Hygiene

With the increased uptake of the COVID-19 vaccination in 2021, universities resumed face-to-face classes and clinical placements. However, even with incentives, some individuals chose not to receive a vaccination due to personal beliefs and other reasons. Understanding motivations for vaccination uptake or vaccine hesitancy is important to help develop future public health strategies. Therefore, a cross-sectional online survey was carried out among students and staff in a UK university to assess the level of vaccination and explore their views on the acceptability of incentives that may encourage uptake. Almost three quarters (74.4%) of the sample had received at least one dose of a COVID-19 vaccine with a higher proportion of staff receiving a vaccine compared to students (80.0% vs. 70.6%, p < 0.001). Vaccine hesitancy or refusal was due to the perceived lack of research and knowledge of the potential long-term effects at the time of vaccination, religious, personal and ethical beliefs and feeling like vaccinations should not be used to restrict social events, travel and medical challenges. This study shows that university staff and students had a relatively high uptake of the COVID-19 vaccination. However, the findings indicate that nearly 20 percent were unsure or unwilling to take the vaccination, therefore suggesting that clearer information and motivational strategies are needed to support the roll out of new vaccines. Full article

The disinfection procedures aim to reduce the microbial load, but there are doubts about the risks of contamination spreading into the lumens of devices, such as three-way stopcocks (3-WS). This study aimed at an in vitro evaluation of the antibacterial procedure of manual friction of 3-WS intentionally contaminated and to determine the solution dispersion into the lumens. Laboratory experiments were developed in two steps: evaluation of bacterial spread through intentional contamination with Staphylococcus aureus and Pseudomonas aeruginosa, and alcohol dispersion into the 3-WS lumens. After manual friction of the 3-WS with saline solution at 0.85% (w/v) [control group], S. aureus and P. aeruginosa were isolated in the lumens of 55.6% and 27.8% of the devices, respectively. However, after the disinfection of the 3-WS with ethyl alcohol at 70% (w/v), there was no bacterial contamination in the lumens of the 3-WS. On the other hand, the solution dispersion (dye) into the lumens was evidenced by two different techniques: Durham tubes (5.6%) and swabs (46.3%). The manual friction of the 3-WS with ethyl alcohol at 70% demonstrated antibacterial efficacy, but it refers to reflections on the risk of solution diffusion into the venous network and the inherent clinical practice situations and patient safety. Full article

As the COVID-19 pandemic begins to abate and national public health systems are treating the SARS-CoV-2 virus as endemic, many public health measures are no longer mandated but remain recommended with voluntary participation. One of these is the wearing of fitted face masks, initially mandated to contain, or at least slow, the spread of SARS-CoV-2, which is primarily transmitted via aerosols emitted while breathing, coughing, or sneezing. Although the habit of once wearing fitted face masks recedes into memory for much of the population, so does the knowledge of the various types of masks that were once en vogue. To create a record for the future, this paper provides the first comprehensive documentation of the nature and range of fitted facemasks that circulated during the COVID-19 pandemic. Full article

This scoping review addresses bacterial contamination of antiseptics, low-level disinfectants, and hand hygiene products in healthcare settings in high-income countries. Over 70 years, 114 articles were found: 68 outbreaks, 13 pseudo-outbreaks and 33 cross-sectional surveys. Outbreaks affected median 29 (1–151) patients, extended for 26 (1–156) weeks and had a case fatality of 0.0% (0.0–60.0%). Most (72.8%) (pseudo-)outbreaks were caused by water-based chlorhexidine (CHG), quaternary ammonium compounds (QUAT) and the combination CHG–QUAT. Contaminating bacteria were nonfermentative Gram-negative rods (87.6% (pseudo-)outbreaks), mainly Burkholderia cepacia, Pseudomonas aeruginosa and Achromobacter spp.) and Enterobacterales (29.6%, 24/81), mostly Serratia spp.). Risk factors were at the level of the bacteria (natural resistance to CHG and QUAT), containers (design and functioning, presence of cork and cotton, biofilm formation), preparation (nonsterile water, overdilution) and practices (too long expiry dates, inappropriate container reprocessing, topping up of containers and deviation from procedures). Transmission occurred through direct contact (antiseptics), contact with semicritical items (disinfectants) and were handborne (soaps). During recent decades, reports of soap contaminated with Enterobacterales emerged and nationwide outbreaks of intrinsically contaminated CHG occurred. Outstanding issues comprise intrinsic contamination, implementation of antiseptic stewardship, the role of unit doses and sterile products, transmission studies, biofilm control and understanding healthcare providers’ perceptions. Full article

Ozone is a triatomic allotropic modification of oxygen with very high oxidation potential and strong antimicrobial properties, and can be used as a disinfecting agent. The aim of this work was to investigate the effectiveness of gaseous ozone in reducing the number of bacteria and the total biomass of E. coli biofilm using different methods of quantification and detection. Biofilm of all tested clinical isolates and standard strain was grown on ceramic tiles with dimensions of 1.0 × 1.0 cm over 24 h. These plates were then treated with gaseous ozone for 1 h. After washing, CFU/cm² was determined, ATP bioluminescence was measured with a luminometer, and the total biomass reduction was measured after crystal-violet staining. Gaseous ozone proved to be very effective in destroying the created bacterial biofilm on ceramic tiles. Treatment caused a reduction in total bacteria number of up to 2.00 log₁₀CFU/cm², followed by a reduction in total biomass of up to 61.40%. Inhibition rates varied from 35.80% to 99.41%, depending on the method of quantification used. All methods used in this study are effective in determining the anti-biofilm activity of gaseous ozone, but more research is needed. Full article

We conducted a systematic review of healthcare-associated outbreaks and cross-sectional surveys related to the contamination of antiseptics, disinfectants, and hand hygiene products in healthcare settings in low- and middle-income countries (PROSPERO CRD42021266271). Risk of bias was assessed by selected items of the ORION and MICRO checklists. From 1977 onwards, 13 outbreaks and 25 cross-sectional surveys were found: 20 from Asia and 13 from Africa. Products most associated with outbreaks were water-based chlorhexidine, chlorhexidine-quaternary ammonium compound combinations (7/13), and liquid soap products (4/13). Enterobacterales (including multidrug-resistant Enterobacter cloacae, Klebsiella pneumoniae, and Serratia marcescens) and non-fermentative Gram-negative rods were found in 5 and 7 outbreaks and in 34.1% and 42.6% of 164 isolates, respectively, from cross-sectional surveys. Risk factors included preparation (place, utensils, or tap water high and incorrect dilutions), containers (reused, recycled, or inadequate reprocessing), and practices (topping-up or too long use). Potential biases were microbiological methods (neutralizers) and incomplete description of products’ identity, selection, and denominators. External validity was compromised by low representativeness for remote rural settings and low-income countries in sub-Saharan Africa. Outstanding issues were water quality, biofilm control, field-adapted containers and reprocessing, in-country production, healthcare providers’ practices, and the role of bar soap. A list of “best practices” to mitigate product contamination was compiled. Full article

The aim of this study was to assess the associations between HIV status, SARS-CoV-2 infection, increase in use of psychoactive substances and oral ulcers among people who use psychoactive substances. This was a secondary analysis of the data of 1087 people who used psychoactive substances collected during the first wave of the COVID-19 pandemic. The data extracted were confounding (age, sex, the highest level of education attained, employment status, emotional distress status), dependent (oral ulcers) and independent (SARS-CoV-2 infection, increase in alcohol consumption, smoking and use of other psychoactive substances, living with HIV) variables. A multivariate logistic regression model was constructed to determine the associations between the dependent and independent variables after adjusting for the confounding variables. Participants who had a history of SARS-CoV-2 infection (AOR:10.37) and people living with HIV (AOR:1.91) had higher odds of reporting oral ulcers. The finding suggests that people who used psychoactive substances, had COVID-19 and lived with HIV were at increased risk for oral ulcers during the first wave of the COVID-19 pandemic. Increased use of psychoactive substances was not associated with a significant increase in the risk for oral ulcers. Further research is needed to better understand the reasons for these findings. Full article

Good access and appropriate use of Water, Sanitation and Hygiene (WASH) is important in the control, elimination and eradication of a number of neglected tropical diseases (NTDs). Poor WASH access and use may explain continued high trachoma prevalence in Nabilatuk district, Uganda. This study aimed to investigate the level of WASH access and use through different WASH data collection methods and the triangulation of their results. A mixed-methods cross-sectional study was conducted in 30 households in Nabilatuk district, from 10 households in each of three nomadic villages. The data collection methods used were: (1) direct observations of routine WASH behaviours; (2) structured quantitative household questionnaires; (3) demonstrations of specific WASH behaviours. With regards to access, observations indicated less WASH access and use compared with questionnaire responses: the questionnaire indicated all households had access to an improved water source, but 70% had a >30-min round-trip, and no households had access to an improved latrine, whereas some observations indicated longer water collection times. In terms of behaviour, there were also differences between the data collection methods, with demonstrations revealing knowledge of good practice, such as thorough handwashing, but this was not routinely observed in the observations. Further systematic investigation of barriers to appropriate WASH access and use in the local context is needed, as is the development of feasible, valid and reliable WASH access and use assessment methods for use in national NTD programmes. Full article

People’s need for information and communication concerning health has emerged from many sources, even for important aspects related to the COVID-19 pandemic. The challenges of those who want to respond to this need are mainly related to which design characteristics could better support their aim. Thus, this article first examines a selected list of examples of different approaches of interventions targeted at citizens aimed at increasing health knowledge. Successively our recent experience regarding a new tool developed to support people’s health by promoting communication about citizens’ approach towards pharmaceuticals is discussed. In addition, here we propose that a similar methodological approach may be useful also to highlight people's critical issues and suggestions regarding health care system, i.e., factors that could play a pivotal role in a pandemic scenario. Our experience in the local context through an integrated strategy can be useful to address key factors concerning people’s approach to medicines, and approach to health care system even during a pandemic scenario. Overall these examples of past experience show how some approaches could support the understanding of suitable future, community-level, interventions to enhance information and communication about health and care. Full article

Golf is a very popular outdoor sport played worldwide by people from various socio-economic backgrounds. During the COVID-19 pandemic, lockdowns and quarantine restrictions led to closures of indoor and outdoor sport facilities and thus also affected the access to golf courses. This study aimed at elucidating perceptions of golfers regarding the impact of the crisis on their sport. We surveyed a sample of golfers in German-speaking countries (primarily Austria and Germany) from March to June 2021. A content analysis on golfers’ responses (n = 923) to an open-ended question on their feelings and engagement in alternative ways of physical activity in light of closed sport facilities was performed. More than 23% of the comments concerned negative feelings on how the pandemic impacted the surveyed golfers, especially due to reluctance to accept the closure of outdoor sports facilities. Almost all participants stated to perform alternative outdoor sports, mostly hiking, biking, walking, and running. In times of a pandemic, public spaces should be designed to allow for safe physical activity to maintain a mentally and physically fit population. In this context, policy makers should provide hygiene concepts that allow for minimal disturbance of sport routines, especially in regard to outdoor sports such as golf. Full article

The COVID-19 pandemic is a source of mental stress, particularly for special populations. The present study identified the associations between emotional distress and HIV status among adults in 152 countries during the first wave of the pandemic. This was a cross-sectional study that gathered data via an online survey carried out between July and December 2020. The dependent variable was emotional distress (frustration/boredom, anxiety, depression, loneliness, anger, or grief/feeling of loss), and the independent variable was HIV status (positive or negative). The confounding factors were sociodemographic variables (age, sex, education level, and employment status). Multivariable logistic regression analyses were performed to assess the associations between the independent and dependent variables after adjusting for confounders. Of the 16,866 participants, 905 (5.4%) reported living with HIV. Of these, 188 (20.8%) felt frustrated/bored, 238 (26.3%) anxious, 160 (17.7%) depressed, 148 (16.4%) lonely, 84 (9.3%) angry, and 53 (5.9%) grief/a sense of loss. Individuals living with HIV had higher odds of feeling anxious (AOR:1.64), depressed (AOR:1.80), and lonely (AOR:1.35) when compared to people living without HIV. This study reveals that the COVID-19 pandemic can exacerbate emotional stress for those living with HIV, and the system in which COVID-19 impacts emotional health among different sociodemographic groups introduces further complexities regarding this observed effect. Full article

Listeria monocytogenes is an ubiquitously occurring foodborne bacterial pathogen known to contaminate foods during the production processes. To assess the presence and persistence of L. monocytogenes in Danish ready-to-eat (RTE) food production companies in response to a Listeria awareness campaign, the production environment of selected companies were sampled in 2016 and in 2020. Whole genome sequencing (WGS) was performed to characterize the isolates (n = 50, plus 35 isolates obtained from the routine surveillance during 2016–2020), including investigation of the presence of virulence, persistence and resistance genes. The number of companies that tested positive by culture was 17/39 (43.6%) in 2016 and 11/34 (32.4%) in 2020, indicating a limited effect of the campaign. WGS analyses of the 85 isolates showed that the most common sequence types (STs) were ST8 and ST121. The single nucleotide polymorphism (SNP) analysis showed that isolates coming from the same company and belonging to the same ST exhibited <10 SNP differences regardless of the sampling year and whether the samples came from the environment or products, indicating the persistence of the specific STs. Several prevalent STs were found in clinical cases concurrently, including genetically similar isolates. This highlights the issue of persistent L. monocytogenes in the food production environment and the need for improved risk communication and mitigation strategies. Full article

In 2016, Tosei General Hospital, a tertiary emergency medical facility with 633 beds in Japan, experienced a large nosocomial outbreak of carbapenemase-producing Enterobacterales (CPE) that had spread to numerous sink outlets. Based on our experience with using steam cleaners to suppress CPE on environmental surfaces, we report the efficacy of steam cleaners in the disinfection of sink outlets. Steam cleaners were used to disinfect 22 target areas. CPE disappeared in 90.9% of the sink outlets within the first two months after disinfection, and, after 12 months, 54.5% of the sink outlets remained negative throughout the remainder of the study period. This study demonstrates the effectiveness of using steam cleaners to disinfect sink outlets contaminated with CPE. Full article

The global COVID-19 pandemic has caused countries to develop novel methods to detect and trace active cases. These methods aim to limit its spread; however, they can also be used to detect other endemic infectious diseases, such as tuberculosis (TB). The current methods used to detect COVID-19 cases, such as temperature-checking and tracing applications, led to the detection of these specific TB cases and their referral to the hospital. In this study, we present four cases of TB in which the patients come from different working backgrounds. We conclude that the current measures used for COVID-19 could also prove to be beneficial in the context of other infectious diseases, mainly TB. Full article

Over the past two centuries since its independence in 1847, Liberia has made significant progress in building an integrated public health system designed to serve its population. Despite a prolonged period of civil conflict (1990–2003) and the emergence of the 2014–2016 Ebola Virus Disease (EVD) that crippled its already weakened health system, Liberia was able to re-emerge, making significant strides and gains in rebuilding and strengthening its health infrastructure and systems. Lessons learnt from the EVD epidemic have led to developments such as the newly established National Public Health Institute of Liberia (NPHIL) and several tertiary public health institutions to meet the growing demands of a skilled workforce equipped to combat existing and emerging health problems and/crisis, including informing the more recent COVID-19 response. This article delineated and documented the historical efforts made towards establishing public health interventions such as infrastructures and systems of the past, and how these structures and systems became the foundation and pillars of the current resilient health system. This paper highlighted some of the key crises and interventions deployed, and some of the historical public health champions, laws, and policies that aided in strengthening the public health systems then and now. It is expected that in addition this paper can be used as a guide for further or future research. Full article

Corrosive surgical instruments are routinely observed in central sterile services departments around the world. In addition to other risks, they can harbor microorganisms in the form of biofilms. Thus, this study aimed to evaluate whether biofilms intentionally formed at corrosion points on surgical instruments are removable by manual and automated cleaning followed by sterilization. Laboratory experiments were performed where samples of corroded surgical instruments in use in practice were evaluated for biofilm presence using a scanning electron microscope. No biofilms were observed in the samples subjected to manual and automated cleaning, nor in the samples in which there was no intentional biofilm formation. Residual organic matter without the presence of microorganisms was observed. Full article

While vaccination is an aid, at least temporarily, for all emerging infectious diseases, not just COVID-19, fair distribution is an issue. Vaccine distribution to smokers is one such example. The provision of vaccine preference to smokers is consistent with the maximum life-saving principle and is justified on utilitarian grounds. However, the following five possible objections can be presented: (1) self-responsibility for smoking; (2) support from non-smokers; (3) preference for those who maintain social function; (4) identification of smokers and inducement to smoking behavior; (5) consideration for passive smokers. However, arguments against prioritizing vaccination based on self-responsibility downplay the social factors of smoking. (1) Smokers should be provided with treatment, not punishment. (2) To understand non-smokers and enhance social cohesion, communitarian explanations based on the reciprocity of care should be carefully provided to non-smokers. (3) The principle of maintaining social functioning does not supersede the principle of maximum life-saving. (4) Support for smokers should be based on self-reporting. (5) Severe cases of COVID-19 caused by passive smoking are among the most important cases to avoid. The extensive implementation of testing should actively identify victims of passive smoking. This will be evidence of the damage caused by passive smoking. Full article

Benzalkonium chloride (BAC) is a chlorine-based chemical compound with proven antimicrobial properties against bacteria, viruses, and fungi, depending on the length of the alkyl chain. It can be used as a biocide, as a cationic surfactant, and as a phase transfer agent. The aim of this study was to investigate the effectiveness of commercial cleaning agents for sanitary areas Bis duo Active (BDA) with BAC as an active compound in working concentrations of 5% and 20% on the destruction of bacterial biofilm formed on ceramic tiles. A biofilm of Staphylococcus aureus, Salmonella enterica serotype Typhimurium, and Listeria monocytogenes were grown on ceramic tiles with dimensions of 2.5 × 2.5 cm over 24 h. These plates were then treated with working concentrations of BAC for 10 min. After washing, ATP bioluminescence was measured with a luminometer, CFU/cm² was determined and the total biomass reduction was measured after crystal-violet staining. Both working concentrations of benzalkonium chloride proved to be very effective in destroying the created bacterial biofilm on ceramic tiles. Both treatments caused a reduction in total bacteria number of up to 3.12 log₁₀CFU/cm², followed by a reduction in total biomass up to circa (ca.) 64%. Inhibition rates varied from ca. 28% to ca. 99%, depending on the method and concentration used. Mechanical cleaning prior or after treatment with BAC is essential to improve biofilm destruction. All methods used in this study are effective for the determination of the anti-biofilm activity of BAC. Further analyses are needed. Full article