Setting the Hygiene Standards for a Healthy Home

A series of practical recommendations from the Hygiene Council to help improve hygiene standards in the home
Developed by the Hygiene Council, April 2008

Hygiene StandardS

Int roduction

why is it so important to improve home hygiene?

Childhood infections Pneumonia, diarrhoea, and HIV/AIDS each account for approximately 30% of child deaths in developing nations, particularly Africa.3

The global increase in infection due to bacteria, viruses, fungi, prions, or parasites is evident in all nations. Western developed nations have seen an increase in hospital acquired infection and antibiotic resistant strains of bacteria, while some developing nations have seen increases in resistant tuberculosis1 and in malaria. 2 Regardless of geographical location, many infectious diseases can be prevented or contained through good hygiene practice and education. Whether this is to ensure that stored water is covered to reduce the spread of dengue or malaria, that purifying tablets are used for drinking water, that the mouth is covered when coughing, or simple effective hand washing when running water is available. But what about hygiene in our homes? We tend not to consider our homes as a source of infection but in fact a wide variety of micro-organisms exist in the home. While not all will necessarily lead to disease there can be no doubt that practicing simple, effective hygiene measures can help to prevent the unnecessary spread of infection in the domestic setting. Prevention is better than cure.

Hygiene Council April 2008 3

Hygiene StandardS

Int roduction

The Role of the Hygiene Council

The Hygiene Council are a group of leading global experts in the fields of microbiology, virology, infectious disease, immunology, and public health. The Council review current infectious disease threats to society and formulate realistic recommendations on simple hygiene measures to help the public improve levels of hygiene in the home and community and in turn help to prevent the spread of all kinds of infections. This year, the Hygiene Council, responding to consumer confusion about how best to be hygienically safe at home, has come up with a set of practical recommendations to help all of us practice good hygiene. By translating science into practice, everyone can have a clear idea of best practice. The Hygiene Standards recommended by the Hygiene Council focuses on four key areas that we should monitor for good home hygiene: our hands, the surfaces in our home, our food preparation and storage and household laundry.

Take Action on Hygiene in the Home - Follow the Hygiene Standards

The Hygiene Council understands that its not practical or desirable to make a home completely germ-free. Instead, its important to pay attention to areas that represent the greatest risk. Paramount among these areas is your hands, hand and food contact surfaces and the laundry!

Pg 6

Pg 10

Pg 14

Pg 18

Hygiene Council April 2008 5

Hygiene StandardS

HANDWASHING

Your health in your hands

WHY is hand washing so important?
The hands are one of the most important causes of cross contamination and cross infection in the home.

WHEN should you wash your hands?

Before... Eating or before feeding children Applying contact lenses Giving any medication or first aid After... Using the toilet or changing a childs nappy Handling pets and domestic animals Contact with blood or body fluids Coughing, sneezing, or blowing and scratching the nose Contact with a potentially contaminated site Before and after... Handling raw food Tending to someone who is sick
Your health in your hands

And whenever... Hands appear dirty HOW should hands be washed? Where soap and clean water are available, follow the six-step hand washing process - See next page Where soap and clean water are not available, alcohol-based hand rubs can be used to kill germs on the hands, but not if the hands are visibly dirty as these products dont clean

Your health in your hands

Did you know?

The number of times a person needs to wash their hands will depend on what they have been doing.

Hygiene Standards

Hygiene Standards

[Insert locally relevant information here]

After hand washing with soap, hands should be thoroughly dried on a clean dry towel
Hygiene Council April 2008 7

The six-step process to washing your hands

1. Wet hands and apply soap. Rub palms together until soap is bubbly 2. Rub each palm over the back of the other hand 3. Rub between your fingers on each hand 4. Rub backs of fingers (interlocked) 5. Rub around each of your thumbs 6. Rub both palms with finger tips then rinse and dry your hands

Only 3 in 5 people (59%) claim their children ALWAYS wash their hands before eating

Your health in your hands

Your health in your hands

A recent Global Survey found that:

[Insert locally relevant survey or home swabbing study data]

Hygiene Standards

The majority of respondents (53%) said they wash their hands for 10 seconds or less (24% for 5 seconds and 29% for 10 seconds) after using the toilet when actually the optimal time for washing is 20 seconds.4 Only 3 in 5 people (59%) claim their children ALWAYS wash their hands before eating. A quarter said most of the time (26%), 9% sometimes, 2% rarely and 1% never.

Hygiene Standards

8 April 2008 Hygiene Council

Hygiene Council April 2008 9

Hygiene StandardS

SURFACE CLEANING

HOW TO KEEP SURFACES SAFE

As well as frequent and thorough hand washing, an equally critical step you can take is to clean and disinfect hand and food contact areas in your home. The reason for this is that bacteria can survive on surfaces in the home for long periods of time. They can then be transferred to other surfaces (including the hands) in sufficient numbers to represent an infection risk.5

WHY is SURFACE CLEANING so important?

Pathogenic micro-organisms entering the home can survive on surfaces for significant periods of time5 Micro-organisms from surfaces can then be transferred to hands Germs from the hands can be transferred to other surfaces and other people leading to infection Clean or disinfect surfaces to reduce the risk of cross contamination

WHEN should SURFACE CLEANING BE DONE?

Immediately... When someone in the household is ill with vomiting If a surface is contaminated by vomit, faeces, blood or any bodily fluid Before and after preparing food Whenever they are dirty Regulary... When someone in the household is ill with colds and sneezes When a surface is frequently touched And frequently... If someone in the household is ill with diarrhoea

Surface cleaning and disinfection

Did you know?

A study carried out by the Hygiene Council found that nine out of ten (89%) kitchen cloths across the world have unsatisfactory or worse levels of bacteria.

Surface cleaning and disinfection

Hygiene Standards

Bacteria can survive on surfaces in the home for long periods of time

Hygiene Standards

Hygiene Council April 2008 11

Appearances can be deceiving

A home hygiene study carried out by the Hygiene Council found that in 12% of cases, visibly clean surfaces were found to be heavily contaminated. Even grimy surfaces could turn out to be very dirty in microbiological terms. This is a potentially harmful situation, as it means consumers may not clean thoroughly enough if they believe a surface to be already clean.6

Easy access to a safe water supply is not always possible in some communities. However there are some practical ways to improve the quality of household stored water and hence reduce risks of diarrhoeal disease.7

HOW to clean water containers and prevent contamination7

Clean water is no good if stored in a dirty container. These should be cleaned and disinfected regularly with detergent followed by an appropriate disinfectant Containers with clean water should not be topped up, but once empty the vessel should be cleaned and disinfected prior to refilling. The time that water is stored should be minimised Avoid putting hands (dipping) and dirty utensils into a water container. This could contaminate the water If water treatments (eg, chlorinating tablets) are used; seperate containers should be used for contaminated water

HOW should surface cleaning be done?

Where rinsing with clean running water is possible, use detergent-based cleaner, followed by thorough rinsing with clean water and drying When thoroughly rinsing is not possible, or if the surfaces carries a particularly high risk of being contaminated, disinfectants should also be used Always use disposable cloths, or reusable cloths, which have been decontaminated and dried after their previous use
How to keep surfaces safe

In 12% of cases, visibly clean surfaces were found to be heavily contaminated

HIGH-RISK HOME SURFACES AND AREAS!

Clean these items regularly Cleaning cloths Chopping boards and utensils Toilet seat and flush handle Taps Kitchen work tops Door and fridge handles Light switches Telephone hand piece Sink, bath and shower Rubbish bin lid Water storage containers and filters

Water should be regularly replaced by fresh water from municipal tap. If the quality of the water supply is poor, or if pond or well water is used, it should be disinfected with appropriate dose of bleaching powder with 33% available chlorine Water can become contaminated by insects, animals, dirt, or debris that carry disease-causing organisms. Therefore water vessels should be covered at all times or a screw cap or spigot used to seal a bottle
[Delete or ammend as necessary]

How to keep surfaces safe

and the treated water Cracked or broken water containers should be discarded
Hygiene Standards

Hygiene Standards

12 April 2008 Hygiene Council

Hygiene Council April 2008 13

Hygiene StandardS

FOOD PREPARATION

Food preparation, cooking & storage

The vast majority of food-borne illnesses occur because food was not handled or cooked properly. The US Center for Disease Control and Prevention has estimated that 50 to 80% of food-borne illnesses happen in the home.8 Foods are safely cooked when they are heated for long enough and at a high enough temperature to kill any harmful micro-organisms. If food isnt cooked properly micro-organisms such as Salmonella, E. coli and Listeria may cause food poisoning. Coupled with this, foods stored incorrectly can also increase the risk of contamination and disease spread. Ideally, all food, particularly cooked food, should be stored in a refrigerator.

How food-borne illnesses are spread

The micro-organisms that cause food-borne illness can be spread from raw meat and vegetables during food preparation,
Food preparation, cooking and storage

directly on to chopping boards, utensils, worktops, and other foods. These micro-organisms can then spread to other surfaces around the home via your hands. Once one person is infected with food-borne micro-organisms, its highly likely that they will pass this on to others in your home and community, particularly if hygiene practice is poor.

Food preparation, cooking and storage

Did you know?

In the US alone, there are as many as 76 million cases of food-borne illnesses per year, resulting in as many as 5,000 unnecessary deaths.8
In
se

WHY SHOULD SPECIAL MEASURES BE TAKEN?

To stop the spread of food-borne illnesses
Hygiene Standards

Hygiene Standards

WHEN SHOULD food hygiene be practised?

Whenever food is handled, cooked or stored

rt

lo c

a l s tat i

s s tic

he

re

Hygiene Council April 2008 15

FOOD PREPARATION

THE BEST practice FOR food hygiene

Store and prepare raw meat, poultry, and seafood away from other foods Store food in the fridge at 5C, do not overfill and allow cold air to circulate Dont forget to clean all contaminated items including utensils, cutting boards, and kitchen worktops after using

Soak, scrape, brush, scald, or wash all fruit, salad and vegetables Always cook all meat products thoroughly at 70C

Where refrigeration is not possible use food preservatives such as salt or freshly prepare food each day Prevent food juices from dripping onto other foods Wash hands after each stage of food preparation and particularly after touching raw meat and poultry Cut meat and vegetables with separate knives and cutting boards

Dont leave cooked food sitting at room temperature for longer than two hours Remember to reheat (at 70C or above) and re-serve leftovers only once Wash hands before and after eating

meats THAT should never be eaten rare!

Poultry, pork, hamburgers, sausages, chicken nuggets, rolled joints, and kebabs - They may harbour bacteria throughout.

If food is piping hot in the middle, then it will be piping hot all the way through. When cooking a very large dish, check the temperature in more than one place.
Food preparation, cooking and storage

Food preparation, cooking and storage

A home hygiene study by the Hygiene Council found that:

[Insert locally relevant survey or home swabbing study data]

19% of kitchen surfaces were contaminated with E. coli. This contamination could have come from raw meat which highlights the importance of handling food carefully in the kitchen.

In the case of poultry, make sure juices run clear during cooking

Hygiene Standards

Hygiene Standards

16 April 2008 Hygiene Council

Hygiene Council April 2008 17

Hygiene StandardS

LAUNDRY

DONT FORGET THE LAUNDRY

Its often a forgotten area of household hygiene because, by its very nature, laundry areas can be perceived as clean. But studies have shown that the transfer of microbes between contaminated and uncontaminated clothing can occur during washing and that microbial transfer is only partially removed during the rinse cycles.9, 10, 11, 12

WHY is l aundry hygiene important?

Microbial transfer can occur between infected and non-infected clothing Low temperature washing may not destroy all the germs

WHEN should it be done?

Whenever clothes are washed (hand wash or machine wash)

HOW CAN YOU MAKE l aundry hygienIC?

Launder clothes, linen, towels, and other fabrics at a high temperature (above 60C) If a lower temperature is recommended or you prefer to wash at a lower temperature then a laundry disinfectant should be added particularly for the laundry of small children or other contaminated items Launder heavily soiled items separately Dry clothes immediately after washing to prevent build up of germs on damp items Run washing machine empty at a high-temperature occasionally to prevent it becoming a reservoir for germs Wash hands after touching any laundry In developing countries, laundry should be washed in clean water and preferably sun-dried in scorching sun and then ironed

Dont forget the laundry

Dont forget the laundry

Did you know?

An average washing machine load can contain 100 million E.coli at any one time.13

Hygiene Standards

Hygiene Standards

As a general rule of thumb, the lower the washing temperature, water volume, and detergent level, the greater the risk of infection
Hygiene Council April 2008 19

Hygiene Council Members

CHAIR Professor John Oxford, Professor of Virology at Barts & The London School of Medicine and Dentistry, London, UK Professor Philip M. Tierno, Director Clinical Departments of Microbiology and Pathology, New Professor Barry D. Schoub, Executive Director, Johannesburg, South Africa Dr. Sandip K. Ray, Immediate Past Secretary General, of Community Medicine, Khaja Bandanawaj Institute of Medical Sciences, Gulbarga, Karnataka, India Dr Christopher Lee, Head & Consultant Infectious Diseases Physician, Department of Medicine, Sungai Buloh Hospital, Kuala Lumpur, Malaysia Prof Martin Exner, Managing Director, of Bonn, Germany Professor Carlo Signorelli, Professor of Hygiene, Society of Hygiene, Italy Professor Tariq Ahmed Madani, Associate Professor of Medicine and Infectious Diseases, Faculty of to the Minister of Health, Ministry of Health, Riyadh, Saudi Arabia Dr. Donald E. Low, Microbiologist-in-Chief at Toronto Dr Kgosi Letlape, Chairman of the South African

Reckitt Benckiser Information

Reckitt Benckiser: www.reckittbenckiser.com Napisan: www.napisan.it Lysol: www.lysol.com Dettol: www.dettol.co.uk Sagrotan: www.sagrotan.de/

Microbiology and Immunology, Associate Professor, York University Medical Centre, USA National Institute for Communicable Diseases,

References
1. Von Gottberg A, Klugman KP, Cohen C et al. Emergence of levofloxacin-non-susceptible streptococcus pneumonia and treatment for multidrug-resistant tuberculosis in children in South Africa: a cohort observational surveillance study. Lancet 2008; 371:1108-13. resources needed to attain international malaria control goals. Bulletin of the World Health Organisation 2007; 85 (8):623-30. counts: use of mortality audit data for decision making to save the lives of mothers, babies, and children in South Africa. Lancet 2008; 371:1294-1304. briefing document for health professionals, July 2007. potential in the domestic setting and the role of hygiene practice in reducing infection. August 2002. Available at: www.ifh-homehygiene.org/2003/2public/INFPOT2.pdf

Indian Public Health Association, India and Professor

2. Kiszewski A, Johns B, Schapira A et al. Estimated global

3. South African Every Death Counts Writing Group. Every death

Institute of Hygiene and Public Health, University

University of Parma, General Secretary of the Italian

4. HAND HYGIENE IN THE HOME AND COMMUNITY: IFH 5. International Scientific Forum on Home Hygiene. The infection

Medicine, King Abdulaziz University, Jeddah, Advisor

6. Hygiene Council Home Hygiene Study, May 2008. 7. www.who.int/water_sanitation_health/dwq/wsh0207/en/ print.html http://www.cdc.gov/ Accessed on 10 June 2008. Clinical Medicine 1966; 3 : 27-29. microorganisms in laundered polyester-cotton sheeting. Applied Microbiology 1973; 25 :431-35. temperature laundering. Journal of Consumer Studies and Home Economics 1989;13 :61-66. infectious disease symptoms in household members. Public Health Nursing 2001;18 :116-27. for laundry [oral presentation]. Proceedings of Perspectives on Home Hygiene: Building a Rational Approach. Columbia 8. Center for Disease Control and Prevention. Available at: 9. Kundsin RB et al. Staphylococcal disease in the home. 10. Wiksell JC, Pickett MS, Hartman PA et al. Survival of

Medical Laboratories/Mount Sinai Hospital, Canada Medical Association (SAMA) and the immediate past President of the World Medical Association (WMA), South Africa Dr Rhonda Stuart, Infectious Disease Physician, Joe Rubino, Director Shared Services, R&D

Monash Medical Centre, Victoria, Australia Laboratories, Reckitt Benckiser

11. Davis S, Ainsworth P et al. The disinfectant action of low-

Websites
International Scientific Forum on Home Hygiene (IFH): www.ifh-homehygiene.org World Health Organisation (WHO): www.who.int European Food Safety Authority: www.efsa.europa.eu Centers for Disease Control and Prevention (CDC): www.cdc.gov/ Hygiene Council: www.hygienecouncil.com

12. Larson EL, Duarte OG. Home hygiene practices and

13. Gerba C et al. A model for assessing risk: preliminary findings

University, New York; February 9, 1999.