Hygiene is a set of practices performed to preserve health. According to the World Health Organization (WHO), "Hygiene refers to conditions and practices that help to maintain health and prevent the spread of diseases."Personal hygiene refers to maintaining the body's cleanliness.
Many people equate hygiene with 'cleanliness,' but hygiene is a broad term. It includes such personal habit choices as how frequently to bathe, wash hands, trim fingernails, and change clothing. It also includes attention to keeping surfaces in the home and workplace, including bathroom facilities, clean and pathogen-free.
Some regular hygiene practices may be considered good habits by a society, while the neglect of hygiene can be considered disgusting, disrespectful, or threatening.
Background
Hygiene is a concept related to cleanliness, health and medicine. It is as well related to personal and professional care practices. In medicine and everyday life settings, hygiene practices are employed as preventative measures to reduce the incidence and spreading of disease.
Hygiene practices vary, and what is considered acceptable in one culture might not be acceptable in another.
In the manufacturing of food, pharmaceutical, cosmetic and other products, good hygiene is a critical component of quality assurance.
The terms cleanliness and hygiene are often used interchangeably, which can cause confusion. In general, hygiene refers to practices that prevent spread of disease-causing organisms. Cleaning processes (e.g., handwashing) remove infectious microbes as well as dirt and soil, and are thus often the means to achieve hygiene.
Other uses of the term appear in phrases including body hygiene, personal hygiene, sleep hygiene, mental hygiene, dental hygiene, and occupational hygiene, used in connection with public health. Hygiene is also the name of a branch of science that deals with the promotion and preservation of health.
Medical hygiene
Medical hygiene pertains to the hygiene practices related to the administration of medicine and medical care that prevents or minimizes the spread of disease.
Medical hygiene practices include:
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Isolation or quarantine of infectious persons or materials to prevent spread of infection.
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Sterilization of instruments used in surgical procedures.
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Use of protective clothing and barriers, such as masks, gowns, caps, eyewear and gloves.
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Proper bandaging and dressing of injuries.
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Safe disposal of medical waste.
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Disinfection of reusables (i.e., linen, pads, uniforms).
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Scrubbing up, hand-washing, especially in an operating room, but in more general health-care settings as well, where diseases can be transmitted.
Most of these practices were developed in the 19th century and were well established by the mid-20th century. Some procedures (such as disposal of medical waste) were refined in response to late-20th century disease outbreaks, notably AIDS and Ebola.
Home and everyday hygiene
Home hygiene pertains to the hygiene practices that prevent or minimize the spread of disease at home and other everyday settings such as social settings, public transport, the workplace, public places etc.
Hygiene in a variety of settings plays an important role in preventing the spread of infectious diseases.It includes procedures used in a variety of domestic situations such as hand hygiene, respiratory hygiene, food and water hygiene, general home hygiene (hygiene of environmental sites and surfaces), care of domestic animals, and home health care (the care of those who are at greater risk of infection).
At present, these components of hygiene tend to be regarded as separate issues, although based on the same underlying microbiological principles. Preventing the spread of diseases means breaking the chain of infection transmission. Simply, if the chain of infection is broken, infection cannot spread. In response to the need for effective codes of hygiene in home and everyday life settings the International Scientific Forum on Home Hygiene has developed a risk-based approach based on Hazard Analysis Critical Control Point (HACCP), also referred to as "targeted hygiene." Targeted hygiene is based on identifying the routes of pathogen spread in the home and introducing hygiene practices at critical times to break the chain of infection.
The main sources of infection in the home are people (who are carriers or are infected), foods (particularly raw foods) and water, and domestic animals (in the U.S. more than 50% of homes have one or more pets). Sites that accumulate stagnant water—such as sinks, toilets, waste pipes, cleaning tools, face cloths—readily support microbial growth and can become secondary reservoirs of infection, though species are mostly those that threaten "at risk" groups. Pathogens (potentially infectious bacteria, viruses etc.—colloquially called "germs") are constantly shed from these sources via mucous membranes, feces, vomit, skin scales, etc. Thus, when circumstances combine, people are exposed, either directly or via food or water, and can develop an infection.
The main "highways" for the spread of pathogens in the home are the hands, hand and food contact surfaces, and cleaning cloths and utensils. Pathogens can also be spread via clothing and household linens, such as towels. Utilities such as toilets and wash basins, for example, were invented for dealing safely with human waste but still have risks associated with them. Safe disposal of human waste is a fundamental need; poor sanitation is a primary cause of diarrhea disease in low income communities. Respiratory viruses and fungal spores are spread via the air.
Good home hygiene means engaging in hygiene practices at critical points to break the chain of infection.Because the "infectious dose" for some pathogens can be very small (10-100 viable units or even less for some viruses), and infection can result from direct transfer of pathogens from surfaces via hands or food to the mouth, nasal mucosa or the eye, 'hygienic cleaning' procedures should be sufficient to eliminate pathogens from critical surfaces.
Hygienic cleaning can be done through
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Mechanical removal (i.e., cleaning) using a soap or detergent. To be effective as a hygiene measure, this process must be followed by thorough rinsing under running water to remove pathogens from the surface.
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Using a process or product that inactivates the pathogens in situ. Pathogen kill is achieved using a "micro-biocidal" product, i.e., a disinfectant or antibacterial product; waterless hand sanitizer; or by application of heat.
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In some cases combined pathogen removal with kill is used, e.g., laundering of clothing and household linens such as towels and bed linen.
Handwashing
Hand hygiene is defined as handwashing or washing hands and nails with soap and water or using a waterless hand sanitizer. Hand hygiene is central to preventing spread of infectious diseases in home and everyday life settings.
In situations where handwashing with soap is not an option (e.g., when in a public place with no access to wash facilities), a waterless hand sanitizer such as an alcohol hand gel can be used. They can be used in addition to handwashing to minimize risks when caring for "at risk" groups. To be effective, alcohol hand gels should contain not less than 60%v/v alcohol.
The World Health Organization recommends handwashing with ash if soap is not available in emergencies, schools without access to soap[11] and other difficult situations like post-emergencies where use of (clean) sand is recommended, too. Use of ash is common in rural areas of developing countries and has in experiments been shown at least as effective as soap for removing pathogens.
Food hygiene at home
Food hygiene is concerned with the hygiene practices that prevent food poisoning. The five key principles of food hygiene, according to WHO, are :
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Prevent contaminating food with mixing chemicals, spreading from people, and animals .
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Separate raw and cooked foods to prevent contaminating the cooked foods.
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Cook foods for the appropriate length of time and at the appropriate temperature to kill pathogens.
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Store food at the proper temperature.
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Use safe water and raw materials.
Hygiene in the kitchen, bathroom and toilet
Routine cleaning of (hand, food, drinking water) sites and surfaces (such as toilet seats and flush handles, door and tap handles, work surfaces, bath and basin surfaces) in the kitchen, bathroom and toilet reduces the risk of spread of pathogens.The infection risk from flush toilets is not high, provided they are properly maintained, although some splashing and aerosol formation can occur during flushing, particularly when someone has diarrhea. Pathogens can survive in the scum or scale left behind on baths and wash basins after washing and bathing.
Water left stagnant in the pipes of showers can be contaminated with pathogens that become airborne when the shower is turned on. If a shower has not been used for some time, it should be left to run at a hot temperature for a few minutes before use.
Thorough cleaning is important in preventing the spread of fungal infections.Molds can live on wall and floor tiles and on shower curtains. Mold can be responsible for infections, cause allergic responses, deteriorate/damage surfaces and cause unpleasant odors. Primary sites of fungal growth are inanimate surfaces, including carpets and soft furnishings.Air-borne fungi are usually associated with damp conditions, poor ventilation or closed air systems.
Laundry hygiene
Laundry hygiene involves practices that prevent disease and its spread via soiled clothing and household linens such as towels. Items most likely to be contaminated with pathogens are those that come into direct contact with the body, e.g., underwear, personal towels, facecloths, nappies. Cloths or other fabric items used during food preparation, or for cleaning the toilet or cleaning up material such as faeces or vomit are a particular risk.
Microbiological and epidemiological data indicates that clothing and household linens etc. are a risk factor for infection transmission in home and everyday life settings as well as institutional settings. The lack of quantitative data linking contaminated clothing to infection in the domestic setting makes it difficult to assess the extent of this risk. It also indicates that risks from clothing and household linens are somewhat less than those associated with hands, hand contact and food contact surfaces, and cleaning cloths, but even so these risks needs to be managed through effective laundering practices. In the home, this routine should be carried out as part of a multibarrier approach to hygiene which includes hand, food, respiratory and other hygiene practices.
Infectious diseases risks from contaminated clothing etc. can increase significantly under certain conditions, e.g., in healthcare situations in hospitals, care homes and the domestic setting where someone has diarrhoea, vomiting, or a skin or wound infection. It increases in circumstances where someone has reduced immunity to infection.
Hygiene measures, including laundry hygiene, are an important part of reducing spread of antibiotic resistant strains. In the community, otherwise healthy people can become persistent skin carriers of MRSA, or faecal carriers of enterobacteria strains which can carry multi-antibiotic resistance factors (e.g. NDM-1 or ESBL-producing strains). The risks are not apparent until, for example, they are admitted to hospital, when they can become "self infected" with their own resistant organisms following a surgical procedure. As persistent nasal, skin or bowel carriage in the healthy population spreads "silently" across the world, the risks from resistant strains in both hospitals and the community increases. In particular the data indicates that clothing and household linens are a risk factor for spread of S. aureus (including MRSA and PVL-producing MRSA strains), and that effectiveness of laundry processes may be an important factor in defining the rate of community spread of these strains.
Experience in the United States suggests that these strains are transmissible within families and in community settings such as prisons, schools and sport teams. Skin-to-skin contact (including unabraded skin) and indirect contact with contaminated objects such as towels, sheets and sports equipment seem to represent the mode of transmission.
During laundering, temperature and detergent work to reduce microbial contamination levels on fabrics. Soil and microbes from fabrics are severed and suspended in the wash water. These are then "washed away" during the rinse and spin cycles. In addition to physical removal, micro-organisms can be killed by thermal inactivation which increases as the temperature is increased. Chemical inactivation of microbes by the surfactants and activated oxygen-based bleach used in detergents contributes to the hygiene effectiveness of laundering. Adding hypochlorite bleach in the washing process achieves inactivation of microbes. A number of other factors can contribute including drying and ironing.
Laundry detergents contain a mix of ingredients including surfactants, builders, optical brighteners, etc. Cleaning action arises primarily from the action of the surfactants and other ingredients, which are designed to maximise release and suspension of dirt and microbes into the wash liquid, together with enzymes and/or an activated oxygen-based bleach which digest and remove stains. Although activated oxygen bleach is included in many powder detergents to digest and remove stains, it produces some chemical inactivation of bacteria, fungi and viruses. As a rule of thumb, powders and tablets normally contain an activated oxygen bleach, but liquids and all products (liquid or powder) used for "coloureds" do not. Surfactants also exert some chemical inactivation action against certain species although the extent of their action is not known.
In 2013 the International Scientific Forum on Home Hygiene (IFH) reviewed some 30 studies of the hygiene effectiveness of laundering at temperatures ranging from room temperature to 70 °C, under varying conditions. A key finding was the lack of standardisation and control within studies, and the variability in test conditions between studies such as wash cycle time, number of rinses, etc. The consequent variability in the data (i.e., the reduction in contamination on fabrics) obtained, in turn makes it extremely difficult to propose guidelines for laundering with any confidence, based on currently available data. As a result, there is significant variability in the recommendations for hygienic laundering of clothing etc. given by different agencies.
Of concern is recent data suggesting that, in reality, modern domestic washing machines do not reach the temperature specified on the machine controls.
Medical hygiene at home
Medical hygiene pertains to the hygiene practices that prevents or minimizes disease and the spreading of disease in relation to administering medical care to those who are infected or who are more "at risk" of infection in the home. Across the world, governments are increasingly under pressure to fund the level of healthcare that people expect. Care of increasing numbers of patients in the community, including at home is one answer, but can be fatally undermined by inadequate infection control in the home. Increasingly, all of these "at-risk" groups are cared for at home by a carer who may be a household member who thus requires a good knowledge of hygiene. People with reduced immunity to infection, who are looked after at home, make up an increasing proportion of the population (currently up to 20%).The largest proportion are the elderly who have co-morbidities, which reduce their immunity to infection. It also includes the very young, patients discharged from hospital, taking immuno-suppressive drugs or using invasive systems, etc. For patients discharged from hospital, or being treated at home special "medical hygiene" (see above) procedures may need to be performed for them e.g. catheter or dressing replacement, which puts them at higher risk of infection.
Antiseptics may be applied to cuts, wounds abrasions of the skin to prevent the entry of harmful bacteria that can cause sepsis. Day-to-day hygiene practices, other than special medical hygiene procedures are no different for those at increased risk of infection than for other family members. The difference is that, if hygiene practices are not correctly carried out, the risk of infection is much greater.
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