Home Hygiene in Developing Countries Prevention of Infection in the Home and the Peri-Domestic Setting

Home Hygiene in Developing Countries Prevention of infection in the home and the peri-domestic setting

A training resource on hygiene for teachers, community nurses, community workers and health professionals in developing countries

Sally F. Bloomfield and Kumar J. Nath

PPLY & SA U NI S TA R T E I T O

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C L O I L C L N A U BO O RATIVE C

Home Hygiene in Developing Countries Prevention of infection in the home and the peri-domestic setting

A training resource on hygiene for teachers, community nurses, community workers and other health professionals in developing countries

Sally F. Bloomfield* and Professor KJ Nath**

*Chairman & Board member of the International Scientific Forum on Home Hygiene; Honorary Professor, London School of Hygiene and Tropical Medicine, UK

**South East Asia Regional co-ordinator of the International Scientific Forum on Home Hygiene; President, Institution of Public Health Engineers, India

For decades, universal access to water and sanitation has been seen as the essential step in reducing the preventable disease burden. It is estimated that up to 1.1 billion people still do not have access to improved or safe water sources, and 2.5 billion people lack adequate sanitation. But it is also now clear that the health impact cannot be achieved by policies focusing only on water and sanitation hardware. There is a general belief that a key mistake in the past has been to undertake water and sanitation programmes in isolation. In order to achieve the primary objective of improving the health status of the community, organisations such as IFH, WSSCC, WHO, IRC, UNICEF and LSHTM are now working to improve attitudes, both with respect to hygiene and general health, and to develop hygiene promotion initiatives and integrate hygiene promotion into programmes related to water and sanitation.

Whereas most people recognise that hygiene means “handwashing”, there is some confusion as to what else is involved. Although there are tools available which give guidance on planning and executing hygiene promotion programmes, these give limited guidance on understanding the routes of infectious disease transmission, identifying “risk practices” and advising on effective hygiene practices. This unique resource is intended to fill a need for such guidance. The resource brings together all aspects of hygiene and looks at it from the point of view of the family and what they need to understand and know in order to protect themselves from infection. The emphasis is on “what to do” in situations where there is a risk of infectious disease transmission.

IFH recognises that, a significant barrier to change is that, in most countries, the separate aspects of hygiene (faeces disposal, food and water hygiene, handwashing, care of the sick, childcare etc) are dealt with by separate agencies. Public health usually focuses on municipal services, hospitals, etc. and there is reluctance to acknowledge the home as a setting of equal importance in the chain of disease transmission. If hygiene promotion is to be effective, ideally there should be a lead agency in each country, and proper infrastructure at national, district and local level for actioning hygiene promotion.

This training resource is intended to give practical support to community workers and teachers at local level who have responsibility for developing school and community hygiene promotion programmes, but can be used by anyone who needs to obtain an overview of hygiene and hygiene practice in developing country situations.

Sally Bloomfield, KJ Nath

3 Acknowledgements

The International Scientific Forum on Home Hygiene would like to thank:

• Carolien van der Voorden and Gourisankar Ghosh from the Water Supply and Sanitation Collaborative Council for believing in the value of this training resource and generously supporting its development

• Dr Jamie Bartram, Dr Jorgen Schlundt, Bruce Gordon and Jacqueline Sims (WHO Geneva) and Dr Valerie Curtis • (London School of Hygiene and Tropical Medicine) for their constructive comments and their contributions to this training resource

• The UK Infection Control Nurses Association, co-author of “Home Hygiene - Prevention of infection in the home: A training resource for carers and their trainers”, from which this version for developing countries has been freely adapted

• Dr Derek Bloomfield, for kindly providing the hand-drawn illustrations.

Copyright • This resource is available for use by anyone wishing to adopt it, free of copyrights. Part or integral reproduction is permitted by the International Scientific Forum on Home Hygiene, provided the original source is acknowledged. Please contact the IFH at [email protected] for further information

5 Contents

INTRODUCTION

PART 1- BREAKING THE CHAIN OF INFECTION USING TARGETED HYGIENE

PART 2 - PUTTING HYGIENE INTO PRACTICE Module 1 - Handwashing Module 2 - Food & Water hygiene Module 3 - Peri-domestic hygiene: disposal of human excreta, refuse and waste-water Module 4 - Personal hygiene Module 5 - General hygiene: breaking the spread of germs link Module 6 - Domestic animals and pets, rodents and insects Module 7 - Where there is more risk: healthcare at home

PART 3 - DEVELOPING A HYGIENE PROMOTION PROGRAMME - ADAPTING TO LOCAL CONDITIONS

Appendices Appendix 1 - Infectious diseases related to water, sanitation and hygiene Appendix 2 - Transmission routes for infectious diseases Appendix 3 - Understanding your community environment - what infections are you aiming to control? Appendix 4 - Chemical disinfectants explained

Introduction

This resource has been developed with the objective of providing practical support for the development of community hygiene promotion programmes aimed at reducing the ID burden across the social spectrum in developing countries.

Building an integrated approach to hygiene Although the major burden of ID and the greatest needs are in the poorest communities, the need for hygiene education and promotion is high even in the most prosperous communities. IFH recognises that, for hygiene promotion to be effective, we need to look at it from the point of view of the family and the range of actions which they need to undertake in order to protect themselves from infectious disease (ID). Starting from the assumption that hygiene promotion programmes should always include an assessment of the knowledge base of the family, and build on what they know, understand and want to know, the IFH developed this resource covering all aspects of hygiene in the home and the peri- domestic environment.

Building capacity for hygiene promotion Organisations such as UNICEF and IFH have jointly identified that, if programmes to promote hygiene practice are to be successful, there must be sufficient trained field workers who are responsible for, and committed to, hygiene education and motivation at the community and family level. It is only by combining their knowledge of local conditions, local needs and constraints, with an understanding of the means to prevent infection through hygiene practice, that hygiene behaviour can be improved.

Hygiene for all Promoting good hygiene practice to families right across the social spectrum is key to reducing the ID burden in developing countries. With this resource, the IFH intends to provide practical support to community workers and teachers (ranging from school teachers to public health educators to community nurses etc.) who have responsibility for developing and implementing community- based programmes to improve home hygiene standards in the household. The resource is written in simple practical language and is based on the IFH guidelines and recommendations and IFH/ICNA Home Hygiene training resource, t