3.4 Hygiene

3.4.1 Hand hygiene

Faecal-oral transmission of Vibrio cholerae may be prevented by hand washing with soap and clean water a Citation a. Hands thoroughly washed with soap and water do not need to be disinfected with 0.05% chlorine solution or alcohol based solutions afterwards. , at "critical times".

Table 3.2 - Critical times when hand washing should be performed

3.4.2 Food hygiene

The risk of transmission is associated with food that is contaminated during handling or with eating raw (or insufficiently cooked) fish products contaminated in the environment.
The risk of transmission through food can be reduced by ensuring that: food is well cooked, eaten hot, stored covered; fruit and vegetables are washed in potable water or peeled (by oneself just before eating); the area where food is prepared and the utensils used are cleaned and dried.

3.4.3 Household hygiene

Cleaning potentially soiled surfaces and materials (water storage receptacles, areas where food is prepared and served, latrines/toilets) with local dish detergent prevents transmission.
Soiled clothes, linens and other articles can be washed with local laundry detergent and then left to dry in the sun b Citation b. Vibrio cholerae does not survive in dry conditions. . Items that cannot be washed (e.g. soiled unprotected mattresses) may be disinfected by drying in the sun [1] Citation 1. UNICEF Cholera Toolkit, 2013.
https://www.unicef.org/cholera/Cholera-Toolkit-2013.pdf . Turn the mattress often on both sides.
If floors or surfaces are soiled by patient faeces or vomit, faeces or vomit should first be wiped away and disposed of in the latrines or buried. Then, the area should be cleaned with local household detergent c Citation c. If bleach is a known and widely available product and there is no risk it will be used incorrectly, the surfaces can be disinfected after cleaning with a 0.2% chlorine solution.  .

Notes:

• Clothing and other articles of cholera patients should not be washed in a source of drinkingwater (stream, river, or water hole).
• Wearing household cleaning gloves does not replace the need for handwashing.

3.4.4 Disinfection of affected households by mobile sprayer teams

Chlorine spraying at households of cholera patients for addressing environmental contamination is still a common practice.
This practice requires considerable logistical resources and staff time, however:

• There are no studies on the impact of chlorine spraying of households of cholera patients on disease spread;
• Most surfaces within a household are not exposed to cholera faeces and are not the main source of contamination;
• The effect of chlorine is limited in duration and recontamination is possible within hours as the chlorine solution evaporates;
• Spraying teams usually only reach the household several days after the onset of cholera in the index case, and other members of the household have likely already been contaminated by the index case or another source;
• Household spraying runs the risk of stigmatizing patients and their families, and being such an ordeal for the households affected that other households become reluctant to report their cases.

Therefore, to reduce the spread of cholera to household contacts, it is recommended to prioritize activities that might have a higher impact such as provision of household hygiene kits d Citation d. The list of articles in the kit depends on the context and needs of the population, for example: a bucket, broom, floorcloth, jerrycan, soap for hand washing and laundry, detergent for floors and surfaces (and bleach, but only if people are used to using it).   [2] Citation 2. M. Gartley, P. Valeh, R. de Lange, S. DiCarlo, A. Viscusi, A. Lenglet and J. F. Fesselet. Uptake of household disinfection kits as an additional measure in response to a cholera outbreak in urban areas of Haiti. J Water Health 2013 Dec; 11(4):623-8. : the material is given to a family member when the patient is admitted to a cholera treatment facility. The kit should be used that same day to clean the objects and surfaces contaminated by the patient at home, and during the following weeks to avoid new cases among the household contacts e Citation e. If a patient arrives to the centre alone, they are given the kit on discharge. .

3.4.5 Corpses and funerals

Like for any other gathering such as weddings, religious festivals, etc., the funerals for those who have died from cholera, or of any other cause, in a population affected by cholera, may contribute to the spread of cholera infection.
Transmission typically occurs in the context of a prolonged funeral, where large numbers of people share community meals prepared or served in unhygienic conditions (e.g. prepared by people who handled the body without washing their hands and/or eaten from the hand without prior hand washing).

People who come in contact with corpses of people who have died from cholera are exposed to Vibrio cholerae through fluids leaking from the digestive tract. Proper hand washing after contact with the corpse and before preparing or serving food or eating, drinking, smoking is the key to preventing contamination.

In addition, the WHO recommends:

• To hold funerals quickly, within 24 hours of death, near the place of death if possible;
• To bury dead bodies more than 50 meters away from water sources, at least 1.5 meters above the water table, with at least 1 meter of covering soil.

Authorities may discourage holding funerals for people who have died from cholera, contact between the family and the corpse, providing food at funerals, etc. However, such restrictions may lead to reluctance to report deaths. It is preferable to allow people to conduct funerals according to their custom while advising basic hygiene precautions. Designated health workers and/or religious leaders present at the funerals may help to improve compliance with hygiene practices.

During a cholera outbreak, authorities may establish team(s) to manage the bodies of people who have died from cholera at home. These teams perform the post-mortem treatment of the corpse using materials and techniques used in cholera treatment facilities and morgues.