Microbial flora of hands of homemakers

Level of Hand Hygiene Compliance and Its Associated Factors Among Health Care Workers at Eka Kotebe General Hospital, Addis Ababa, Ethiopia

BACKGROUND

Poor hand hygiene is an important source of infection, but maintaining hand hygiene is the most important measure to prevent infections. Hand hygiene compliance and its associated factors are not well recognized in Ethiopia. Therefore, this study was intended to determine hand hygiene compliance and its associated factors among health care workers in Eka Kotebe General Hospital.

METHODS

A cross-sectional study was conducted among health care workers at Eka Kotebe General Hospital. A self-administered questionnaire supplemented by a World Health Organization Hand Hygiene Technical Reference Manual was used to collect data. Data was entered using Epi Info 7.2.0.1 and exported to SPSS 23 for analysis. The data were analyzed using descriptive and inferential statistics. Statistical significance was determined using a P-value of ⩽.05 with a 95% confidence interval.

RESULTS

Hand hygiene compliance among healthcare workers was 22.2%. Hand hygiene training (AOR = 2.9, 95% CI: 1.13-7.52), presence of hand hygiene indication poster (AOR = 3.38, 95% CI: 1.18-9.66), hand hygiene promotion by IPC team (AOR = 4.2, 95% CI: 2.53-8.58)), working experience ⩾5 years of a health care providers (AOR = 3.96, 95% CI: 1.12-13.9), being midwife (AOR = 17.1, 95% CI: 2.8-10), being nurse (AOR = 5.3, 95% CI: 2.09-7.8) by profession, and presence of water (AOR = 2.50, 95% CI: 2.20-11.78) were significantly associated factors to hand hygiene compliance.

CONCLUSION

The level of hand hygiene compliance among health care providers was found to be low. Training about hand hygiene, the presence of hand hygiene indication posters, hand hygiene promotion by the IPC team, working experience of health care providers, being a nurse and midwife, and the presence of water were independent predictors of hand hygiene compliance. Health care workers need to be given training on hand hygiene as well as hand hygiene facilities shall be installed and supplied by the hospital in a sustained manner.

U can't touch this! Face touching behaviour whilst driving: implications for health, hygiene and human factors

Analysis of thirty-one hours of video-data documenting 36 experienced drivers highlighted the prevalence of face-touching, with 819 contacts identified (mean frequency: 26.4 face touches/hour (FT/h); mean duration: 3.9-seconds). Fewer face-touches occurred in high primary workload conditions (where additional physical/cognitive demands were placed on drivers), compared to low workload (4.4 and 26.1 FT/h, respectively). In 42.5% of touches (or 11.2 FT/h), mucous membrane contact was made, with fingertips (33.1%) and thumbs (35.6%) most commonly employed. Individual behaviours differed (ranging from 5.1 to 90.7 FT/h), but there were no significant differences identified between genders, age-groups or hand used. Results are of relevance from an epidemiological/hygiene perspective within the context of the COVID-19 pandemic (and can therefore inform the design of practical solutions and encourage behavioural change to reduce the risk of self-inoculation while driving), but they also help to elucidate how habitual human behaviours are imbricated with the routine accomplishment of tasks.

Emerging Concern with Imminent Therapeutic Strategies for Treating Resistance in Biofilm

Biofilm production by bacteria is presumed to be a survival strategy in natural environments. The production of biofilms is known to be influenced by a number of factors. This paper has precisely elaborated on the different factors that directly influence the formation of biofilm. Biofilm has serious consequences for human health, and a variety of infections linked to biofilm have emerged, rapidly increasing the statistics of antimicrobial resistance, which is a global threat. Additionally, to combat resistance in biofilm, various approaches have been developed. Surface modifications, physical removal, and the use of nanoparticles are the recent advances that have enabled drug discovery for treating various biofilm-associated infections. Progress in nanoparticle production has led to the development of a variety of biofilm-fighting strategies. We focus on the present and future therapeutic options that target the critical structural and functional characteristics of microbial biofilms, as well as drug tolerance mechanisms, such as the extracellular matrix, in this review.

Scientific Evidence Supports the Use of Alcohol-Based Hand Sanitizers as an Effective Alternative to Hand Washing in Retail Food and Food Service Settings When Heavy Soiling Is Not Present on Hands

ABSTRACT

Suboptimal food worker health and hygiene has been a common contributing factor in foodborne disease outbreaks for many years. Despite clear U.S. Food and Drug Administration (FDA) Model Food Code recommendations for hand washing and glove use, food worker compliance with hand washing recommendations has remained poor for >20 years. Food workers' compliance with recommended hand washing guidelines is adversely impacted by a number of barriers, including complaints of time pressure, inadequate number and/or location of hand washing sinks and hand washing supplies, lack of food knowledge and training regarding hand washing, the belief that wearing gloves obviates the need for hand washing, insufficient management commitment, and adverse skin effects caused by frequent hand washing. Although many of the issues related to poor hand washing practices in food service facilities are the same as those in health care settings, a new approach to health care hand hygiene was deemed necessary >15 years ago due to persistently low compliance rates among health care personnel. Evidence-based hand hygiene guidelines for health care settings were published by both the Centers for Disease Control and Prevention in 2002 and by the World Health Organization in 2009. Despite similar low hand washing compliance rates among retail food establishment workers, no changes in the Food Code guidelines for hand washing have been made since 2001. In direct contrast to health care settings, where frequent use of alcohol-based hand sanitizers (ABHSs) in lieu of hand washing has improved hand hygiene compliance rates and reduced infections, the Food Code continues to permit the use of ABHSs only after hands have been washed with soap and water. This article provides clear evidence to support modifying the FDA Model Food Code to allow the use of ABHSs as an acceptable alternative to hand washing in situations where heavy soiling is not present. Emphasis on the importance of hand washing when hands are heavily soiled and appropriate use of gloves is still indicated.

HIGHLIGHTS

Isolation and characterization of bacteriophage to control multidrug-resistant Pseudomonas aeruginosa planktonic cells and biofilm

Pseudomonas aeruginosa is Gram-negative bacterium, one of the leading cause of drug-resistant nosocomial infections in developing countries. This bacterium possesses chromosomally encoded efflux pumps, poor permeability of outer-membrane and high tendency for biofilm formation which are tools to confer resistance. Bacteriophages are regarded as feasible treatment option for control of resistant P. aeruginosa. The aim of the current study was isolate and characterized a bacteriophage against P. aeruginosa with MDR and biofilm ability. A bacteriophage MA-1 with moderate host range was isolated from waste water. The phage was considerable heat and pH stable. Electron microscopy revealed that phage MA-1 belongs to Myoviridae family. Its genome was dsDNA (≈50 kb), coding for eighteen different proteins (ranging from 12 to 250 KDa). P. aeruginosa-2949 log growth phase was significantly reduced by phage MA-1 (2.5 × 10³ CFU/ml) as compared to control (without phage). Phage MA-1 also showed significant reductions of 2.0, 2.5 and 3.2 folds in 24, 48, and 74 h old biofilms after 6 h treatment with phage respectively as compared to control. It was concluded from this study that phage MA-1 has capability of killing P. aeruginosa planktonic cells and biofilm, but for complete eradication cocktail will more effective to avoid resistance.

Deposition of Bacteria and Bacterial Spores by Bathroom Hot-Air Hand Dryers

Hot-air hand dryers in multiple men's and women's bathrooms in three basic science research areas in an academic health center were screened for their deposition on plates of (i) total bacteria, some of which were identified, and (ii) a kanamycin-resistant Bacillus subtilis strain, PS533, spores of which are produced in large amounts in one basic science research laboratory. Plates exposed to hand dryer air for 30 s averaged 18 to 60 colonies/plate; but interior hand dryer nozzle surfaces had minimal bacterial levels, plates exposed to bathroom air for 2 min with hand dryers off averaged ≤1 colony, and plates exposed to bathroom air moved by a small fan for 20 min had averages of 15 and 12 colonies/plate in two buildings tested. Retrofitting hand dryers with HEPA filters reduced bacterial deposition by hand dryers ∼4-fold, and potential human pathogens were recovered from plates exposed to hand dryer air whether or not a HEPA filter was present and from bathroom air moved by a small fan. Spore-forming colonies, identified as B. subtilis PS533, averaged ∼2.5 to 5% of bacteria deposited by hand dryers throughout the basic research areas examined regardless of distance from the spore-forming laboratory, and these were almost certainly deposited as spores. Comparable results were obtained when bathroom air was sampled for spores. These results indicate that many kinds of bacteria, including potential pathogens and spores, can be deposited on hands exposed to bathroom hand dryers and that spores could be dispersed throughout buildings and deposited on hands by hand dryers.IMPORTANCE While there is evidence that bathroom hand dryers can disperse bacteria from hands or deposit bacteria on surfaces, including recently washed hands, there is less information on (i) the organisms dispersed by hand dryers, (ii) whether hand dryers provide a reservoir of bacteria or simply blow large amounts of bacterially contaminated air, and (iii) whether bacterial spores are deposited on surfaces by hand dryers. Consequently, this study has implications for the control of opportunistic bacterial pathogens and spores in public environments including health care settings. Within a large building, potentially pathogenic bacteria, including bacterial spores, may travel between rooms, and subsequent bacterial/spore deposition by hand dryers is a possible mechanism for spread of infectious bacteria, including spores of potential pathogens if present.

Faecal contamination of commuters' hands in main vehicle stations in Dhaka city, Bangladesh

BACKGROUND

Faecal-oral carriage via hands is an important transmission pathway for diarrhoeal pathogens. The level of faecal contamination of commuters' hands in Dhaka, Bangladesh, was examined in this study.

METHODS

A total of 900 hand washing samples, including both left and right hands, were collected during one year to cover three different seasons in Bangladesh: winter, summer and rainy seasons. Standard membrane filtration technique was used to quantify total coliforms (TC), faecal coliforms (FC), faecal streptococci (FS), Escherichia coli (EC) and Clostridium perfringens (CP).

RESULTS

The hands of the commuters were contaminated with TC, FC, FS, CP and EC. The TC, FC, FS, CP and EC counts were 1.95, 1.65, 4.04, 1.54 and1.46 log10 colony forming units (cfu) in the left hand; and 2.13, 1.82, 4.11, 1.52 and 1.61 log10 cfu in the right hand, respectively. There were no statistically significant differences in counts of left and right hands. The highest counts were observed for FS in all seasons.

CONCLUSIONS

This evidence based study may be used to provide interventions to reduce the contamination of commuters' hands through washing with detergent and, thus, help to prevent the spread of infectious diseases.

Isolation and characterization of a bacteriophage and its utilization against multi-drug resistant Pseudomonas aeruginosa-2995

AIMS

To identify, isolate, and characterize a lytic bacteriophage against the multiple-drug resistant clinical strain of Pseudomonas aeruginosa-2995 and to determine the phage efficacy against the bacterial planktonic cells and the biofilm.

MAIN METHODS

Wastewater was used to isolate a bacteriophage. The phage was characterized with Transmission electron microscopy (TEM). Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS PAGE) was used to identify the expressed proteins. Bacteria were cultured in both suspension and biofilm to check and compare their susceptibility to phage lytic action. The activity of the phage (determined as AZ1) was determined against P. aeruginosa-2995 in both planktonic cells and the biofilm.

KEY FINDINGS

A bacteriophage, designated as AZ1, was isolated from waste water showing a narrow host range. AZ1 was characterized by TEM and could be identified as an isolate in the family Siphoviridae [order Caudovirals]. Seventeen structural proteins ranging from about 12 to 110kDa were found through SDS-PAGE analysis. Its genome was confirmed as dsDNA with a length of approx. 50kb. The log-phase growth of P. aeruginosa-2995 was significantly reduced after treatment with AZ1 (4.50×10⁸ to 2.1×10³CFU/ml) as compared to control. Furthermore, phage AZ1 significantly reduced 48h old biofilm biomass about 3-fold as compared to control.

SIGNIFICANCE

Pseudomonas aeruginosa is a ubiquitous free-living opportunistic human pathogen characterized by high antibiotic tolerance and tendency for biofilm formation. The phage, identified in this study, AZ1, showed promising activity in the destruction of both planktonic cells and biofilm of P. aeruginosa-2995. However, complete eradication may require a combination of phages.

Exploring the potential of antimicrobial hand hygiene products in reducing the infectious burden in low-income countries: An integrative review

BACKGROUND

The purpose of this review was to understand whether adding antimicrobial agents to hand hygiene products could increase the health benefits of handwashing with plain soap (HWWS) in low-income settings.

METHODS

A review of experimental studies comparing the effects of HWWS with antimicrobial soap and waterless hand sanitizer on health and hand contamination in naturalistic conditions was conducted. In addition, an analysis was completed of the evidence from laboratory studies examining the factors that may affect the impact of antimicrobial soap, taking into account the conditions in low-income settings.

RESULTS

The review found no evidence for a superior effect of antimicrobial products compared with HWWS on disease incidence and limited evidence for an effect on hand contamination under naturalistic conditions. An analysis of the effectiveness of antimicrobial soap in laboratory settings suggested that it was only more effective than HWWS when handwashing frequency, duration, and product concentrations were above levels that could be expected in low-income settings.

CONCLUSIONS

The limited available evidence suggests that under naturalistic conditions, antimicrobial products are no more effective than HWWS in removing pathogens from hands. Without significant improvement in efficacy, antimicrobial products are unlikely to produce greater health gains than HWWS in low-income settings.

Patients' potential role in the transmission of health care-associated infections: prevalence of contamination with bacterial pathogens and patient attitudes toward hand hygiene

BACKGROUND

Transmission of health care-associated infections (HAIs) has been primarily attributed to health care workers, and hand hygiene is considered the most important means to reduce transmission. Whereas hand hygiene research has focused on reducing health care worker hand contamination and improving hand hygiene compliance, contamination of patients' hands and their role in the transmission of HAIs remains unknown.

METHODS

Patients' hands were sampled by a "glove juice" recovery method and enumerated for the presence of common health care-associated pathogens. Patient demographics and other covariates were collected to determine their association with patient hand contamination. Patient attitudes and practices toward hand hygiene were also surveyed and analyzed.

RESULTS

Of the 100 patients in the study, 39% of hands were contaminated with at least 1 pathogenic organism, and 8% were contaminated with 2 or more pathogens 48 hours after admission. Patient admission from or discharge to an outside institution and self-reported functional limitations were the only covariates that were significantly associated with hand contamination.

CONCLUSION

Pathogenic organisms can be frequently detected on hands of acute care patients. Future studies are needed to better understand the relationship between patient hand contamination and the acquisition of HAIs in addition to the role patient hand hygiene can play in reducing HAIs.

Household transmission of meticillin-resistant Staphylococcus aureus and other staphylococci

Although the role of pets in household transmission of meticillin-resistant Staphylococcus aureus (MRSA) has been examined previously, only minor attention has been given to the role of the abiotic household environment independent of, or in combination with, colonisation of pets and human beings to maintain transmission cycles of MRSA within the household. This report reviews published work about household transmission of S aureus and other staphylococci and describes contamination of household environmental surfaces and colonisation of pets and people. Household microbial communities might have a role in transfer of antimicrobial resistance genes and could be reservoirs for recolonisation of people, although additional research is needed regarding strategies for decontamination of household environments. Household-based interventions should be developed to control recurrent S aureus infections in the community, and coordination between medical and veterinary providers could be beneficial.

Skin flora: Differences between people affected by Albinism and those with normally pigmented skin in Northern Tanzania - cross sectional study

Background

Skin flora varies from one site of the body to another. Individual’s health, age and gender determine the type and the density of skin flora.

Methods

A 1 cm² of the skin on the sternum was rubbed with sterile cotton swab socked in 0.9% normal saline and plated on blood agar. This was cultured at 35°C. The bacteria were identified by culturing on MacConkey agar, coagulase test, catalase test and gram staining. Swabs were obtained from 66 individuals affected by albinism and 31 individuals with normal skin pigmentation. Those with normal skin were either relatives or staying with the individuals affected by albinism who were recruited for the study.

Results

The mean age of the 97 recruited individuals was 30.6 (SD ± 14.9) years. The mean of the colony forming units was 1580.5 per cm². Those affected by albinism had a significantly higher mean colony forming units (1680 CFU per cm²) as compared with 453.5 CFU per cm² in those with normally pigmented skin (p = 0.023). The skin type and the severity of sun- damaged skin was significantly associated with a higher number of colony forming units (p = 0.038).

Conclusion

Individuals affected by albinism have a higher number of colony forming units which is associated with sun- damaged skin.

Quantifying school officials' exposure to bacterial pathogens at graduation ceremonies using repeated observational measures

The purpose of this study was to estimate the risk of acquiring pathogenic bacteria as a result of shaking hands at graduation ceremonies. School officials participating in graduation ceremonies at elementary, secondary, and postsecondary schools were recruited. Specimens were collected before and immediately following graduation. Cultures identified any pathogenic bacteria in each specimen. Subjects shook a total of 5,209 hands. Staphylococcus aureus was separately detected on one pregraduation right hand, one postgraduation right hand, and one postgraduation left hand. Nonpathogenic bacteria were collected in 93% of specimens. Pregraduation and postgraduation specimens were of different strains. We measured a risk of one new bacterial acquisition in a sample exposed to 5,209 handshakes yielding an overall estimate of 0.019 pathogens acquired per handshake. We conclude that a single handshake at a graduation offers only a small risk of bacterial pathogen acquisition.

Skin microbiota: microbial community structure and its potential association with health and disease

Skin, the largest human organ, is a complex and dynamic ecosystem inhabited by a multitude of microorganisms. Host demographics and genetics, human behavior, local and regional environmental characteristics, and transmission events may all potentially drive human skin microbiota variability, resulting in an alteration of microbial community structure. This alteration may have important consequences regarding health and disease outcomes among individuals. More specifically, certain diversity patterns of human microbiota may be predictive or diagnostic of disease. The purpose of this review is to briefly describe the skin microbiota, outline the potential determining factors driving its variability, posit the likelihood of an association between the resulting microbial community structure on the skin with disease outcomes among individuals, and finally, to present some challenges and implications for studying the skin microbiota.

Antimicrobial activity and mechanism of action of Nu-3, a protonated modified nucleotide

Background

"Nubiotics" are synthetic oligonucleotides and nucleotides with nuclease-resistant backbones, and are fully protonated for enhanced ability to be taken up by bacterial cells. Nu-3 [butyl-phosphate-5'-thymidine-3'-phosphate-butyl], one of the family members of Nubiotics was efficacious in the treatment of burn-wound infections by Pseudomonas aeruginosa in mice. Subsequent studies revealed that Nu-3 had a favorable toxicological profile for use as a pharmaceutical agent. This study evaluated the antibacterial activity of Nu-3 in vitro and its efficacy as a topical antibiotic. In addition, we investigated the possible mechanisms of Nu-3 action at the levels of DNA synthesis and bacterial membrane changes.

Methods

Antimicrobial minimum inhibitory concentrations (MIC) experiments with Nu-3 and controls were measured against a range of Gram-positive and Gram-negative bacteria, including some hospital isolates according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Analysis of the killing kinetics of Nu-3 was also performed against two strains (Staphylococcus aureus cvcc 2248 and Pseudomonas aeruginosa cvcc 5668). The mouse skin suture-wound infection model was used to evaluate the antibacterial activity of Nu-3. We used a 5-Bromo-2'-deoxy-uridine Labeling and Detection Kit III (Roche, Switzerland) to analyze DNA replication in bacteria according to the manufacturer's instruction. The BacLight™ Bacterial Membrane Potential Kit (Invitrogen) was used to measure the bacterial membrane potential in S. aureus.

Results

Nu-3 had a wide antibacterial spectrum to Gram-positive, Gram-negative and some resistant bacteria. The MIC values of Nu-3 against all tested MRSA and MSSA were roughly in a same range while MICs of Oxacillin and Vancomycin varied between the bacteria tested. In the mouse model of skin wound infection study, the treatment with 5% Nu-3 glycerine solution also showed comparable therapeutic effects to Ciprofloxacin Hydrochloride Ointment. While Nu-3 had no effect on DNA synthesis of the tested bacteria as demonstrated in a BrdU assay, it could cause bacterial cell membrane depolarization, as measured using a BacLight™ Bacterial Membrane Potential Kit.

Conclusions

These results provide additional experimental data that are consistent with the hypothesis that Nu-3 represents a new class of antibacterial agents for treating topical infections and acts via a different mechanism from conventional antibiotics.

A review of hand-washing techniques in primary care and community settings

AIM

This review seeks to identify the most effective hand-washing and hand-cleansing practice that could be used in primary care.

BACKGROUND

Healthcare associated infection is a major problem in the UK causing 5000 deaths every year. Current guidelines indicate expert opinion is the level of evidence for hand washing as an activity to reduce infection.

DESIGN

Systematic review.

METHOD

Publications on hand-washing, hand-cleansing studies, policy and practice-based documents were sought by searching several databases. Terms used included hand washing, hand cleansing, hand hygiene, hand decontamination, infection control and primary care.

RESULTS

Few articles described the hand-washing technique in detail and some publications simply referred to either the European and British Standards or the Centre for Disease Control statement on hand washing. Major discrepancies in hand position and water flow direction were found. Several methodological problems were also identified and few studies were undertaken in primary care.

CONCLUSION

This review has found a lack of evidence for hand-washing techniques being undertaken in practice today. Findings from hand-washing technique studies were inconclusive and methodological issues exist resulting in sparse reliable evidence. There is an urgent need to undertake methodologically sound studies of hand-washing techniques for use in the ever expanding scope of primary care practice.

RELEVANCE TO CLINICAL PRACTICE

Evidence for hand-washing and hand-cleansing techniques will inform healthcare professional practice, and contribute to the overall management of infection control in primary care.

Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 8. Gloves as barriers to prevent contamination of food by workers

The role played by food workers and other individuals in the contamination of food has been identified as an important contributing factor leading to foodborne outbreaks. To prevent direct bare hand contact with food and food surfaces, many jurisdictions have made glove use compulsory for food production and preparation. When properly used, gloves can substantially reduce opportunities for food contamination. However, gloves have limitations and may become a source of contamination if they are punctured or improperly used. Experiments conducted in clinical and dental settings have revealed pinhole leaks in gloves. Although such loss of glove integrity can lead to contamination of foods and surfaces, in the food industry improper use of gloves is more likely than leakage to lead to food contamination and outbreaks. Wearing jewelry (e.g., rings) and artificial nails is discouraged because these items can puncture gloves and allow accumulation of microbial populations under them. Occlusion of the skin during long-term glove use in food operations creates the warm, moist conditions necessary for microbial proliferation and can increase pathogen transfer onto foods through leaks or exposed skin or during glove removal. The most important issue is that glove use can create a false sense of security, resulting in more high-risk behaviors that can lead to cross-contamination when employees are not adequately trained.

Efficacy of waterless hand hygiene compared with handwashing with soap: a field study in Dar es Salaam, Tanzania

Effective handwashing with soap requires reliable access to water supplies. However, more than three billion persons do not have household-level access to piped water. This research addresses the challenge of improving hand hygiene within water-constrained environments. The antimicrobial efficacy of alcohol-based hand sanitizer, a waterless hand hygiene product, was evaluated and compared with handwashing with soap and water in field conditions in Dar es Salaam, Tanzania. Hand sanitizer use by mothers resulted in 0.66 and 0.64 log reductions per hand of Escherichia coli and fecal streptococci, respectively. In comparison, handwashing with soap resulted in 0.50 and 0.25 log reductions per hand of E. coli and fecal streptococci, respectively. Hand sanitizer was significantly better than handwashing with respect to reduction in levels of fecal streptococci (P = 0.01). The feasibility and health impacts of promoting hand sanitizer as an alternative hand hygiene option for water-constrained environments should be assessed.

[Pre- and probiotic cosmetics]

The human skin provides a habitat for a variety of microorganisms, the skin microflora. There is a complex network of interactions between the microbes and cells of the epidermis. Modern analytical methods in molecular biology have revealed new insights into this complex diversity of partially unculturable microbial organisms. Most of the resident microbes on healthy skin can be regarded as being harmless or even beneficial to skin. In the case of diseases with some imbalance in microorganisms, such as impure skin/mild acne or dry skin/mild atopic dermatitis, pre- and probiotic concepts represent an effective alternative to strictly antibacterial products. Prebiotic actives rebalance the skin microflora while probiotic approaches predominantly consist of applying an inactivated microbial biomass of beneficial bacteria. Several examples of successful in vivo studies illustrate this new principle for gentle cosmetics derived from the food sector.

Dirty hands: bacteria of faecal origin on commuters' hands

Although many studies have investigated bacteria on the hands of health-care workers and caregivers, few have looked at microbiological contamination on the hands of the general adult public. This study investigated faecal bacteria on the hands of commuters in five UK cities. Of the 404 people sampled 28% were found to have bacteria of faecal origin on their hands. A breakdown by city showed that the proportion of people with contaminated hands increased the further north the city of investigation (P<0·001), an effect which was due in large part to a significant trend in men but not in women. Bus users were more contaminated than train users. The results of this exploratory study indicate that hand hygiene practices in the UK may be inadequate and that faecal indicator bacteria on hands may be used to monitor the effect of hand-washing promotion campaigns.

Biometric fingerprinting for visa application: device and procedure are risk factors for infection transmission

BACKGROUND

Biometric fingerprint identity verification is currently introduced in visa application and entry screening at border control. The system implies physical contact between the skin and the surface of the fingerprint-capturing and reading devices.

AIM

To assess the risk of infection transmission through fingerprinting.

METHODS

The medical literature was reviewed for the potential of microorganisms to be carried on the skin of hands in the community, to be transferred from hands to inanimate surfaces, to survive on surfaces, and to be transferred in doses exceeding the infectious dose. The fingerprinting procedures as currently applied were reviewed.

RESULTS

Factors that favor transfer of microorganisms are large skin-surface contact between flat fingers (2 x 20 cm(2)) and fingerprint-capturing device, nonporous contact surface, large overlap of contact surface and short turnaround time between successive applicants, high contact pressure, and difficulties to disinfect devices. Transmission risk exists for enteric viruses (rotavirus, norovirus, and hepatitis A virus), respiratory viruses (respiratory syncytial virus, rhinovirus, influenza virus, etc.), and enteropathogenic bacteria with low infectious doses (Shigella dysenteriae, Enterohemorrhagic Escherichia coli, etc.). Using Monte Carlo risk analysis on US data, transmission of human rotavirus is estimated at 191 [95% credible intervals (CI) 0-289] per million fingerprint-capturing procedures. Application of 70% isopropyl hand rub and 85% ethanol hand gel reduces the risk to 77 (95% CI 0-118) and 0.3 (95% CI 0-0.3) transmissions per million procedures, respectively.

CONCLUSIONS

The fingerprinting procedure as currently used is associated with a risk of infection transmission. Simple hygienic measures can considerably reduce this transmission risk.

Molecular characterization of hand flora and environmental isolates in a community setting

We analyzed 69 bacterial isolates, comprising seven species of gram-negative bacterial rods and three species of coagulase-negative staphylococci, recovered from both the hands of caretakers and their environment in households sampled in upper Manhattan. Repetitive sequence-based PCR and dendrogram analysis were used to determine strain similarity. Greater than 25% of individual species of Acinetobacter, Enterobacter, and coagulase-negative staphylococci recovered from the hands and immediate environment within each household shared the same genotype. This study is the first to demonstrate the frequency of bacteria shared within community households. These strains may serve as potential reservoirs for either community- or hospital-acquired infections.

Could hospital patients' hands constitute a missing link?

The relationship between contamination of patients' hands and transmission of healthcare-associated infection has received only limited attention, but may represent a previously overlooked but potentially significant link in the chain of infection. This paper aims critically to review the literature to determine whether this possible epidemiological relationship is worthy of further consideration. Studies that have investigated the microbiology or hand hygiene behaviours of patients and other groups are examined to establish their limitations and implications for future practice and research. Examples of healthcare-associated infections where improving patient hand hygiene may have a favourable impact on transmission, and how this might be achieved within the context of current UK health service initiatives, are discussed. It is recommended that systematic studies of the role of patients' hands in the chain of hospital infection should be undertaken.

Hand hygiene: simple and complex

This review gives an overview of hand hygiene in healthcare and in the community, including some aspects which have attracted little attention, such as hand drying and cultural issues determining hand hygiene behaviour. Hand hygiene is the most effective measure for interrupting the transmission of microorganisms which cause infection both in the community and in the healthcare setting. Using hand hygiene as a sole measure to reduce infection is unlikely to be successful when other factors in infection control, such as environmental hygiene, crowding, staffing levels and education are inadequate. Hand hygiene must be part of an integrated approach to infection control. Compliance with hand hygiene recommendations is poor worldwide. While the techniques involved in hand hygiene are simple, the complex interdependence of factors which determine hand hygiene behaviour makes the study of hand hygiene complex. It is now recognised that improving compliance with hand hygiene recommendations depends on altering human behaviour. Input from behavioural and social sciences is essential when designing studies to investigate compliance. Interventions to increase compliance with hand hygiene practices must be appropriate for different cultural and social needs. New strategies to promote hand hygiene worldwide include the formation of public-private partnerships.

An investigation of contact transmission of methicillin-resistant Staphylococcus aureus

Hand hygiene is critical in the healthcare setting and it is believed that methicillin-resistant Staphylococcus aureus (MRSA), for example, is transmitted from patient to patient largely via the hands of health professionals. A study has been carried out at a large teaching hospital to estimate how often the gloves of a healthcare worker are contaminated with MRSA after contact with a colonized patient. The effectiveness of handwashing procedures to decontaminate the health professionals' hands was also investigated, together with how well different healthcare professional groups complied with handwashing procedures. The study showed that about 17% (9-25%) of contacts between a healthcare worker and a MRSA-colonized patient results in transmission of MRSA from a patient to the gloves of a healthcare worker. Different health professional groups have different rates of compliance with infection control procedures. Non-contact staff (cleaners, food services) had the shortest handwashing times. In this study, glove use compliance rates were 75% or above in all healthcare worker groups except doctors whose compliance was only 27%.

Relationship between triclosan and susceptibilities of bacteria isolated from hands in the community

The possible association between triclosan and bacterial susceptibility to antibiotic was examined among staphylococci and several species of gram-negative bacteria (GNB) isolated from the hands of individuals in a community setting. Hand cultures from individuals randomized to using either antibacterial cleaning and hygiene products (including a hand soap containing 0.2% triclosan) or nonantibacterial cleaning and hygiene products for a 1-year period were taken at baseline and at the end of the year. Although there was no statistically significant association between triclosan MICs and susceptibility to antibiotic, there was an increasing trend in the association the odds ratios (ORs) for all species were compared at baseline (OR = 0.65, 95% confidence interval [95%CI] = 0.33 to 1.27) versus at the end of the year (OR = 1.08, 95%CI = 0.62 to 1.97) and for GNB alone at baseline(OR = 0.66, 95%CI = 0.29 to 1.51) versus the end of year (OR = 2.69, 95%CI = 0.78 to 9.23) regardless of the hand-washing product used. Moreover, triclosan MICs were higher in some of the species compared to earlier reports on household, clinical, and industrial isolates, and some of these isolates had triclosan MICs in the range of concentrations used in consumer products. The absence of a statistically significant association between elevated triclosan MICs and reduced antibiotic susceptibility may indicate that such a correlation does not exist or that it is relatively small among the isolates that were studied. Still, a relationship may emerge after longer-term or higher-dose exposure of bacteria to triclosan in the community setting.

Therapeutic efficacy of "nubiotics" against burn wound infection by Pseudomonas aeruginosa

"Nubiotics" are a novel class of proprietary protonated nucleic acid-based drugs shown to have potent in vitro antibacterial activities against a number of gram-positive and gram-negative bacteria. These nubiotics are evaluated here for their in vivo therapeutic efficacy for the treatment of burn wound infection caused by Pseudomonas aeruginosa. To achieve this, a burn wound infection model was established in mice by using a highly pathogenic burn wound clinical isolate of P. aeruginosa. Lethal doses of the bacteria were determined for two routes of infection (subcutaneous and topical), representing systemic and local forms of infection, respectively. Using this infection model, treatment with nubiotics by various routes of drug administration was evaluated and optimized. A total of 12 nubiotics and their analogues were tested and of these, Nu-2, -3, -4, and -5 were found to be extremely efficacious in the postexposure treatment of burn wound infection (60 to 100% survival rates versus 0% for untreated control [P < 0.05]). These nubiotics were effective when given either systemically by intravenous and/or subcutaneous administration or given locally to the affected site in the skin by topical application. Treatment by these two routes resulted in almost 100% survival rates and complete eradication of the bacteria from infection sites in the livers, spleens, and blood. These nubiotics were found to be as effective as intravenously administered ciprofloxacin, a potent and broad-spectrum fluoroquinolone. These results suggest that nubiotics may be a promising and effective approach for the treatment of burn wound infection caused by P. aeruginosa.

Molecular epidemiology of gram-negative bacilli from infected neonates and health care workers' hands in neonatal intensive care units

We sought to characterize the molecular epidemiology of gram-negative bacilli (GNB) causing infections in infants and associated with carriage on nurses' hands after hand hygiene was performed. From March 2001 to January 2003, GNB caused 192 (34%) of 562 hospital-acquired infections in the 2 participating neonatal intensive care units (NICUs) and were isolated from the hands of 45 (38%) of 119 nurses. Five species--Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Serratia marcescens and Enterobacter cloacae, all of which were typed by pulsed-field gel electrophoresis--caused 169 (88%) of 192 of GNB infections. Overall, 58% of infections were caused by unique strains not cultured from other infants or nurses, and 31% of infections were part of unrecognized molecular clusters. In contrast, only 9% of strains that caused infections were cultured from nurses' hands. These data suggest that practices in addition to hand hygiene are needed to prevent horizontal transmission of GNB in the NICU.

Transmission des agents conventionnels en consultation

Outpatient care bring together in a single location a large number of patients potentially bearing conventional infectious agents (virus, bacteria, fungi, parasites). This report details the germs potentially involved. We emphasize adenovirus epidemic keratoconjunctivitis, which is particularly prevalent in ophthalmology outpatient care. We analyze the modes of contamination and the means to prevent iatrogenic infections.

Controlling healthcare-associated infections: the role of infection control and antimicrobial use practices

Healthcare-associated infections are a major cause of morbidity and mortality in pediatric patients in the United States and throughout the world. Overall rates of infection range widely depending on the pediatric population, with the highest rates being in patients in neonatal intensive care units, followed by those in pediatric intensive care units, immunocompromised patients, and those undergoing surgical procedures. Risk factors for healthcare-associated infection include intrinsic and extrinsic factors. The major intrinsic factors are age, birth weight, underlying diseases, and immune status. The major extrinsic factors are presence of invasive devices and procedures. The major risk factors for healthcare-associated infection caused by antimicrobial-resistant pathogens are either the transmission of pathogens from person to person (directly or indirectly, usually via the hands of healthcare workers) or the emergence of resistance after exposure to antimicrobials. Preventing healthcare-associated infections caused by antimicrobial-resistant pathogens requires a comprehensive approach that includes: 1) preventing infections through the use of vaccines and prophylaxis; 2) minimizing the use of invasive devices; 3) understanding and fully implementing (and complying with) current guideline recommendations for the prevention of infections; and 4) using antimicrobials judiciously. Implementing such a comprehensive program will reduce healthcare-associated infections, reduce the prevalence of antimicrobial-resistant pathogens, improve patient outcomes, and reduce health care costs.