Water Handwashing Research Articles

Elizabethkingia meningoseptica : Emerging nosocomial pathogen in bedside hemodialysis patients

Elizabethkingia meningoseptica, a ubiquitous gram-negative aerobic bacillus, is an emerging hospital acquired pathogen in patients on dialysis. It has been isolated in the hospital environment in water supplies, disinfectants, and medical devices. We present here an analysis of eight healthcare-acquired infections with this organism in adults. To the best of our our knowledge, this is the first report of infections with this organism in patients on hemodialysis.Materials and Methods:Over a 6-month period, eight patients were infected with E. meningoseptica in our hospital. These patients had bacteremia and lower respiratory tract infection. All these patients were on on mechanical ventilation and undergoing bedside hemodialysis in the intensive care unit (ICU). Environmental surveillance was done to detect the possible source.Results:These patients had a common denominator of bedside hemodialysis, and use of broad-spectrum antibiotics. E. meningoseptica was isolated from the water and sink of the ICU.Conclusion:E. meningoseptica is emerging as a nosocomial pathogen among patients on hemodialysis. Its unusual resistance pattern coupled with inherent resistance to colistin makes this organism difficult to treat unless susceptibility patterns are available. Isolation of this organism in handwash sink and water is a significant finding as they have been reported to survive in chlorinated water. Disinfecting the sinks and using filtered water for hand washing in critical areas may help in preventing infections with this organism.

A study on personal hygiene and sanitary practices in a rural village of Mornag District of Nepal

Background: Inadequate sanitation has direct effect on health of individual, family, communities and nation as a whole. Objective: To assess the personal hygiene and sanitary condition of the Katahari Village Development Committee (VDC). Methods: The cross sectional study was done in Katahari VDC of Morang district. A total of 80 households were randomly selected from two wards of VDC. The data were collected by interview method using interview schedule. Data were entered in Excel sheet and analyzed on SPSS program. Results: Many respondents (61%) were unable to read and write, 33% involved in private job in various factory. Knowledge of sanitation was high (90%) but only 65% of them were using soap water for hand washing. Sixty percent had no toilet facilities. There was significant association between education and toilet facilities among community people. Land holding and type of family had no significant association with toilet facilities. Conclusion: The knowledge regarding sanitation was high among community people but very poor in practice.DOI: http://dx.doi.org/10.3126/jonmc.v1i2.7298 Journal of Nobel Medical College (2012), Vol.1 No.2 p.39-44

Presence of Coliforms and Fecal Coliforms in Fast Food Items of Local Restaurants and Fast Food Outlets of Dhaka City

The Microbiological status of 50 fast food samples collected from middle class and lower middle class retail outlets of fast food shops and restaurants at New Market and Dhanmondi area of Dhaka city were assessed. Eighty four percent of the samples were found to be satisfactory and 16% of the samples were found to be unsafe for human consumption. Total coliform, fecal coliform, Salmonella spp, Staphylococcus aureus and fungal count in 12%, 8%, 16%, 14% and 14% samples respectively have crossed the recommended limits and were unsafe for human consumption. Bare-handed handling of foods and use of unsafe water for dish washing and hand washing by food handlers, keeping food for long time under lighting in display glass boxes with elevated temperatures and storage of uncooked and half cooked meat items side by side in the refrigerator were noticed to be the possible sources and causes of microbiological contamination of the fast food items. DOI: http://dx.doi.org/10.3329/bjm.v28i1.11810 Bangladesh J Microbiol, Volume 28, Number 1, June 2011, pp 49-51

Water and sanitation in schools: a systematic review of the health and educational outcomes.

A systematic review of the literature on the effects of water and sanitation in schools was performed. The goal was to characterize the impacts of water and sanitation inadequacies in the academic environment. Published peer reviewed literature was screened and articles that documented the provision of water and sanitation at schools were considered. Forty-one peer-reviewed papers met the criteria of exploring the effects of the availability of water and/or sanitation facilities in educational establishments. Chosen studies were divided into six fields based on their specific foci: water for drinking, water for handwashing, water for drinking and handwashing, water for sanitation, sanitation for menstruation and combined water and sanitation. The studies provide evidence for an increase in water intake with increased provision of water and increased access to water facilities. Articles also report an increase in absenteeism from schools in developing countries during menses due to inadequate sanitation facilities. Lastly, there is a reported decrease in diarrheal and gastrointestinal diseases with increased access to adequate sanitation facilities in schools. Ensuring ready access to safe drinking water, and hygienic toilets that offer privacy to users has great potential to beneficially impact children’s health. Additional studies that examine the relationship between sanitation provisions in schools are needed to more adequately characterize the impact of water and sanitation on educational achievements.

The C. diff Cycle: The Necessity of Going Beyond the Basics

When Clostridium difficile infection (CDI) rates increased in 2007, a vigorous campaign was launched at our large tertiary care teaching hospital to stop transmission of these infections. Initiatives included: 1) improving prompt communication of positive laboratory results to the nursing units and the environmental services staff (EVS), 2) modifying room cleaning protocols by instituting bleach-cleaning, 3) working with bed control to reduce unnecessary room transfers, 4) providing education on CDI to staff via videos, in-services, focused stand-up meetings, posters, and screen saver messages, and 5) Contact Precautions at symptom onset with strict soap and water handwashing.

Anal cleansing practices and faecal contamination: a preliminary investigation of behaviours and conditions in schools in rural Nyanza Province, Kenya

To learn how children in rural schools in Nyando District, Kenya clean themselves after defecation. Six focus group discussions were held with boys and girls ages 12-15 in three rural schools in mid-2009. Parents were interviewed in one setting. In early 2010, a survey of head teachers was conducted in 114 schools in Nyanza Province, Kenya, to assess the provision of anal cleansing materials and handwashing water and soap in schools. Anal cleansing behaviour is linked with access to materials, age, social pressure, perceived personal risk of illness and emotional factors. Materials used for anal cleansing include schoolbook paper, leaves, grasses, stones, corncobs and one's own hands. Students have knowledge gaps in terms of personal hygiene. They were forthcoming with information on their anal cleansing practices. Almost no schools budgeted for or provided anal cleansing materials regularly. Anal cleansing is a necessary human activity. However, because of social taboos, there are few articles on the topic. School health plans overlook it as well. Researchers need to determine if and how current practices could harm child health to inform policy.

Flow Water Hand Washing with Electrolytic Product of Sodium Chloride

Flow Water Hand Washing with Electrolytic Product of Sodium Chloride

A community-based participatory worksite intervention to reduce pesticide exposures to farmworkers and their families.

We evaluated a community-based participatory research worksite intervention intended to improve farmworkers' behaviors at work and after work to reduce occupational and take-home pesticide exposures. The workers received warm water and soap for hand washing, gloves, coveralls, and education. Self-reported assessments before and after the intervention revealed that glove use, wearing clean work clothes, and hand washing at the midday break and before going home improved significantly. Some behaviors, such as hand washing before eating and many targeted after-work behaviors, did not improve, indicating a need for additional intervention.

Investigation into the effect of an alcohol-based hand product on infection rate in a nursing home setting

The study assessed the impact on nursing home (NH) resident infection rates of providing staff with a personal alcohol-based hand product (ABHP) with and without training on its use. Fifteen North Wales NHs were recruited and randomly allocated into one of three groups. All monitored infection rates throughout the study period of 18 weeks (Phase I [weeks 1—9], Phase II [weeks 11—19]). NHs used liquid soap and water for hand washing throughout the study. Groups B and C introduced interventions during week ten: Group B were provided with personal ABHPs without training on use; Group C personal ABHPs with standard training from the sponsoring hand hygiene company. Infection rates between groups and pre- and post-intervention were compared. Infection rates (per 1,000 bed days) for Phase I vs. Phase II of the study were: Group A: 6.99 vs. 7.16; Group B: 6.08 vs. 3.46; and Group C: 5.04 vs. 6.78 respectively. Change in infection rates in Groups B and C pre- and post-intervention did not reach statistical significance, p = 0.097 and p = 0.072 respectively. Comparison of rates in non-intervention Group A with the intervention groups indicated a significantly lower rate after the intervention in Group B ( p = 0.035) but not Group C ( p = 0.765). Findings are limited due to sample size; introduction of personal ABHPs with training did not reduce infection rates. This conflicts with other studies examining education and improvement of hand hygiene compliance. However, infection rates fell in NHs not receiving training, possibly mediated through a sense of `ownership' of the intervention.

The status of safe drinking water and sanitation in Batabaria, Comilla, Bangladesh

Background: In a developing country like Bangladesh, people are constantly battling different diseases most of which are caused by a lack of clean drinking water and sanitation. Improved hygiene (hand washing and safe water use) and sanitation (sanitary latrine) are also essential for reducing cases of diarrhea, parasitic infestation, morbidity, and mortality. A field study was carried out in the village of Batabaria in Comilla to identify the status of safe drinking water and sanitation. Materials and Methods: The village of Batabaria under Comilla Sadar was selected for data collection. Data was collected by using the direct observation method, a sample questionnaire, and discussions with key informants. Thirty houses were chosen from the village. A total of 158 respondents were interviewed to gather information for the study. Results: The average family size was 5.26, which is more or less the same average of Comilla, however, it is a little lower than the national average of 5.6. Most of the family members were students (40.5%) and housewives (22.78%). Thirty percent of the respondents live below the poverty line while the national average is 47%. The percentage of respondents engaged in agricultural work is 11.2%, which is far lower than our national percentage of 53%. All of the households use tube wells for drinking and domestic purposes, presumed to be arsenic free. A total of 98% use sanitary latrines. Among the respondents, 76% wash their hands before meals and after defecation. Conclusion: A comprehensive village development plan should be carried out in every village in Bangladesh to improve the standard of safe water use and sanitation.

Beyond the Bench: Prevention Pays for Farmworkers

Many agricultural growers use pesticides to protect crops and ensure satisfactory yields. Although the United States has some of the strictest laws governing pesticide applications and re-entry into fields after application, a number of studies have demonstrated that farmworkers are still being exposed to pesticides in the fields and that they may take the chemicals home on their skin and clothing, potentially exposing their families. This risk prompted the University of California, Berkeley, Center for Children’s Environmental Health Research to join with community partners Clinica de Salud del Valle de Salinas, the California Rural Legal Assistance Program, and the Central Coast Grower–Shipper Association to conduct a study on ways to alleviate this hazard. The community-based participatory research study employed a field-based technical intervention designed to reduce farmworker exposure to pesticides and the potential for take-home pesticide exposures. The partnership, through its Center for Health Assessment of Mothers and Children of Salinas (CHAMACOS), recruited 130 study participants working at two Monterey County strawberry farms during the summer of 2003. Then they initiated preventive measures to decrease direct exposure to malathion (a pesticide commonly used in strawberry fields) and lessen the amount of pesticide residues workers carried home on clothing, skin, and shoes. “The agricultural work environment is very complex, with changes in weather parameters, soil moisture, crops, tasks, and other factors occurring over short time frames,” says Asa Bradman, CHAMACOS associate director. “We focused on strawberry harvesting to ensure that the crop and task could be held constant. We chose to study malathion because it can be [simultaneously] measured in . . . foliar residue samples, in personal samples such as hand rinse and clothing patch samples, and in urine as the metabolite malathion dicarboxylic acid.” The study began with surveys, urine sampling, and foliage sampling during a pre-intervention process to determine the farmworkers’ initial exposure levels. Intervention activities began a month later. The team provided protective clothing (lightweight coveralls and disposable gloves), educational sessions at the worksite on exposure prevention, shoe boxes and laundry bags to store work clothing and shoes, and a field station with warm water and soap for handwashing. Post-intervention data collection in October of the same year included surveys, urine sampling, hand rinse sampling, clothing patch sampling, and foliage sampling. The initial feedback from the participants indicated that the intervention strategies could lower overall exposure if used on a regular basis. One of the solutions, the use of a hot water heater in the field to provide warm water for handwashing, had never been tried before. During the pre-intervention phase, many farmworkers revealed that they had previously avoided washing their hands while picking strawberries because they believed that washing with cold water, which was all that was available, could cause arthritis. The availability of the warm water led to more handwashing and thus less pesticide residue on hands. The protective clothing and storage for work clothes and shoes also proved helpful to the workers in limiting pesticide exposure. Alicia Salvatore, CHAMACOS intervention study coordinator, says, “Many [farmworkers] reported that they experienced fewer dermal rashes when they used gloves, and almost all workers noticed a marked change in amount of dirt that they carried home at the end of the day on the clothing that they wore under their coveralls. Almost all workers who participated were interested in continuing these behaviors.” Brenda Eskenazi, CHAMACOS director and principal investigator of the project, sees a necessity and potential for these types of measures, and says the partnership will continue to advance that cause. “We believe it is important to develop sustainable interventions—that is, interventions that are cheap and effective in reducing exposure to pesticides,” she says. “This intervention . . . is an important first step in this direction.” Bradman says the growers who participated in the intervention were supportive of the project and plan to continue to use the preventive measures to the fullest extent possible. He adds that the community partners in CHAMACOS are presenting their findings to other growers and agricultural organizations, as well as preparing reports for publication.

An alternative process for cleaning knives used on meat slaughter floors

Traditionally on slaughter floors operator knives are cleaned by rinsing in hand wash water at 20–40 °C followed by brief immersion in baths termed “sterilisers” which contain water no cooler than 82 °C. Under Australian legislation, both domestic and export, it is possible for a meat processing establishment to apply to the Controlling Authority for permission to implement an alternative procedure providing that it is at least the equivalent of that legislated. No firm evidence appears to exist for the 82 °C requirement and the possibility of replacing this element of the knife cleaning procedure with an alternative procedure using 60 °C water and a longer immersion time was investigated at an abattoir slaughtering cattle and sheep. Knives were tested at a range of work stations located along beef and mutton slaughter floors for Aerobic Plate Counts (APCs) and E. coli. For knives used on the beef chain the mean log APC/cm 2 was 2.18 by the current knife cleaning process and 1.78 by the alternate procedure ( P < 0.001). Using the current system E. coli was isolated from cleaned knives on 20/230 (8.7%) occasions compared with 21/230 (9.1%) occasions using the alternative system. The mean log E. coli of positive knives was 0.43/cm 2 and 0.61/cm 2 from the current and alternative systems, respectively. On the mutton chain the mean log APC/cm 2 was 1.95 using the current knife cleaning process and 1.69 by the alternative procedure ( P = 0.014). Using the current system E. coli was isolated from cleaned knives on 24/130 (18.5%) occasions compared with 29/130 (22.3%) occasions using the alternative system. The mean log E. coli of positive knives was 0.90/cm 2 and 0.76/cm 2 from the current and alternative systems, respectively. It is concluded that using two knives alternatively, rinsing them in hand wash water, then immersing them between uses in 60 °C water provides a microbiological outcome equivalent to rinsing them and momentary dipping in 82 °C water.

Evaluation of Tap Water for Surgical Handwashing

In Japan, sterile water is used for rinsing in surgical handwashing, whereas in Western countries tap water is generally used. We conducted this study to examine the conditions and the equipment that affect bacterial contamination in tap water and to determine whether the tap water in our institute is suitable for surgical handwashing. First, we examined the water pipes and measured the free chlorine content in the tap water in the operating room. Next, we recruited 40 volunteers and conducted preliminary tests with sterile water. Thirty of these subjects participated in a handwashing test using tap water. The mean free chlorine levels in the tap water and the sterile water were 0.30 +/- 0.05 and 0.07 +/- 0.03 mg/l, respectively. The handwashing test using tap water showed immediate, persistent, and cumulative bacteria activity within the minimum limits set by the Food and Drug Administration (FDA). The free chlorine levels in the tap water in our institute satisfied Japanese health regulations. Moreover, the handwashing test met the criteria of the FDA. Thus, we conclude that this tap water is safe to use for rinsing in surgical handwashing.

Occupational Health Survey of Farm Workers by Camp Health Aides

Little is known about the magnitude of occupational health problems among migrant farm workers. A community-based cross-sectional survey was conducted in two migrant farm worker communities: Homestead, Florida, and Kankakee, Illinois. Camp Health Aides (CHAs) interviewed 425 workers about job tasks, personal protective equipment (PPE), field sanitation, work exposures, and selected health conditions. Limited provision of personal protective equipment was reported among those reporting early re-entry tasks: 35% in Kankakee and 42% in Homestead were provided gloves, and 22% in Homestead and 0% in Kankakee were provided protective clothing. About two-thirds were provided toilet facilities and water for hand-washing. Workers reported high prevalences of health conditions consistent with exposure to ergonomic hazards and pesticides. The prevalence of back pain in the past 12 months was 39% in Homestead and 24% in Kankakee. Among Homestead participants, 35% experienced eye symptoms, while 31% reported skin symptoms. These symptoms were less prevalent among Kankakee participants (16% for both eye and skin symptoms). Specific areas of concern included back pain associated with heavy lifting and ladder work; eye and skin irritation associated with fertilizer application tasks and with working in fields during or after spraying of chemicals, especially early re-entry of sprayed fields; and skin irritation associated with a lack of access to hand-washing facilities. In both Kankakee and Homestead, better adherence to safety standards is needed, as well as greater efforts to implement solutions that are available to help prevent work-related musculoskeletal problems.

Arsenic on the Hands of Children: Wang et al. Respond

In our study of arsenic on children’s hands (Kwon et al. 2004), we measured arsenic in water samples in which participating children washed both hands after playing on selected playgrounds. The hand-washing water was filtered, and the soluble arsenic concentration in the filtrate was determined by inductively coupled plasma mass spectrometry. In response to Kissel’s comment that we did not measure insoluble arsenic, we analyzed the arsenic levels in the insoluble residue collected on the filter and summarized the unpublished data here. Results from the analysis of 64 samples from the CCA playgrounds and another 63 samples from the non-CCA playgrounds are available upon request. The total amount of arsenic in the insoluble residue collected in the hand-washing water of 64 children from the eight CCA playgrounds was 418 ± 601 ng (mean ±SD), compared to 172 ± 278 ng in the hand-washing water of 63 children from the eight non-CCA playgrounds. The total arsenic collected in the hand-washing water (insoluble arsenic on the filter plus water-soluble arsenic in the filtrate) was 934 ± 940 ng for the CCA playground and 265 ± 311 ng for the non-CCA playgrounds. The maximum amount of total arsenic collected from children’s hands was 4,743 ng (4.7 μg). This is compared with the 3.9 μg that we reported previously (Kwon et al. 2004). To provide a perspective of relative contribution of this amount of arsenic to the overall exposure to arsenic, in our article (Kwon et al. 2004) we included references for the average daily dietary ingestion of total arsenic: 38 μg (15 μg for children 1–4 years of age) for Canada (Dabeka et al. 1993), 62 μg for the United States (Gartrell et al. [1985]), 89 μg for the United Kingdom (Food Additives and Contaminants Committee 1984), 55 μg for New Zealand (Dick et al. 1978), and 160–280 μg for Japan (Tsuda et al. 1995). A range of arsenic species that have different toxicities may be present in food (Le et al. 2004). Estimated daily dietary intake of inorganic arsenic was 8.3–14 μg in the United States (Yost et al. 1998), 4.8–12.7 μg in Canada (Yost et al. 1998), and 15–211 μg in Taiwan (Schoof et al. 1998). We did not monitor children’s hand-to-mouth activity because this behavior has already been documented in the literature (Reed et al. 1999; Tulve et al. 2002). Our intent was to provide direct measurements of the amount of arsenic on children’s hands. We recognize the importance of these other studies, as we pointed out in our “Conclusions” (Kwon et al. 2004): The results—along with other information, such as the frequency and habit of hand-to-mouth activity, efficiency of transfer of arsenic from hands to mouth, and repeated contact of hands with CCA-treated wood surface after hand-to-mouth activity—are useful for assessing children’s exposure to arsenic. We have measured arsenic in sequential hand-washings and found that most arsenic was present in the first hand-washing (unpublished data). Results of arsenic in hand-washings of three children before and after playing on a CCA playground are available upon request. The amount of arsenic in the second washing was < 10% of that in the first washing, suggesting that the arsenic on children’s hands is readily washed off with water. Therefore, we conclude that children should “wash their hands after playing to reduce their potential exposure to arsenic” (Kwon et al. 2004). Biomonitoring of arsenic species in urine samples from children who play on CCA-treated structures and children who do not could be useful if the ingestion of arsenic from dietary sources would not be a major confounder.

Arsenic on the Hands of Children

Kwon et al. (2004) reported significantly elevated dislodgeable soluble arsenic loads on (one or both?) hands of children following play on structures treated with chromated copper arsenate (CCA) but then concluded that the observed difference is unimportant: With a safe conservative assumption that all the arsenic on children’s hands is ingested, the measured value is below the estimated average daily intake of inorganic arsenic from water and food …. However, Kwon et al.’s analysis is not conservative for at least two reasons. First, it is likely that they substantially underestimated arsenic on hands. Kwon et al. reported, but apparently did not actually measure, total arsenic on hands. They washed hands, filtered the wash water, and measured soluble arsenic in the filtrate. Insoluble residue was measured as dry mass gain on the filters. They then estimated insoluble arsenic on hands as the product of the average arsenic concentration in playground sand samples (not solids recovered from hands) and filter dry weight gain. I did not arrive at this conclusion because the procedures are clearly described in the paper but because a) there is no discussion of extraction of filters and b) the ratios of minimum, mean, median, and maximum “sand arsenic” on hands to minimum, mean, median, and maximum sand mass recovered from hands are nearly constant and equivalent (in all cases but one) to the mean concentration reported for each playground. This procedure could easily give a very poor estimate of insoluble arsenic on hands because unfractionated 0- to 6-in sand samples are likely to be a poor surrogate for adherent particles. The filter residue from the hand-wash water probably contained at least some wood particles with much higher arsenic concentrations and lower densities than the playground sand. Hemond and Solo-Gabriele (2004) reviewed studies in which (typically adult) human hands were used to deliberately wipe CCA-treated lumber and reported much higher arsenic residues on hands than found by Kwon et al. (2004). One obvious potential explanation is that the arsenic concentration in material dislodged from CCA-treated wood (Nico et al. 2004) can easily be 1,000-fold higher than the 2–3 ppm found by Kwon et al. in playground sand. Second, the observed loads that Kwon et al. (2004) reported may be greatly influenced by the very activity they wish to assess. That is, mass recoverable at any given time reflects net accumulation and does not include material already ingested. Consider the following simplified model of mass accumulation on hands: where A = area (in square centimeters), L = load (in milligrams per square centimeter), G = net gain in the absence of ingestion (addition minus losses other than ingestion; in milligrams per hour), and king = a first order rate constant describing ingestion (per hour). At steady state, and Assuming reasonable efficiency of washing, Kwon et al. (2004) provided a measure of the product of the two variables on the left hand side (for soluble arsenic). They have not measured either of the variables on the right hand side. In the absence of knowledge of king, they guessed. Because an infinite number of paired values of G and king can be selected to match the available data, large values of king are not excluded. Hence any reassuring conclusion based on this work is a reflection of the assumed rate at which hand residues are orally harvested and not of the reported measurements. Kwon et al. (2004) further concluded that Most of the arsenic on children’s hands is water soluble and is readily washed off with water. We recommend that children wash their hands after playing to reduce their potential exposure to arsenic. Again, this conclusion is not supported by evidence presented in the article. To evaluate efficiency of washing, some measure of the initial mass present is required. Kwon et al. measured removable soluble arsenic and estimated removable insoluble arsenic. They did not measure or estimate either soluble or insoluble arsenic remaining on the hands. Because insoluble arsenic bound to soil or wood is likely to be at least partially removed mechanically by washing regardless of solubilization, washing is probably a good strategy. However, that argument is merely logical rather than empirical and could have been made in the absence of Kwon et al.’s experiments. Kwon et al. (2004) stated that the purpose of their study was to provide “direct measurement of arsenic levels on the hands of children in contact with … CCA-treated wood ….” Given that arsenic is amenable to biomonitoring via urine, comparable urine samples from children who do and do not play on CCA-treated structures are what is most needed. Then perhaps we would be able to stop guessing about ingestion rates.

Are Sterile Water and Brushes Necessary for Hand Washing before Surgery in Japan?

To examine whether sterile water and brushes are necessary for hand washing before surgery. Twenty-two operating room nurses were randomly divided into two groups as follows: 11 nurses who used 7.5% povidone iodine (PVI group) and another 11 nurses who used 4% chlorhexidine gluconate (CHG group) to wash their hands using the rubbing method. All the nurses were examined for bacterial contamination of their hands before and after surgical hand rubbing. We used tap water to wash the hands at the sink used for washing surgical instruments in the operating room and non sterilized plastic brushes. No bacteria were detected in the tap water. Before washing the hands, the number of bacteria detected was 5.0 x 10(3) cfu/H in the PVI group and 4.0 x 10(3) cfu/H in the CHG group, which were similar in both groups. After washing the hands, the median value of the bacteria decreased to 8.7 x 10(2) cfu/H in the PVI group and 0 cfu/H in the CHG group. Sterile water and brushes are not necessary for preoperative scrubbing up. When using tap water for surgical hand washing, 1) the hand-rubbing method should be used; 2) a quick-alcohol-based disinfectant scrub should be used; 3) the concentration of free chloride in the water should be maintained at over 0.1 PPM; 4) the bacterial contamination of the water should be checked; and 5) the faucet should be routinely cleaned and sterilized.

Ressources et organisation de 124 établissements de l'interrégion Sud-Est pour la mise en œuvre des précautions standard et d'isolement septique

Objectives. – The authors had aimed to evaluate resources and organization necessary for applying guidelines issued 5 years earlier in various institutions: standard precautions, septic isolation, prevention against spread of multidrug-resistant bacteria. Material and methods. – Volunteer institutions were surveyed for hygiene product consumption, architectural requirements, inventory of protocols, description septic patients'management, and available personnel. Results. – One hundred and twenty-four institutions (40,784 beds) were included in the study. Eleven percent had no hygiene physician or nurse; the rates of personnel specialized in hygiene practice were 0.4 physicians per 800 beds and 0.8 registered nurses per 400 beds. Eighty-eight percent of the studied institutions had a protocol for standard precautionary measures, 77% had a septic isolation protocol. A multidrug-resistant bacteria identification sheet was attached to examination reports in 87% of cases. Multidrug-resistant bacteria screening was practiced by 18.1% of the institutions. Hygiene product consumption for 1000 days of hospitalization was 7861 disposable gloves, 2.3 l of hydroalcoholic solution, and 63 disposable gowns. 28.9% of the wards lacked water hand washing points, 32.2% had no sinks, and 48.5% had no local equipment maintenance. In addition, 40.7% of the beds were in single rooms, 4.8% of the institutions had no single rooms. Differences were observed depending on specialties and institutions. Conclusion. – Analysis of consumption shows insufficient application of standard precautions, notably for hydroalcoholic solutions. The number of single rooms is acceptable, architectural requirements were not adequate in too many wards. These results can explain some problems encountered in applying the guidelines.

Arsenic on the hands of children after playing in playgrounds.

Increasing concerns over the use of wood treated with chromated copper arsenate (CCA) in playground structures arise from potential exposure to arsenic of children playing in these playgrounds. Limited data from previous studies analyzing arsenic levels in sand samples collected from CCA playgrounds are inconsistent and cannot be directly translated to the amount of children’s exposure to arsenic. The objective of this study was to determine the quantitative amounts of arsenic on the hands of children in contact with CCA-treated wood structures or sand in playgrounds. We compared arsenic levels on the hands of 66 children playing in eight CCA playgrounds with levels of arsenic found on the hands of 64 children playing in another eight playgrounds not constructed with CCA-treated wood. The children’s age and duration of playtime were recorded at each playground. After play, children’s hands were washed in a bag containing 150 mL of deionized water. Arsenic levels in the hand-washing water were quantified by inductively coupled plasma mass spectrometry. Our results show that the ages of the children sampled and the duration of play in the playgrounds were similar between the groups of CCA and non-CCA playgrounds. The mean amount of water-soluble arsenic on children’s hands from CCA playgrounds was 0.50 μg (range, 0.0078–3.5 μg). This was significantly higher (p < 0.001) than the mean amount of water-soluble arsenic on children’s hands from non-CCA playgrounds, which was 0.095 μg (range, 0.011–0.41 μg). There was no significant difference in the amount of sand on the children’s hands and the concentration of arsenic in the sand between the CCA and non-CCA groups. The higher values of arsenic on the hands of children playing in the CCA playgrounds are probably due to direct contact with CCA-treated wood. Washing hands after play would reduce the levels of potential exposure because most of the arsenic on children’s hands was washed off with water. The maximum amount of arsenic on children’s hands from the entire group of study participants was < 4 μg, which is lower than the average daily intake of arsenic from water and food.

Evaluation of disinfective potential of reactivated free chlorine in pooled tap water by electrolysis

Tap water is one of the causative factors of hospital infections. We examined the disinfective potential of electrolysis and mechanism of disinfection, and clarified the disinfective effect of electrolysis on tap water contaminated with bacteria, and discussed its clinical applications. Tap waters artificially contaminated with Pseudomonas aeruginosa, Escherichia coli, Legionella pneumophila, and Staphylococcus aureus could be sterilized by electrolysis at 20–30 mA for 5 min. A high-density suspension (10 6 CFU/ml) of a spore forming bacterium, Bacillus subtilis was not completely sterilized by electrolysis at 50 mA up to 30 min, but a low-density suspension (10 5 CFU/ml) was totally sterilized by electrolysis at 50 mA for 5 min. Electrolyzed P. aeruginosa changed morphologically, that is, there was bleb formation on the cell wall and irregular aggregation of cytoplasmic small granules. Moreover, cytoplasmic enzyme, nitrate reductase, was inactivated by the electrolysis. On the other hand, genomic DNA of the electrolyzed bacteria was not degenerated, therefore, their DNA polymerase activity was not completely inactivated. Consequently, the major agent in electrolysis for bactericidal action was considered to be free chlorine, and the possible bactericidal mechanism was by destruction of bacterial membranes, followed by the aggregation of peripheral cytoplasmic proteins. Electrolysis of tap water for both disinfecting contaminating bacteria and increasing the disinfectant capacity was considered effective with some limitations, particularly against high-density contamination by spore-forming bacteria. In clinical settings, electrolysis of tap water is considered effective to disinfect water for hand washing in operation theatres, and bathing water for immunocompromised hosts.