Efforts to reduce the length of hospital stay and the preferences of patients and their families have contributed to the growth in homecare. Set up in 1957, the Paris “hospital at home” structure currently manages 820 patients. The unit provides care to patients of all ages with a variety of diseases. Patients receiving medical care at home are at risk of acquiring the same infections as hospital patients. An infection control committee was established in 1999, with the initial objective of estimating the prevalence of hospital acquired infections (HAIs) in the homecare setting to determine potential risk factors for infection and to increase staff awareness of HAI. This study (reported in Journal of Hospital Infection 2005; 59: 148-51) evaluated patients undergoing a care procedure with an infection risk and who had been in homecare for >48 hours on the day of the survey. Overall, 6.1% of 542 patients had at least one HAI. The most common infection was urinary tract infection (50%) followed by skin infection (37.9%). E. coli (29.4%), Staphylococcus aureus (29.4%) and Enterococcus species (17.6%) were the most predominant species. HAIs were significantly associated with the presence of a urinary catheter, a low KI, advanced age, longer duration in homecare and skin wounds. The use of a central venous catheter, surgery, tracheotomy, parental nutrition, HIV infection and sex were not found to be risk factors.

A recent paper in the Journal of Hospital Infection (2005; 59: 180-7) describes a study carried out in Germany of healthcare workers (HCWs) who had close and regular contact with MRSA-colonized patients. MRSA was identified from the nasal swabs of 87 workers who were immediately withdrawn from work and treated with topical antibiotics/antiseptics. They were advised to disinfect their bathrooms and personal hygiene articles, and to wash bed linen and pillows. Seventy-three (84%) HCWs lost their carrier status when tested after 3 days, and this was maintained after further sampling at 10 days, 1 and 3 months. In 11 cases, MRSA was detected, but only in “later” swabs, indicating recolonisation. In eight of these 11 cases, screening identified colonisation of close household contacts. Environmental sampling detected contamination in 7/8 home environments. Contaminated surfaces included pillows, bed linen, brushes, cosmetics and hand contact surfaces, as well as household dust. When eradication treatment was applied to household contacts and surfaces were cleaned and disinfected, carriage cleared in most cases within a few weeks. However, when home environments were heavily contaminated, despite adequate medical treatment, eradication took up to 2 years. These experiences support the hypothesis that measures to control MRSA carriage in HCWs should not be restricted to antibiotic or antiseptic treatment of carriers, but must also include cleaning and disinfection of the home.

This is a booklet published by IRC International Water and Sanitation Centre in the Netherlands. It describes in 10 points those issues that are important when dealing with children, hygiene and sanitation in the school environment. It provides practical, easily accessible guidance to policy makers, programme designers and implementers at field level. It covers all the stages of a design project, from needs assessment to operation and maintenance. It stresses the importance of active involvement of children, teachers, parents and the community during all of these stages so that they themselves will be able to find solutions for their own problems and needs.

The ideas presented are “concepts” intended to stimulate discussions and creative thinking on how to promote a creative child-oriented linkage between hygiene promotion and the design of hygiene and sanitation facilities. Child-friendly hygiene and sanitation facilities in schools: indispensable to effective hygiene education. Zomerplaag J, Mooijman A. (2005) (Technical paper series; no. 47). IRC International Water and Sanitation Centre. The booklet can be downloaded from http://www.irc.nl/page/9587

UPCOMING CONFERENCES

6^th Congress of the International Federation of Infection Control, Istanbul, October 13 ^th-16 ^th 2005 Istanbul, October 13^th-16^th 2005.
More details from: www.ific.narod.ru

2^nd South East Asian Conference on Sanitation (SACOSAN), Islamabad 21^th-23^rd November 2005
The aim of the conference is “to accelerate the the progress of sanitation and hygiene work in South Asia so as to enhance its peoples quality of life in fulfilment of the Millennium Development Goals. More details can be obtained from www.envronment.gov.pk/sacosan-2005/index.htm

From Local Action to Global Targets, AGUA 2005, Cali, Colombia, 31^st Oct – 4^th Nov 2005
Organised by: Cinara (Instituto de Investigación y Desarrollo en Abastecimiento de Agua, Saneamiento Ambiental y Conservación del Recurso Hídrico), this event will discuss water-related issues within the framework of the International Decade for Action “Water for Life” and the Decade of Education for Sustainable Development, using the MDGs as a reference point. This is a 2-day conference “From Local Action to Global Targets” and four parallel seminars including “Water, Sanitation and Hygiene Programmes: Facing the Millennium Challenges” and “School and Hygiene Education and the MDGs”. Contact: Aberto Galvis.

Cleaning for the Healthy Indoor Environments for Children, Simmons Center for Hygiene & Health in Home and Community, Boston, USA, 24^th & 25^th October 2005
The conference will focus on presenting new information and practical approaches on cleaning for a healthy indoor environment for children. The focus will be on the control of pathogenic bacteria and viruses on surfaces to reduce the risk of infection acquisition and transmission, and the prevention and control of mould for indoor air quality. The aim is to educate consumers, the working public and those who have responsibilities for children. It will also include an E-briefing session at Simmons website. More details will follow.

A one-year intensified study of outbreaks of gastroenteritis in The Netherlands. van Duynhooven YTHP, de Jager CM, Kortbeek LM, Vennema H, Koopmans MPG, van Leusden F, van der Poel WHM, van den Broek MGL. Epidemiology and Infection 2005; 133: 9-21.

This paper describes a study of 281 gastroenteritis outbreaks mainly from nursing homes and homes for the elderly (57%) (restaurants (11%) hospitals (9%) and day care centres (7%). Direct person-to-person spread was the pre-transmission route in all settings (78%) except for the rest of the outbreaks where food was suspected in almost 90% of cases. The most common pathogen was norovirus (54%) followed by Salmonella spp (4%), rotavirus group A (2%) and Campylobacter spp (1%).

The seasonality of human campylobacter infections and Campylobacter isolates from fresh retail chicken in Wales. Meldrum RJ, Griffiths JK, Smith RMM, Evans MR. Epidemiology and Infection 2005; 133: 49-52.

Seasonal peaks in human Campylobacter infections and poultry isolates have been observed in several European countries but remain unexplained. This study compared data on human infections and isolation rates from fresh retail chicken portions purchased in Wales between January and December 2002. Overall, 71% of chicken samples were positive for Campylobacter, with rates in excess of 90% in week 24. Human isolates (2631) peaked between weeks 22 and 25, and chicken isolates (364) between weeks 24 and 26. The authors postulate that the seasonal rise in human infections is not caused by a rise in poultry isolation rates, but that both are more likely to be associated with a common, but as yet unidentified environmental source.

Focussing on improved water and sanitation for health. Bartram J, Lewis K, Lenton R, Wright A. Lancet 2005; 365: 810-2.

This paper argues the case for greater emphasis on initiatives to improve water and sanitation.

A microbiological survey of communal kitchens used by undergraduate students. Sharp K, Walker H. International Journal of Consumer Studies 2003; 27: 11.

This study investigated key sites in six student communal kitchens. Results show that visual hygiene assessments are not a good indicator of contamination, which in this study revealed poor hygiene levels. Food safety errors were common by kitchen users and they showed limited food safety knowledge and absence of feelings of responsibility for the hygiene standards of the kitchen.

Prevalence of Campylobacter, Salmonella, and Escherichia coli on the external packaging of raw meat. Burgess F, Little CL, Allen G, Williamson K, Mitchell RT. 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 PA. 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 the 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.

Water, sanitation and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Fewtrell L, Kaufmann RP, Kay D, Enanario W, Huller L, Colford JM. Lancet Infectious Diseases 2005; 5: 42-52.

This paper presents a systematic review of all published studies and, where appropriate, meta-analysis of studies that reported interventions in water quality, water supply, hygiene, and sanitation in less developed countries. The meta-analyses focus on the evidence for any change arising from the interventions in diarrhoeal disease occurrence in non-outbreak conditions.

A preliminary evaluation of the effect of glove use by food handlers in fast food restaurants. Lynch R. Journal of Food Protection 2005; 68: 187-90.

A total of 371 tortillas purchased from fast food restaurants were analysed for microbial contamination. Coliform bacteria were found in 9.6% of samples handled by gloved workers and 4.3% of samples handled by bare hands. The distribution of heterotrophic plate count bacteria was higher in samples handled by gloved workers. E. coli, Klebsiella and S. aureus were detected in one, two and eight samples, respectively, and there were no significant differences between samples handled by gloved or bare hands. The observed tendency of food workers to wear the same pair of gloves for extended periods, and complacency, might account for the apparent failure of gloves to reduce or prevent contamination. Gloves might be counterproductive because workers wash their hands less frequently.

The effect of perasafe and sodium dicholoroisocyanurate (NaDCC) against spores of Clostridium difficile and Bacillus atrophaeus on stainless steel and poylvinylchloride surfaces. Block C. Journal of Hospital Infection 2004; 57: 144-8.

This paper describes a comparison of the efficacy of perasafe (a peroxygen generating peracetyl ions) and NaDCC (1000 ppm available chlorine) against spores of Clostridium difficile and Bacillus atrophaeus on stainless steel and poylvinylchloride surfaces using a contact time of 2, 5 and 10 min.

Reducing diarrhoea through the use of household-based water filters: a randomised controlled trial in rural Bolivia. Clasen T Brown J, Collins S, Suntura O, Cairncross S. American Journal of Tropical Medicine and Hygiene 2004; 70: 651-7.

This paper describes a 6-month study in Bolivia involving 50 rural village households. The 25 intervention households used a gravity water filter system consisting of two porous ceramic filter elements suspended within a 15-litre container, mounted over a second 15-litre receiving/storage vessel with a spigot. Of the 96 water samples from the filter households, 100% were free of coliforms, compared with 15.5% of the control samples. Diarrhoeal disease risk for individuals in the intervention households was 70% lower than for controls. For children <5 y the risk reduction was 83%.

A systematic review of the health outcomes related to household water quality in developing countries. Gundry S, Wright J, Conroy R. Journal of Water and Health 2004 (in press).

A systematic review showed that, although there was a clear relationship between improved water quality by home water treatment and storage intervention and incidence of cholera, for general diarrhoea, no clear relationship was found with point-of-use quality, although interventions significantly reduced diarrhoeal incidence.

Household water management: refining the dominant paradigm. Clasen TF, Cairncross S. Tropical Medicine and International Health 2004; 9: 187-91.

This paper questions the validity of the currently held paradigm that greater emphasis should be given to safe excreta disposal and the use of water for domestic and personal hygiene than to drinking water quality. It critically analyses aspects of the methodology of earlier studies such as the inclusion criteria, systematic review methods and statistical approach. The authors report on a brief analysis of 21 field trials dealing specifically with interventions to enhance household drinking water quality, which suggests a median reduction in diarrhoeal disease of 42%. The result was fairly consistent regardless of the nature of the intervention.

Whither triclosan? Russel AD.Journal of Antimicrobial Chemotherapy 2004; 53: 693-5.

Triclosan has activity against gram-negative and gram-positive bacteria, although Pseudomonas aeruginosa is highly resistant. Its growth inhibitory properties probably result from enoyl reductase inhibition, whilst membrane destabilisation is responsible for bactericidal action at higher concentrations. Resistance can arise from mutations in, or over production of, enoyl reductase, impermeability or efflux. The author concludes that whilst triclosan resistance in laboratory experiments may be associated with changes in antibiotic susceptibility, comprehensive surveys have not demonstrated any association between triclosan usage and antibiotic resistance in clinical practice. Triclosan has several important uses and the aim must be to retain these applications whilst eliminating unnecessary ones.

Bacterial adaptation and resistance to antiseptics, disinfectants and preservatives is not a new phenomenon. Russell AD. Journal of Hospital Infection 2004; 57: 97-104.

This paper is a historical review on the development of resistance to antibacterial compounds. As reduced susceptibility to biocides has been known for a long time, it might be expected by now to have resulted in the development of highly biocide resistant strains. Since this does not appear to be the case, it might, therefore, be argued that resistance to biocides is unlikely to occur. The author concludes that this conclusion is unwarranted and that biocides should only be incorporated into formulated products where necessary, and only with full appreciation of factors influencing their activity.

Characterization of Staphylococcus aureus mutants expressing reduced susceptibility to common house-cleaners. Davis AO, O’Leary JO, Muthaiyan A, Langervin MJ, Delgado A, Abalos AT, Fajarda AR, Marek J, Wilkinson BJ, Gustafson JE. Journal of Applied Microbiology 2005; 98: 364-72.

Spontaneous mutants of Staph aureus demonstrating reduced susceptibility to one of four house-cleaner formulations were selected and their susceptibility to a range of house-cleaners and their components together with hydrogen peroxide was determined by measuring minimum inhibitory concentrations and minimum bactericidal concentrations. The mutants demonstrated altered susceptibility to multiple antimicrobials. The authors speculate, however, that the reduced susceptibility probably does not pose any threat to efficacy under conditions where products are used at much higher concentrations. Of 76 clinical MRSA, 20 exhibited reduced susceptibility to a house cleaner.

It does last! Some findings from a multi-country study of hygiene sustainability. Cairncross S, Shordt K. Waterlines 2004; 22: 4-7.

This paper report a study of hygiene behaviour after a time elapse of one or more years following a hygiene promotion programme in Ghana, India, Uganda, Nepal Kenya and Sri Lanka. Hygiene aspects studied were handwashing (when and how), latrine use and maintenance, and household hygiene (water storage, environmental cleanliness and covering food). Hygiene behaviour was sustained, but the extent to which this occurred depended on a number of variables such as the intensity of the programme, whether it was a one-to-one intervention etc. The authors concluded that continued access to services (water and sanitation) is not enough to sustain hygiene behaviour; it is the “software” aspects, which are more important. Hygiene promotion should not be a low-visibility add-on. Sustained behaviour only results from giving high priority and adequate resources to hygiene promotion.

A model of hygiene practices and consumption patterns in the consumer phase. Christensen BB, Rosenquist H, Sommer H, Nielsen N, Fagt S, Andersen NL, Norrung B. Risk analysis - an official publication of the Society for Risk Analysis 2005; 25: 49-60.

This paper describes a model addressing hygiene practices during food preparation. The simulated results show that the probability of ingesting a chicken risk meal at home depends not only on the hygiene practices of the person preparing the food, but also on the consumption patterns of consumers, and the relationship between people preparing and ingesting food. Monte Carlo simulations showed that the probability of ingesting a risk meal was highest for young males (aged 18-29 y) and lowest for the elderly (<60 y). Children aged 0-4 y had a higher probability of ingesting a risk meal than children aged 5-17 y. The differences were ascribed to variations in the hygiene levels of food preparers. This suggests a need to include data on consumer behaviour in the consumer phase of exposure assessments.