APPENDIX I: DEFINITIONS

For the purpose of this document the following definitions apply. Some of the definitions are taken from agreed national and European standards e.g. British Standards (BS). For some hygiene processes referred to in this document there is no agreed definition or the definitions are currently under discussion within ISO (International Standards Organisation) or CEN (Comitè European de Normalisation) bodies:

Bactericide (BS 5283): A chemical agent that under defined conditions is capable of killing bacteria, but not necessarily bacterial spores.

Cleaning/cleaner: A physical process or product that removes soil or organic material from an object or surface, but does not have bactericidal, sporicidal, virucidal, fungicidal activity and does not necessarily reduce the level of microbial contamination.

Clean surface:
Visibly clean surface - A surface (hands or other surface) which shows no evidence of visible dirt.

Hygienically clean surface - A surface which does not constitute a threat to health as a result of the presence of microorganisms.

Contamination: The presence of an infectious agent on a body surface, clothes, bedding, toys, instruments, dressings, other inanimate articles or substances, or present in food or water.

Decontamination: The destruction (by physical or chemical agents) or removal of microorganisms, but not usually bacterial spores: it does not necessarily kill all microorganisms, but reduces them to a level acceptable for a defined purpose, for example a level which is harmful neither to health not to the quality of perishable goods.

Disinfectant (BS 5283): A chemical agent that under defined conditions is capable of the destruction of microorganisms, but not usually bacterial spores: it does not necessarily kill all microorganisms, but reduces them to a level acceptable for a defined purpose, for example a level which is harmful neither to health nor to the quality of perishable goods.

Fungicide (BS 5283): A chemical agent that under defined conditions is capable of killing fungi.

Hygienic cleaning/hygienic cleaner: A practice or product that removes soil or organic material from an object or surface and also causes destruction of microorganisms through an inherent bactericidal, virucidal or fungicidal activity: the combination of soil removal and destruction reduces contamination to a level where there is no longer a threat to health by transmission of the microorganisms.

Infection: Colonisation of the body of humans or animals by an infectious agent that may manifest in disease or remain inapparent.

Infectious disease: A clinically manifest disease of humans or animals resulting from an infection.

Sporicide (BS 5283): A chemical agent that under defined conditions is capable of killing bacterial spores.

Virucide (BS 5283): A chemical agent that under defined conditions is capable of killing or inactivating viruses.

Other commonly used definitions

Antibacterial: A product or process which kills bacteria or inhibits their growth.

Germ: A microorganism capable of causing an infectious disease.

Sterile (EN 556): The state of being free from viable organisms. Note: the theoretical probability of there being a viable organism present should be less than or equal to 1 x 10⁶.

APPENDIX II: INSTRUCTIONS FOR EFFECTIVE HAND WASHING 

These instructions may be helpful in distributing to parents in order to provide them with a method for effective handwashing.

1. Use warm running water and preferably a liquid soap.

2. Apply a small quantity of soap to the hands.

3. Rub hands together vigorously and ensure soap and water is applied to all surfaces of the hands. Be sure to scrub between fingers, under fingernails and around the tops and palms.

4. Rinse hands under running water. Leave the water running while drying hands.

5. Dry hands with a clean towel.

6. Turn the tap off. Wherever possible try to avoid touching the tap directly with washed hands since there is the possibility of recontamination (for rigorous hygiene, the tap should be turned off using a disposable paper towel).

Suggested sequence for hand washing:

a: palm to palm

b: with the palm over the back of the hand

c: palm to palm with fingers interlaced

d: the back of the fingers with the opposing palm

e: rotational rubbing of the thumbs in the palm of the hand

f: rotational rubbing of fingers in the palm

Children
Hale, C.M. and Polder, J.A. (1996) The ABCs of Safe and Healthy Child Care. A handbook for child care providers. Department of Health and Human Services, US Public Health Service, Centers for Disease Control and Prevention.

Disinfectant guidelines
Anon (1991) British Standard document BS 7152. Guide to Choice of Chemical Disinfectants. London: BSI Standards.
List of Disinfectants published by the Disinfectant Commission of the German Society for Hygiene and Microbiology. Wiesbaden: mph-Verlag GmbH.

E. coli O157:H7
Anon (1992c) Preventing foodborne illness: Escherichia coli O157:H7. US Department of Health and Human Services, Centers for Disease Control, Division of Bacterial and Mycotic Diseases. CDC.

HIV
Anon (1995a) USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with HIV. Morbidity and Mortality Weekly Report 44, 1-34.

I.V. care
Simmons, B.P., Hanton, T.M., Wang, E.S. and Allen, J.R. (1982) Guidelines for prevention of intravascular infections. Infection Control 3, 61-72.

Listeriosis
Anon (1992b) Preventing foodborne illness: Listeriosis. US Department of Health and Human Services, Centers for Disease Control, Division of Bacterial and Mycotic Diseases. CDC.

MRSA
Anon (1995b) Guidelines on the control of methicillin-resistant Staphylococcus aureus in the community. Journal of Hospital Infections 31, 1-12.

Universal blood and body fluid precautions
Anon (1987) Centers for Disease Control. Recommendations for precautions of HIV transmission in health care settings. Morbidity and Mortality Weekly Report 36 Suppl 2S, 1-18S.
Anon (1988) Centers for Disease Control. Universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus and other bloodborne pathogens in health-care settings. Morbidity and Mortality Weekly Report 37, 377-382/387-388.