Food Hygiene

How to integrate water, sanitation and hygiene into HIV programmes

WHO and US AID, 2010

Available at

This publication provides guidance for national authoritiesT on how to integrate water, sanitation and hygiene, including food hygiene, into national HIV programmes.  Action include treatment of  drinking water – even where a reliable source of safe water is available, it is often difficult to assure safe transport and storage practices; it is therefore good practice to treat drinking water where it is used, using chlorination systems, solar disinfection, boiling or filtration. Store treated drinking water safely – ideally, treated water would be stored in a vessel or container with a narrow mouth and lid to prevent recontamination of treated water, and preferably a tap or spigot. Promote hand washing – programmes should provide guidance and training on washing hands at critical times and with proper technique across all HIV programmes (e.g. home, community, school and facilitybased programmes); and place hand-washing stations with needed supplies (soap or ash, and water) in programme sites.xvi How to integrate water, sanitation and hygiene into HIV programmes Handle and dispose of faeces safely – programmes should support construction of simple, on-site waste disposal systems such as latrinesand, for those clients without bowel control or with mobility problems, promote simple methods to handle and dispose of faeces safely in clinical settings and in households. Manage menstruation – steps include safe disposal of items soaked in menstrual blood, or cleaning them for re-use. Prepare, handle and store food safely – sanitary food preparation, handling and storage can prevent diarrhoea; special food hygiene behaviours should be practised when preparing food for infants and young children. Promote personal cleanliness of PLHIV and their environment – simple steps can prevent the spread of infection, boost client morale and improve the health of HIV-affected communities; these steps include bathing daily with soap, washing clothing and bed linen regularly, and controlling animals.When implementing the priority WASH practices, the focus should be on measures considered feasible by the householder, taking into account the current practice, the available resources and the particular social context. The home visitor, counsellor, family member or clinician must assess what the current barriers are to each WASH practice, and how they can be overcome. They can then negotiate a commitment to try a few practices that seem feasible, worth changing and safe, from the point of view of the householder.Including WASH in global and national HIV/AIDS policy and guidanceA systematic review of HIV and AIDS policies and guidelines from 14 countries demonstrated that details of specific wash actions were often lacking. The WASH areas most frequently addressed were safe drinking water and safe food consumption. A few documents mentioned hand washing, faeces disposal and personal hygiene, but this material was often located in the background information. No document mentioned anything about water quantity or storage, menstrual blood management, or adaptation of sanitation and water supply systems for people with mobility restrictions. Also, these documents provided almost no information on how to practise WASH actions.Steps to integrate WASH into global HIV/AIDS policy and guidance include: modifying reference documents used to develop country policies and guidelines; revising minimum packages, home-based care kits, school-based HIV education kits, indicator lists and monitoring forms to include WASH;Executive summary xvii ensuring that policies and guidelines suggest environmental health collaboration at all levels, as part of the multisectoral focus; learning from other multisectoral interventions; developing a list of key WASH behaviours for PLHIV.On the national level, it is not necessary to develop a free-standing WASH and HIV policy; instead, it is best to integrate WASH policies and guidance into overall HIV policies, whether general HIV or area-specific. Countries can improve WASH guidance when writing or revising HIV-related policies, guidelines and handbooks by including specific details such as water access, water quantity, sanitation, hygiene and hand-washing knowledge and practice.This document provides examples of specific language that can be used to modify HIV/AIDS policies and related materials.Integrating WASH–HIV programmesHIV and AIDS are often characterized as health issues and are therefore not integrated into plans and activities of other sectors. In particular, ministries of health and ministries of water and/or sanitation rarely coordinate or develop joint plans. To integrate HIV and WASH programmes, the sectors should consider protecting human resources through HIV prevention and mitigation programmes, and consider the special hardware needs of those affected by HIV in WASH programmes and activities.Comprehensive WASH strategies include a wide range of interventions to improve the quality of life for PLHIV and their families. These interventions are not specific to any one setting or location, and are generally delivered through the home, community, school or facility. WASH interventions cannot be standardized for all situations and countries; interventions should be designed to suit local priorities and resources.This document is the first to systematically bring together information on integrating WASH and HIV to assist country-level programming. It is presented as a step towards the goal of making WASH a routine part of HIV prevention and care, and HIV considerations a routine part of water and sanitation programmes around the world.  The section dealing with food hygiene follows:

2.6 Prepare, handle and store food safely
Sanitary food preparation, handling and storage can prevent diarrhoea. This 
section lists recommendations adapted from guidance provided by the WHO 
(WHO, 2009a, 2010). These recommendations describe optimal practices, but 
they may not be feasible in resource-poor contexts. Local adaptations that 
consider local context and feasibility should be developed and incorporated
into national guidance.
The recommendations are listed below.
 Keep food areas and utensils clean – Clean all surfaces and equipment 
used for food preparation with water and soap. Wash utensils with soap 
(or ash) and water. Protect kitchen areas and food from insects, pests and 
animals. Use closed containers to keep food protected.
 Wash hands – Wash hands as specified in section 2.3.1, above. (See 
Annex 3: Hand washing instructions.)
 Separate raw and cooked food – Keep raw and cooked food separate, to
avoid cross contamination. Also:
– keep equipment and utensils used for handling raw foods separate
from those used for cooked foods;Priority WASH practices to integrate into national HIV/AIDS programmes 21
– store cooked foods in proper containers to prevent contact with raw
– use separate plates for raw and cooked foods.
 Cook food thoroughly – Bring foods such as soups and stews to a boil to 
prevent worm infestation.
 Keep food at safe temperatures – Do not eat food that has been sitting at 
room temperature for more than 2 hours. If thawing frozen food, do so in 
the refrigerator rather than at room temperature. For food that is eaten hot, 
keep it “piping” hot (i.e. with visible steam rising from it) until served.
 Use safe water – Use water that has been treated to make it safe (see 
section 2.1) to wash raw food, mix with food, make drinks and prepare
 Practise special food hygiene behaviours for infants and young children –
Infants and young children are particularly susceptible to diarrhoea from 
unsafe water, food preparation or food storage. Section 2.6.1, below, gives 
details of special food hygiene behaviours for this age group.
2.6.1 Special food hygiene behaviours for infants and young 
Infants under six months
If a mother or caregiver is unable to practice exclusive breastfeeding for 
infants under six months, she must follow the WHO’s safe infant feeding 
criteria (Ma et al., 2009; WHO, 2010):1
 use a reliable supply of treated water that is stored properly to prepare 
replacement foods;
 wash hands and utensils thoroughly with soap or ash;
 boil water to prepare foods;
 store unprepared foods in clean, covered containers;
 treat or boil utensils regularly to sterilize them (if boiling is not feasible, 
use detergent with water treated with chlorine, as this will safely disinfect 
containers and utensils).
Utensils include feeding bottles, teats, cups and spoons. Keeping bottles and 
teats clean may be especially difficult in developing country settings, and their 
use is discouraged. Using a cup and spoon for feeding infants is 
In accordance with How to prepare powdered infant formula in care settings (WHO and FAO 2007), How to integrate water, sanitation and hygiene into HIV programmes
Discard prepared feeds, including infant formula, within one hour if the child 
does not finish the entire portion. Following these precautions can be difficult,
but is critical in preventing diarrhoea in young children.
Infants six months and over
Once children reach six months of age, mothers should combine breastfeeding 
or safe replacement feeding with additional complementary foods. Preparation 
of such foods requires the same critical hygiene strategies as stated above 
(i.e. safe water, safe food preparation and safe storage), while the mother and 
baby continue to be regularly monitored for adequate nutrition. HIV-infected 
mothers should receive specific counselling and support for at least the first 
year of the child’s life, to ensure adequate infant feeding (WHO, 2010).
Adaptations for resource-poor households
For resource-poor households, the recommendations may be adapted as 
described below.
 Dedicate a small surface that is easy to clean for food preparation; if 
possible, this area should be out of reach of small children.
 Create another place to store cleaned dishware. Basic dish racks or tables 
off the ground will help to avoid utensils coming into contact with soil or 
animals. If possible, cover this place with a washable surface, such as 
plastic or a sheet of paper that is changed regularly.
 Clean food preparation surfaces before use with soap and water.
 Cover all raw and cooked foods with a clean cover (e.g. a bowl, plate or 
plastic film) to keep flies away from the food.
 Heat all food until steam is seen rising from the food.
 Serve food hot.
 Do not eat food that has been sitting at room temperature for more than 
two hours.
 Treat or boil water used to wash food, mix with food that will not be 
boiled, make drinks, etc.

Written by geraldmoy

February 22, 2011 at 2:57 pm