2. CONTAMINATION AND CROSS CONTAMINATION IN THE HOME

Selected articles

Health-care workers: source, vector, or victim of MRSA?
Albrich WC, Harbarth S, MD. The Lancet Infectious Diseases 2008;8:289-301.
We conducted  a search of the literature from January, 1980, to March, 2006, to determine the likelihood of MRSA colonisation and infection in health-care workers and to assess their role in MRSA transmission. In 127 investigations, the average MRSA carriage rate among 33,318 screened health-care workers was 4.6%; 5.1% had clinical infections. Risk factors included chronic skin diseases, poor hygiene practices, and having worked in countries with endemic MRSA. We discuss advantages and disadvantages of screening and eradication policies for MRSA control and give recommendations for the management of colonised health-care workers in different settings.

Methicillin-resistant Staphylococcus aureus transmission: The possible importance of unrecognized health care worker carriage.
Ben-David D, Mermel LA, Parenteau S. American Journal of Infection Control. 2008;36(2):93-979.
This study was conducted to evaluate the ongoing transmission of methicillin-resistant Staphylococcus aureus (MRSA) in a 10-bed trauma intensive care unit (TICU) in a large teaching hospital. Colonized or infected patients were placed on contact precautions. 19 burn patients were admitted to the TICU after a local mass casualty event. Universal barrier precautions were implemented for all patients, and point-prevalence surveys (nares cultures) were used to detect MRSA acquisition. 58% of the burn patients developed MRSA infection or colonization. Six of 133 health care workers (HCWs) had positive MRSA screening cultures. Seven patients and 4 HCWs harbored the pulsed-field gel electrophoresis clone A. Two patients and 1 HCW harbored clone B. Once the colonized HCWs were successfully decolonized, a sustained reduction in MRSA infections occurred. Transmission of MRSA in an ICU was observed despite various infection control precautions. Identifying and treating colonized HCWs was followed by a significant reduction in the incidence of MRSA. Unrecognized MRSA-colonized HCWs may be an important reservoir in endemic institutions that could impair other control measures.

Transmission of influenza A in human beings.
Brankston G, Citterman L, Hirji Z, Lemieux C, Gardam M. Lancet Infect Dis 2007;7:2S7-6S.
This paper considers the evidence for and against airborne transmission of influenza A.

Occurrence of faecal contamination in households along the US–Mexico border.
Carrasco L, Mena KD, Mota LC, Ortiz M, Behravesh CM, Gibbs SG, et al.
The study aim was to determine the presence of total and faecal coliforms on kitchen surfaces, in tap water and on the hands of caregivers in households on both sides of the US–Mexico border. Samples were collected in 135 randomly selected households. Different surfaces in the kitchen and head of households’ hands were sampled using sterile cotton swabs moistened in D/E neutralizing solution. Sponge/dishcloth and drinking water samples were also obtained. Total and faecal coliforms were enumerated on m-Endo LES and mFC respectively. Total coliforms and Escherichia coli in drinking water samples were enumerated in accordance with the Quanti-TrayTM method. The results allowed us to conclude  that hand washing should be emphasized, and additional interventions should be directed to specific kitchen areas, such as sponges/dishcloths, tables/countertops and cutting boards.

MRSA and the environment: implications for comprehensive control measures.
Cimolai N. Eur J Clin Microbiol Infect Dis 2008.
Environmental contamination with methicillin-resistant Staphylococcus aureus (MRSA) is established soon after colonized or infected patients become resident. There are many studies that detail the mechanisms of spread and environmental survival of methicillin-susceptible Staphylococcus aureus (MSSA); this knowledge translates directly into the same findings for MRSA. The potential ubiquity of MRSA in a health-care setting poses challenges for decontamination. Whereas patients and medical staff are important sources for MRSA spread, the environmental burden may contribute significantly in various contexts. Effective control measures must therefore include consideration for MRSA in the environment.

Household Transmission of Carbapenemase-producing Klebsiella pneumoniae.
Gottesman T, Agmon O, Shwartz O, Dan M. Emerg Infect Dis; May 2008.
Carbapenemase-producing K. pneumoniae is a recent addition to the pool of multidrug-resistant nosocomial pathogens. Until now, the strain has been recovered only from hospitalized patients with a longer hospital stay, those given multiple antimicrobial drug courses, and those mechanically ventilated. The strain can colonize the urinary, intestinal, and respiratory tracts, as well as wounds. Hand carriage is probably the biggest factor in transmission of extended-spectrum β-lactamase producers. Environmental contamination plays a limited role in transmission. Caregivers should be aware that multidrug-resistant organisms of nosocomial origin can be transmitted in the community. Acquisition of such strains is probably of negligible importance in an otherwise healthy person. However, consequences may be different if the recipient of the strain is a debilitated patient.

Bacterial contamination of domestic kitchens over a 24-hour period.
Haysom IW, Sharp AK. British Food Journal. 2005;107(7)453-66.
This study investigates changes in levels of bacterial contamination at five key sites in ten domestic kitchens during a period of 24 hours. Microbiological swabs were used to provide an aerobic colony count and an Enterobacteriacea count. A record was kept of cooking, cleaning and other activities within the kitchen. Contamination levels varied during the day, peaking after meal preparation and generally falling overnight. There was also indirect evidence of cross contamination, particularly from hands to other surfaces. Levels of microbiological contamination were lower in vegetarian than non-vegetarian households. A variety of data showed that non-food preparation activities also take place in the kitchen. These could also introduce bacterial contamination into the kitchen and facilitate their spread. The results demonstrate  the importance of cleaning the kitchen immediately after food has been prepared, focussing on high risk areas such as work surfaces, chopping board, taps and other hand contact surfaces.

Survival of Clostridium difficile on copper and steel: futuristic options for hospital hygiene.
Weaver L, Michels HT, Keevil CW. Journal of Hospital Infection. 2008;68:145-51.
This study evaluated survival of C. difficile vegetative cells and spores on surfaces commonly found in healthcare settings, stainless steel, compared to five copper alloys (65e100% copper content). C. difficile requires prolonged incubation to grow, therefore the total number and number of viable cells were estimated using a fluorescence dual-staining technique. The results suggest that using copper alloys in hospitals and other healthcare facilities could potentially reduce the spread of C. difficile from contaminated surfaces.

Tubewell water quality and predictors of contamination in three flood-prone areas in Bangladesh.
Luby SP, Gupta SK, Sheikh MA, Johnston RB, Ram PK, et al. Journal of Applied Microbiology (2008).
This study measured the enteric bacterial contamination of tubewells in three flood prone areas in Bangladesh and the relationship of bacteriological contamination with tubewell sanitary inspection scores. Microbiologists selected 207 tubewells and assessed their physical characteristics, collecting a single water sample from each. The results let to the conclusion that tubewells in flood-prone regions of Bangladesh were commonly contaminated with low levels of faecal organisms; this could not be predicted by examining the tubewell’s external characteristics. Significantly, the forms currently used for sanitary inspection do not identify the most important causes of drinking water contamination in these communities.

Staphylococcus aureus nasal colonization in HIV outpatients: Persistent or transient?
Padoveze MC, de Jesus Pedro R, Blum-Menezes D, Bratfich OJ, Moretti ML. American Journal of Infection Control. 2008;36(3):187-91.
Staphylococcus aureus nasal carriage in HIV patients remains incompletely characterized. This study aimed to describe epidemiologic and molecular features of S. aureus nasal colonization in HIV outpatients. HIV outpatients with no history of hospitalization within the previous 2 years were screened for S. aureus nasal colonization. Three samples were collected from each patient, and the risk factors for colonization were assessed. The study concluded that HIV patients had a high rate of S. aureus nasal colonization. The most common characteristic of colonization was simple persistent colonization showing the same genomic profile.

Hose as a source of Legionella pneumonia. A new risk factor for gardeners?
Pisoa RJ, Caruso A, Nebiker M. Elsevier Ltd on behalf of The Hospital Infection Society (2007).
Legionella pneumophila is responsible for 6-11% of community-acquired pneumonias. While association with contaminated cold and hot water supplies, evaporative condensers, spa pools, thermal springs or respiratory therapy equipment has been documented, hoses have not yet been linked to Legionnaires’ disease. This paper reviews evidence of the role of garden hoses as a risk factor for L. pneumophila.

Pseudomonas aeruginosa in the home environment of newly infected cystic fibrosis patients.
Schelstraete P, Van Daele S, De Boeck K,  Proesmans M, Lebecque P, Leclercq-Foucart J, et al. Eur Respir J. 2008;31:822-9.
The source of acquisition of P. aeruginosa in cystic fibrosis (CF) patients remains unknown. Patient-to-patient transmission has been well documented but the role of the environment as a source of initial infection is as yet unclear. In the present study, the origin of the first P. aeruginosa isolate in CF patients was investigated by comparing the P. aeruginosa genotype(s) from newly infected patients with genotypes of P. aeruginosa isolates from the home environment and from other patients from the same CF centre. A total of 50 newly infected patients were studied. P. aeruginosa could be cultured from 5.9% of the environmental samples, corresponding to 18 patients. For nine of these, the genotype of the environmental P. aeruginosa isolate was identical to the patient's isolate. In total, 72% of the environmental P. aeruginosa isolates were encountered in the bathroom. Patient-to-patient transmission within the CF centre could not be ruled out for three patients. In summary, a low prevalence of P. aeruginosa was found in the home environment of the newly infected cystic fibrosis patients. The bathroom should be targeted in any preventive cleaning procedures. An environmental source of the new infection could not be ruled out in nine patients.

Human infections associated with wild birds.
Tsiodrasa S, Kelesidisb T, Kelesidisb I, Bauchingerc U, Falagasd ME. Journal of Infection. 2008;56(2): 83-98.
Wild birds and especially migratory species can become long-distance vectors for a wide range of microorganisms. The objective of the current paper is to summarize available literature on pathogens causing human disease that have been associated with wild bird species. A systematic literature search was performed to identify specific pathogens known to be associated with wild and migratory birds. The evidence for direct transmission of an avian-borne pathogen to a human was assessed. The results demonstrate that several wild and migratory birds serve as reservoirs and/or mechanical vectors for numerous infectious agents. Nevertheless only one case of direct transmission from wild birds to humans was found. The available evidence suggests wild birds play a limited role in human infectious diseases. Direct transmission of an infectious agent from wild birds to humans is rarely identified. Potential factors and mechanisms involved in the transmission of infectious agents from birds to humans need further elucidation.

Probable limited person-to-person transmission of highly pathogenic avian influenza A (H5N1) virus in China.
Wang H, Feng Z, Shu Y, Yu H, Zhou L, Rongqiang Zu R, et al. The Lancet. 2008;371:1427-34.
Two individuals infected with highly pathogenic avian influenza A (H5N1) virus were identified in Jiangsu Province, China. Field and laboratory investigations were immediately implemented. Epidemiological, clinical, and virological data were collected and analysed. Respiratory specimens were tested by reverse transcriptase (RT) PCR and by viral culture for the presence of H5N1 virus. Contacts of the cases were monitored for symptoms of illness for 10 days. Any contacts who became ill had respiratory specimens collected for H5N1 testing by RT PCR. Sera were obtained from contacts for H5N1 serological testing by microneutralisation and horse red-blood-cell haemagglutinin inhibition assays. The 24-year-old index case died, and the second case, his 52-year-old father, survived after receiving early antiviral treatment and post-vaccination plasma from a participant in an H5N1 vaccine trial. Ninety-one contacts with close exposure to one or both cases, without adequate protective equipment, provided consent for serological investigation. The investigations demonstrated that limited, non-sustained person-to-person transmission of H5N1 virus probably occurred in this family cluster.

Dog-human and dog-dog interactions of 260 dog-owning households in a community in Cheshire.
Westgarth C, Pinchbeck GL, Bradshaw JWS, Dawson S, Gaskell M, Christley RM. The Veterinary Record. 2008;162:436-42.
This study investigated the nature and frequency of the contacts that occur between dogs, and between dogs and people, by means of a questionnaire survey of 260 dog-owning households in a community in Cheshire, UK. The contacts were highly variable and were affected by the size, sex and age of the dog, individual dog behaviours, human behaviours and human preferences in the management of the dog. A number of situations were identified that may be important in relation to zoonoses, including sleeping areas, playing behaviours, greeting behaviours, food sources, walking, disposal of faeces, veterinary preventive treatment and general hygiene.

Irrigated urban vegetable production in Ghana: microbiological contamination in farms and markets and associated consumer risk groups.
Amoah P., Drechsel P., Henseler M., Abaidoo R.C. Journal of Water and Health 2007;5:455-66.
Over 12 months, April 2004-June 2005, lettuce samples from the same production sites in 2 cities were followed and analyzed along the “farm to fork” pathway for total and faecal coliform (FC) and helminth egg numbers. Questionnaire surveys were conducted among producers, sellers and consumers. The study identified the farm as the main point of lettuce contamination. Besides the irrigation water, contamination was also attributed to manure application and already contaminated soil. Despite poor sanitary conditions in markets, post-harvest handling and marketing did not further increase the farm-gate contamination levels.

Occurrence of Escherichia coli O157 on hides of slaughtered cattle.
Nastasijevic I., MitrovicR., Buncic S. Letters in Applied Microbiology 2007;46:126-31.
A total of 355 swabs were taken on the slaughterline from 5 areas of hide of each of 71 cattle in an abattoir in Serbia. E. coli O157 was isolated from the hides of 20 animals (28.2%). The occurrence of the pathogen was: hooves (11.3%), brisket (8.4%), rump (7.0%), neck (4.2) and flank (2.8%). Factors that had effects on the occurrence included visible dirtiness of the hide, cattle’s age category, geographical origin of the animals and season. This study confirmed the hide as an important potential source of related contamination of beef carcasses.

Pasteurella multocida meningitis: case report and review of the literature.
O’Neill E., Moloney A., Hickey M. Journal of Infection 2005;50:344-5.
Pasteurella multocida forms part of the normal flora in the nasopharynx of many domestic and wild animals. Most human P. multocida infections are soft tissue infections due to animal bites. P. multocida meningitis is a rare condition. The paper reports a case of P. multocida meningitis with a complicated outcome and review the literature of this condition.

Survey of Salmonella contamination of raw shell eggs used in catering premises in the UK.
Health Protection Report 2007.
The Food Standards Agency (FSA) has published a survey of salmonella contamination in raw shell eggs used in catering premises in the UK November 2005 to December 2006, and was one of two surveys launched following an unusual number of SalmonellaEnteritidis outbreaks associated with the use of eggs in catering premises during 2002 to 2004. 9,528 eggs were collected from 1,567 catering premises. Salmonella was isolated from six pooled samples (0.38%) of eggs. Of these, five were SalmonellaEnteritidis (0.31%). The eggs were produced in eight European countries (France, Germany, Poland, Portugal, Republic of Ireland, Spain, The Netherlands, and the UK), with most (89%) originating from the UK.

Importance of the environment for patient acquisition of methicillin-resistant Staphylococcus aureus in the intensive care unit: A baseline study.
Wilson A.P., Hayman S., Whitehouse T., et al. Critical Care Medicine 2007;35(10):2275-9.
This study assessed environmental contamination with MRSA in critical care and the likelihood of new patient acquisition if carriers were (or not) moved to single rooms; 2,436 samples were taken from environments around 114 patients, plus 349 samples from doctors’ hands and telephones. Of 47 bed areas where MRSA strains were identified that were not found initially on patients, only 1 patient subsequently acquired the same strain. Five other patients became colonized with new strains, but these were not found in their environment beforehand. Of 52 colonized patients, 34 had a similar strain found subsequently in their environment. It was concluded that whereas MRSA-colonized patients frequently contaminates their environment, transmission from the environment to the patient was not commonly identified.

Dampness and mold in the home and depression: an examination of mold-related illness and perceived control of one’s home as possible depression pathways.
Shenassa E.D., Daskalakis C., Liebhaber A., Braubach M., Brown M.J. American Journal of Public Health 2007;97:1893-9.
Using survey data from 8 European cities the authors evaluated the association between residence in a damp and moldy dwelling and the risk of depression and investigated whether depression was mediated by perception of control over one’s home or mold-related physical illness. Dampness and mold were associated with depression, independent of individual and housing characteristics. This association was independently mediated by perception of control over one’s home and by physical health.

Nasal carriage of methicillin-resistant Staphylococcus aureus in medical students.
Baliga S., Bansil R., Suchitra U., Bharati B., Vidyalakshmi K., Shenoy S. Journal of Hospital Infection 2007; 5 Dec.
A study was conducted to ascertain the nasal carriage of MRSA among 50 medical students in Kasturba Medical College, Mangalore posted in surgical wards, medical wards, ICU, postoperative wards and the microbiology laboratory. All 26 postgraduates (100%) and 18 undergraduates (75%) were colonised with S. aureus. Of these, only one undergraduate (4.16%) and 11 postgraduates (42.3%) were colonised with MRSA.

Methicillin-resistant Staphylococcus aureus carriage among district nurse patients and medical admissions in a UK district.
Thomas S., Karas J.A., Emery M., Clark G. Journal of Hospital Infection 2007;66:369-73.
The study was carried out in the medical assessment unit of the local hospital and district nurse patient (DNP) population in Huntingdonshire. In all, 162 participants were recruited. Factors found to be significantly associated with MRSA colonization were age (76.6 years), presence of wound/ulcer, hospital admission in the past year, past history of MRSA, and antibiotic use in the preceding 6 months. The only independent predictor for MRSA colonization was found to be past history of MRSA. The DNP population are a significant reservoir for MRSA in the community and policies on screening high-risk patients need to reflect this.

Community-associated methicillin-resistant Staphylococcus aureus prevalence: how common is it? A methodological comparison of prevalence ascertainment.
Furaya E.Y., Cook H.A., Lee M,.H., et al. American Journal of Infection Control 2007;35:359-66.
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are becoming increasingly prevalent. There is geographic variation in their reported prevalence across the United States; however, studies reporting on CA-MRSA prevalence also demonstrate great variability in their case-finding methodology. A comparison of three different methods to ascertain CA-MRSA prevalence revealed that variability in case-finding methodologies can lead to different prevalence estimates. Key factors to consider when comparing CA-MRSA rates include the definition of CA-MRSA, choice of denominator, and method and setting of sample collection.

Wastewater-irrigated vegetables: market handling versus irrigation water quality.
Jeroen H., Ensink J., Mahmood T. Dalsgaard A. Tropical Medicine and International Health 2007;12(suppl 2):2-7.
Vegetables irrigated with untreated domestic wastewater were, at the time of harvest, analysed for the presence of the faecal indicator, Escherichia coli, and helminth eggs in Faisalabad, Pakistan. Vegetables from the same harvested batch were collected approximately 12 hours later from the local market. The results of the survey suggest that unhygienic post harvest handling was the major source of produce contamination. Interventions at the market, such as the provision of clean water to wash produce in, are better ways to protect public health and more cost effective than wastewater treatment.

Prevalence of Salmonella enterica serovars and genovars from chicken carcasses in slaughterhouses in Spain.
Capita R., Alonso-Calleja C., Prieto M. Journal of Applied Microbiology 2007;103(5):1366-75.
A total of 336 chicken carcasses were collected from 6 slaughterhouses in Northwestern Spain. Salmonella were detected in 60 (17·9%) carcasses. Isolates belonged to 9 different serotypes, with Salmonella Enteritidis being the most common. Three strains (5%) were resistant to one antibiotic and 24 (40%) were multi-resistant. Salmonella serotypes and phage types detected are among those most frequently associated with human diseases in Spain. This study emphasizes the importance of controlling this pathogen in poultry products.

A new microbiological problem in intensive care units: environmental contamination by MRSA with reduced susceptibility to glycopeptides.
Perdelli F., Dallera M., Cristina M.L., et al. International Journal of Hygiene and Environmental Health 2007; 23 Jul.
The study evaluated the percentage of MRSA strains with reduced susceptibility to glycopeptides in four intensive care units by environmental sampling of air and surfaces. Antibiograms revealed that 85.7% of all air samples were positive for MRSA, and that 64.3% of all the samples were heterogeneously resistant to glycopeptides. Methicillin resistance was recorded in 41.0% of surface samples, and 32.5% of all samples proved positive for hGISA.

The effect of humidity on the survival of MRSA on hard surfaces.
Makison J., Swan J. Health & Safety Laboratory
The study measured the effect that different humidities potentially achievable on a hospital ward have on survival of MRSA on hard surfaces. The investigation revealed that surface type had a greater effect on the rate of reduction of MRSA than that of humidity and that different types of disinfectant/detergent appear to have different efficacies on different surface/material types. This report and the work it describes were undertaken by the UK Health and Safety laboratory of the Department of health.

Human noroviruses in swine and cattle.
Mattison K., Shukla A., Cook A., et al. Emerging Infectious Diseases 2007;13(8):1184-8.
GIII (bovine), GII.18 (swine), and GII.4 (human) norovirus sequences, were isolated from animal faecal samples demonstrating that GII.4-like strains can be present in livestock. In addition, GII.4-like noroviral RNA was detected from a retail meat sample. This finding highlights a possible route for indirect zoonotic transmission of noroviruses through the food chain.

Methicillin-resistant Staphylococcus aureus (MRSA) in hospitals and the community: model predictions based on the UK situation.
Robotham J.V., Scarff C.A. , Jenkinsb D.R., Medley G.F., Journal of Hospital Infection 2007;65(Suppl 2):93-9.
Theoretical modelling shows that patient movements in and out of hospitals are likely to affect nosocomial transmission dynamics. The community acts as a “reservoir” and readmission of individuals colonised during previous admissions can result in sporadic transmission within hospitals. A 7-year investigation of patient movement patterns showed that an infected person has a 44.2% chance of being readmitted while still infected. This value is far higher than previous estimates (3.7%) highlighting the potential importance of transmission driven by hospital admissions. For this reason we believe consideration of readmissions from the community population to be critical to the success of hospital acquired infection control.

Transmission of influenza A in human beings.
Brankston G., Gitterman L., Hirji Z., Lemieux C., Gardam M. The Lancet Infectious Diseases 2007;7:257-65.
There continues to be much debate about how influenza is transmitted. This paper is a systematic review of the literature on this subject. The authors find that data are limited on modes of transmission in the natural setting. They concluded however that transmission occurs at close range rather than over long distances, suggesting that airborne transmission, as traditionally defined, is unlikely to be of significance in most clinical settings. Further research is required to better define conditions under which the influenza virus may transmit via the airborne route.

The significance of fomites in the spread of respiratory and enteric viral disease .
Boone S.A. , Gerba C.P. Applied and Environmental Microbiology 2007;73:1687-96.
This paper is a detailed review of the published evidence on the spread of respiratory and enteric viral disease via fomites.

Lack of occurrence of methicillin-resistant Staphylococcus aureus on municipal public telephones.
O'Connor A., Loughrey A., Millar B.C., Lowery C.J., Dooley J.S., Goldsmith C.E., Rooney P.J., Moore J.E. American Journal of Infection Control 2007;35:285-6.

Residence time and food contact time effects on transfer of Salmonella Typhimurium from tile, wood and carpet: testing the five-second rule .
Dawson P., Han I. , Cox M., Black C., Simmons L. Journal of Applied Microbiology 2007;2:945-53.
Experiments were conducted to determine the survival and transfer of Salmonella Typhimurium ( S. Typhimurium ) from wood, tile or carpet to bologna (sausage) and bread. S. Typhimurium can survive for up to 4 weeks on dry surfaces in high-enough populations to be transferred to foods. Over 99% of bacterial cells were transferred from the tile to the bologna after 5 sec of bologna exposure to tile. Transfer from carpet to bologna was very low (<0·5%) when compared with the transfer from wood and tile (5-68%), and S. Typhimurium can be transferred to the foods tested almost immediately on contact.

Enumeration of Campylobacter spp. on the surface and within chicken breast fillets.
Luber P., Bartelt E. Journal of Applied Microbiology 2007;102:313-8.
One hundred fresh retail chicken breast fillets were analysed using a rinse sample for surface and 55 fillets for internal pathogen contamination using 10 g meat and a most probable number technique. Prevalence was 87% on the surface and 20% in the deep tissue. The mean number of Campylobacter on the surface was 1903 CFU, with a median of 537 CFU and a maximum of 38,905 CFU. Counts inside the tissue were <1 CFU / g meat (mean = 0.24 CFU, median = 0.15 CFU, maximum = 0.74 CFU). Given the high numbers of the pathogen on the chicken meat surface in comparison with low levels of internal contamination, it can be concluded that cross-contamination during the preparation of contaminated chicken is a more important pathway for consumers' exposure to Campylobacter than the consumption of undercooked meat.

Occurrence of moulds in drinking water.
Hageskal G., Gaustad P., Heier B.T., Skaar I. Journal of Applied Microbiology 2007;102:774-80.
In order to determine the occurrence of filamentous fungi in public drinking water systems in Norway , water from 14 water supply networks from all over the country was sampled and analysed.

MRSA in non-clinical areas of hospitals.
Brown N.M. , Lee S.D., Duerden B.I., Gillanders S.A., Cookson B., Neville L., Jenks P., Catchpole C., Wright P., Spencer R.C. Journal of Hospital Infection 2006;64:402-3.
In order to establish whether or not MRSA could be detected in non-clinical areas, a standard protocol for the detection of MRSA in the hospital environment was developed. Non-clinical areas were chosen in corridors outside wards housing MRSA-positive patients, outside intensive care units and in outpatient clinics. Items sampled included door handles and push plates, stair rails, lift buttons and equipment trolleys. No MRSA was isolated from any of the non-clinical sites in any of the hospitals.

Is your phone bugged? The incidence of bacteria known to cause nosocomial infection on healthcare workers' mobile phones.
Brady R.R.W., Wasson A., Stirling I., McAllister C., Damani N.N. Journal of Hospital Infection 2006;62:123-5.
The authors undertook a study to investigate healthcare workers' (HCWs) use of mobile phones within a district general hospital. Of the 148 HCWs sampled, 145 (98.0%) owned a mobile phone. In total, 96.2% of phones demonstrated evidence of bacterial contamination, and 15 (14.3%) of the mobile phones sampled grew bacteria that are known to cause nosocomial infection. It was found that 38.1% of phones grew one bacterial species, 38% grew two different species and 20.95% grew three or more different species.

Evaluation of real-time polymerase chain reaction for the detection of methicillin-resistant Staphylococcus aureus on Environmental Surfaces.
Otter J.A, Havill N.L., Boyce J.M. Infection Control and Hospital Epidemiology 2007;28:1003-1005
Real-time polymerase chain reaction (RT-PCR) was compared with in vitro culture for detecting methicillin-resistant Staphylococcus aureus (MRSA) in samples from environmental surfaces. The sensitivity of RT-PCR, compared with culture, was 92.5%, and the specificity was 51.4%. Because of poor specificity, the RT-PCR kit tested is not suitable for the detection of MRSA on hospital surfaces.

Bacterial contamination of keyboards: efficacy and functional impact of disinfectants.
Rutala W.A., White M.S., Gergen M.F., Weber D.J. Infection Control and Hospital Epidemiology 2006;27:372-7.
This study assessed the six different disinfectants (one each containing chlorine, alcohol, or phenol and three containing quaternary ammonium) against three test organisms (oxacillin-resistant Staphylococcus aureus [ORSA], Pseudomonas aeruginosa, and vancomycin-resistant Enterococcus species) inoculated onto computer keyboards. Potential pathogens cultured from more than 50% included ORSA (4% of keyboards), OSSA (4%), vancomycin-susceptible Enterococcus species (12%), and nonfermentative gram-negative rods (36%). All disinfectants, as well as the sterile water control, were effective at removing or inactivating more than 95% of test bacteria. No damage to keyboards was observed after 300 disinfection cycles.

Prevalence of nasal colonization among patients with community-associated methicillin-resistant Staphylococcus aureus infection and their household contacts.
Zafar U., Johnson L.B., Hanna M., Riederer K., Sharma M., Fakih M.G., Thirumoorthi M.C., Farjo R., Khatib R. Infection Control and Hospital Epidemiology 2007;28:966-969.
This paper describes a study of nasal colonization among patients and their household members from in an urban medical center. Skin and soft-tissue infections were seen in 50 patients (98%) and two household members. Twenty-one (41%) of 51 patients and 10 (20%) of 49 household members were colonized with methicillin-resistant Staphylococcus aureus (MRSA). Most isolates (95%; infective and colonizing) carried the mec type IV complex. Of the colonized household members, five had isolates related to the patients' infective isolate. The report suggests that the frequency of CA-MRSA colonization among household members of patients with CA-MRSA infections is higher than among the general population. Among colonized household members, only half of the MRSA strains were related to the patients' infective isolate. Within the same household, multiple strains of CA-MRSA may be present.

Use of cellular telephones and transmission of pathogens by medical staff in New York and Israel.
Goldblatt J.G., Krief I., Klonsky T., Haller D., Milloul V., Sixsmith D.M., Srugo I., Potasman I. Infection Control and Hospital Epidemiology 2007;28:500-502.
Findings from this study show that cellular telephones are commonly used by hospital personnel, even during patient contact. One-fifth of the cellular telephones examined in this study were found to harbor pathogenic microorganisms, showing that these devices may serve as vectors for transmission to patients.

A Study of the relationship between environmental contamination with methicillin-resistant Staphylococcus Aureus (MRSA) and patients' acquisition of MRSA.
Hardy K.J., Oppenheim B.A., Gossain S., Gao F., Hawkey P.M. Infection Control and Hospital Epidemiology 2006;27:127-32.
A prospective study was conducted in a 9-bed intensive care unit for 14 months. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from the environment at every environmental screening, when both small and large numbers of patients were colonized. On only 20 (35.7%) of 56 occasions were the strains isolated from the patients and the strains isolated from their immediate environment indistinguishable. There was strong evidence to suggest that 3/26 patients who acquired MRSA while in the intensive care unit acquired MRSA from the environment.

Survey of Salmonella contamination of non-UK produced shell eggs on retail sale in the north west of England and London .
Commun Dis Rep CDR Wkly 2006; 16(46): news.
Since 2002, the emergence of egg-associated S. Enteritidis phage types other than PT4 causing human infection has taken place in the United Kingdom, with the greatest increases occurring in S. Enteritidis PT1 and PT14b [4,5]. A survey of Salmonella contamination of non-UK eggs on retail sale over a period of 16 months, between March 2005 and July 2006, showed that 157 (9.0%) samples were contaminated with Salmonella on the shell of the egg. This equates to an estimated prevalence of 3.3%; equivalent to 1 in every 30 ‘boxes' of 6 eggs. Of these 157 samples, S. Enteritidis were detected in 136. The eggs sampled were produced in eight European countries, with most (66.3%) originating from Spain . Of the 157 Salmonella shell-positive samples, 10 were also contents-positive.

How long do nosocomial pathogens persist on inanimate surfaces? A systematic review.
Kramer A., Schwebke I. , Kampf G. BMC Infectious Diseases 2006, 6:130 doi:10.1186/1471-2334-6-130.
A systematic review of the literature shows that common nosocomial pathogens can survive on surfaces for months and thereby be a continuous source of infection transmission. Gram+ve bacteria, such as Enterococcus spp. Staph. aureus (including MRSA), or Strep. pyogenes , survive for months on dry surfaces. Gram -ve species, such as Acinetobacter spp, E. coli , Klebsiella spp., P.aeruginosa or Shigella spp. can also survive for months. A few others, such as H. influenzae , or Vibrio cholerae , however, persist only for days. Mycobacteria, including Mycobacterium tuberculosis , and spore-forming bacteria, including Cl. difficile , can survive for several months whilst Candida albicans can survive up to 4 months. Viruses from the respiratory tract, such as corona , coxsackie , influenza , SARS or rhino virus, can persist on surfaces for a few days whilst viruses from the GI tract, such as astro virus, HAV , polio- or rota virus, persist for approximately 2 months. Blood-borne viruses, such as HBV or HIV, can persist for more than 1 week, and Herpes viruses persist from only a few hours up to 7 days.

The occurrence of influenza A virus on household and day care center fomites.
Boone S.A.. Gerba C.P.. Journal of Infection 2005; 51:103-109.
During two and a half years, 218 fomites were tested from 14 different day care centers. Ten different fomites from bathrooms, kitchens and play areas were sampled. In addition, 92 fomites from eight different homes with children were tested. Fourteen different household fomites from bathrooms, kitchens and living areas were sampled. Influenza was detected on 23% of day care fomites sampled during the fall and 53% of fomites sampled during the spring. No influenza was detected on home fomites sampled during the summer. In contrast, influenza was detected on 59% of home fomites sampled during March.

Can soaps act as fomites in hospitals?
Junu V.G., Shetty A., Jisho M.B. Journal of Hospital Infection 2006;62:244-5.
Ten soap cakes and 10 samples of liquid soap taken from a hospital environment in Mangalore, India were tested for microbial contamination. The 12 soap cake samples showed heavy contamination with Pseudomonas aeruginosa, whilst one sample also contained Staphylococcus aureus. None of the liquid soap samples showed evidence of contamination.

Survival on uncommon fomites of feline calicivirus, a surrogate of noroviruses.
Clay S., Maherchandani S., Malik Y.S., Goyal S.M. American Journal of Infection Control 2006;34:41-3.
Fomites such as computer mouse, keyboard keys, telephone wire, telephone receiver, telephone buttons, and brass disks representing faucets and door handle surfaces were artificially contaminated with known amounts of feline calicivirus (FCV). The virus survived for up to 3 days on telephone buttons and receivers, for 1 or 2 days on computer mouse, and for 8-12 hours on keyboard keys and brass. The time for 90% virus reduction was <4 hours on computer keys, mouse, brass and telephone wire; 4-8 hours on telephone receiver; and 12-24 hours on telephone buttons.

Ecology of Pseudomonas aeruginosa in the intensive care unit and the evolving role of water outlets as a reservoir of the organism.
Trautmann M., Lepper P.M., Haller M. American Journal of Infection Control 2005;33(suppl 1):S41-9.
Pseudomonas aeruginosa is an important pathogen causing intensive care unit (ICU)-related infections. Horizontal transmissions between patients have long been considered the most frequent source of Paeruginosa colonisations/infections. A review of prospective studies published between 1998 and 2005 showed that between 9.7% and 68.1% of randomly taken tap water samples on different types of ICUs were positive for P aeruginosa, and between 14.2% and 50% of infection/colonisation episodes in patients were due to genotypes found in ICU water.

Prevention and control of health care-associated waterborne infections in health care facilities.
TExner M., Kramer A., Lajoie L., Gebel J., Engelhart S., Hartemann P. American Journal of Infection Control 2005;33(suppl 1):S26-40.
The paper discusses the problems related to waterborne pathogens in the hospital environment as a source of health care-associated infections (HAIs). Not only are Legionella spp involved in HAIs, but also Pseudomonas aeruginosa, other gram-negative microorganisms, fungi and amoeba-associated bacteria are considered.

Transmission of avian influenza viruses to and between humans. Hayden F., Croisier A., Journal of Infectious Diseases 2005;192:1311-1314.
Recent research raises questions about the routes of transmission of avian viruses to and between humans. Data indicate possible differences in transmission patterns between human and avian influenza viruses, and implications for prevention in health care, household, and community settings. Transmission of human virus occurs by inhalation of infectious droplets or airborne droplet nuclei and, perhaps, by indirect (fomite) contact followed by self-inoculation of the upper respiratory tract or conjunctival mucosa. The relative importance of these routes is debated, and there is evidence to support each of them. It is likely that each route contributes to transmission under appropriate circumstances and that the manifestations of illness, respiratory tract viral loads, and, perhaps, the type of infecting influenza virus influence the likelihood of transmission by a particular route. The multiple potential routes for the spread of avian influenza viruses, particularly H5N1, indicate that, in addition to protection for the respiratory tract and eyes, proper hand hygiene may be especially important in preventing infection. In households in which illness has occurred, specific protective measures would be advisable for known household contacts. In affected countries, public education regarding simple precautionary measures for food preparation, poultry handling, and avoidance of contaminated water are essential until effective human vaccines for H5N1 viruses become available.

The occurrence of influenza A virus on household and day care center fomites. Boone S.A.. Gerba C.P.. Journal of Infection 2005; 51:103-109.
During two and a half years, 218 fomites were tested from 14 different day care centers. Ten different fomites from bathrooms, kitchens and play areas were sampled. In addition, 92 fomites from eight different homes with children were tested. Fourteen different household fomites from bathrooms, kitchens and living areas were sampled. Influenza was detected on 23% of day care fomites sampled during the fall and 53% of fomites sampled during the spring. No influenza was detected on home fomites sampled during the summer. In contrast, influenza was detected on 59% of home fomites sampled during March.

Occurrence of bacteria and biochemical markers on public surfaces. Reynolds K.A., Watt P.M., Boone S.A., and Gerba C.P., International Journal of Environmental Health Research2005;15: 225-234.
From 1999 – 2003, the hygiene of 1,061 environmental surfaces from shopping, daycare, and office environments, personal items, and miscellaneous activities (i.e., gymnasiums, airports, movie theaters, restaurants, etc.), in four US cities, was monitored. Samples were analyzed for fecal and total coliform bacteria, protein, and biochemical markers. Biochemical markers, i.e., hemoglobin (blood marker), amylase (mucus, saliva, sweat, and urine marker), and urea (urine and sweat marker) were detected on 3%, 15% and 6% of the surfaces, respectively. Protein (general hygiene marker) was present on 26% of surfaces. Surfaces from children's playground equipment and daycare centers were the most frequently contaminated. Half and one-third of the sites positive for biochemical markers were also positive for total and fecal coliforms, respectively. Artificial contamination of public surfaces with an invisible fluorescent tracer showed that contamination from outside surfaces was transferred to 86% of exposed individual's hands and 82% tracked the tracer to their home or personal belongings hours later. Results provide information on the relative hygiene of commonly encountered public surfaces and aid in the identification of priority environments where contaminant occurrence and risk of exposure may be greatest.

Prevalence of Campylobacter, Salmonella, and Escherichia coli on the external packaging of raw meat. Burgess F., Little C.L., Allen G., Williamson K., Mitchell R.T. Journal of Food Protection 2005;68:469-75.
A UK study of 3,662 prepackaged raw meat samples from retail premises showed that the external packaging of raw meats is a vehicle for potential cross-contamination by Campylobacter, Salmonella, and E. coli, which could potentially cross-contaminate ready-to-eat foods during and after purchase in consumers’ homes. Salmonella was detected on two (<1%) samples of external packaging (both raw chicken), and Campylobacter was detected on 41 (1.1%) samples of external packaging. The external packaging of game fowl exhibited the highest Campylobacter contamination (3.6%), followed by raw chicken (3.0%), lamb (1.6%), turkey (0.8%), pork (0.2%) and beef (0.1%); Campylobacter jejuni and Campylobacter coli accounted for 24/41 and 10 /41 of the contaminating Campylobacter species, respectively. E. coli was isolated from the external packaging on 4% of the raw meat samples at levels of 40 -10(5) CFU per swab.

Salmonellosis associated with pet turtles – Wisconsin and Wyoming 2004.Centers for Disease Control and Prevention (CDC).Morbidity and Mortality Weekly Report 2005;54:223-6.
This paper reports six cases of Salmonellosis associated with small pet turtles in the United States.

Incidence of Listeria spp in domestic refrigerators in Portugal. Azvedo I., Regalo M., Mena C., Almeda G., Carneiro L., Teixeira P., Hogg T., Gibbs P.A. Food Control 2005;16:121-4.
A study of domestic refrigerators in Portugal showed that Listeria mononcytogenes was present in 3/68 refrigerators investigated. L. grayi and L. inoccua were isolated from four and one refrigerators, respectively. Approximately 78% of refrigerators were operating at temperatures >6.1 degrees C, 87% were cleaned only monthly or less frequently, and only 8% were cleaned with appropriate proprietary cleaning products available in local supermarkets. The survey demonstrates the need for education regarding safe food handling practices.

The community prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in older people living in their own homes: implications for treatment, screening and surveillance in the UK. Maudsley J., Stone S.P. Kibbler C.C., Iliffe S.R., Conaty S.J., Cookson B.D., Duckworth G.J., Johnson A., Wallace P.G. Journal of Hospital Infection 2004;57:258-62.
This paper describes a study concerning the prevalence of MRSA in one London general practice, screening 258 elderly people living in their own home. MRSA was found in two participants. A history of MRSA was the only significant risk factor. The results of this and other studies suggest that national guidelines recommending early discharge of MRSA carriers have not resulted in widespread community acquisition amongst elderly people living in their own homes.

Legionella detection from clinical and environmental samples. Ricci M.L. Italian Journal of Public Health 2004;1:74-5.
This paper describes the methods used for diagnosis of Legionella. Diagnosis is an essential tool for prompt and proper antimicrobial therapy, and for understanding transmission routes. Likewise, environmental sample analysis allows us to know the distribution of Legionella in the environment and to detect the origins of infection during outbreaks by comparing clinical and environmental strains.

Contamination of chicken carcasses in Gauteng, South Africa, by Salmonella, Listeria monocytogenes and Campylobacter. van Nierop W., Dusé A.G., Marais E., Aithma N., Thothobolo N., Kassel M, Stewart R., Potgieter A., Fernandes B., Galpin J.S., Bloomfield S.F. International Journal of Food Microbiology 2005;99:1-6.
A study of 99 whole chicken carcasses sourced from various retailers in Gauteng, South Africa, showed that 60.6% of samples were contaminated with one or more spp., with a 19.2% prevalence for Salmonella spp. and L. monocytogenes, and 32.3% for Campylobacter spp. The overall contamination rate was not significantly different between fresh or frozen samples or between butcheries, supermarkets or street vendors. Significantly more Salmonella spp.was isolated from fresh samples from butcheries than other sources, while increased Campylobacter spp. levels were detected in fresh supermarket samples.

Animal-to-human transmission of Salmonella Typhimurium DT104A variant.
Hendriksen S.W.M., Orsel K., Wagenaar J.A., Miko A., van Duijkeren E. Emerging Infectious Diseases 2004;10:2225-7.
Salmonella enterica serovar Typhimuriumwas isolated from a pig, a calf, and a child on a farm in The Netherlands. The isolates were indistinguishable by phenotyping and genotyping methods, which suggests non-foodborne animal-to-animal and animal-to-human transmission. People in close contact with farm animals should be aware of this risk.

Transmission of influenza: implications for control in health care settings. Bridges C.B., Kuehnert M.J., and Hall C.B. Clinical Infectious Diseases 2003; 37, 1094-1101.
Annual influenza epidemics in the United States result in an average of 136,000 deaths and 114,000 hospitalizations. Although droplet transmission is thought to be the primary mode of influenza transmission, limited evidence is available to support the relative clinical importance of contact, droplet, and droplet nuclei (airborne) transmission of influenza. In this article, the results of studies on the modes of influenza transmission and their relevant isolation precautions are reviewed.

Challenges in cross contamination modelling in home and food service settings. Schaffner, D.W. Food Australia 2003:55;583-586.
This article summarises the key findings of cross-contamination and hand-washing research the laboratory has been involved in, and indicates current and future research directions of the field as a whole, and provides some preliminary ideas on how cross contamination might be incorporated into future microbial risk assessment.

Risk Factors for Norovirus, Sapporo-like Virus, and Group A Rotavirus Gastroenteritis. de Wit, M.A.S., Koopmans, M.P.G. and van Duynhoven, Y.T.H.P. Emerg Infect Dis 2003;9:1563-1570.
This study identified risk factors, modes of transmission, and opportunities for prevention for gastroenteritis attributable to norovirus, Sapporo-like virus (SLV), and rotavirus. The main risk factor for viral gastroenteritis was contact with other persons with gastroenteritis, supporting the hypothesis that these viruses are mainly transmitted from person to person. However, for NV gastroenteritis, foodborne transmission seems to play an important role. Hygienic food-handling procedures can therefore further prevent the infection spreading from one person to another.

The survival of foodborne pathogens during domestic washing-up and subsequent transfer onto washing-up sponges, kitchen surfaces and food. Mattick, K., Durham, K., Domingue, G., Jorgensen, F., Sen, M., Schaffner, D.W., and Humphrey, T. Int J Food Microbiol 2003;85(3):213-226.
This study highlights the potential for survival and cross contamination of foodborne bacteria in the kitchen. In a typical UK washing-up process simulation, bacterially contaminated soiled dishes were washed in warm water containing detergent. The risk of bacterial transfer to other dishes and sponges, kitchen surfaces or food was assessed. Some dishes remained contaminated with bacteria after washing-up. Water hardness did not appear to affect survival. E. coli and Salmonella survived towel or air-drying on dishes and after towel-drying the cloth became contaminated on every occasion. Some sterile dishes washed after contaminated dishes became contaminated. Washing-up sponges frequently became contaminated with bacteria. Frequency of transfer of bacteria from contaminated dishes to food was low.

Household contamination with Salmonella enterica. Rice, D.H., Hancock, D.D., Roozen, P.M. et al. Emerging Infectious Diseases 2003;9(1):120-122.
This paper suggests that Salmonella contamination does occur in the home environment under certain conditions. Contamination increases when occupational exposure to Salmonella exists, such as cattle farms with known salmonellosis. The study examined the contents of household vacuum cleaner bags. A total of 16 bags from 79 bags were positive for S. enterica. They also studied means of decontaminating carpet that was artificially contaminated with Salmonella. Use of a carpet cleaner and several cleaners/disinfectants reduced, but failed to eliminate, S. enterica from artificially contaminated carpet.

Environmental surface cleanliness and the potential for contamination during handwashing. Griffith, C.J., Malik, R., Cooper, R.A., Looker, N. and Michaels, B. AJIC 2003;31:93-6.
This study aimed to determine the general organic, microbial and staphylococcal load on surfaces in hospital wards that could be touched during handwashing. Tap handles, soap dispensers and paper-towel dispensers were tested in two paediatric and surgical wards in four UK hospitals. Tap handles presented the greatest risk, being the most contaminated, more likely to be wet and exceed benchmark cleaning values. Many of the organisms isolated were staphylococci and the results are discussed within the context of microbial cross-contamination and potential pathogen spread.

Kitchen hygiene in daily life. Beumer, R.R. and Kusumaningrum H. International Biodeterioration & Biodegradation 2003;
This paper highlights the reasons for the increasing incidence of gastrointestinal infections associated with the domestic environment, as in Europe and North America more than half of the registered food infections appear to be contracted in the home. The main sources of infection in the domestic environment are also discussed. To highlight the importance of hygiene measures required in the home, the paper summaries the findings from three studies: presence of foodborne pathogens in domestic kitchens, microbiological quality of leftover food stored in the refrigerator and the efficacy of antibacterial dishwashing liquid on sponges against foodborne pathogens.

The sink environment as a source of microbial contamination in the domestic kitchen. Tierney, J., Moriarty, M. and Kearney, L. Dairy, Food and Environmental Sanitation 2002;22(9):658-666.
Samples from the sink base, draining board, joint around the tap and tap nozzle surfaces were taken in 35 homes and analysed for bacteria, particularly E. coli and Salmonella. The surfaces were stainless steel. Total bacterial counts of over 100/cm2 are considered to represent high contamination levels. 14% of sink basins, 6% of draining boards and 17% of joints around the tap had >1 million bacteria/cm2. There was a high occurrence of both E. coli and Salmonella from all sites, for example 29% of joints around the sink were positive for Salmonella and 54% of sink basins were positive for E. coli.

Hygiene measures and microorganisms in Japanese households. Ojima, M et al. Journal of Applied Microbiology 2002;93:800–809.
This study enumerated bacteria and fungi from over 100 places in the home directly touched by people. The study was carried out in 86 households with pre-school children. The kitchen and dining room had the greatest level of microbial contamination, with bathrooms the next highest level. The largest bacterial counts were for wet/moist items such as dishwashing sponges, sinks and bathroom sponges. Toilets were found to have an unexpectedly low level of bacterial contamination. Fungi were found throughout the homes. The authors conclude it is necessary to identify items that can spread bacteria (e.g. cloths/sponges) and the places such as kitchen counter tops that subsequently become contaminated, and use timely and effective disinfection or sanitising measures, after activities such as handling raw meat. They highlight that attention should be paid when the home contains vulnerable groups.

Comparative surface-to-hand and fingertip-to-mouth transfer of gram-positive bacteria, gram-negative bacteria and phage. Rusin, P., Maxwell, S. and Gerba, C. J Appl Microbiol 2002; 93:585–592.
This is the first study to directly compare the transfer of germs from household surfaces to the hands. After activities involving contaminated surfaces, bacteria and bacteriophages were counted on volunteers’ hands. Activities included wringing out a dishcloth/sponge, turning on/off a tap, making hamburgers, holding a phone receiver and removing laundry from a washing machine. The highest bacterial transfers to hands was from hard, non-porous surfaces, e.g. up to 65% of bacteria were transferred from the phone receiver to hand. Levels of hand contamination were often very high after handling porous items such as a dishcloth. This work highlights that household surfaces can become contaminated with bacteria or viruses that can easily be transferred to hands and then the mouth.

The role of the home environment in the transmission of infectious diseases. Kagan LJ, Aiello AE and Larson E. Journal of Community Health 2002;27:247-267
Examines the health care literature from 1980-2000 regarding the microbiology of the home, and summarises the evidence of transmission within the home, and assesses the effectiveness of cleaning practices and products. The home environment serves as a reservoir of large numbers of micro-organisms and infectious disease transmission has been demonstrated to occur in 6-60% of households in which one member is ill. Routine cleaning is often sufficient, but in cases of household infection, may not adequately reduce environmental contamination. The behavioural aspects of infection prevention in the home warrant increased public attention and education.

Community-acquired Methicillin-resistant Staphylococcus aureus, Finland. Salmenlinna S, Lyytikainen O and Vuopio-Varkila, J. Emerging Infectious Diseases 2002;8: 602-607.
This paper reports that one fifth of all Finnish MRSA isolates came from people with no connections to health-care facilities, suggesting that these isolates may be community acquired. Children were more likely to have a community- than a hospital-acquired MRSA. One third of all community-acquired strains were isolated because of screening of persons exposed to a known MRSA carrier, most of whom were family members.

Sensitisation to airborne moulds and severity of asthma: cross sectional study from European Community respiratory health survey. Zureik M, Neukirch C, Leynaert B, Liard R, Bousquet J and Neukirch F. BMJ 2002;325:411-417.
Over 1100 adults with asthma were examined to see if their symptoms worsened on exposure to various allergens. Three out of four people were sensitive to at least one allergen. Two out of three people were sensitive to 2 or more allergens. Almost 1 in 5 was allergic to Alternaria alternata or Cladosporium herbarum. People sensitive to mould were more likely to have a severe form of asthma. This may be because mould spores can reach the lower airways. In addition, these spores were present in the home where people generally spent most of their time.

Contamination of room door handles by methicillin-sensitive/methicillin-resistant Staphylococcus aureus. Oie S, Hosokawa I and Kamiya A. Journal of Hospital Infection 2002;51:140-143.
An investigation of the contamination of room door handles (196) in university hospital wards. Door handles in 27% of rooms were contaminated with Staphylococcus aureus, with MRSA on door handles of 17 rooms (8.7%). Thus, handwashing should continue to be emphasised and routine disinfection of door handles is necessary.

Regrowth and survival of indicator microorganisms on the surfaces of household containers used for storage of drinking water in rural communities of South Africa. Momba MNB, Kaleni MP. Water Research 2002;36:3023-28
This study revealed that the two types of household containers (polyethylene and galvanized steel) that are used in rural communities in South Africa, supported the growth and survival of indicator microorganisms due to the bad quality of the intake water before storage. The storage of drinking water for 48 h mainly resulted in the regrowth of total coliforms. Nevertheless, the persistence of other indicator microorganisms was observed on the surface of household containers.

Domestic transmission routes of pathogens: the problem of in-house contamination of drinking water during storage in developing countries. Jensen PK, Ensink JHJ, Jayasinghe G et al. Tropical Medicine and International Health 2002;7:604-609.
In this intervention study, 67 households in Punjab, Pakistan, were provided with new water storage containers, either a traditional wide-necked pitcher or a narrow-necked water storage pitcher, preventing direct hand contact with the water. Narrow-necked pitchers were to some extent capable of reducing E. coli levels in the stored water by minimising the contamination within the home. However, if the main water supply is of poor quality (i.e. above 100cfu/100ml) then improved means of storage may not lead to better quality of water, so interventions should be aimed at the public domain (not the domestic domain).

Pseudomonas aeruginosa outbreak in a hematology-oncology unit associated with contaminated surface cleaning equipment. Engelhart S, Krizek L, Glasmacher A, Fischnaller E, Marlein G and Exner M. J Hosp Infect 2002;52:93-98.
From the patients’ environment, a total of 4.5% of samples from sanitary equipment and 20% of samples from surface cleaning equipment were found to be contaminated with P. aeruginosa. It was found that cleaning staff had used cleaning solution instead of disinfectants for decontamination of the patients’ environment. The outbreak stopped after re-adoption of surface disinfection, application of sterile filters on taps and shower heads and chemical disinfection of the washbasin drains.

A study of cross-contamination of food-borne pathogens in the domestic kitchen in the Republic of Ireland. Gorman, R., Bloomfield, S. and Adley, C.C. International Journal of Food Microbiology 2002;76:143-150.
This work looked at cross-contamination in the domestic kitchen during preparation of a roast chicken lunch. The chickens were found to be contaminated with Salmonella, Campylobacter, Staph. aureus or E. coli, which were subsequently found on hand and food contact surfaces after food preparation, demonstrating cross-contamination in the kitchen during meal preparation.

Bacterial contamination of Japanese households and related concern about sanitation. Ojima, M., Toshima, Y., Ara, K., Kawai, S. and Ueda, N. International Journal of Environmental Health Research 2002;12:41-52.
In this study samples were taken from 90 sites in 5 homes. Homes with pre-school children were selected as these would demonstrate relatively high concern about hygiene. The kitchen was found to have the greatest degree of contamination, and the toilet had the lowest contamination levels. Areas where water is used tended have higher counts. A survey of 28 housewives with pre-school children determined their concerns about sanitation of the home. They were concerned about ‘germs’ on items such as washing-up sponges, chopping boards, hand towels and toys.
However, they were not concerned about ’germs’ on knife handles, faucet handles and other contact surfaces.

An outbreak of community-acquired foodborne illness caused by Methicillin-Resistant Staphylococcus aureus. Jones, T.F., Kellum, M.E., Porter, S.S., Bell, M. and Schaffner, W. Emerging Infectious Diseases 2002;8:82-84.
The investigation into an outbreak of gastrointestinal illness in which the vehicle of infection was food from a delicatessen contaminated by MRSA. A food handler in the delicatessen, an asymptomatic carrier of the same strain of MRSA, probably contaminated the food. The person may have acquired it during visits to a nursing home prior to the outbreak, demonstrating the spread of MRSA into the community. This is the first report of an outbreak of gastrointestinal illness caused by community-acquired MRSA.

General outbreaks of infectious intestinal diseases linked with private residences in England and Wales, 1992-9: questionnaire study. Gillespie, I.A., O’Brien, S.J. and Adak, G.K. BMJ 2001;323:1097-8.
General outbreaks in the home accounted for 5% of outbreaks reported. Food was the predominant transmitter (85%), with person-to-person and waterborne transmission accounting for 6% and 1% respectively. Foodborne transmission was linked to social functions, e.g. barbecues and dinner parties more frequently than other modes of transmission. Salmonella was the most frequently reported pathogen. The most common faults in food hygiene were inappropriate storage, inadequate cooking, and cross contamination (39%, 31% and 20% respectively). Inappropriate storage was more commonly reported as a food hygiene fault in homes than in other premises.

Potential role of fomites in the vehicular transmission of human astroviruses. Abad, F.X., Villena, C., Guix, S., Caballero, S., Pinto, R.M. and Bosch, A. Applied and Environmental Microbiology 2001;67:3904-3907.
In this study astrovirus showed considerable persistence when dried onto porous and nonporous material. On china it survived for 60 days at 4ºC and 7 days at 20ºC. On paper at 4ºC, astrovirus infectivity was detected after 90 days, and for up to 60 days at 20ºC.

A review: spread and prevention of some common viral infections in community facilities and domestic homes. Barker, J., Stevens, D. and Bloomfield, S.F. Journal of Applied Microbiology 2001;91:7-21.
The paper highlights that viruses are probably the most common cause of infections acquired indoors and that gastrointestinal and respiratory viral infections spread rapidly in within families and the community.Person-to-person transmission via hands and surfaces plays a key role in the spread of viral infections, and improved targeted hygiene (personal or environmental) has a considerable impact on the control and prevention of viral infections.

Quantification and variability analysis of bacterial cross-contamination rates in common food service tasks. Chen, Y., Jackson, K.M., Chea, F.P. and Schaffner, D.W. Journal of Food Protection 2001;64:72-80
A study investigating the transfer of bacteria between hands and other kitchen surfaces during food preparation using Enterobacter aerogenes as a model.  Transfer of bacteria was studied when handling a chicken, lettuce and a tap with results showing plenty of variation but quite a high rate of transfer in all these situations