IFH 1997-2004: what has it done, where is it going?
A report from the Chairman |
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IFH was established in 1997 in response to concerns about the absence of international, or even national, bodies that could speak from a scientific standpoint about the need for effective home and community hygiene practices.
The key distinguishing feature of IFH is that it looks at hygiene from the point of view of the family and the range of problems they face in reducing infectious disease (ID) risks. Through its various initiatives, IFH has become an authoritative voice on the subject of hygiene risks in the home and provided sound scientifically-based guidance on best hygiene practice. The “welcome” that IFH has received in these years from the national and international bodies involved in health policy and promotion demonstrates that it addresses a previously unmet need.
Several important initiatives mark the continuing success of IFH. This includes the publication of consensus documents which review the scientific basis of home hygiene, and the Guidelines which make detailed recommendations for home hygiene practice which were first published in 1998 and 2002. It also includes the IFH 2000 & 2002 conferences in London and Delhi, which attracted speakers from major health authorities and a full audience of delegates, the IFH website which currently attracts around 4000 visitors per month and the quarterly email alerts and newsheets IFH which communicate with over 1800 scientists in 85 countries, all of whom have specific association with home hygiene.
Since the formation of IFH in 1997, attitudes towards hygiene have continued to evolve. Even within the period since IFH was established, the profile of hygiene has increased, although there are significant differences between the developed and developing world:
- In the developed world, ID and hygiene continue to move back up the health agenda as the result of the whole range of demographic and social changes which are taking place. These include concerns about foodborne, waterborne, and other infectious intestinal diseases, which remain at unacceptably high levels, concerns about antibiotic resistance which compromises our ability to treat bacterial diseases, concerns about viral agents which are not treatable by antibiotics, and about new agents such as SARS and their potential for rapid global spread. Of particular relevance to the home is the increasing prevalence of “at risk” groups in this setting.
- In the developing world the 2002 United Nations (UN) Millennium Development Goals (MDG) firmly established the issues of “water, sanitation and hygiene” on the global agenda. There is widespread consensus however that, one of the past mistakes in tackling ID, has been to give priority to water over sanitation and to sanitation over hygiene. In reality it is hygiene (e.g. keeping faecal matter away from hands, food and water, preventing cross contamination from raw to “ready to eat” food etc) that reduces the burden of ID. The neglect of hygiene goes a long way to explaining why water and sanitation programmes have often not brought the expected benefits.
Although there is a renewed emphasis amongst public health scientists, health professionals and global health organisations on the importance of hygiene promotion, this does not necessarily translate into commitment to action by national and international government and non-government departments and agencies. We need to persuade governments and funding agencies both in developed as well as developing countries to invest in hygiene promotion. One of the significant barriers to progress is the fact that, in most countries, the separate aspects of hygiene promotion (faeces disposal, food and water hygiene, handwashing, care of the sick, childcare etc) are dealt with by separate agencies. If hygiene promotion is to be effective, ideally there should be single national lead agencies, and appropriate infrastructures at national, district and local level which are specific for actioning hygiene promotion. A key need is to bring the separate “hygiene-related” agencies together and develop programmes in collaboration. The fact that IFH looks at hygiene “holistically” from the point of view of the family and the range of problems which they face in protecting against infectious diseases puts it in a good position to participate in the global drive to improving health through hygiene, both for its intrinsic competencies and the position it has established within the network of donors, government agencies, NGOs and private sector partners.
The year 2004 has again been very productive for IFH, but there is much still to do. In 2004 we published new reports on topics such as the hygiene hypothesis, fungi in the home, and cost effectiveness studies on hygiene in developing country situations. We have also established a South East Asia office in Calcutta under the direction of our board member Professor Nath. Through the various conferences which we have attended, our exhibition stands and our workshops, we have continued to promote the IFH approach to hygiene practice, and distribute IFH materials on hygiene practice such as the home hygiene guidelines and the home hygiene training resource. All of these materials are available through our website. The IFH/ICNA training resource on home hygiene has sold some 400 copies in the past year and we are now seeking new partners to produce translated versions, and versions that are adapted to developing country situations. We look forward to 2005, and hope that it will turn out to be another productive year.
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New Fact Sheet on the IFH website |
 The new IFH advice sheet on “Cleaning up the home after Floods” provides general guidelines for reducing the risk of contamination from germs during a flood, including information on surface cleaning, decontamination of drinking water sources, treatment of water for domestic use during the flood and links to useful internet resources.
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| Global WASH Forum – Water, sanitation and hygiene for all – solutions and actions – local and national |
The first Global Wash Forum was organised by the Water and Sanitation Collaborative Council in Dakar, Senegal from 29th Nov to 3rd Dec. The stated aim of the Forum was “to accelerate action in water sanitation and hygiene towards achieving the Millennium Development Goals”. The conference was attended by around 500 international delegates and comprised a series of plenary sessions, partner events and exhibition stands. Throughout the conference considerable attention was given to hygiene and the need to integrate hygiene promotion into water and sanitation programmes. IFH organised a partner event on “developing and promoting hygiene practice in the home and community setting”. A report of the IFH session can be downloaded from the “events” section of the IFH website. Other partner sessions on hygiene were organised by IRC, Streams of Knowledge, Ecosan, London School of Hygiene, WELL, and NETWAS. The immediate outcomes from the forum are the “conference statement” and the “road map”. Reports and presentations from all sessions will be made available through the WSSCC website at a later date.
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IFIC conference – Croatia |
 The annual conference of the International Federation of Infection Control was held in Croatia on October 9-12 2004. IFIC is a federation of infection control societies from more than 35 countries around the world, which is working to reduce risks for patients and personnel related to health care. At the conference IFH hosted an exhibition stand to promote IFH concepts and IFH materials. These materials were well received by delegates, many of whom talked about the need for more support for community health workers on protecting those more vulnerable to infection in the home. IFIC produces two very valuable  resource documents on infection control which may be of interest to readers of this newsletter. The first - “Information Resources in Infection Control” - is a significant “global” collation of materials supporting infection control activities including publications, guidelines and website addresses. The second “Infection control: Basic concepts and training” outlines the basic principles and practices of hospital infection control. |
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| New papers on the hygiene hypothesis |
Professor David Strachan, who first elaborated the hygiene hypothesis, has published an update review (Curr Opin Otolaryngol Head Neck Surg, 2004 12: 232-236) assessing recent epidemiological evidence, and evidence related to biological plausibility. He concludes that the hypothesis remains a credible but non-specific explanation for the recent rise in atopic disease, but that more studies are needed to unravel the key elements - which infectious agents exert a protective effect, the time period of importance for exposure (e.g. early childhood) and the environmental characteristics causing the effect - before we can begin to identify opportunities for intervention. In a review published in the Journal of the European Molecular Biology Organisation (EMBO reports 2004 5 1122-1124), Professor Graham Rook hypothesises that the key agents are harmless microbes such as Lactobacilli, saprophytic mycobacteria and parasitic worms, once abundant, but are now absent from everyday life. Helminths such as pin worms disappeared from our environment just prior to the rise in allergies in the 60s and 70s. Saprophytic mycobacteria are no longer present in our chlorinated water where previously they would have been common. Rook suggests that these agents were important because they taught the immune system not to overreact. The body learned to tolerate Helminth invasions which would otherwise have overwhelmed the immune system, and to overlook gut lactobacilli which are beneficial. He says “we are so focussed on the immune system responding to things, we forget that 99.999% of the time its function is not to respond”. His conclusions are in line with those contained in the IFH “Hygiene Hypothesis” report – “what we are talking about is fundamental changes in lifestyle, not just trivial matters of everyday domestic hygiene – it’s the fact that we no longer drink water from streams, and we no longer have worms”
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A new study of cost-effectiveness analysis (CEA) of hygiene promotion in developing country situations |
This new WELL study by Trea Christoffers and Christine van Wijk of the IRC Water and Sanitation Centre reviews the results of a number of studies which assess the cost-effectiveness of hygiene promotion as part of, or in addition to, investment programmes for water supply, sanitation and/or health and hygiene. The study critically reviews the methodologies used in these assessments. In these studies two main approaches have been used, namely 1) general sector studies using DALYs and 2) evaluations of specific projects or programmes.
The outcomes of studies using DALYs to measure cost-effectiveness of hygiene promotion varied a lot. The research methods are complex and involve a number of assumptions that are not easy to prove. Evaluation at the programme or project level indicated the importance of evaluating all aspects including inputs, processes, outputs and effectiveness of the hygiene programme; studies often focus on the inputs and the outputs of a programme and far less on the effectiveness in terms of behaviour change. When evaluating programme effectiveness it has to be carefully decided which results are to be measured: the direct results, the sustained results or the health impact. Health impacts are less often assessed than improved conditions and practices because they are difficult to measure without using qualified health staff, which is not always available – also because it makes no sense to measure impacts without first establishing that sustained behavioural change has been achieved.
The authors conclude overall that:
- hygiene promotion has a substantial positive impact on people’s health, in particular on the reduction of diarrhoeal diseases.
- hygiene promotion is more cost-effective than other water and sanitation interventions. This effectiveness is greatest in combination with improved and affordable and accepted water and sanitation services.
- more priority should be given to hygiene promotion as a separate component in a water and/or sanitation programme, or as a project or programme on its own.
The authors also advise that:
- CEA should become part of every project proposal and every project evaluation. Doing so, hygiene promotion methods can be compared in terms of cost-effectiveness and the most cost-effective hygiene promotion methods can be retained and replicated. This way, CEA can ensure best ‘value for money’ from efforts to achieve the MDGs.
- Environmental health programmes planners need to be made aware that CEA methods and tools exist and can be included in their projects and programmes. The importance of CEA studies calls for a clear, simple and sound methodology that can be used at project and programme level and whose results can be accepted and validated by the sector. The development of such a methodology is urgently needed.
From Feb/March 2005 a WELL Briefing Note on this subject and the full paper will be available at http://www.lboro.ac.uk/well/
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| Achieving and Sustaining hygiene change interventions – findings of a multicentre study and implications for developing Water, Sanitation and Hygiene programmes |
From 2000-2003 six research teams, each from a different country and coordinated by IRC, carried out studies into the effectiveness of hygiene promotion interventions in developing country situations. The studies are recorded in 2 booklets rather than as a detailed academic report. IRC says “We believe that this will best serve the interests of busy people requiring an easily accessible reference to the study and its outcomes”. Booklet 1 provides information on how to set up a study on hygiene promotion, and how to avoid the mistakes of earlier studies. Booklet 2 is for those wanting to set up or improve their own hygiene promotion efforts. The booklets have been written is such a way that each can be read on its own. If you would like a copy of these booklets contact the IRC through their website http://www.irc.nl/
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| Developing survey methodology for Water, Sanitation and Hygiene practices. By Kristof Bostoen, London School of Hygiene and Tropical Medicine |
 In the developing world almost one in four people lack access to water while over half the population have no access to sanitation. Targets like Vision 21 and the Millennium Development Goals (MDG) have been set to improve this situation, and quantifying access through surveys will be essential to attain these goals. Current figures are based on surveys conducted for other sectors, to which water and sanitation questions are added. They mainly refer to national level and are collected with inappropriate frequency and timing for local and project use. The Environmental Health Group at the London School of Hygiene and Tropical Medicine (LSHTM) on request by the Water Supply an Sanitation Collaborative Council is designing a sector specific survey methodology suitable for sub-national and project level as well as national data collection. The Water, Sanitation and Hygiene survey methodology (WaSH) being developed at the LSHTM, is a cross-sectional, cluster survey method to measure progress toward the MDGs. Apart from the traditional questionnaires, WaSH uses spot observations, pocket voting and demonstrations. So far it has been tested in Kosovo, Kenya, South Africa and Laos. Validating the indicators has proved difficult, for lack of a gold standard. This is particularly true when measuring hygiene behaviour. Households might, in terms of hygiene behaviour, not be the most suitable ‘basic sampling unit’ (BSU) as within the household women, men or children could have distinctive different behaviours which will be difficult to distinguish in a household survey. Another major finding is the high design effect in water and sanitation cluster surveys which has implications for the way representative sampling is done in household cluster surveys. To measure coverage, suitable simple sampling techniques equivalent to those used in the WHO and UNICEF Expanded Programme of Immunisation (EPI-sampling) still need developing and testing. Current representative sampling methods are too complex and often have a bias towards ‘better’ socio-economical groups. Currently LSHTM is preparing a project to test such alternative sampling methods. Only with such an appropriate survey design can accountability be introduced into the water sector, ensuring that coverage in the 21st century reaches the levels attained by immunization in the 20th century.
A draft of the WaSH methodology will be available by mid 2005. Further information can be obtained by e-mail citing this article at well@lshtm.ac.uk. Further information on assessing hygiene improvements can be found on the WebSite of the former USAID Environmental Health Project. |
Update on IFH SEA office activities |
On 20 and 21 December, IFH organised a two day workshop/brainstorming in the Calcutta Medical College jointly with the Indian Public Health Association to interact with the experts/trainers of health education, public health nursing and medical courses on the adaptation of the training resource on home hygiene developed by IFH/ICNA.
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UPCOMING CONFERENCES
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Learning Alliances for Scaling Up Innovative Approaches in the Water and
Sanitation Sector, Delft, The Netherlands, 6 Jun 05 - 10 Jun 05.
Organised by: IRC International Water and Sanitation Centre and Unesco-IHE Institute for Water Education
31st WEDC International Conference – Maximising the Benefits from Water and Environmental Sanitation, Kampala, Uganda, 31st October - 4 November 2005 Organised by the Water Engineering and Development Centre at Loughborough University in the UK.
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| New publications in the IFH Reading Rooms |
Burden of infecious diseases in South East Asia. Zaidi, AKM, Janaka deSilva AH. British Medical Journal 2004, 328, 811-815
This paper reviews the underlying causes of some of the more common infectious illnesses in South East Asia and strategies to improve their detection and control.
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Dietary intake and domestic food preparation and handling as risk factors for gastroenteritis: a case-control study. Mitakakis T Z. Wolfe R. Sinclair M I. Fairley, CK, Leder, K, Hellard, ME. Epidemiology and Infection 2004, 132: 601-606.
Cases of gastroenteritis were examined to identify if dietary intake prior to an episode and food-handling and storage practices in the home were risk factors for illness. Comparing cases to themselves when well, subjects were more likely to have eaten cold sliced salami, fried rice and foods cooked elsewhere, and to have had a baby in nappies in the house. Cases compared to non-cases were more likely to have bought frozen poultry, have eaten foods cooked elsewhere and to have had a baby in nappies in the house. Although food -handling and storage practices were considered important, it was not possible to detect an association in this study.
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Prevalence of microbial biofilms on selected fresh produce and household surfaces. Rayner, J, Veeh, R. Flood, J. International Journal of Food Microbiology 2004, 95: 29-39.
Samples of household surfaces, including food, laundry and kitchen items, were analyzed for evidence of biofilms. Visualization of the surfaces was carried out using cryostage scanning electron microscopy and light microscopy. Qualitative evidence of the presence of biofilm formation was obtained from all of the sample groups analyzed, suggesting the widespread existence of microorganisms in biofilms on domestic surfaces. This suggests that biofilms may be important in household hygiene, and highlights the need for standardized, approved biofilm methods suitable for consumer products testing.
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Severe acute respiratory syndrome coronavirus on hospital surfaces. Dowell, S.F. Simmerman, J.M. Erdman, D.D. Wu, J.-S.J. Chaovavanich, A. Javadi, M. Yang J.-Y. Anderson, L.J. Tong, S. Mei, S.H. Clinical Infectious Diseases, 2004, 39: 652-657.
The possible contribution of hospital surfaces to SARS transmission was examined in 2 hospitals where there were infected patients. Twenty-six of 94 swab samples tested positive for viral RNA. Swab samples of respiratory secretions from each of the 4 patients examined tested positive by RT-PCR, as were 12 of 43 swabs from patient rooms and 10 of 47 swabs from other parts of the hospital, including the computer mouses at 2 nursing stations and the handrail of the public elevator. Specimens from areas with patients with SARS in the most infectious phase of illness were more likely to be RNA positive than were swab specimens from elsewhere. Health care workers should be aware that SARS coronavirus can contaminate environmental surfaces in the hospital, and fomites should be considered to be a possible mode of transmission of SARS.
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Toys in a pediatric hospital: Are they a bacterial source? Avila-Aguero, M.L. German, G. Paris M.M. and Herrera J.F. American Journal of Infection Control, 2004. 32: 287-290.
This study was conducted to determine whether toys were contaminated with potentially pathogenic bacteria when they arrived in the hospital from home, and whether they were contaminated in the hospital. Seventy children's toys were included in this study. Respiratory infections (43%) and diarrhea (26%) were the most common causes of hospitalization. Twenty-nine(41%) were brought from home, 38(55%) were purchased from roving vendors, and 3(4%) from toy stores. All cultures were positive for at least 1 pathogenic microorganism including coagulase-negative Staphylococcus, Bacillus spp, Staphylococcus aureus, alpha-hemolytic Streptococcus, Pseudomonas spp, Stenotrophomonas maltophilia, and other gram-negative organisms.
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A quantitative analysis of cross-contamination of Salmonella and Campylobacter spp. via domestic kitchen surfaces. Kusumaningrum H.D. Van Asselt, E.D. Beumer, R.R. Zwietering, M.H. Journal of Food Protection, 2004, 67: 1892-1903.
A quantitative analysis was carried out to estimate contamination of Salmonella and Campylobacter spp. on salads as a result of cross-contamination from chicken carcasses via kitchen surfaces. A deterministic approach and Monte Carlo simulations were used to estimate the contamination of the product. The results show that the probability of Campylobacter spp. contamination on salads is higher than that of Salmonella spp., since both the prevalence and levels of Campylobacter spp. on chicken carcasses are higher than those of Salmonella spp. It is realistic to expect that a fraction of the human exposure to Campylobacter spp., in particular, originates from cross-contamination in private kitchens during food handling. The number of human campylobacteriosis cases could be reduced either by reducing the degree of Campylobacter spp. contamination on chicken carcasses or by improving the hygiene in private kitchens .
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Seroepidemiology and risk factors for sporadic norovirus/Mexico strain. Peasey, AE. Ruiz –Palacios, GM. Qigley, M. Newsholme, W. Martinez, J. Rosales, G. Xi Jiang. Blumenthal, R. The Journal of infectious diseases, 2004, 189: 2027-2036.
Risk factors associated with transmission of sporadic norovirus (NV) were identified in a seroepidemiological study conducted in rural Mexico. Personal and domestic hygiene measures, such as hand washing, general cleanliness of the mother's clothing, and the type of room assigned for cooking were significantly associated with odds of a seroresponse. For infants, having a dog in or near the home was a risk factor for seroresponse (P<.01), whereas, for older children, the mother's involvement in agricultural activities was a risk factor.
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A review of outbreaks of foodborne disease associated with passenger ships: evidence for risk management. Rooney Roisin, M. Cramer EH, Stacey, M, Nichols G. Bartram J. Farber, J. Benembarek, PK. Public health reports, 2004, 119, 427-34.
The authors reviewed data on 50 outbreaks of foodborne disease associated with passenger ships. For each outbreak, data on pathogens/toxins, type of ship, factors contributing to outbreaks, mortality and morbidity, and food vehicles were collected. Factors associated with the outbreaks reviewed include inadequate temperature control, infected food handlers , contaminated raw ingredients, cross-contamination, inadequate heat treatment, and onshore excursions. Seafood was the most common food vehicle implicated in outbreaks.
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Predictors of infectious disease symptoms in inner city households. Larson, E.L, Lin, S. and Gomez-Pichardo, C. Nursing research 2004, 53 . 190-7.
This study aimed to determine the incidence and predictors of infectious disease symptoms over a 48-week period in inner city households. Cleaning and hygiene practices and the incidence of infectious disease symptoms were closely monitored prospectively for 48 months in 238 households. Four factors were significantly associated with infection. Drinking only bottled water increased risk. Using hot water and bleach for laundry and reporting that germs were most likely to be picked up in the kitchen were protective. No other hygiene practices, including hand washing, were associated with infection risk. The authors conclude that further studies of a potential role for bottled water in infections are warranted, as is a renewed appreciation for the potential protective role of laundry practices such as using bleach and hot water.
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Effect of intensive handwashing promotion on childhood diarrhea in high-risk communities in Pakistan: A randomized controlled trial. Luby S.P.; Agboatwalla M.; Painter J.; Altaf A.; Billhimer W.L.; Hoekstra R.M. Journal of the American Medical Association, 2004, 291, 2547-2554.
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.
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Inactivation of caliciviruses. Duizer, E. Bijkerk, P. Rockx, B. de Groot, A.Twisk, F. Koopmans, M. Applied and Environmental Microbiology 2004, 70: 4538-4543.
The inactivation of the reported enteric canine calicivirus no. 48 (CaCV) and the respiratory feline calicivirus F9 (FeCV) was studied and was correlated with inactivation to reduction in PCR units of FeCV, CaCV, and a norovirus. For all treatments, detection of viral RNA underestimated the reduction in viral infectivity. Norovirus was never more sensitive than the animal caliciviruses and profoundly more resistant to low and high pH. Overall, both animal viruses showed similar inactivation profiles when exposed to heat or UV-B radiation or incubated in ethanol or hypochlorite. The incomplete inactivation by ethanol and the high hypochlorite concentration needed for sufficient virus inactivation are of concern for decontamination of fomites and surfaces contaminated with noroviruses and virus -safe water.
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The efficacy of cleaning products on food industry surfaces. Lalla F.; Dingle P. Journal of Environmental Health 2004, 67: 17-21.
The sanitizing performance of kitchen fiber cloths and all-purpose fiber cloths sanitized with hot water at 75C was compared with that of antibacterial cloths and cleaning cloths sanitized with hot water at 75C or chemical sanitizers-quaternary ammonium compound (QAC) and hypochlorite. The QAC sanitizer resulted in the lowest overall concentrations of bacteria. The sanitizing performance of the fiber cloths was similar to that of the antibacterial cloths and cloths sanitized with QAC. Use of the fiber cloths resulted in lower concentrations of bacteria on stainless-steel kitchen surfaces, compared with the use of the cloths sanitized with hot water at 75C. Surface contamination after use of the all-purpose fiber cloths and after use of cloths sanitized with hypochlorite were similar.
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Inactivation of feline calicivirus, a surrogate of norovirus (formerly Norwalk-like viruses), by different types of alcohol in vitro and in vivo Gehrke, C. Steinman, J. Goroncy-Bermes, P. Journal of hospital infection, 2004, 56: 49-55.
Three types of alcohol were examined for virus-inactivating properties against feline calicivirus (FCV) as a surrogate for norovirus. Tests were performed as quantitative suspension assays or as in vivo experiments with artificially contaminated fingertips. The in vitro experiments showed that 1-propanol was more effective than ethanol and 2-propanol for inactivation of FCV. 70% ethanol showed the greatest efficacy in vivo with a log reduction factor (RF) of 3.78 compared with 70% 1-propanol (RF 3.58) and 70% 2-propanol (RF 2.15).
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An investigation into techniques for cleaning mold-contaminated home contents. Wilson SC. Brasel CG. Carriker, GD. Portenbury, MR. Fogel, MR. Martin, JM. Wu, C. Adriychuk, LA. Karunesasena, E. Straus, DC, Journal of Occupational and Environmental Hygiene. 2004, 1:442-447.
The study examined the effects of various treatments in eliminating fungal spores and mycotoxins from various materials commonly found in homes. Results showed that bleach/detergent washing was more effective overall in reducing contamination than gamma radiation and steam cleaning.
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Relationship between triclosan and susceptibilities of bacteria isolated from hands in the community. Aiello, A.E. Bonnie, M. Levy, S.B, Della-Latta, P. and Larson E. Antimicrobial agents and chemotherapy 2004, 48, 2973-9.
The possible association between triclosan and bacterial susceptibility to antibiotic was examined among staphylococci and several species of gram-negative bacteria (GNB) isolated from the hands of individuals in a community setting. The absence of a statistically significant association between elevated triclosan MICs and reduced antibiotic susceptibility may indicate that such a correlation does not exist or that it is relatively small among the isolates that were studied. Still, a relationship may emerge after longer-term or higher-dose exposure of bacteria to triclosan in the community setting.
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The hygiene theory: fact or fiction? Sheikh, A and Strachan DP. Current opinion in otolaryngology & head and neck surgery 2004, 12, 232-6.
The " hygiene hypothesis" offers a potentially credible and parsimonious explanation for the increasing prevalence of allergy noted in many westernized populations. The authors review recent evidence both for and against this hypothesis.
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Effects of quaternary-ammonium-based formulations on bacterial community dynamics and antimicrobial susceptibility. McBain A.J.; Ledder R.G.; Moore L.E.; Catrenich C.E.; Gilbert P. Journal: Applied and Environmental Microbiology, 2004, 70, 3449-3456.
The effects of a QAC-containing domestic cleaning fluid on the population dynamics and antimicrobial susceptibility of domestic sink drain biofilm communities was examied. QAC susceptibilities of numerically dominant, culturable drain bacteria were determined in vitro before and after repeated QAC exposure. A fully characterized drain microcosm was then exposed to short-term and long-term dosing with a QAC-containing domestic detergent. The data demonstrate the recalcitrance of domestic drain biofilms toward QAC and that although repeated QAC exposure of drain isolates in pure culture results in susceptibility change in some test bacteria, such changes do not necessarily occur within complex communities.
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Resistance in the environment. Journal of Antimicrobial Chemotherapy, 2004, 54: 311-320.
Increasingly, antibiotic resistance is seen as an ecological problem. This includes both the ecology of resistance genes and that of the resistant bacteria themselves. Little is known about the effects of subinhibitory concentrations of antibiotics and disinfectants on environmental bacteria, especially with respect to resistance. According to the present state of our knowledge, the impact on the frequency of resistance transfer by antibacterials present in the environment is questionable. The input of resistant bacteria into the environment seems to be an important source of resistance in the environment.
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Comparative analysis of antibiotic and antimicrobial biocide susceptibility data in clinical isolates of methicillin-sensitive Staphylococcus aureus, methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa between 1989 and 2000. Lambert, R J W. Journal of applied microbiology 2004, 97: 699-711.
Minimum inhibitory concentrations (MICs) data from clinical strains of Staph. aureus and Ps. aeruginosa were examined for changes over a 10-year period. Comparisons suggest that alterations in the susceptibility of Staph. aureus to biocides have occurred between 1989 and 2000, but that these changes were mirrored in MSSA and MRSA suggests that methicillin resistance has little to do with these changes. Between 1989 and 2000 a sub-population of MRSA has acquired higher resistance to biocides, but this has not altered the antibiotic susceptibility of that group. In both Staph. aureus and Ps. aeruginosa several correlations (both positive and negative) between antibiotics and antimicrobial biocides were found. From the analyses it is very difficult to support a hypothesis that increased biocide resistance is a cause of increased antibiotic resistance in Staph. aureus or Ps. aeruginosa.
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Kitchen practices used in handling broiler chickens and survival of Campylobacter spp. on cutting surfaces in Kampala, Uganda. Wanyenya, I. Muyanja, C. Nasinyama, GW. Journal of Food Protection, 2004 67: 1957-1960.
Handling practices used during preparation of broiler chickens in 31 fast-food restaurants and 86 semisettled street stands (street vendors). These establishments used wood, plastic, or metal cutting surfaces during the preparation of broiler chickens. In 87% of food establishments, the same work area was used for preparation of raw and cooked chicken, and in 68% of these establishments the same cutting boards were used for raw and cooked chicken. None of the establishments applied disinfectants or sanitizers when washing contact surfaces. Campylobacter spp. survived on wooden and plastic but not on metal cutting boards after 3h of exposure.
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Food safety in family homes in Melbourne, Australia Mitakakis, T.Z. Sinclair, M. Fairley CK. Lightbody, PK. Leder, K. Hellard, M.E Journal of food protection, 2004, 67: 818-822.
During 1998 food handling and food storage questionnaires were completed by an adult member in 524 and 515 families, respectively. Overall, 99.0% of respondents reported some form of mishandling, which included 70.3% who handled food preparation surfaces poorly, 46.6% who did not wash their hands appropriately or in a timely manner, 41.7% who mishandled raw foods, and 70.1% who mishandled cooked foods. Food was inappropriately located in the refrigerator by 81.2%, and chicken was thawed using unsafe means by 76.3% of respondents.
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Consumer food handling behaviours associated with prevention of 13 foodborne illnesses. Hillers, VN. Medieros, L. Kendall, P. Cheng, G. and Dimascola, S. Journal of Food Protection, 2003, 66: 1893-1899.
A four round Delphi technique was used to survey experts in food microbiology, epidemiology, food safety education and food safety policy with the aim of identifying and ranking in order of perceived importance various food handling behaviours such as temperature control, handwashing, avoidance of high risk foods etc. The authors concluded that the experts ranking of behaviours could help consumers to make informed choices about food consumption and food handling behaviours which could help educators prioritise in terms of their educational efforts.
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Home storage emperatures and consumer handling of refrigerated foods in Sweden. Marklinder, JMLindblau, M. Erikson, JM, Finnson, AM and Lindqvist, R. Journal of Food Protection, 2004 67, 2570-77.
Consumers for 202 households in Sweden were instructed to purchase a number of food items and store them overnight. The following day the participants were interviewed and the temperatures measured. Most respondents knew the recommended maximum temperature but less than one fourth claimed to know the temperature in their own refrigerator. The current situation might be improved if consumers could be persuaded to use a thermometer to monitor refrigerator temperatures.
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| Occurrence of Campylobacter in retail foods in Ireland. P. Whyte, K. McGill, D. Cowley, R.H. Madden, L. Moran, P. Scates, C. Carroll, A. O'Leary, S. Fanning, J.D. Collins, E. McNamara, J.E. Moore, M. Cormican. Journal: International Journal of Food Microbiology, 2004, 95, 111-118. |
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