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Hygiene Introduction


Touching clothes or bedclothes of a person infected with scabies or ringworm can ... spread typhus or relapsing fever, hide in seams of clothes and bedclothes ... – PowerPoint PPT presentation

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Title: Hygiene Introduction

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

Hygiene Promotion One of the Big Five to Reduce
Diarrheal Disease
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 May3(5)275-81.

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
  • Crucial times for handwashing to reduce
    transmissions are
  • after defecation and after contact with
    childrens 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

Cleaning fingernails
  • Closely related to handwashing.
  • Handwashing does not ensure fingernails get
  • 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.

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.

Washing the face
  • Has an important role in the prevention of
  • 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.

Washing clothes and bedding
  • Major preventive measures to reduce transmission
    of scabies and louse-borne typhus and relapsing
  • 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

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

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.

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

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
  • Implement through initiatives such as lifeskills
    training programs, curriculum development and
    integrated sanitation and hygiene education in
    schools, and maternal and child health education

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

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
    promotion until the new behavior has become

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.

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

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

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.

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
  • Children learn through
  • Helping (e.g., with chores)
  • Playing
  • Being creative
  • Dealing with others (interaction and
  • Playing
  • Exercising

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

Benefits of School Hygiene and Sanitation
  • Effective learning Children perform better when
    they function in a hygienic and clean
  • 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 childrens 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.

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
  • 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.

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

Five Fallacies about Hygiene Promotion
  • Fallacy No. 1. Behaviour change is easy.
  • Fallacy No. 2. Knowledge changebehaviour
  • Fallacy No. 3. Experts know how to change
  • 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.

Lessons from Marketing and Private Industry
Public-Private Partnerships
  • Private Industry is very successful at changing
  • 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
  • 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.  

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.

Hygiene Improvement Framework
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