The Environmental Cleanliness and Clutter Scale (ECCS) in the management of sanitary risks in dwellings of hoarders in North Italy

Abstract: The aims of this work were to apply the Environmental Cleanliness and Clutter Scale (ECCS) in order to assess domestic squalor in dwellings of hoarders, prevent sanitary risks, and intervene in solving the problem. Methods: The ECCS is a domestic squalor scale, developed as a quantitative descriptive tool, based on ten items and a four-point scale. ECCS was applied in addition to the usual procedure during 40 site inspections in Milan, in two different surveys of dwellings of hoarders (2016 and 2019). A correction only for companion animal hoarders was introduced. Results: In the first investigation, which included animal accumulation, our 20 raters reported six cases of mild squalor and six and eight respectively of moderate and severe squalor. After our correction for animal hoarders’ dwellings, we identified six cases of mild, four of moderate, and ten of severe squalor. In the second part of our assessment involving another 20 home visits, object hoarding only was assessed in order to evaluate the reliability of the ECCS method. We found varying total scores between the operators with different experience on this issue, but the same evaluation of the severity of the squalor in 14/15 (93%) cases therefore resulted in the same type of intervention. Conclusion: The ECCS score made an evaluation of the severity of hoarding/squalor, and supported the Local Health Protection Agency personnel in making decisions about timing and type of intervention.