Water Handwashing Research Articles

The water supply of a pediatric hospital as a possible source of an outbreak of diarrhea due to Microsporidium spp. in immunocompromised patients

The hospital water supply is a reservoir of a variety of potentially pathogenic microorganisms that can particularly affect children and immunocompromised patients. Potentially pathogenic Microsporidium spp. have been identified in water. Microsporidiosis is an emerging parasitic and opportunistic infection in immunocompromised patients. to describe an outbreak of nosocomial diarrhea due to Microsporidium, species Encephalitozoon intestinalis. Seven cases of E. intestinalis associated diarrhea were reported between november 2012 and february 2013, in a unit of immunocompromised patients in L. Calvo Mackenna Children's Hospital. Microsporidium spp. was found in the hospital water supply and water reservoir tank. Secondary cases were transmitted by contact. Control measures included contact precautions, not to use faucet water for hand washing, bottled water for drinking and water reservoir tank sanitation. This research is about a nosocomial outbreak associated with water supply. Water quality in Chilean hospitals is an unresolved issue, especially in immunocompromised patient areas. Compliance of cleaning and disinfection of water supply systems in hospitals must be ensured.

综合医院ICU实习护生手卫生依从性及影响因素分析

Objective: To understand the cognition and compliance rate of hand hygiene among ICU practice nurses in comprehensive hospital. Methods: Self-made questionnaire and hidden observation were conducted. Results: The knowledge about the time of hand washing, the hand disinfectant use and their indications existed some less cognition or miscognition among practice nurses in ICU. The compliance of hand hygiene before the practice nurses contact with patients was 71.4%, 70.3%, 65.4% and 55.6% respectively in ICU, NICU, PICU, RICU. The main factors affecting the hand hygiene performance were busy at work and reliable effect on using stream water for hand washing. Conclusions: It is necessary to strengthen the training, improve hand hygiene complianceso as to better control hospital infection when hand hygiene facilities are well equipped.

An adenovirus 4 outbreak amongst staff in a pediatric ward manifesting as keratoconjunctivitis—a possible failure of contact and aerosol infection control

An adenovirus serotype 4 outbreak was identified on a pediatric ward involving 4 members of the health care staff. Two inpatients on the ward at the time (1 immunocompromised) were shedding this virus from their respiratory tracts and could have acted as independent index cases for the staff infections. Significantly, upon investigation, it was found that staff members were unaware that adenoviruses are not completely eliminated by alcohol gel handrubs and that soap and water handwashing is also required.

Study of hand washing practices in rural community of Pune, India

Background: Hand washing is well recognized preventive tool disease prevention . To study hand washing practices in rural community; Objectives: a]. To study medium of hand washing, b]. To determine any association between hand washing practices and some socio-demographic characteristics, c]. To study association between hand washing practices and certain infections. Methods: A community based observational study was conducted in five randomly selected villages in rural field practice area of medical college in Pune, Maharashtra. In house to house survey, interview was conducted on pre-tested questionnaire regarding hand washing practices. On site inspection of designated place for hand washing was also done. Statistical analysis: Percentages, Proportions and chi-square test. Results: A total of 1468 (799 males & 669 females) individuals participated in the study. Majority (37.23%) were from 21 to 40 years age-group. 698 were studied up to secondary grade. In 48.46% study participants the family was major source of information regarding importance of hand washing was family. 1167 (79.49%) were using soap and water, 117 (7.98%) used water and antiseptic solution for hand washing. 184 (12.53%) used only water for hand washing. 100% practiced hand washing after defecation. There was significant association between medium of hand washing and age-group, literacy status. Association was also found between the history of episode of upper respiratory tract infection and diarrhea with medium of hand washing. Conclusions: Majority of the study participants used water with soap for hand washing. This finding is encouraging and sustainable practice is recommended.

Bacterial contamination survey and a review of the control method for water for hand washing of operating rooms

Bacterial contamination survey and a review of the control method for water for hand washing of operating rooms

Salmonella Enteric Fevers and Microbial Contamination in Public Eating Places in Makurdi, Nigeria.

Food, drinking water, table and utensil swab and hand washing water samples were examined for Salmonella sp contamination. Microbiological examination of samples using lactose broth, Cystine- Lactose-Electrolyte-Deficient (CLED) agar and Eosin-Methylene-Blue (EMB) agar was done to identify Salmonella sp, other organisms and indicator organisms. Indicator organisms identified were Aerobocter aerogenes and Escherichia coli. Other organisms include Streptococcus faecalis, Proteus sp and Staphylococcus aureus. 74.7% of examined samples showed Salmonella sp contamination while 89.8% of examined samples were contaminated with indicator organisms. Observed Salmonella sp were also examined biochemically to identify different species/strains. Species/strains identified were Salmonella typhi, S. paratyphi A, S. paratyphi B, S. cholerae-suis, S. enteritidis. There was a significant association between sanitary conditions and the occurrence of S. typhi in food, water, surroundings. It is very likely that poor hygiene and sanitary conditions encourage the occurrence of S. typhi in water, food, surroundings. Personal and environmental hygiene should be strictly adhered to especially in the study area so as to prevent and control S. typhi infections.

Hand Hygiene: Knowledge and Attitudes of Fourth-Year Clerkship Medical Students at Alfaisal University, College of Medicine, Riyadh, Saudi Arabia.

Introduction: Little is known about the clerkship (clinical) medical students’ knowledge of hand hygiene as the single most important precautionary measure to reduce nosocomial healthcare-associated infections. The aim of this study is to explore the knowledge of, and attitudes towards, hand hygiene practices among fourth-year clerkship medical students at Alfaisal University, College of Medicine, Riyadh, Saudi Arabia.Materials and Methods: A cross-sectional, paper-based, Yes/No formatted questionnaire was administered to explore the students’ knowledge of, and attitudes towards, hand hygiene practices. Data were decoded in Microsoft Excel sheet and presented as numbers and percentages.Results: One hundred and eleven students (n=111/147) participated in the questionnaire (response rate: 76%). Although the majority of students had a fair knowledge of hand hygiene practices, a number of them had some misconceptions. Only 14% of students correctly agreed to the statement: "Traditional hand washing (water, plus regular soap) decreases the number of germs." Furthermore, only 32% of students correctly answered that "hand washing with a regular soap, instead of an antiseptic soap, is better in limiting the transmission of clostridium difficile infections". Almost all students (93%) agreed to the importance of hand hygiene education in medical curricula and its awareness in healthcare centers. Despite the importance of hand hygiene, only 13% of students reviewed the respective WHO and CDC guidelines before starting their clinical training in the teaching hospital.Discussion: The students’ inadequate knowledge about hand hygiene needs to be enriched by well-structured curricular and extra-curricular programs as well as more positive attitudes by healthcare workers.

Unlocking the Sporicidal Potential of Ethanol: Induced Sporicidal Activity of Ethanol against Clostridium difficile and Bacillus Spores under Altered Physical and Chemical Conditions.

BackgroundDue to their efficacy and convenience, alcohol-based hand sanitizers have been widely adopted as the primary method of hand hygiene in healthcare settings. However, alcohols lack activity against bacterial spores produced by pathogens such as Clostridium difficile and Bacillus anthracis. We hypothesized that sporicidal activity could be induced in alcohols through alteration of physical or chemical conditions that have been shown to degrade or allow penetration of spore coats.Principal FindingsAcidification, alkalinization, and heating of ethanol induced rapid sporicidal activity against C. difficile, and to a lesser extent Bacillus thuringiensis and Bacillus subtilis. The sporicidal activity of acidified ethanol was enhanced by increasing ionic strength and mild elevations in temperature. On skin, sporicidal ethanol formulations were as effective as soap and water hand washing in reducing levels of C. difficile spores.ConclusionsThese findings demonstrate that novel ethanol-based sporicidal hand hygiene formulations can be developed through alteration of physical and chemical conditions.

Characterization of the relative importance of human- and infrastructure-associated bacteria in grey water: a case study.

Development of efficacious grey water (GW) treatment systems would benefit from detailed knowledge of the bacterial composition of GW. Thus, the aim of this study was to characterize the bacterial composition from (i) various points throughout a GW recycling system that collects shower and sink handwash (SH) water into an equalization tank (ET) prior to treatment and (ii) laundry (LA) water effluent of a commercial-scale washer. Bacterial composition was analysed by high-throughput pyrosequencing of the 16S rRNA gene. LA was dominated by skin-associated bacteria, with Corynebacterium, Staphylococcus, Micrococcus, Propionibacterium and Lactobacillus collectively accounting for nearly 50% of the total sequences. SH contained a more evenly distributed community than LA, with some overlap (e.g. Propionibacterium), but also contained distinct genera common to wastewater infrastructure (e.g. Zoogloea). The ET contained many of these same wastewater infrastructure-associated bacteria, but was dominated by genera adapted for anaerobic conditions. The data indicate that a relatively consistent set of skin-associated genera are the dominant human-associated bacteria in GW, but infrastructure-associated bacteria from the GW collection system and ET used for transient storage will be the most common bacteria entering GW treatment and reuse systems. This study is the first to use high-throughput sequencing to identify the bacterial composition of various GW sources.

Practice of personal hygiene among rural women of a selected community in Bangladesh

Background : Good health is a marker of good economic status of a nation. Personal hygiene should be maintained first for obtaining great accuracy in work, low suffering from diseases and to reduce possibility of diseases.Objective : This study was undertaken to assess practice of personal hygiene among rural women of a selected community in Bangladesh.Materials & Methods : A descriptive type of cross sectional study was conducted during March–June 2012. 150 women of various ages selected from Garibpur and Tangurpur villages of Jessore District to assess two basic components of personal hygiene, hand washing and safe drinking water. Non probability convenient sampling technique was followed and data were collected by face to face interview using pre tested, self administered, semi structured questionnaire.Results : The mean age of the respondents was 33 years. Regarding educational qualification, 87.33% were educated in different levels and 12.67% were illiterate. Occupational status revealed majority (74.67%) of them were housewives. Regarding economic condition, most (60%) of the respondents had family income <10,000 Taka. In this study, majority (87.34%) had practiced hand washing before eating. Among them on taking different types of food (86.26%) practiced hand washing before taking meals only 13.74% before taking breakfast and none of the respondents washed hands before taking any dry food. Majority (95.34%) practiced hand washing after defecation, among them (82%) used soap, 16% used ash and 2% used soil after defecation. In this study, majority (90.67%) used tube well which was not marked red, 6% used pond and 3.33% used river as their source of drinking water.Conclusion : Good practice of personal hygiene and use of safe drinking water has significant importance to lead a healthy life, the villagers of Bangladesh should be well motivated regarding this aspect by regular health education programmes.Northern International Medical College Journal Vol.6(1) 2014: 29-31

Estimating drinking-water ingestion and dermal contact with water in a French population of pregnant women: the EDDS cohort study.

The aim of the present study, a part of the Endocrine Disruptor Deux-Sèvres (EDDS) cohort study, was to estimate water-use habits of pregnant French women. The study population consisted of 132 pregnant women living in Deux-Sèvres (France) in 2012-2013, in areas where drinking water is exclusively produced by surface water. Drinking-water data included ingested water (tap, bottled and filtered) and ingestion place (home, work and elsewhere). Dermal contact with water included showering, bathing, swimming, spa use, hand-washing and other water activities. Data were collected through face-to-face interviews at second and third trimesters of pregnancy with a 1-day-recall questionnaire. Intertrimestral differences in water-use habits were assessed. Predictors of water ingestion and duration of dermal contact with water were assessed with multiple linear regressions. At the second trimester of pregnancy, the mean total drinking-water ingestion was 1.8±0.6 l per day (mean and SD), 71% of which was tap water. Total drinking-water ingestion was not different between both trimesters but ingestion place differed. Dermal contact with water estimate was 188±118 and 173±92 min/week at second and third trimesters, respectively. Smoking increased water ingestion 777 ml/day 95% CI (171-1384). Duration of dermal contact in spring was 30 min/week 95% CI (13-48) higher than in winter. Obese women spend 26 min/week 95% CI (2-50) more showering than women with recommended weight. Our estimates of pregnant French women's exposure to water will help researchers to better assess water pollutant risks.

The elusive effect of water and sanitation on the global burden of disease

About 2.5 billion people lack access to improved sanitation, and 1 billion have no access to any form of sanitation (UNICEF 2013). About 780 million people lack access to an improved water source, a figure that is based on a fairly generous definition incorporating little with respect to reliability, proximity and convenience of access (UNICEF 2013). While the ancient Romans may already have been aware of it (Bradley 2012), water and sanitation came to be regarded as key to improve health in the growing cities of Europe and America in the late 19th and early 20th centuries. A number of notable observational studies were carried out that even with the limited epidemiological tools available at the time all but proved the direct link between water, sanitation and health (Snow 1860; Pringle 1910). By contrast, in the early days of development aid in the post-colonial era, water and sanitation were often not regarded as a health issue, but primarily provided with the aim of making people’s life easier and enable developmental activities. Whoever tried to argue for more investment on health grounds was faced by a lack of epidemiological studies conducted in low-income settings, which led to a renewed interest in research from the 1970s.

Study on knowledge and practice of water and sanitation application in Chandragadhi VDC of Jhapa District

Background: Poor hygiene practices and inadequate sanitary conditions play major roles in the increased burden of communicable diseases within developing countries. Objectives: To know the knowledge and practice of the people about the diseases related to water and sanitation and to know the pattern of water related diseases in last one year in that area. Methods: The crosssectional study was conducted from 16th March to 30th March 2008 in Chandragadhi VDC where 203 households were taken as subjects. Convenient purposive sampling technique was applied. Semi-structured questionnaire was used and face to face interview was conducted. Chisquare test was applied to find out the significant difference between various diseases and related to water and sanitation system of the study areas. Results: People drinking untreated water suffered from diarrhea (38.46%) followed by dysentery (9.89%) respectively. People who devoid of latrine facilities suffered from diarrhea (40.74%) followed by dysentery (12.03%) respectively. Almost (38%) of the population under study gets rid of the excreta of their children in the river nearby and (32.5%) throw in the same latrine they use. Almost (66%) people wash their hands with soap water after defecation. Conclusion: A majority of people with knowledge of safe water and sanitation used soap and water for hand washing before meal and after defecation. People drinking untreated water showed significant with water related diseases ie diarrhoea followed by dysentery. DOI: http://dx.doi.org/10.3126/hren.v11i3.9639 Health Renaissance 2013;11(3):241-245

Food hygiene practices of mothers of under-fives and prevalence of diarrhoea in their children in Oghara, Delta state

Diarrhoea remains one of the major public health problems in developing countries. The objective of this study was to investigate potential factors of food hygiene practices of mothers in the home on the prevalence of diarrhoea among under five children in Edjemuonyavwe community, Oghara, Delta State. This descriptive cross sectional study was carried out among 495 mothers with children aged 6-59 months in a rural community of southern Nigeria. Selection of participants was by multistage sampling technique. Tool for data collection was interviewer administered semi structured questionnaire which sought information on age, occupation and educational status of the mother; history of diarrhoea in the child and food hygiene practices of the mother. Data was analysed using SPSS version 13 statistical soft ware. The prevalence of diarrhoea among the under fives was 43.4%. The rate of diarrhoea was higher among children of mothers who prepared child's food on the floor (45.5%) than thosewho prepared it on the table (40.7%), and those who used only water for hand washing (48.2%) than those who used soap and water (40.3 %). There was no relationship between the prevalence of diarrhoea and the mothers' age. The rate of diarrhoea decreased with increasing order of the child's position in the family (p=0.19). Although not statistically significant, there was an association between the prevalence of diarrhoea andmothers' educational level (p=0.49 ) and occupation (p=0.10 ). The prevalence of diarrhoea was considerably high among the under fives. Mothers' food hygiene habit was associated with the development of diarrhoea among their underfives. Health educations on diarrhoea and food hygiene practices need to be intensified at the community level to improve mothers' food hygienic practices.

Health care workers' hand contamination levels and antibacterial efficacy of different hand hygiene methods used in a Vietnamese hospital

Handwashing with soap or another antisepsis disinfectant solution is a common practice in Vietnam, but the availability and quality of tap water is unpredictable. We assessed the risk for hand contamination and compared the efficacy of 5 hand hygiene methods in a tertiary Vietnamese hospital. Five fingertip imprints of the dominant hand of 134 health care workers (HCWs) were sampled to establish the average bacterial count before and after hand hygiene action using (1) alcohol-based handrub (ABHR), (2) plain soap and water handwashing with filtered and unfiltered water, or (3) 4% chlorhexidine gluconate hand antisepsis with filtered and unfiltered water. Average bacterial contamination of hands before hand hygiene was 1.65 log(10). Acinetobacter baumannii, Klebsiella pneumoniae, and Staphylococcus aureus were the most commonly isolated bacterial pathogens. The highest average count before hand hygiene was recovered from HCWs without direct patient contact (2.10 ± 0.11 log(10)). Bacterial counts were markedly reduced after hand hygiene with ABHR (1.4 log(10); P < .0001) and 4% chlorhexidine gluconate with filtered water (0.8 log(10); P < .0001). Use of unfiltered water was associated with minimal nonsignificant bacterial reduction. HCWs carry high levels of bacteria on their dominant hand, even without direct patient contact. ABHR as an additional step may overcome the effect of high bacterial counts in unfiltered water when soap and water handwashing is indicated.

Preparedness and health risks associated with Moulay Abdellah Amghar moussem, Morocco, 2009-2010

The objective of this study was to describe the risks and human health outcomes associated with attendance at the Moulay Abdellah Amghar moussem (a pre-planned mass gathering attracting more than 360 000 participants) for the purposes of public health prevention, planning, preparedness and response. We performed an environmental health risk assessment and retrospectively reviewed local health centre records before, during and after the event. In addition, standardized interviews with key stakeholders were performed to qualitatively evaluate local public health preparedness and response capacities. During the event, average daily health centre visits increased 5-fold. The sex ratio of health-care visits changed significantly from an average of 1.8:1 female:male visits per day to 1.2:1. The proportion of injuries varied from an average of 3.7% pre- and post-event to 14.8% (P < 0.01) during the event. A significant increase in digestive diseases was also observed during the event. Recommendations include increasing accessibility to free sanitation and hygiene facilities and improving health communications concerning hand washing and food and water safety.

Detection of Achromobacter xylosoxidans in Hospital, Domestic, and Outdoor Environmental Samples and Comparison with Human Clinical Isolates

Achromobacter xylosoxidans is an aerobic nonfermentative Gram-negative rod considered an important emerging pathogen among cystic fibrosis (CF) patients worldwide and among immunocompromised patients. This increased prevalence remains unexplained, and to date no environmental reservoir has been identified. The aim of this study was to identify potential reservoirs of A. xylosoxidans in hospital, domestic, and outdoor environments and to compare the isolates with clinical ones. From 2011 to 2012, 339 samples were collected in Dijon's university hospital, in healthy volunteers' homes in the Dijon area, and in the outdoor environment in Burgundy (soil, water, mud, and plants). We designed a protocol to detect A. xylosoxidans in environmental samples based on a selective medium: MCXVAA (MacConkey agar supplemented with xylose, vancomycin, aztreonam, and amphotericin B). Susceptibility testing, genotypic analysis by pulsed-field gel electrophoresis, and blaOXA-114 sequencing were performed on the isolates. A total of 50 strains of A. xylosoxidans were detected in hospital (33 isolates), domestic (9 isolates), and outdoor (8 isolates) samples, mainly in hand washing sinks, showers, and water. Most of them were resistant to ciprofloxacin (49 strains). Genotypic analysis and blaOXA-114 sequencing revealed a wide diversity among the isolates, with 35 pulsotypes and 18 variants of oxacillinases. Interestingly, 10 isolates from hospital environment were clonally related to clinical isolates previously recovered from hospitalized patients, and one domestic isolate was identical to one recovered from a CF patient. These results indicate that A. xylosoxidans is commonly distributed in various environments and therefore that CF patients or immunocompromised patients are surrounded by these reservoirs.

Hand Washing Quality among Biosafety Level 2 Research Laboratory Workers

Soap and water hand washing (HW) is recommended as the standard microbiological practice for removing transient microbes from laboratory workers' hands. The effectiveness of HW in preventing pathogen transmission depends largely on the technique used by the individual, but little is known about laboratory workers' compliance with recommended HW protocols. This study evaluated the quality of HW performed by research workers (N = 93) in 21 biosafety level 2 (BSL-2) laboratories at a large university. Study personnel measured the quality of workers' HW by direct observation while subjects performed their regularly assigned work tasks. Five HW quality indicators as well as hand and wrist jewelry use were measured using an existing tool designed for use in the healthcare setting and modified for this study. A total of 49 soap and water washes were measured during 118 hours of observation. Duration of scrubbing was 9 seconds or less in 41 (84%) cases. Soap was used in 45 (92%) washes, but in 25 (51%) cases where soap was used, lathering was not visible to the observer. Subjects covered dorsal, wrist, palm, and interdigital areas as recommended in only 16 (33%) cases. In 29 (59%) HW events subjects turned off the faucet with bare hands. Hand or wrist jewelry was worn by 60 (65%) participants while in the containment lab. In this study, four of five HW quality indicators were poorly performed. Poor quality HW may result in low reductions of transient pathogens on workers' hands, and may explain many laboratory-associated infections where the route of transmission is otherwise unknown.

Testing biological effects of hand-washing grey water for reuse in irrigation on an urban farm: a case study

The feasibility of reusing hand-washing grey water contaminated with antibacterial hand-washing liquid for irrigation purposes in an urban farm is explored in this case study. Experiments are carried out to investigate if the quality of this grey water allows for its reuse in agriculture as per the guidelines established by the World Health Organization (WHO). However, there is no guideline to test the biological effect of grey water prior to agricultural use. It is plausible that the antibacterial property of the grey water can harm the soil microbial system and plants when applied to land, even if all other water quality parameters satisfy the WHO limit. We use algae (Chlorella vulgaris) and indigenous soil bacteria as initial plant and soil bacteria indicators, respectively, to test the potential inhibition of the water on plants and soil bacteria. Results show that the chemical oxygen demand (COD) of the grey water is 10% higher than the WHO permissible level, while all other water quality parameters are within the limits after four days of our experimental period. An inhibitory effect is observed in all of the biological tests. However, the inhibitory effect on algae and soil bacteria is not observed after the four-day period. The case study demonstrates a new approach for testing the biological effect of grey water, which can be used in conjunction with the WHO guideline, and provides data for this urban farm to set up a future water treatment system for grey-water reuse in irrigation.

Health risk assessment of exposure to chlorpyrifos and dichlorvos in children at childcare facilities

The present study evaluated 168 childcare facilities from 6 cities in South Korea to assess exposure to organophosphorus pesticides (OPs) in children through 4 major pathways (indoor air, indoor dust, surface wipe of indoor objects, and hand wash water of children). The Excess Cancer Risk (ECR) was calculated based on the Cancer Potency Factor (CPF) and Age Dependent Adjustment Factor (ADAF) in adults. Dichlorvos residues were detected in the indoor air, indoor dust, surface wipes of indoor objects, and the hand wash water of children at frequencies of 47.4, 90, 100, and 100%, respectively. After revision based on the ADAF, total cancer risk in the 50th percentile was 3.99×10−3 for inhalation, oral intake, and dermal contact in children ages 3 to 4 and 4.63×10−4 in kindergarteners ages 5 to 6. Inhalation was the primary pathway of pesticide exposure in children in childcare facilities. Children ages 3 to 4 in daycare centers had a Hazard Quotient (HQ) of 0.5 for dichlorvos, which was 50% lower than the risk criterion level of 1 but was higher than the 95% percentile with a HQ of 1.9. This study postulates that children in childcare facilities may be exposed to specific OPs.