SANITATION, ARTHROPOD AVOIDANCE, AND WATER DISINFECTION - Medicine for Mountaineering and Other Wilderness Activities - page 60

CHAPTER 6
SANITATION, ARTHROPOD AVOIDANCE, AND WATER DISINFECTION
James A. Wilkerson, M.D.
Principal Contributor
Sanitation and water disinfection play vital roles in preventing infections, particularly in
developing nations that do not have clean water supplies and sewage disposal facilities to
which residents of industrialized countries are accustomed.
SANITATION
Many inhabitants of developing countries know nothing about the most rudimentary sanita-
tion procedures, such as washing their hands after defecating. Even when they follow such
practices,manydonotunderstandtheirpurposeandconsiderthemtheidiosyncrasiesoffor-
eigners.Whenlocalinhabitantsareemployedascooksorinsimilarroles,handwashingand
disinfection; disinfection of water for drinking, cooking, or even washing dishes; and sanit-
ary food preparation must be vigorously enforced and tightly supervised.
Everyone should wash their hands with water and soap, preferably an antibacterial soap,
after using the toilet, before eating, and any time their hands become contaminated, such as
after covering their mouth or nose when they cough or sneeze, after contact with animals,
and after handling money. Alcohol-based gels, such as Purell® and Isogel-X®, are an ef-
fective adjunct to hand washing and kill 99.9 percent of all bacteria on the hands. They are
alcohol based and evaporate in about fifteen seconds, so drying with a towel that might be
contaminated is not needed.
Locally obtained food must be regarded with the same distrust as the water supply. The
onlyfoodthatcanberegardedassafefromcontaminationisthatwhichhasbeenthoroughly
cooked under supervision. Eating utensils and plates are rarely washed in water hot enough
to kill bacteria, and soap may not have been added to the water. The most common practice
istosimplyrinsetheseitemswithwaterthathasnotbeendisinfected.However,wellcooked
foodservedimmediatelyusuallyissafe—andoftendelicious—iftravelersprovidetheirown
plate, cup, and spoon.
Fruits that have been picked above ground level, cleaned with disinfected water, and
peeled or sliced by the eater should be safe because bacteria cannot enter the fruit as it is
growing. However, fruits that have been sliced for display often have been cut with contam-
inated knives and sprinkled with undisinfected water to keep them attractive for potential
buyers.Bacteriaontheskinoforangesatthetimetheyaresqueezedcancontaminateorange
juice. Melons sold by the pound may be injected with undisinfected water to increase their
weight. Leafy vegetables are often fertilized with human feces and cannot be adequately