Infectious diseases are a major preventive medicine problem for U.S. Army Soldiers living in close quarters. Some of these infections are caused by direct person-to-person contact, but a vast majority of infections are caused by the germs found on surfaces. Improved hygiene can help reduce the spread of infection. An effective hygiene plan must start with accepting that disease-causing bacteria, viruses, fungi, and protozoa are always indoors on people, food, insects, and potentially in the air. Cleaning must be adequate to reduce germs to a level which is not harmful to health. A sterile environment is not expected. To achieve a hygienically clean (as opposed to visibly clean) surface the germs must either be removed or they must be killed by disinfection. Methods of hygienically cleaning sites and surfaces include detergent-based cleaning followed by rinsing, and the use of disinfecting agents. The hands are probably the most important cause of cross-contamination and cross-infection. The World Health Organization suggests that sanitation-related disease in developing countries could be reduced by up to 60% if people washed their hands after defecating. Acute respiratory infections (colds, sore throats, bronchitis) are most frequently transmitted by droplets from coughing or sneezing. Using tissues or shirt sleeves to interrupt these droplets are effective ways to prevent transmission. However, coughing or sneezing into your hands allows the spread of the germs to other parts of the body (through the eyes or breaks in skin, etc.) or to other individuals through touch. Toilets, showers, and sinks can become reservoirs of germs. Moisture and residual soil at these sites provide an ideal environment for the growth of germs. Exposure to disease-causing germs from contaminated floors and furnishings is very low. Germs are usually transferred from environmental surfaces to individuals by hand contact with the surface. Household bleach with water is the recommended disinfectant solution. It is effective, economical, convenient, and readily available. The solution of bleach and water is easy to mix, safe if handled properly, and kills most infectious germs. Standards of personal hygiene varied according both to the facilities available and the type of combat the individual was engaged in. Theater preventive medicine officers at all levels realized the necessity for convincing company officers of the importance of command responsibility for enforcing adequate standards of personal hygiene. The relative role of personal hygiene in control of disease varied considerably according to the degree of unit sanitation and area control achieved and according to the degree of specific protection afforded by measures such as immunization. There are few outbreaks of disease in which only one factor can be implicated; it is therefore difficult in most cases to correlate specifically good or bad personal hygiene with disease incidence.
A continuing educational program, combined with frequent inspection by both commanders and medical personnel, was found necessary to keep individual health observance at proper levels. A problem of the Medical Department was to convince line officers of their responsibility in enforcing health precautions, such as water discipline, eating only authorized foods, care of the feet, and proper wearing of the uniform for protection against arthropod vectors of disease. The soldier, too, had to be convinced of the relationship between his actions and his health and the health of his entire unit. Agencies were set up, within the Office of The Surgeon General and at all major command levels, to insure the dissemination of information necessary for the soldier to safeguard his health. The effectiveness with which personal hygiene measures were applied, both in training situations and in active theaters, varied widely. Experienced observers agree that there were numerous lapses from established minimum standards and that, in future military operations, thorough training in personal hygiene will be necessary. This training must include not only the principles and methods to be applied, but should also serve to motivate personnel of all ranks. In addition, there must be command and medical inspections coupled with provisions for effective corrective actions.
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