In their recent paper, Juliet Waterkyn and Sandy Cairncross from the London School of Hygiene and Tropical Medicine explore the proposition that, unless strategies are found to galvanise rural communities and create a demand for sanitation, the Millennium Development Goal of halving the 2.4 billion people without sanitation by the year 2015 is not achievable. In sub-Saharan Africa, sanitation coverage has not kept up with population growth, but has dropped from 60% in 1990, to 47% in 2003. In order to reverse this trend, a proven approach to community mobilisation is required that can be readily adopted and taken to scale in order to create the demand for sanitation.

Participatory approaches to achieve community mobilisation were first used in the 1980s. By the mid-1990s, a local variant known as PHAST (Participatory Hygiene and Sanitation Transformation) (http://www.who.int/water_sanitation_health/hygiene/envsan/phast/en/) was widely acknowledged as good practice. By 1997, the methodology had became established in Zimbabwe, a “toolkit” distributed to 800 environmental health technicians (EHTs) at rural health centres, and 48 out of 57 districts had been introduced to the approach, with an estimated 3,800 extension workers trained. However, although the concept was well known, it failed to be translated into well-supported programmes. In all but two districts, staff failed to use PHAST in their routine work. It was seen as labour-intensive and reliant on trainers with extrovert personalities. Lack of funding, the inadequacy of the 5-day training given to field staff, and the fact that conventional didactic methods were too firmly engrained were also cited as constraints. By 2001, regional planners who had launched PHAST were losing interest. PHAST had failed to produce evidence of behavioural change, and indicators of change were too few to convince donors to continue support.

In 1995, Juliet Waterkyn aware of the shortcomings of PHAST, but convinced of the ability of participatory approaches to achieve behavioural change, set up a pilot project to address the various issues. In this study, participatory activities were linked to achievable objectives with measurable outcomes. Health promotion focused on dedicated community health club (CHC) membership, promoting inspired leadership rather than using conventional village gatherings controlled by traditional leadership. The concept of clubs fits with traditional values of conformity in rural society in Zimbabwe, building on women’s groups developed throughout the colonial period through the missionaries and philanthropic societies, where a smart, club-going woman was seen as a pillar of society. In rural Zimbabwe, CHCs have been active since 1995 to change health behaviour and increase demand for better sanitation.

The pilot study led to a larger study initiated in 1998 in two rural districts with more than 13,000 CHC members. In stage 1, health education provided the entry point as a means of galvanising and forming a “common unity” within the target population. Stage 2 was in the second year, where knowledge was applied to daily life through ensuring good hygiene, safe water supplies and improved sanitation. Effectiveness was measured in terms of observable indicators of behavioural change rather than health outcome, given the unreliability of health outcomes for operational evaluation.

The training material consisted of 14 sets of illustrated cards. The topics were listed on a “membership card”, which provided an outline of the syllabus. Trained local EHTs led weekly meetings of CHC members focusing on one topic such as diarrhoea or TB. Through repeated interaction, a strong and informed leadership, elected by the members, emerged in most clubs before any implementation (such as latrine construction) took place. “Homework” was agreed at each session with members pledging small home improvements and behavioural changes to be effected by the following week. These changes included a cover for the drinking water, a ladle to draw water, the construction of a garbage pit, a pot/drying rack and a hand washing facility. Home visits between members were arranged to monitor one another’s progress. It took between 6 and 8 months to complete the course of 20 sessions with weekly attendance.

Between August 2000 and March 2001, a survey was conducted to analyse the levels of behavioural change. A control group for each district was selected to match the intervention area. Each home visit took approximately one hour. Compliance indicators were ascertained by observation, and nothing was recorded purely on the report of good practice by the respondent. For example, open faecal disposal was observed by a walk around the bush surrounding each home to check for unburied faeces. Latrines were inspected by a request to use this facility. A child in the home demonstrated hand washing by being asked to assist with hand washing. A request for a drink of water would demonstrate whether a ladle was used to draw water and whether the container was well covered.

In the Makoni District, 1,244 health sessions were held by 14 trainers, involving 11,450 club members (68,700 beneficiaries). In the Tsholotsho District, 2,105 members participated in 182 health promotion sessions held by three trainers. Within 2 years, 2,400 latrines had been built in Makoni, and in Tsholotsho latrine coverage rose to 43% compared to 2% in the control area, with 1,200 latrines being built in 18 months. Although Zimbabwe has historically relied on subsidies to stimulate sanitation, this intervention shows how total sanitation could be achieved; 57% of CHC members without latrines in Tsholotsho all practised faecal burial, a method previously unknown to them. Club members’ hygiene was significantly different (p<0.0001) from the control group regarding 17 key hygiene practices including hand washing, demonstrating that if a strong community structure is developed and the norms of the community are altered, sanitation and hygiene behaviour are likely to improve. The authors of the study concluded that this methodology could be scaled up to contribute to ambitious global targets.

The study is described in more detail in: Waterkeyn J., Cairncross S. Creating demand for sanitation and hygiene through Community Health Clubs: a cost-effective intervention in two districts in Zimbabwe. Social Science and Medicine 2005;61:1958-70. [http://dx.doi.org/10.1016/j.socscimed.2005.04.012] or contact: juliet.waterkeyn@lshtm.ac.uk

The Africa AHEAD Association has now been registered in South Africa to provide assistance to other organisations or government ministries with funding for a health promotion campaign using the CHC approach. A training module has been developed to enable the adaptation of this model to other areas, with the development of culture specific participatory training materials and the training of health workers on how to set up and run health clubs. For example, in 2003-2004, Africa AHEAD was asked to help CARE International partnered with the Health Integrated Development Organisation (HIDO) to address the appalling lack of sanitation in internally displaced people’s (IDP) camps in war torn Northern Uganda. Within 6 months over 100 health clubs had been started with over 120,000 people being reached by a health promotion campaign in 15 IDP camps. Health club members constructed over 11,000 latrines within an 8-month period, and other hygiene behaviour improved (Waterkeyn, Okot & Kwame), 2005, Proceedings of the 31st WEDC International Conference, Uganda).

For more information go to: www.africaahead.com

The UK trade union UNISON (for people delivering public services) has commissioned Dr. Stephanie Dancer to carry out a one-year project at a Glasgow teaching hospital to evaluate the impact of rigorous environmental hygiene regimes, which include not only the cleaning of floors but also of hand contact surfaces such as bedside tables, on MRSA infection rates.

This report highlights the benefits of placing women at the core of the planning and implementation of Water Sanitation Hygiene (WASH) programmes. It deals with six issues: better services for all; better health for all; privacy and dignity; women’s health and well-being; girls’ school attendance; women’s status; and income-generation. It demonstrates how women’s empowerment and the improvement of the water supply, sanitation facilities and hygiene practice are inextricably linked, and argues that if women play a central role in water, sanitation and hygiene efforts, progress towards achieving the Millennium Development Goals (MDGs) will be significantly advanced. The evidence comes from recent literature, project reports and evaluations and from personal correspondence with those involved.

The report can be downloaded from: http://www.wsscc.org/pdf/publication/FOR_HER_ITs_THE_BIG_ISSUE_Evidence_Report-en.pdf

The US-based Institute for Food Technology (IFT) has issued a new report entitled “Antimicrobial resistance: implications for the food system”. The report is based on a detailed review of the literature carried out by an IFT expert group. The report concludes that the prudent use of decontaminants, sanitizers and other antimicrobial treatments in the production and manufacture of food, appears to generate no bacterial resistance of concern to human health, and that antimicrobial treatments should continue to be used to ensure food safety and public health.

The full report is available online at: http://members.ift.org/IFT/Research/IFTExpertReports/antimicrobial_report.htm

Household water management was addressed in a number of events at the 4th World Water Forum, the most significant being the session jointly convened by the WHO Network, PAHO/AMRO, and the NGO CAWST on 19 March 2006. WHO/PAHO has been promoting household water treatment as an interim solution to bring about the health gains associated with safe drinking water, and to advance the achievement of the “safety” component of the Millennium Development Goal on water. Presenters addressed different themes (implementation, education and training, research and external support) drawing on experiences in Asia, Africa and Latin America. Presentations included:

• Implementation of household water treatment (HWT) in Nepal - Roshan Shrestha, ENPHO
• Reaching scale with HWT - Greg Allgood, P&G
• HWT: the perspective of an educator and trainer - Camille Dow Baker, CAWST
• Household water treatment and safe storage (HWTS). Research and implementation - Thomas Clasen, LSHTM
• HWTS: what motivates external support - John Borrazzo, USAID.

An expert panel raised some additional points, and re-confirmed key points:

• The evidence-base is crucial: there is the need to evaluate what is working, what is not, and to move forward with proven interventions. Research that guides us in implementing options at scale is needed.
• Interventions must work in the lab, and be robust enough to be also effective in the field. The technology must be accepted by users, and demonstrate health impacts. The intervention must be able to go to scale.
• There is the need to educate implementers and consumers on the suitability of various treatment and storage options available, recognising the varying circumstances of different households.

Further details and presentations can be downloaded from: http://www.who.int/household_water/advocacy/wwf/en/print.html

Household water treatment and safe storage (HWTS), together with the provision of improved water supply, adequate sanitation and hand washing promotion are highly effective interventions, receiving increasing attention from donors and implementers. Improving access to safe water poses a number of challenges. To share experiences around these challenges, USAID’s Hygiene Improvement Project (HIP) organised an e-conference on two HWTS themes. Position papers were prepared to frame a discussion around these two themes:

• HWTS: what can the poor afford?
• How do programmes promote water treatment and ensure that the government continues to supply improved drinking water sources?

More than 550 people were invited to join the conference and over 50 participants posted 144 messages. Tracing website hits indicated a diverse participant base representing 23 countries and a range of government, commercial, NGO and network institutions. Those participating were characterised by a mix of technical expertise and practitioners working directly with communities and consumers/beneficiaries. Discussions ranged from information sharing to conversations among contributors. Several participants discussed the importance of offering HWTS choices and ensuring that products were not specifically marketed and labelled for the poor. Others discussed the need to understand cultural and individual preferences to develop desirable products. Ways to continue to share information and to network with one another was also a prominent theme.

Participants indicated that the conference was a useful exchange in that it challenged people’s assumptions, and enabled them to share experiences and knowledge. It also demonstrated the wide range of professionals knowledgeable about, and dedicated to, improving the quality of drinking water around the world. One comment can be seen as a call to action, “The combined knowledge and resources of the people working in this field is capable of realising many times our current efforts with the multiplier effect of synergy in a team effort”.

HIP has synthesised the discussions and posted these along with the entire conference contributions on its website. The topics broadly fall into the following categories: technology, marketing, improving practices, networking/information sharing, new products and subjects needing more discussion. The HIP team has also compiled and categorised all the resources mentioned in the e-conference and is publishing this as a separate document, which will also be available on the HIP website.

For the latest go to: http://hip.watsan.net/page/491

Jal Mandir Technology Clearinghouse is a website that has been developed to provide assistance and information about the research and development of innovative technologies associated with household water treatment. It covers chemical treatment, coagulation and filtration technologies, precipitation, and thermal and UV treatments.

The website can be found at: http://www.jalmandir.com/clearinghouse/english.html

According to the regional report for Europe, presented at the 4th World Water Forum, there are still huge disparities in access to drinking water and basic sanitation among the 46 countries of the European continent, 25 of which are Member States of the European Union (EU). Around 41 million people lack access to safe drinking water, and 85 million people have no basic sanitation. This contributes to waterborne diseases such as hepatitis, cholera and diarrhoeal disease. Europe also treats less than 50% of the polluted urban water it produces.

For more details of “Europe, water and the world: European regional document” go to http://www.wwf4europe.org/ - click on regional document or: http://www.worldwaterforum.org/uploads/TBL_PROOMS_404_
53.%20Europa%20(inglés).doc.pdf

Waterborne disease across the European region is also reviewed in the 2006 IFH report “Household water treatment, handling and safe storage”: http://www.ifh-homehygiene.org/2003/2library/low_res_water_paper.pdf

The Public-Private Partnership for Hand Washing, (PPPHW) the global initiative to promote hand washing with soap to reduce diarrhoea, hosted a 3-day consultants training workshop from 3-5 May 2006, in Washington DC. More than 40 participants from four regions attended. The purpose of the workshop was to provide technical skills training in topics where ongoing and future PPPHWs will need support, including:

• Hand washing evidence-base
• Strategic marketing
• The “Hand Washing Project Cycle”
• Country assessments
• Partnership building
• Fundraising

Participants in the workshop included independent consultants, PPPHW country coordinators, PPPHW partners, and government representatives.

The workshop report and presentations will be available shortly. Read the March 2006 edition of the PPPHW newsletter “SoapBox” at: http://www.globalhandwashing.org/Publications/Attachments/Soap
BoxMarch2006.pdf

MRSA bacteraemia in patients on arrival in hospital: a cohort study in Oxfordshire 1997-2003. Wyllie D.H., Peto T.E., Crook D. BMJ 2005;331:992.

In an Oxford teaching hospital, there were found to be 479 patients with MSSA and 116 with MRSA bacteraemia admitted from the community. Among this group, which was comprised of 24% of all hospital MRSA cases, at least 91% had been in hospital previously; the median time since discharge was 46 days. About half the cases were patients in whom MRSA had not been isolated before.

Non-pharmaceutical interventions for pandemic influenza, international measures World Health Organization Writing Group. Emerging Infectious Diseases 2006; 12:81-7.

This is the first part of a two part report which summarises the scientific data, historic experience, and contemporary observations that make up the limited evidence base for these interventions as applied to influenza. Part 1 summarizes the relevant transmission characteristics of influenza and the basis for interventions to prevent spread from one country to another. Non-pharmaceutical interventions outside of healthcare settings focus on measures to 1) limit international spread (e.g., travel screening and restrictions); 2) reduce spread within national and local populations (e.g., isolation and treatment of ill persons; monitoring and possible quarantine of exposed persons; and social distancing measures, such as cancellation of mass gatherings and closure of schools); 3) reduce an individual person’s risk for infection (e.g., hand hygiene); and 4) communicate risk to the public. Part 1 discusses the first category

Non-pharmaceutical public health interventions for pandemic influenza, national and community measures. World Health Organization Writing Group. Emerging Infectious Diseases 2006;12:88-94.

This is the second part of a two part report which summarises the scientific data, historic experience, and contemporary observations that make up the limited evidence base for these interventions as applied to influenza. Part 2 summarises the basis for measures within countries at the national and community levels. Non-pharmaceutical interventions outside of healthcare settings focus on measures to 1) limit international spread (e.g., travel screening and restrictions); 2) reduce spread within national and local populations (e.g., isolation and treatment of ill persons; monitoring and possible quarantine of exposed persons; and social distancing measures, such as cancellation of mass gatherings and closure of schools); 3) reduce an individual person’s risk for infection (e.g., hand hygiene); and 4) communicate risk to the public. Categories 2 and 3 are addressed in Part 2.

Emergence and resurgence of Methicillin-resistant Staphylococcus aureus as a public-health threat. Grundmann H., Aires-de-Sousa M., Boyce J., Tiemersma E. Published online June 21, 2006 DOI:10.1016/S0140-6736(06)68853-3 1.

This paper reviews the scientific literature related to the emergence and resurgence of MRSA

Animal-to-human transmission of Salmonella Typhimurium DT104A variant. Hendriksen S.W.M., Orsel K., Wagenaar J.A., Miko A., van Duijkeren E. Emerging Infectious Diseases 2004;10:2225-7.

Salmonella enterica serovar Typhimurium was isolated from a pig, a calf, and a child on a farm in The Netherlands. The isolates were indistinguishable by phenotyping and genotyping methods, which suggests non-foodborne animal-to-animal and animal-to-human transmission. People in close contact with farm animals should be aware of this risk.

Prevention and control of health care-associated waterborne infections in health care facilities. Exner M., Kramer A., Lajoie L., Gebel J., Engelhart S., Hartemann P. American Journal of Infection Control 2005;33(suppl 1):S26-40.

The paper discusses the problems related to waterborne pathogens in the hospital environment as a source of health care-associated infections (HAIs). Not only are Legionella spp involved in HAIs, but also Pseudomonas aeruginosa, other gram-negative microorganisms, fungi and amoeba-associated bacteria are considered.

Ecology of Pseudomonas aeruginosa in the intensive care unit and the evolving role of water outlets as a reservoir of the organism. Trautmann M., Lepper P.M., Haller M. American Journal of Infection Control 2005;33(suppl 1):S41-9.

Pseudomonas aeruginosa is an important pathogen causing intensive care unit (ICU)-related infections. Horizontal transmissions between patients have long been considered the most frequent source of P aeruginosa colonisations/infections. A review of prospective studies published between 1998 and 2005 showed that between 9.7% and 68.1% of randomly taken tap water samples on different types of ICUs were positive for P aeruginosa, and between 14.2% and 50% of infection/colonisation episodes in patients were due to genotypes found in ICU water.

Survival on uncommon fomites of feline calicivirus, a surrogate of noroviruses. Clay S., Maherchandani S., Malik Y.S., Goyal S.M. American Journal of Infection Control 2006;34:41-3.

Fomites such as computer mouse, keyboard keys, telephone wire, telephone receiver, telephone buttons, and brass disks representing faucets and door handle surfaces were artificially contaminated with known amounts of feline calicivirus (FCV). The virus survived for up to 3 days on telephone buttons and receivers, for 1 or 2 days on computer mouse, and for 8-12 hours on keyboard keys and brass. The time for 90% virus reduction was <4 hours on computer keys, mouse, brass and telephone wire; 4-8 hours on telephone receiver; and 12-24 hours on telephone buttons.

Can soaps act as fomites in hospitals? Junu V.G., Shetty A., Jisho M.B. Journal of Hospital Infection 2006;62:244-5.

Ten soap cakes and 10 samples of liquid soap taken from a hospital environment in Mangalore, India were tested for microbial contamination. The 12 soap cake samples showed heavy contamination with Pseudomonas aeruginosa, whilst one sample also contained Staphylococcus aureus. None of the liquid soap samples showed evidence of contamination.

Combining drinking water treatment and hand washing for diarrhoea prevention, a cluster randomised controlled trial. Luby S.P., Agboatwalla M., Painter J., Altaf A., Billhimer W., Keswick J.B., Hoekstra R.M. Tropical Medicine & International Health 2006;11:479-89.

The study was conducted in squatter settlements of Karachi, Pakistan. Households in 10 neighbourhoods received diluted bleach and a water vessel; nine neighbourhoods received soap and were encouraged to wash hands; nine neighbourhoods received flocculent-disinfectant water treatment and a water vessel; 10 neighbourhoods received disinfectant-disinfectant water treatment and soap and were encouraged to wash hands; and nine neighbourhoods were followed as controls. Study participants in control neighbourhoods had diarrhoea on 5.2% of days. Compared to controls, participants living in intervention neighbourhoods had a lower prevalence of diarrhoea: 55% lower in bleach and water vessel neighbourhoods, 51% lower in hand washing promotion with soap neighbourhoods, 64% lower in disinfectant-disinfectant neighbourhoods, and 55% lower in disinfectant-disinfectant plus hand washing with soap neighbourhoods. Although each of the home-based interventions significantly reduced diarrhoea, there was no benefit by combining hand washing promotion with water treatment.

Etiology and epidemiology of diarrhea in children in Hanoi, Vietnam. Vu Nguyen T., Le Van P, Le Huy C, Nguyen Gia K, Weintraub A. International Journal of Infectious Disease 2006;10:298-308.

The study compared 587 children with diarrhoea with 249 age matched healthy controls, to assess the main epidemiological factors contributing to diarrheal disease in children. More children got diarrhoea in (i) poor families; (ii) families where piped water and a latrine were lacking; (iii) families where mothers washed their hands less often before feeding the children; (iv) families where mothers had a low level of education; (v) families where information on health and sanitation less often reached their households.

A systematic review of the evidence for interventions for the prevention and control of meticillin-resistant Staphylococcus aureus (1996-2004): report to the Joint MRSA Working Party (Subgroup A). Loveday H.P., Pellowe C.M., Jones S, Pratt R. Journal of Hospital Infection 2006;63(suppl 1):S45-70.

This paper reviews evidence published between 1996 and 2004 on the effectiveness, and associated economic costs, of a range of interventions to prevent and control the transmission of meticillin-resistant Staphylococcus aureus (MRSA) in hospital settings. The review questions focused on screening, patient isolation, use of decolonisation strategies, feedback of surveillance data, and environmental hygiene interventions. The methodological quality of studies retrieved was such that there is currently insufficient high-quality evidence for infection prevention and control interventions in the fields identified for this review. However, evidence from clinically based, non-experimental studies does provide support for continued use of a range and combination of interventions that contribute to the prevention and control of MRSA within acute hospitals and long-term care settings.

Cost effectiveness of home-based chlorination and safe water storage in reducing diarrhea among HIV-infected households in rural Uganda. Shrestha R.K., Marseille E., Kahn J.G., Lule J.R., Pitter C., Blandford J.M., Bunnell R., Courinho A., Kizitio F., Quick R., Mermin J. American Journal of Tropical Medicine and Hygiene 2006;74:884-90.

This study examined the cost-effectiveness of a safe water system (SWS) for HIV-affected households using health outcomes and costs from a randomised controlled trial in Tororo, Uganda. SWS was part of a home-based health care package that included rapid diarrhoea diagnosis and treatment of 196 households with relatively good water and sanitation coverage. SWS use averted 37 diarrhoea episodes and 310 diarrhoea-days, representing 0.155 disability-adjusted life year (DALY) gained per 100 person-years, but did not alter mortality. Net programme costs were $5.21/episode averted, $0.62/diarrhoea-day averted, and $1,252/DALY gained. The high SWS cost per DALY gained was probably caused by a lack of mortality benefit in a trial designed to rapidly treat diarrhoea. SWS is an effective intervention whose cost-effectiveness is sensitive to diarrhoea-related mortality, diarrhoea incidence, and effective clinical management.

Chlorine spot treatment of flooded tube wells, an efficacy trial. Luby S., Islam S., Johnston R. Journal of Applied Microbiology 2006;100:1154-8.

The study team identified and tested water samples from 127 tube wells that were flooded within the preceding 4 weeks. On initial screening, water samples from 56 recently inundated tube wells (44%) were contaminated with thermotolerant coliforms. Among the 13 wells randomised to chlorination, there was no change in the proportion of water samples that had no detectable thermotolerant coliform bacteria immediately before chlorine treatment (n=4, 23%) and 60 minutes following chlorine treatment (n=4, 23%). Similarly, there was no difference in the proportion of water samples that had no detectable thermotolerant coliforms between chlorine spot treated and control tube wells 7-18 days later. The study suggests that unless modified methods improve effectiveness, resources should not be spent promoting spot chlorination of flooded tube wells.

The effect of an antibacterial washing-up liquid in reducing dishwater aerobic plate counts. Holah J.T., Hall K.E. Letters in Applied Microbiology 2006; 42: 532-7.

Antibacterial washing up liquid was shown to significantly reduce the aerobic plate count (APC) of catering dishwaters as compared with the traditional product. APCs were lower for each of the three weekly time periods for the antibacterial product. Continued use of the antibacterial product did not decrease the APC of the dishwater, though with the traditional product, dishwater counts increased throughout the trial week. Antibacterial washing-up liquids, with proven activity in controlling levels of microorganisms could play a significant role in reducing the risk of cross-contamination during washing-up operations.

Hand sanitizer alert. Reynolds S.A., Levy F., Walker E.S., Quillen J.H. Emerging Infectious Diseases 2006;12:527-9.

For alcohol-based hand sanitizers, the Food and Drug Administration (FDA) recommends a concentration of 60% to 95% ethanol or isopropanol, the concentration range of greatest germicidal efficacy. While non-healthcare groups also recommend alcohol-based hand sanitizers, they usually do not specify an appropriate concentration of alcohol. This paper reports the results of tests in which hands were sampled before and after 15 seconds of treatment with handrubs containing 40% ethanol indicated that the treatment failed to produce any significant reduction in CFU recovered from the hands.

Virucidal activity of a quaternary ammonium compound disinfectant against feline calicivirus: a surrogate for norovirus. Jimenez L., Chiang M. American Journal of Infection Control 2006;34:269-73.

Formulation R-82, a quaternary ammonium compound, is a one-step disinfectant cleaner, which exhibited virucidal activity against feline calicivirus suspensions dried on hard surface carriers.

Comparative efficacy of ethanol and isopropanol against feline calicivirus, a norovirus surrogate. Malik Y.S., Maherchandani S., Goyal S.M. American Journal of Infection Control 2006;34:31-5.

The virucidal efficacy of various concentrations of ethanol and isopropanol was evaluated against feline calicivirus (FCV), dried on an inanimate, non-porous contact surface for contact times of 1, 3 and 10 minutes. Ethanol at 70% and 90% and isopropanol at 40% to 60% concentrations were found to be the most effective, killing 99% of FCV within a short contact time of 1 minute.

Comparative efficacy of hand hygiene agents in the reduction of bacteria and viruses. Sickhert-Bennett E.E., Webber D.J., Gergen-Teague M.F., Sobsey M.B., Samson G.P., Rutala W. American Journal of Infection Control 2005;33:67-77.

These workers studied the efficacy of hand hygiene agents (n=14) following 10-second applications to reduce levels of Serratia marcescens and MS2 bacteriophage from the hands of volunteers using the ASTM-E-1174-94 test method. Antimicrobial handwashing agents were the most efficacious, whereas waterless agents showed variable efficacy. Alcohol-based handrubs compared with other products demonstrated better efficacy after one use rather than 10 uses. Effective hand hygiene for high levels of viral contamination with a non-enveloped virus was best achieved by physical removal with a non-antimicrobial soap or tap water alone.

Comparative efficacy of hand hygiene agents in the reduction of bacteria and viruses. Rotter M., Sattar S.A., Dharan S., Webber P., Voss A., Pittet D. American Journal of Infection Control 2005;33:558-60.

This “letter to the editor” is a response to the study by Sickbert-Bennett et al (American Journal of Infection Control 2005;33:67-77) which evaluated hand hygiene agents common in US hospitals. In this study a 10-second application time was selected because it was considered more realistic and relevant to clinical conditions than the 20- to 60-second applications used in most other studies. The authors of the letter state “although the topic deserves investigation, they believe that the study’s findings must be interpreted carefully because of major limitations in its design”. These limitations are discussed in the letter.

Sodium dichloroisocyanurate (NaDCC) tablets as an alternative to sodium hypochlorite for the routine treatment of drinking water at the household level. Clasen T., Edmondson P.International Journal of Hygiene and Environmental Health 2006 [epub ahead of press: doi:10.1016/j.ijheh.2005.11.004].

This paper is a review of the properties of Sodium dichloroisocyanurate for use in the household treatment of drinking water.

Disinfection of fabrics and carpets artificially contaminated with calicivirus: relevance in institutional and healthcare centres. Malik Y.S., Allwood P.B., Hedberg C.W., Goyal S.M. Journal of Hospital Infection 2006;63:205-10.

The study evaluated five disinfectants against feline calicivirus (FCV) on various fabrics or carpets. Metricide, an activated dialdehyde-based product, was found to be the most effective disinfectant on all types of fabric and carpet, inactivating more than 99.99% of the virus in 1-10 minutes. In general, effectiveness of disinfectants increased with an increase in exposure time from 1-10 minutes. The disinfection of carpets was more difficult than the disinfection of fabrics; 100% polyester was the least amenable to disinfection. Only Metricide and Microbac-II (a phenolic compound) were able to inactivate 99% of FCV on 100% polyester.

Effects of chronic triclosan exposure upon the antimicrobial susceptibility of 40 ex-situenvironmental and human isolates. Ledder R.G., Gilbert P., Willis C., McBain A.J. Journal of Applied Microbiology 2006;100:1132-40.

Triclosan (TCS) exposure of Eschenchia coli selects for tolerant clones, mutated in their enoyl-acyl carrier protein reductase. It has been inferred that this phenomenon is widespread amongst bacterial genera and might be associated with resistance to third party agents. These data suggest that selection for high level resistance by TCS exposure is not widespread and appears to be confined to certain enteric bacteria, especially E coli. Change in TCS susceptibility did not affect susceptibility towards chemically unrelated antimicrobials. It is concluded that acquired high-level TCS resistance is not a widespread phenomenon.

Antimicrobial drug resistance: “Prediction is very difficult especially about the future”. Courvalin P. Emerging Infectious Diseases 2005;11:1503-6.

Evolution of bacterial resistance to antimicrobial drugs is unavoidable. The only means of dealing with it is to delay emergence and subsequent dissemination of resistant bacteria or resistance genes. Resistance to antimicrobials can result from mutations in housekeeping structural or regulatory genes, or horizontal acquisition of foreign genetic information. The two phenomena are not mutually exclusive and can be associated in the emergence and more efficient spread of resistance. This review discusses the predictable future of the relationship between antimicrobial drugs and bacteria.

Antibiotic use is associated with resistance of environmental organisms in a teaching hospital. Dancer S.J., Coyne M., Robertson C., Thomson A., Gulerj A., Alcock S. Journal of Hospital Infection 2006;62:200-6.

An intensive care unit (ICU), acute stroke unit (ASU) and medical day bed unit (MDBU) underwent a standardised 4-month environmental screening programme to examine environmental organisms from these wards and to compare bacterial resistances in association with antimicrobial usage. Antibiotic resistance was significantly associated with individual wards for staphylococci and coliforms, and trends were also demonstrated for other gram-negative organisms. Antibiotic consumption on the ICU was six-fold higher than on the ASU and MDBU. Associations were found between the consumption of selected antibiotic groups and the corresponding resistances among staphylococci and gram-negative bacilli. Antibacterial resistance was the only significant difference between environmental bacteria from different wards, and appeared to reflect prescribing pressure.

Observation of food safety practices using notational analysis. Clayton D., Griffith C.J. British Food Journal 2004;106:211-27.

Microbiological and observational analysis of cross contamination risks during domestic food preparation. Redmond E.G., Griffith C. J., Slader J., Humphrey T. British Food Journal 2004;106:581-597.

Sustained high levels of stored drinking water treatment and retention of hand-washing knowledge in rural Kenyan households following a clinic-based intervention. Parker A.A., Stephenson R., Riley P.L., Ombeki S., Komolleh C., Sibley L., Quick R. Epidemiology and Infection 2006.

A new study by Parker et al., demonstrates high hand washing knowledge retention rates among clients, who received hand washing education during their visits to a Maternal and Child Health clinic in Nyanza Province, Kenya. Two weeks after the health clinic visit, 41% of clients were able to perform all hand washing steps correctly. After one year, 34% of clients were able to demonstrate all six hand washing steps correctly.

Confidence in controlling a SARS outbreak: experiences of public health nurses in managing home quarantine measures in Taiwan. Hsu C.C., Chen T., Chang M., Chang Y.K. American Journal of Infection Control 2006;34:176-81.

Public health nurses in Taiwan faced unprecedented challenges in implementing policy to prevent disease spread during the 2003 SARS epidemic. This paper assesses factors related to nurses’ confidence in managing community SARS control programmes. Nurses’ individual risk perception and the prompt update of epidemic information significantly affected levels of professional confidence, a key factor influencing quarantine implementation success. Strategies to promote collaboration and advocate participatory policy making involving health workers at all levels are needed to control effectively infectious disease outbreaks.

Creating demand for sanitation and hygiene through Community Health Clubs: a cost-effective intervention in two districts in Zimbabwe. Waterkeyn J., Cairncross S. Social Science and Medicine 2005;61:1958-70.

This study describes the development of Community Health Clubs which significantly changed hygiene behaviour and built rural demand for sanitation. In one year in the Makoni District, 1,244 health promotion sessions were held by 14 trainers involving 11,450 club members (68,700 beneficiaries). In the Tsholotsho District, 2105 members participated in 182 sessions held by three trainers involving 12,630 beneficiaries. Within 2 years, 2,400 latrines had been built in Makoni, and in Tsholotsho latrine coverage rose to 43% contrasted to 2% in the control area, with 1,200 latrines built in 18 months. The remaining 57% of club members without latrines in Tsholotsho all practised faecal burial, a method previously unknown to them. Club members’ hygiene was significantly different (p=0.0001) from a control group across 17 key hygiene practices including hand washing, showing that if a strong community structure is developed and the norms of a community altered, sanitation and hygiene behaviour are likely to improve. This methodology could be scaled up to contribute to ambitious global targets.

Household-based ceramic water filters for the prevention of diarrhoea: a randomized, controlled trial of a pilot programme in Colombia. Clasen T., Garcia Parra G., Boisson S., Collin S. American Journal of Tropical Medicine and Hygiene 2005;73:790-5.

Oxfam GB undertook a pilot project to explore the use of household-based ceramic water filters in three remote communities in Colombia. In a randomised, controlled trial over a period of 6 months, the filters were associated with a 75.3% reduction in arithmetic mean thermotolerant coliforms (TTCs). A total of 47.7% and 24.2% of the samples from the intervention group had no detectible TTCs/100 mL or conformed to WHO limits for low risk (1-10 TTCs/100 mL), respectively, compared with 0.9% and 7.3% for control group samples. Overall, the prevalence of diarrhoea was 60% less among households using filters than among control households. However, the microbiologic performance and protective effect of the filters was not uniform throughout the study communities, suggesting the need to consider the circumstances of the particular setting before implementing this intervention.