

30. MNJ Cancer Hospital – About • Government Cancer Hospital • 400 beds • 100 children with cancer treated everyday • Largest center for treatment of blood cancers in our state • Patient Population • Below poverty Line • Daily Wage Earners • Outside Hyderabad

31. Children and Cancer • Program for Children with cancer – started at MNJ in 2008 • Highly Curable Condition (90% for blood cancers) • Requires high dose chemotherapy • Blood counts drop during treatment • Children are very prone to infections • Infections = Death

32. Hygiene at MNJ - 2008 Hospital Patients No handwashing Personal Hygiene Hair Nails Bath Menstrual Hygiene Home Hygiene Food and Kitchen Hygiene • No 24 hour access to water • Not enough bathrooms • No proper waste segregation methods • No proper waste disposal • No Handwashing • No gloves • No sterile technique

33. UNICEF Hygiene Improvement Framework

34. Access to Facilities 24 hour water provision • Borewell connection • Donations raised for clean water supply • Installation of Ro plant • Hand Sanitizers for hospital staff Waste Segregation and Disposal • Access to color coded plastic covers • 24 hour provision of Cleaning materials

35. Hygiene Promotion – Identifying Behavioral Domains for 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

36. Personal Hygiene Measures – Patient Education • 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.

37. Personal Hygiene Measures – Patient Education • Food and Kitchen Hygiene • How to wash vegetables • How to wash fruits • How to throw items in thrash • How and where to wash hands • How to clean utensils, knives, cutting boards, kitchen surfaces

38. Hygiene Measures – Staff Education • Importance of Hand washing after each procedure • Correct Method of hand washing • Sterile Methods of Procedures • Personal Protection • How to segregate hospital waste • How to dispose hospital waste

39. Motivating Staff and PatientsGood Hygiene = Saved Lives Patients Staff Daily checking for hand sanitizers Team for checking Waste Segregation Sterile Technique Repeated Meetings on hand washing Techniques Morbidity and Mortality meetings • Repeated Reminders for Personal Hygiene • Daily Meetings • Weekly support group meetings • Meetings after every death • Encouraging good behaviour • Children • Stickers • Gifts • Provision of Hygiene Kits

40. 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.

41. 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.

42. Hygiene Improvement Framework