Home Visitor’s Guide to Helping Families Reduce the Spread of Illness

Home visitors are in a unique position to support children’s health and family well-being. There are many everyday moments when you can talk about health with families. These conversations can support activities in a home-visiting curriculum and help families achieve their wellness goals.

Use this resource to:

• Learn about germs and healthy behaviors to reduce the spread of germs that may cause illness.
• Consider when and how to share health information with families during home visits.
• Understand how to talk about and model simple actions for families to reduce the spread of illness at home.

Important Facts About Germs and Preventing Illness

Remember that:

• Germs are a normal part of daily life. Some are good and help our bodies, and some make us sick.
• Germs are often known by the illnesses they cause, such as the common cold, strep throat, or flu.
• Germs are everywhere and are so small we cannot see them. Reducing the number of germs on hands and surfaces is the best way to avoid spreading illness.
• Children easily pick up and spread germs because they explore using their senses, for example, by touching and putting objects in their mouths.
• Because children pick up a lot of germs, it is normal for them to get mildly sick often.
• An environment cannot be germ-free. But there are steps that can keep germs at low levels and less likely to make people sick.

Learn More About Healthy Behaviors

These three simple behaviors can help everyone stay healthy:

• Hand-washing
• Covering a cough or sneeze
• Cleaning surfaces

Hand-washing

Research shows hand-washing prevents up to 30% of illnesses. This means more healthy days and less missed school or work! Hands pick up germs from everything they touch and then spread them around. Germs on the hands can enter the body and make us sick. Touching food, eyes, nose, mouth, or any area on the body where the skin is broken (e.g., a cut or rash) can let germs into the body.

When healthy behaviors are part of a daily routine, adults and children are more likely to remember to do them.

For example, washing hands should be a regular part of everyone’s daily routines. Important times to wash hands include the following:

• Before eating, feeding, or preparing food. This prevents germs from getting into the mouth from hands.
• After touching saliva (e.g., from feeding or eating), mucus (e.g., from wiping a nose, using a tissue), body fluids (e.g., from using the toilet, diapering), food, animals, or garbage. This prevents the spread of germs from these substances.
• After cleaning. This prevents the spread of germs that may have gotten on your hands.
• When entering the home. This helps avoid you bringing in germs from public places or outside.

Washing with Soap and Water

Hand-washing with soap and water is always the best choice. It removes the dirt you can see and the germs you can’t see. All you need is soap and clean, running water. Washing hands well is important for getting rid of germs that can make us sick. To wash your hands:

Soap Tips
Clean hands need clean soap! Germs can grow on bar soap if it sits in water or is not rinsed after use. Rinse bar soap off before and after using it. Use plain hand soap to wash hands. Antibacterial soap doesn’t do a better job of removing germs and it can harm your health and the environment.

• Wet your hands with clean, running water (warm or cold) and add soap.
• Rub your hands together to make a lather and scrub your hands well. Be sure to scrub the backs of your hands, between your fingers, and under your nails.
• Continue rubbing your hands for at least 20 seconds. To keep the time, you can hum the “Happy Birthday” song twice.
• Rinse your hands.
• Dry them off with an air dryer or clean towel.

Infants and young children need help with hand-washing. Remember to:

• Safely cradle an infant in one arm to wash their hands at a sink.
• Help with hand-washing if the child can stand but not wash their hands by themselves.
• Offer a stool to young children so they may safely reach the sink.

Using Hand Sanitizers

Help families understand when and how to safely use hand sanitizers. Hand sanitizers can be used if soap and running water are not available and hands are not visibly dirty. Watch children to make sure they use hand sanitizer correctly and do not eat it or rub it into their eyes, mouth, or cuts.

Important things to know about hand sanitizer include the following:

• It is poisonous and can catch on fire, so store it out of children’s reach and sight.
• It is effective only when it is at least 60% alcohol.

Covering a Cough or Sneeze

Germs are less likely to spread through the air or land on surfaces when you cover a cough or sneeze.

To cover your cough or sneeze, place a tissue over your mouth and nose (be sure to put it in the garbage afterward). If you don’t have a tissue, cough or sneeze into your upper sleeve or elbow. Then wash your hands, regardless of how you covered your cough or sneeze.

Cleaning Surfaces

Germs spread onto surfaces in different ways. It may be helpful for families to understand even surfaces that look clean should be washed, because we cannot see germs. It is important to clean all surfaces well, including toys and or other objects that a young child might put in their mouth.

Some spaces often have a lot of germs and should be cleaned regularly. In the bathroom, using the toilet and diapering spreads germs from body fluids and poop. These germs spread easily to hands, flushers, and faucets. Regularly wash bathroom surfaces to remove most germs and prevent them from spreading. Pay special attention to the surfaces and objects that an ill person has touched. Cleaning thoroughly can help others in the family avoid getting the same illness.

In the kitchen, make sure food is prepared on clean surfaces. Remember that germs from raw food can get on surfaces and utensils and make people sick. After preparing raw meat, clean anything that it touched immediately before using that surface or utensil to do anything else. To prevent food-borne illness, clean surfaces, separate meat from other food, cook food to the proper temperatures, and chill stored food.

The labels on cleaning products may have the words “cleaning,” “sanitizing,” and “disinfecting.” These mean different things. Remember that:

• Cleaning removes germs and dirt you can see. Soap and water will clean most surfaces.
• Sanitizing reduces germs to a number that is unlikely to cause disease. Sanitizers may be good choices for cleaning surfaces where you eat (such as a table or highchair tray) and for toys that children place in their mouths.
• Disinfecting destroys all germs on surfaces. You may use disinfectants on diaper-changing tables, toilets, and countertops.

To support families when using cleaning products:

• Read labels together and review the instructions.
• When using cleaning products on surfaces that are put in the mouth or touch food, rinse or wipe the area or object with plain water to remove any chemicals.
• Store cleaning products out of reach of children. Some products are dangerous for children.

Help Families Turn Behaviors into Habits

Share what you know about germs, how they cause illness, and why healthy behaviors reduce the spread of germs with families. Help families make behaviors that reduce illness part of their daily routine. When families learn and ask questions during home visits, it can help them understand information their health care provider has given them.

Family members may need your support until the behaviors become a habit — something the whole family does all the time. With support, caregivers will be able to make changes to support their family’s well-being and children’s healthy development.

Have “Health Moments” During Home Visits

“Health moments” are opportunities to share information and strategies to reduce illness. You can use health moments to connect families with their child’s health care provider and work together to promote their child’s health. Below are some examples of everyday health moments when a home visitor can share these behaviors with families.

Health Moment: Entering the Home

To start the conversation, you can ask, “Is it OK if I wash my hands before we start [insert activity]?”

Share the following information with families:

• Our hands can spread germs, making ourselves and other people sick.
• Hand-washing is important for good health because it helps you get rid of germs on your hands.

Practice the following strategies to reduce illness:

• As you wash your hands, point out how you use soap and water to get rid of germs.
• Invite the family to wash their hands with you.

Health Moment: Preparing Food or Putting Away Groceries

To begin the conversation, you can say:

• “I have some information that I like to share with families about washing fruits and vegetables. Would you be interested?”
• “I’ve found that many people don’t know that raw meat can leave germs on the counter. Is this a good time to share some simple steps to follow when cooking or touching raw meat?”

Share the following information with families:

• Some foods, such as raw meats and some fruits and vegetables, have germs that can make people sick, especially infants, children, and pregnant women and pregnant people.
• Washing surfaces and foods can help.

Practice the following strategies to reduce illness:

• Prepare meat separately from other foods to avoid mixing bacteria from raw meat with foods that will not be cooked, like vegetables.
• Wash hands after touching raw meat.
• Wash all counters, dishes, and utensils that touch raw meat.
• Wash fruits and vegetables.
• Avoid tasting food more than once with the same utensil; this action transfers germs from our mouths back to the food, and someone else can pick them up. If you use a spoon or utensil to taste food, set it aside or in the sink to wash.

Health Moment in Action
Lenora, a home visitor, arrives for a visit with Inez and her son Javier. Javier wakes up from a nap with dried mucus on his nose and across his cheek. “Javier, do you have a cold?” Lenora asks. He smiles as his nose continues to run. Inez says Javier has had a cold for a couple of days. He is getting better, but she feels like she is getting a cold now. Lenora knows that Inez is worried about the health of Javier’s grandmother, who lives with them. She asks Inez if anyone has ever explained how to cover a cough or sneeze to make it less likely other people will get sick. Inez asks what she means. Lenora shows Inez a Cover Your Cough brochure in Spanish. Lenora explains covering your nose with your hands can spread germs and get other people sick. “Your hands touch everything,” Lenora explains, “but your upper arm is a safer place for germs.” Inez responds, “I always wondered why people do that. We’ll try it!

Health Moment: Changing the Baby’s Diaper or Helping the Child Use the Toilet

To start the conversation, you can say, “I know you do everything you can to keep your child healthy. I’d like to share some health tips with you that you can use each time you change a diaper or help your child use the toilet. Is this OK to talk about now?”

Share the following information with families:

• Germs can spread from poop and make children and adults sick.
• Washing hands and surfaces can help get rid of many germs.

Practice the following strategies to reduce illness:

• Wash your hands and your baby’s hands with soap and water after using the bathroom, helping a child use the toilet, or changing a diaper.
• Change diapers on a washable surface that is not used to prepare food.
• Wash surfaces used for diapering after changing a child’s diaper.
• Clean the bathroom handles, doorknobs, and faucet regularly.

Health Moment: Sneezing or Coughing

To start the conversation, you can say, “I see that you (or your child) are ill today. It is even more important to pay attention to germs when somebody is sick. I’d like to talk about some things that you may want to do to keep everyone else healthy. Is this all right?”

Celebrate healthy behaviors when you see them!
If you see a caregiver washing their hands after changing their child’s diaper, say something like: “I noticed you washed your hands when you were done. That helps make sure germs do not spread from your baby’s diaper to other places.”

Share the following information with families:

• When you cough or sneeze, it spreads germs into the air and on surfaces.
• Covering a cough or sneeze reduces the spread of germs that make people sick.

Practice the following strategies to reduce illness:

• Practice together how to cover a cough or sneeze with a tissue or elbow. Remember to wash hands afterwards.
• Remind families to pay extra attention to hand-washing and cleaning when someone in the home is ill, especially when families are preparing food.

Ideas for “Health Moment” Learning Activities

Fun learning activities can help families understand why behaviors help prevent illness and keep their families healthy. Doing playful activities with families is an easy way to model and practice behaviors.

Hand-washing can be fun: Most children love to play in water. They often enjoy making bubbles with water and soap, which can make washing hands fun. While practicing hand-washing, caregivers can sing to children as they wash their hands or ask them to count their fingers. Older children can sing, rhyme, count, and practice their independent skills.
Germ handprints: Use flour or cornstarch as “germs.” Sprinkle some flour on a table. Ask the child or caregiver to touch the “germs,” then touch other objects to see how the germs spread:

• Try this in the bathroom. Touch the flusher, faucet, bathtub, and more.
• Try this in the kitchen. Touch the faucet, cabinet handles, and more.
• Help families clean those surfaces afterwards, modeling good cleaning practices.

Spray bottle sneeze: Take a spray bottle and fill it with water. Explain that the water shows how germs spread during a sneeze or cough. Squirt the bottle (away from anyone’s face) to show how a sneeze sends germs into the air that land on the table, counters, and floors. Talk about why it is important to cover a cough, wash hands, and clean surfaces.
Pretend meal: Bring play food on the home visit and have a pretend meal with a toddler or preschool child and their caregiver. Then talk about how hand-washing before eating helps to keep our bodies healthy.
Puppet play: Use a puppet to show how to cover a sneeze or cough. Have the puppet say, “This is how I cover my mouth when I sneeze or cough.” Ask the child if they want to wipe the puppet’s nose with the tissue you have brought. Tell them that the puppet needs to wash its hands after it wipes or blows its nose. You can invite the caregiver to practice these behaviors, too, because children learn from watching what their caregivers do.

Last Updated: January 15, 2025