Planning guidance, not medical advice

This page provides hygiene and sanitation guidance for emergency conditions. It does not provide clinical instruction, wound care protocols, or treatment recommendations. Consult a physician or pharmacist for any medical concerns that develop during a disruption.

Why hygiene belongs in medical preparedness

Sanitation failures during disasters cause their own outbreak.

The diseases that follow disasters are often more preventable than the disaster itself. Diarrheal illness spreads through disrupted sanitation. Respiratory infections spread through crowded shelters. Skin infections develop from inadequate wound care. These are not inevitable — they are the predictable result of hygiene failures that can be reduced with planning.

The CDC identifies basic hygiene practices — particularly handwashing — as among the most effective disease prevention measures available, including in disaster and displacement settings.¹ This page applies that principle to the specific conditions an emergency creates: limited water, disrupted sanitation, crowded environments, and reduced access to medical care.

What this page does not cover

Water storage, purification, and conservation → Self-Reliance: Water — that's the supply side; this page covers the health outcomes side

Wound care and first aid → Skills: First Aid

General laundry and household cleanliness during emergencies → covered briefly in this guide, depth in the Household Hygiene guide

When water is limited — priority order

Not every hygiene practice requires the same amount of water, and not every hygiene action has the same disease prevention impact. When water is genuinely scarce, concentrate it in this order.

Hand hygiene at critical moments

Before eating, after bathroom use, after diaper changes, before and after caring for someone ill. This single action interrupts more disease transmission than any other hygiene practice. When running water is unavailable, hand sanitizer (60%+ alcohol) is the substitute for non-visibly soiled hands.

Dental hygiene — minimal water required

Brushing and flossing require less than a cup of water per session. Dental infections that develop during disruptions are painful and may not have accessible treatment. The water cost is low; the benefit is real.

Wound and skin care for anyone with broken skin

People with wounds, surgical sites, or skin conditions that compromise the skin barrier need clean water for wound care before any other personal hygiene use. Skin infections can escalate in emergency conditions when antibiotic access is limited.

Personal hygiene — wet wipe approach

A wet-wipe body wash (face, underarms, groin, feet) using unscented wet wipes maintains personal hygiene with no water. This approach is used in medical and field settings worldwide and is effective for multi-day disruptions.

¹ CDC. "Handwashing: A Healthy Habit in the Kitchen." CDC.gov/handwashing — CDC identifies handwashing with soap as one of the most important steps people can take to avoid getting sick and spreading germs in both routine and emergency conditions.

What to do

Five categories. Each with specific actions, not general advice.

Hand Hygiene

The single highest-return hygiene action in any emergency setting

When running water is available: soap and water for 20 seconds is the standard. Concentrate on the eight critical moments: before eating, after bathroom use, after diaper changes, before and after caring for someone ill, before food preparation, after handling garbage, after blowing your nose

When running water is unavailable: hand sanitizer (60%+ alcohol content) is effective for most disease-causing organisms when hands are not visibly dirty. Rub until completely dry — this takes 20-30 seconds. Do not use sanitizer on visibly soiled hands; use a wet wipe first

Sanitizer is not effective against all organisms — particularly norovirus and some bacterial spores. Soap and water, even in small amounts, is preferred when any water is available

Bar soap lasts significantly longer than liquid soap for the same volume — for extended disruptions, bar soap is more efficient in the supply stockpile

Nitrile gloves are appropriate when handling waste or caring for a sick person — but hand hygiene is required when removing gloves, not instead of it. Contaminated glove exteriors transfer contamination to hands when removed improperly

Personal Hygiene Without Running Water

Body care, dental hygiene, and menstrual hygiene when normal bathroom access is unavailable

Body hygiene

Wet-wipe body wash: one wipe for the face, one for underarms, one for groin, one for feet. Four wipes for a full functional washdown. Unscented wipes are gentler and less likely to cause skin irritation

Dry shampoo for scalp hygiene when shampooing is not possible

Change clothing daily when possible — even without washing, fresh clothing reduces skin irritation during extended displacement

Dental hygiene

Brush with a small amount of clean water (or bottled water) — less than ¼ cup per session

Floss daily — flossing requires no water and prevents gum disease and infection

Mouthwash as a substitute rinse when water is scarce

Stock: one toothbrush and travel toothpaste per person in the go-bag

Menstrual hygiene

Maintain at least a 2-week supply in the household go-bag — this is the category most commonly under-supplied in emergency kits

Menstrual cups and reusable period underwear have supply advantages during extended disruptions where disposable products may be unavailable — if not currently used, understand that using an unfamiliar product under emergency conditions adds complexity

Disposal when normal trash service is unavailable: seal in a plastic bag, double-bag, and store with other waste until disposal is possible. Do not attempt to burn in an open container

Waste Disposal

When toilets are unavailable or sanitation systems fail

When toilets are unavailable (water pressure loss, septic failure, power outage affecting a well pump): a portable toilet or 5-gallon bucket with a snap-on toilet seat and heavy-duty waste bags is the standard emergency option. Commercially available systems include treated waste bags that reduce odor and contain waste safely

The core rule: human waste must be contained and kept away from any water source, food preparation area, and areas where people walk. This is the sanitation principle underlying all waste disposal methods

Lined bucket approach: heavy-duty garbage bag inside the bucket, change the bag after each use or at least daily. Tie the bag securely and store in a sealed container away from living areas until disposal is possible

For outdoor settings when no portable toilet is available: dig a cathole at least 6-8 inches deep, at least 200 feet from any water source, trail, or camp area. Cover and pack out waste bags when possible

Hand hygiene is required after any waste disposal activity — this is the critical contamination point

Diaper disposal: seal used diapers in a plastic bag, double-bag, and store with other waste. The same applies to adult incontinence products

Shelter and Crowded Environments

Illness spreads faster in emergency shelters — specific practices reduce that risk

Emergency shelters concentrate many people in a small space, including people who may already be ill. Disease transmission in shelter settings is a documented public health concern that hand hygiene meaningfully addresses²

Apply hand hygiene at every transition point: entering a shared space, before eating, after any bathroom use, after contact with any shared surfaces

If any household member has respiratory symptoms: N95 respirators reduce transmission risk in shared spaces. Bring one per person in the go-bag — they are the same masks used during wildfire smoke events and serve dual purposes

Keep personal items separate from shared surfaces — sleeping bags, pillows, towels, eating utensils. Cross-contamination from shared surfaces is a significant transmission pathway in shelter settings

If possible, create physical distance between your sleeping area and others — even a few feet reduces close-contact exposure time

Ventilation: if conditions and weather allow, fresh air reduces airborne pathogen concentration. If a shelter space allows windows to be opened safely, this is worth doing

Surface Disinfection

Keeping high-contact surfaces clean when normal cleaning is disrupted

High-priority surfaces: food preparation surfaces, eating utensils, doorknobs and handles, bathroom fixtures, and any surfaces contacted by someone who is ill

Unscented household bleach diluted in water is the standard emergency disinfectant: approximately 1 tablespoon bleach per gallon of water for surface disinfection. Apply, let stand for a few minutes, then wipe. Confirm the bleach is sodium hypochlorite-based and not more than 1 year old — bleach degrades over time³

Disinfecting wipes are the packaged alternative — effective for high-contact surfaces and require no mixing or water

Do not mix bleach with ammonia-based cleaners or vinegar — produces toxic fumes. Use one product at a time

After flood exposure: any surface that was in contact with floodwater should be treated as contaminated and disinfected before use. Floodwater typically contains sewage and pathogens

² CDC. "Emergency Preparedness and Response: Hygiene and Hand Washing." CDC.gov/disasters. ³ CDC. "Emergency Disinfection of Drinking Water." CDC.gov/niosh/topics/emres/chemagent.html — bleach concentration and degradation guidelines.

Specific protocols for vulnerable household members

Standard hygiene isn't always enough for everyone.

Four groups in most households need something beyond the standard protocol. These are not different principles — they are the same principles applied with a higher standard of care.

Immunocompromised people

People undergoing chemotherapy, taking immunosuppressants, or living with HIV or other conditions affecting immune function face serious risk from organisms that a healthy person would fight off easily. Standard hand hygiene protocols apply at the highest level of rigor — hand sanitizer at every transition, not just before meals. Speak with the treating physician before any emergency about specific hygiene protocols for their condition.

Infants

Hand hygiene before any contact with an infant is critical — before feeding, before diaper changes, and before any skin contact. For bottle feeding: if water quality is uncertain, use shelf-stable ready-to-feed formula rather than mixing powder with potentially contaminated water. Keep all feeding equipment as clean as conditions allow.

Older adults with fragile skin

Skin integrity decreases with age. Wet-wipe washing should be gentle — avoid scrubbing. Regular repositioning during extended displacement prevents pressure injuries for anyone with limited mobility. Keep skin moisturized when possible — dry, cracked skin breaks down the barrier against infection. Note any skin condition concerns in the household medical profile.

People with wounds or surgical sites

Anyone with an open wound, recent surgical incision, or skin condition that breaks the skin barrier needs particular care during emergencies. The first claim on any clean water is wound care. Keep wounds clean and dry. If wound care supplies are running short, prioritize the household's clean water for this use over personal hygiene. See Skills: First Aid for wound care protocols.

Supplies to stock

What to have on hand before an emergency.

A 72-hour hygiene supply fits in a small zippered bag. A 2-week supply fits in a shoebox. The cost is modest; the value during an extended disruption is significant.

Hygiene supplies checklist — 72-hour minimum

Hand sanitizer — 60%+ alcohol, minimum 8oz per person

Unscented bar soap — one bar per person

Unscented wet wipes — 2 packs per person minimum; more for infants and older adults

Toothbrush and travel toothpaste — one per person, already in the go-bag

Dental floss — one roll per household

Dry shampoo — one can per adult

Menstrual supplies — 2-week supply minimum for anyone who uses them

Diapers and/or adult briefs — 3-5 day supply as applicable

Nitrile gloves — one box of 50

Portable toilet or 5-gallon bucket with snap-on seat and at least 10 waste bags

Unscented household bleach — small bottle for surface disinfection

N95 respirators — one per person (serves dual purpose: shelter illness prevention + wildfire smoke)

Heavy-duty garbage bags — for waste containment

Water supply note

This hygiene supply list assumes some access to water for the highest-priority uses (handwashing, dental hygiene, wound care). For water storage, purification, and conservation planning, see Self-Reliance: Water — that is the companion section to this guide's hygiene protocols.

Medical Go-Bag Checklist

Includes a hygiene and sanitation category in the full go-bag checklist.

Emergency hygiene is illness prevention, not just comfort.