Hygiene, Volume 4, Issue 1 (March 2024) – 8 articles

The pre-cleaning of reusable medical devices is essential for successful cleaning, as it prevents biofilm formation that can compromise disinfection and sterilization. This study aimed to reflect on the recommendations regarding the pre-cleaning of reusable medical devices carried out in care units, such as wards, based on recommendations from guidelines/standards related to this important step in reusable medical device reprocessing. However, recommendations for pre-cleaning in care units are not unanimous and contrast with detailed recommendations on reusable medical device reprocessing in the Central Sterile Services Department (CSSD). This topic is an unresolved issue, strongly related to patient and worker safety, which points to the lack of investigations to provide indicators of best practice and highlights the need for shared responsibility management between care units and CSSD. Full article

In the European Union, Occupational Safety and Health legislation generally refers to European Regulation (CE) n. 1272/2008 to define and classify carcinogens of concern for occupational risk assessment and exposure assessment. In Europe, the current reference is Directive (UE) 2022/431, regarding carcinogen, mutagen, and reprotoxic agent (CMR) exposure. However, at the worldwide level, different classification approaches are used to establish carcinogenicity of substances and it is often difficult to compare the classifications of carcinogenicity (CoCs) proposed by different international bodies. This study aims to investigate a list of carcinogens of concern in occupational settings based on the CLP (Classification Labelling Packaging) CoC and to create a tool that allows a rapid translation–comparison of some international CoCs with the reference one. CoCs proposed by various sources were consulted and used to apply a translation method, to favor an alignment of different CoCs according to a reference. Results outlined that, considering diverse sources, CoCs can result in different classifications of the same chemicals. Overall, this may have implications for the hazard assessment process, which is the base of risk assessment. The proposed tool is expected to help risk assessors in the occupational field when it is needed to have a comparison with different CoC systems. Full article

This in vitro study aimed to confirm the effect of the additional features of Kirei Keep Light (KKL), a commercial UV-C irradiation system that was originally created for coating the surface of removable dentures with photoreactive 2-methacryloyloxyethyl phosphorylcholine (MPC), on the antimicrobial efficacy aspect against Candida albicans biofilm on a denture base material (PMMA) and SARS-CoV-2. Materials and Methods: The antimicrobial efficacy on C. albicans biofilm was evaluated through quantitative (CFU) and qualitative (SEM images) analysis of three groups: no treatment (control), KKL, and immersion in a disinfectant solution, MCAE. The quantitative evaluation on SARS-CoV-2 was performed by comparing the untreated (control) group and the KKL group. Results: In comparison with the control group (2.39 × 10⁶ CFU/mL), KKL irradiation resulted in a 91.01% reduction in C. albicans biofilm (2.15 × 10⁵ CFU/mL), whereas for the MCAE group, this reduction was 99.98% (4.64 × 10² CFU/mL). The SEM image results also corroborate the CFU results, which showed that the fewest clean surfaces were found in the control, and this gradually increased with KKL and MCAE. SARS-CoV-2 inhibition, indicated by its TCID50 value, demonstrated that KKL almost completely inhibited SARS-CoV-2 infection and replication (99.99% reduction). Conclusion: KKL possesses antimicrobial efficacy on C. albicans biofilm on PMMA and SARS-CoV-2. Full article

Patients’ effective hand hygiene helps to reduce healthcare-associated infections and prevents the spread of nosocomial infections and communicable diseases, such as COVID-19. Accordingly, this study aimed to describe effective hand hygiene decisions based on the Health Action Process Approach (HAPA) and whether this pattern is invariant for mental health. Data were collected cross-sectionally from patients who had previously been admitted to a hospital (N_{study 1} = 279; study 1) and longitudinally from psychosomatic rehabilitation patients (N_{study 1} = 1073; study 2). The fit of the HAPA framework and changes in hand hygiene decisions regarding compliance, social-cognitive variables of the HAPA, and mental health status were examined. The results revealed that the trimmed HAPA framework fitted the data well (χ² = 27.1, df = 12, p < 0.01, CMIN/df = 2.26, CFI = 0.97, RMSEA = 0.08). According to multi-group structural equation modeling, the HAPA model with hand hygiene behavior was found to be invariant regarding mental health. To conclude, the trimmed HAPA framework was revealed to be a generic framework for explaining social-cognitive processes relating to hand hygiene decisions. Therefore, helping individuals to perform hand hygiene recommendations requires intention formation and bridging the intention–behavior gap. This can be undertaken by promoting planning and self-efficacy. All processes appear generic to participants with and without mental health challenges. Full article

Urban waters (UW) are complex environments, and their definition is related to water systems in urban zones, whether in a natural system or an urban facility. The health of these environments is related to public health and the quality of life because public health is the focal point of environmental and anthropic impacts. Infrastructure is paramount for maintaining public health and social and economic development sanitation. Insufficient infrastructure favors disease vectors. The population and environment suffer from deficient urban water infrastructure in Brazil despite government efforts to manage the existing systems. In this work, machine learning (regression trees) demonstrates the deficiency of sanitation and UW management fragmentation on public health by using the Aedes aegypti infestation index (HI) and water supply, wastewater, stormwater and drainage indicators (SNIS data). The results show that each Brazilian region faces different problems. The more infested regions were Northeastern, Northern and Southeastern. Moreover, municipalities with better SNIS data have lower infestation rates. Minimizing problems related to sanitation through the integrated management of water and urban areas is extremely important in developing countries. UW governance is connected to public health. Water management fragmentation leads to more complex issues, and managers must confront them to improve the quality of life in urban zones. Full article

The protective effect of COVID-19 vaccination for contact persons is controversial. Therefore, the aim of this review was to determine whether COVID-19 vaccination provides significant protection for them. A PubMed search was carried out using the terms “unvaccinated vaccinated covid” in combination with “viral load” and “transmission”. Studies were included if they reported original comparative data on the SARS-CoV-2 viral load, duration of SARS-CoV-2 detection, or SARS-CoV-2 transmission rates. A total of 332 articles were identified, of which 68 were included and analyzed. The differences in the viral load were equivocal in 57% of the 35 studies, significantly lower in the vaccinated in 11 studies and in the unvaccinated in 3 studies. The infectious virus levels were significantly lower in the vaccinated in two out of six studies. Virus clearance was significantly faster in vaccinated subjects in two of eight studies (detection of viral RNA) and two of four studies (detection of infectious virus). The secondary attack rates were significantly lower in vaccinated index cases in 6 of 15 studies. The vaccination status of contacts was described in two of the six studies and was 31.8% and 39.9% lower in households with an unvaccinated index case. The inconsistent and variable differences in the viral load, viral clearance and secondary attack rates between vaccinated and unvaccinated individuals, especially during the omicron predominance, suggests that COVID-19 vaccination is unlikely to prevent a relevant proportion of transmissions to contact persons, taking into account the relevance of the immunological status of the contact population (vaccination rates and previous infection). Full article

Handwashing with soap is a fundamental practice for preventing communicable diseases, particularly in resource-constrained settings like Nepal, where various factors influence maternal handwashing behaviours. A systematic search encompassing PubMed/Medline, Embase, PsycINFO, CINAHL and grey literature source was conducted. Extracted eligible articles underwent descriptive analysis and their quality assessment was carried out following STROBE guidelines. From the initial screening of 187 database articles and 18 from grey literature, a total of 120 full text articles and records were retrieved to evaluated for inclusion in the review, identifying nine articles meeting the inclusion criteria for the review. Maternal handwashing with soap frequencies varied during critical moments ranging from 6% to 100%, and a 47% availability of soap and water at the household level was reported. Factors influencing handwashing included education, wealth, ecology, and participation in health promotion campaigns. Barriers included knowledge gaps, contrary beliefs, unavailability of soap and water, financial constraints, maternal demotivation, and low participation in decision-making. Limitations include study design heterogeneity (cross-sectional, Randomized Controlled Trials-RCT, Cohort), sample size variability, and geographical bias, potentially limiting generalizability of this study, limited reporting on soap and water availability for mothers at the household level is noted, and temporal variability introduces study inconsistency. Availability of soap, water, and effective health education is crucial for promoting sustained handwashing practices. Community-based interventions involving mothers in decision making and policy initiatives are essential for overcoming barriers and promote behavioural change to improve public health outcomes. This paper aims to determine the rates of handwashing with soap among mothers in Nepalese households and explore the factors associated with the uptake of handwashing. Full article

Background: The tobacco industry has actively advocated for electronic cigarettes (e-cigarettes) and heated tobacco products (HTPs) as harm-reduction alternatives to traditional cigarettes. Around 40% of smoking physicians have adopted HTPs. This study aimed to uncover the motivations behind Japanese physicians’ e-cigarette and HTP use while analyzing the associations between product use, physician demographics, lifestyles, and smoking preferences. Methods: A mail-based survey was conducted in 2020, targeting 6000 male and 1500 female physicians. From the 5492 survey participants, 346 physicians aged 28 to 98 who were current smokers were selected. The survey assessed their usage of e-cigarettes and HTPs and explored the reasons for initial adoption. A multivariate logistic regression analysis examined the relationships between product use, physician characteristics, and behaviors. Results: Approximately 33.8% of smoking physicians had experimented with e-cigarettes and HTPs. E-cigarette and HTP use correlated with youthfulness, nicotine addiction, and a history of medical treatment. The primary drivers for adopting e-cigarettes and HTPs were reduced odor (74.4%), perceived harm reduction (48.7%), and decreased exposure to secondhand smoke (29.1%). Conclusions: Physicians, when transitioning from conventional cigarettes to HTPs or e-cigarettes, are primarily motivated by a desire to reduce the odor of conventional cigarettes rather than health-related concerns. Full article