Improved Hygiene Practices Research Articles

The elderly—a challenge for appropriate drug treatment

The current rise in life expectancy in the industrial world has made aging a “hot” topic in life sciences and public health. Major contributing factors to this success are improved hygiene practices, a sharp fall in infant mortality and the development of beneficial drugs [1]. In general, there is an increase in drug consumption with age because elderly subjects often suffer from multiple (chronic) disease states and organ dysfunctions [2]. In addition, in keeping with the above statement of J. Swift, there is presently considerable “hype” on antiaging medicine. However, as pointed out by an expert panel there is no evidence that there is any remedy which can slow aging or increase longevity in humans [3]. Thus, there is no need to discuss anti-aging compounds which only will help the distributors but not the consumers. In contrast, we have to remember that many effective drugs have contributed to our extended life expectancy by curing diseases, improving pathophysiological conditions and increasing the quality of life. When talking about such positive drug actions one should also consider that the elderly patients, as defined by the WHO as those with an age above 65 years, might differ in their drug response when compared to younger subjects [4]. When considering drug consumption in 70-year-old Scandinavian populations between 1971 and 2000 there was a 12–19% increase in the proportion of subjects using drugs during that period. At 79–80 years, the mean number of drugs was 3.3 in men and 4.0 in women in 1980 and 4.0 in men and 4.7 in women in 1995 [5]. Thus, problems associated with polypharmacy have apparently been increasing in recent years. They primarily consist of adverse drug reactions (ADR), which are more often observed in the elderly [6], and drug interactions which occur frequently in this population. [7]. As most of these drug-related problems are dose-dependent, pharmacological knowledge and skills are needed to find the right dosage for elderly patients. The prescribing physician should be aware that age-related changes in pharmacokinetics (PK) and pharmacodynamics (PD) will occur with several drugs and these often need to be considered for an adjusted dosing regimen. There might be age-related up or down regulations of targets (receptors), transmitters or signalling pathways which can modify the action of drugs. Body composition changes with advancing age (relative lipid content increases; total body water and lean body mass decreases) which can affect drug distribution and often will result in drug retention and prolonged t1/2. Kidney function will decline in old age, but in the absence of diseases, it does not decrease as greatly as previously accepted. Likewise, hepatic function seems to be quite well preserved in the fit elderly [4, 7, 8]. Consequently, drug elimination in the elderly is only slightly reduced if at all. When considering the impact of old age on the action of drugs one has to differentiate the group of fit elderly from that of frail elderly which represent a subgroup of patients in whom it is not aging per se but multiple disease states that Eur J Clin Pharmacol (2008) 64:225–226 DOI 10.1007/s00228-007-0410-5

Incidence of and risk factors for skin ailments among farmers working with wastewater-fed agriculture in Hanoi, Vietnam

The use of wastewater in agriculture and aquaculture is widespread in many developing countries, but limited information is available about the health hazards associated with this practice. To study the occurrence of skin ailments in relation to wastewater use in agriculture and aquaculture, an open cohort of 636 adults aged 15-70 years living in a wastewater-irrigated area in Hanoi, Vietnam, was followed by weekly visits for 12 months. A nested case-control study with 108 case/control pairs was conducted to investigate possible risk factors for skin ailments. The incidence rate of skin ailments was 32.5 episodes per 100 person-years at risk. Independent determinants of skin ailments included wastewater contact in the past 7 days (odds ratio (OR=2.74, 95% confidence interval (CI) 1.29-5.82), female gender (OR=2.48, 95% CI 1.06-5.76), fish farming-related jobs (OR=3.47, 95% CI 1.27-9.50) and lack of protective measures (OR=2.24, 95% CI 1.21-4.12). It is likely that effective promotion of personal protective measures and improved hygiene practices amongst wastewater users will mitigate the risk of dermatological problems and will thus be of benefit to public health in communities that rely on the use of wastewater for agricultural and aquacultural productions.

First wash your hands! Control of nosocomial infections in practice

TWO years ago, in response to concerns about the nosocomial infection rate in its veterinary hospital, Davies Veterinary Specialists set up an infection control group to investigate infection risks and...

Too clean, or not too clean: the hygiene hypothesis and home hygiene.

SummaryThe ‘hygiene hypothesis’ as originally formulated by Strachan, proposes that a cause of the recent rapid rise in atopic disorders could be a lower incidence of infection in early childhood, transmitted by unhygienic contact with older siblings. Use of the term ‘hygiene hypothesis’ has led to several interpretations, some of which are not supported by a broader survey of the evidence. The increase in allergic disorders does not correlate with the decrease in infection with pathogenic organisms, nor can it be explained by changes in domestic hygiene. A consensus is beginning to develop round the view that more fundamental changes in lifestyle have led to decreased exposure to certain microbial or other species, such as helminths, that are important for the development of immunoregulatory mechanisms. Although this review concludes that the relationship of the hypothesis to hygiene practice is not proven, it lends strong support to initiatives seeking to improve hygiene practice. It would however be helpful if the hypothesis were renamed, e.g. as the ‘microbial exposure’ hypothesis, or ‘microbial deprivation’ hypothesis, as proposed for instance by Bjorksten. Avoiding the term ‘hygiene’ would help focus attention on determining the true impact of microbes on atopic diseases, while minimizing risks of discouraging good hygiene practice.

Personal Hygiene and Methicillin-resistantStaphylococcus aureusInfection

Methicillin-resistant Staphylococcus aureus (MRSA) infections outside the healthcare setting are an increasing concern. We conducted a case-control study to investigate an MRSA outbreak during 2002-2003 in a Missouri prison and focused on hygiene factors. Information on sociodemographic characteristics, medical history, and hygiene practices of study participants was collected by interview and medical record review. Logistic regression was used to evaluate MRSA infection in relation to hygiene factors individually and as a composite hygiene score; potential confounding factors were controlled. Selected MRSA isolates were analyzed by pulsed-field gel electrophoresis (PFGE). MRSA infection was significantly associated with a low composite hygiene score. Transmission among prison inmates appeared to be responsible for this outbreak. PFGE analysis showed that isolates were indistinguishable and associated with community-onset MRSA infections in other US prisons. Improving hygiene practices and environmental conditions may help prevent and interrupt future MRSA outbreaks in prison settings.

Sistema multimídia de apoio à decisão em procedimentos de higiene para unidades de alimentação e nutrição

É objetivo deste estudo desenvolver um sistema multimídia com a finalidade de subsidiar a melhoria de procedimentos de higiene em Unidades de Alimentação e Nutrição. O sistema Clean Up, composto de várias bases de conhecimento e informações interligadas e organizadas em módulos foi avaliado por 30 usuários que responderam ao teste de aceitação baseado na Escala Likert modificada, com os atributos próprios de escala hedônica, com notas de 1 a 9, para classificação que varia de "extremamente bom" a "extremamente ruim". A partir dos dados coletados foram calculadas a moda e os valores máximo e mínimo das notas para cada atributo julgado pelos avaliadores. A nota 8 foi a mais freqüente, classificando os módulos como "muito bom", segundo a escala Likert. É também função do multimídia entreter o usuário. As cores, sons, filmes, imagens devem surpreender e criar expectativas positivas, aumentando a vontade de explorar o conteúdo durante a aquisição do conhecimento.

Emergence of Enterobacter cloacae as a common pathogen in neonatal units: pulsed-field gel electrophoresis analysis

In the first week of December 2002, three infants hospitalized in the neonatal department of our hospital had blood cultures positive with Enterobacter cloacae. Screening cultures and genotyping showed that 10 of 25 screened patients also carried E. cloacae and that nine isolates belonged to the same clone as that responsible for all three bacteraemias. This epidemic cluster was limited to one of the two units of the department. Surveillance of both units continued until the end of March 2003; 51 of 159 neonates screened were colonized with E. cloacae, 38 out of 80 (47.5%) in the premature unit (PU) and 13 out of 79 (16.4%) in the paediatric intensive care unit (PICU). Pulsed-field gel electrophoresis (PFGE) analysis of 130 available isolates revealed 30 different pulsotypes, including 24 unique pulsotypes from individual patients and six from multiple patients. Antibiotic (particularly β-lactam) use did not significantly vary from 1999 to 2003. The consumption of alcohol-based hand rub (four-fold higher in the PICU than in the PU) and nurse-to-patient ratio (1:2 in the PICU and 1:4 in the PU) might explain the higher cross-transmission rate in the PU. Finally, despite an epidemiological survey, we failed to identify the causes of the emergence of E. cloacae in our neonatology units. However, improved hygiene practices combined with restriction of admission led to the progressive disappearance of the epidemic strain. The increasing importance of this type of unit and the dramatic consequences of infections emphasize the need for additional research on the constitution of the flora of newborns and the mode of acquisition Gram-negative multi-resistant bacteria.

Occurrence of pathogenic bacteria in raw milk, cultured pasteurised milk and naturally soured milk produced at small-scale dairies in Zimbabwe

The presence of selected pathogenic bacteria in raw milk (RM), cultured pasteurised milk (CPM), and naturally soured raw milk (NSRM) sold at three small-scale dairies in Zimbabwe was determined. Mean levels of Escherichia coli in RM, CPM and NSRM were 4.5, 7.1 and 7.8 log 10 CFU ml −1, respectively. Enterotoxigenic E. coli (ETEC), producing heat-stable enterotoxin (ST1) was found in 16 of the samples. Presumptive Staphylococcus aureus was identified in 7 of 12 RM, 15 of 27 CPM and 20 of 21 NSRM samples at mean levels of 5.2, 7.3 and 7.8 log 10 CFU ml −1, respectively. Klebsiella pneumonia spp., Enterobacter cloacae, Proteus mirabilis, Hafnia alvei, Citrobacter spp., Serratia marcescens and Aeromonas hydrophilia were found in 27 samples. The high number of S. aureus, E. coli, identification of ETEC-ST1 and the other pathogenic microorganisms found in pasteurised and unpasteurised milk products represent a health hazard to the consumers and emphasises the need for improved hygiene practice at all levels in the dairy.

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

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

Home hygiene and environmental sanitation: a country situation analysis for India

Problems of the environment and of domestic hygiene are always related to poverty of population and the sanitation of settlements. Most cities and towns in developing countries, like India, are characterised by over-crowding, congestion, inadequate water supply and inadequate facilities of disposal of human excreta, waste water and solid wastes. Inadequacy of housing for most urban poor invariably leads to poor home hygiene. Personal and domestic hygiene practices cannot be improved without improving basic amenities, such as water supply, waste water disposal, solid waste management and the problems of human settlements. But even under the prevailing conditions, there is significant scope of improving hygiene practices at home to prevent infection and cross-infection. Unfortunately, in developing countries, public health concerns are usually raised on the institutional setting, such as municipal services, hospitals, environmental sanitation, etc. There is a reluctance to acknowledge the home as a setting of equal importance along with the public institutions in the chain of disease transmission in the community. Managers of home hygiene and community hygiene must act in unison to optimise return from efforts to promote public health. Current practices and perceptions of domestic and personal hygiene in Indian communities, the existing levels of environmental and peri-domestic sanitation and the 'health risk' these pose will be outlined, as well as the need for an integrated action for improving hygiene behaviour and access to safe water and sanitation.

Effect of an Integrated Nutrition Program on Child Morbidity Due to Respiratory Infection and Diarrhea in Northern Viet Nam

Infectious disease and poor diet are the two proximal causes of malnutrition in children. During the 1990s, integrated nutrition programs implemented by Save the Children (SC) in Viet Nam reduced severe child malnutrition, but it has not been clear if this impact was due primarily to improved diet or reduced disease. The aim of this study was to determine whether a community-based, integrated nutrition program in Viet Nam reduced child morbidity due to diarrhea or acute respiratory infections. Children 5 to 25 months old were randomly selected from randomly assigned intervention and comparison communes. Caregivers of children from the intervention and comparison groups (n = 119 per group) were interviewed about their child's morbidity at program baseline and at study months 2, 4, 6, and 12. Multiple logistic regression and general estimating equations (GEE) were used to evaluate the effect of the intervention on the occurrence of any diarrhea and respiratory illness in the preceding two weeks. Respiratory illness, mainly upper respiratory illness, was more common than diarrheal disease at baseline (54% vs. 6%, respectively). During follow-up, children in the intervention communes had approximately half the respiratory illness experienced by those in comparison communes (AOR = 0.5; p = .001). Diarrheal disease was also lower in the intervention group, although differences were not statistically significant. We conclude that SC's integrated nutrition program was associated with reduced upper respiratory illness, perhaps due to improved hygiene practices and/or improved micronutrient intakes.

An intervention for the promotion of hygienic feces disposal behaviors in a shanty town of Lima, Peru.

This paper describes the design, implementation and evaluation of an intervention to promote improved hygiene practices in a shanty town area of Lima, Peru. Following formative research, the intervention focused on behaviors associated with the hygienic use of potties by children aged 15-47 months and keeping the home environment free from feces. A health communications strategy was developed involving delivery through routine health services, and using video presentations, leaflets and counseling by health staff during consultations. Intervention activities occurred during a 6-month period in health centers and posts of four intervention communities; four other communities acted as a comparison group. Process and impact indicators were measured through questionnaires and 4-h structured observations conducted in over 600 households both pre- and post-intervention implementation, and through intervention monitoring activities. The intervention materials and approach were well received by the study community; however, in the time-frame of the project only limited coverage of the target audience was achieved, which was insufficient to result in an impact on behaviors. Nevertheless sufficient positive features existed to suggest that with higher coverage, an impact on target behaviors might have been achieved. Reasons for the intervention's shortcomings are discussed and suggestions made for more effective implementation.

Effect of an Integrated Nutrition Program on Child Morbidity due to Respiratory Infection and Diarrhea in Northern Viet Nam

Infectious disease and poor diet are the two proximal causes of malnutrition in children. During the 1990s, integrated nutrition programs implemented by Save the Children (SC) in Vietnam reduced severe child malnutrition, but it has not been clear if this impact was due primarily to improved diet or reduced disease. The aim of this study was to determine whether a community-based, integrated nutrition program in Vietnam reduced child morbidity due to diarrhea or acute respiratory infections. Children 5 to 25 months old were randomly selected from randomly assigned intervention and comparison communes. Caregivers of children from the intervention and comparison groups (n = 119 per group) were interviewed about their child's morbidity at program baseline and at study months 2, 4, 6, and 12. Multiple logistic regression and general estimating equations (GEE) were used to evaluate the effect of the intervention on the occurrence of any diarrhea and respiratory illness in the preceding two weeks. Respiratory illness, mainly upper respiratory illness, was more common than diarrheal disease at baseline (54% vs. 6%, respectively). During follow-up, children in the intervention communes had approximately half the respiratory illness experienced by those in comparison communes (AOR = 0.5; p = . 001). Diarrheal disease was also lower in the intervention group, although differences were not statistically significant. We conclude that SC's integrated nutrition program was associated with reduced upper respiratory illness, perhaps due to improved hygiene practices and/or improved micronutrient intakes.

Smallholder dairy processing in Zimbabwe: the production of fermented milk products with particular emphasis on sanitation and microbiological quality

Microbiological quality and hygienic practice during the production of naturally sour milk (NSM), made of unpasteurised milk, and cultured milk (CM), made of pasteurised milk, were studied at three smallholder dairies in Zimbabwe. Petrifilm™ was used for the determination of Escherichia coli, coliforms and aerobic mesophilic count (AMC). AMC Petrifilms used as contact plates showed that 52% of utensils at the dairies ( N=80) were not acceptably clean (>100 CFU per 20 cm 2 ). E. coli was found in 81% of the samples of NSM ( N=31) and in all samples of CM ( N=70). Approx. 39% of NSM samples and 47% of the CM samples contained more than 1000 CFU E. coli ml −1. The high numbers of E. coli found in pasteurised milk emphasise the need for improved hygiene practice at the dairies. Since NSM is not pasteurised, the hygiene at the farm is additionally important for production of NSM. The hygiene and handling at the farm should therefore be especially emphasised at the dairies where NSM is commonly produced.

Importance of improved hygiene practices in the household

Importance of improved hygiene practices in the household

Preventing acute respiratory infections and diarrhoea in child care centres

This study was designed to explore the physical characteristics and child care practices of child care centres as potential risk factors for respiratory infections and diarrhoea in children 3–35 mo of age. A dynamic cohort averaging 667 children from 40 child care centres in Campinas (Brazil) was followed up for 8 mo. Direct structured observations were made to collect information on the centres' physical structure, child activities and child care practices. Despite their good infrastructures, hand washing in the centres was infrequent, and nearly 30% of diaper changes were unhygienic. Risk factors for diarrhoea included the presence of flies during meals, infrequent child hand washing before meals, and infrequent child hand washing after defecation, with relative risks of 1.33, 1.73 and 1.63, respectively. There was 33% less diarrhoea in classes where soap was frequently used during diapering. Contrary to our hypotheses, ventilation, group size and child density were not associated with respiratory infections, as was the case for most other factors studied. Only mixing of groups and a larger classroom area were found to be negatively associated with lower and upper respiratory infections, respectively. The results indicate that improving hygiene practices is the only intervention in child care centre characteristics with good potential to reduce diarrhoea among attendees. For respiratory infections, no modifiable characteristic with intervention potential was identified.

The Andha Andhi Community Health Project, Nepal

AbstractWaterAid, backed by a pledge from the Institution of Water and Environmental Management to raise £5000, has agreed to support its local partner, Nepal Water for Health which, in turn, will assist the Andha Andhi Community Development Centre in this integrated water, sanitation and health education project. The budget is £10 570 (co‐funded by UNICEF†), to be spent during 1995−96, and the project is to serve 558 people living in Andha Andhi.The scheme comprises: the construction of a gravity water supply system; the installation of pit latrines; training of the scheme caretaker, health volunteers, a health motivator, sanitation worker and coordinator.Benefits are expected to arise from (a) the provision of safe drinking water, (b) education in improved hygiene practices, and (c) the easing of the burden of water collection on women and girls.

Sustained improvements in hygiene behaviour amongst village women in Lombok, Indonesia

Fifty-seven mothers in Indonesia were involved in a face-to-face health education programme which encouraged hand-washing with soap. The intervention spanned 4 months and comprised fortnightly visits by 2 community organizers, who supplied free soap. Two years after the intervention, 79% of mothers were still using hand soap, despite the fact that they now had to buy it themselves. The community seemed to be benefiting from a sustained reduction in diarrhoea episodes due to improved hygiene practices.

A longitudinal study of the impact of behavioural change intervention on cleanliness, diarrhoeal morbidity and growth of children in rural Bangladesh

A community-based intervention was developed through direct participation of the target population in assessment and iterative trials to improve hygiene practices and to reduce childhood diarrhoea in lowland rural Bangladesh. A total of 185 (98%) households with children ages 0–18 months in five contiguous villages were targeted for the interventions. A comparison site was selected for a detailed observational study and for use as a control for the intervention. About 97% of all households with children ages 0–18 months were enrolled for study at the control site. Children in this age group were targeted because at this developmental stage they were most vulnerable to diarrhoeal morbidity and malnutrition (related to unhygienic practices). The intervention was implemented with the assistance of village leaders through a “Clean Life” campaign by local project workers and volunteer mothers who were chosen from the target households. The intervention activities started in January 1986 and lasted for 7 months. Higher adoption rates of the intervention were associated with better cleanliness status, which was related to lower diarrhoea and malnutrition rates in the intervention site. The results of between-site longitudinal analyses showed that after the intervention, the intervention site had substantially higher cleanliness scores, lower diarrhoeal morbidity, and better growth status compared to those of the control site, with differences increasing over time. The findings suggest that this type of community-based intervention can be very beneficial in modifying hygiene behaviours and lowering childhood diarrhoea and malnutrition.

Community-Based Trial and Ethnographic Techniques for the Development of Hygiene Intervention in Rural Bangladesh

Community-based three-stage iterative trials were performed to develop interventions for improving hygiene practices to reduce childhood diarrhea in rural Bangladesh. Ethnographic techniques were used to identify practices associated with diarrhea, to understand cultural beliefs and reasoning related to causes of diarrhea, and to tap community resources. Hygiene behaviors and products designed through in-home problem diagnosis went through trials sequentially at three socio-economic levels consisting of ten educated project workers, twenty-five volunteer mothers and twenty-five very low- income mothers. These levels, chosen in order to meet the needs of all including the poorest, permitted new practices which proved feasible in the workers' trial to be then tried by the volunteers. The results were synthesized, with successful behavioral advice translated into simple verbal messages created to resemble locally popular proverbs, poems and folk songs. The messages and products were finalized after pretesting and revision among the very low-income group of mothers. Evaluation of the community-wide campaign showed very high rates of adoption (85%-95%) of the interventions. The involvement of target groups and their opinion leaders in the intervention development process contributed to the sense of ownership reflected in the high rate of adoption. Program organizers' comprehensive understanding of practices associated with diarrhea and its cultural context, and the community's empowerment to find local solutions are both critical to the success of such interventions.