Home hygiene: taking care of a baby
Babies and children under the age of five years are more at risk of infection because
their immune systems are not yet fully developed. Good hygiene practice is important
to protect them from infection, especially during the first few months of life. This
briefing material has been produced for those who work in healthcare professions,
the media, and others who are looking for background understanding of and/or those
who are responsible for providing guidance to the public on how to prevent the
spread of infectious diseases in their homes.
What are the risks ?
Babies and children under the age of five years are more at risk of infection because
their immune systems are not yet fully developed. They will also have weak cough
reflexes and chest muscles that put them at risk of chest infections.
It is particularly important during the first few months of life to practice good hygiene
to protect a baby from exposure to germs1. It is important however, not to become
hygiene-obsessed and try to create a “sterile” environment. Babies are inevitably
exposed to micro-organisms in their environment which, in addition to some germs
will also include organisms which need to become established as part of their normal
gut flora, on their skin etc. Gradual exposure to small numbers of a wide range of
microbes is also important for priming the immune system. Even with the most
rigorous hygiene, babies will inevitably be exposed to the micro-organisms of other
family members and of their home environment (including some germs. Some of
these organisms will gradually become established as the “normal” flora in their own
gut, on their skin etc. Hygiene should focus on protecting infants against exposure to
“infectious doses” of harmful organisms which their immune systems are not
equipped to deal with.
The concept of a link between reduced “infection” exposure and increasing levels of
allergic diseases such as asthma and hayfever in young children was first proposed
in the 1990s, and was named the hygiene hypothesis. This fuelled the idea that we
have become too clean for our own good, which unfortunately still persists, despite
the fact that the hypothesis has been substantially revised, to the extent that the
assigning the term “hygiene” to the hypothesis is a misleading misnomer. A more
rational explanation, which is now generally accepted, is that, although microbial
exposure is important, particularly during early development, the vital exposures are
not colds, influenza, measles and other common childhood infections which have
evolved relatively recently over the last 10,000 years, but the microbes already
1
Germs is the term which we use to describe those micro-organisms (bacteria, fungi, viruses and
protozoa) which cause infectious diseases, and to distinguish them from the thousands of species of
micro-organisms which are non-harmful
present over 2 million years ago in hunter-gatherer times when the human immune
system was developing. The challenge we face is to reintroduce the microbes we
need to our human bodies without reintroducing the disease-causing organisms.
Recent studies indicate that changes which could be beneficial range from
encouraging natural childbirth, sustained breastfeeding. For more information about
this issue go to: http://www.ifh-homehygiene.org/best-practice-review/hygiene-hypothesisand-its-implications-home-hygiene-lifestyle-and-public
How do babies become infected?
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Tummy bugs/diarrhoea. Babies get tummy bugs if germs get into their mouths.
This can happen if their food or drink contains harmful organisms, or if they put
fingers which are contaminated with germs into their mouths.
Runny noses, colds and influenza. Babies can develop respiratory infections if
respiratory germs (these are mostly viruses) are inhaled. The germs cause
infection by invading the tissues of the nose or the lungs. Cold viruses can also
infect via the conjunctiva of the eye. This means that infection can occur by
rubbing the eyes or the lining of the nose with contaminated fingers.
Skin infections can occur if germs are allowed to get into cuts or abrasions on the
skin. Skin rashes including nappy rashes are also more prone to infection.
Eye infections – babies are particularly prone to eye infections. These can be
caused by rubbing the baby’s eyes with contaminated hands or a dirty face cloth.
Hygiene advice for care of babies
Handwashing
The hands are one of the key “superhighways” for spread of germs in the home.
Always wash your hands:
 after visiting the toilet
 after handling or caring for pet animals
 after handling raw foods such as meat and poultry
 when you come home from work, shopping etc.
 before handling and preparing food for your baby
 before caring for/handling your baby
To protect other family members – also wash your hands:
 after changing a baby’s nappy
 after handling tissues or wipes used to wipe the baby’s nose, eyes, bottom etc.
Make sure the hands are washed thoroughly so that all the germs are removed.
Rubbing with soap and water lifts germs off the hands, but rinsing under running
water is the process which actually removes germs from the hands. It is always
difficult to find enough time when caring for a new baby, but proper hand hygiene is
probably the most important hygiene measure.
The accepted procedure for handwashing is:
 ensure a supply of liquid soap, warm running water, clean hand
towel/disposable paper towels and a foot-operated pedal bin
 always wash hands under warm running water
 apply soap
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rub hands together for 15–30 seconds, paying particular attention to
fingertips, thumbs and between the fingers.
rinse well and dry thoroughly.
In situations where soap and running water is not available (or convenient) an
alcohol-based hand rub or hand sanitiser can be used to achieve hand hygiene:
 apply product to the palm of one hand.
 rub hands together.
 rub the product over all surfaces of hands and fingers until hands are dry.
It can be very useful to have an alcohol hand rub available in the nursery, since it can
often be difficult to leave the baby to go to the bathroom.
Note: In high risk situations where there is an outbreak of infection in the home,
handwashing followed by use of an alcohol rub/sanitiser should be encouraged.
With a new baby it is necessary to wash your hands many times a day. Using a
moisturising soap, or an alcohol hand rub which contains an emollient, will help to
prevent the skin from chaffing and cracking.
Feeding your baby
Breast milk is the best food for a baby. Babies should, if possible, be fed only breast
milk for the first few months. Breast milk contains antibodies that help protect the
baby from infection during the early months of life when its own immune system is
developing. Rigorous hygiene practice is important when preparing feeds and drinks
for a baby, to reduce the risks of tummy infections. This is particularly important
during the early stages of weaning the baby away from breast milk:
 wash your hands before preparing baby foods or feeding a baby
 clean and sterilise feeding equipment* (feeding bottles, teats, breast pumps,
spoons, cups, teething rings etc.)
 to “sterilise” feeding equipment:
- clean the equipment thoroughly with hot soapy water and a bottle brush
- use the bottle brush to clean off remnants of milk and ensure that the teats
are clean by washing both sides and then running water through the hole.
- sterilise using your method of choice*
 make up formula milk and solid food just before the baby needs it. If feeds are
stored at room temperature for any length of time, germs can grow in the food to
high levels. As a general rule – do not store prepared foods at room temperature.
Do not store prepared foods in a fridge for more than 8 hours.
 tap water used for drinking or preparing baby feeds should be boiled for at least 5
mins
 at the end of a feed, discard any leftovers
 current guidelines suggest that sterilising a baby's bottle feeding equipment
should be continued until the baby reaches 1 year of age.
For mothers who are breastfeeding:
 wash your hands before breast feeding
 expressed breast milk can be stored in a sealed sterilised bottle in a refrigerator
for up to 24 hours. Keep well away from any raw foods in the refrigerator
 at the end of a feed, discard any leftover expressed or formula milk
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Changing the baby’s nappy
Mothers are often reluctant to believe that their babies faeces can be just as
dangerous a source of germs as those of any other member of the family. There is
potentially a greater risk of spread of infection from babies with diarrhoea because
they have no control over their bowels and they rely on others to meet their hygiene
needs.
 Do not change nappies in the kitchen or other eating areas
 When cleaning the baby’s bottom always wipe from the front to the back
 For disposable nappies:
- seal in a plastic bag (or nappy sack) and place them in the outdoor rubbish
bin
 For reusable nappies:
- place solid material into the toilet (do NOT dispose of down the sink)
- place the nappy into a nappy bucket containing a suitable disinfectant/
sanitiser solution. Nappy buckets usually have a straining system built in so
the sanitising solution can be drained off before the nappies are washed.
- launder at 60C with a powder detergent containing active oxygen bleach
(see ingredients on back of pack) and dry as quickly as possible.
 Decontaminate the changing mat either by cleaning followed by disinfection or by
using a combined disinfectant/cleaner**.
 Wash hands thoroughly after changing a baby’s nappy
Hygiene in the nursery
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Keep surfaces clean and dry. Pay particular attention to hand contact surfaces
which, together with the hands are the main highways for the spread of germs.
This can be achieved by cleaning with a detergent cleaner followed by thorough
rinsing under running water, or when this is not possible, e.g. for door handles,
cot rails, etc., using a disinfectant cleaner which is effective against bacteria and
viruses**
Choose baby clothes and cot linen that can be washed at a high temperature.
Clothing, cot linen and towels should be regularly laundered using a laundry cycle
which will remove/destroy any pathogenic organisms. Either:
- for preference, wash at 60C or above, using a powder or tablet detergent
containing active oxygen bleach (see ingredients on back of pack).
- alternatively wash at 40C with a powder or tablet detergent containing active
oxygen bleach (see ingredients on back of pack)
Note: washing at 40C without the presence of active oxygen bleach will not
destroy bacteria and viruses
Do not share the baby’s towels, toothbrushes and other personal hygiene items
with other family members.
Clean up any vomit, faeces or other body fluids as quickly as possible.
- remove as much as possible of the excreta, from the surface using paper or
a disposable cloth or wipe, then
- apply disinfectant cleaner** to the surface using a fresh cloth or paper towel
to remove residual dirt – then
- apply disinfectant cleaner** to the surface a second time using a fresh cloth
or paper towel to destroy any residual contamination.
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- disposable gloves should be worn if in contact with faeces, and hands
should be washed after removing gloves.
Keep pets out of the nursery
Cloths, tissues and wipes
Cloths, tissues, wet wipes etc. are very important for cleaning hands, surfaces and
babies’ bottoms. Unless we handle them properly, however, they can very easily
contribute to the spread of germs. If a dirty wipe or cloth is used to wipe a clean
surface, then the germs will be transferred to that surface.
 For preference use disposable materials. Damp cloths (including face cloths) in
particular, readily harbour germs. If left in a damp state, the germs are likely to
multiply on the cloth fibres and the cloth can become very difficult to disinfect.
 Use wipes, tissues etc. once only and dispose of. Do not be tempted to use them
for a number of tasks.
 Immediately dispose of tissues and wipes into a polythene bag and seal. Do not
leave them lying around for someone else to pick up. Hands can readily become
contaminated with germs by handling contaminated wipes or tissues
 If it is necessary to use a cloth, DO NOT leave the cloth lying around in a damp
condition. After use, wash in warm soapy water (or launder) and dry thoroughly.
Toys in the nursery
Toys quite easily become contaminated with germs. Toys are passed from child to
child and become contaminated through handling or by children putting their mouths
to them. Some germs can remain viable on toys for some periods of time. Cleaning
of toys should be included in the regular household cleaning rota to ensure that they
are regularly cleaned. Choose toys for your baby which can be easily cleaned.
For soft toys:
 soft toys should be washable and should be put into a washing machine in the
hot water cycle.
For hard toys:
 scrub the toy with soapy warm water and a brush
 rinse with clean water and dry
Or,
 scrub the toy with soapy warm water and a brush
 immerse in a mild bleach solution, allowing it to soak for around 10 to 20 minutes
 rinse well with cool clean water and dry
Or,
 put the toy the dishwasher or washing machine.
For more details see the IFH information and hygiene advice sheet “Toys and home
hygiene”
Potties
Small children should be encouraged to use a potty. The contents of the potty should
be disposed of into a toilet (do not empty down the sink), then rinsed, and the
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rinsings disposed of in the same way. The potty should be dried and kept covered to
avoid attracting flies.
If children defecate without using the toilet or potty, the faeces should be cleaned up
immediately and put down the toilet. The floor area should be cleaned and
disinfected**.
Preventing eye infections
Babies frequently suffer eye infections. Good hygiene, particularly hand hygiene, is
very important to prevent eye infections. Up to 60% of people are carriers of
Staphylococcus aureus without showing any symptoms of disease, unless the
organism gets into a cut or abrasion, when it can cause sepsis. The organism can be
found on the hands of a “carrier” mother and is a common cause of eye infections in
babies.
 Always wash hands before caring for a baby
 Use cotton wool dipped into boiled water to gently remove any eye discharge
 Do not wipe the baby’s face with a dirty cloth or wipe
*Methods of sterilising baby feeding equipment
Boiling is the traditional method for sterilising bottles. Use a saucepan that has not
been used for any other purpose (i.e. cooking), fill it with water and fully submerge
the bottles etc. inside. Boil the equipment for at least 10 minutes.
Steaming - Steam sterilisers are an efficient way to ensure that feeding equipment is
safe to use. The process takes approximately 8 minutes and, if sealed, can keep
equipment clean for up to 3 hours.
Sterilising solutions often come in the form of a tablet which is dissolved in cold
water. The process takes approximately half an hour (although you should check
individual instructions) and can allow you to leave bottles soaking for up to 24 hours if
sealed, although bottles should not be left any longer than this without changing the
solution. It is possible to use any container with a sealed, fitted lid, Special sterilising
containers with plungers that keep bottles fully submerged are also available.
Microwavable sterilisers - Steamers for use in the microwave are available
although they cannot be used to clean equipment with metal components.
Additionally self-sterilising microwavable bottles are also available.
When sterilising bottles and other feeding equipment, ensure that they are fully
submerged for the whole time and check that there are no air bubbles present.
Additionally, dispose of bottles and teats once they are showing signs of wear and
tear as they become more difficult to fully sterilise once cracks are starting to form in
the plastic. After removing the feeding equipment from the sterilisation container it
should be filled with milk as soon as possible to avoid contamination.
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**Disinfectants and disinfectant cleaners
Make sure you use a disinfectant or disinfectant/cleaner such as a bleach-based
product, which is active against bacteria and viruses. For more details on choosing
the appropriate disinfectant, see the IFH information sheet “Cleaning and
disinfection: Chemical Disinfectants Explained”. Consult the manufacturers’
instructions for information on the “spectrum of action”, and method of use (dilution,
contact time etc). For bleach (hypochlorite) products, use a bleach solution diluted to
0.5% w/v or 5000ppm available chlorine. Household bleach (both thick and thin
bleach) for domestic use typically contains 4.5 to 5.0% w/v (45,000-50,000 ppm)
available chlorine. If “concentrated bleach” is recommended, a solution containing
not less than 4.5% w/v available chlorine should be used. Bleach/cleaner
formulations (e.g. sprays) are formulated to be used “neat” (i.e. without dilution). It is
always advisable however to check the label as concentrations and directions for use
can vary from one formulation to another.
More information
1. Healthy hints for you and your new baby. A CPHVA guide to good hygiene. for
new mums and dads Health visitors and healthcare professionals. To download
copies of this booklet, log on to the members area of the CPHVA website at:
www.unitetheunion.org/cphva - Or to order printed copies, contact Pat Cole at:
Hartford Cottage, 1 Longstaff Way, Hartford, Huntingdon PE29 1XT, or email
pat@patcole.co.uk.
2. Guide
to
pregnancy
and
baby
care.
www.askbaby.com
http://www.askbaby.com/sterilising-baby-feeding-equipment.htm
3. Sterilising
bottle-feeding
equipment.
Babycentre.
http://www.babycentre.co.uk/baby/formula/sterilising/
Other materials may be found at:
http://www.ifh-homehygiene.org/consumer-information-babies-infants
IFH Guidelines and Training Resources on Home Hygiene
1. Guidelines for prevention of infection and cross infection the domestic
environment. International Scientific Forum on Home Hygiene. Available from:
http://www.ifh-homehygiene.com/best-practice-care-guideline/guidelinesprevention-infection-and-cross-infection-domestic
2. Guidelines for prevention of infection and cross infection the domestic
environment: focus on issues in developing countries. International Scientific
Forum on Home Hygiene. Available from: http://www.ifh-homehygiene.org/bestpractice-care-guideline/guidelines-prevention-infection-and-cross-infectiondomestic-0
3. Recommendations for suitable procedure for use in the domestic environment
(2001). International Scientific Forum on Home Hygiene. http://www.ifhhomehygiene.org/best-practice-care-guideline/recommendations-suitableprocedure-use-domestic-environment-2001
4. Home hygiene - prevention of infection at home: a training resource for carers and
their trainers. (2003) International Scientific Forum on Home Hygiene. Available
from: http://www.ifh-homehygiene.com/best-practice-training/home-hygiene%E2%80%93-prevention-infection-home-training-resource-carers-and-their
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5. Home Hygiene in Developing Countries: Prevention of Infection in the Home and
Peridomestic Setting. A training resource for teachers and community health
professionals in developing countries. International Scientific Forum on Home
Hygiene. Available from: www.ifh-homehygiene.org/best-practice-training/homehygiene-developing-countries-prevention-infection-home-and-peri-domestic. (Also
available in Russian, Urdu and Bengali)
This fact/advice sheet was last updated in June 2014
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