Washing one's hands,[1] a form of hygiene, is the most effective way to prevent the spread ofinfectious diseases.
Hygiene is a set of practices performed to preservehealth.According to theWorld Health Organization (WHO), "Hygiene refers to conditions and practices that help to maintain health and prevent the spread ofdiseases."[2]Personal hygiene refers to maintaining the body's cleanliness. Hygiene activities can be grouped into the following: home and everyday hygiene, personal hygiene, medical hygiene, sleep hygiene, andfood hygiene. Home and every day hygiene includeshand washing, respiratory hygiene, food hygiene at home, hygiene in the kitchen, hygiene in the bathroom, laundry hygiene, and medical hygiene at home.
Many people equate hygiene with "cleanliness", but hygiene is a broad term. It includes such personal habit choices as how frequently to take a shower or bath, wash hands, trimfingernails, and wash clothes. It also includes attention to keeping surfaces in the home and workplace clean, includingbathroom facilities. Adherence to regular hygiene practices is often regarded as a socially responsible and respectable behavior, while neglecting proper hygiene can be perceived as unclean or unsanitary, and may be considered socially unacceptable or disrespectful, while also posing a risk to public health.
Hygiene is a practice[3] related tolifestyle,cleanliness,health, andmedicine. In medicine and everyday life, hygiene practices are preventive measures that reduce the incidence and spread of germs leading todisease.[4]
Hygiene practices vary from oneculture to another.[5]
In the manufacturing of food,[6] pharmaceuticals,[7] cosmetics,[8] and other products, good hygiene is a critical component ofquality assurance.
The terms cleanliness and hygiene are often used interchangeably, which can cause confusion. In general, hygiene refers to practices that prevent spread of disease-causing organisms. Cleaning processes (e.g.,handwashing[1]) remove infectious microbes as well as dirt and soil, and are thus often the means to achieve hygiene.
Home hygiene pertains to the hygiene practices that prevent or minimize the spread of disease at home and other everyday settings such as social settings, public transport, the workplace, public places, and more. Hygiene in a variety of settings plays an important role in preventing the spread of infectious diseases.[9] It includes procedures like hand hygiene, respiratory hygiene, food and water hygiene, general home hygiene (hygiene of environmental sites and surfaces), care of domestic animals, and home health care (the care of those who are at greater risk of infection).[10]
At present, these components of hygiene tend to be regarded as separate issues, although based on the same underlying microbiological principles. Preventing the spread of diseases means breaking the chain of infection transmission so that infection cannot spread. "Targeted hygiene" is based on identifying the routes of pathogen spread in the home and introducing hygiene practices at critical times to break the chain of infection.[11] It uses arisk-based approach based on Hazard Analysis Critical Control Point (HACCP).[12]
The main sources of infection in the home are people (who are carriers or are infected), foods (particularly raw foods), water, pets, and domestic animals.[13] Sites that accumulate stagnant water – such as sinks,toilets, waste pipes, cleaning tools, and face cloths – readily support microbial growth and can become secondary reservoirs of infection, though species are mostly those that threaten "at risk" groups.Pathogens (such as potentially infectious bacteria and viruses – colloquially called "germs") are constantly shed via mucous membranes, feces, vomit, skin scales, and other means. When circumstances combine, people are exposed, either directly or via food or water, and can develop an infection.[14]
The main "highways" for the spread of pathogens in the home are the hands, hand and food contact surfaces, and cleaning cloths and utensils (e.g.fecal–oral route of transmission). Pathogens can also be spread via clothing and household linens, such astowels. Utilities such as toilets and wash basins were invented to deal safely with human waste but still have risks associated with them. Safe disposal of human waste is a fundamental need; poorsanitation is a primary cause of diarrhea disease in low-income communities. Respiratory viruses and fungal spores spread via the air.[15]
Good home hygiene means engaging in hygiene practices at critical points to break the chain of infection.[11][13] Because the "infectious dose" for some pathogens can be very small (10–100 viable units or even less for some viruses), and infection can result from direct transfer of pathogens from surfaces via hands or food to the mouth, nasal mucous, or the eye, "hygienic cleaning" procedures should be adopted to eliminate pathogens from critical surfaces.[16]
Hand washing (or handwashing), also called hand hygiene, is the process of cleaning the hands withsoap or handwash andwater to eliminatebacteria,viruses,dirt,microorganisms, and other potentially harmful substances. Drying of the washed hands is part of the process as wet and moist hands are more easily recontaminated.[17][18] If soap and water are unavailable,hand sanitizer that is at least 60% (v/v)alcohol in water can be used as long as hands are not visibly excessively dirty or greasy.[19][20] Hand hygiene is central to preventing the spread ofinfectious diseases in home and everyday life settings.[21] Meta-analyses have shown that regular hand washing in community settings can significantly reduce respiratory and gastrointestinal infection[22]
TheWorld Health Organization (WHO) recommends washing hands for at least 20 seconds before and after certain activities.[23][24] These include the five critical times during the day where washing hands with soap is important to reducefecal-oral transmission of disease: after using thetoilet (forurination,defecation,menstrual hygiene), after cleaning a child's bottom (changingdiapers), before feeding a child, before eating and before/after preparing food or handling raw meat, fish, orpoultry.[25]
Regular handwashing with soap is one of the most effective ways to prevent the transmission of pathogens. It significantly reduces the risk of gastrointestinal and respiratory infections.
A tippy tap for handwashing after using aurine-diverting dry toilet in Pumpuentsa, EcuadorWashing hygiene
Routine cleaning of hands, food, sites, and surfaces (such astoilet seats andflush handles, door and tap handles, work surfaces, and bath and basin surfaces) in the kitchen,bathroom, andtoilet rooms reduces the spread of pathogens.[26] The infection risk fromflush toilets is not high, provided they are properly maintained, although some splashing andaerosol formation can occur during flushing, particularly when someone has diarrhea. Pathogens can survive in the scum or scale left behind on baths,showers, and washbasins after washing andbathing.[27][28][29]
Hygiene in the toilet
Thorough cleaning is important to prevent the spread of fungal infections. Molds can live on wall and floor tiles and on shower curtains. Mold can be responsible for infections, cause allergic reactions, deteriorate/damage surfaces, and cause unpleasant odors. Primary sites of fungal growth are inanimate surfaces, including carpets and soft furnishings.[30][31] Airborne fungi are usually associated with damp conditions, poor ventilation, or closed air systems.[32]
Mechanical removal (i.e., cleaning) using asoap ordetergent. To be effective as a hygiene measure, this process must be followed by thorough rinsing under running water to remove pathogens from the surface.
Hygiene cleaning to improve sanitation in KampalaUsing a process or product that inactivates the pathogensin situ. Pathogen kill is achieved using a "micro-biocidal" product, i.e., adisinfectant orantibacterial product;waterless hand sanitizer; or by application of heat.
In some cases, combined pathogen removal with kill is used, e.g., laundering of clothing and household linens such as towels and bed linen.
House deep-cleaning an intensive cleaning process targeting often-neglected areas, enhancing aesthetics, and improving health by reducing allergens and bacteria. It typically includes tasks like detailed dusting, appliance cleaning, and carpet shampooing, recommended biannually to maintain a home's hygiene and air quality.
Laundry hygiene involves practices that prevent disease and its spread via soiled clothing and household linens such as towels.[35] Items most likely to be contaminated with pathogens are those that come into direct contact with the body, e.g., underwear, personal towels, facecloths, nappies. Cloths or other fabric items used during food preparation, or for cleaning the toilet or cleaning up material such as feces or vomit are a particular risk.[13]
Microbiological and epidemiological data indicates that clothing and household linens are a risk factor for infection transmission in home and everyday life settings as well as institutional settings. The lack of quantitative data linking contaminated clothing to infection in the domestic setting makes it difficult to assess the extent of this risk.[35][13][36] This also indicates that risks from clothing and household linens are somewhat less than those associated with hands, hand contact and food contact surfaces, and cleaning cloths, but even so these risks need to be managed through effective laundering practices. In the home, this should be carried out as part of a multibarrier approach to hygiene which includes hand, food, respiratory, and other hygiene practices.[35][13][36]
Infectious disease risks from contaminated clothing can increase significantly under certain conditions - for example, in healthcare situations in hospitals, care homes, and the domestic setting where someone has diarrhoea, vomiting, or a skin or wound infection. The risk increases in circumstances where someone has reduced immunity to infection.
Hygiene measures, including laundry hygiene, are an important part of reducing spread of antibiotic-resistant strains of infectious organisms.[37][38][39] In the community, otherwise-healthy people can become persistent skin carriers ofMRSA, or faecal carriers of enterobacteria strains which can carry multi-antibiotic resistance factors (e.g.NDM-1 orESBL-producing strains). The risks are not apparent until, for example, they are admitted to hospital, when they can become "self infected" with their own resistant organisms following a surgical procedure. As persistent nasal, skin, or bowel carriage in the healthy population spreads "silently" across the world, the risks from resistant strains in both hospitals and the community increases.[38] In particular the data indicates that clothing and household linens are a risk factor for spread ofS. aureus (including MRSA andPVL-producing MRSA strains), and that effectiveness of laundry processes may be an important factor in defining the rate of community spread of these strains.[35][40] Experience in the United States suggests that these strains are transmissible within families and in community settings such as prisons, schools, and sport teams. Skin-to-skin contact (including unabraded skin) and indirect contact with contaminated objects such as towels, sheets, and sports equipment seem to represent the mode of transmission.[35]
During laundering, temperature anddetergent work to reduce microbial contamination levels on fabrics. Soil and microbes from fabrics are severed and suspended in the wash water. These are then "washed away" during the rinse and spin cycles. In addition to physical removal, micro-organisms can be killed by thermal inactivation which increases as the temperature is increased. Chemical inactivation of microbes by the surfactants and activated oxygen-based bleach used in detergents contributes to the hygiene effectiveness of laundering. Adding hypochlorite bleach in the washing process achieves inactivation of microbes. A number of other factors can contribute including drying and ironing.
Drying laundry on a line in direct sunlight is known to reduce pathogens.[41]
In 2013, the International Scientific Forum on Home Hygiene reviewed 30 studies of the hygiene effectiveness of laundering at temperatures ranging from room temperature to 70 °C (158 °F), under varying conditions.[42] A key finding was the lack of standardization and control within studies, and the variability in test conditions between studies such as wash cycle time, number of rinses, and other factors. The consequent variability in the data (i.e., the reduction in contamination on fabrics) in turn makes it extremely difficult to propose guidelines for laundering with any confidence. As a result, there is significant variability in the recommendations for hygienic laundering given by different agencies.[43]
Medical hygiene pertains to hygiene practices that prevent or minimize disease and the spreading of disease in relation to administering medical care to those who are infected or who are more at risk of infection in the home. Members of "at-risk" groups are cared for at home by a carer who may be a household member and who requires a good knowledge of hygiene. People with reduced immunity to infection, who are looked after at home, make up an increasing proportion of the population (as of 2009[update], up to 20%).[9] The largest proportion are the elderly who have co-morbidities that reduce their immunity to infection. It also includes the very young, patients discharged from hospital, taking immuno-suppressive drugs, or using invasive systems, etc. For patients discharged from hospital, or being treated at home, special "medical hygiene" procedures may need to be performed for them, such as catheter or dressing replacement, which puts them at higher risk of infection.
Antiseptics may be applied to cuts, wounds, and abrasions of the skin to prevent the entry of harmful bacteria that can cause sepsis. Day-to-day hygiene practices, other than special medical hygiene procedures,[44] are no different for those at increased risk of infection than for other family members. The difference is that, if hygiene practices are not correctly carried out, the risk of infection is much greater.
Chemical disinfectants[45] are products that killpathogens. If the product is a disinfectant, the label on the product should say "disinfectant" or "kills" pathogens. Some commercial products, e.g. bleaches, even though they are technically disinfectants, say that they "kill pathogens" but are not actually labelled as "disinfectants". Not all disinfectants kill all types of pathogens. All disinfectants kill bacteria (called bactericidal). Some also kill fungi (fungicidal), bacterial spores (sporicidal), or viruses (virucidal).
Anantibacterial product acts against bacteria in some unspecified way. Some products labelled "antibacterial" kill bacteria while others may contain a concentration of active ingredient that only prevents them from multiplying. It is, therefore, important to check whether the product label states that it "kills bacteria". An antibacterial is not necessarily anti-fungal or anti-viral unless this is stated on the label.
The termsanitizer has been used to define substances that both clean and disinfect. More recently this term has been applied to alcohol-based products that disinfect the hands (alcohol hand sanitizers). Alcohol hand sanitizers however are not considered to be effective on soiled hands.[46]
The termbiocide is a broad term for a substance that kills, inactivates or otherwise controls living organisms. It includesantiseptics and disinfectants, which combat micro-organisms, andpesticides.
Personal hygiene involves those practices performed by a person to care for their bodily health and well-being through cleanliness. Motivations for personal hygiene practice include reduction of personal illness, healing from illness, optimal health and sense of wellbeing, social acceptance, and prevention of spread of illness to others. What is considered proper personal hygiene can be culture-specific and may change over time.
Practices that are generally considered proper hygiene include showering orbathing regularly,washing hands regularly and especially before handling food,face washing, washing scalp hair, keeping hair short or removing hair, wearing clean clothing, brushing teeth, and trimming fingernails and toenails. Some practices are sex-specific, such as by a woman duringmenstruation.
Toiletry bags hold body hygiene and toiletry supplies.
Anal hygiene is the practice that a person performs on their anal area afterdefecation. Theanus andbuttocks may be either washed with liquids or wiped withtoilet paper, or by addinggel wipe to toilet tissue as an alternative towet wipes or other solid materials in order to remove remnants offeces.
People tend to develop a routine for attending to their personal hygiene needs. Other personal hygienic practices include covering one's mouth when coughing, disposal of soiled tissues appropriately, making sure toilets are clean, and making sure food handling areas are clean, besides other practices. Some cultures do not kiss or shake hands in order to reduce transmission of bacteria by contact.
Personal grooming extends personal hygiene as it pertains to the maintenance of a good personal and public appearance, which need not necessarily be hygienic. It may involve, for example, using deodorants or perfume,shaving, orcombing.
Excessive cleaning of theear canals can result in infection or irritation. The ear canals require less care than other parts of the body because they are sensitive and mostly self-cleaning. There is a slow and orderly migration of the skin lining the ear canal from the eardrum to the outer opening of the ear. Old earwax is constantly being transported from the deeper areas of the ear canal out to the opening where it usually dries, flakes, and falls out.[47] Attempts to clean the ear canals through the removal ofearwax can push debris and foreign material into the ear that the natural movement of ear wax out of the ear would have removed.
It is recommended that all healthy adults brush twice a day,[48][49] softly,[50] with the correct technique, replacing their toothbrush every few months (~3).[51]
Teaching a child how to properly brush the teeth
There are a number of common oral hygiene misconceptions. TheNational Health Service (NHS) of England recommends not rinsing the mouth with water after brushing – only to spit out excesstoothpaste. They claim that this helpsfluoride from toothpaste bond to teeth for its preventative effects against tooth decay.[52] It is also not recommended to brush immediately after drinking acidic substances, including sparkling water.[53] It is also recommended to floss once a day,[54] with a different piece of floss at each flossing session. The effectiveness ofamorphous calcium phosphate products, such as Tooth Mousse, is in debate.[55] Visits to a dentist for a checkup every year at least are recommended.[56]
Sleep hygiene is the recommended behavioral and environmental practices that promote better quality sleep.[57] These recommendations were developed in the late 1970s as a method to help people with mild to moderateinsomnia, but, as of 2014[update], the evidence for effectiveness of individual recommendations is "limited and inconclusive".[57] Clinicians assess the sleep hygiene of people who present with insomnia and other conditions, such as depression, and offer recommendations based on the assessment. Sleep hygiene recommendations include establishing a regular sleep schedule, using naps with care, not exercising physically or mentally too close to bedtime, and avoidingalcohol as well asnicotine,caffeine, and otherstimulants in the hours before bedtime.[58] Further recommendations include limiting worry, limiting exposure to light in the hours before sleep, getting out of bed if sleep does not come, not using the bed for anything but sleep, and having a peaceful, comfortable, and dark sleep environment.
Excessive body hygiene is a possible sign ofobsessive–compulsive disorder. Neglecting bodily hygiene, or the cleanliness of one's environment, may be a sign ofmajor depression and other psychological disorders.
Although media coverage of thehygiene hypothesis has declined, popular folklore continues to sometimes assert that dirt is healthy and hygiene unnatural. This has caused health professionals to be concerned that hygiene behaviors which are the foundation of public health are being undermined. In response to the need for effective hygiene in home and everyday life settings, the International Scientific Forum on Home Hygiene developed a "risk-based" or targeted approach to home hygiene that seeks to ensure that hygiene measures are focused on the places and times most critical for infection transmission.[11] While targeted hygiene was originally developed as an effective approach to hygiene practice, it also seeks, as far as possible, to sustain "normal" levels of exposure to the microbial flora of our environment to the extent that is important to build a balanced immune system.
Although there is substantial evidence that some microbial exposures in early childhood can in some way protect against allergies, there is no evidence[citation needed] that humans need exposure to harmful microbes (infection) or that it is necessary to develop a clinical infection.[59] Nor is there evidence[citation needed] that hygiene measures such as hand washing, food hygiene, etc., are linked to increased susceptibility toatopic disease. If this is the case, there is no conflict between the goals of preventing infection and minimizing allergies. A consensus is now developing among experts that the answer lies in more fundamental changes in lifestyles that have led to decreased exposure to certain microbial or other species, such as helminths, that are important for development of immuno-regulatory mechanisms.[60] There is still much uncertainty as to which lifestyle factors are involved.
Medical hygiene pertains to hygiene practices related to the administration ofmedicine and medical care that prevents or minimizes the spread of disease.
Medical hygiene practices include:
isolation of infectious persons or materials to prevent spread of infection
disinfection of reusables (i.e., linen, pads, uniforms)
scrubbing up,handwashing, especially in an operating room, but in more general health-care settings as well, where diseases can be transmitted
ethanol-based sanitizers
Most of these practices were developed in the 19th century and were well-established by the mid-20th century. Some procedures (such as disposal ofmedical waste) were refined in response to late-20th centurydisease outbreaks, notablyAIDS andEbola.
Culinary hygiene (or food hygiene) pertains to practices of food management and cooking that preventfood contamination, preventfood poisoning, and minimize thetransmission of disease to other foods, humans, or animals. Culinary hygiene practices specify safe ways to handle, store, prepare, serve, and eat food.
Food safety (or food hygiene) is used as a scientific method/discipline describing handling,preparation, andstorage of food in ways that preventfoodborne illness. The occurrence of two or more cases of a similar illness resulting from the ingestion of a common food is known as a food-borne disease outbreak.[61] Food safety includes a number of routines that should be followed to avoid potentialhealth hazards. In this way, food safety often overlaps withfood defense to prevent harm to consumers. The tracks within this line of thought are safety between industry and the market and then between the market and the consumer. In considering industry-to-market practices, food safety[62] considerations include the origins of food including the practices relating tofood labeling, food hygiene,food additives andpesticide residues, as well as policies onbiotechnology and food and guidelines for the management of governmentalimport andexport inspection andcertification systems for foods. In considering market-to-consumer practices, the usual thought is that food ought to be safe in the market and the concern is safe delivery and preparation of the food for the consumer. Food safety,nutrition andfood security are closely related. Unhealthy food creates a cycle of disease andmalnutrition that affects infants and adults as well.[63]
Hygiene aspects in low- and middle-income countries
Indeveloping countries (or low- and middle-income countries), universal access to water andsanitation, coupled with hygiene promotion, is essential in reducing infectious diseases. This approach has been integrated into theSustainable Development Goal Number 6 whose second target states: "By 2030, achieve access to adequate and equitable sanitation and hygiene for all and endopen defecation, paying special attention to the needs of women and girls and those in vulnerable situations".[64] Due to their close linkages, water, sanitation, hygiene are together abbreviated and funded under the termWASH indevelopment cooperation.
About two million people die every year due to diarrheal diseases; most of them are children less than five years of age.[65] The most affected are people in developing countries who live in extreme conditions of poverty, normally peri-urban dwellers or rural inhabitants. Providing access to sufficient quantities of safe water and facilities for a sanitary disposal of excreta, and introducing sound hygiene behaviors are important in order to reduce the burden of disease.
Research shows that, if widely practiced,hand washing with soap could reduce diarrhea by almost fifty percent[66] and respiratory infections by nearly twenty-five percent[67] Hand washing with soap also reduces the incidence of skin diseases,[68] and eye infections like trachoma and intestinal worms, especiallyascariasis andtrichuriasis.[69] Other hygiene practices, such as safe disposal of waste, surface hygiene, and care of domestic animals, are important in low income communities to break the chain of infection transmission.[70]
Cleaning oftoilets and hand wash facilities is important to prevent odors and make them socially acceptable. Social acceptance is an important part of encouraging people to use toilets and wash their hands, in situations whereopen defecation is still seen as a possible alternative, e.g. in rural areas of some developing countries.
Household water treatment and safe storage ensure drinking water is safe for consumption. These interventions are part of the approach ofself-supply of water for households.[71]Drinking water quality remains a significant problem in developing[72] and in developed countries;[73] even in the European region it is estimated that 120 million people do not have access tosafe drinking water. Point-of-use water quality interventions can reduce diarrheal disease in communities where water quality is poor or in emergency situations where there is a breakdown in water supply.[72][73][74][75]Since water can become contaminated during storage at home (e.g. by contact with contaminated hands or using dirty storage vessels),safe storage of water in the home is important.
Methods for treatment of drinking water at the household level include:[26][75]
chemical disinfection using chlorine or iodine
boiling
filtration using ceramic filters
solar disinfection — Solar disinfection is an effective method, especially when no chemical disinfectants are available.[76]
UV irradiation — Community or household UV systems may be batch or flow-though. The lamps can be suspended above the water channel or submerged in the water flow.
combined flocculation/disinfection systems — available as sachets of powder that act by coagulating and flocculating sediments in water followed by release of chlorine
multibarrier methods — Some systems use two or more of the above treatments in combination or in succession to optimize efficacy.
Bathing culture inChinese literature can be traced back to theShang dynasty (1600–1046 BCE), whenOracle bone inscriptions describe people washing their hair and body in a bath. TheBook of Rites, a work regardingZhou dynasty (1046–256 BCE) ritual, politics, and culture compiled during theWarring States period, recommends that people take a hot shower every five days, and wash their hair every three days. It was also considered good manners to take a bath provided by the host before adinner. In theHan dynasty, bathing became a regular activity, and for government officials bathing was required every five days.[77]
Ancient bath facilities have been found in ancient Chinese cities, such as Dongzhouyang archaeological site inHenan Province. Bathrooms were calledBi (Chinese:湢), and bathtubs were made of bronze or timber.[78] Bath beans – a powdery soap mixture of ground beans, cloves, eaglewood, flowers, and even powdered jade – were recorded in the Han Dynasty. Bath beans were considered luxury toiletries, while common people simply used powdered beans without spices mixed in. Luxurious bathhouses built around hot springs were recorded inTang dynasty.[77] While royal bathhouses and bathrooms were common among ancient Chinese nobles and commoners, public bathhouses were a relatively late development. In theSong dynasty (960–1279 CE), public bathhouses became popular and people could find them readily.[78]Bathing became an essential part of social life and recreation. Bathhouses often provided massage, nail cutting service, rubdown service,ear cleaning, food, and beverages.[78]Marco Polo, who traveled to China during theYuan dynasty, noted Chinese bathhouses were usingcoal to heat the bathhouse, which he had never seen before in Europe.[79] Coal was so plentiful that Chinese people of every social class had bathrooms in their houses, and people took showers every day in the winter for enjoyment.[80]
A typicalMing dynasty bathhouse had slabbed floors and brick domed ceilings. A huge boiler would be installed in the back of the house, connected with the bathing pool through a tunnel. Water could be pumped into the pool byturning wheels attended by the staff.[78]
The origin of Japanese bathing ismisogi, ritual purification with water.[81]
In theHeian period (794–1185 CE), houses of prominent families, such as the families of court nobles or samurai, had baths. The bath had lost its religious significance and instead became leisure.Misogi becamegyōzui (to bathe in a shallow wooden tub).[81]: 36 In the 17th century, the first European visitors to Japan recorded the habit of daily baths in mixed sex groups.[81]
The earliest written account of elaborate codes of hygiene can be found in several Hindu texts, such as theManusmriti and theVishnu Purana.[82] Bathing is one of the fivenitya karmas (daily duties) in Hinduism, and not performing it leads to sin, according to some scriptures.
Ayurveda is a system of medicine developed in ancient times that is still practiced in India, mostly combined with conventional Western medicine. Contemporary Ayurveda stresses asattvic diet and good digestion andexcretion. Hygiene measures includeoil pulling, andtongue scraping. Detoxification also plays an important role.[83]
Spanish chronicles describe the bathing habits of the peoples ofMesoamerica during and after theconquest.Bernal Díaz del Castillo describesMoctezuma (the Mexica, orAztec,emperor at the arrival ofCortés) in hisHistoria verdadera de la conquista de la Nueva España as being "...Very neat and cleanly, bathing every day each afternoon...".
Bathing was not restricted to the elite, but was practiced by all people; the chronicler Tomás López Medel wrote after a journey toCentral America that " and the custom of washing oneself is so quotidian [common] amongst the Indians, both of cold and hot lands, as is eating, and this is done in fountains and rivers and other water to which they have access, without anything other than pure water..."[84]
The Mesoamerican bath, known astemazcal inSpanish, from the Nahuatl wordtemazcalli, a compound oftemaz ("steam") andcalli ("house"), consists of a room, often in the form of a small dome, with an exterior firebox known astexictle (teʃict͜ɬe) that heats a small portion of the room's wall made of volcanic rocks; after this wall has been heated, water is poured on it to produce steam, an action known astlasas. As the steam accumulates in the upper part of the room a person in charge uses a bough to direct the steam to the bathers who are lying on the ground, with which he later gives them a massage, then the bathers scrub themselves with a small flat river stone and finally the person in charge introduces buckets with water along with soap and grass used to rinse. This bath had also ritual importance, and was tied to the goddessToci; it is also therapeutic when medicinal herbs are used in the water for thetlasas. It is still used inMexico.[84]
Regular bathing was a hallmark ofRoman civilization.[85] Elaboratebaths were constructed in urban areas to serve the public, who typically demanded the infrastructure to maintain personal cleanliness. The complexes usually consisted of large, swimming pool-like baths, smaller cold and hot pools, saunas, and spa-like facilities where people could be depilated, oiled, and massaged. Water was constantly changed by anaqueduct-fed flow. Bathing outside of urban centers involved smaller, less elaborate bathing facilities, or simply the use of clean bodies of water. Roman cities also had largesewers, such as Rome'sCloaca Maxima, into which public and private latrines drained. Romans did not have demand-flush toilets but did have some toilets with a continuous flow of water under them. TheRomans usedscentedoils (mostly from Egypt), among other alternatives.
In the 11th and 12th centuries, bathing was essential to the Western European upper class: theCluniac monasteries (popular centers for resorting and retiring) were always equipped with bathhouses. These baths were also used ritually when the monks took full immersion baths at the two Christian festivals of renewal.[97] The rules of theAugustinians andBenedictines contained references toritual purification,[98] and, inspired byBenedict of Nursia, encouraged the practice of therapeutic bathing.Benedictine monks also played a role in the development and promotion ofspas.[99]
On the other hand, bathing also sparked erotic phantasies, played upon by the writers ofromances intended for the upper class;[citation needed] in the tale ofMelusine the bath was a crucial element of the plot.
Bathing and grooming were regarded with suspicion by moralists, however, because they unveiled the attractiveness of the body. Bathing was said to be a prelude to sin, and in the penitential ofBurchard of Worms we find a full catalogue of the sins that ensued when men and women bathed together.[97]
Cities regulated public bathing – the 26 public baths of Paris in the late 13th century were strictly overseen by the civil authorities[97] and guild laws banned prostitutes from bathhouse admission.[100]
In 14th century Tuscany, newlywed couples commonly took a bath together and we find an illustration of this custom in a fresco in the town hall of San Gimignano.[101] As evident inHans Folz'Bath Booklet (a late 15th century guide on European baths)[102] and various artistic depictions such asAlbrecht Dürer'sWomen's Bath(seeabove), public bathing continued to be a popular past time in theRenaissance. In Britain, the rise ofProtestantism also played a prominent role in the development ofspa culture.[99]
Until the late 19th century, only the elite in Western cities typically possessed indoor facilities for relieving bodily functions. The poorer majority used communal facilities built abovecesspools in backyards and courtyards. This changed after Dr.John Snow discovered thatcholera wastransmitted by the fecal contamination of water. Though it took decades for his findings to gain wide acceptance, governments and sanitary reformers were eventually convinced of the health benefits of usingsewers to keep human waste from contaminating the water. This encouraged the widespread adoption of both theflush toilet and the moral imperative that bathrooms should be indoors and as private as possible.[103][verification needed]
Modern sanitation was not widely adopted until the 19th and 20th centuries. According to medieval historian Lynn Thorndike, people inMedieval Europe probably bathed more than people did in the 19th century.[104][better source needed] Some time afterLouis Pasteur's experiments proved thegerm theory of disease andJoseph Lister and others put this into practice insanitation, hygienic practices came to be regarded as synonymous withhealth, as they are in modern times.
The importance of hand washing for human health – particularly for people in vulnerable circumstances like mothers who had just given birth or wounded soldiers in hospitals – was first recognized in the mid 19th century by two pioneers of hand hygiene: the Hungarian physicianIgnaz Semmelweis who worked in Vienna, Austria, andFlorence Nightingale, the English "founder of modern nursing".[105] At that time most people still believed that infections were caused by foul odors calledmiasmas.
In theAbbasid Caliphate (8th–13th centuries), its capital city ofBaghdad (Iraq) had 65,000 baths, along with a sewer system.[109] Cities and towns of themedieval Islamic world hadwater supply systems powered byhydraulic technology that supplieddrinking water along with much greater quantities of water for ritual washing, mainly inmosques andhammams (baths). Bathing establishments in various cities were rated by Arabic writers intravel guides. Medieval Islamic cities such as Baghdad,Córdoba (Islamic Spain),Fez (Morocco), andFustat (Egypt) also had sophisticatedwaste disposal andsewage systems with interconnected networks of sewers. The city of Fustat also had multi-storeytenement buildings (with up to six floors) withflush toilets, which were connected to a water supply system, andflues on each floor carrying waste to underground channels.[110]
A basic form ofcontagion theory dates back to the Persian medicine in the medieval, where it was proposed by Persian physicianIbn Sina (also known as Avicenna) inThe Canon of Medicine (1025), the most authoritative medical textbook of the Middle Ages. He mentioned that people can transmit disease to others by breath, noted contagion withtuberculosis, and discussed the transmission of disease through water and dirt.[111] The concept of invisible contagion was eventually widely accepted byIslamic scholars. In theAyyubid Sultanate, they referred to them asnajasat ("impure substances"). Thefiqh scholarIbn al-Haj al-Abdari (c. 1250–1336), while discussingIslamic diet and hygiene, gave advice and warnings about how contagion can contaminate water, food, and garments, and could spread through the water supply.[112]
In the 9th century,Ziryab invented a type ofdeodorant.[113] He also promoted morning and evening baths, and emphasized the maintenance of personal hygiene. Ziryab is thought to have invented a type oftoothpaste, which he popularized throughoutIslamic Iberia.[114] The exact ingredients of this toothpaste are not known,[115] but it was reported to have been both "functional and pleasant to taste."[114]
By the 15th century, the manufacture of soap in Christendom had become virtually industrialized, with sources inAntwerp,Castile,Marseille,Naples, andVenice.[120] In the 17th century the SpanishCatholic manufacturers purchased themonopoly onCastile soap from the cash-strappedCarolinian government.[121] Industrially-manufactured bar soaps became available in the late 18th century, as advertising campaigns in Europe and America promoted popular awareness of the relationship between cleanliness and health.[122]
Many religions require or encourage ritual purification via bathing or immersing the hands in water. InIslam, washing oneself viawudu orghusl is necessary for performingprayer.Islamic tradition also lists a variety of rules concerning proper hygiene after using the bathroom. TheBaháʼí Faith mandates the washing of the hands and face prior to theobligatory Baháʼí prayers.Orthodox Judaism requires amikveh bath following menstruation and childbirth, whilewashing the hands is performed upon waking up and before eating bread.Water plays a role in Christian rituals as well,[131] and in certaindenominations of Christianity such as theEthiopian Orthodox Tewahedo Church which prescribes several kinds ofhand washing for example after leaving the latrine, lavatory, or bathhouse, or before prayer, or after eating a meal, or ritual handwashing.[132][131]
First attested in English in 1676, the wordhygiene comes from theFrenchhygiène, thelatinisation of theGreekὑγιεινή (τέχνη)hygieinē technē, meaning "(art) of health", fromὑγιεινόςhygieinos, "good for the health, healthy",[133] in turn fromὑγιής (hygiēs), "healthful, sound, salutary, wholesome".[134] Inancient Greek religion,Hygeia (Ὑγίεια) was the personification of health, cleanliness, and hygiene.[135]
^abUNICEF and WHO (2021),State of the World's Hand Hygiene: A global call to action to make hand hygiene a priority in policy and practice, New York: UNICEF
^"Hygiene: Overview". World Health Organization (WHO). Retrieved29 January 2020.
^WHO guidelines on hand hygiene in health care: first global patient safety challenge clean care is safer care. Geneva: World Health Organization. 2009.ISBN978-92-4-159790-6.OCLC854907565.
^Lelieveld H, Holah J, Napper D, eds. (2014).Hygiene in food processing: principles and practice (2nd ed.). Oxford: Woodhead.ISBN978-0-85709-863-4.OCLC870650548.
Fraise AP, Maillard J, Sattar S, eds. (2013).Russell, Hugo & Ayliffe's principles and practice of disinfection, preservation and sterilization (5th ed.). Chichester: Wiley-Blackwell.ISBN978-1-118-42587-9.OCLC825550689.
Curtis V, Cairncross S (2003). "Effect of washing hands with soap on diarrhea risk in the community: a systematic review".Lancet Infectious Diseases.3 (5):275–81.doi:10.1016/S1473-3099(03)00606-6.PMID12726975.
Luby S, Agboatalla M, Feikin DR, Painter J, Billhimmer W, Atref A, Hoekstra RM (2005). "Effect of hand-washing on child health: a randomized control trial".Lancet.366 (9481):225–33.doi:10.1016/S0140-6736(05)66912-7.PMID16023513.S2CID13024434.
Luby S, Agboatwalla M, Schnell BM, Hoekstra RM, Rahbar MH, Keswick BH (2002). "The effect of antibacterial soap on impetigo incidence, Karachi, Pakistan".American Journal of Tropical Medicine and Hygiene.67 (4):430–35.doi:10.4269/ajtmh.2002.67.430.PMID12452499.S2CID9987503.
^abRutherdale M (2006). "Ordering the Bath: Children, Health, and Hygiene in Northern Canadian Communities, 1900–1970". In Warsh CK, Strong-Boag V (eds.).Children's Health Issues in Historical Perspective. Wilfrid Laurier Univ. Press. p. 315.ISBN978-0-88920-912-1.... Thus bathing also was considered a part of good health practice. For example, Tertullian attended the baths and believed them hygienic. Clement of Alexandria, while condemning excesses, had given guidelines for Christian] who wished to attend the baths ...
^Gibson MD (1903).The Didascalia Apostolorum in English. C.J. Clay. pp. 9–10.
^abThurlkill M (2016).Sacred Scents in Early Christianity and Islam: Studies in Body and Religion. Rowman & Littlefield. pp. 6–11.ISBN978-0-7391-7453-1....Clement of Alexandria (d. c. 215 CE) allowed that bathing contributed to good health and hygiene... Christian skeptics could not easily dissuade the baths' practical popularity, however; popes continued to build baths situated within church basilicas and monasteries throughout the early medieval period...
^abSquatriti P (2002).Water and Society in Early Medieval Italy, AD 400-1000, Parti 400–1000. Cambridge University Press. p. 54.ISBN978-0-521-52206-9....but baths were normally considered therapeutic until the days of Gregory the Great, who understood virtuous bathing to be bathing "on account of the needs of body"...
^abE Clark M (2006).Contemporary Biology: Concepts and Implications. University of Michigan Press. p. 613.ISBN978-0-7216-2597-3.Douching is commonly practiced in Catholic countries. The bidet... is still commonly found in France and other Catholic countries.
^Forgione A (2013).Made in Naples: Come Napoli ha civilizzato l'Europa (e come continua a farlo) [Made in Naples. How Naples civilised Europe (And still does it)] (in Italian). Addictions-Magenes Editoriale.ISBN978-88-6649-039-5.
Black W (2019).The Middle Ages: Facts and Fictions. ABC-CLIO. p. 61.ISBN978-1-4408-6232-8.Public baths were common in the larger towns and cities of Europe by the twelfth century.
Kleinschmidt H (2005).Perception and Action in Medieval Europe. Boydell & Brewer. p. 61.ISBN978-1-84383-146-4.
Kourkoutidou-Nikolaidou E, Tourta A (1997).Wandering in Byzantine Thessaloniki. Kapon Editions. p. 87.ISBN960-7254-47-3.
^abcBraunstein P (1988). "Solitude: eleventh to the thirteenth century". In Duby G (ed.).A History of Private Life. Vol. II. Revelations of the Medieval World. p. 525.
^Hembry P (1990).The English Spa, 1560–1815: A Social History. Fairleigh Dickinson Univ. Press.ISBN978-0-8386-3391-5.
^abBradley I (2012).Water: A Spiritual History. Bloomsbury Publishing.ISBN978-1-4411-6767-5.
^de Boileu E (1993). "Le Livre des Métiers". In Amt E (ed.).Women's Lives in Medieval Europe: A Sourcebook. Routledge. p. 162.
^Classen A (2017).Bodily and Spiritual Hygiene in Medieval and Early Modern Literature: Explorations of Textual Presentations of Filth and Water. de Gruyter. p. 535.ISBN978-3-11-052379-9.
^al-Hassan AY, ed. (2001).Science and Technology in Islam: Technology and applied sciences. The Different Aspects of Islamic Culture. Vol. 4.UNESCO. pp. 73–74.
^Newell S (2006).International Encyclopaedia of Tribal Religion: Christianity and tribal religions. Ohio University Press. p. 40.ISBN978-0-8214-1709-6.
^Grypma S (2008).Healing Henan: Canadian Nurses at the North China Mission, 1888–1947. University of British Columbia Press. p. 27.ISBN978-0-7748-5821-2.the Gospel of Christ was central to the 'missionary' aspect of missionary nursing, the gospel of soap and water was central to 'nursing' aspect of their works.
^Thomas K (2011).Securing the City: Neoliberalism, Space, and Insecurity in Postwar Guatemala. Duke University Press. pp. 180–181.ISBN978-0-8223-4958-7.Christian hygiene existed (and still exists) as one small but ever important part of this modernization project. Hygiene provides an incredibly mundane, deeply routinized, marker of Christian civility ...Identifying the rural poor as 'The Great Unwashed,' Haymaker published Christian pamphlets on health and hygiene,... of personal hygiene' (filled with soap, toothpaste, and floss), attempt to shape Christian Outreach and Ethnicity.
Bauman CM (2008).Christian Identity and Dalit Religion in Hindu India, 1868–1947. Wm. B. Eerdmans Publishing. p. 160.ISBN978-0-8028-6276-1.Along with the use of allopathic medicine, greater hygiene was one of the most frequently mobilized markers of the boundary between Christians and other communities of Chhattisgarh... The missionaries had made no secret of preaching 'soap; along with 'salvation'...
Baral KC (2005).Between Ethnography and Fiction: Verrier Elwin and the Tribal Question in India. North Eastern Hill University Press. p. 151.ISBN978-81-250-2812-3.where slavery was in vogue Christianity advocated its end and personal hygiene was encouraged
^Taylor JG (2011).Cleanliness and Culture: Indonesian Histories. Royal Netherlands Institute of Southeast Asian and Caribbean Studies. pp. 22–23.ISBN978-90-04-25361-2.Cleanliness and Godliness: These examples indicate that real cleanliness was becoming the preserve of Europeans, and, it has to be added, of Christianity. Soap became an attribute of God — or rather the Protestant
^Choi H (2009).Gender and Mission Encounters in Korea: New Women, Old Ways: Seoul-California Series in Korean Studies. Vol. 1. University of California Press. p. 83.ISBN978-0-520-09869-5.In this way, Western forms of hygiene, health care and child rearing became an important part of creating the modern Christian in Korea.
^Channa S (2009).The Forger's Tale: The Search for Odeziaku. Indiana University Press. p. 284.ISBN978-81-7755-050-4.A major contribution of the Christian missionaries was better health care of the people through hygiene. Soap, tooth-powder and brushes came to be used increasingly in urban areas.
^Thomas J (2015).Evangelising the Nation: Religion and the Formation of Naga Political Identity. Routledge. p. 284.ISBN978-1-317-41398-1.cleanliness and hygiene became an important marker of being identified as a Christian
^abZ Wahrman M (2016).The Hand Book: Surviving in a Germ-Filled World. University Press of New England. pp. 46–48.ISBN978-1-61168-955-6.Water plays a role in other Christian rituals as well.... In the early days of Christianity, two to three centuries after Christ, the lavabo (Latin for "I wash myself"), a ritual handwashing vessel and bowl, was introduced as part of Church service.
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