Hygiene

Infectious diseases are largely preventable, yet they continue to pose a significant threat to public health, particularly among vulnerable populations in developing countries. Basic hygiene practices, especially hand and skin hygiene, have been shown to significantly reduce the risk of the cross-transmission of infections, including those caused by multi-drug-resistant organisms. In light of the growing global concern about antimicrobial resistance, there is an urgent need to review and reinforce these practices. This study provides a general overview of the role that hand hygiene practices play in decreasing infectious diseases by conducting a comprehensive review. Multiple online databases, including Google Scholar, Scopus, and Web of Science, were searched using relevant keywords such as “hygiene practices”, “infectious diseases”, “public health”, “Africa”, and “sanitation”. After filtering the search results for relevancy, selected studies were narratively synthesized to present the latest data on hand hygiene and its impact on infectious diseases. Strengthening hand and skin hygiene, along with environmental sanitation and preventive measures, can help reduce the spread of nosocomial infections. By emphasizing the importance of these fundamental hygiene practices, particularly in regions where the burden of infectious diseases is highest, the development of antibiotic-resistant diseases can be prevented, improving patient safety, and enhancing public health outcomes. Adopting comprehensive hygiene policies, including regular handwashing, is crucial for reducing the prevalence of infectious diseases and improving health outcomes in developing countries. Full article

The symptoms of foodborne illness caused by Bacillus cereus often go unreported, complicating the effectiveness of conventional chemical and physical methods used to inhibit its growth in food production. This challenge, combined with the increasing use of lactic acid bacteria (LAB) in the food industry and consumer preference for minimally processed products, prompted this study. The antibacterial activity of diffusible substances produced by Lactococcus lactis ATCC 11454 against Bacillus cereus NC11143 and Escherichia coli K-12 MG1655 was investigated using a non-contact co-culture model utilising deMann Rogosa and Sharpe broth, with glucose as a carbon source. This study employed plate counting and flow cytometry to assess the impact of these substances on bacterial growth and to analyse their composition and antimicrobial efficacy. The co-culture of Lactococcus lactis ATCC 11454 resulted in the production of a stable antimicrobial peptide, which was heat resistant and acid tolerant. Purification was achieved via ammonium sulphate precipitation and preparative HPLC, yielding a peptide with a molecular mass of 3.3 kDa, with daughter ion fractions similar to nisin A. Antimicrobial activity studies demonstrated that the diffusible substances effectively inhibited B. cereus growth over a period of eight days and exhibited bactericidal activity, killing 99% of the B. cereus cells. Additionally, these substances also inhibited Escherichia coli K-12 MG1655 grown under similar conditions. Comparative analysis revealed that in the co-culture assay, L. lactis produced a 50% higher yield of the antimicrobial peptides compared to pure cultures. Similarly, the specific growth rate of L. lactis was four times higher. With respect to protein purification and concentration, ammonium sulphate precipitation coupled with solid phase extraction was most effective in the purification and concentration of the diffusible substances. The findings provide a basis for utilising bacteriocin-producing strains as a preservation method, offering an alternative to traditional chemical and physical control approaches especially for the food industry. Full article

Background/Objectives: Fungal infections, commonly referred to as mycoses, are widespread and affect various parts of the body. Common types of fungal skin infections include tinea pedis, tinea unguim, tinea cruris, tinea versicolor, and tinea manuum. Athletes, in particular, are at a higher risk of contracting these infections due to several factors inherent to their training and competitive environments. Methods: This research examined the incidence, anatomical distribution, and seasonal occurrence of fungal skin infections among beach volleyball athletes in Greece. The study cohort consisted of 785 participants, with an average age of 28.4 years. Variables recorded included gender, the seasonal periods during which athletes might be more prone to injuries, and the specific body areas affected by fungal infections. In addition, training-related data such as weekly training frequency, and daily training duration were collected. Results: Incidence rates correlated in relation to gender: male, tinea pedis (p < 0.000), tinea manuum (p < 0.010); number of weekly trainings: tinea pedis (p < 0.000), tinea unguium (p < 0.043), tinea cruris (p < 0.008), tinea versicolor (p < 0.038), tinea manuum (p < 0.043); average hours of daily training: tinea unguium (p < 0.039), tinea manuum (p < 0.039). Conclusions: Athletic activities often involve exposure to warm, moist conditions that promote fungal growth. Locker rooms, showers, and equipment can harbor fungi, spreading infections among athletes. Understanding these infections is essential for effective prevention and management, as they can impact performance and health if untreated. Proper hygiene, antifungal treatments, and public health measures are crucial to reducing the risk in athletic settings. Full article

Background: Hands are critical vectors for microorganisms that cause healthcare-associated infections (HAIs). Hand hygiene, being done the right way, at the right time, and being given the right priority in a healthcare setting is an effective strategy to reduce HAIs and associated costs. Different strategies have been put in place to help improve hand hygiene compliance among healthcare workers; amongst them, continuous training is advised at all levels of care. Aim: This study, focusing on nursing students, aimed to describe their knowledge, attitudes, and perceptions towards hand hygiene, highlighting their crucial role in maintaining health and preventing infections. Methods: This study was a quantitative cross-sectional study. One hundred and fourteen questionnaires were distributed; 103 were filled out and returned by willing students at Maluti Adventist College, thus a 90% response rate. Results: 62% (64) demonstrated moderate knowledge, all had positive attitudes, and 61% (63) had a positive perception towards hand hygiene. There was a significant (p-value = 0.012) association between knowledge and training. Conclusions and recommendations: These provide valuable input for enhancing the World Health Organization’s (WHO) hand hygiene multimodal strategy, the SAFE LIFE Clean YOUR HAND campaign, and healthcare workers’ teaching curriculum. All stakeholders should implement strategies that prioritize knowledge dissemination to promote effective hand hygiene practices among healthcare workers worldwide. Full article

Tuberculosis (TB) is a dangerous disease caused by the bacterium Mycobacterium tuberculosis. Its transmission occurs through aerosols, making healthcare workers particularly vulnerable to it. At the San Cecilio Clinical University Hospital in Granada (HUCSC), preventive measures such as the use of personal protective equipment (PPE) and IGRA (interferon-gamma release assay) tests were implemented to detect latent tuberculosis infection. At HUCSC, between 2022 and 2024, 4.75% (92/1936) of workers were found to have positive IGRA test results, with no significant differences observed between professional categories. However, variability in positive IGRA rates was noted across different medical departments, with pulmonology and sample handling being the most affected. Additionally, a relationship was found between age and the likelihood of obtaining a positive IGRA test result. These findings underscore the importance of targeted preventive measures and a multifaceted approach to controlling and preventing tuberculosis in workplace environments. Full article

Dental students are frequently exposed to percutaneous injuries (PCIs) due to the nature of their clinical work, which involves sharp instruments and close patient contact. The COVID-19 pandemic further emphasized the need for stringent biosafety measures and the use of personal protective equipment (PPE). Despite these precautions, injuries remain prevalent, highlighting the need for comprehensive education and training in biosafety and infection control. This study investigates the incidence and causes of injuries among undergraduate dental students during clinical sessions. This study was conducted at the Department of Dentistry, National and Kapodistrian University of Athens, focusing on injuries reported from 2021 to 2024. Data were collected through self-reported clinical records. The primary variables assessed included the type of injury, the instrument involved, the clinical procedure performed, and the immediate actions taken post-injury. Serological testing was conducted on students and patients to assess the risk of the transmission of bloodborne pathogens. The findings reveal a high prevalence of injuries, with needles being the most common cause (51.4%), followed by other tools such as dental probes (25.7%) and burs (8.6%). The most frequent injury type is piercing (74.2%), primarily affecting the fingers (88.6%). Periodontal treatments, restorative procedures, and endodontic treatments are the main activities leading to injuries, with 17.1% of injuries being caused by each. No statistically significant results are recorded. Despite regular medical records for most patients treated by injured students, serological testing shows significant positivity rates for HCV and HBV. Notably, most injured students demonstrate their commitment to safety by adhering to recommended post-exposure protocols, including wound cleaning, disinfecting, and serological testing. Furthermore, the impact of COVID-19 heightened the importance of personal protective equipment (PPE) and reinforced occupational health standards. Our study highlights the critical need for enhanced biosafety awareness and training among undergraduate dental students to reduce injury risks. Full article

Emerging antimicrobial-resistant (AMR) Candida auris presents a formidable global health challenge, causing severe healthcare-associated infections (HAIs) with high mortality rates. Its ability to colonize surfaces and resist standard disinfectants undermines traditional hygiene practices, prompting an urgent need for new strategies. Ultraviolet C (UVC) light offers a promising approach with rapid and broad-spectrum germicidal efficacy. This review examines current literature on UVC LED technology in combating C. auris, highlighting its effectiveness, limitations, and applications in healthcare hygiene. UVC light has potent activity against C. auris, with up to 99.9999% inactivation depending on certain conditions such as microbial load, type of organism, surface, environmental, equipment, and UVC radiation factors. UVC LEDs can effectively combat C. auris, driving down healthcare costs and reducing attributable global mortality. Here, we explore implementation strategies for the targeted disinfection of high-risk areas and equipment, air handling units (AHUs), and water treatment systems. Challenges associated with UVC LED disinfection devices in healthcare settings, current performance limitations, and radiation safety are discussed. This will help in optimizing application protocols for effective disinfection and radiation safety. To further strengthen healthcare facility hygiene practices and curb the global spread of C. auris, recommendations for integrating UVC LED disinfection into infection control programs are shared. Full article

Objective: This clinical investigation evaluated oral health improvements after the use of a novel zinc toothpaste in comparison to a control after 3 weeks and 6 weeks of use. Clinical assessments of gingivitis, bleeding and dental plaque evaluated oral health. Methods: Healthy adults meeting the study criteria (plaque index scores ≥ 1.5 and gingival index scores ≥ 1.0) were randomized into a treatment group with 74 participants assigned to the test and 73 participants assigned to the control groups. With the assigned toothpaste, subjects were instructed to brush at home twice a day for one minute. Subjects were evaluated clinically for gingivitis, plaque and bleeding at the baseline, employing 3-week and 6-week examinations. Results: All one hundred and forty-seven (147) subjects completed the 6-week study with no significant differences between groups at baseline (p > 0.05). The test demonstrated progressive improvements at the 3-week and 6-week evaluations as compared to the control (p < 0.001). In comparison to the control, the test demonstrated reductions of 13.4%, 17.0% and 55.3% for gingivitis, dental plaque and gingival bleeding, respectively, at the final visit (p < 0.001). Conclusions: Clinical improvements in gingivitis, dental plaque and gingival bleeding were registered in the group assigned the test toothpaste as compared to the control. The test toothpaste demonstrated statistically significant and progressively improving gingivitis, dental plaque and gingival bleeding scores that were all statistically significant versus the control at each post-treatment assessment. Full article

This study assessed knowledge, attitudes, and practices related to food hygiene among mothers from Malawi’s rural communities against the WHO Five Keys to Safer Food (WHO-FKSF) and good pre-and post-harvest practices (GPPHPs) as reference points. Five hundred twenty-two mothers from six rural communities across two districts were selected for the survey. The results indicated limited knowledge among participating mothers regarding managing food hazards, including mycotoxins, bacteria, viruses, and parasites (BVPs). A significant proportion (89.5%) of women reported inconsistent or no handwashing with soap after using the toilet. In addition, 48.7% failed to plant with the first good rains, 38.7% neglected to check for moldy cobs during harvesting, 57.4% dried maize on bare soil, and 99.2% bought maize with noticeable mold. Higher education, knowledge, and positive attitudes were associated with enhanced BVP control practices, while larger households and positive attitudes were linked to improved mold/mycotoxin management (p < 0.05). Mothers showed lower (p < 0.05) knowledge and attitude levels regarding molds than BVPs but demonstrated relatively better practices for mold control. A comprehensive education program based on the WHO Five Keys to Safer Foods, tailored to local socio-cultural norms and incorporating mold and mycotoxin management guidelines, is recommended. Full article

Background: Over the past few decades, epidemic outbreaks and disease occurrences have become more frequent and widespread in Africa, posing challenges for poor countries in the region and impacting vulnerable populations. Limited resources, inadequate healthcare infrastructure, socioeconomic inequalities, malnutrition, mass gatherings, and lack of proper sanitation and hygiene contribute to Africa’s high burden of epidemics and infectious diseases such as cholera, measles, monkeypox, Ebola viral disease, and COVID-19. This paper reviewed epidemic outbreaks and diseases transmitted through intimate contact in Africa and their impacts on vulnerable populations. Methods: A narrative review approach was adopted to gather and analyze the relevant literature on epidemic outbreaks in African sub-regions. The review encompassed causes, transmission patterns, demographic impact, community susceptibility, preventive measures, and psychosocial risk-taking behaviors. Results: This study emphasizes the importance of addressing the causes of response lapses and the resulting human, material, and economic losses in the region. Effective preventive measures include disease surveillance, early mitigation strategies, contact tracing, personal protective measures, improved political and public health leadership, and socioeconomic equity. However, the review highlights challenges in implementing these measures effectively due to limited resources, delayed detection, and difficulties in scaling up response solutions. Conclusions: There is a need for a comprehensive approach involving health departments, infrastructure development, and addressing socioeconomic factors. Full article

Campylobacter jejuni plays a significant role in human health, food production, and veterinary practice. Biofilm formation is a likely mechanism explaining the survival of C. jejuni in seemingly unfavourable environments, but the underlying mechanisms are poorly understood. We propose a mathematical model to unify various observations regarding C. jejuni biofilm formation. Specifically, we present a cellular automaton with stochastic dynamics that describes both the probability of biofilm initiation and its subsequent growth. Our model incorporates fundamental processes such as cell rearrangement, diffusion of chemical compounds, accumulation of extracellular material, cell growth, lysis, and deactivation due to nutrient scarcity. The model predicts an optimal nutrient concentration that enhances population survival, revealing a trade-off where higher nutrient levels may harm individual cells but benefit the overall population. Our results suggest that the lower biofilm accumulation observed experimentally in aerobic conditions compared to microaerobic conditions may be due to a reduced surface invasion probability of individual cells. However, cells that do manage to invade can generate microcolonies of a similar size under both aerobic and microaerobic conditions. These findings provide new insights into the survival probability and size of C. jejuni biofilms, suggesting potential targets for controlling its biofilm formation in various environments. Full article

Habits formed during adolescence tend to persist into adulthood, and correcting poor habits or behaviors during this time is more effective than at other times. Particularly, parents and caregivers should encourage good hygiene habits in their adolescent children by setting a positive example themselves. Using logistic regression, we analyzed the association between brushing teeth after lunch and washing hands before lunch by family type among 54,848 adolescents from the 17th Youth Health Behavior Survey raw data in 2021. Four logistic regression models were used to adjust for confounders hierarchically. In all models, adolescents who practiced tooth brushing after lunch were 2.09 times more likely to practice hand washing before lunch than those who did not. With and without adjustment, we found that the association between adolescents’ tooth brushing and hand washing practices in two-parent households was stronger than the association between adolescents’ tooth brushing and hand washing practices in single-parent households. Associations were found between tooth brushing and hand washing practices, and these associations were higher among adolescents in two-parent households than among adolescents in single-parent households. The finding of a significant link between family type and personal hygiene habits indicates the need for interventions to enhance the oral health of children and adolescents. Such interventions should be customized to reflect the specific characteristics of the child’s household. Full article

The issue of antibiotic resistance represents a significant threat that extends beyond human health, encompassing animal welfare and the sustainability of the natural environment. The inappropriate use of antibiotics, poor sanitation and inadequate control measures have contributed to the emergence of drug-resistant bacteria, which can spread at the human–animal–environment interface. The documented presence of antimicrobials in agriculture, veterinary medicine and human medicine has convinced all stakeholders of the need to contribute to the development of a “One Health” approach, which recognises the interrelationships between animals, humans and their environment and the need to adopt a common strategy encompassing these sectors to limit the spread of bacterial antimicrobial resistance (AMR). Although a number of countries have implemented integrated surveillance systems to monitor antibiotic use and antimicrobial resistance, available data suggest that the use of antibiotics in humans, animals and the environment is increasing worldwide. Consequently, the emergence of antibiotic-resistant pathogens is becoming a recurring concern. This review provides a comprehensive overview of the measures that are necessary to be taken and implemented in order to guarantee global health security. Full article

Environmental monitoring (EM) is the cornerstone for the assurance of sterility during aseptic manufacturing. In this study, the EM quality aspects in the radiopharmaceutical cleanrooms of the University Medical Center Groningen (UMCG), The Netherlands, were evaluated. Hereto, data obtained from EM over the period 2010–2022 were analyzed. The data were sorted according to the Good Manufacturing Practice (GMP) classification of the respective premises with their corresponding limits, and frequencies of excursions were determined per location. The frequency of conducted measurements gradually increased between the start and end of the assessed period. There was a trend of increased action limit excursions observed between 2010–2022. We found that EM in grade A areas appeared to be significantly less compliant with GMP specifications than the combined data from all sampled premises at the facility (p < 0.00001; two-sided Fisher’s exact test). A trend was found for reduced action limit excursions for passive air sampling and particle counting, suggesting improved GMP compliance over time for this specific type of EM. The contamination recovery rate (CRR) found for cleanroom conditions, around 10%, was considered sufficient. From this comprehensive data analysis, we learn that, in order to be fully compliant with the requirements set in the recent revision of EU (European Union)-GMP Annex 1 ‘Manufacture of sterile medicinal products’ (in force as of 25 August 2023), strategies to further improve product protection are justified. For example, improved cleaning and disinfection procedures, more efficient working methods as well as optimization of the conditions under which aseptic manufacturing is performed are to be considered. Full article

Mechanically transmissible and stable viruses such as tobamoviruses, which include Tobamovirus fructirugosum (syn. tomato brown rugose fruit virus (ToBRFV), will continue to pose major challenges for farmers. Consequently, holistic hygiene concepts are being implemented to prevent the introduction and spread of these viruses. The decontamination of tires and castors was previously a weak point in many industrial hygiene concepts. For this reason, the ProfilGate clean-off zone was tested in combination with the disinfectant MENNO Florades for the decontamination of ToBRFV-contaminated tires. In total, 478 tire segments were sampled to evaluate the contamination of ToBRFV and the following decontamination of the tires. This treatment reliably removed high (4.5 µg/cm²), medium (0.45 µg/cm²), and low concentrations (0.045 µg/cm²) of ToBRFV from the tires, as shown by a bioassay. The reduction in necrotic local lesions on susceptible indicator plants N. tabacum cv. Xanthi NN was between 91.9 and 97.6%. The reduction in ToBRFV contamination largely depended on the length of the rollover distance, i.e., the number of tire rotations. For transport trolleys with polyamide and rubber tires, depletions of 97.4 and 97.6%, respectively, was determined after 16 rotations. For transport wagons with tires twice the size and polyurethane tread, the depletion was still at least 91% after eight wheel turns. Even in the case of gross soiling of the tires, the mean reduction from the different tread materials was 80.9 to 98.9%. Subsequent analysis of the clean-off zone revealed that ToBRFV did not accumulate, even when the contaminated tires were driven over several times, but was safely inactivated completely in the disinfectant solution. This provides growers with an effective tool for preventing the introduction and spread of ToBRFV. Full article

In light of the close contact between patient and clinician during ophthalmic examinations and the multiple opportunities for pathogen transmission, we identified and evaluated potential pathogen transmission routes through high-touch surfaces in an outpatient ophthalmology clinic. A circuit simulation was performed to replicate a patient’s journey through an ophthalmology clinic with various stations. Fluorescent oil and powder were applied to the hands of Simulated Patient A who went through the circuit. Routine disinfection of surfaces in the slit lamp environment and hand hygiene by the ophthalmologist were conducted prior to Simulated Patient B going through the same circuit with untagged hands. Ultraviolet black light was used to identify fluorescent marker contamination after Simulated Patient B completed the circuit. Fluorescent marker contamination was found on the hands of all the simulated patients and staff, various items of the simulated patients, multiple equipment surfaces—particularly the ophthalmologist’s working table and slit lamp environment—and miscellaneous objects like appointment cards and files. Fluorescent marker contamination on Simulated Patient B’s untagged hands despite proper hand hygiene being performed prior suggests suboptimal surface disinfection following Simulated Patient A’s circuit. Through this pilot study, we recognised the key role that ophthalmic high-touch surfaces play in fomite transmission and that thorough disinfection of high-touch surfaces is essential on top of proper hand hygiene. With the contact sequences delineated in this pilot study, specific cues for hand hygiene and surface disinfection may be implemented at suitable intervals during contact with high-touch surfaces. Environmental decontamination adjuncts could also be considered to reinforce surface disinfection. Full article

Staphylococcus aureus and coagulase-negative staphylococci account for about 80% of infections associated with medical devices and are associated with increased virulence due to their ability to form biofilm. In this study, we aimed to construct a comprehensive reference map followed by significant pathway analysis in the proteome of S. aureus biofilm grown for 3 days compared with 24 h of planktonic culture using a high-resolution Tandem Mass Tag (TMT)-based MS. We identified proteins associated with secondary metabolites, ABC transporters, biosynthesis of amino acids, and response to stress, and amino sugar and nucleotide sugar metabolism were significantly upregulated in 3-day biofilm. In contrast, proteins associated with virulence factors, microbial metabolism in diverse environments, secondary metabolites, translation, and energy metabolism were significantly downregulated. GO functional annotation indicated that more proteins are involved in metabolic processes, catalytic activity, and binding in biofilm, respectively. Among the significantly dysregulated proteins, hyaluronidase (hysA) in conjunction with chitinase may play a significant role in the elimination and/or prevention of biofilm development. This study advances the understanding of the S. aureus subproteome, identifying potential pathways significant to biofilm biology. The insights gained may aid in developing new therapeutic strategies, including antibiofilm agents, for treating biofilm-related infections associated with implantable medical devices. Full article

Objectives: In the protocol for cleaning and sterilizing dental handpieces (DHs), water retention within the instrument poses a challenge and may compromise the sterilization process. This study aimed to assess the reliability and reproducibility of the sterilization protocol regarding the dryness of DHs. It evaluated the presence of residual water in these instruments after various conditions of treatment through multiple dryness tests. Methods: This comparative study examined the dryness of seven different DHs following five washing–disinfection and/or sterilization protocols. Dabbing tests, shaking by hand, or compressed air tests through DHs and over absorbent paper were employed to ascertain the thorough dryness of DHs after treatment. As soon as the first sign of water appeared on the absorbent paper, the DH was deemed to be not dry. Results: Upon completion of the washing–disinfection protocol without sterilization, five out of seven DHs were deemed dry using the dabbing test, yet none were fully dry when subjected to shaking or compressed air. However, in the four protocols incorporating final sterilization, all DHs were dry according to the three drying tests. Conclusion: This study underscores the essential role of the sterilization step in eliminating residual water from DHs, thereby ensuring optimal conditions for effective sterilization in terms of dryness. Furthermore, the study recommends against relying solely on the dabbing drying test, emphasizing the importance of shaking or using compressed air to confirm instrument dryness. Full article

Orthodontic therapy is associated with a more significant accumulation of dentobacterial plaque and impaired oral hygiene, which increase the risk of developing dental caries and periodontal disease. Therefore, it is crucial to educate orthodontic patients about proper oral hygiene maintenance and oral health before and during treatment. The aim of this pilot study was to implement evidence-based best practices related to oral hygiene in adult orthodontic patients and improve compliance. In addition to evaluating oral hygiene practices, another goal of the project was to assess the knowledge of orthodontic patients regarding oral health. Questionnaires with seven pre- (before) and post-test criteria (90 day after implementation) were developed based on the best evidence available. This project was conducted in a private dental clinic in Split, Croatia, and included 45 patients. The baseline audit showed a gap between clinical practice and the best evidence. Three criteria achieved a high compliance baseline, while after implementation, there were substantial improvements in compliance for all. The everyday use of mouthwash improved from 17.8% at baseline to 66.7% at follow-up, as did the use of interdental aids, which increased from 55.6% to 91.1%. Statistically significant differences were found in the total score for oral health knowledge between the baseline (6.67 ± 1.74) and the follow-up audit (7.78 ± 0.56, p ≤ 0.001). The strategies developed in this project were effective in providing essential information to adult orthodontic patients and improving compliance with evidence. Guidelines on this topic should be designed to assist orthodontists and patients in maintaining oral health and oral hygiene. Full article