The
new IFH/ICNA home hygiene training resource
is now available |
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 This
training package is the result of a collaboration
between the UK Infection Control Nurses Association
(ICNA) and the IFH. It uniquely combines the practical
expertise of the ICNA and the IFH’s scientific
understanding of how infections are spread in the
home with the aim to provide practical and scientifically
solid advice.
It is designed for all those (professional home
carers and family members) who actively care for
others at home, but it can also be used to educate
any group that requires an understanding of home
hygiene, such as doctors, pharmacists, public health
and social care workers, health promotion organisations,
food standards authorities, consumer groups and commercial
organisations.
The resource describes how targeted hygiene can
be used in the home to reduce infection risks. It
is subdivided into several sections on:
- how infections are spread in the home
- the principles of targeted hygiene putting targeted
hygiene into practice
- dealing with people and situations where there
is greater risk of infection in the home
- how to select and use disinfectant products where
appropriate
- concerns and frequently asked questions. about
home hygiene
It is written in a straightforward, easy to follow
and practical manner. Making it an even more complete
resource, it comprises notes for the carer, summarising
the key points, and notes for the trainer which provide
background information.
The training
resource, available in CD-ROM or print, can be
ordered through the ICNA website (www.icna.co.uk)
at a cost of £10 (£5 for ICNA members)
plus handling&shipping.
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WHO
INFORMAL INTER-COUNTRY WORKSHOP ON SAFE WATER,
FOOD AND HYGIENE
Kathmandu, Nepal, 23 – 25
July 2003 |
 The
World Health Report 2000 shows that countries in
South East Asia bear some 48 % of the global diarrhoeal
disease burden. Undoubtedly, unsafe water, food and
hygiene are major contributing factors to the prevalence
of diarrhoea in this Region. A close relationship
exists among water, food and hygiene particularly
at community and household level and addressing any
one route of faecal contamination apart from others
may not be effective in reducing the incidence of
diarrhoeal diseases.
The
South East Asian Region Office of the World Health
Organisation hosted a three-day regional
informal workshop on safe water, food and hygiene.
A major
aim of the workshop was to share learnings on “in
country” situations and programmes. A further
aim was to develop an inter-country project to
support both ongoing initiatives in India and Nepal
on safe
water, food and hygiene at household level and
plaaned initiatives in Bangladesh, Myanmar and
elsewhere
.
IFH board members Professor KJ Nath and Professor
Sally Bloomfield attended this informal workshop
together with delegates from India, Indonesia, Myanmar,
Nepal and Sri Lanka.
Status
reports on in country situations showed that:
- In 12 West Delhi slums, India, a demonstration
project on reducing diarrhoea disease by integrating
safe water with improved food hygiene and handwashing
interventions has been ongoing since October 2001.
- WHO-Bangladesh has indicated that it is ready
to develop a similar project.
- In Nepal, the NGO Environment and Public Health
Organization (ENPHO) is implementing a safe water
project based on a low cost point-of-use disinfectant.
It is recognised that a need exists to strengthen
some aspects of the project and to integrate food
and personal hygiene strategies.
- Myanmar government representatives have agreed
in principle to develop a household-level water disinfection
demonstration project.
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| Are
we too clean: experts caution about the need to maintain
hygiene standards |
| In
Europe and the USA, the idea that we could be too clean
for our own good has received a great deal of attention
in the media in the last 5 years. On one hand the question
being asked is “Could being cleaner be one of
the factors behind the steep rise in asthma, eczema
and similar atopic conditions?”. Others, however,
caution that “the 'hygiene hypothesis' is a dangerous
idea that could lead to increased infection rates from
food poisoning and other diseases”.
In September 2002, the Royal Institute of Public Health
(RIPH) in London, brought together a group of immunologists
and public health experts to present their views at
a one-day symposium. As the result of this effort,
RIPH has published a consensus statement that, while
keeping an open mind on the hygiene hypothesis, stresses
the importance of not undermining hygiene standards
because of worries about being too clean. The keynote
speaker at the symposium was the originator of the
hygiene hypothesis, Prof. David Strachan, who is also
a signatory of the consensus. RIPH has placed the consensus
statement on its website at http://www.riph.org.uk/hygienehypothesis.html
and is actively encouraging its dissemination among
health and hygiene professionals.
In short, the consensus statement says:
· The totality of evidence supporting the hygiene hypothesis
remains conflicting.
·
As yet there is no clear indication of the types of
microbes that might be ‘protective’ against
allergy, the groups of people affected, or the nature,
extent or timing of the critical changes in microbial
exposure.
· Other environmental and lifestyle changes might also
be the cause of increased predisposition to allergy,
including diet and lack of exercise, etc.
· Infectious disease (ID) continues to be a significant
threat to society. In all settings we depend both collectively
and as individuals, on good hygiene as a primary defence
against infectious disease.
· While work continues on the hygiene hypothesis, it
is important that defence against ID is not undermined.
Initiatives to maintain and improve hygiene standards
should continue to be fully supported.
· These initiatives should follow modern hygiene approaches
based on risk assessment and should focus on preventing
exposure to harmful organisms. Such approaches are
likely to be both the most effective in preventing
ID, and the least likely to disturb harmless exposure
to microbes.
The
Symposium is reported in a supplement to the RIPH
journal ‘Health & Hygiene’.
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| WASH
Handwash Campaign in South Africa |
 Since
1994, the delivery of basic water services has been a
key priority of the South African Government. The Department
of Water Affairs and Forestry, in collaboration with
other national authorities, has a mandate to deliver
and support the delivery of water supply and sanitation
to South Africa. In March 2002, minister Kastrils launched
the South African WASH programme, which in its first
year of operation focussed on hygiene education and,
in particular, the promotion of handwashing via a substantial
national campaign and market research to develop effective
approaches to marketing simple hygiene messages.
In the first year, the target was a broad national
audience concentrated on urban, peri-urban and some
rural settlements. Key targets were health professionals
together with mothers, children and teachers. The colourful
campaign focussed single, simple messages that people
could and would want to identify with, namely when
to wash hands:
· Before cooking and handling food
· Before feeding children and eating
· After going to the toilet
·
After changing baby’s nappy
- and how to wash hands:
· Always wash both hands
· Use soap and water when washing hands
· Scrub hands together at least 3 or 4 times
· Dry hands on a clean towel or shake hands dry
The material, produced in 11 languages, used an impactful
mix of press and radio media, and other vehicles such
as posters, leaflets, CDs, t-shirts and stickers. The
next phase of the WASH campaign will attempt to keep
the momentum obtained from the first year campaign
and focus more specifically on rural women and children.
For further information on the WASH campaign you may
contact Babs Naidoo at DWAF (bda@dwaf.gov.za).
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| UPCOMING
EVENTS |
| - IFH is organising a parallel symposium
on Home Hygiene at the next European Public
Health Association annual conference in Rome,
from 20 to 22 November 2003. The title of
the IFH symposium, chaired by IFH board members
Prof. G. Fara, is Preventing infectious disease
in the domestic setting: a shared responsibility.
-
IFH board member Dr. E. Scott, will
present a paper on ‘Infection Control
Practice in the Home’ at the APIC
meeting ‘North Carolina Fall Infection
Control Conference’ on 30 September
2003 at the Inn on Biltmore, NC.
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| Proceedings
of the international symposium
on hygiene and disinfection held
in Wageningen published |
The
12 papers contained in a special
issue of International Biodeterioration
and Biodegradation (2003,vol 51,
231-302) represent some of the
latest ideas on the impact of hygiene
and disinfection in daily life.
The papers were presented in the
second international symposium “Disinfection
and hygiene: future prospects” at
the Institute of Consumer Technology
and Product Use of the Wageningen
Agricultural University on the
18-19 October 2002.
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| Resolving
the global burden of gastrointestinal
illness: a call to action |
The
significance of gastrointestinal diseases
as a major health concern in developed
and developing countries is reviewed
in a report issued by the American Academy
of Microbiology “The global burden
of infectious intestinal diseases through
the gastrointestinal tract: a critical
scientific assessment of exposure”.
This excellent and probing report is
based on a colloquium convened by AAM
in Feb 2002, in Galway, Ireland. Colloquium
participants discussed data issues central
to the question of the global burden
of gastrointestinal disease and to matters
of public health, and agreed upon a series
of specific recommendations. The report
is available as a pdf file at
http://www.asmusa.org/acasrc/pdfs/
GIDiseasesReport.pdf. |
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WASH
HandwasNEW PUBLICATIONS – A
SELECTION OF NEW ENTRIES
IN THE IFH READING ROOMS |
Disinfectant
use can reduce the incidence of hospital
acquired-infections
IFH holds the view that, within a targeted
approach to home hygiene, there are times and
places where the use of a disinfectant product
is advisable. Despite the fact that this conclusion
is based on a significant amount of supporting
microbiological evidence, we are always being
asked to prove that disinfectant usage does
not just kills germs, but actually reduces
infection rates. A study recently published
in the Journal of Hospital Infection provides
evidence that hypochlorite environmental cleaning
may significantly reduce the incidence of infections
associated with Clostridium difficile, a major
cause of hospital-acquired diarrhoea. The study
looked at the impact of environmental cleaning
on the incidence of CDI (C. difficile infection).
Over 2 years, 1128 environmental samples from
two wards were examined. Environmental prevalence
of the bacterium was similar during the two
different cleaning regimens, but there was
a significant decrease in CDI incidence during
hypochlorite cleaning (1000ppm) on one of the
two study wards, with 17 fewer cases than during
detergent-based cleaning.
MH Wilcox et al. Comparison of the effect of
detergent versus hypochlorite cleaning on environmental
contamination and incidence of Clostridium
difficile infection. Journal of Hospital Infection
2003; 54(2):109-114.
Review paper: Disinfection and the prevention
of infectious disease
This paper presents a detailed review of
the published data on disease transmission
in home,
community and hospital settings, which is
then used to assess whether environmental
disinfection
plays a significant part in prevention of
infectious disease (ID) transmission. It
makes reference
to the infection control guidelines written
by the IFH (International Scientific Forum
on Home Hygiene), as well as guidelines by
the US Centers for Disease Control and Prevention,
the Food and Drug Administration, the Environmental
Protection Agency. These guidelines and the
review paper all acknowledge that IDs can
arise through insufficient disinfection
and thus
that one of the means for prevention of disease
is through proper disinfection. The paper
does not however make references to the
importance
of using disinfectants within a ‘risk-based’ or ‘targeted’ hygiene
approach in order to achieve maximum benefit,
nor does it compare the hygiene benefits
of disinfection against detergent-based cleaning.
Cozad A and Jones RD. Am J Infect Control 2003;
31:243-54
Microbial contamination in home laundry operations
in Japan.
The home-laundering situation in Japan is unique
among many countries as leftover bath water
is used for laundering the next day. However,
such a unique custom may cause household microbial
transmission. A bacteriological investigation
of various articles was carried out to clarify
the link between the microbial transmission
and the home laundering operation. Children's
underwear, bath towels, kitchen rags, washing
machine and leftover bath water were investigated.
Staphylococcus was isolated from every sample.
Although pathogenic bacteria were not detected,
some opportunistic pathogens were. Since many
bacteria were isolated from bath water, home-laundering
with used bath water may cause microbial contamination
of the laundry.
Ref: Tabata A et al. Biocontrol Science (Japan)
2003; 8(1):9-18.
The microbiological quality of washing-up
water and the environment in domestic and commercial
kitchens
The temperature of washing-up water and bacterial
quality of the water, dishcloths, tea towels
and other surfaces was determined following
meal preparation by people without food safety
training in their own kitchen or by trained
staff in a commercial kitchen. This study reinforces
the message that bacteria can survive and spread
in the home during and after high-risk practices
such as food preparation. Campylobacter and
Salmonella were found in 96% and 13% respectively
of raw chickens used in the meal preparation.
In domestic kitchens, 2 of 45 sponges/dishcloths/scourers
and 1 of 32 hand/tea-towels were contaminated
with Campylobacter after washing-up and cleaning.
Campylobacter was detected in 1 of 10 washing-up
water samples from the commercial kitchen.
Mattick, K., Durham, K., Hendrix, M., Slader,
J., Griffith, C., Sen, M. and Humprhey, T.
J. Appl Microbiol 2003; 94:842-848.
Effect of washing hands with soap on diarrhoea
risk in the community: a systematic review.
This review set out to determine the impact
of washing hands on the risk of diarrhoea
in the community. Seventeen studies (seven
interventions,
six case-control, two cross-sectional, and
two cohorts) that linked handwashing with
diarrhoeal diseases were analysed. Based
on the evidence
analysed, washing hands with soap could reduce
the risk of diarrhoeal diseases by 42–47%.
The risks of severe intestinal infections
and of shigellosis were associated with reductions
of 48% and 59%, respectively. The authors
extrapolated
that the potential number of diarrhoea deaths
that could be prevented by handwashing is
about 1 million. They recommend that more
and better-designed
trials are needed to measure the impact of
washing hands on diarrhoea and acute respiratory
infections in developing countries.
Curtis, V. and Cairncross, S. Lancet Infectious
Diseases 2003; 3:275-281.
Hygiene in the home: relating bugs and behaviour.
This study looked at families with an infant
recently immunised against polio. Hygiene
practices were observed, and surfaces touched
after nappy changing were swabbed and examined
for poliovirus in order to show where cross-contamination
occured as a result of poor hygiene practices.
Only 43% of child-carers washed their hands
with soap after changing a dirty nappy. Although
nappy changing took place mainly in living
rooms, evidence of faecal contamination was
also found in kitchens and bathrooms. Poliovirus
was also detected 12% of living room surfaces.
Curtis, V., Biran, A., Deverell, K., Hughes,
C., Bellamy, K. and Drasar, B. Social
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