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Lewis HE, Greenland K, Curtis V, Schmidt WP. Effect of a School-Based Hygiene Behavior Change Campaign on Handwashing with Soap in Bihar, India: Cluster-Randomized Trial. Am J Trop Med Hyg 2019; 99:924-933. [PMID: 30105966 PMCID: PMC6159589 DOI: 10.4269/ajtmh.18-0187] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Changing hand hygiene behavior at scale in the community remains a challenge. The objective of this study was to estimate the effect of Unilever’s school-based “School of 5” handwashing campaign on handwashing with soap (HWWS) in schoolchildren and their mothers in the Indian state of Bihar. We conducted a cluster-randomized trial in two districts. We randomized a total of 32 villages with at least one eligible school to intervention and control groups (1:1) and recruited 338 households in each group for outcome measurement. We used structured observation in households to measure HWWS at target occasions (after defecation, soap use during bathing, and before each main meal) in schoolchildren and their mothers. Observers were blinded to intervention status. We observed 636 target occasions (297 in the intervention arm and 339 in the control arm) in mothers and school-going children. After the intervention, HWWS prevalence at target occasions was 22.4% in the control arm and 26.6% in the intervention arm (prevalence difference +4.4%, 95% confidence interval: −4.0, 12.8). The difference was similar in children and mothers. Observers appeared to be adequately blinded to intervention status, whereas observed households were successfully kept unaware of the purpose of observations. To conclude, we found no evidence for a health-relevant effect of the School of 5 intervention on HWWS in schoolchildren and their mothers. Qualitative research suggested that reasons for the low impact of the intervention included low campaign intensity, ineffective delivery, and a model possibly not well tailored to these challenging physical and social environments.
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Affiliation(s)
- Henrietta E Lewis
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Katie Greenland
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Val Curtis
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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202
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Diefenbacher S, Pfattheicher S, Keller J. On the Role of Habit in Self-Reported and Observed Hand Hygiene Behavior. Appl Psychol Health Well Being 2019; 12:125-143. [PMID: 31353823 DOI: 10.1111/aphw.12176] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The present contribution tests the main ideas that (a) hand hygiene behavior is associated with habit, and (b) this association is robust when deliberative constructs (i.e. knowledge and intention) are controlled for, indicating an automatic component in hand hygiene behavior. METHODS Two correlational studies using different operationalisations of hand hygiene behavior are reported. In Study 1, hand hygiene was assessed in the context of food preparation; data were measured using the Day Reconstruction Method in a sample of the general population. Study 2 considered hand hygiene compliance of healthcare workers applying video observation by body cameras and additionally self-reported behavior. In both studies, habit was assessed using the Self-Report Behavioral Automaticity Index. RESULTS Both studies found the expected positive association between habit and hand hygiene (0.271 < r < 0.570). Habit was further analyzed in combination with knowledge and intention (Study 2), and emerged as a significant predictor of observed hand hygiene, while knowledge and intention were marginally significant. No significant interactions were found. CONCLUSIONS The present work provides evidence that hand hygiene behavior is reliably related to habit. The findings speak to the notion that addressing the automatic route to hand hygiene behavior when designing interventions can be fruitful.
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203
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Jess RL, Dozier CL, Foley EA. Effects of a handwashing intervention package on handwashing in preschool children. BEHAVIORAL INTERVENTIONS 2019. [DOI: 10.1002/bin.1684] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Rachel L. Jess
- Department of Applied Behavioral ScienceUniversity of Kansas Kansas USA
| | - Claudia L. Dozier
- Department of Applied Behavioral ScienceUniversity of Kansas Kansas USA
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204
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Kitsanapun A, Yamarat K. Evaluating the effectiveness of the "Germ-Free Hands" intervention for improving the hand hygiene practices of public health students. J Multidiscip Healthc 2019; 12:533-541. [PMID: 31371978 PMCID: PMC6628857 DOI: 10.2147/jmdh.s203825] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 05/23/2019] [Indexed: 12/30/2022] Open
Abstract
PURPOSE This quasi-experimental study sought to assess the effectiveness of a multidisciplinary intervention called "Germ-Free Hands" to improve the hand hygiene practices of students attending Thailand's Sirindhorn College of Public Health (SCPH). METHODS The intervention was developed and implemented at SCPH and incorporated education, training, a workshop, and performance feedback. The intervention targeted behavioral antecedents specified by the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB). Handwashing determinants (knowledge, beliefs, attitudes, subjective norms, perceived behavioral control, and intentions) and hand hygiene behaviors were assessed at baseline, immediately post-intervention, and 3 months post-intervention for the intervention group at (n=60) at the Suphanburi campus of SCPH and a matched control group (n=60) of students at the Ubonratchathani campus. Data analysis included descriptive statistics, independent samples t-tests, two-way measures of analysis of variance, and a generalized estimating equation to compare handwashing practices by self-reports between two groups. RESULTS The "Germ-Free Hands" intervention produced significant improvements in the intervention group's handwashing knowledge, behavioral and control beliefs, subjective norm scores, intentions, and behaviors, as compared to the control group. However, the intervention had no significant impact on normative beliefs, attitudes, or perceived behavioral control. Reported improvements also decreased 3 months post-intervention, and the number of bacterial colonies on students' hands increased over the course of the study. CONCLUSION This study adds to the evidence that multidisciplinary interventions can be effective at improving handwashing rates. However, education and training must be continuous, rather than delivered as a one-time program, in order to have sustained results. Participants may also require more in-depth instruction in correct handwashing and drying techniques to remove bacteria effectively and prevent recolonization.
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Affiliation(s)
- Apaporn Kitsanapun
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Khemika Yamarat
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
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205
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Wichaidit W, Steinacher R, Okal JA, Whinnery J, Null C, Kordas K, Yu J, Pickering AJ, Ram PK. Effect of an equipment-behavior change intervention on handwashing behavior among primary school children in Kenya: the Povu Poa school pilot study. BMC Public Health 2019; 19:647. [PMID: 31138168 PMCID: PMC6537192 DOI: 10.1186/s12889-019-6902-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 04/26/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Handwashing prevalence in schools in Kenya is low due to lack of access to water and soap and lack of drive for handwashing. Soapy water made from detergent powder is an inexpensive alternative to bar soap and disgust and social norms change can be powerful drivers of handwashing, but their effectiveness has not been assessed in school setting. In Kenyan public schools, we evaluated an equipment-behavior change intervention's effect on handwashing outcomes. We also monitored functionality of the Povu Poa prototypes to identify design improvements necessary for continued high usage in institutional settings. METHODS The intervention included the "Povu Poa", a new type of handwashing station that dispensed foaming soap and rinse water, combined with school-wide behavior change promotion based on disgust and social norms. In this stepped-wedge cluster-randomized trial, we randomly selected 30 schools and divided them into 3 groups of 10. Following baseline data collection, we delivered the intervention sequentially (Group 1: 3-5 weeks after baseline; Group 2: 6-8 weeks; Group 3: 19-24 weeks). We observed outcomes [1] availability of handwashing materials at handwashing places, and; 2) observed handwashing behavior after toilet use among schoolchildren) at baseline and in three follow-up rounds. We compared the outcomes between schools that had received the intervention and schools that had not yet received the intervention. RESULTS Water and soap/soapy water were available at 2% of school visits before intervention, and at 42% of school visits after intervention.. Before intervention, we observed handwashing with water after 11% of 461 toilet use events; no one was observed to wash hands with soap/soapy water. After intervention, we observed handwashing after 62% of 383 toilet use events (PR = 5.96, 95% CI = 3.02, 11.76) and handwashing with soap/soapy water after 26% of events (PR incalculable). Foaming soap dispenser caps were cracked in 31% of all observations, but were typically still functional. CONCLUSIONS Our combined equipment-behavior intervention increased availability of handwashing materials and improved the compliance with handwashing after using the toilet, but handwashing with soap was still rare. Equipment durability must be improved for deployment in schools at scale. American Economic Association's Registry for Randomized Controlled Trials; Trial Registry Number (TRN): AEARCTR-0000662; Date of Registry: April 14, 2015.
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Affiliation(s)
- Wit Wichaidit
- Department of Epidemiology and Environmental Health, State University of New York at Buffalo, Buffalo, USA.
| | | | | | | | - Clair Null
- Innovations for Poverty Action, New Haven, USA
| | - Katarzyna Kordas
- Department of Epidemiology and Environmental Health, State University of New York at Buffalo, Buffalo, USA
| | - Jihnhee Yu
- Department of Biostatistics, State University of New York at Buffalo, Buffalo, USA
| | - Amy J Pickering
- Department of Civil and Environmental Engineering, Tufts University, Medford, USA
| | - Pavani K Ram
- Department of Epidemiology and Environmental Health, State University of New York at Buffalo, Buffalo, USA
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206
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Biezen R, Grando D, Mazza D, Brijnath B. Visibility and transmission: complexities around promoting hand hygiene in young children - a qualitative study. BMC Public Health 2019; 19:398. [PMID: 30975108 PMCID: PMC6460784 DOI: 10.1186/s12889-019-6729-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 03/31/2019] [Indexed: 11/19/2022] Open
Abstract
Background Effective hand hygiene practice can reduce transmission of diseases such as respiratory tract infections (RTIs) and gastrointestinal infections, especially in young children. While hand hygiene has been widely promoted within Australia, primary care providers’ (PCPs) and parents’ understanding of hand hygiene importance, and their views on hand hygiene in reducing transmission of diseases in the community are unclear. Therefore, the aim of this study was to explore the views of PCPs and parents of young children on their knowledge and practice of hand hygiene in disease transmission. Methods Using a cross-sectional qualitative research design, we conducted 30 in-depth interviews with PCPs and five focus groups with parents (n = 50) between June 2014 and July 2015 in Melbourne, Australia. Data were thematically analysed. Results Participants agreed that hand hygiene practice was important in reducing disease transmissions. However, barriers such as variations of hand hygiene habits, relating visibility to transmission; concerns around young children being obsessed with washing hands; children already being ‘too clean’ and the need to build their immunity through exposure to dirt; and scepticism that hand hygiene practice was achievable in young children, all hindered participants’ motivation to develop good hand hygiene behaviour in young children. Conclusion Despite the established benefits of hand hygiene, sustained efforts are needed to ensure its uptake in routine care. To overcome the barriers identified in this study a multifaceted intervention is needed that includes teaching young children good hand hygiene habits, PCPs prompting parents and young children to practice hand hygiene when coming for an RTI consultation, reassuring parents that effective hand hygiene practice will not lead to abnormal psychological behaviour in their children, and community health promotion education campaigns.
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Affiliation(s)
- Ruby Biezen
- Department of General Practice, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia.
| | - Danilla Grando
- School of Science, RMIT University, Building 223, Level 1, Bundoora Campus, Plenty Road, Bundoora, VIC, 3083, Australia
| | - Danielle Mazza
- Department of General Practice, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia
| | - Bianca Brijnath
- National Ageing Research Institute LTD, 34-54 Poplar Road, Parkville, VIC, 3052, Australia
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207
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Han MA. Hand Hygiene Practices Among Adults with Diabetes Living in Communities: The 2015 Korea Community Health Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071279. [PMID: 30974788 PMCID: PMC6480019 DOI: 10.3390/ijerph16071279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 04/04/2019] [Accepted: 04/06/2019] [Indexed: 11/16/2022]
Abstract
Hand hygiene is the most effective strategy to prevent infectious diseases. This study investigated and compared the hand hygiene practices of adults with diabetes and an age- and gender-matched comparison group. Adults with diabetes (n = 22,920) who participated in the 2015 Korea Community Health Survey and an appropriate comparison group (n = 22,920) were selected. Descriptive analyses, chi-square tests, and multiple logistic regression analyses were used. Greater than 98% of participants with diabetes recognized that hand hygiene helps prevent infectious diseases. Among participants with diabetes, 84.3%, 82.4%, 72.5%, and 64.1% washed their hands frequently before eating, after using the restroom, after returning from the outdoors, and with soap or hand sanitizer, respectively, but these values were significantly lower than those of the comparison group. After performing multiple regression analyses, treatments for diabetes, being educated about diabetes management and handwashing, and awareness of hemoglobin A1c levels were significantly associated with hand hygiene practices in participants with diabetes. Almost all people with diabetes were aware of the efficacy of hand hygiene, but handwashing rates were significantly lower in people with diabetes than in the comparison group. Considering treatments for diabetes, educational campaigns regarding handwashing, and increasing awareness of handwashing efficacy will help improve hand hygiene in people with diabetes.
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Affiliation(s)
- Mi Ah Han
- Department of Preventive Medicine, College of Medicine, Chosun University, 309 Pilmun-Daero, Dong-Gu, Gwangju 61452, Korea.
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208
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Kang Y, Chang Y. Using a motion‐controlled game to teach four elementary school children with intellectual disabilities to improve hand hygiene. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:942-951. [DOI: 10.1111/jar.12587] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 01/08/2019] [Accepted: 02/27/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Ya‐Shu Kang
- Department of Special Education Chung Yuan Christian University Chung‐Li Taiwan
| | - Yao‐Jen Chang
- Department of Electronic Engineering Chung Yuan Christian University Chung‐Li Taiwan
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209
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Mbakaya BC, Kalembo FW, Zgambo M. Community-based interventions for preventing diarrhoea in people living with HIV in sub-Sahara Africa: A systematic review. Malawi Med J 2019; 31:86-94. [PMID: 31143403 PMCID: PMC6526344 DOI: 10.4314/mmj.v31i1.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 05/01/2018] [Accepted: 05/06/2018] [Indexed: 11/24/2022] Open
Abstract
Background High prevalence rates of people living with HIV (PLHIV) are more predominant in sub-Saharan Africa compared to any region globally. Nonetheless, many people in the region have little access to safe water and live in poor sanitation environment. This region is, therefore, faced with a challenge in protecting PLHIV from infectious diseases that are transmitted through unhygienic conditions. Aim This systematic review was conducted to identify effective community-based interventions for the prevention of diarrhoea among PLHIV in sub-Saharan Africa. Methods Studies included in this systematic review were sought from PubMed, EMBASE, PsycINFO, AMED, CINAHL, DOAJ, Web of science, WHO Global Index Medicus Library, Cochrane and ProQuest (GeoRef). Articles were appraised using MMAT scale. Results From a search finding of 3,849 articles, only nine papers whose participants were people living with HIV and had incidence or prevalence of diarrhoea as an outcome met our inclusion criteria. Community-based interventions such as water treatment and safe storage were associated with 20%-53% reduction in diarrhoea episodes among PLHIV. The review has also demonstrated that the impact of hand hygiene and health education on the prevention of diarrhoeal infections is not adequately assessed. Conclusion Future studies are, therefore, warranted to assess the effect of hand hygiene and health education interventions on prevention and reduction of diarrhoea in PLHIV in Sub-Saharan Africa.
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Affiliation(s)
| | | | - Maggi Zgambo
- St John's College of Nursing, P.O. Box 18, Mzuzu, Malawi
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210
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Najnin N, Leder K, Forbes A, Unicomb L, Winch PJ, Ram PK, Nizame FA, Arman S, Begum F, Biswas S, Cravioto A, Luby SP. Impact of a Large-Scale Handwashing Intervention on Reported Respiratory Illness: Findings from a Cluster-Randomized Controlled Trial. Am J Trop Med Hyg 2019; 100:742-749. [PMID: 30608050 PMCID: PMC6402932 DOI: 10.4269/ajtmh.18-0644] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 11/02/2018] [Indexed: 12/14/2022] Open
Abstract
We assessed the impact of handwashing promotion on reported respiratory illness as a secondary outcome from among > 60,000 low-income households enrolled in a cluster-randomized trial conducted in Bangladesh. Ninety geographic clusters were randomly allocated into three groups: cholera-vaccine-only; vaccine-plus-behavior-change (handwashing promotion and drinking water chlorination); and control. Data on respiratory illness (fever plus either cough or nasal congestion or breathing difficulty within previous 2 days) and intervention uptake (presence of soap and water at handwashing station) were collected through monthly surveys conducted among a different subset of randomly selected households during the intervention period. We determined respiratory illness prevalence across groups and used log-binomial regression to examine the association between respiratory illness and presence of soap and water in the handwashing station. Results were adjusted for age, gender, wealth, and cluster-randomized design. The vaccine-plus-behavior-change group had more handwashing stations with soap and water present than controls (45% versus 25%; P < 0.001). Reported respiratory illness prevalence was similar across groups (vaccine-plus-behavior-change versus control: 2.8% versus 2.9%; 95% confidence interval [CI]: -0.008, 0.006; P = 0.6; cholera-vaccine-only versus control: 3.0% versus 2.9%; 95% CI: -0.006, 0.009; P = 0.4). Irrespective of intervention assignment, respiratory illness was lower among people who had soap and water present in the handwashing station than among those who did not (risk ratioadjusted: 0.82; 95% CI: 0.69-0.98). With modest uptake of the handwashing intervention, we found no impact of this large-scale intervention on respiratory illness. However, those who actually had a handwashing station with soap and water had less illness. This suggests improving the effectiveness of handwashing promotion in achieving sustained behavior change could result in health benefits.
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Affiliation(s)
- Nusrat Najnin
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Karin Leder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew Forbes
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Leanne Unicomb
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Peter J. Winch
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Fosiul A. Nizame
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shaila Arman
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farzana Begum
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shwapon Biswas
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Department of Medicine, Rangpur Medical College Hospital, Rangpur, Bangladesh
| | - Alejandro Cravioto
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Facultad de Medicina, Universidad Nacional Autónoma de Mexico, Ciudad de Mexico, Mexico
| | - Stephen P. Luby
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Stanford University, Stanford, California
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211
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Bressler JM, Hennessy TW. Results of an Arctic Council survey on water and sanitation services in the Arctic. Int J Circumpolar Health 2019; 77:1421368. [PMID: 29383987 PMCID: PMC5795745 DOI: 10.1080/22423982.2017.1421368] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
As part of a project endorsed by the Arctic Council’s Sustainable Development Working Group (SDWG), a survey was conducted to describe the current status of water, sanitation and hygiene (WASH) services in the Arctic region. The English language internet-based survey was open from April to September, 2016 and drew 142 respondents from seven Arctic nations. Respondents provided information on access to WASH services, notification requirements for water-related infectious diseases, and examples of environmental- or climate-change related events that impact the provision of WASH services. Many remote Arctic and sub-Arctic residents lack WASH services, and these disparities are often not reflected in national summary data. Environmental changes impacting WASH services were reported by respondents in every Arctic nation. Participants at an international conference co-sponsored by SDWG reviewed these results and provided suggestions for next steps to improve health of Arctic residents through improved access to water and sanitation services. Suggestions included ongoing reporting on WASH service availability in underserved populations to measure progress towards UN Sustainable Development Goal #6; evaluations of the health and economic consequences of disparities in WASH services; and Arctic-specific forums to share innovations in WASH technology, improved management and operations, and adaptation strategies for environmental or climate change.
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Affiliation(s)
- Jonathan M Bressler
- a Alaska Division of Public Health , Section of Epidemiology , Anchorage , AK , USA.,b Applied Epidemiology Fellowship , Council of State and Territorial Epidemiologists , Atlanta , GA , USA
| | - Thomas W Hennessy
- c Arctic Investigations Program , National Center for Emerging and Zoonotic Infectious Diseases, CDC , Anchorage , AK , USA.,d Arctic Human Health Experts Group , Sustainable Development Working Group , Arctic Council , Ottawa , Canada
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212
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Breidablik HJ, Lysebo DE, Johannessen L, Skare Å, Andersen JR, Kleiven OT. Ozonized water as an alternative to alcohol-based hand disinfection. J Hosp Infect 2019; 102:419-424. [PMID: 30731184 DOI: 10.1016/j.jhin.2019.01.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 01/29/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Hand hygiene plays a vital role in the prevention of transmission of micro-organisms. Ozone (O3) is a highly reactive gas with a broad spectrum of antimicrobial effects on bacteria, viruses, and protozoa. It can easily be produced locally in small generators, and dissolved in tap water, and quickly transmits into ordinary O2 in the surrounding air. AIM To compare ozonized tap water and alcohol rub in decontamination of bacterially contaminated hands. METHODS A cross-over study among 30 nursing students. Hands were artificially contaminated with Escherichia coli (ATCC 25922), then sanitized with ozonized tap water (0.8 or 4 ppm) or 3 mL standard alcohol-based rub (Antibac 85%). The transient microbes from fingers were cultivated and colony-forming units (cfu)/mL were counted. The test procedure was modified from European Standard EN 1500:2013. FINDINGS All contaminated hands before disinfection showed cfu >30,000/mL. The mean (SD) bacterial counts in (cfu/mL) on both hands combined were 1017 (1391) after using ozonized water, and 2337 (4664) after alcohol hand disinfection. The median (range) values were 500 (0-6700) and 250 (0-16,000) respectively (non-significant difference). Twenty per cent of participants reported adverse skin effects (burning/dryness) from alcohol disinfection compared with no adverse sensations with ozone. CONCLUSION Ozonized tap water is an effective decontaminant of E. coli, and it could be an alternative to traditional alcohol-fluid hand disinfectants both in healthcare institutions and public places. Ozonized water may be especially valuable for individuals with skin problems.
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Affiliation(s)
- H J Breidablik
- Center of Health Research, Førde Hospital Trust, Førde, Norway.
| | - D E Lysebo
- Haukeland University Hospital, Bergen, Norway
| | - L Johannessen
- Thelma Indoor Air & Working Environment AS, Microbiology Department, Trondheim, Norway
| | - Å Skare
- Førde Hospital Trust, Department for Infection Control, Førde, Norway
| | - J R Andersen
- Faculty of Western Norway University of Applied Sciences, Førde, Norway
| | - O T Kleiven
- Faculty of Western Norway University of Applied Sciences, Førde, Norway
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213
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Bowman LG, Hardesty SL, Sigurdsson SO, McIvor M, Orchowitz PM, Wagner LL, Hagopian LP. Utilizing Group-Based Contingencies to Increase Hand Washing in a Large Human Service Setting. Behav Anal Pract 2019; 12:600-611. [PMID: 31976267 DOI: 10.1007/s40617-018-00328-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Hand washing is the most important preventative measure for the reduction of contagious disease. Although hand washing is easy to perform, non-adherence is a ubiquitous problem. Several studies have demonstrated the effectiveness of multi-component intervention packages to improve hand washing among employees; however, interventions are limited to acute settings, are often implemented for a short period of time, and rarely, if ever, include information on long-term effectiveness. The purpose of the current study was to utilize a behavior analytic approach to determine the stimulus conditions under which hand washing should occur, and to assess and then implement a long-term monitoring system among direct care workers in a large, non-acute inpatient unit. A single-case repeated measures reversal design was used to evaluate the effectiveness of two interventions aimed at improving hand washing adherence. A lottery was found to be effective in increasing hand hygiene for 2-years with 170 staff.
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Affiliation(s)
- Lynn G Bowman
- 1Neurobehavioral Unit, Kennedy Krieger Institute, 707 N. Broadway, Baltimore, MD 21205 USA.,2Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Samantha L Hardesty
- 1Neurobehavioral Unit, Kennedy Krieger Institute, 707 N. Broadway, Baltimore, MD 21205 USA.,3University of Maryland, Baltimore County, Baltimore, MD USA
| | | | - Melissa McIvor
- 1Neurobehavioral Unit, Kennedy Krieger Institute, 707 N. Broadway, Baltimore, MD 21205 USA
| | - Phillip M Orchowitz
- 1Neurobehavioral Unit, Kennedy Krieger Institute, 707 N. Broadway, Baltimore, MD 21205 USA
| | - Leaora L Wagner
- 1Neurobehavioral Unit, Kennedy Krieger Institute, 707 N. Broadway, Baltimore, MD 21205 USA
| | - Louis P Hagopian
- 1Neurobehavioral Unit, Kennedy Krieger Institute, 707 N. Broadway, Baltimore, MD 21205 USA.,2Johns Hopkins University School of Medicine, Baltimore, MD USA
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214
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Alzaher AA, Almudarra SS, Mustafa MH, Gosadi IM. The importance of hand hygiene education on primary schoolgirls' absence due to upper respiratory infections in Saudi Arabia. A cluster randomized controlled trial. Saudi Med J 2019; 39:1044-1049. [PMID: 30284589 PMCID: PMC6201029 DOI: 10.15537/smj.2018.10.23344] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To quantify the reduction in absence due to upper respiratory infections (URIs) among primary schoolgirls attending Riyadh’s schools after delivering a hand hygiene workshop intervention over a period of 5 weeks. Methods: A cluster randomized trial was conducted among girls attending 4 primary schools between January and March 2018. The participants attended a hand hygiene workshop. The schoolgirls’ absences were followed up for 5 weeks. Incidence rate, percentage of absence days, and absence rate were calculated for total and URIs absences. Result: Total number of participating schoolgirls was 496. Upper respiratory infections accounted for 15.3% of absence episodes. Schoolgirls lost 521 days of school and 19.4% of them were URIs-related. Absence rate due to URIs were 12.4 and 23.4 as well as 5.62 and 11.72 per 100 schoolgirls in the control (CG) and experimental (EG) groups, respectively. Percentage of absence days were lower in the experimental group (CG: 0.86% and 1.39% versus EG: 0.39% and 0.72%). Incidence rates of absence due to URIs were 0.54 and 1.02 in CG versus 0.24 and 0.51 in EG per 100 schoolgirls per day. Conclusion: There could be further reduction in school absences if education was accompanied by hand soap dissemination. The study could serve as a pilot for major studies in the future. Sustainability of the intervention can be tested in studies with longer durations.
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Affiliation(s)
- Abrar A Alzaher
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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215
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Moncion K, Young K, Tunis M, Rempel S, Stirling R, Zhao L. Effectiveness of hand hygiene practices in preventing influenza virus infection in the community setting: A systematic review. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2019; 45:12-23. [PMID: 31015816 PMCID: PMC6461122 DOI: 10.14745/ccdr.v45i01a02] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hand hygiene is known to be an effective infection prevention and control measure in health care settings. However, the effectiveness of hand hygiene practices in preventing influenza infection and transmission in the community setting is not clear. OBJECTIVE To identify, review and synthesize available evidence on the effectiveness of hand hygiene in preventing laboratory-confirmed or possible influenza infection and transmission in the community setting. METHODS A systematic review protocol was established prior to conducting the review. Three electronic databases (MEDLINE, Embase and the Cochrane Library) were searched to identify relevant studies. Two reviewers independently screened the titles, abstracts and full-texts of studies retrieved from the database searches for potential eligibility. Data extraction and quality assessment of included studies were performed by a single reviewer and validated by a second reviewer. Included studies were synthesized and analyzed narratively. RESULTS A total of 16 studies were included for review. Studies were of low methodological quality and there was high variability in study design, setting, context and outcome measures. Nine studies evaluated the effectiveness of hand hygiene interventions or practices in preventing laboratory-confirmed or possible influenza infection in the community setting; six studies showed a significant difference, three studies did not. Seven studies assessed the effectiveness of hand hygiene practices in preventing laboratory-confirmed or possible influenza transmission in the community setting; two studies found a significant difference and five studies did not. CONCLUSION The effectiveness of hand hygiene against influenza virus infection and transmission in the community setting is difficult to determine based on the available evidence. In light of its proven effectiveness in other settings, there is no compelling evidence to stop using good hand hygiene practice to reduce the risk of influenza infection and transmission in the community setting.
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Affiliation(s)
- K Moncion
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - K Young
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - M Tunis
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - S Rempel
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - R Stirling
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - L Zhao
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
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216
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Alsagher MR, Soudah SA, Khsheba AE, Fadel SM, Dadiesh MA, Houme MA, Eshagroni AS, Alosta FF, Almsalaty SM. Hand Washing Before and After Applying Different Hand Hygiene Techniques in Places of Public Concern in Tripoli-Libya. Open Microbiol J 2018. [DOI: 10.2174/1874285801812010364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:Hand hygiene has being considered as one of the primary measures to improve standards and practice for hospital care and to minimize the transmission of nosocomial pathogens. There is substantial evidence that incidence of hospital acquired infections is reduced by applying hand antisepsis. Regarding hand hygiene and public concern, hand washing has revealed that 85% of the observed adults wash their hands after using public toilets.Objective:To compare the efficacy of hand rubbing with an alcohol based solution versus conventional hand washing with antiseptic and non-antiseptic soaps in reducing bacterial counts using different hand hygiene techniques.Methods:Ninety-three volunteers took part in this study; 57 from Tripoli Medical Center (TMC); 16 from school; 11 from bank; and 9 from office. All volunteers performed six hand hygiene techniques, immediately before and after a volunteer practice activity: hand washing with non-antiseptic soap for 10 and 30 second (s); hand washing with antiseptic soap for 10, 30 or 60 s; and alcohol-based hand rub. A total of 864 specimens were taken: 432 before and 432 after volunteer's hand hygiene. The fingertips of the dominant hand for each volunteer were pressed on to agar for culture before and after each hand hygiene technique. Plates were incubated at 37oC, and colony-forming units were counted after 48 hours and pathogenic bacteria were identified.Results:Results showed that 617 specimens (71.41%) were positive for bacterial growth. 301 (48.78%) were from TMC, 118 (19.12%) were from office; 107 (14.34%) were from school and 91 (14.75%) were from bank.Conclusion:Both antiseptic and non–antiseptic soaps did not work properly in reducing bacterial counts of worker’s hands at all places of study, but significantly improved by an application of alcohol based gel.
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217
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Kim JH, Cheong HK, Jeon BH. Burden of Disease Attributable to Inadequate Drinking Water, Sanitation, and Hygiene in Korea. J Korean Med Sci 2018; 33:e288. [PMID: 30416408 PMCID: PMC6221858 DOI: 10.3346/jkms.2018.33.e288] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 08/09/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Diarrheal and intestinal infectious disease caused by inadequate drinking water, sanitation, and hygiene (WASH) is not only a great concern in developing countries but also a problem in low-income populations and rural areas in developed countries. In this study, we assessed the exposure to inadequate WASH in Korea and estimated the burden of disease attributable to inadequate WASH. METHODS We used observational data on water supply, drinking water, sewage treatment rate, and hand washing to assess inadequate WASH conditions in Korea, and estimated the level of exposure in the entire population. The disease burden was estimated by applying the cause of death data from death registry and the morbidity data from the national health insurance to the population attributable fraction (PAF) for the disease caused by inappropriate WASH. RESULTS In 2013, 1.4% of the population were exposed to inadequate drinking water, and 1.0% were living in areas where sewerage was not connected. The frequency of handwashing with soap after contact with excreta was 23.5%. The PAF due to inadequate WASH as a cluster of risk factors was 0.353 (95% confidence interval [CI], 0.275-0.417), among which over 90% were attributable to hand hygiene factors that were significantly worse than those in American and European high-income countries. CONCLUSION The level of hand hygiene in Korea has yet to be improved to the extent that it shows a significant difference compared to other high-income countries. Therefore, improving the current situation in Korea requires a continuous hand washing campaign and a program aimed at all people. In addition, continuous policy intervention for improvement of sewage treatment facilities in rural areas is required, and water quality control monitoring should be continuously carried out.
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Affiliation(s)
- Jong-Hun Kim
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Hae-Kwan Cheong
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Byoung-Hak Jeon
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea
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218
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Azor-Martinez E, Yui-Hifume R, Muñoz-Vico FJ, Jimenez-Noguera E, Strizzi JM, Martinez-Martinez I, Garcia-Fernandez L, Seijas-Vazquez ML, Torres-Alegre P, Fernández-Campos MA, Gimenez-Sanchez F. Effectiveness of a Hand Hygiene Program at Child Care Centers: A Cluster Randomized Trial. Pediatrics 2018; 142:peds.2018-1245. [PMID: 30297500 DOI: 10.1542/peds.2018-1245] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Respiratory infections (RIs) are an important cause of morbidity and excessive antibiotic prescriptions in children attending day care centers (DCCs). We aimed to assess the effectiveness of an educational and hand hygiene program in DCCs and homes in reducing RI incidence and antibiotic prescriptions in children. METHODS A cluster, randomized, controlled, and open study of 911 children aged 0 to 3 years attending 24 DCCs in Almería (Spain) with an 8-month follow-up. Two intervention groups of DCC families performed educational and hand hygiene measures, 1 with soap and water (SWG; n = 274), another with hand sanitizer (HSG; n = 339), and the control group (CG; n = 298) followed usual hand-washing procedures. RI episode rates were compared through multilevel Poisson regression models. The percentage of days missed were compared with Poisson exact tests. RESULTS There were 5211 RI episodes registered. Children in the HSG had less risk of RI episodes (incidence rate ratio [IRR]: 0.77; 95% confidence interval [CI]: 0.68-0.88) and antibiotic prescriptions (IRR: 0.69; 95% CI: 0.57-0.84) compared with the those in the CG. Children in the SWG had a higher risk of RI episodes (IRR: 1.21; 95% CI: 1.06-1.39) and antibiotic prescriptions (IRR: 1.31; 95% CI: 1.08-1.56) than those in the HSG. Pupils missed 5186 DCC days because of RIs, and the percentage of days absent was significantly lower in the HSG compared with the CG (P < .001) and the SWG (P < .001). CONCLUSIONS Hand hygiene programs that include hand sanitizer and educational measures for DCC staff, children, and parents, reduce absent days, RIs, and antibiotic prescriptions for these infections in children at DCCs.
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Affiliation(s)
| | | | | | | | | | | | - Llenalia Garcia-Fernandez
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Seplin Soluciones Estadísticas, Granada, Spain; and
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219
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Waddington H, Chirgwin H, Eyers J, PrasannaKumar Y, Zehra D, Cairncross S. PROTOCOL: Evidence and Gap Map Protocol: Interventions promoting safe water, sanitation, and hygiene for households, communities, schools, and health facilities in low- and middle-income countries. CAMPBELL SYSTEMATIC REVIEWS 2018; 14:1-41. [PMID: 36949737 PMCID: PMC8428037 DOI: 10.1002/cl2.199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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220
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Watson J, Dreibelbis R, Aunger R, Deola C, King K, Long S, Chase RP, Cumming O. Child's play: Harnessing play and curiosity motives to improve child handwashing in a humanitarian setting. Int J Hyg Environ Health 2018; 222:177-182. [PMID: 30219482 DOI: 10.1016/j.ijheh.2018.09.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/04/2018] [Accepted: 09/06/2018] [Indexed: 12/30/2022]
Abstract
In humanitarian emergency settings there is need for low cost and rapidly deployable interventions to protect vulnerable children, in- and out-of-school, from diarrhoeal diseases. Handwashing with soap can greatly reduce diarrhoea but interventions specifically targeting children's handwashing behaviour in humanitarian settings have not been tested. Traditional children's handwashing promotion interventions have been school-focused, resource-intensive and reliant on health-based messaging. However, recent research from non-humanitarian settings and targeting adults suggests that theory-based behaviour change interventions targeting specific motives may be more effective than traditional handwashing interventions. In this proof-of-concept study we test, for the first time, the distribution of a modified soap bar, designed to appeal to the motives of play and curiosity, in a household-level, rapidly deployable, handwashing promotion intervention for older children in a humanitarian setting - an internally displaced persons camp in Iraqi Kurdistan. Out of five total blocks within the camp, one was assigned to intervention and one to control. 40 households from each assigned block were then randomly chosen for inclusion in the study and the practice of handwashing with soap at key times was measured at baseline and four weeks after intervention delivery. Children in intervention households received transparent soaps with embedded toys, delivered within a short, fun, and interactive household session with minimal, non-health-based, messaging. The control group received plain soap delivered in a short standard, health-based, hygiene promotion session. At the 4-week follow-up, children in the intervention group were 4 times more likely to wash their hands with soap after key handwashing occasions than expected in the counterfactual (if there had been no intervention) based on the comparison to children in the control group (adjusted RR = 3.94, 95% CI 1.59-9.79). We show that distributing soaps with toys embedded inside, in a rapidly deployable intervention, can improve child handwashing behaviour in a humanitarian emergency context. Further studies are needed to determine the longer-term behavioural and health impact of such an intervention when delivered at a greater scale in a humanitarian context.
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Affiliation(s)
- Julie Watson
- Department for Disease Control, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK.
| | - Robert Dreibelbis
- Department for Disease Control, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK
| | - Robert Aunger
- Department for Disease Control, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK
| | - Claudio Deola
- Save the Children, 1 St John's Ln, Clerkenwell, London, EC1M 4AR, UK
| | - Katrice King
- Save the Children, 1 St John's Ln, Clerkenwell, London, EC1M 4AR, UK
| | - Susan Long
- Field Ready, 922 Davis Street, Evanston, IL, 60201, USA
| | - Rachel P Chase
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Oliver Cumming
- Department for Disease Control, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK
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221
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A hand hygiene intervention to decrease hand, foot and mouth disease and absence due to sickness among kindergarteners in China: A cluster-randomized controlled trial. J Infect 2018; 78:19-26. [PMID: 30134143 DOI: 10.1016/j.jinf.2018.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 07/27/2018] [Accepted: 08/14/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate the effect of the "Clean Hands, Happy Life" intervention on the incidence of hand, food and mouth disease (HFMD) and on school absences due to sickness in kindergarten students. METHODS The intervention consisted of four hand hygiene (HH) promotion components and was evaluated in a cluster-randomized controlled trial among 8275 children and 18 kindergartens from May to October, 2015 in Shenzhen, China. We compared two intervention arms - received the intervention in kindergartens only and in both kindergartens and families, respectively - to the control arm in multilevel analyses. RESULTS During the follow-up, the incidence of HFMD in both intervention arms was significantly lower than in the control arm (IRR1: 0.39, 95%CI: 0.26-0.59; IRR2: 0.30, 95%CI: 0.19-0.49); the duration of absence due to sickness (in days) in both intervention arms was significantly shorter than in the control arm (β1 = 0.58, 95%CI: 0.41-0.74; β2 = 0.34, 95%CI: 0.17-0.50), controlling for the area type of kindergarten and grade level of children. Furthermore, during the follow-up we found that there were fewer episodes of absence due to respiratory, skin and eye infections (P < 0.05). CONCLUSIONS Our intervention is effective at reducing HFMD infections and absence due to sickness in children attending kindergartens in China.
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222
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Benjamin-Chung J, Amin N, Ercumen A, Arnold BF, Hubbard AE, Unicomb L, Rahman M, Luby SP, Colford JM. A Randomized Controlled Trial to Measure Spillover Effects of a Combined Water, Sanitation, and Handwashing Intervention in Rural Bangladesh. Am J Epidemiol 2018; 187:1733-1744. [PMID: 29596644 PMCID: PMC6070113 DOI: 10.1093/aje/kwy046] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 02/27/2018] [Indexed: 12/17/2022] Open
Abstract
Water, sanitation, and handwashing interventions may confer spillover effects on intervention recipients’ neighbors by interrupting pathogen transmission. We measured geographically local spillovers in the Water Quality, Sanitation, and Handwashing (WASH) Benefits Study, a cluster-randomized trial in rural Bangladesh, by comparing outcomes among neighbors of intervention versus those of control participants. Geographically defined clusters were randomly allocated to a compound-level intervention (i.e., chlorinated drinking water, upgraded sanitation, and handwashing promotion) or control arm. From January 2015 to August 2015, in 180 clusters, we enrolled 1,799 neighboring children who were age matched to trial participants who would have been eligible for the study had they been conceived slightly earlier or later. After 28 months of intervention, we quantified fecal indicator bacteria in toy rinse and drinking water samples and measured soil-transmitted helminth infections and caregiver-reported diarrhea and respiratory illness. Neighbors’ characteristics were balanced across arms. Detectable Escherichia coli prevalence in tubewell samples was lower for intervention participants’ neighbors than control participants’ (prevalence ratio = 0.83; 95% confidence interval: 0.73, 0.95). Fecal indicator bacteria prevalence did not differ between arms for other environmental samples. Prevalence was similar in neighbors of intervention participants versus those of control participants for soil-transmitted helminth infection, diarrhea, and respiratory illness. A compound-level water, sanitation, and handwashing intervention reduced neighbors’ tubewell water contamination but did not affect neighboring children’s health.
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Affiliation(s)
- Jade Benjamin-Chung
- School of Public Health, University of California, Berkeley, Berkeley, California
| | - Nuhu Amin
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Ayse Ercumen
- School of Public Health, University of California, Berkeley, Berkeley, California
| | - Benjamin F Arnold
- School of Public Health, University of California, Berkeley, Berkeley, California
| | - Alan E Hubbard
- School of Public Health, University of California, Berkeley, Berkeley, California
| | - Leanne Unicomb
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mahbubur Rahman
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Stephen P Luby
- Infectious Diseases & Geographic Medicine, Stanford University, Stanford, California
| | - John M Colford
- School of Public Health, University of California, Berkeley, Berkeley, California
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223
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McGuinness SL, Barker SF, O'Toole J, Cheng AC, Forbes AB, Sinclair M, Leder K. Effect of hygiene interventions on acute respiratory infections in childcare, school and domestic settings in low- and middle-income countries: a systematic review. Trop Med Int Health 2018; 23:816-833. [PMID: 29799658 DOI: 10.1111/tmi.13080] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Acute respiratory infections (ARIs) disproportionately affect those living in low- and middle-income countries (LMICs). We aimed to determine whether hygiene interventions delivered in childcare, school or domestic settings in LMICs effectively prevent or reduce ARIs. METHODS We registered our systematic review with PROSPERO (CRD42017058239) and searched MEDLINE, EMBASE, CENTRAL, and Scopus from inception to 17 October 2017 for randomised controlled trials (RCTs) examining the impact of hygiene interventions on ARI morbidity in adults and children in community-based settings in LMICs. We stratified data into childcare, school and domestic settings and used the Grading of Recommendations Assessment, Development and Evaluation approach to assess evidence quality. RESULTS We identified 14 cluster RCTs evaluating hand-hygiene interventions in LMICs with considerable heterogeneity in setting, size, intervention delivery and duration. We found reduced ARI-related absenteeism and illness in childcare settings (low- to moderate-quality evidence). In school settings, we found reduced ARI-related absenteeism and laboratory-confirmed influenza (moderate- to high-quality evidence), but no reduction in ARI illness (low-quality evidence). In domestic settings, we found reduced ARI illness and pneumonia amongst children in urban settlements (high-quality evidence) but not in rural settlements (low-quality evidence), and no effect on secondary transmission of influenza in households (moderate-quality evidence). CONCLUSIONS Evidence suggests that hand-hygiene interventions delivered in childcare, school and domestic settings can reduce ARI morbidity, but effectiveness varies according to setting, intervention target and intervention compliance. Further studies are needed to develop, deliver and evaluate targeted and sustainable hygiene interventions in LMICs.
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Affiliation(s)
- Sarah L McGuinness
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of Infectious Diseases, Alfred Hospital, Melbourne, VIC, Australia
| | - S Fiona Barker
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Joanne O'Toole
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Allen C Cheng
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of Infectious Diseases, Alfred Hospital, Melbourne, VIC, Australia
| | - Andrew B Forbes
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Martha Sinclair
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Karin Leder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC, Australia
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224
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Al-Rifaai JM, Al Haddad AM, Qasem JA. Personal hygiene among college students in Kuwait: A Health promotion perspective. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2018; 7:92. [PMID: 30079363 PMCID: PMC6052777 DOI: 10.4103/jehp.jehp_158_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 03/17/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Most infectious diseases result from a lack of knowledge and poor personal hygiene. Hand hygiene, in particular, is one of the most common means by which pathogens are transmitted. The aim of this study was to determine college student's knowledge and awareness of personal hygiene in Kuwait. MATERIALS AND METHODS A multi-dimensional health assessment approach was followed using a self-administered questionnaire that was distributed among students of two colleges (the College of Nursing and the College of Health Sciences). Item analysis was conducted on 33 items of the questionnaire and measure five types of hygiene practices: hand hygiene, body hygiene, special hair application, oral care, and clothes hygiene. The data collected in the questionnaires and results were analyzed using statistical software SPSS version 23. Statistical analysis was performed using ANOVA and Student's t-test. Internal consistency, reliability was good, with an overall Cronbach's Alpha value of 0.749. RESULTS Most respondents were female with 64%, while 80% of the college students were in the age of <20-year-old. Twelve items were underhand hygiene practices, and four items under body hygiene. Nine items were under oral care; three, items were under hair application. Three were under clothes hygiene. CONCLUSIONS This study showed that female students had a better knowledge and were more hygienic in hand hygiene, hair application, and body hygiene whereas, male students showed a better oral hygiene practice. Nevertheless, this study shows that the hygiene questionnaire is an acceptable and reliable measure of awareness and practice among college students.
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Affiliation(s)
- Jenan M. Al-Rifaai
- Department of Natural Sciences, College of Health Sciences, The Public Authority for Applied Education and Training, Adailiyah, Kuwait
| | - Aneesa M. Al Haddad
- Department of Natural Sciences, College of Health Sciences, The Public Authority for Applied Education and Training, Adailiyah, Kuwait
| | - Jafar A. Qasem
- Department of Applied Medical Sciences, College of Health Sciences, Public Authority for Applied Education and Training, Adailiyah, Kuwait
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225
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Ford TE, Hamner S. A Perspective on the Global Pandemic of Waterborne Disease. MICROBIAL ECOLOGY 2018; 76:2-8. [PMID: 26022715 DOI: 10.1007/s00248-015-0629-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 05/14/2015] [Indexed: 05/26/2023]
Abstract
Waterborne diseases continue to take a heavy toll on the global community, with developing nations, and particularly young children carrying most of the burden of morbidity and mortality. Starting with the historical context, this article explores some of the reasons why this burden continues today, despite our advances in public health over the past century or so. While molecular biology has revolutionized our abilities to define the ecosystems and etiologies of waterborne pathogens, control remains elusive. Lack of basic hygiene and sanitation, and failing infrastructure, remain two of the greatest challenges in the global fight against waterborne disease. Emerging risks continue to be the specter of multiple drug resistance and the ease with which determinants of virulence appear to be transmitted between strains of pathogens, both within and outside the human host.
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Affiliation(s)
- Timothy E Ford
- School of Health Professions, Shenandoah University, Winchester, VA, 22601, USA.
| | - Steve Hamner
- Department of Microbiology and Immunology, Montana State University, Bozeman, MT, 59717, USA
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226
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Handler A, Lustgarten M, Zahavi A, Freedman D, Rosoph L, Hurley KF. Summer Camp Health Initiative: An Overview of Injury and Illness in Two Canadian Summer Camps. Cureus 2018; 10:e2905. [PMID: 30397558 PMCID: PMC6207272 DOI: 10.7759/cureus.2905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: Summer camp is an important part of the lives of millions of youth worldwide. Injuries and illnesses at general residential camps have not been quantified in a Canadian setting. The objective of this study was to examine the incidence of injuries and illnesses that present to camp health centres at two Canadian residential summer camps. Method: This prospective cross-sectional study examined the incidence of new-onset injuries and illnesses that presented to camp infirmaries and circumstances surrounding their occurrence. Data collection forms were completed by trained infirmary staff during each camper’s presentation to the infirmary at two general residential camps in Canada in the summers of 2015 and 2016. Results: There were 1872 infirmary presentations, resulting in a frequency of 52.6 presentations per 1000 camp days (CD). The incidence of illness was 34.8 per 1000 CD and the incidence of injury was 17.9 per 1000 CD. Communicable disease was the most common diagnosis (15.2/1000 CD), most often an upper respiratory tract infection. The most common symptoms upon presentation were sore throat (14.1/1000 CD), headache (9.9/1000 CD), runny nose/congestion (6.2/1000 CD), cough (6.0/1000 CD) and nausea and vomiting (4.8/1000 CD). The most common injuries were cuts/lacerations/bruises (4.9/1000 CD), followed by muscle/tendon injury (4.9/1000 CD). The most frequent cause of injuries was participation in sports (3.9/1000 CD) and sports fields and courts were the most frequent location for injuries to occur (2.7/1000 CD). Females accounted for 52.8% of infirmary presentations. Senior campers (ages 12-16 years) presented most frequently (43.4%), followed by junior campers (ages 6-11 years; 38.1%) and staff (age ≥17 years; 18.0%). When age-specific CDs were calculated, junior campers had the highest frequency of infirmary presentations relative to their time spent at camp (79.7/1000 CD). Fifty people (1.4/1000 CD) were sent to a hospital for further assessment. Conclusion: Injuries and illnesses presenting for infirmary care in summer camp are generally minor in nature. Canadian data compares similarly to United States (US) studies. Future studies should focus on interventions to reduce these injuries and illnesses, particularly communicable illnesses.
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Affiliation(s)
- Adam Handler
- University of Toronto, Toronto Western Hospital, Torotno, CAN
| | | | - Arielle Zahavi
- Faculty of Medicine, University of Toronto, Toronto, CAN
| | | | - Les Rosoph
- Dermatology, Northern Ontario School of Medicine, North Bay, CAN
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Gizaw Z, Adane T, Azanaw J, Addisu A, Haile D. Childhood intestinal parasitic infection and sanitation predictors in rural Dembiya, northwest Ethiopia. Environ Health Prev Med 2018; 23:26. [PMID: 29933747 PMCID: PMC6015452 DOI: 10.1186/s12199-018-0714-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 05/29/2018] [Indexed: 01/01/2023] Open
Abstract
Background Intestinal parasites are a common problem in the world. The greater proportion of infections is associated with poor water, sanitation, and hygiene (WASH). This study was conducted to assess intestinal parasites, WASH condition, and their association in rural Dembiya, northwest Ethiopia. Methods A cross-sectional study was employed. Two hundred twenty-five children aged 6–59 months were included. Mothers were interviewed using a structured questionnaire, and the living environment was observed using checklists. Kato-Katz technique was used to determine the intensity of parasitic infections. Escherichia coli (E. coli) was used as a biological indicator for drinking water quality. Multivariable binary logistic regression analysis was conducted to identify WASH predictors of parasites on the basis of adjusted odds ratio (AOR) with 95% confidence interval (CI) and p < 0.05. Results The prevalence of intestinal parasites was 25.8% (95% CI = 20.3–32.0%). Ascaris lumbricoides (78%), hookworm (12%), Hymenolepis nana (7%), Enterobius vermicularis (5%), Schistosoma mansoni (3%), Giardia lamblia (3%), and Trichuris trichiuria (2%) were identified infections. Intestinal parasites were associated with poor child hand washing practice [AOR = 3.86, 95% CI = 1.53, 9.75], unprotected water sources [AOR = 7.79, 95% CI = 3.30, 18.40], access to water below 20 l/c/d [AOR = 3.05, 95% CI = 1.28, 7.23], poor food safety[AOR = 4.33, 95% CI = 1.62, 11.58], and poor sanitation [AOR = 5.01, 95% CI = 1.56, 16.16]. Conclusion A. lumbricoides, hookworm, H. nana, E. vermicularis, S. mansoni, G. lamblia, and T. trichiuria were identified. Child hand washing practice, service level of water supply, water sources, food safety, and sanitation were associated with intestinal parasites. WASH promotion is needed to prevent infections.
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Affiliation(s)
- Zemichael Gizaw
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Tsegaye Adane
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Jember Azanaw
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ayenew Addisu
- Department of Parasitology, School of Biomedical Science, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Daniel Haile
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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228
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Burns J, Maughan-Brown B, Mouzinho Â. Washing with hope: evidence of improved handwashing among children in South Africa from a pilot study of a novel soap technology. BMC Public Health 2018; 18:709. [PMID: 29879942 PMCID: PMC5992781 DOI: 10.1186/s12889-018-5573-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 05/17/2018] [Indexed: 11/29/2022] Open
Abstract
Background While regular handwashing effectively reduces communicable disease incidence and related child mortality, instilling a habit of regular handwashing in young children continues to be a challenging task, especially in developing country contexts. This randomised controlled pilot study assessed the effect of a novel handwashing intervention – a bi-monthly delivery of a colourful, translucent bar of soap with a toy embedded in its centre (HOPE SOAP©) – on children’s handwashing behaviour and health outcomes. Methods Between September and December 2014, 203 households in an impoverished community in Cape Town, South Africa, were randomised (1:1) to the control group or to receive HOPE SOAP©. Of all children (N = 287) aged 3–9 years and not enrolled in early childhood development programmes, 153 residing in intervention households received a bar of HOPE SOAP© every two weeks (total of 4 bars). Children in control households received a colourful, translucent bar of soap of equal size to HOPE SOAP©, with a toy alongside it. Two ‘snack tests’ (children were offered crackers and jam) were used to provide objective observational measures of handwashing. Through baseline and endline surveys, data were collected from caregivers on the frequency (scale of 1–10) of handwashing by children after using the toilet and before meals, and on soap-use during handwashing. Data on 14 illnesses/symptoms of illness experienced by children in the two weeks preceding the surveys were collected. Multivariable Ordinary Least Squares regression analyses were used to assess the intervention effect on handwashing behaviours and health outcomes. Results At endline, HOPE SOAP© children were directly observed as being more likely to wash their hands unprompted at both snack tests (49% vs 39%, β: 0.10, p = 0.27). They were more likely to score ≥8/10 for using soap when washing their hands (β: 0.14, p = 0.011). HOPE SOAP© children, in general, had better health outcomes, and those who used the soap as intended, and did not cheat to remove the toy from the soap, were less likely to have been ill (β: − 0.15, p = 0.049). Conclusions Results point towards HOPE SOAP© being an effective intervention to improve handwashing among children. Further research on this novel handwashing intervention is warranted. Trial registration NCT03280771 (www.clinicaltrials.gov) retrospectively registered on 8 September 2017. Electronic supplementary material The online version of this article (10.1186/s12889-018-5573-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Justine Burns
- School of Economics, University of Cape Town, Private Bag, Rondebosch, 7701, South Africa.
| | - Brendan Maughan-Brown
- Southern Africa Labour and Development Research Unit, University of Cape Town, Private Bag X3, Rondebosch, 7701, South Africa
| | - Âurea Mouzinho
- Abdul Latif Jameel Poverty Action Lab, University of Cape Town, Private Bag, Rondebosch, 7701, South Africa
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Arıkan D, Gürarslan Baş N, Kurudirek F, Baştopcu A, Uslu H. The Effect of Therapeutic Clowning on Handwashing Technique and Microbial Colonization in Preschool Children. J Nurs Scholarsh 2018; 50:441-450. [PMID: 29764000 DOI: 10.1111/jnu.12392] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE This study aimed to determine the effect of therapeutic clowning on handwashing technique and microbial colonization in preschool children. DESIGN This randomized controlled trial was conducted using pre-test and post-test experimental and control groups. METHODS The study was conducted between March and June 2016 in two kindergartens in eastern Turkey. The study was completed with a total of 195 students, including 90 students in the experimental group and 105 students in the control group. A questionnaire was used for data collection. This questionnaire included sections about the subjects' descriptive characteristics and the results of the bacterial cultures of their hand swabs. For the collection of these swabs, the subjects were informed in advance, and samples were collected at predetermined times. The swabs were analyzed to determine the bacterial colonization of the subjects' hands. Clowns and video activities were used as intervention tools in the study. FINDINGS In the post-test, the microbial growth was ≤103 in 68.9% and >103 in 31.1% of the subjects in the experimental group. In contrast, the growth was ≤103 in 34.3% and >103 in 65.7% of the control group subjects. The difference in the post-test microbial growths of the two groups was statistically significant (p < .000). CONCLUSIONS The hygienic handwashing technique taught in the therapeutic clowning and videos reduced the bacterial colonization on the preschool children's hands by 50%. Moreover, this method was effective in reducing the growth rate of coliform bacteria that indicate undesirable, poor hygiene of the hands. CLINICAL RELEVANCE Considering these results, we recommend that pediatric healthcare professionals use entertaining methods such as those involving clowns to teach and guide children regarding hygienic handwashing techniques.
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Affiliation(s)
- Duygu Arıkan
- Professor, Atatürk University Faculty of Nursing, Department of Child Health and Diseases Nursing, Erzurum, Turkey
| | - Nazan Gürarslan Baş
- Assistant Professor, Munzur University High School of Health, Department of Nursing, Tunceli, Turkey
| | - Fatma Kurudirek
- Assistant Professor, Atatürk University Faculty of Nursing, Department of Child Health and Diseases Nursing, Erzurum, Turkey
| | - Ayşe Baştopcu
- Research Asistant, Atatürk University, Faculty of Medicine Clinical Microbiology, Department of Medical Microbiology, Erzurum, Turkey
| | - Hakan Uslu
- Professor, Atatürk University, Faculty of Medicine Clinical Microbiology, Department of Medical Microbiology, Erzurum, Turkey
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Antiseptic Agents Elicit Short-Term, Personalized, and Body Site-Specific Shifts in Resident Skin Bacterial Communities. J Invest Dermatol 2018; 138:2234-2243. [PMID: 29753031 DOI: 10.1016/j.jid.2018.04.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/09/2018] [Accepted: 04/23/2018] [Indexed: 01/19/2023]
Abstract
Despite critical functions in cutaneous health and disease, it is unclear how resident skin microbial communities are altered by topical antimicrobial interventions commonly used in personal and clinical settings. Here we show that acute exposure to antiseptic treatments elicits rapid but short-term depletion of microbial community diversity and membership. Thirteen subjects were enrolled in a longitudinal treatment study to analyze the effects of topical treatments (i.e., ethanol, povidone-iodine, chlorhexidine, and water) on the skin microbiome at two skin sites of disparate microenvironment: forearm and back. Treatment effects were highly dependent on personalized and body site-specific colonization signatures, which concealed community dynamics at the population level when not accounted for in this analysis. The magnitude of disruption was influenced by the identity and abundance of particular bacterial inhabitants. Lowly abundant members of the skin microbiota were more likely to be displaced, and subsequently replaced, by the most abundant taxa prior to treatment. Members of the skin commensal family Propionibactericeae were particularly resilient to treatment, suggesting a distinct competitive advantage in the face of disturbance. These results provide insight into the stability and resilience of the skin microbiome, while establishing the impact of topical antiseptic treatment on skin bacterial dynamics and community ecology.
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231
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Gidado S, Awosanya E, Haladu S, Ayanleke HB, Idris S, Mamuda I, Mohammed A, Michael CA, Waziri NE, Nguku P. Cholera outbreak in a naïve rural community in Northern Nigeria: the importance of hand washing with soap, September 2010. Pan Afr Med J 2018; 30:5. [PMID: 30123408 PMCID: PMC6093587 DOI: 10.11604/pamj.2018.30.5.12768] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 03/24/2018] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Cholera outbreaks in rural communities are associated with high morbidity and mortality. Effective interventions to control these outbreaks require identification of source and risk factors for infection. In September, 2010 we investigated a cholera outbreak in Bashuri, a cholera naïve rural community in northern Nigeria to identify the risk factors and institute control measures. METHODS We conducted an unmatched case-control study. We defined a case as any resident of Bashuri community two years and above with acute watery diarrhea with or without vomiting and a control as any resident two years and above without acute watery diarrhea and vomiting. We recruited 80 hospital-based cases and 80 neighborhood controls. We collected and analyzed data on demographic characteristics, clinical information and risk factors. Laboratory analysis was performed on 10 stool samples and 14 open-well samples. RESULTS Mean age was 29 years (± 20 years) for cases and 32 years (± 16 years) for controls; 38 (47.5%) of cases and 60 (75%) of controls were males. Compared to controls, cases were less likely to have washed hands with soap before eating (age-adjusted odds ratio (AAOR) = 0.27, 95% confidence interval (CI): 0.10-0.72) and less likely to have washed hands with soap after using the toilet (AAOR = 0.34, 95% CI: 0.15-0.75). Vibrio cholerae O1 was isolated from six stool samples but not from any open-well samples. CONCLUSION Unhygienic hand washing practices was the key risk factor in this outbreak. We educated the community on personal hygiene focusing on the importance of hand washing with soap.
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Affiliation(s)
- Saheed Gidado
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
| | - Emmanuel Awosanya
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
| | - Suleiman Haladu
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
| | | | - Suleman Idris
- Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Ismaila Mamuda
- Epidemiology Unit, Ministry of Health, Jigawa State, Nigeria
| | - Abdulaziz Mohammed
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
| | | | | | - Patrick Nguku
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
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Parveen S, Nasreen S, Allen JV, Kamm KB, Khan S, Akter S, Lopa TM, Zaman K, El Arifeen S, Luby SP, Ram PK. Barriers to and motivators of handwashing behavior among mothers of neonates in rural Bangladesh. BMC Public Health 2018; 18:483. [PMID: 29642885 PMCID: PMC5896121 DOI: 10.1186/s12889-018-5365-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 03/22/2018] [Indexed: 11/18/2022] Open
Abstract
Background To design a maternal handwashing intervention for the newborn period, this qualitative study explored drivers of handwashing among mothers and other caregivers of neonates and infants in two rural areas of Bangladesh. Methods We conducted 40 semi-structured observation sessions to observe handwashing behaviors of primiparous and multiparous mothers of neonates, and to understand the contextual factors that facilitated or hampered those behaviors. We then conducted 64 interviews with mothers of neonates and mothers of infants and 6 group discussions with mothers of infants, other female caregivers and fathers to explore perceptions, beliefs, and practices related to handwashing in the neonatal period. Based on a conceptual model and the Theory of Reasoned Action/Theory of Planned Behavior, we developed a conceptual model a priori, we performed thematic analysis to explain determinants of maternal handwashing behaviors. Results We conducted 200 h of observation among mothers of neonates. The age range of participating mothers varied between 17 and 25 years and their maximum education was up to 10th grade of schooling. Mothers, other female caregivers and fathers perceived a need to wash hands with or without soap before eating or before feeding a child by hand to prevent diarrhea. Mothers expressed the importance of washing their hands before holding a baby but were rarely observed doing so. All respondents prioritized using soap for visible dirt or feces; otherwise, water alone was considered sufficient. Lack of family support, social norms of infrequent handwashing, perceptions of frequent contact with water as a health threat and mothers’ restricted movement during first 40 days of neonate’s life, and childcare and household responsibilities adversely impacted handwashing behavior. Conclusions Addressing emotive drivers of handwashing within existing social norms by engaging family members, ensuring handwashing facilities and clarifying neonatal health threats may improve maternal handwashing behavior in the neonatal period. Electronic supplementary material The online version of this article (10.1186/s12889-018-5365-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shahana Parveen
- Programme for Emerging Infections, Infectious Diseases Division, icddr,b (International Centre for Diarrhoeal Diseases Research, Bangladesh), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Sharifa Nasreen
- Programme for Emerging Infections, Infectious Diseases Division, icddr,b (International Centre for Diarrhoeal Diseases Research, Bangladesh), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Jelena V Allen
- Maternal and Neonatal Health, Maternal and Child Health Division, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Kelly B Kamm
- Maternal and Neonatal Health, Maternal and Child Health Division, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Shifat Khan
- Programme for Emerging Infections, Infectious Diseases Division, icddr,b (International Centre for Diarrhoeal Diseases Research, Bangladesh), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Shirina Akter
- Programme for Emerging Infections, Infectious Diseases Division, icddr,b (International Centre for Diarrhoeal Diseases Research, Bangladesh), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Tajnin Marin Lopa
- Programme for Emerging Infections, Infectious Diseases Division, icddr,b (International Centre for Diarrhoeal Diseases Research, Bangladesh), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - K Zaman
- Maternal and Neonatal Health, Maternal and Child Health Division, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Shams El Arifeen
- Maternal and Neonatal Health, Maternal and Child Health Division, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Stephen P Luby
- Programme for Emerging Infections, Infectious Diseases Division, icddr,b (International Centre for Diarrhoeal Diseases Research, Bangladesh), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.,Infectious Diseases and Geographic Medicine, Stanford University, Y2E2, MC 4205473 Via Ortega, Stanford, CA, 94305, USA
| | - Pavani K Ram
- School of Public Health and Health Professions, University at Buffalo, 3435 Main Street, Rm. 237 Farber Hall, Buffalo, NY, 14214, USA
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Zivich PN, Gancz AS, Aiello AE. Effect of hand hygiene on infectious diseases in the office workplace: A systematic review. Am J Infect Control 2018; 46:448-455. [PMID: 29195781 DOI: 10.1016/j.ajic.2017.10.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 10/11/2017] [Accepted: 10/12/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Extensive data suggests that hand hygiene is a critical intervention for reducing infectious disease transmission in the clinical setting. However, it is unclear whether hand hygiene is effective at cutting down on infectious illnesses in non-clinical workplaces. The aim of this review is to assess the current literature concerning the effects of hand-washing interventions on infectious disease prevention among employees in nonclinical, office-based workplaces. METHODS In compiling this review, PubMed, Scopus, and Business Source Premier were examined for studies published from 1960 through 2016. RESULTS Eleven studies (eight experimental, two observational, one a simulation) were identified as eligible for inclusion. Hand-hygiene interventions at various levels of rigor were shown to reduce self-reported illness symptoms. CONCLUSIONS Hand hygiene is thought to be more effective against gastrointestinal illness than it is against respiratory illness, but no clear consensus has been reached on this point. Minimal hand-hygiene interventions seem to be effective at reducing the incidence of employee illness. Along with reducing infections among employees, hand-hygiene programs in the workplace may provide additional benefits to employers by reducing the number of employee health insurance claims and improving employee morale. Future research should use objective measures of hand hygiene and illness, and explore economic impacts on employers more fully.
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High vaccination coverage is associated with low epidemic level of seasonal influenza in elementary schools: an observational study in Matsumoto City, Japan. BMC Infect Dis 2018. [PMID: 29534676 PMCID: PMC5851075 DOI: 10.1186/s12879-018-3025-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Influenza virus transmission may be prevented by infection control measures, including vaccination, wearing a mask, gargling with water, and hand washing. It is unclear, however, whether these measures affect influenza epidemics in school settings. Methods A prospective epidemiological survey in all public elementary schools in Matsumoto City, Japan, during the 2014/2015 season evaluated the number of diagnosed patients in each school and calculated the reproduction number of schoolchildren. At the end of the prospective survey, a cross-sectional survey evaluated the implementation of infection control measures in these schools. Both results were combined and associations among infection control measures including vaccination, mask wearing, hand washing, water gargling, and epidemic level were evaluated. Results Of the 13,217 schoolchildren in 29 schools, 2548 were diagnosed with seasonal influenza. A significant negative association was observed between vaccination coverage and reproduction number at each school, but not between other infection control measures and the reproduction number. A regression curve with exponential function was most predictive. At 0% vaccination, the reproduction number was estimated to be 1.39. Conclusion These findings provide evidence that high vaccination coverage was associated with reduced epidemic levels in schools and suggest the need for increased vaccination of schoolchildren.
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Bloomfield SF, Rook GA, Scott EA, Shanahan F, Stanwell-Smith R, Turner P. Time to abandon the hygiene hypothesis: new perspectives on allergic disease, the human microbiome, infectious disease prevention and the role of targeted hygiene. Perspect Public Health 2018; 136:213-24. [PMID: 27354505 PMCID: PMC4966430 DOI: 10.1177/1757913916650225] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Aims: To review the burden of allergic and infectious diseases and the evidence for
a link to microbial exposure, the human microbiome and immune system, and to
assess whether we could develop lifestyles which reconnect us with exposures
which could reduce the risk of allergic disease while also protecting
against infectious disease. Methods: Using methodology based on the Delphi technique, six experts in infectious
and allergic disease were surveyed to allow for elicitation of group
judgement and consensus view on issues pertinent to the aim. Results: Key themes emerged where evidence shows that interaction with microbes that
inhabit the natural environment and human microbiome plays an essential role
in immune regulation. Changes in lifestyle and environmental exposure, rapid
urbanisation, altered diet and antibiotic use have had profound effects on
the human microbiome, leading to failure of immunotolerance and increased
risk of allergic disease. Although evidence supports the concept of immune
regulation driven by microbe–host interactions, the term ‘hygiene
hypothesis’ is a misleading misnomer. There is no good evidence that
hygiene, as the public understands, is responsible for the clinically
relevant changes to microbial exposures. Conclusion: Evidence suggests a combination of strategies, including natural childbirth,
breast feeding, increased social exposure through sport, other outdoor
activities, less time spent indoors, diet and appropriate antibiotic use,
may help restore the microbiome and perhaps reduce risks of allergic
disease. Preventive efforts must focus on early life. The term ‘hygiene
hypothesis’ must be abandoned. Promotion of a risk assessment approach
(targeted hygiene) provides a framework for maximising protection against
pathogen exposure while allowing spread of essential microbes between family
members. To build on these findings, we must change public, public health
and professional perceptions about the microbiome and about hygiene. We need
to restore public understanding of hygiene as a means to prevent infectious
disease.
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Affiliation(s)
- Sally F Bloomfield
- London School of Hygiene & Tropical Medicine and International Scientific Forum on Home Hygiene, The Old Dairy Cottage, Montacute, Somerset TA15 6XL, UK
| | - Graham Aw Rook
- Centre for Clinical Microbiology, Department of Infection, University College London (UCL), London, UK
| | - Elizabeth A Scott
- Center for Hygiene and Health, Department of Biology, Simmons College, Boston, MA, USA
| | - Fergus Shanahan
- APC Microbiome Institute, University College Cork - National University of Ireland, Cork, Ireland
| | | | - Paul Turner
- Section of Paediatrics (Allergy & Infectious Diseases) and MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, UK; Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, NSW, Australia
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Impact of Water, Sanitation and Hygiene Interventions on Growth, Non-diarrheal Morbidity and Mortality in Children Residing in Low- and Middle-income Countries: A Systematic Review. Indian Pediatr 2018. [DOI: 10.1007/s13312-018-1279-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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237
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Prevalence and Source of Fecal and Oral Bacteria on Infant, Child, and Adult Hands. mSystems 2018; 3:mSystems00192-17. [PMID: 29359197 PMCID: PMC5768791 DOI: 10.1128/msystems.00192-17] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 12/15/2017] [Indexed: 12/18/2022] Open
Abstract
Bacteria live all around us, and we are constantly exposed to them during our everyday lives. Modern standards of hygiene aim to limit exposure to fecal bacteria, and yet bacteria rapidly colonize the gut in early life and following antibacterial treatment. Exposures to fecal and oral microbes provide risk of disease, but are also necessary since commensal microbes play important roles in health. This work establishes that bacteria of both fecal and oral origins are commonly found on hands. It also establishes that the uniqueness of fecal and oral bacterial communities across people can allow for determination of the likely individual from whom the fecal and oral bacteria came. These techniques allow for understanding the hands as a vector for microbial transmission within families and across populations, which has important implications for public health. Modern hygienic practices are applied to avoid exposure to pathogens that spread via fecal-oral transmission. Despite this, the gastrointestinal tract is quickly colonized by fecal microbes. The hands are an important vector for the transmission of microbes, but the frequency at which fecal and oral microbes exist on hands and the source of those microbes have not been extensively described. Using data from a previous study that characterized the fecal, oral, and skin microbiota from 73 families, we found a significant incidence of fecal and oral microbes on hands. Of palms, 48.9% had fecal signal and 67.2% had oral signal. Fecal, oral, and forehead microbes were tracked to family members and an individual’s own palms far more often than to unrelated individuals and showed relationships with age, gender, and parental status. For instance, oral microbes that were specifically sourced to the same individual (oneself) were most common on infant palms; mothers had more infant-child-sourced and oral-sourced microbes on their palms than nonparents. Fecal microbes on palms more often sourced to members of the family than unrelated individuals, but more often to other members of the family than oneself. This study supports that the hands are an important vector for the transfer of fecal and oral microbes within families. IMPORTANCE Bacteria live all around us, and we are constantly exposed to them during our everyday lives. Modern standards of hygiene aim to limit exposure to fecal bacteria, and yet bacteria rapidly colonize the gut in early life and following antibacterial treatment. Exposures to fecal and oral microbes provide risk of disease, but are also necessary since commensal microbes play important roles in health. This work establishes that bacteria of both fecal and oral origins are commonly found on hands. It also establishes that the uniqueness of fecal and oral bacterial communities across people can allow for determination of the likely individual from whom the fecal and oral bacteria came. These techniques allow for understanding the hands as a vector for microbial transmission within families and across populations, which has important implications for public health.
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Abstract
Hand hygiene is a basic but effective strategy against infectious disease. This study investigated an ecological association between hand hygiene and tuberculosis (TB) risk in Korea. Hand hygiene data were obtained from the 2015 Community Health Survey. Information on TB incidence and mortality in 2015 were obtained from the National Infectious Diseases Surveillance System and death monitoring database, respectively. In multiple linear regression analysis, frequent hand washing rates after using the restroom (B = -0.78, P = .037), after returning from the outdoors (B = -0.28, P = .049), and with soap or hand sanitizer (B = -0.54, P = .018) were negatively associated with TB incidence. TB mortality were associated with frequent hand washing rates after returning from the outdoors (B = -0.05, P = .035), and with soap or hand sanitizer (B = -0.10, P = .010), respectively. Hand washing was associated with lower TB incidence and mortality at the community level. These results could contribute to develop community-based health promotion strategies.
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Affiliation(s)
- Mi Ah Han
- 1 College of Medicine, Chosun University, Gwangju, Republic of Korea
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240
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Larson EL, Murray MT, Cohen B, Simpser E, Pavia M, Jackson O, Jia H, Hutcheon RG, Mosiello L, Neu N, Saiman L. Behavioral Interventions to Reduce Infections in Pediatric Long-term Care Facilities: The Keep It Clean for Kids Trial. Behav Med 2018; 44. [PMID: 28632004 PMCID: PMC5732083 DOI: 10.1080/08964289.2017.1288607] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Children in pediatric long-term care facilities (pLTCF) represent a highly vulnerable population and infectious outbreaks occur frequently, resulting in significant morbidity, mortality, and resource use. The purpose of this quasi-experimental trial using time series analysis was to assess the impact of a 4-year theoretically based behavioral intervention on infection prevention practices and clinical outcomes in three pLTCF (288 beds) in New York metropolitan area including 720 residents, ages 1 day to 26 years with mean lengths of stay: 7.9-33.6 months. The 5-pronged behavioral intervention included explicit leadership commitment, active staff participation, work flow assessments, training staff in the World Health Organization "'five moments of hand hygiene (HH)," and electronic monitoring and feedback of HH frequency. Major outcomes were HH frequency, rates of infections, number of hospitalizations associated with infections, and outbreaks. Mean infection rates/1000 patient days ranged from 4.1-10.4 pre-intervention and 2.9-10.0 post-intervention. Mean hospitalizations/1000 patient days ranged from 2.3-9.7 before and 6.4-9.8 after intervention. Number of outbreaks/1000 patient days per study site ranged from 9-24 pre- and 9-18 post-intervention (total = 95); number of cases/outbreak ranged from 97-324 (total cases pre-intervention = 591 and post-intervention = 401). Post-intervention, statistically significant increases in HH trends occurred in one of three sites, reductions in infections in two sites, fewer hospitalizations in all sites, and significant but varied changes in the numbers of outbreaks and cases/outbreak. Modest but inconsistent improvements occurred in clinically relevant outcomes. Sustainable improvements in infection prevention in pLTCF will require culture change; increased staff involvement; explicit administrative support; and meaningful, timely behavioral feedback.
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241
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Park YH, Lee SH, Yi YM, Lee CY, Lee MH. Compliance with Respiratory Infection Preventive Behaviors and Its related Factors in Older Adults using a Senior Center. ACTA ACUST UNITED AC 2018. [DOI: 10.12799/jkachn.2018.29.3.322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Yeon-Hwan Park
- Professor, College of Nursing, Seoul National University, Seoul, Korea
| | - Seong Hyeon Lee
- Master's Degree Student, College of Nursing, Seoul National University, Seoul, Korea
| | - Yu Mi Yi
- Doctoral Student, College of Nursing, Seoul National University, Seoul, Korea
| | - Chi Young Lee
- Doctoral Student, School of Nursing, Duke University, Durham, NC, USA
| | - Min Hye Lee
- Doctoral Student, College of Nursing, Seoul National University, Seoul, Korea
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242
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Trudeau J, Aksan AM, Vásquez WF. Water system unreliability and diarrhea incidence among children in Guatemala. Int J Public Health 2017; 63:241-250. [PMID: 29143849 DOI: 10.1007/s00038-017-1054-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 10/23/2017] [Accepted: 11/06/2017] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES This article examines the effect of water system unreliability on diarrhea incidence among children aged 0-5 in Guatemala. METHODS We use secondary data from a nationally representative sample of 7579 children to estimate the effects of uninterrupted and interrupted water services on diarrhea incidence. The national scope of this study imposes some methodological challenges due to unobserved geographical heterogeneity. To address this issue, we estimate mixed-effects logit models that control for unobserved heterogeneity by estimating random effects of selected covariates that can vary across geographical areas (i.e. water system reliability). RESULTS Compared to children without access to piped water, children with uninterrupted water services have a lower probability of diarrhea incidence by approximately 33 percentage points. Conversely, there is no differential effect between children without access and those with at least one day of service interruptions in the previous month. Results also confirm negative effects of age, female gender, spanish language, and garbage disposal on diarrhea incidence. CONCLUSIONS Public health benefits of piped water are realized through uninterrupted provision of service, not merely access. Policy implications are discussed.
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Affiliation(s)
- Jennifer Trudeau
- Department of Business Economics, Sacred Heart University, 5151 Park Avenue, Fairfield, CT, 06825, USA.
| | - Anna-Maria Aksan
- Department of Economics, Fairfield University, 1073 North Benson Road, Fairfield, CT, 06824, USA
| | - William F Vásquez
- Department of Economics, Fairfield University, 1073 North Benson Road, Fairfield, CT, 06824, USA
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Figueroa A, Gulati RK, Rainey JJ. Estimating the frequency and characteristics of respiratory disease outbreaks at mass gatherings in the United States: Findings from a state and local health department assessment. PLoS One 2017; 12:e0186730. [PMID: 29077750 PMCID: PMC5659613 DOI: 10.1371/journal.pone.0186730] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/08/2017] [Indexed: 11/18/2022] Open
Abstract
Mass gatherings create environments conducive to the transmission of infectious diseases. Thousands of mass gatherings are held annually in the United States; however, information on the frequency and characteristics of respiratory disease outbreaks and on the use of nonpharmaceutical interventions at these gatherings is scarce. We administered an online assessment to the 50 state health departments and 31 large local health departments in the United States to gather information about mass gathering-related respiratory disease outbreaks occurring between 2009 and 2014. The assessment also captured information on the use of nonpharmaceutical interventions to slow disease transmission in these settings. We downloaded respondent data into a SAS dataset for descriptive analyses. We received responses from 43 (53%) of the 81 health jurisdictions. Among these, 8 reported 18 mass gathering outbreaks. More than half (n = 11) of the outbreaks involved zoonotic transmission of influenza A (H3N2v) at county and state fairs. Other outbreaks occurred at camps (influenza A (H1N1)pdm09 [n = 2] and A (H3) [n = 1]), religious gatherings (influenza A (H1N1)pdm09 [n = 1] and unspecified respiratory virus [n = 1]), at a conference (influenza A (H1N1)pdm09), and a sporting event (influenza A). Outbreaks ranged from 5 to 150 reported cases. Of the 43 respondents, 9 jurisdictions used nonpharmaceutical interventions to slow or prevent disease transmission. Although respiratory disease outbreaks with a large number of cases occur at many types of mass gatherings, our assessment suggests that such outbreaks may be uncommon, even during the 2009 influenza A (H1N1) pandemic, which partially explains the reported, but limited, use of nonpharmaceutical interventions. More research on the characteristics of mass gatherings with respiratory disease outbreaks and effectiveness of nonpharmaceutical interventions would likely be beneficial for decision makers at state and local health departments when responding to future outbreaks and pandemics.
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Affiliation(s)
- Argelia Figueroa
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Reena K. Gulati
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jeanette J. Rainey
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
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Announcement: Global Handwashing Day — October 15, 2017. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2017; 66:1083. [PMID: 29023434 PMCID: PMC5657931 DOI: 10.15585/mmwr.mm6640a6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pokrywka M, Buraczewski M, Frank D, Dixon H, Ferrelli J, Shutt K, Yassin M. Can improving patient hand hygiene impact Clostridium difficile infection events at an academic medical center? Am J Infect Control 2017; 45:959-963. [PMID: 28863811 DOI: 10.1016/j.ajic.2017.06.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/09/2017] [Accepted: 06/09/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hand hygiene plays an important role in the prevention of Clostridium difficile (CD) infection (CDI). Patient hand hygiene (PHH) may be a potentially underused preventative measure for CDI. Patient mobility and acuity along with a lack of education present obstacles to PHH for the hospitalized patient. Surveys of patients at our institution showed a need for increased PHH opportunities. The objective of this study was to increase PHH and to examine if PHH affected CDI at our hospital. METHODS A biphasic, quasi-experimental study was performed to increase PHH through education for staff and to provide education, assistance, and opportunities to the patient for hand cleaning. PHH practice was assessed by patient surveys and analyzed by χ2 test. PHH effect on CDI was determined by following health care facility-onset CD laboratory-identified events data analyzed by National Healthcare Safety Network standardized infection ratios (SIRs). RESULTS PHH opportunities improved significantly (P < .0001) after staff and patient education. CD SIRs deceased significantly for 6 months (P ≤ .05) after the PHH intervention. CONCLUSIONS PHH opportunities can be increased by providing education and opportunities for patients to clean their hands. PHH should be considered a relevant preventative measure for CDI in hospitalized patients.
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246
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Davis NL, Wiener J, Juliano JJ, Adair L, Chasela CS, Kayira D, Hudgens MG, van der Horst C, Jamieson DJ, Kourtis AP. Co-trimoxazole Prophylaxis, Asymptomatic Malaria Parasitemia, and Infectious Morbidity in Human Immunodeficiency Virus-Exposed, Uninfected Infants in Malawi: The BAN Study. Clin Infect Dis 2017; 65:575-580. [PMID: 28444232 PMCID: PMC5850033 DOI: 10.1093/cid/cix367] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 04/18/2017] [Indexed: 12/19/2022] Open
Abstract
Background Human immunodeficiency virus (HIV)-exposed infants are disproportionately at risk of morbidity and mortality compared with their HIV-unexposed counterparts. The role of co-trimoxazole preventive therapy (CPT) in reducing leading causes of infectious morbidity is unclear. Methods We used data from the Breastfeeding, Antiretrovirals and Nutrition (BAN) clinical trial (conducted 2004-2010, Malawi) to assess the association of (1) CPT and (2) asymptomatic malaria parasitemia with respiratory and diarrheal morbidity in infants. In June 2006, all HIV-exposed infants in BAN began receiving CPT (240 mg) from 6 to 36 weeks of age, or until weaning occurred and HIV infection was ruled out. All HIV-exposed, uninfected infants (HEIs) at 8 weeks of age (n = 1984) were included when CPT was the exposure. A subset of HEIs (n = 471) were tested for malarial parasitemia using dried blood spots from 12, 24, and 36 weeks of age. Cox proportional hazards models for recurrent gap-time data were used to examine the association of time-varying exposures on morbidity. Results CPT was associated with a 36% reduction in respiratory morbidity (hazard ratio [HR], 0.64 [95% confidence interval {CI}, .60-.69]) and a 41% reduction in diarrheal morbidity (HR, 0.59 [95% CI, .54-.65]). Having asymptomatic malaria parasitemia was associated with a 40% increase in respiratory morbidity (HR, 1.40 [95% CI, 1.13-1.74]) and a 50% increase in diarrheal morbidity (HR, 1.50 [95% CI, 1.09-2.06]), after adjusting for CPT. Conclusions CPT may have an important role to play in reducing the leading global causes of morbidity and mortality in the growing population of HEIs in malaria-endemic resource-limited settings.
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Affiliation(s)
- Nicole L Davis
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeffrey Wiener
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jonathan J Juliano
- Division of Infectious Diseases, Department of Medicine, School of Medicine
| | - Linda Adair
- Carolina Population Center, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Charles S Chasela
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Parktown, South Africa
| | | | - Michael G Hudgens
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, USA
| | | | - Denise J Jamieson
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Athena P Kourtis
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Kumar S, Loughnan L, Luyendijk R, Hernandez O, Weinger M, Arnold F, Ram PK. Handwashing in 51 Countries: Analysis of Proxy Measures of Handwashing Behavior in Multiple Indicator Cluster Surveys and Demographic and Health Surveys, 2010-2013. Am J Trop Med Hyg 2017; 97:447-459. [PMID: 28722572 PMCID: PMC5544068 DOI: 10.4269/ajtmh.16-0445] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 03/17/2017] [Indexed: 11/07/2022] Open
Abstract
In 2009, a common set of questions addressing handwashing behavior was introduced into nationally representative Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), providing large amounts of comparable data from numerous countries worldwide. The objective of this analysis is to describe global handwashing patterns using two proxy indicators for handwashing behavior from 51 DHS and MICS surveys conducted in 2010-2013: availability of soap anywhere in the dwelling and access to a handwashing place with soap and water. Data were also examined across geographic regions, wealth quintiles, and rural versus urban settings. We found large disparities for both indicators across regions, and even among countries within the same World Health Organization region. Within countries, households in lower wealth quintiles and in rural areas were less likely to have soap anywhere in the dwelling and at designated handwashing locations than households in higher wealth quintiles and urban areas. In addition, disparities existed among various geographic regions within countries. This analysis demonstrates the need to promote access to handwashing materials and placement at handwashing locations in the dwelling, particularly in poorer, rural areas where children are more vulnerable to handwashing-preventable syndromes such as pneumonia and diarrhea.
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Affiliation(s)
| | - Libbet Loughnan
- Consultant Advisor, World Bank, Washington, District of Columbia
| | - Rolf Luyendijk
- Consultant Advisor, World Bank, Washington, District of Columbia
| | - Orlando Hernandez
- United Nations Children’s Fund (UNICEF), Joint Monitoring Programme, New York, New York
| | - Merri Weinger
- International Business and Technical Consultants, Inc. (IBTCI) Global Health Practice, Washington, District of Columbia
| | - Fred Arnold
- U.S. Agency for International Development, Bureau for Global Health, Washington, District of Columbia
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Abstract
BACKGROUND The associations between allergies, antibiotics use, and multiple sclerosis (MS) remain controversial and their mediating or moderating effects have not yet been examined. We aimed to assess the direct and indirect influences of allergies and antibiotics use on MS development, and their interactions. METHODS A 1:3 matched case-control study was performed using the National Ambulatory Medical Care Survey database from 2006 to 2013 in the USA. Multiple sclerosis was identified based on the ICD-9 code (340.0) in any position. Cases were matched to their controls based on survey year, age, gender, race, payer type, region, and tobacco use. Allergy diseases and antibiotics prescriptions were extracted by ICD-9 code and drug classification code, respectively. Both generalized structural equation model and MacArthur approach were used to examine their intrinsic relationships. RESULTS The weighted prevalence of MS was 133.7 per 100,000 visits. A total of 829 MS patients and 2441 controls were matched. Both respiratory tract allergies (OR = 0.29, 95% CI: 0.18, 0.49) and other allergies (OR = 0.38, 95% CI: 0.19, 0.77) were associated with a reduction of the risk of MS. Patients with respiratory tract allergies were more likely to use penicillin (OR = 8.73, 95% CI: 4.12, 18.53) and other antibiotics (OR = 3.77, 95% CI: 2.72, 5.21), and those with other allergies had a higher likelihood of penicillin use (OR = 4.15, 95% CI: 1.27, 13.54); however, the link between antibiotics use and MS was not confirmed although penicillin use might mediate the relationship between allergies and MS. CONCLUSIONS The findings supported allergy as a protective factor for MS development. We also suggest antibiotics use might not be a suitable indicator of bacterial infection to investigate the cause of MS.
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Affiliation(s)
- Jinma Ren
- a Center for Outcomes Research , University of Illinois College of Medicine at Peoria , Peoria , Illinois , USA
| | - Huijuan Ni
- b Department of Mathematics , Illinois State University , Normal , Illinois , USA
| | - Minchul Kim
- a Center for Outcomes Research , University of Illinois College of Medicine at Peoria , Peoria , Illinois , USA
| | - Kimberly L Cooley
- c Research, Jump Simulation and Education Center , Peoria , Illinois , USA
- d Neurology, OSF Saint Francis Medical Center , Peoria , Illinois , USA
| | | | - Carl V Asche
- a Center for Outcomes Research , University of Illinois College of Medicine at Peoria , Peoria , Illinois , USA
- e Center for Pharmacoepidemiology & Pharmacoeconomic Research, University of Illinois College of Pharmacy at Chicago , Illinois , USA
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Vandegrift R, Bateman AC, Siemens KN, Nguyen M, Wilson HE, Green JL, Van Den Wymelenberg KG, Hickey RJ. Cleanliness in context: reconciling hygiene with a modern microbial perspective. MICROBIOME 2017; 5:76. [PMID: 28705228 PMCID: PMC5513348 DOI: 10.1186/s40168-017-0294-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 06/28/2017] [Indexed: 05/04/2023]
Abstract
The concept of hygiene is rooted in the relationship between cleanliness and the maintenance of good health. Since the widespread acceptance of the germ theory of disease, hygiene has become increasingly conflated with sterilization. In reviewing studies across the hygiene literature (most often hand hygiene), we found that nearly all studies of hand hygiene utilize bulk reduction in bacterial load as a proxy for reduced transmission of pathogenic organisms. This treatment of hygiene may be insufficient in light of recent microbial ecology research, which has demonstrated that humans have intimate and evolutionarily significant relationships with a diverse assemblage of microorganisms (our microbiota). The human skin is home to a diverse and specific community of microorganisms, which include members that exist across the ecological spectrum from pathogen through commensal to mutualist. Most evidence suggests that the skin microbiota is likely of direct benefit to the host and only rarely exhibits pathogenicity. This complex ecological context suggests that the conception of hygiene as a unilateral reduction or removal of microbes has outlived its usefulness. As such, we suggest the explicit definition of hygiene as "those actions and practices that reduce the spread or transmission of pathogenic microorganisms, and thus reduce the incidence of disease."
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Affiliation(s)
- Roo Vandegrift
- Biology and the Built Environment Center, University of Oregon, Eugene, OR USA
- Institute of Ecology and Evolution, Department of Biological Sciences, University of Oregon, Eugene, OR USA
| | - Ashley C. Bateman
- Biology and the Built Environment Center, University of Oregon, Eugene, OR USA
- Institute of Ecology and Evolution, Department of Biological Sciences, University of Oregon, Eugene, OR USA
| | - Kyla N. Siemens
- Biology and the Built Environment Center, University of Oregon, Eugene, OR USA
- Institute of Ecology and Evolution, Department of Biological Sciences, University of Oregon, Eugene, OR USA
| | - May Nguyen
- Biology and the Built Environment Center, University of Oregon, Eugene, OR USA
- Energy Studies in Buildings Laboratory, Department of Architecture, University of Oregon, Eugene, OR USA
| | - Hannah E. Wilson
- Biology and the Built Environment Center, University of Oregon, Eugene, OR USA
- Institute of Ecology and Evolution, Department of Biological Sciences, University of Oregon, Eugene, OR USA
| | - Jessica L. Green
- Biology and the Built Environment Center, University of Oregon, Eugene, OR USA
- Institute of Ecology and Evolution, Department of Biological Sciences, University of Oregon, Eugene, OR USA
| | - Kevin G. Van Den Wymelenberg
- Biology and the Built Environment Center, University of Oregon, Eugene, OR USA
- Energy Studies in Buildings Laboratory, Department of Architecture, University of Oregon, Eugene, OR USA
| | - Roxana J. Hickey
- Biology and the Built Environment Center, University of Oregon, Eugene, OR USA
- Institute of Ecology and Evolution, Department of Biological Sciences, University of Oregon, Eugene, OR USA
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Halden RU, Lindeman AE, Aiello AE, Andrews D, Arnold WA, Fair P, Fuoco RE, Geer LA, Johnson PI, Lohmann R, McNeill K, Sacks VP, Schettler T, Weber R, Zoeller RT, Blum A. The Florence Statement on Triclosan and Triclocarban. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:064501. [PMID: 28632490 PMCID: PMC5644973 DOI: 10.1289/ehp1788] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 04/06/2017] [Accepted: 04/08/2017] [Indexed: 05/20/2023]
Abstract
The Florence Statement on Triclosan and Triclocarban documents a consensus of more than 200 scientists and medical professionals on the hazards of and lack of demonstrated benefit from common uses of triclosan and triclocarban. These chemicals may be used in thousands of personal care and consumer products as well as in building materials. Based on extensive peer-reviewed research, this statement concludes that triclosan and triclocarban are environmentally persistent endocrine disruptors that bioaccumulate in and are toxic to aquatic and other organisms. Evidence of other hazards to humans and ecosystems from triclosan and triclocarban is presented along with recommendations intended to prevent future harm from triclosan, triclocarban, and antimicrobial substances with similar properties and effects. Because antimicrobials can have unintended adverse health and environmental impacts, they should only be used when they provide an evidence-based health benefit. Greater transparency is needed in product formulations, and before an antimicrobial is incorporated into a product, the long-term health and ecological impacts should be evaluated. https://doi.org/10.1289/EHP1788.
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Affiliation(s)
- Rolf U Halden
- Biodesign Center for Environmental Security, Arizona State University , Tempe, Arizona, USA
| | | | - Allison E Aiello
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina , Chapel Hill, North Carolina, USA
| | - David Andrews
- Environmental Working Group, Washington, District of Columbia, USA
| | - William A Arnold
- Department of Civil, Environmental, and Geo-Engineering, University of Minnesota , Minneapolis, Minnesota, USA
| | - Patricia Fair
- Medical University of South Carolina , Department of Public Health Sciences, Charleston, South Carolina, USA
| | - Rebecca E Fuoco
- Health Research Communication Strategies , Los Angeles, California, USA
| | - Laura A Geer
- Department of Environmental and Occupational Health Sciences, State University of New York, Downstate School of Public Health , Brooklyn, New York, USA
| | - Paula I Johnson
- California Safe Cosmetics Program, California Department of Public Health , Richmond, California, USA
| | - Rainer Lohmann
- University of Rhode Island Graduate School of Oceanography , Narragansett, Rhode Island, USA
| | - Kristopher McNeill
- Institute for Biogeochemistry and Pollutant Dynamics , ETH Zurich, Zurich, Switzerland
| | | | - Ted Schettler
- Science and Environmental Health Network, Ames, Iowa, USA
| | - Roland Weber
- POPs Environmental Consulting, Schwäbisch Gmünd, Germany
| | - R Thomas Zoeller
- University of Massachusetts Amherst , Amherst, Massachusetts, USA
| | - Arlene Blum
- Department of Chemistry, University of California at Berkeley , Berkeley, California, USA
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