Hygiene, Volume 3, Issue 4 (December 2023) – 11 articles

Disinfectants purchased from retail outlets form the cornerstone of infection control and prevention within the domestic household. The growing utilisation of the concept of “hospital-at-home” places greater emphasis on domestic disinfection by the householder in helping to prevent the acquisition of infections within the home. No reports or data exist that indicate how readable the information provided on disinfectants is, which would help householders use disinfectants optimally. The aim of this study was therefore to quantitatively examine the readability (Flesch Reading Ease; Flesch–Kinkaid Grade Level; text metrics) of consumer (public)-facing information (n = 108) of domestic household disinfectants sourced from (i) UK high street supermarket chains (n = 4) and (ii) disinfectant manufacturers (n = 6). The readability of all supermarket and manufacturer information (n = 108) gave a mean Flesch Reading Ease score of 51.7 (target ≥ 60) and a Flesch–Kinkaid Grade Level score of 8.1 (target ≤ 8), thereby failing to achieve readability reference target values. Authors preparing information on the domestic use of disinfectants should be aware of the value of quantitative readability metrics and online tools to help support their writing of such information in order to produce materials which are within target readability values, thereby further supporting health literacy in this population and disinfectant efficacy. Full article

Providing safely managed sanitation/hygiene requires key competencies for education, training, service delivery, enterprise development and management, product and infrastructure design and development, construction and installation, governance, financing, research, etc. These strategic sanitation capacities will have to be built from higher education’s academic and professional programmes structured and designed to produce skilled and knowledgeable professionals and practitioners. This study aims to investigate the quality of the sanitation/hygiene management content of Environmental Health programmes; the adequacy of the existing central curricula; and the perception of environmental health sanitation/hygiene-trained professionals to determine the next phase for building knowledge and capacity of sanitation professionals in Nigeria through higher education institutions. A multi-level mixed method concurrent study was used for sampling and data collection with a multi-level perception analysis to examine the perceptions of students, lecturers and graduate alumni, as well as employers/supervisors and clients/service users of sanitation/hygiene-related graduates. The main findings of this paper show a limited understanding of the concepts of contemporary issues of sanitation/hygiene management like sustainable sanitation, citywide inclusive sanitation, regenerative sanitation, circular bioeconomy, etc.; the central/national teaching and curricula were found to be seriously out of date; and clients/service users were dissatisfied with the skills and knowledge levels of the graduates. The study concludes by recommending a national sanitation management higher education pathway to guide the provision of integrated sanitation/hygiene management education at higher education institutions (HEIs), to build an effective, efficient, competent and sufficient workforce for the country. Full article

Hospital-acquired infections are a significant concern in healthcare settings, leading to patient safety risks, increased morbidity and mortality, and financial burdens. Hand hygiene is crucial in preventing the spread of bacteria in hospitals and communities. Manual hand sanitizer dispensers can harbor presumptive pathogenic bacteria and act as fomites for bacterial transmission. This study aimed to assess the microbial contamination of manual hand sanitizer dispensers in a hospital setting and to study their antibiotic resistance profiles. Samples were collected using sterile cotton swabs and then inoculated into brain heart infusion broth. Subsequent subcultures were performed on both blood and MacConkey agar. The isolates were then identified using the Bruker MALDI Biotyper (Bruker Daltonik, Bremen, Germany) to the species level. Sampling was conducted in various wards and in the hospital and the University areas on dispenser levers and nozzle areas. The results showed that all samples yielded one or more bacterial species. Bacterial isolates identified belonged to species commonly found on the skin microflora and some Gram-negative enteric bacilli. Higher colonization was observed on the dispenser lever. Among Gram⁺ microorganisms, most bacterial species were shown to be sensitive to β-lactams, with the exception of Staphylococcus spp., resistant to AMP (Ampicillin) and Penicillin. However, no Methicillin resistant isolates were detected. Gram⁻ microorganisms such as Pseudomonas luteola were shown to be sensitive to all tested antibiotics, while Pantoea agglomerans was shown to be resistant to AMC (amoxicillin–clavulanic acid). Rifampicin tested only against Bacilli showed resistance. Based on the findings, it is recommended to implement systematic cleaning and proper maintenance of manual dispenser areas or to use automated dispensers to reduce hand contact and minimize microbial contamination. Monitoring the presence of microorganisms in hand sanitizing gels and dispensers is an essential infection control strategy. Full article

Brazil faces many types of pollution, including atmospheric CO₂ pollution due to Amazon deforestation, pollution by heavy metals, microplastics, pesticides, pathogens, and other classes of environmental contaminants. Pathogen pollution refers to (I) the introduction of a pathogen to a new host species or population and (II) a concept used in the study of pathogenic organisms in water or terrestrial ecosystems. Anthropogenic activities are the leading forces of pathogen pollution in both contexts previously cited. In this Opinion article, we discuss the impacts of pathogen pollution on public health, infectious diseases emergence, and ecosystems using mosquito- and water-borne viral diseases in Brazil as case studies. Finally, we advocate improvements and expansion in sanitation systems, considering sewage treatment and soil waste management, as an umbrella factor to minimize risks and spreading of pathogen pollution in Brazil. Full article

The recommendations for the wear and hygiene of ocular prostheses can vary among practitioners, and it is still a controversial theme in the literature. This clinical trial evaluated the microbial load, tissue health of the socket, and the participants’ opinions before and after the use of two hygiene protocols. Thirty ocular prosthesis wearers used either a Daily Protocol (DPt: hygiene once a day) or Weekly Protocol (WPt: hygiene once a week) for 5 weeks with a washout of 7 days. The microbial load was quantified by the colony-forming unit count of the aerobic bacteria, Candida spp., Staphylococcus spp., and Gram-negative bacteria. The tissue health of the socket was evaluated by scores, and patients’ opinion of the protocols was evaluated using the analogic visual scale (VAS). Data were analyzed by ANOVA Repeated Measures, Friedman, Cochran’s Q Test, Wilcoxon, Fisher, and Pearson’s chi-square tests considering p < 0.05. There was no difference in the microbial load of the microorganisms (p > 0.05). Both protocols improved socket inflammation (p = 0.005) and discharge (p < 0.001); DPt improved edema (p = 0.021) and crusting (p = 0.020). There was no difference in patients’ rating responses (VAS) for all the questions of patients’ opinion (Q1: p = 1.0; Q2: p = 1.0; Q3: p = 1.0; Q4: p = 1.0; Q5: p = 1.0; Q6: p = 0.317; Q7: p = 1.0; Q8: p = 0.159). There was a correlation between eye drops/edema (p = 0.030), eye drops/pain (p = 0.016), microbial load with discharge, inflammation, eyelid edema, and pain. Inflammation was correlated with edema at baseline (p < 0.001) and after DPt (p = 0.018), and with crusting at baseline (p = 0.003); edema was correlated with crusting at baseline (p < 0.001); crusting was correlated with discharge after WPt (p < 0.001). The protocols showed no effects on the microbial load of the anophthalmic socket and ocular prosthesis. However, better tissue health and patient acceptance were observed after both regimens. Full article

In social cognitive theory, self-efficacy refers to the belief of a person in their own capacity to successfully perform certain tasks or behaviors. This study measured the self-efficacy of health professionals in hand hygiene (HH) and glove usage (GU) during the COVID-19 pandemic. It was an observational Brazilian multicenter study with a cross-sectional design with an online application of an instrument measuring the self-efficacy of health professionals in HH and GU. Health professionals (n = 193) participated in this study: 96 (49.7%) were nursing professionals, 38 (20.2%) were dental professionals, 21 (10.9%) were physicians, 10 (5.2%) were pharmacists, and 27 (14.0%) were other health professionals. Regarding the instrument applied, the maximum score (100 points) was achieved by 167 (86.5%) participants on Question 2 (confidence in regular routine behaviors), and the lowest scores achieved were 0, 10, 30, 40, and 50 points, referring to 18 (9.3%) participants, on Question 14 (the influence of management’s conduct related to practices). A total of 64.1% dental professionals, 57.1% of physicians, 39.6% of nurses, 20.0% of pharmacists, and 55.6% of other health professionals were classified as having self-efficacy. There was only a significant association between being a dental professional and having self-efficacy regarding HH and GU during the COVID-19 pandemic in relation to other health professional categories. Full article

Good hand hygiene has proven to be essential in reducing the uncontrolled spread of human pathogens. Cold atmospheric plasma (CAP) may provide an alternative to disinfecting hands with ethanol-based handrubs when handwashing facilities are unavailable. CAP can be safely applied to the skin if the energy is well controlled. In this study, radio frequency (RF) and direct current (DC) plasma sources were built with a pin-to-mesh electrodes configuration inside a fused silica tube with a 5 mm inner diameter. Microbiological assays based on EN 13697:2015+A1:2019 using Escherichia coli DSM 682 or Staphylococcus epidermidis DSM 20044 were used to examine the antimicrobial effect of various plasma conditions. Metal and silicone disks that model skin were used as inoculation matrices. The prototype air RF CAP achieved significant disinfection in the MHz range on stainless steel and silicone substrates. This is equivalent to half the performance of direct current CAP, which is only effective on conductive substrates. Using only electricity and air CAP could, with further optimization to increase its efficacy, replace or complement current hand disinfection methods, and mitigate the economic burden of public health crises in the future. Full article

In the United States, there has been a long history of environmental injustice that disproportionately affects racial and ethnic minorities and low-income communities due to racially targeted policies and widespread discrimination. Environmental racism can be revealed in housing discrimination that perpetuates inequities in exposure to environmental pollutants. Biased credit and mortgaging practices such as redlining have led to housing segregation of racial and ethnic minorities in the USA, permitting policymakers to diminish and disinvest in these communities. The COVID-19 pandemic has amplified housing instability for families of color, including Black and Hispanic/Latinx communities, putting them at increased risk for COVID-19 exposure. There is a need to investigate how environmental injustice intensifies the COVID-19 pandemic, illuminates racial and ethnic inequities in exposure to environmental contaminants, and fuels disparities in COVID-19 outcomes. The aims of this paper are to analyze and discuss environmental injustice and racial and ethnic disparities related to COVID-19 and housing. We also propose recommendations to address this pervasive issue. Full article

Bearing in mind the socio-economic consequences of COVID-19 on airports and passengers, this study considers cleaning and hygiene a top priority in airports and airlines’ operating processes. Both airport operators and passengers should be aware that the COVID-19 pathogen has not yet gone away and, thus, continues to spread despite mass vaccination. In this context, this paper’s objective is to show the importance of cleaning and hygiene in the air transport industry to encourage the passengers’ confidence in making decisions to travel on commercial airlines and help airport and airline operators make better decisions in their efforts to improve the cleaning and hygiene protocols. Passengers’ awareness of hygiene and cleanliness has increased, but unfortunately, airports and airlines have reduced cleaning and hygiene activities to save costs. Although there is much to do to help the aviation sector recover, we also see plenty of reasons to be optimistic about the air transport industry’s future, as long as airport and airline operators can guarantee an adequate quality of service with regard to cleaning and hygiene in order to ensure passengers’ safety and well-being. Airports and airlines cannot lower their guard because the SARS, H1N1, MERS, and COVID-19 viruses remain active in society. Full article

Adolescents are vulnerable to marketing and normalization of electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS). ENDS/ENNDS have lung and neurological impacts and a potential for oral health consequences. The aim of this study is to compare adolescents who use ENDS/ENNDS with adolescents who do not use ENDS/ENNDS in oral healthcare needs. A cross-sectional design was used with U.S. Population Assessment of Tobacco and Health wave 5 (PATH5; 2018–2019) data, (n = 12,098 adolescents, ages 12–18 years). The Wave 5 response, weighted to be nationally representative was 83.5%. This study included 9538 adolescent/parent dyads. The outcome variable was parent/guardian report of their child’s oral health need(s). The independent variable was self-reported current use/non-use of ENDS/ENNDS. Chi square and logistic regression analyses for oral health need were conducted. The Adjusted Odds Ratio for oral health needs comparing ENDS/ENNDS use vs. no use was 1.26 (95% CI: 1.01, 1.58; p = 0.0451) controlling for sex/gender, age, race, highest education in the household, physical activity of 60 min daily, self-perceived health, and language spoken at home. ENDS/ENNDS use continues to be a public health concern for U.S. youth. In this study, adolescents who used ENDS/ENNDS were more likely to have oral healthcare need than adolescents who did not use ENDS/ENNDS. Full article

The purpose of this study was to investigate the knowledge, attitudes, and behaviors of Greek undergraduate students on hand hygiene and mobile phone hygiene, in relation to their mobile phones’ microbial load. An anonymous self-reported questionnaire was distributed among 100 students and swabs were taken from their devices for microbiological cultures and for an on-site bioluminescence microbial load assessment. Hand washing was considered the most effective personal protective behavior by the majority (89%), while spatial restrictions (40%) and forgetfulness (31%) were the main reasons for neglecting hand washing. Most students washed their hands 6–10 times/day (32%) for approximately 11–20 s (35%). Although most devices were cleaned/disinfected within the last week (28%), many were contaminated with Staphylococcus saprophyticus (84%), Staphylococcus aureus (13%), and Escherichia coli (39%), while 75% of the samples exceeded the “fail” threshold limit of the luminometer’s measurements. Moreover, statistically significant differences (p < 0.05) were found between the devices’ microbial load and certain hand hygiene behaviors and preferences. The median cfu/cm² of Escherichia coli was higher among first-year students of health sciences, while Staphylococcus aureus was more prevalent in females’ than in males’ mobile phones. It w therefore understood that undergraduate students’ knowledge, attitudes, and behaviors on hand hygiene and mobile phone hygiene are highly intertwined with the microbial load on their mobile phones. Full article