1. Hand hygiene general recommendations;
Hand hygiene has been shown to prevent respiratory illness. Hand washing is recommended after coughing and sneezing
and/or disposing of a tissue, on entering the home having
come from public places, before preparing food, before and
after eating and feeding/breastfeeding, after using the toilet or changing a child’s diaper and after touching animals. For
people with limited WASH (water, sanitation and
hygiene) services it is vital to prioritize the
key times for hand hygiene.
As part of a new hand hygiene campaign, WHO recommends
that universal access to hand hygiene facilities should be
provided in front of all public buildings and transport hubs −
such as markets, shops, places of worship, schools and train
or bus stations. In addition, functioning hand washing
facilities with water and soap should be available within 5m
of all toilets, both public and private.
The number or size of these hand hygiene stations should be
adapted to the number and type of users such as children or
those with limited mobility, to encourage use and reduce
waiting times. The installation, supervision and maintenance
of equipment, including where necessary, regular refilling of
water and soap and/or alcohol-based hand rub should be
under the overall leadership of the public health authorities.
Maintaining supplies should be the responsibility of the
manager of the building or store, transport provider etc. Civil
society and the private sector can be engaged to support the
functioning and correct use of such facilities and to prevent
vandalism. 2. Hand hygiene materials
The ideal hand hygiene materials for communities and homes
in order of effectiveness are:
• Water and soap or alcohol-based hand rub
• Ash or mud
• Water alone
Hand hygiene stations can consist of either water,
i such as
sinks attached to a piped-water supply, refillable water
reservoir or clean, covered buckets with taps equipped with
plain soap or alcohol-based hand rub dispensers. Where
alcohol-based hand rub or bar soap is not feasible, a liquid
soap solution, mixing detergent with water can be used . The
ratio of detergent to water will depend on types and strengths
of locally available product. Soap does not need to be
antibacterial and evidence indicates that normal soap is
effective in inactivating enveloped viruses, such as
corona viruses. Alcohol-based hand rub should contain at
least 60% alcohol. Such products should be certified and,
where supplies are limited or prohibitively expensive, can be
produced locally according to WHO-recommended
formulations. When soap or alcohol-based hand rub are not available, the
use of ash or soil can be considered and has shown to be
effective in some cases. Ash, in particular, may inactivate
pathogens by raising the pH. However, in communities with
limited sanitation services, soil may be faecally contaminated,
and thus it is important to weigh the benefits against the risk of contaminating hands. Finally, washing with water alone,
although the least effective of the four options, this can result
in reductions in faecal contamination on hands and in
diarrhoea. Regardless of the type of material, the washing
and rubbing of hands, and the amount of rinsing water in
particular, are important determinants in the reduction of
pathogen contamination on hands.
3. Water quality and quantity requirements for
hand washing
The quality of water used for hand washing does not need to
meet drinking-water standards. Evidence suggests that even
water with moderate faecal contamination when used with
soap and the correct technique can be effective in removing
pathogens from hands. However, efforts should be made to
use and source water of the highest quality possible (e.g. an
improved water source) . Reported quantities of water used
for hand washing that have enabled reduction of faecal
contamination ranges from 0.5-2 litres per person. Furthermore, the quantity of water used has been associated
with less viral contamination of hands. Where water is
limited, hands can be wetted with water, the water then turned
off while lathering with soap and scrubbing for at least 20 seconds, and then the water can be turned on again to rinse.
Water should always be allowed to flow to a drainage area or
receptacle, and hands should not be rinsed in a communal
basin, as this may increase contamination.
4. Hand washing facility options
A number of design features should be considered in
selecting and/or innovating on existing hand washing facility
options. These features include:
• Turning the tap on/off: either a sensor, foot pump,
or large handle so the tap can be turned off with
the arm or elbow
• Soap dispenser: for liquid soap either sensor controlled or large enough to operate with the
lower arm; for a bar of soap, the soap dish should
be well-draining, so the soap doesn’t get soggy
• Grey water: ensure the grey water is directed to,
and collected in, a covered container if not
connected to a piped system
• Drying hands: paper towels and a bin provided;
if not possible encourage air drying for several
seconds
• Materials: generally, the materials should be
easily cleanable and repair/replacement parts
can be sourced locally
• Accessible: should be accessible to all users,
including children and those with limited
mobility.
A number of hand washing designs have been implemented
in households, schools and in public settings in both developed and developing countries . In schools, a number of
simple, easy to maintain, and durable low-cost designs have
been successfully implemented.
5. Treatment and handling requirements for
excreta
When there are suspected or confirmed cases of COVID-19
in the home setting, immediate action must be taken to
protect caregivers and other family members from the risk of
contact with respiratory secretions and excreta that may
contain the COVID-19 virus. Frequently touched surfaces
throughout the patient’s care area should be cleaned regularly,
such as tables and other bedroom furniture. Cutlery and
crockery should washed and dried after each use and not
shared with others. Bathrooms should be cleaned and
disinfected at least once a day. Regular household soap or
detergent should be used for cleaning first and then, after
rinsing, regular household disinfectant containing 0.1%
sodium hypochlorite (that is, equivalent to 1000 ppm or 1 part
household bleach with 5% sodium hypochlorite to 50 parts
water) should be applied. PPE should be worn while cleaning,
including mask, goggles, a fluid-resistant apron and gloves, and hand hygiene should be performed after removing PPE.
Consideration should be given to safely managing human
excreta throughout the entire sanitation chain, starting with
ensuring access to regularly cleaned, accessible and
functioning toilets or latrines and to the safe containment,
conveyance, treatment and eventual disposal of sewage.
6. Management of waste generated at home
Waste generated at home during quarantine, while caring for
a sick family member or during the recovery period should
be packed in strong black bags and closed completely before
disposal and eventual collection by municipal waste services.
Tissues or other materials used when sneezing or coughing
should immediately be thrown in a waste bin. After such
disposal, correct hand hygiene should be performed.
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