Background: Access to Healthy Living Practice 2: Washing Clothes and Bedding (HLP2) is broadly important for health and wellbeing and reflects human rights to water and sanitation, housing, and dignity. In remote Aboriginal and Torres Strait Islander communities, access to functional household washing machines and dryers is variable and generally low.
Washing fabrics such as clothes, bedding and towels, is commonly recommended to help control skin infections and prevent the spread of Strep A bacteria. Community laundries are also increasingly funded and promoted on the basis of specific health outcomes, including reductions in skin infections and rheumatic heart disease (RHD) [1].
However, it is not completely understood if Strep A and other skin pathogens survive on environmental surfaces or are transmitted through fabrics. This can lead to inconsistent public health messaging and uncertainty about the importance of HLP2 in managing Strep A infections and RHD.
The aims of our work are to 1) understand the potential for Strep A transmission via fabric fomites and the role of HLP2 in helping to manage skin infections, and 2) ensure that community members have active voices and choices in decision-making processes concerning access to laundry infrastructure that supports their wellbeing and potential health outcomes.
Quantitative research: A systematic literature review of fabric contamination by skin pathogens was conducted [2]. We also ran laboratory experiments using two Strep A strains. There is limited existing evidence for survival of Strep A and scabies on fabrics, but evidence was stronger for other skin pathogens such as staph and tinea. Hot washing or drying at 60°C is considered effective for decontamination. Laboratory experiments showed that the survival of Strep A on fabrics declines rapidly at first but extended low-level survival may occur depending on environmental conditions.
Qualitative research: We used a yarning methodology to privilege the practices, knowledges, experiences and priorities for accessing HLP2 among more than 30 First Peoples from the East Kimberley region (WAAHEC HREC: 1412). Themes explored include historical and contemporary washing and drying practices, barriers and challenges, knowledges and preferences surrounding products, equipment, and services, perceptions of the benefits of washing, and the social and cultural contexts that shape access and practices, including spirituality and kinship.
Conclusions: Fabrics are unlikely to be a major Strep A reservoir or driver of transmission. While HLP2 may contribute to skin health, the effect for Strep A is likely to be modest and mediated primarily through reduction of other skin pathogens. Access to facilities for HLP2 is a human right that is important for wellbeing, but direct connections to RHD are less clear. In the East Kimberley, community beliefs and practices surrounding HLP2 are well-developed. Service delivery and health promotion should be focused on providing ‘choices’ rather than ‘education’.
Governance: This work is grounded in strong Aboriginal leadership and a spirit of reciprocity, respect, and relationship; it sits within a broader NHMRC funded project focused on environmental health initiatives to prevent Strep A infections and acute rheumatic fever, which is led by an Indigenous Governance Council.