Several new papers have recently been published on the subject of “disinfectants” - and the issues associated with their use. The June issue of the American Journal of Infection Control contains two short “commentaries” focussing mainly on the issue of hospital hygiene. The first one, by the German Professor Franz Daschner, a strong opponent of disinfectant usage both in hospitals and at home, argues that targeted disinfection regimens may be useful in certain risk situations, but strongly contests the need for disinfectant in “routine” situations. In Professor Daschners paper, however, "routine" could be intended to mean "daily or weekly" or it could mean "in routine wards" i.e. in wards where there are no MRSA-infected patients or where there are no high dependence immune compromised patient i.e. ICUs. In another recent paper (AJIC vol32, 84-88), he suggests that there is a need for surface disinfectants in e.g. MRSA isolation wards - so from this we deduce that, by routine, he means daily/weekly cleaning on "routine wards". If this is the case this means that he is largely in agreement with the views expressed by US Professor Bill Rutala in his paper entitled “The benefits of surface disinfection”, the difference is largely down to the definition of "routine”? The paper can be downloaded by clicking here.

The papers were submitted in response to an earlier published review by Cozad et al (AJIC 2003; 31:243-53) evaluating the benefits of disinfection in hospital and home settings. IFH also responded to this paper with a paper published in the AJIC July issue ( http://authors.elsevier.com/sd/article/S0196655304003633 ) arguing the case for a rational, targeted approach to hygiene, and for disinfectant use in situations where detergent-based cleaning is inadequate.

A paper by Prof. Peter Gilbert has also been published in "Microbiology today" (vol.31, 62-63). In this paper Prof Gilbert argues that the risks associated with biocide use, in relation to microbial resistance, have been overstated. The paper states “it is now imperative that confidence is restored in these products". Professor Gilbert also presented a paper supporting the same arguments at the Annual meeting of the American Society for Microbiology in June. Prof Gilbert’s recent research findings are reviewed in an IFH Home Hygiene Library paper “ Biocide usage and antimicrobial resistance in home settings: an update”.

An intensive program of handwashing education and promotion in Pakistan decreased the incidence of diarrhoea by more than 50 percent among children, according to a study in the June issue of The Journal of the American Medical Association (vol. 291, pp2547-54). The study was carried out by Dr Stephen Luby, of the Center for Disease Control and Prevention, Atlanta.

The study was conducted among 36 neighbourhoods in urban squatter settlements in Karachi, Pakistan. Field workers visited households weekly for 1 year to provide education to all household members old enough to understand about proper handwashing with soap after defecation and before preparing food, eating, and feeding a child. They used slide shows, videotapes, and pamphlets to illustrate health problems resulting from contaminated hands. In the study, 300 households (1523 children) received antibacterial soap (containing triclorocarban, TCC) and 300 households (1640 children) received plain soap. The results clearly document the public health benefits of handwashing with soap (i.e., ~50% reduction in the incidences of diarrhoea), although the authors failed to find any difference in efficacy between the antibac and non-antibac soap groups. This was perhaps not surprising, since TCC is not effective against the gram negative and other organisms responsible for most forms of diarrhoea. The antibac vs. nonantibac comparison was only expected to be significant in relation to efficacy against the skin disease impetigo.

This is the first of three studies to be published examining how handwashing could decrease incidence of diarrhoea, upper respiratory illness and impetigo. The authors additionally report that they did not see any significant difference between the effectiveness of the two soaps against impetigo.

At the World Summit on Sustainable Development held in Johannesburg in September 2002, world leaders accepted the clear goal of halving the proportion of people without safe water and sanitation by the year 2015.

In response to the challenges posed by the impending water and sanitation crisis especially in urban areas, and inspired by the launch of the global WASH (Water, Sanitation and Hygiene for ALL) campaign in Bonn, Germany, the Water Supply and Sanitation Collaborative Council (WSSCC) South-East Asia Coordinating Office set up the WASH Manila Project in early 2002. The WSSCC, an international organization dedicated to enhancing collaboration in water supply and sanitation among multi-stakeholders, was mandated by a United Nations resolution in 1990.

The main objectives of the Manila Project are to spread the WASH messages by creating a sustainable and replicable water and sanitation package that includes Appropriate Technology Transfer, Education, Advocacy, Livelihood skills training and the development of IEC (Information, Education and Communication) materials. It also aims to get the support of organizations with expertise in community organizing and provide logistical support, and to partner with other local/international organizations which are willing to integrate and replicate the project into their existing efforts and communities.

With these objectives in mind, the WASH Manila Project has successfully accomplished the following activities:

• Establishment of the WASH Manila Project in slum areas in Manila.
• Training of WASH Advocates or Change Agents.
• Development and publication of a WASH Learning Module “Ang Kalusugan Ay Nasa Inyong Mga Kamay (Your Health Is In Your Hands).”
• Development of WASH Information and Education (IEC) Materials.
• Launching of the Community WASH Days in urban slum communities.
• Launching of the WASH Caravan at Baseco Compound, Tondo, Manila.
• Establishment of linkages and partnerships with various governmental, non-governmental and civil society organizations with like-minded interests in the programs of WASH & WSSCC.
• Participation in various fora and meetings focusing on issues of Water and Sanitation such as the Third World Water Forum In Kyoto in 2003.
• Media exposure via television, local and international newspapers and other media organizations.

WASH Manila continues to explore new avenues by establishing partnerships with local and international organizations to further expand the reach of the project around the Philippines and in Southeast Asia so that more people will be able to realize the importance of water, hygiene and sanitation.

For more information, please contact: WASH Training and Resource Center, 4336 Montojo St., Makati City, Philippines, Telefax: (632)896-5483 E-mail: washtrc@molave.org

World Congress on Foodborne infections June 2004

In June, IFH board members participated in the 5th World Congress on Food-borne Infections, BerlinPromoted by the Federal Institute for Risk Assessment, FAO and WHO, the World Congress on Food Borne Infections was a platform for interdisciplinary exchange on the subject of detecting, fighting and preventing foodborne diseases between the groups working in the field of consumer health protection. Prof Rijkelt Beumer, IFH Board Member, and Dr Kusumaningrum, presented two research papers: "Cross-Contamination of foodborne pathogens in (household) kitchens", and "Survival of foodborne pathogens in (household) kitchens". The studies evaluated the probability of contamination as a result of cross-contamination in the kitchen, and the potential bacterial contamination occurring in kitchen environments implicated in the transmission of infectious disease. IFH guidelines and recommendations were distributed to participants as supporting evidence for the potential for infection and cross-infection in the home and for providing guidance on how to prevent such infections.

In recent years laundry practices across Europe have changed considerably. In particular there has been a trend towards use of lower temperatures. Many of these changes have been introduced in order to reduce the environmental impact of domestic laundering. Although the impact on cleaning efficiency and textile quality has been assessed, little is known about the hygienic effects of these changes. In response to these concerns Prof Paul Terpstra at Wageningen University and co-workers have carried out a study of laundry processes in four European countries, Netherlands, Norway, Greece and Spain. For each country the hygienic quality of naturally soiled domestic laundry, washed according to the 2 most common practices of the country, was assessed by determining the microbiological count of relevant micro-organisms on naturally soiled domestic laundry before and after washing. On one hand the results show interesting differences between laundry habits across Europe. The results also show that the hygienic quality of the washing processes at lower temperatures (40°C) is relatively poor; in some cases, contamination was little affected by the laundry process. The 60°C programmes performed better but even with these programmes, the laundry remained contaminated after the wash process. The research confirms that increased washing temperatures and the presence of bleach agents in the detergent improve the level of hygiene. A summary of the findings of this project can be found in the IFH home hygiene library. Copies of the full report can be obtained from Mrs. Ir. I.A.C. Van Kessel of the SOHIT Research Institute : Inge.vanKessel@SOHIT.nl or pterpstra@mac.com.

In the next months, IFH members of the Scientific Advisory Board will be available to meet you at the following events

• 5th Congress of the International Federation on Infection Control (IFIC), Porec, Croatia, 9 – 12 October 2004. (Please visit us at our exhibition stand)
  
• Water Supply and Santiation Collaborative Council "WASH Forum", Dakar, Senegal, 29 November - 3 December 2004. (Come attend our participatory session and visit us at our exhibition stand)

Increase in viral gastroenteritis outbreaks in Europe and epidemic spread of new norovirus variant . Lopman, B., Vennema, H., Kohli, E., et al. Lancet 2004;363:682-88

During 2002 there were a high number of gastroenteritis outbreaks in hospitals and on cruise ships due to Noroviruses (NV). Data from 10 European countries was analysed and compared to historic data to investigate whether this reported activity was unusual. The data showed a striking increase and unusual seasonal pattern of NV gastroenteritis in 2002 that occurred concurrently with the emergence of a new genogroup II4 variant. The variant was first noted in January in Germany and Netherlands, and throughout 2002 became the predominant cause of NV outbreaks in Europe. The researchers were unable to explain how the variant spread but the dissemination was associated with a wave of person-to-person outbreaks.

Prevalence and numbers of Escherichia coli O157:H7 in minced beef and beef burgers from butcher shops and supermarkets in the Republic of Ireland. Cagney, C., Crowley, H., Duffy, G., Sheridan, J.J. et al. Food Microbiology 2004;21:203-212.

In this study 1533 samples of fresh and frozen minced beef or beef burgers were collected over a 13-month period. Overall, E. coli O157:H7 was recovered from 2.8% samples with counts ranging from <0.52–4.03 log 10cfu/g. Of the positive samples, 2.7% were purchased from supermarkets and 3.14% from butcher shops. Only one product type (fresh unpacked burgers from supermarkets) was negative for E. coli O157:H7. Of the products containing the pathogen, fresh packaged burgers from supermarkets had the highest prevalence of 4.5% while fresh unpackaged mince purchased from supermarkets had the lowest prevalence of 2%.

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.

The effect of enhanced hygiene practices on absences due to infectious diseases among children in day care centers in Helsinki. Ponka, A., Opoussa, T. and Laosmaa, M. Infection 2004;32:2-7.

The study was conducted as an open, controlled cluster study. It included 60 DCCs for intervention and 228 DCCs as controls. The hygiene intervention program included 8 steps such as intensified handwashing among both children and staff, washing toys weekly, surfaces reachable by children were washed daily. The control DCC continued to follow their usual hygiene policies and practices. The main indicator was the occurrence of absences due to upper respiratory tract infections, otitis media, eye infection and diarrhea per child-month. In the intervention DCC absences due to infections reduced by 26% among under 3-year olds, but not among older children.

Norovirus Cross-Contamination during Food Handling and Interruption of Virus Transfer by Hand Antisepsis: Experiments with Feline Calicivirus as a Surrogate. Bidawid, S., Malik, N., Adegbunrin, O., Sattar, S.A. and Farber, J.M. J Food Protect 2004; 67:103-109.

FCV was deposited onto fingerpads and allowed to air dry. The contaminated fingerpad was then pressed onto 1cm disks of ham, lettuce or metal. The virus remaining and transferred was measured. Virus transfer to clean hands from experimentally contaminated disks of ham, lettuce, and metal was also tested. Nearly 46%, 18% and 13% of virus transferred from fingerpads to ham, lettuce and metal, respectively. Approx. 6%, 14% and 7% virus transferred from ham, lettuce, and metal disks to hands. Washing of the fingerpads either with water or with both topical agent and water significantly reduced virus transfer to a 0.9%, as compared with a 2.3 and a 3.4% transfer following treatments with either 75% ethanol or a commercial hand gel containing 62% ethanol, respectively.

Effect of intensive handwashing program on childhood diarrhoea in high risk communities in Pakistan. Luby S Abboatwalla M, Painter J, Altaf A, Ward BL, Hoekstra R. Journal of the American Medical Association 2004, 291, 2547-54.

The study was conducted among 36 neighbourhoods in urban squatter settlements in Karachi, Pakistan. Field workers visited households weekly for 1 year to provide education to all household members old enough to understand about proper handwashing with soap after defecation and before preparing food, eating, and feeding a child. They used slide shows, videotapes, and pamphlets to illustrate health problems resulting from contaminated hands. In the study 300 households (1,523 children) received antibacterial soap (containing triclorocarban, TCC) and 300 households (1,640 children) received plain soap. The results clearly document the public health benefits of hand washing with soap (i.e., ~50% reduction in the incidences of diarrhoea), although the authors failed to find any difference in efficacy between the antibac and non-antibac soap groups. This was perhaps not surprising, since TCC is not effective against the gram negative and other organisms responsible for most forms of diarrhoea. The antibacterial versus.non-antibacterial comparison was only expected to be significant in relation to efficacy against e.g impetigo.

Effect of antibacterial home cleaning and handwashing products on infectious disease symptoms. A randomised double-blind trial. Larson, E.L., Lin, S.X., Gomez-Pichardo, C. and Della-Latta, P. Ann Intern Med 2004;140:321-329.

The aim of this US study was to evaluate the effect of antibacterial cleaning and handwashing products in 238 households (that included at least one preschool-age child) on the occurrence of infections. Households were randomly assigned to use either antibacterial or nonantibacterial products for general cleaning, laundry, and handwashing. Hygiene practices and infectious disease symptoms were monitored by weekly telephone calls, monthly home visits, and quarterly interviews for 48 weeks. It concluded that antibacterial products, such as soaps, laundry detergents and household cleaners do not reduce infection rates in families. However, the study did not look at how products were used. The study reports no effect on viral illness, but the products tested were antibacterial, and therefore not designed to kill viruses

Cross-resistance to antibiotics of Escherichia coli adapted to benzalkonium chloride or exposed to stress-inducers. Langsrud, S., Sundheim, G. and Holck, A.L. J Appl Microbiol 2004;96:201-208.

This study looked at the effects of adaptation and stress on the resistance to benzalkonium chloride (BAC) and cross-resistance to antibiotics. Exposure of E. coli to stress inducers (salicylate, chenodeoxycholate and methyl viologen) generally increased the tolerance to BAC and chloramphenicol (CHL). This indicated that adaptation to BAC could be partly attributed to stress responses. Enhanced efflux was one of the observed differences in adapted cells. The authors conclude that provided not taking due precautions, extensive use of disinfectants could lead to emergence of antibiotic-resistant isolates.