2.2 The role of sanitation and hygiene

As you saw in the previous section, pathogens can be transmitted indirectly by the faecal–oral route. Faecal–oral transmission occurs when unclean hands, food or other objects contaminated by faeces enter the mouth. These different faecal–oral transmission routes are illustrated by the ‘F-diagram’ (Figure 6).

Figure 6 The ‘F-diagram’: faecal–oral transmission routes and barriers to transmission.

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This figure comprises a schematic showing faecal–oral transmission routes and barriers to transmission. The diagram is known as the F-diagram. On the left is faeces. This label is connected via arrows to fluids, fingers, flies, fields and food. These labels are connected directly to a new host via arrows. Fluids, fingers, flies and flies are also connected via arrows to food. There is a vertical line drawn through the arrows between faeces, and flies, fluid, fingers, field and food. This vertical line is labelled primary barrier. There are vertical lines drawn through the arrows connecting fluid, fingers, flies and fields with foods and then also between fluid, fingers, flies, fields and foods, and a new host. These lines are labelled secondary barrier.

Figure 6 The ‘F-diagram’: faecal–oral transmission routes and barriers to transmission.

Transmission by these routes can be stopped (or reduced) by sanitation and hygiene barriers (Figure 6).

• A primary barrier prevents the initial contact with faeces. This includes improving access to toilets to separate faeces from the environment and washing hands after going to the toilet.
• A secondary barrier prevents infectious pathogens being eaten by the new host. This includes using a clean water source, washing hands before preparing or consuming food, and covering food.

Next, you will look at how these hygiene barriers can be used to lower antibiotic demand and reduce unnecessary use.