Developing an effective policy for home hygiene: a risk-based approach

Evaluation of the infection potential in the home suggests that improved hygiene practice could significantly reduce the impact of infectious diseases. Fundamental to developing infection prevention policy for the home is the need to recognise that people live in an environment where all human activities occur, including food and water hygiene, hand hygiene, and hygiene related to care of vulnerable groups. In all these situations, reducing infection risks is based on the same underlying microbiological principles. In developing countries, disposal of human and animal excreta and other waste is often also the responsibility of the family and community. Adopting a holistic approach provides the opportunity for a rational approach to home hygiene based on risk assessment. The International Scientific Forum on Home Hygiene (IFH) believes that to deliver hygiene policy with real health benefits, a risk-based approach must be developed and promoted for the home. A risk-based approach starts from the principle that pathogens are introduced continually into homes on people, food and water, pets, insects and air. Inadequate disposal of human and animal excreta serves to increase this risk. Additionally, sites where stagnant water accumulates, such as sinks, toilets and cleaning cloths can support microbial growth and become a source of infection. By assessing the frequency occurrence of pathogens and potential pathogens on hands, hand and food contact surfaces, laundry, reservoir and reservoir/disseminator sites, together with the potential for transfer in the home, the exposure risk can be assessed.     

手部卫生与医院感染的研究进展

医疗机构中医务人员手上携带的细菌已成为医院感染的主要致病源,这些病原体不仅可从已感染伤口或引流伤口处获得,还可从正常、完整的皮肤区域获得。手的清洗和消毒是防止医院感染的最重要措施之一。论文概述了手清洗、卫生手消毒和外科手消毒的分类定义。并对目前使用的酒精、洗必泰葡萄糖酸盐、碘伏、六氯酚、三氯生等各类手卫生产品的作用机理、效果对比及其特点进行了讨论。总结了手卫生存在的一些问题,包括医护人员手卫生遵守率低下,医疗机构对手卫生的重视不足,细菌对消毒剂敏感度的降低和消毒剂使用中发生的接触性皮炎等。并就如何降低接触性皮炎的发生率、减少杀菌剂不利效果的方法、提高手卫生遵守率等一些最新的旨在改进手卫生状况的策略和对策进行阐述。     

Street foods in Accra,Ghana: how safe are they?

OBJECTIVE: To investigate the microbial quality of foods sold on streets of Accra and factors predisposing to their contamination. METHODS: Structured questionnaires were used to collect data from 117 street vendors on their vital statistics, personal hygiene, food hygiene and knowledge of foodborne illness. Standard methods were used for the enumeration, isolation, and identification of bacteria. FINDINGS: Most vendors were educated and exhibited good hygiene behaviour. Diarrhoea was defined as the passage of > or =3 stools per day) by 110 vendors (94.0%), but none associated diarrhoea with bloody stools; only 21 (17.9%) associated diarrhoea with germs. The surroundings of the vending sites were clean, but four sites (3.4%) were classified as very dirty. The cooking of food well in advance of consumption, exposure of food to flies, and working with food at ground level and by hand were likely risk factors for contamination. Examinations were made of 511 menu items, classified as breakfast/snack foods, main dishes, soups and sauces, and cold dishes. Mesophilic bacteria were detected in 356 foods (69.7%): 28 contained Bacillus cereus (5.5%), 163 contained Staphylococcus aureus (31.9%) and 172 contained Enterobacteriaceae (33.7%). The microbial quality of most of the foods was within the acceptable limits but samples of salads, macaroni, fufu, omo tuo and red pepper had unacceptable levels of contamination. Shigella sonnei and enteroaggregative Escherichia coli were isolated from macaroni, rice, and tomato stew, and Salmonella arizonae from light soup. CONCLUSION: Street foods can be sources of enteropathogens. Vendors should therefore receive education in food hygiene. Special attention should be given to the causes of diarrhoea, the transmission of diarrhoeal pathogens, the handling of equipment and cooked food, hand-washing practices and environmental hygiene.     

Importance of disinfection as a means of prevention in our changing world hygiene and the home

Contrary to expectation, the risks of infection are growing rather than declining, even in everyday life. After all, who is able to make a distinction between cleanliness and hygiene? This situation is further compounded by the growing number of persons who are susceptible to infections. If one wants to combat infectious diseases in an economically feasible and consistent manner, public support must be sought. In turn, the public have a right to be informed in a proper and responsible manner. The difference between “dirt” and “contamination” must be highlighted once again.To create a forum for everyday hygiene, an international expert working group was set up (http://www.ifh-homehygiene.org). The hallmark of this group is its holistic view of hygiene in the family setting, something that is not true in the case of most public health sectors. Based on the latest study results, the International Forum for Hygiene (IFH) has coined a new motto “Selective Hygiene”, and evaluates the causes of infection so as to be able to react in an appropriate manner. The aim cannot be routine, daily repetitive decontamination of all potentially dangerous microbes that are found in a normal household, but rather selective reaction to important transmission processes, i.e. hands and foodstuffs, kitchen, bathroom and toilet. The motto can be summarized as follows: “Do the right thing at the right time”. This, however, calls for an understanding of the risks and of effective procedures for microbial reduction. Depending on the respective circumstances, hands can be washed with running water or by using a hand disinfectant. Even experts must learn that hygiene in the home must be evaluated differently from that of the hospital setting. The comparatively lower risk is offset by markedly less awareness of the risks involved. These risks can be significantly increased by any members of the household who are ill. Hence in some cases it is advisable to use disinfectants in the home too – even if it is claimed in certain quarters that we have become “too clean”, and have thus lower immunity. Study data demonstrate that disinfectants have become indispensable in the household in the context of “selective hygiene strategies” so as to prevent infectious diseases.     

The infection potential in the home and the role of hygiene: historical and current perspectives

The control of infection through hygiene has a long erratic history. Personal hygiene and handwashing was less appreciated in the past, since it was not known that invisible organisms could spread from apparently clean hands and surfaces. The role of a hygienic home environment received little attention until the 19th century. Since then, the modern tradition of hygiene has served us well, with improved water and drainage developing alongside vaccination, antibiotics, water purification, improved food production and hygienic food preparation and storage. Two major epidemiological trends are relevant to hygiene perspectives: the decline in the morbidity and mortality from infection, and the transition towards higher levels of chronic or debilitating disease. While mortality from some infections has decreased, communicable disease is no less prevalent. Infectious intestinal disease is still unacceptably high in both developed and developing countries. The control of infection within the home needs to take account of changing epidemiological trends, emphasis on evidence-based approaches and loss of public awareness of the role of hygiene. In earlier eras lack of research on the home environment prevented sufficient attention to infection transmission in the domestic setting. Recent research has demonstrated how microbial contamination can be transmitted by activities in the home. Application of this knowledge could significantly reduce the continuing impact of infectious diseases in our communities.     

Handwashing: a simple, economical and effective method for preventing nosocomial infections in intensive care units

As most nosocomial infections are thought to be transmitted by the hands of healthcare workers, handwashing is considered to be the single most important intervention to prevent nosocomial infections. However, studies have shown that handwashing practices are poor, especially among medical personnel. This review gives an overview of handwashing in health care and in the community, including some aspects that have attracted little attention, such as hand drying and cultural issues determining hand hygiene behaviour. Hand hygiene is the most effective measure for interrupting the transmission of micro-organisms which cause infection, both in the community and in the healthcare setting. Using hand hygiene as a sole measure to reduce infection is unlikely to be successful when other factors in infection control, such as environmental hygiene, crowding, staffing levels and education, are inadequate. Hand hygiene must be part of an integrated approach to infection control. Compliance with hand hygiene recommendations is poor worldwide. While the techniques involved in hand hygiene are simple, the complex interdependence of factors that determine hand hygiene behaviour makes the study of hand hygiene complex. It is now recognized that improving compliance with hand hygiene recommendations depends on altering human behaviour. Input from behavioural and social sciences is essential when designing studies to investigate compliance. Interventions to increase compliance with hand hygiene practices must be appropriate for different cultural and social needs.     

Historische Entwicklung und aktuelle Anforderungen an die ?rztliche Aus-, Fort- und Weiterbildung in der Hygiene und Infektionspr?vention

New risks in nosocomial infections and the dramatic increase in antibiotic-resistant pathogens in healthcare facilities have pointed to the urgent need for a good education of students and practitioners in the basics of hospital hygiene and infection prevention. On the other hand in the last 10 years a large number of institutes of hygiene in universities were closed with remarkable consequences concerning the decreased education in modern hygiene and public health. A broad historical overview over the last 200 years of teaching hygiene and public health at German universities is given which was integrated into the education of medical students. Nowadays many universities do not teach modern hygiene and public health. The demand of re-establishing new institutes of hygiene by the German Medical Council is discussed. The curriculum for the formation of hospital hygienists is presented.     

Importance of environmental decontamination--a critical view

The level of evidence supporting different disinfection and cleaning procedures performed in healthcare settings worldwide is low. With respect to environmental surfaces, the final assessment of whether use of disinfectants rather than detergents alone reduces nosocomial infection rates in different clinical settings still awaits conclusive study. It must be kept in mind that the effect of surface disinfection is only transient microbial contamination will have reached its former level within a few hours. While resistance to biocides is generally not judged to be as critical as antibiotic resistance, scientific data support the need for proper use, i.e. avoidance of widespread application, especially in low concentrations and in consumer products. The decontamination ability of the substances used; prevention of resistance; and safety for patients, personnel and the environment; are the cornerstones that interact with each other. Future work should focus on this complex background. Targeted disinfection of environmental surfaces (those frequently touched) is an established component of infection control activities to prevent the spread of nosocomial (multi-resistant) pathogens, but of lesser importance than proper hand hygiene. However, since the use of disinfectants may pose a danger to staff, patients and the environment, prudent use combined with the application of proven safety precautions is important. Since emerging resistant pathogens will challenge healthcare facilities in future even more than today, well-designed studies addressing the role of disinfection in the healthcare-setting are needed.     

烧伤病区医务人员手污染带菌状况调查

目的 了解烧伤病区医务人员手卫生的现状,为有效预防控制烧伤病区医院感染的发生,提供参考依据.方法 随机抽取30名烧伤病区医务人员,对其手进行采样并送细菌培养.结果 受检的30名烧伤病区医务人员手细菌平均菌落数是105.42 CFU/cm~2,个人手最高带菌1093 CFU/cm~2;手部携带菌群以枯草芽胞杆菌黑色变种芽胞、微球菌属、金黄色葡萄球菌为主,分别为:40.91%、36.36%、13.64%.结论 烧伤病区医务人员手卫生现状不容乐观,加强手卫生宣传教育,提高医务人员手卫生执行率,是预防与控制烧伤病区医院感染的重要措施之一.     

Observation of Hand Hygiene Practices in Home Health Care

ObjectiveTo describe nurse hand hygiene practices in the home health care (HHC) setting, nurse adherence to hand hygiene guidelines, and factors associated with hand hygiene opportunities during home care visits.DesignObservational study of nurse hand hygiene practices.Settingand Participants: Licensed practical/vocational and registered nurses were observed in the homes of patients being served by a large nonprofit HHC agency.MethodsTwo researchers observed 400 home care visits conducted by 50 nurses. The World Health Organization's “5 Moments for Hand Hygiene” validated observation tool was used to record opportunities and actual practices of hand hygiene, with 3 additional opportunities specific to the HHC setting. Patient assessment data available in the agency electronic health record and a nurse demographic questionnaire were also collected to describe patients and nurse participants.ResultsA total of 2014 opportunities were observed. On arrival in the home was the most frequent opportunity (n = 384), the least frequent was after touching a patient's surroundings (n = 43). The average hand hygiene adherence rate was 45.6% after adjusting for clustering at the nurse level. Adherence was highest after contact with body fluid (65.1%) and lowest after touching a patient (29.5%). The number of hand hygiene opportunities was higher when patients being served were at increased risk of an infection-related emergency department visit or hospitalization and when the home environment was observed to be “dirty.” No nurse or patient demographic characteristics were associated with the rate of nurse hand hygiene adherence.Conclusions and ImplicationsHand hygiene adherence in HHC is suboptimal, with rates mirroring those reported in hospital and outpatient settings. The connection between poor hand hygiene and infection transmission has been well studied, and it has received widespread attention with the outbreak of SARS-CoV-2. Agencies can use results found in this study to better inform quality improvement initiatives.     

集中隔离医学观察场所感染防控专家共识

 为科学指导新型冠状病毒肺炎(以下简称新冠肺炎, COVID-19)疫情期间集中隔离医学观察场所内感染防控工作, 在早期有效识别感染者的同时, 有效避免集中隔离医学观察场所内的交叉感染, 中华预防医学会医院感染控制分会、中国医院协会医院感染管理专业委员会、中国感染控制杂志编辑部组织有关专家共同制定本共识。本共识适用于确诊病例、疑似病例、无症状感染者的密切接触者、密切接触者的密切接触者, 以及入境人员或其他根据防控工作需要"应隔尽隔"人员开展集中隔离医学观察时所设置的集中隔离医学观察场所, 指导其工作人员正确做好个人防护及防止感染传播工作, 避免发生场所内感染及传播。本共识借鉴医疗机构内新型冠状病毒感染防控的基本原则、文件规范, 结合集中隔离医学观察场所的特点与实际工作情况, 对不同区域工作人员、工作环节开展新型冠状病毒传播的风险评估, 并据此对集中隔离医学观察场所的感染防控组织架构、选址布局、人员防护、人员闭环管理、清洁消毒、环境核酸监测、人员健康监测、职业暴露处理及交叉感染判定原则等感控相关工作给予指导。     

住院患者多药耐药菌感染的监测分析

目的 调查住院患者多药耐药菌感染的情况,为预防控制医院感染提供依据.方法 对2009年1月-2010年12月检出的耐甲氧西林金黄色葡萄球菌(MRSA)、耐万古霉素肠球菌(VRE)、耐碳青霉烯类铜绿假单胞菌和泛耐药鲍氏不动杆菌进行统计分析.结果 多药耐药菌感染部位以呼吸系统为主,占73.1％；神经外科、ICU多药耐药菌感染较严重,分别占总感染数的30.0％、27.0％；MRSA、泛耐药鲍氏不动杆菌,已成为医院多药耐药菌感染的主要致病菌.结论 加强对多药耐药菌的监测,合理使用抗菌药物,做好消毒隔离及手卫生,可有效防止耐药菌株的流行和传播.     

Respiratory Practices in the Long-term Care Setting: A Human Factors–Based Risk Analysis

ObjectiveTo systematically assess safety risks pertaining to tracheostomy care in the long-term care (LTC) setting using a human factors engineering approach.DesignWe utilized a 5-part approach to complete our proactive risk assessment: (1) performed a hierarchical task analysis of the processes of tracheostomy stoma and suctioning; (2) identified failure modes where a subtask may be completed inappropriately; (3) prioritized each failure mode based on a risk priority scale; (4) identified contributing factors to and consequences for each of the prioritized failure modes; and (5) identified potential solutions to eliminate or mitigate risks.SettingThree high-acuity LTC facilities with ventilator units across Maryland.MethodsThe hierarchical task analysis was conducted jointly by 2 human-factors experts and an infectious disease physician based on respiratory care policies from the Centers for Disease Control and Prevention and existing policies at each LTC facility. The findings were used to guide direct observations with contextual inquiry and focus group sessions to assess safety risks for residents receiving tracheostomy care.ResultsDirect observations of tracheostomy care and suctioning in the LTC setting revealed significant variations in practice. Respiratory therapists working in LTC reported lack of training and ambiguity concerning recommended procedures to reduce infection transmission in daily care. Highest risk steps identified in tracheostomy care and suctioning included hand hygiene, donning gloves, and providing intermittent suctioning as the suction catheter was withdrawn. Participants identified risk mitigation strategies targeting these high-risk failure modes that addressed contributing factors related to 5 work system components: person (knowledge and competency), task (eg, urgency or time constraints), tools and technology (eg, availability of hand sanitizer), environment (eg, communal rooms), and organization (eg, patient safety culture).Conclusions and implicationsHuman factors analysis of the highest-risk steps in respiratory care activities in the LTC setting suggest several potential mitigation strategies to decrease the risk of infection transmission. Clear procedure guidelines with training are needed to reduce ambiguity and improve care in this setting. Involving frontline staff in patient safety issues using human factors principles and risk analysis may encourage participation and improve the infection prevention culture in LTC.     

HACCP and food hygiene in hospitals: knowledge, attitudes, and practices of food-services staff in Calabria, Italy. Collaborative Group.

OBJECTIVES: To determine adherence to Hazard Analysis and Critical Control Points (HACCP) methods and to evaluate knowledge, attitudes, and practices of food-services staff with regard to food hygiene in hospitals. DESIGN: A survey. PARTICIPANTS: Hospital medical directors and food-services staff of 36 hospitals in Calabria, Italy. METHODS: A questionnaire about hospital characteristics, food-services organization, and measures and procedures for the control and prevention of foodborne diseases was sent to medical directors; a questionnaire about demographic and practice characteristics, knowledge, attitudes, and behaviors about control and prevention of foodborne diseases was sent to food-services staff. Multiple logistic regression analysis was performed. RESULTS: Only 54% of the 27 responding hospitals were using the HACCP system and, of those using HACCP, 79% adopted a food-hygiene-practice manual; more than one half already had developed written procedures for food storage, personal hygiene, cleaning and disinfection; one half or less performed microbiological assessment of foods and surfaces. Of the 290 food-services staff who responded, 78.8% were aware of the five leading foodborne pathogens; this knowledge was significantly higher among those with a higher educational level and those who worked in hospitals that had implemented the HACCP system. Younger staff and those who had attended continuing educational courses about food hygiene and hospital foodborne diseases had a significantly higher knowledge of safe temperatures for food storage. A positive attitude toward foodborne-diseases prevention was reported by the great majority, and it was significantly higher in older respondents and in those working in hospitals with a lower number of beds. Only 54.9% of those involved in touching or serving unwrapped raw or cooked foods routinely used gloves during this activity; this practice was significantly greater among younger respondents and in those working in hospitals using HACCP. CONCLUSION: Full implementation of the HACCP system and infection control policies in hospital food services is needed.     

What is left to justify the use of chlorhexidine in hand hygiene?

The CDC guideline for hand hygiene describes chlorhexidine gluconate as an agent with "substantial residual activity". But not all studies support this claim. In both suspension tests (e.g. EN 13727) and tests under practical conditions (e.g. EN 1500) it is crucial to neutralize any residual activity in the sampling fluid in order to make sure that the agent does not continue to damage surviving cells after exposure. The neutralization step must also be validated. If this is not done the efficacy may be significantly overestimated, and the healthcare professional may rely on data which do not represent the true efficacy of an agent. A review of eight studies which are cited to support "substantial residual activity" show that none of them were performed with validated neutralization. Seven of them do not demonstrate any residual activity for chlorhexidine gluconate. Only in one study some residual activity is described but the validity of the study design does not allow make this claim as no neutralizing agents were used at all. The benefits of using an active agent must outweigh any risks in order to justify its use. If no real benefits are left for chlorhexidine gluconate in hand hygiene, all the risks count even more such as skin irritation, allergic reactions including anaphylactic shock, and acquired bacterial resistance. Unless there is new and valid evidence to clearly support a benefit of using chlorhexidine gluconate in hand hygiene, healthcare workers should prefer formulations without this agent.     

连云港市第一人民医院感染病区医护人员手卫生依从性调查及对策

目的分析了解连云港市第一人民医院感染病区医护人员手卫生依从性的现状,探讨一系列科学、合理、切实可行的手卫生干预方法,以提高医护人员手卫生的依从性。方法采用自行设计的调查问卷并结合现场观察手卫生过程的方法,了解感染病区医护人员对手卫生知晓情况,评估医护人员手卫生的依从性。结果感染病区86.0%的医护人员接受过手卫生知识的培训,但手卫生依从性仅为45.8%。接触患者前的手卫生依从性仅为30%,接触2位患者之间手消毒依从性仅为35.0%,接触患者后的手卫生依从性达90.0%。结论医护人员手卫生的意识薄弱,手卫生相关知识缺乏,手卫生管理制度落实不到位。有必要总结一套合理有效的干预方案提高医护人员手卫生的依从性,降低医院感染率,减轻患者痛苦和经济损失。     

浅谈预防门急诊输液室医院内感染的护理

目的:预防门急诊输液室院内感染。方法:通过对门急诊输液室的合理布局、严格无菌操作、加强手卫生进行有效管理、监控。结果:采取行之有效的护理措施是防止输液室院内感染发生的前提。结论:落实护理措施能有效预防门急诊输液室院内感染的发生。     

Energy forest irrigated with wastewater: a comparative microbial risk assessment

In this study, risks for human infection associated with irrigation of municipal wastewater on short rotation willow coppice (Salix) were evaluated in three countries. The aim was also to determine the reduction of indicator organisms and pathogens in the treatment plants. Two of the field sites were chosen for further evaluation by QMRA (quantitative microbial risk assessment) applied to three scenarios: accidental ingestions of wastewater, exposure to aerosols and ingestion of groundwater. The risks of infection for bacteria (Salmonella), virus (rotavirus) and protozoa (Giardia, Cryptosporidium) were characterised as probability of infections per exposure and number of infections per year.     

Orf virus infection in humans--New York, Illinois, California, and Tennessee, 2004-2005

Orf virus is a zoonotic parapoxvirus endemic to most countries in the world and is principally associated with small ruminants (e.g., sheep and goats). Human orf infections appear as ulcerative skin lesions after contact with an infected animal or contaminated fomite. This report summarizes the epidemiologic and laboratory investigations of four sporadic cases of human orf infection, emphasizing the temporal association between human lesions and skin trauma or recent flock vaccination with live orf vaccine. This zoonotic infection shares clinical manifestations and exposure risks with other, potentially life-threatening zoonoses (e.g., cutaneous anthrax) and is likely under-recognized because of a lack of clinical suspicion and widely available diagnostics. Barrier precautions and proper hand hygiene are recommended for the prevention of orf virus infection in humans.     

县级医院护士手卫生依从性调查分析

目的了解县级医院护士洗手依从性现状,分析影响护士洗手依从性的相关因素。方法采用分层抽样方法,抽取XX县医院、县妇幼医院、县中医医院、县骨科医院300名护士进行调查。采用自制手卫生知识问卷、洗手依从性问卷、洗手健康信念问卷,并进行统计分析。结果共回收有效问卷288份,护士洗手依从性得分为61.73±22.62),得分率为74.66%。影响因素为洗手行动障碍,是否接受过预防知识的培训,所在的医院和科室环境等。结论县级医院护士洗手的依从性低,存在医院感染隐患,需要从各方面进行改进以提高护士洗手依从性。