Cleaning and hygiene for health: communicating with consumers

1. Cleaning and hygiene for health:communicating with consumers Sally Bloomfield, Chairman and Scientific Advisory Board Member, IFH Hon. Professor, London School of Hygiene and Tropical Medicine

2. Effective communication about cleaning and hygiene products is not just about safe and sustainable use Communicating proper use, combined with clear understanding of their role in hygiene, is a key part of achieving sustainable health and well-being in the European Community

3. The International Scientific Forum on Home Hygiene (IFH) • Established 1997 as a professional, not-for profit, non-government organisation. • Primary objectives: • Raise awareness of the fundamental role of hygiene in preventing infectious disease • Promote understanding of home hygiene practice • Ensure home hygiene is based on the scientific evidence • Need for authoritative body which could speak from a scientific/medical viewpoint about home hygiene in response to the changing hygiene climate www.ifh-homehygiene.org

4. The changing hygiene climate • 20th century saw massive decline in concern about infectious diseases and the role of hygiene • Infectious disease has now moved back up health agenda • National and international govt & non-govt agencies making significant investment on preventive strategies such as hygiene promotion • Increasingly this includes promotion of hygiene to consumers • Why?

5. Healthcare associated infections and the home and community • Across Europe controlling HCAI a major issue in delivering health • MRSA, C. difficile, norovirus etc are community as well as hospital problem • Hospital managers/ICPs realise: • managing HCAI hampered by patients/visitors who are carriers that walk into their facilities. • Also: • “at risk” patients at home infected by family members who are carriers

6. Antibiotic resistant strains inthe home and community • Hygiene is seen as part of the solution • Good hygiene means fewer infections, fewer patients demanding antibiotics from GP, fewer resistant strains in the community • Fewer resistant strains brought into healthcare facilities

7. Infectious intestinal disease • Foodborne disease remains at unacceptable levels • WHO estimate for Europe • 40% of foodborne infections occur at home • Foodborne illness almost 100% preventable • Foodborne infection only a fraction of total IID • IID transmitted from person to person in home & community • 1 in 5 of UK population suffers a bout of IID each year

8. At risk groups in the home and community • Governments under pressure to fund level of healthcare people expect • Increasing care in the community, but savings undermined by inadequate infection control at home • Up to 1 in 5 at increased risk of infection • Increasing elderly population • Shorter hospital stays • drug treatment (e.g chemotherapy) • catheterisation, inhalation systems

9. Emerging infectionsOne pathogen “under control” another emerges • Since 1980 - norovirus, Legionella, Campylobacter, E coli O157 • poor hygiene contributed to their spread • Poor cough, hand and surface hygiene contribute to spread of colds and flu • hygiene a component part of global action which halted spread of SARS • Flu pandemic, hygiene will be important first line of defence during early critical period Global preparedness means making respiratory, hand and surface hygiene part of our daily lives BEFORE the event

10. The changing hygiene climate • Put together - strong case for investment in hygiene promotion • If ID is to be contained in a manner which is economically sustainable, it must be a responsibility shared by the public • Patient empowerment is not enough, we need family empowerment? • What do we need to do to achieve this ?

11. 1. Concerted rather than fragmented approach Currently: • separate issues – food hygiene, pandemic flu preparedness, patient empowerment etc - dealt with by separate agencies • Public receive fragmented information - mainly rule based • Need: • - Fragmented/rule-based knowledge not enough to meet challenges we face • - Look at hygiene holistically from the point of view of the family • - Agencies need to work in partnership • - Introduce ID and hygiene education back into school curriculum

12. Currently: hygiene has a negative image old fashioned/ disciplinarian dirt is natural/hygiene unnatural Need: Make hygiene more appealing to consumers - realign it alongside positive attributes of health and well-being Persuade consumers to share responsibility without shifting blame 2. Engage the family/change attitudes:

13. 3. Balancing risks against benefits of hygiene:

14. Perceived risks of being too clean? Hygiene Hypothesis • Evidence that microbial exposure in early childhood may help to protect against allergies • No evidence that we need exposure to harmful microbes or to suffer a clinical infection Immunity to infection No evidence that we need to get regular “infections” to “strengthen” our immunity to infection

15. Biocide usage and “superbugs” ? • Some evidence of links between resistance to biocides and antibiotics - but: • evidence is lab-based • currently no evidence that biocide usage has contributed to problems of antibiotic reistance - antibiotic over-prescribing is the main cause

16. Dirt is good for you Are we giving too much attention to hygiene-associated risks - at the expense of stressing the risks of not doing hygiene properly?

17. The IFH - developing and promoting a sustainable approach to hygiene in the home and community

18. A risk assessment approach to home hygiene • IFH has developed a “risk-based” approach to home hygiene • the accepted approach for controlling microbial risks in food, pharmaceutical and other manufacturing environments – also now being applied in hospitals • This approach to home hygiene has come to be known as the “targeted hygiene”

19. Targeted hygiene: understanding the chain of infection Sources of infection faeces swallowed Way in Way out coughs Food particles inhaled sneezes spread hands Toilets, baths, basins Hand contact surfaces

20. Targeted hygiene: breaking the chain of infection Sources of infection faeces swallowed coughs Way in Way out Food particles inhaled hands sneezes spread Toilets, baths, basins Hand contact surfaces

21. Targeted hygiene: preventing the spread of germs/infection Risk assessment allows us to construct a hierarchy of risks. Hands, hand and food contact surfaces and cloths form a “superhighway” for spread of germs in the home Hands Hand contact surfaces Food contact surfaces Clean- ing cloths Toilets, baths, basins, etc floors, walls etc

22. Targeted hygiene: effective policy for home hygiene: • Good hygiene is not a “once weekly deep down clean” to get rid of germs • It needs to be an ongoing part of our daily lives • targeting hygienic cleaning measures where & when it is necessary to reduce exposure to microbes which could be harmful • we need to distinguish between “hygiene” and “cleaning”

23. Targeted hygiene: rational, sustainable and healthy • “Targeted” hygiene offers the means to deliver messages which make sense to consumers • It offers the means to maximise protection against infection • whilst minimising the impact on our human and natural environment • i.e “normal” exposure to non-harmful microbes

24. In summary • Infectious disease is a significant threat to health and prosperity of the EC • Burden of ID could be significantly reduced through better standards of hygiene in the home and community • To achieve this we need: • better communication with “the family” • concerted action involving public and private sector which is family-orientated not agency- centred

25. The way forward: • IFH has produced a range of materials promoting a risk-based approach to hygiene in the home and community • review papers and briefing documents • guidelines and training materials for workers in the community • IFH is working to identify and bring together key stakeholders in the public and private sector at European level who are working to promote hygiene • private sector has key role to play • IFH is looking to develop partnerships to maximise application of resources and expertise to develop and promote hygiene to consumers • Contact us at www.ifh-homehygiene.org