[3-4] Consider events and phenomena that are, or are likely to be, a threat to the growth and developmentof children in Cambodia.

Chapter 4

Cleanliness, hygiene and health
Learning objectives
You will be able to gain proper understanding and explain:- The principles of cleanliness and hygiene.
- With examples, diseases and conditions that arise from unsanitary and unhygienic behavior.
- With examples, good hygiene behavior and behavior to keep our bodies clean.
- With concrete examples, unhygienic environments (home, school, town/community).
- With multiple examples, diseases and conditions that arise from unhygienic environments.
- With examples, what can be done to improve unhygienic environments.
- Ideas on how unhygienic and unclean behaviors can be changed.
In this chapter, we learn about cleanliness and hygiene in relation to children, homes, schools, andcommunities. The speciﬁc learning topics are hand washing, bathing, clean water, hygienic foodpreparation, cleaning, waste separation, and water and sewage systems.

References
1

Edited by Emiko Fukuda, (Ed.) “Ningen hattatsugaku (Human development)” 5th edition, Tokyo: Chugai-Igakusha, 2019.

2

Edited by Goro Kono and Etsujiro Takahashi, (Eds.) “Hoikuno nakano hoken – Yochien/hoikusho denohokenshido no riron to jissen(Health as part of nursing – Theory and practice of health guidance in nursery schools),” revised edition, Tokyo: Houbunshorin,
2010.

3

Ruffin N.J. Human growth and development – A matter of principles. Virginia Cooperative Extension. Virginia Tech. 2019. https://www.pubs.ext.vt.edu/content/dam/pubs_ext_vt_edu/350/350-053/350-053 (FCE-134 P).pdf

4

Dhaker R. Growth and development. https://www.slideshare.net/rdhaker2011/growth-and-developmentppt

5

Schaffer H.R. Key Concepts in developmental psychology, 58-61, Los Angeles, Sage, 2006.

6

Montessori M. Six “Sensitive Periods.” https://www.montessoritrainingusa.com/sites/montessoritrainingusa.com/files/Six%20
Sensitive%20Periods.pdf

78

To lead healthy lives, we need to keep our own bodies clean and hygienic. “Cleanliness” refers to thestate or habit of keeping yourself and your surroundings free from dirt. “Hygiene” means the practice ofpreventing illness or the spread of disease by keeping yourself and your home, workplace, and community

Who-Was-Maria-Montessori

environments clean. Key behaviors in maintaining cleanliness and hygiene are washing your hands,

Committee on Evaluation of Children’s Health. Children’s Health, the Nation’s Wealth: Assessing and Improving Child Health. p.4,

brushing your teeth, and bathing.

Committee on Evaluation of Children’s Health. Children’s Health, the Nation’s Wealth: Assessing and Improving Child Health.
p.45-90, Washington DC, The National Academies Press, 2004. https://www.ncbi.nlm.nih.gov/books/NBK92200/#ch3.s1

10 Pem D. Factors Affecting Early Childhood Growth and Development: Golden 1000 Days. Journal of Advanced Practices in Nursing,
1:1, 2015. DOI:10.4172/2573-0347.1000101.
11 Ali S.S. A brief review of risk-factors for growth and developmental delay among preschool children in developing countries.
Advanced Biomedical Research. 2:91.2013 doi: 10.4103/2277-9175.122523.
12 National Institute of Statistics, Directorate General for Health, and ICF Macro, 2011. 2010 Cambodia. Demographic and HealthFirst, to prevent infectious diseases, it is important that your hands are clean (not dirty) and hygienic(no cause for disease to take effect). Hands need to be washed with water and well-lathered soap toremove dirt attached to the surface of the hands (cleanliness), while also removing the viruses andbacteria that are the cause of disease (hygiene), blocking this infection route. As explained in detail in
Chapter 7, the three main factors in the transmission of infectious diseases are pathogens (for example,
bacteria and viruses that cause disease), transmission routes (the routes whereby bacteria and viruses

Survey: Key Findings. Phnom Penh, Cambodia and Calverton, Maryland, USA: National Institute of Statistics, Directorate General

are communicated), and hosts (people’s resistance and immunity to bacteria and viruses). Transmissionfor Health, and ICF Macro. https://www.nis.gov.kh/nis/CDHS/CDHS_2010_Key_Findings.pdf

routes include direct contact, droplets, and airborne transmission. To prevent direct contact

13 The National Committee of Early Childhood Care and Development. National Action Plan on Early Childhood Care andDevelopment 2014-2018. https://planipolis.iiep.unesco.org/sites/planipolis/files/ressources/cambodia_early_childhood_national_
action_plan_2014-2018.pdf

641) Personal cleanliness and hygiene

American Montessori Association. Who Was Maria Montessori? https://amshq.org/About-Montessori/History-of-Montessori/

Washington DC, The National Academies Press, 2004. https://www.ncbi.nlm.nih.gov/books/NBK92198/#ch2.s3
9

1. Personal and environmental cleanliness and hygiene(home, school, town/community)transmission in particular, it is important to maintain cleanliness and hygiene by washing your hands,
sterilizing your ﬁngers, and sterilizing surfaces that are touched by multiple people.
Chapter 4

Cleanliness, hygiene and health65

Next, cleanliness and hygiene are also the foundation for preventing tooth disease and keeping teeth

and after using the toilet. On the other hand, around 20 percent of children had taken time off school in

healthy. If teeth are not brushed correctly, food particles are not completely removed, and the particles

the last 12 months because of toothache, which shows that cavities and periodontal disease prevention

attach to the tooth surface. Bacteria then flourish, forming a sticky white substance called plaque. Plaquethrough correct brushing is clearly an issue in school health care.

can grow within approximately eight hours of your last meal. Many bacteria live in the plaque adhering
to your teeth, with mutans streptococci (‘cavity bacteria’) and lactobacilli converting the sugar fromfood particles into acid that begins to dissolve the teeth. To prevent tooth disease and keep teeth healthy,2) Home cleanliness and hygiene

it is therefore vital to keep teeth clean so that food particles don’t remain on the teeth, and to maintainoral hygiene by removing the clumps of bacteria and bacterial metabolites that make up plaque. ThisA clean and hygienic home environment is closely related to your health. For example, cleaning yourmeans, firstly, brushing your teeth correctly every day. Brushing using a fluoride toothpaste and using

house and separating your household waste properly prevents vector insects and environmental

dental floss or an interdental brush for interdental care are also effective methods. Fluorides encourage

pollution. Make sure that you use the right disposal methods for waste and recycling resources. Organic

tooth recalcification, repairing the tooth damage caused by decalcification and restoring the teeth towaste (food scraps) should be placed in a polythene bag for disposal, or, if you are burying it, covered

health. Fluorides also inhibit the production of acid by plaque (see Chapter 8 for details).

with a good layer of soil. Glass bottles, cans, and plastic bottles should be put out for recycling.

Cleanliness and hygiene are also fundamental in preventing infectious diseases and dermatitis (skindisease) (Figure 4.1, Figure 4.2). After you have washed dirt from your body in a shower or tub using coldor hot water and soap and then dried yourself, your skin needs to be moisturized. Brushing and washing

Column: Vector insects — Insects causing direct harm to people, including lice, mites, cockroaches, and flies

your hair and trimming your nails so that your skin is not scratched also help to maintain personal

Ensuring clean water with no pathogens helps to prevent food poisoning and the intestinal infectious

cleanliness. Washing dirty clothing and towels prevents diseases and the bad odors caused by thediseases which are so common in Cambodia. Dirty water contains pathogenic microbes such as

reproduction of the bacteria and mold feeding off sebum and protein in the stratum corneum (hygiene).

pathogenic Escherichia coli (E. coli), Salmonella enterica, Staphylococcus aureus, viruses, and1

A survey on the cleaning practices and hygiene behaviors of Cambodian children aged 13–17 found

Entamoeba histolytica that cause infectious gastroenteritis. For drinking water, buy mineral water or,that most brush their teeth at least once a day and are in the habit of washing their hands before meals

if none is available, drink boiled tap water. In the countryside, when using water from wells, rivers,
lakes, and springs, remove any dust and dirt first by straining the water through clothing, a
handkerchief, or a towel and then boil the water to kill bacteria and viruses, which cannot be simply
strained out. The boiling time must be at least five minutes.
You can prevent food poisoning by acquiring fresh food ingredients, storing them appropriately,
preparing them hygienically, and storing food appropriately after cooking. In particular, raw fish andWashing your face

Brushing your teeth

Washing your hands

Washing your hairmeat that have been purchased at the market should be cooked immediately or, if you have arefrigerator, stored in the refrigerator. If you don’t have a refrigerator, use all the fish or meat at once.
If there are best-before or use-by dates on food packaging, make sure you consume that foodcompletely before the given date.

Changing your clothes

Brushing your hair

Using the toilet

Washing your body

Figure 4.1 Practicing personal cleanliness and hygiene

Column: Drinking water in Cambodia

The World Health Organization (WHO) defines drinking water as including all water used in daily life,
breaking this up into three levels. ‘Improved drinking water sources’ comprise ‘piped water on thepremises’ (from a household well, for example), while ‘other improved drinking water sources’
comprise public wells and rainwater tanks, etc. All of these have lids to prevent contamination by
fecal matter and are relatively hygienic, but they can still be contaminated with bacteria, so care isneeded. ‘Unimproved drinking water sources’ comprise sources that are not protected from theexternal environment and could be contaminated by fecal matter, etc. (https://www.who.int/water_

Dermatitis

Stomachache

Fever and coughToothachesanitation_health/monitoring/water.pdf).

Figure 4.2 Disease caused by unhygienic behaviors

66

Chapter 4

Cleanliness, hygiene and health67

According to a study on the drinking water used by Cambodian children aged six to 36 months,

It is also important to make the classroom a good learning environment. Not only do classrooms

more than 90 percent of city children use relatively hygienic water, including 34.8 percent who useneed to be clean and free of waste but care also needs to be taken with the air quality (temperature,bottled water and 58.1 percent who use piped water on the premises. In rural areas, however, thehumidity, dust), brightness (natural light and artificial light), and noise levels (Figure 4.4). Natural andtotal was only around 30 percent, including 23.6 percent who use bottled water and 7.9 percent who

artificial light should be used to ensure that classroom brightness is right for learning, and the air in theuse piped water on the premises. Around 40 percent of rural drinking water comes from unimproved

classroom should be kept at a normal level by bringing in fresh air from outside and expelling stale air.

drinking water sources, making securing safe and hygienic drinking water a key challenge in healthprotection (Poirot et al, “Water quality for young children in Cambodia: High contamination atcollection and consumption level,” Maternal and Child Nutrition, 2019; e12744. doi.org/10.1111/

Refresh air

Bring in light

Prevent glareand flickeringmcn.12744).
Reduce noise
Column: Best-before and use-by dates

The food that you buy in stores only tastes good and can be consumed safely for a certain length of

Clean desktops
and floors
Separate waste

time. Food packaging and containers are usually marked with a best-before or use-by date. The
best-before date is the date up to which, if the packaging or container around the food remains
unopened, the food will taste good and have lost none of its quality. The use-by date is the date up
to which, if the packaging or container around the food remains unopened, the food may have lost
some of its quality and not taste as good but is still safe to eat. Food stored at high temperatures andFigure 4.4 How to keep classrooms healthy and hygienic

humid conditions tends to spoil more quickly than the indicated date. Once the packaging or container
has been opened, the product should be consumed as quickly as possible regardless of the date.

Table 4.1 Examples of necessary conditions for the school environment in Cambodia

Category

3) School hygiene

Requirement

Example• All students have safe drinking waterin schools.

All students have safe drinking
water at least 500 ml per shift bybringing from home or from othersources.

• All students can use functional andclean latrines in both shifts.

The school has 1 latrine for boys
and 1 latrine for girls.

Hand Washing Facilities• All students can use hand-washingfacilities with water and soap.

A basic hand washing facility isnext to each latrine or/andclassroom.

Environment and Safety• All students participate in dailycleaning of school premises,classrooms, latrines and hand-washingfacilities.

Drinking Water

Because many people gather at schools, they can become places for disease transmission. Schools alsoneed to provide a good learning environment to promote children’s growth and development. Care
therefore needs to be taken to ensure a clean and hygienic school environment. First, toilets must be used
for all urination and defecation, and children must be taught to wash their hands with well-lathered soap

Latrines and Urinals

after using the toilet (Figure 4.3). Classrooms must be kept clean and food debris and waste placed inwaste bins, not left lying around.

• No waste in school premises andclassrooms.

School has at least one waste bin
per classroom and latrine, and they
are used.

Created from Minimum Requirement Guidelines on Water, Sanitation and Hygiene in Schools (2016)

4

Cambodia has set the target of having hygiene facilities installed in all schools to create a healthy
Beforedefecation

Defecating

DefecatedAfterdefecation

Figure 4.3 Hygienic behavior at school(left: how to use the toilet, right: placing waste in waste bins)

68

Dustbinand safe learning environment and enable children to practice desirable health behavior.2,3 In 2016, theSchool Health Department created the Minimum Requirement Guidelines on Water, Sanitation andHygiene in Schools (WinS) that stipulate necessary school conditions in relation to (a) drinking water,(b) toilets, (c) hand washing facilities, and (d) environment and safety (Table 4.1), as well as mechanisms
for the improvement of hygiene facilities and for health and hygiene activities.4
Chapter 4

Cleanliness, hygiene and health69

In 2019, the School Health Policy was upgraded into a National Policy on School Health,5 of which
one of the strategies is to “strengthen the concepts of cleanliness, safety and good hygiene practiceregularly in the workplace and in educational institutions.” In other words, in addition to creating

4) Town and community hygiene(1) Waste disposal

mechanisms for health and hygiene activities and improving hygiene facilities, Cambodia has now

In Cambodia, rapid socioeconomic development and the advance of the tourism industry have madereached a stage whose aim is to introduce clear standards for cleanliness, safety, and hygiene.

waste disposal a huge social problem. Throwing waste on roads and into empty lots makes your town
look ugly, and people are offended by the putrid smell. Not only that, discarded waste makes the living
environment unhygienic. Piles of waste provide breeding grounds for mosquitoes, flies, and other insects

Column: School environmental hygiene in Japan

harmful to human health, for example, as well as generating toxic gases, and when it rains, waste-

In Japan, the School Health and Safety Act requires regular school environment hygiene

clogged drainage ditches flood the town with dirty water. In rural areas, rain falling on piles of waste

inspections based on the school environmental hygiene standards.6 These regular inspections

creates polluted water that then flows into farmland and pollutes the crops. Waste is not a problem

check whether schools are maintaining appropriate learning environments. For example, theycreated solely by Cambodians, but also by tourists visiting the country. At the same time, mountains ofmeasure carbon dioxide, temperature, relative humidity, floating dust, air flow, carbon monoxide,

waste can also be a source of revenue supporting people’s lives in some poor regions and regions withnitrogen dioxide, volatile organic compounds, mite allergens, illumination, glare, and noise levels.

little industry. We need to recognize that waste is a complex issue in which social development,

The inspections are conducted by experts or by teachers under the guidance of experts.

environmental and ecosystem pollution, and people’s livelihoods and health are all interwoven.
To address the waste issue in daily life, it is important to start by learning about the necessity ofIn addition to the inspections, there are also several items that must be checked daily (Table 4.2).
Teachers can conduct these checks every day either visually or using simple instruments.

waste separation and recycling, including setting up boxes and containers so that waste can be divided
into recyclables, non-recyclables, and organic waste when it is thrown out. Ideally, social mechanisms
will be developed for collecting and processing the separated waste.

Table 4.2 Examples of school environmental hygiene items subject to daily checks in Japan

Item(1) Ventilation

Classroom
environment

Standard(4) Noisemosquitoes, and other disease vectors carrying the pathogenic microbes that cause infectious diseases is(2) Appropriate ventilation

number of people affected increases during the rainy season. Certainly, people should take personal care

(1) Sufficient light to be able to clearly see letters and diagrams on
blackboards and desktops(6) Vermin andinsect pests

also important to create an environment that prevents mosquitoes from breeding, such as removing old
tires, empty cans, and plastic bottles where water could collect and provide a home for mosquito larvae(3) No light reflections on the blackboard

created in the first place will be critical for Cambodian society in addressing the waste problem.

Students can easily hear what the teacher is teaching.

In addition to developing social mechanisms for waste disposal, reducing the amount of waste(2) Drinking water and wastewater treatment
The public facilities that supply potable water are called waterworks, while the facilities that purify
rainwater and sewage (the generic term for human waste) and then release it into rivers and seas are(3) Toilets and toilet facilities are clean, functional, andundamaged.

called sewers. Waterworks send water to households and factories via (a) water tanks in which waste(4) No mud or sand has built up in drainage ditches and theirsurrounds, and there are no foul odors.

are mixed in thoroughly to have the water purified; (c) flocculation tanks which use chemicals to(5) Rubbish collection points, waste bins, and their surroundings
are clean.

tanks that filter the impurities; and (f) reservoirs for adding chlorine and storing clean water). The water

There are no mice, wild dogs or cockroaches inhabiting schoolbuildings or school grounds.

Created from Ministry of Education, Culture, Sports, Science and Technology, School Environmental Hygiene Management Manual,
2018 revision 6

70of themselves to avoid mosquito bites, such as using insect repellant and mosquito nets. However, it is(see Chapter 7).

(2) Sports grounds and sandpits are clean and free from waste andanimal fecal matter.
(5) Schoolcleanliness

just as important. For example, because dengue fever and malaria are transmitted by mosquitoes, the(2) No glare interfering with the visibility of blackboards,
desktops, and surroundings(1) School facilities and classroom equipment are clean andundamaged.

School cleanliness,vermin, and insect
pests

other vector insects, so the waste must be disposed of hygienically. The elimination of cockroaches,(1) No irritants or foul odors are detected on entering theclassroom from outside

The classroom is at a temperature conducive to learning (in Japan,(2) Temperature
stipulated at 17°–28°C).

(3) Brightness
and glare

If not dealt with, organic waste in particular becomes a breeding ground for flies, cockroaches, andand sand is precipitated from water taken from rivers; (b) mixing tanks where microorganisms and air
flocculate impurities; (d) sedimentation tanks that settle the suspended particles of impurities; (e) filter
purification system at the Phnom Penh waterworks is shown in Figure 4.5.7
Ensuring safe drinking water and preventing infectious diseases require installing combined septic
tanks and sewage systems to process town and community sewage. Sewage is the generic term for the
Chapter 4

Cleanliness, hygiene and health71human waste from toilets as well as domestic wastewater from cooking and laundry, along with theindustrial wastewater from business operations (stores, hotels, and workshops through to large factories).
Waterworks are gradually being installed in Cambodia, starting with Phnom Penh and other cities.
However, there are still few sewage systems, with sewage passing from septic tanks through drainage

2. Tips for creating a clean and hygienic personalenvironment1) Preventing food poisoning

canals out into lakes and wetlands where it is purified by natural processes. Given the issues related to
sewage treatment as shown in Table 4.3, Cambodia clearly needs to install combined septic tanks andsewers.

8

To prevent food poisoning, hygiene needs to be maintained at each stage of consumption, from buying
and storing food to preparing and cooking it, eating it, and storing the leftovers. Key points in relation
to each of these are shown in Figure 4.6. First, when buying food (point 1), choose fresh ingredients,

Hydraulic Mixing Tank

Flocculation Tank

PAC Chlorine

check the use-before dates (see Column: Best-before and use-by dates), and get your groceries home as
quickly as possible. Store raw fish and meat and perishable ingredients in the refrigerator (point 2), if
one is available, to protect the food from perishing or being contaminated by flies. At the preparation
stage (point 3), don’t use the same chopping board and knife that you used for raw fish and meat foryour vegetables, wash your cooking implements thoroughly afterwards, and wash your hands afterRiver
Rapid Sand Filters

Sedimentation

handling raw fish and meat. Avoid undercooking by heating food to the point that it reaches a sufficienttemperature even right in the middle (point 4). Wash your hands before eating and use clean tableware(point 5). Store remaining food and ingredients in the refrigerator and throw out old food (point 6).

Chlorine
Commercial Consumers
Clean Water Tank

Point 1: Buying food
• Choose fresh ingredients• Check the use-before date

Point 2: Storing food
• Use the refrigerator toprevent food from spoiling

Point 3: Preparing food
• Wash your hands first• Use clean cooking implements
and wash them well afterwards

Point 4: Cooking food• Cook your food rightthrough (raise thetemperature sufficiently)

Point 5: Eating food
• Wash your hands before
eating• Use clean tableware

Point 6: Store leftovers• Use a fly net or a fridge• Throw out old foodDistribution Station
Domestic Consumers

Figure 4.5 Water treatment process7

Table 4.3 Sewage treatment issues in Cambodia81

Because septic tanks have not been installed, untreated sewage percolates underground or isreleased directly into drainage canals and rivers.

2

Even when septic tanks are installed, they have insufficient capacity.

3

Only human waste is treated in septic tanks, with domestic wastewater directly released to theenvironment.

4

Septic tank sludge is not properly scooped up, so septic tank treatment efficiency is low.

Tidying and cleaning your environment contributes to safe and healthy living by helping to prevent

5

Households along rivers and waterways release their sewage directly into the water.

infectious diseases and allergies as well as injuries from falling. Engage in cleaning activities, including

Figure 4.6 Actions to prevent food poisoning

2) Cleaning

using a dustpan, broom, or vacuum cleaner to remove dust from floors, wiping desks with a cloth, andputting the accumulated waste in waste bins (Figure 4.7). Particularly when infectious diseases are goingaround, use disinfectants to sterilize surfaces that many people touch (Figure 4.8) and engage in cleaning
activities to block infection routes (for more on infection routes, see Chapter 7).
72

Chapter 4

Cleanliness, hygiene and health73

The coronavirus (SARS-CoV-2), and infectious disease caused by them (COVID-19) has been
sweeping the world since January 2020, and effective treatments and vaccines to increase immunity
against the virus are still in development. The virus is transmitted via droplets and fingers, so it is vitalto follow cough etiquette when coughing, and to wash your hands carefully and thoroughly for at least
30 seconds. Cough etiquette means using your sleeve, a tissue, a handkerchief, or a mask to cover yournose and mouth when coughing or sneezing to avoid spreading the virus to others (Figure 4.10).

Figure 4.7 Classroom cleaning

Figure 4.8 Examples of disinfectants

Column: Disinfectants by efficacy

There are many types of disinfectant with varying efficacies, so the right disinfectant needs to be

1 Wet hands

2 Squirt hand soap

with wateron to palm

used for the right job. Ethanol is used to sterilize fingers and objects such as doorknobs and tables.

3 Rub palms

together tocreate a lather

4 Use palm to rub

5 Interlace fingers

9 Rinse under

10 Dry well withback of other
hand, then swap

and rub between
them

However, there are some viruses on which ethanol has little effect unless it is very concentrated. It
also has no sterilizing effect on spores, which are the special cellular structures that form when somemicrobes are placed in an environment in which they cannot reproduce. Spores are highly resistantto heat, desiccation, and drugs, and cannot be sterilized using ethanol.
Sodium hypochlorite is usually found in bleach and has powerful disinfecting properties. Unlike
ethanol, it should not be used on the skin, but it can be used to soak clothes and dishes or applied
directly to vomit for sterilization (see also Chapter 15). Check the product label for the appropriate

6 Clasp thumbwith other hand
and rotate

concentration. For skin applications, people who are allergic to alcohol can use povidone iodine
also work on spores given a long disinfection period. The area of skin to which it is applied will turn

3. Good hygiene practices
1) Effective handwashing techniqueInfluenza and many other infectious diseases can be spread by human fingers, so making it a habit towash your hands effectively using water and well-lathered soap increases the chances of preventing
infectious disease. The specific method (Figure 4.9) is to wash hands with running water, pick up thesoap and lather it well, and then wash your hands for around 30 seconds in the following order: palms,
palm side of fingers, back of hands, back of fingers, between fingers right down to the base, thumbs andon opposite
palm

8 Rub each wristwith opposite
handrunning watera paper towel

Figure 4.9 Washing hands with soap

(isodine) instead. Povidone iodine is sometimes used to sterilize wounds and injection sites. It canbrown, but this will wash off with water.

7 Rub fingertips

Table 4.4 Effect of handwashing by duration and no. of times

Handwashing method

No. of viral flora remaining (survival rate)

No handwashing

Approx. 1,000,000

Wash 15 seconds under running water

Approx. 10,000 (approx. 1%)

Rub with hand soap for 10 seconds, then rinse under
running water for 15 seconds

Several hundreds (approx. 0.01%)

Rub with hand soap for 30 seconds, then rinse under
running water for 15 seconds

Several hundreds (approx. 0.01%)

Rub with hand soap for 60 seconds, then rinse under
running water for 15 seconds

Several dozen (approx. 0.001%)

Rub with hand soap for 10 seconds, rinse under
running water for 15 seconds, then repeat

Several (approx. 0.0001%)

cushion at the base of thumbs, fingertips, and wrists. Then rinse thoroughly with running water to wash
off the soap. After washing your hands, wipe and dry your hands using a clean towel or paper towel.
Please do not use a shared or dirty towel, as the effect of hand washing can be lost as a result. Disinfecting
your hands with alcohol once you have wiped away the water is also effective. Washing your hands withsoap using the correct method increases the chance of eliminating bacteria and viruses (Table 4.4).974

Chapter 4

Cleanliness, hygiene and health75

and health. Draw a diagram of how these elements are related.
[4-6] Discuss your experiences of food poisoning and think about how they could have been prevented.
[4-7] Discuss how to ensure that there is always soap in school bathrooms when schools have such tightbudgets.

Wear a mask

Cover your mouth andnose with a tissue or
handkerchief, etc.

Cover your mouth and nosewith the inside of your jacket
or your sleeve

Figure 4.10 Cough etiquette

Exercises for further thought and research[4-1] Try an experiment on effective handwashing.
You will need: Starch, iodine solution (or another disinfectant containing iodine), basin.
Method (Figure 4.11):(1) Rub the starch over your hands and wrists like hand cream.
(2) Let it dry.
(3) Wash and dry your hands using your usual method.
(4) Place the iodine solution in the basin and soak your hands into it.
(5) The iodine solution will react with any remaining starch by turning purple.
(6) Discuss those areas easily missed when washing your hands.

References
1

Global School Based Student Health Survey 2013. https://www.who.int/ncds/surveillance/gshs/Cambodia_2014_GSHS_Report.pdf

2

Ministry of Education, Youth and Sport (2006), School Health Policy. https://www.moeys.gov.kh/index.php/en/policies-andstrategies/1986.html

Figure 4.11 Experiment on effective handwashing

3

Ministry of Rural Development (2011), National Strategy for Rural Water Supply, Sanitation and Hygiene 2011-2025

4

School Health Department, Ministry of Education, Youth and Sport (2016), Minimum Requirement Guidelines on Water, Sanitation andHygiene in Schools. https://www.washinschoolsindex.com/storage/articles/zaEGjjZVB2WzMWY7UOommy58UP0AZdWq5zQLecNp.

[4-2] Identify an unhygienic environment close at hand and discuss in groups how it could be improved.
[4-3] Identify unclean or unhygienic actions by people around you and discuss in groups how thoseactions could be changed.
[4-4] Discuss in groups problems related to using and cleaning school toilets and cleaning classrooms
and school grounds, as well as possible solutions to these problems.
[4-5] Research waste treatment problems in developing countries and discuss why these problems are
occurring and what impact they are having on the environment and on people’s lives and healthfrom the perspectives of social development, the environment and ecosystems, and people’s lives
76

pdf
5

Royal Government of Cambodia Council of Ministers (2019), National Policy on School Health6

Ministry of Education, Culture, Sports, Science and Technology, Japan (2018), Manual for Management of School Environmental
Health. https://www.mext.go.jp/component/a_menu/education/detail/__icsFiles/afieldfile/2018/07/31/1292465_01.pdf

7Phnom Penh Water Supply Authority, Water Treatment Process. https://ppwsa.com.kh/en/index.php?page=water-treatment-process

8

Global Environment Department, Japan International Cooperation Agency (2018), Detailed Evaluation Report on Capacity Building
Project for Sewerage System Management in Phnom Penh, Cambodia. https://openjicareport.jica.go.jp/pdf/12320883.pdf

9Mori Kōji, Hayashi Yukinao, Noguchi Yayoi, Kai Akemi, Ohe Kyōko, Sakai Sachi, Hara Motonobu, and Morozumi Satoshi (2006),“Effects of Handwashing on Feline Calicivirus Removal as Norovirus Surrogate,” The Journal of The Japanese Association for
Infectious Diseases 80, no.5: 496-500. http://journal.kansensho.or.jp/Disp?pdf=0800050496.pdf
Chapter 4

Cleanliness, hygiene and health77