Hygiene & sanitation

Hand hygiene — the keystone

Wash or sanitize: after any toilet use or nappy change, after handling waste or sick people, before cooking, before eating, after coming in from outside. In a crisis this is not fussiness — it is the wall between one sick person and a sick family.

1. Soap and water beats everything. Wet, lather thoroughly — backs, thumbs, between fingers, under nails — for 20 seconds (sing "Happy Birthday" twice), rinse, dry on a clean cloth or air.
2. Water is precious? A proper wash needs less than half a liter — see the tippy-tap below.
3. Alcohol sanitizer (60%+) when hands are not visibly dirty: cover every surface, rub until dry. Grease and grime defeat sanitizer — visibly dirty hands need soap.
4. No soap at all? Ash from a wood fire scrubbed with a little water is a proven substitute; sand scrubbing then a clean-water rinse is better than nothing.

Body, clothes & dishes with little water

• Priority when rationing: hands (always), then face/armpits/groin daily ("bird bath" with a basin and cloth — under 2 L), then hair and full body when supply allows. Health lives in the first two; comfort in the last.
• Bird-bath order: face first, feet last, one basin: wet cloth, soap the body, wipe clean, towel. Two people can bathe from 3 liters.
• Teeth still get brushed — a cup of water per person per day covers it. Oral infections in a crisis are misery with no dentist.
• Clothes: underwear and socks daily if at all possible (a small basin does it); outerwear can wait. Sun-dry everything — strong sunlight sanitizes fabric well. Soak-wash saves water: soak in soapy water 30 minutes, agitate, wring, one rinse. Skill card: efficient hand-wash routine →
• Dishes without a tap: three containers — (1) scrape + wash in warm soapy water, (2) rinse, (3) sanitize: 30-second dip in bleach solution (1 teaspoon bleach per 2 L water) or a scalding-water dip. Air-dry; towels re-contaminate. Scrape plates thoroughly first and the wash water lasts a whole meal's dishes.
• Reuse greywater (wash water) for toilet flushing or soaking the next round of laundry — never for anything that touches food.
• Menstrual hygiene: stock ahead (it vanishes from shops); washable cloth pads are the resilient backup — wash with soap, dry in full sun. Privacy, a wash basin, and discreet disposal bags keep dignity intact; plan them, don't improvise them.
• Babies: nappy changing is the highest-risk hygiene task in the house — dedicated changing surface, waste straight into a sealed bag, hands washed every time without exception. Cloth backups: scrape, soak in bleach solution, wash, sun-dry.

Improvised toilets

Toilets fail in two ways: no water to flush, or the sewer itself is broken. Know which you have — the answers differ.

Sewer intact, no running water

1. Keep using the toilet. Flush by pouring a bucket (3–4 L, greywater or any non-drinking water) quickly into the bowl — the rush triggers the siphon.
2. Flush solids only; "if it's yellow, let it mellow". Close the lid; a splash of bleach solution controls odor.

Sewer broken or unknown (post-earthquake, flood)

Do not flush into a broken sewer — it can back sewage into your or a neighbor's home. Switch to the bucket system:

1. Line a sturdy bucket (or the water-drained toilet bowl itself) with two heavy rubbish bags, one inside the other. A toilet seat, pool noodle slit lengthwise, or padded rim makes it usable for everyone.
2. After each solid use, cover the deposit with a scoop of dry material — sand, dry soil, ash, sawdust, shredded paper. This kills odor and flies, which are the disease carriers. Keep the scoop bucket beside it.
3. Keep a lid on between uses. Tippy-tap and soap stand beside it.
4. Two-bucket upgrade (strongly recommended): one bucket for urine, one for feces. Urine is near-sterile and can be poured on waste ground away from water; separating it keeps the solids bucket dry, light, and far less foul, so it lasts days instead of hours.
5. When two-thirds full: squeeze out air, knot the inner bag, knot the outer bag over it, and store per waste handling.

Outdoors / garden latrine (longer crises)

1. Site it at least 60 m (200 ft) from any well, water tank, or water source, downhill of them, 30+ m from the kitchen, away from where children play.
2. Dig a trench ~30 cm wide, 50–60 cm deep, as long as needed. Straddle or rig a seat over it.
3. Every use gets covered with the excavated soil (leave the pile and a scoop beside it). Fully cover and mark the trench when it fills to 20 cm below the surface; dig the next one.
4. Handwashing station within 5 steps, always.

Waste handling

• Human waste bags: double-bagged, tightly knotted, stored in a lidded, animal-proof container (bin with a strap, drum) outside the living area, in shade — away from children, food, and water. Do not bury bagged plastic waste; hold it for restored collection or official instructions. Never put waste bags in the street uncontained — that starts the epidemic you're avoiding.
• Food waste draws flies and rats within a day in heat: scrape plates into one sealed bag per day; bury food scraps 30+ cm deep away from the house if collection has stopped, or burn dry combustibles where lawful and safe.
• Medical waste (dressings, gloves, anything with blood or body fluids): its own bag, sealed, into the outside container. Needles into a rigid bottle with a screw cap, capped and labeled.
• General rubbish: crush and compact (volume is the enemy), keep the container closed, wash hands after every handling contact.
• Dead animals near the home: do not touch bare-handed; report if authorities function; otherwise bury deep (1 m), well away from water, using tools, gloves, and a hand wash after.
• Rats and flies boom after disasters: food sealed in hard containers, no standing food waste, standing water tipped out (mosquitoes), gaps under doors blocked.

Disinfection — the bleach kitchen

Plain unscented household bleach (5–9% sodium hypochlorite) is the crisis disinfectant. Mix fresh daily — diluted bleach dies within a day or two. Gloves on, ventilate, and never mix bleach with other cleaners (toxic gas).

Clean visible dirt with soap and water first; bleach on top of grime is wasted. Sunlight and complete drying are free co-disinfectants for bedding, mattresses, and washed clothing.

Disease prevention in shelters & crowded homes

Two households under one roof, or a communal shelter, concentrates every risk: one infected person, shared toilets, shared air. The countermeasures are organizational, and someone must own them — volunteer.

1. Guard the water: one clearly-marked safe drinking supply, served by pouring or a tap — never by dipping cups or hands into the container. Purification duty assigned by name.
2. Guard the toilets: enough capacity (aim for one per ~20 people at worst), cleaned on a rota twice daily with bleach solution, handwashing station with soap at every single one, lights or torches so night use stays safe and sanitary.
3. Guard the kitchen: fewest possible cooks, all washing hands; no one with diarrhea or vomiting prepares food — full stop — until 48 hours after symptoms end; food covered, served hot, no heat-and-hold leftovers (food safety rules).
4. Space and air: maximum spacing between sleeping families, heads-to-feet arrangement, ventilation open whenever weather allows — crowded still air is how respiratory infections harvest a shelter.
5. Isolate early: anyone with fever, new cough, vomiting, or diarrhea moves to a designated sick corner/room with own utensils and (ideally) own toilet at the first symptom — not once half the room has it. See the sickroom.
6. Watch for the waterborne alarm: multiple people developing watery diarrhea within a day or two means the water or kitchen chain has failed — reboil/re-chlorinate everything, rehydrate aggressively (ORS), find and fix the breach, and get word to health authorities however you can.
7. Children's hygiene needs running: scheduled handwashing (they won't self-start), nappy station away from food and water, and quickly re-established routines — see keeping children steady.

The sickroom — nursing without spreading

1. Sick person gets a room, or at minimum a curtained corner with 2 m separation, and stays there; family traffic minimized to the one carer (see caring for the sick).
2. Own cup, plate, cutlery, towel, and bedding — washed separately in hot soapy water, sun-dried.
3. Carer washes hands entering and leaving; masks on both for coughing illness; the carer never also runs the kitchen during a vomiting/diarrhea illness if anyone else can.
4. Air the room fully at least twice a day; sun in the window when possible.
5. High-touch surfaces (door handle, light switch, bedside table) wiped daily with bleach solution; vomit/stool accidents get the 1:10 spill protocol above.
6. Sickroom waste is medical waste — bagged in the room, sealed, straight out.
7. Recovery isn't the end: keep the separations for 48 hours after the last fever, vomit, or loose stool, then strip, wash, sun, and disinfect the room.