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

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

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

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?

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

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

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

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

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

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 ?

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

2. Engage the family/change attitudes:

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

3. Balancing risks against benefits of hygiene:

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

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

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?

The IFH - developing and promoting a sustainable

approach to hygiene in the home and community

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”

Targeted hygiene: understanding the chain of infection

Sourcesof

infection

Way outWay out

spreadspread

Way inWay incoughs

sneezes

Foodparticles

faeces

hands

Hand contact surfaces

Toilets, baths, basins

swallowed

inhaled

Targeted hygiene: breaking the chain of infection

Sourcesof

infection

Way outWay out

spreadspread

Way inWay in

coughs

sneezes

Foodparticles

faeces

hands

Hand contact surfaces

Toilets, baths, basins

swallowed

inhaled

Targeted hygiene: preventing the spread of germs/infection

Hands

Handcontact

surfaces

Foodcontact

surfaces

Clean-ing

cloths

Toilets, baths, basins, etc

floors, walls etc

Risk assessment allows us to construct a hierarchyof risks.

Hands, hand and food contact surfaces and

cloths form a “superhighway” for

spread of germsin the home

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”

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

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

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