No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Handwashing and respiratory illness among young adults in military training
Abstract
In response to increasing concerns about respiratory illness in military recruits, a simple handwashing program was developed and evaluated at a large Navy training center.
Clinical records from 1996 through 1998 were reviewed to determine weekly rates of respiratory illness before and after program implementation (1,089,800 person-weeks reviewed). A supplemental survey was given to a sample of recruits to assess self-reported respiratory illness and compliance with the handwashing program.
A 45% reduction in total outpatient visits for respiratory illness was observed after implementation of the handwashing program. No change was noted in hospitalization rates for respiratory illness, which remained low during the observation period. Survey data supported clinical observations, as frequent handwashers self-reported fewer respiratory illness episodes when compared to infrequent handwashers. Surveys also revealed challenges with handwashing compliance.
Implementation of a handwashing program in this population of healthy young adults was associated with a marked reduction in outpatient visits for respiratory illness. Despite its success, maintenance of the handwashing program has been challenging in the time-constrained setting of military training.
... Handwashing is identified as an effective measure in reducing the influenza virus infection in the health centers [33][34][35] and several other settings (school, community, and military settings). 32,36,37 However, the results of compliance and the effectiveness of these interventions in the community are less known (see Table 1). [36][37][38][39][40] Recently, specific studies have been performed on the effectiveness of handwashing-based COVID-19 protection measures. ...
... 32,36,37 However, the results of compliance and the effectiveness of these interventions in the community are less known (see Table 1). [36][37][38][39][40] Recently, specific studies have been performed on the effectiveness of handwashing-based COVID-19 protection measures. However, it is still unclear whether handwashing by soap is more effective or handwashing by alcohol. ...
... There were challenges in the time-constrained setting of military training. 36 Soap and water-based handwashing Households (children) ...
Coronavirus disease 2019 (COVID-19) was found first in Wuhan (China), which was considered as an infectious disease caused by severe acute respiratory syndrome coronavirus 2. Hence, in order to prevent an increasing infectious disease risk, current management strategies against COVID-19 should strictly comply for stopping-up the spread of COVID-19 outbreak. There is a major challenge in the timely diagnosis (by kits, etc.) to prevent COVID-19 infection outbreak until proper drugs or vaccines for treating COVID-19 patients are introduced. Therefore, it is essential to demand personal protective manners for each person in against of COVID-19 infection. In this article, the symptoms of COVID-19 and the effect of handwashing in against of COVID-19 are mentioned, as well as its benefits in the COVID-19 infection prevention are understood more clearly.
... Handwashing is identified as an effective measure in reducing the influenza virus infection in the health centers [33][34][35] and several other settings (school, community, and military settings). 32,36,37 However, the results of compliance and the effectiveness of these interventions in the community are less known (see Table 1). [36][37][38][39][40] Recently, specific studies have been performed on the effectiveness of handwashing-based COVID-19 protection measures. ...
... 32,36,37 However, the results of compliance and the effectiveness of these interventions in the community are less known (see Table 1). [36][37][38][39][40] Recently, specific studies have been performed on the effectiveness of handwashing-based COVID-19 protection measures. However, it is still unclear whether handwashing by soap is more effective or handwashing by alcohol. ...
... There were challenges in the time-constrained setting of military training. 36 Soap and water-based handwashing Households (children) ...
Coronavirus disease 2019 (COVID-19) was found first in Wuhan (China), which was considered as an infectious disease caused by severe acute respiratory syndrome coronavirus 2. Hence, in order to prevent an increasing infectious disease risk, current management strategies againstCOVID-19 should strictly comply for stopping-up the spread of COVID-19 outbreak. There is a major challenge in the timely diagnosis (by kits, etc.) to prevent COVID-19 infection outbreak until proper drugs or vaccines for treating COVID-19 patients are introduced. Therefore, itis essential to demand personal protective manners for each person in against of COVID-19infection. In this article, the symptoms of COVID-19 and the effect of handwashing in against of COVID-19 are mentioned, as well as its benefits in the COVID-19 infection prevention are understood more clearly.
... In particular, ARIs are responsible for decreased job performance, loss of work-time, and hospitalization, which seriously impact unit readiness. [5,6,[9][10][11][12] Therefore, decreasing ARI incidence may help improve training accomplishments and trainees' health. ...
... [18] In military environments, adopting simple hand washing programs that mandate hand washing at least 5 times daily significantly reduces the incidence of respiratory illness. [12] Despite the importance of hand washing for the prevention of ARIs, performing hand washing during field training might not be feasible under certain circumstances related to water shortage, that is, field training during a very cold winter season. However, a few data are available on whether adopting hand washing during field training can reduce ARIs among trainees participating in basic military training. ...
... The implementation of early hand washing reduced the ARI rate by 15.0%. Although there have been a few studies that show hand washing reduces respiratory infection in military settings, [12,20] there have been no studies showing that hand washing performed during field training further decreases ARI. Thus, this study carries considerable weight in this field. ...
Hand washing plays a key role in preventing respiratory infection in many clinical settings. However, its effectiveness in preventing acute respiratory illness (ARI) during field training in military training facilities has been not studied.
A quasi-interventional study was performed to evaluate the prevalence of ARIs over 4 weeks in a Korean army training center in South Korea from January 2009 to February 2009. A total of 1291 recruits participating in military training for 4 weeks were randomly distributed to 2 battalions (one with 631 and the other with 660). After noticing there is a difference between the 2 battalions in terms of the development of ARIs at the end of 2 weeks of training, we conducted interviews with the battle commanders to determine factors that may be related to one battalion having a higher incidence of ARI. Thereafter, we performed an intervention, which consists of instructing the battalion having a higher incidence of ARI to implement field hand washing from the third week. Following the intervention, we compared the cumulative rate of ARI during 4 weeks of training.
The interviews revealed that there were no major differences between the 2 battalions in terms of the training schedules, living environments, or indoor hand washing methods. However, there was difference in terms of hand washing during field training for the first 2 weeks; whereas one battalion (the early hand washing group) implemented hand washing during field training starting in the first week, the other battalion did not implement hand washing for the first 2 weeks but instead began in the third week (the late hand washing group). The cumulative incidence rate of ARI during 4 weeks of training was significantly lower in the early hand washing group (13.0%, 95% confidence interval [CI]: 10.6%–15.9%) than in the late hand washing group (28.0%, 95% CI, 24.7%–31.5%).
Our study suggests that outdoor hand washing during field training may be an effective precaution for reducing ARI incidence among recruits participating in military training.
... 1 Children and adolescents should wash their hands frequently because they are the age group most likely to contract a disease from dirty hands. 2 Additionally, there is an elevated chance for the transmission of infectious diseases because of the conditions of nearby children in classrooms. 2 Within the grounds of primary schools, diarrhea and acute respiratory infections are frequently spread. Crowded environments and the absence of knowledge about taking care of themselves are conducive to the spread of microorganisms. ...
... 1 Children and adolescents should wash their hands frequently because they are the age group most likely to contract a disease from dirty hands. 2 Additionally, there is an elevated chance for the transmission of infectious diseases because of the conditions of nearby children in classrooms. 2 Within the grounds of primary schools, diarrhea and acute respiratory infections are frequently spread. Crowded environments and the absence of knowledge about taking care of themselves are conducive to the spread of microorganisms. ...
Poor water sanitation and hygiene is a public health problem in developing and underdeveloped countries, including Ethiopia, and remains an important public health issue among primary school students. Students have been repeatedly exposed to various communicable diseases associated with water sanitation and hygiene. The objective of this study was to assess predictors of handwashing practice among second-cycle public primary school students in East Dembiya District, northwestern Ethiopia, 2022. A cross-sectional study was conducted among 752 second-cycle primary school students. Data were gathered through face-to-face interviews using a structured interviewer-administered questionnaire and observational checklists adopted and modified from different sources of literature. The data were checked further by visualizing and computing rates with the SPSS version 26 statistical software. Multivariable logistic regression was used to identify predictors. The prevalence of washing practices among second-cycle primary school students was 57.6% (95% CI 53.90–61.10). Residency (urban) (adjusted odds ratio [aOR] = 2.17, 95% CI: 1.30–2.87), access to media (aOR = 1.66, 95% CI: 1.11–2.49), hygiene and sanitation club membership (aOR = 1.88, 95% CI: 1.26–2.80), good knowledge about handwashing (aOR = 3.93, 95% CI: 2.34–6.60), and a positive attitude toward handwashing (aOR = 3.63, 95% CI: 2.01–5.584) were predictors of handwashing practice among second-cycle primary school students. This study showed that handwashing practice among primary school students was low. Availing handwashing facilities, better media access, formation of a hygiene and sanitation club in the school, celebration of “Handwashing Day” with students, and leading behavior change communication are all important for improving students’ handwashing practice.
... It is likely that better handwashing practices are associated with other hygienic practices that may decrease the risk of ILI acquisition and handwashing has been shown to reduce respiratory infections in both clinical and non-clinical settings. [22][23][24][25] In a handwashing trial implemented at a Navy training center, researchers reported a 45% reduction in respiratory infectionassociated clinic visits after the researchers facilitated the distribution of health education messages, encouragement by leadership to wash hands, and increased availability of soap for handwashing. 22 These handwashing-related interventions, if implemented at a larger scale, have the potential to augment the current influenza and adenovirus vaccination programs and further decrease the burden of respiratory infections in the military. ...
... [22][23][24][25] In a handwashing trial implemented at a Navy training center, researchers reported a 45% reduction in respiratory infectionassociated clinic visits after the researchers facilitated the distribution of health education messages, encouragement by leadership to wash hands, and increased availability of soap for handwashing. 22 These handwashing-related interventions, if implemented at a larger scale, have the potential to augment the current influenza and adenovirus vaccination programs and further decrease the burden of respiratory infections in the military. ...
Introduction
Influenza-like illnesses (ILIs) are common in military populations and can impair mission-readiness, particularly in the current severe acute respiratory syndrome coronavirus 2 pandemic; therefore, it is important to identify potential risk factors for infection and better understand the burden of infection.
Materials and Methods
A survey was administered to military medical trainees living in a congregated setting on JBSA Fort Sam Houston, Texas, from January 2017 to February 2019. The survey included questions about ILI experience and potential ILI risk factors.
Results
2,121 individuals completed the survey. Respondents had a median age of 21 years, 46% were female, 32.6% were Air Force, 33.6% were Army, and 33.8% were Navy/Marines. Among the 815 (38%) who reported an ILI during training, 40% sought health care. The primary reasons for seeking healthcare included illness severity, concern about transmission, and accessibility of healthcare. Over half (54%) of the trainees who reported an ILI said the ILI had an impact on their performance, including reduced study time, missed physical training, and missed class. Multivariate model results indicate that women and younger trainees (<30 years) were more likely to report having had an ILI (women: OR 1.58, (95% CI 1.30, 1.92); age <30 years: OR 1.58, (1.06, 2.36)). In a subset analysis, those who reported washing their hands 10+ times per day were less likely to report an ILI (OR 0.61 (0.42, 0.89)).
Conclusions
ILIs are likely to be more common during training than healthcare records indicate and may result in decreased training effectiveness. Increasing access to handwashing facilities and education about the importance of handwashing to prevent the spread of disease will likely reduce the ILI burden in this population.
... Dedicated medical equipment should be used for these patients which should be cleaned and disinfected with an appropriate disinfectant after each patient's use. [6,20,21] Inanimate objects in patient surroundings, fomites, bed rails are major reservoirs of the virus through which indirect transmission may occur. [20,21] Hand hygiene is the best available entity to ensure the prevention of the spread of the virus to humans from contaminated environmental surfaces. ...
... [6,20,21] Inanimate objects in patient surroundings, fomites, bed rails are major reservoirs of the virus through which indirect transmission may occur. [20,21] Hand hygiene is the best available entity to ensure the prevention of the spread of the virus to humans from contaminated environmental surfaces. Another major aspect is the decontamination of environmental surfaces with either one of the disinfectants such as phenol, quaternary ammonium compounds, alcohol or 1%-2% sodium hypochlorite. ...
... the most susceptible to infections gained from unwashed hands. 2 Many infections start when hands are contaminated with disease causing organisms. This can happen after using the toilet, coughing or blowing your nose, playing, handling garbage and touching other contaminated surfaces. ...
... Hand washing has been shown to be effective and also cost-effective means of preventing communicable diseases. 2 It is against this backdrop that this study examines the availability of hand washing facilities, hand washing knowledge, and practices among public primary schools in Kintampo Municipality. ...
Background: Hand washing is very effective in preventing communicable diseases. Hand washing is particularly important for children, as they are more vulnerable to infections gained from unwashed hands and also due to their unhealthy behaviour. The study was conducted to determine the availability of hand washing facilities, hand washing knowledge and practices among public primary schools in Kintampo Municipality.Methods: A cross sectional survey was carried out among 300 children and 10 headmasters in 10 selected schools. Data were collected using questionnaires and observation checklist regarding socio-demographic characteristics, knowledge of hand washing, hand washing practices and availability of hand washing facilities in the selected schools.Results: All the children indicated that it was important to wash their hands with water and soap. About (37.67%) washed their hands in order to prevent diseases, 53.33% had never been educated on how to wash their hands. Only 23.33% of the children demonstrated correctly on how to wash hands, a little over 15% washed their hands under clean running water whiles 23.33% wipe their hands using handkerchiefs. Forty-three percent indicated after visiting toilet as necessary to wash hands whiles 42.33% cited lack of water as the barrier to hand washing. About 39.88% always washed their hands with soap after using the toilet; about 60% of the schools had hand washing points. Only 30% of the schools have clean running water.Conclusions: There is the need for effective hand washing education in the schools to help improve hand washing knowledge and practices. Hand washing facilities in the schools were found to be inadequate.
... De façon tout à fait intéressante, il a été mis en évidence à l'occasion de la perte de ce vaccin que les mesures barrières et l'hygiène des mains, y compris chez des soldats disciplinés, n'était pas suffisante pour endiguer une épidémie d'adénovirus (Ryan, Christian, and Wohlrabe 2001 ...
Les infections des voies respiratoires basses de l’enfant sont extrêmement fréquentes et potentiellement graves. L’étude des agents étiologiques responsables de ces infections a beaucoup accéléré ces dernières années en raison de l’apparition et de la démocratisation de nouvelles méthodes comme la PCR et les tests antigéniques délocalisables.A travers six articles de recherches scientifiques, nous abordons ici l’impact de l’usage de ces tests en pratiques clinique, ce qu’ils peuvent apporter à la science fondamentale et à l’avenir de la prise en charge de ces malades.Deux articles s’attachent à préciser l’usage d’une PCR multiplex sur les infections respiratoires, une étude épidémiologique confirmant la grande part des infections virales dans ces pathologies et une étude randomisé prospective confirmant l’intérêt d’un tel examen pour adapter la prescription à la réalité étiologique.Quatre articles viennent ensuite apporter des précisions sur l’usage des tests antigéniques aux urgences pédiatriques, en pratique clinique. Un premier propose un algorithme de recherche du pneumocoque – germe commensale également – dans les sécrétions rhinopharyngées de l’enfant. Le deuxième et le troisième identifient l’impact et la performance de test grippe et VRS aux urgences pédiatriques.Enfin, un dernier article traite de la détection du SARS-CoV-2 aux urgences pédiatriques, en période pandémique avec un test dans la sensibilité est déterminée par ce travail.L’ensemble de ces travaux concoure à préciser l’utilité et la pertinence d’un diagnostic étiologique précoce et de qualité pour améliorer la qualité des soins.
... [7] Hand washing is very important for youngsters and adolescents, as these age groups are the most vulnerable to infections gained from unwashed hands. [8] School children are particularly vulnerable to neglect of basic personal hygiene due lack of knowledge and practice. [9] Poor knowledge, practice of and attitudes to personal hygiene such as hand washing play major roles in the high incidence of communicable diseases and therefore has negative consequences for a child's long term overall development. ...
Introduction: Medical evidence suggests that contaminated hands are the main transmitters of disease. Hand washing is reflected as effective hygiene promotion activities for public health in the whole world. Aim: This study aimed to determine the effectiveness of hand washing education on knowledge regarding hand washing and its importance among adolescence in selected schools. Materials & methods: A quantitative research approach with Pre-experimental one group pretest and posttest design was used to conduct the study in selected schools of Uttar Pradesh. Non-probability purposive sampling technique was employed to select 40 adolescence. A self-structured knowledge questionnaire containing 30 items were used for assessing the level of knowledge among the subjects. Data were analyzed using SPSS version 25. Results: The mean score of the adolescence in pretest 10.2±4.1 is lesser than the mean score in posttest 20.2±4.3, t-value 18.8 which is significant P = 0.001. There was an association found between the levels of knowledge among the adolescence with their mother's education. Conclusion: The study is concluded that hand washing education is effective to enhance knowledge among adolescence regarding hand washing and its importance. Attitude and practice of adolescence regarding hand washing also can be assessed in future studies.
... Several studies have been conducted to assess the effect of handwashing on the rate of airway infections with positive results, in different population contexts such as the university, geriatric homes, and military barracks [12][13][14]. Meta-analysis studies report conflicting results ranging from an effect on decreased respiratory symptoms and diseases such as influenza [15], to a non-significant effect on laboratory-confirmed influenza reduction (RR=0.82; 95%IC 0.66-1.02; ...
Introduction: The World Health Organization released recommendations including social distancing, use of personal protective equipment, and respiratory hygiene to decrease the risk of coronavirus disease (COVID-19).
Objective: to estimate the number of potentially infectious self-contact in people located in concurred areas before and during the quarantine.
Methods: We conducted an observational study in Bucaramanga and nearby cities in Colombia, before and during the mandatory quarantine
due to COVID-19 pandemic. Trained health professionals recorded the times that people touched their faces (nose, mouth, and eyes) or their masks with the hand or other fomites (cell phones, pens, etc.). Sex, apparent age, and observation time were also recorded.
Results: We observed 87 people at a hospital, a university, banks, and stores/wholesales, The mean observation time was 14.1 minutes
(minimum 3 and maximum 66). A potential infectious self-contact occurred every 2.43 minutes. Before quarantine, the mean rate of hand-to-face contact was 30.4(9-88.4) times/hour and between fomites-to-face was 6.8(0-40) times/hour. During quarantine, the self-contact between handsmasks was 17.4(0-60) times/hour and between fomites-masks was 3.6(0-20) times/hour. We found a reduction in total contact rates after the quarantine (p=0.038), especially with fomites (p=0.027); women were more likely to self-contact (IRR:1.2, 95% CI:1.09-1.32) also people between 25 and 34 years (1.2, 1.05-1.39). The places with the highest frequency of contact were the university (1.39, 1.20-1.60) and banks (1.57, 1.28-1.92).
Discussion: The recommendation for handwashing may not be sufficient on its own, because the frequency of contact may be greater than that of washing or the use of hand sanitizer.
Keywords: Coronavirus infections, Quarantine, Infection control, Disease transmission, Fomites, Behaviour, Personal protection
... With the benefits of hand washing in hospitals established, emphasis shifted to hand washing in the community as an intervention which can be harnessed alongside other measures such as routine vaccinations aimed at tackling childhood morbidity and mortality from infections. Increasing evidence suggested that hand washing could significantly reduce the risk of respiratory tract infections and diarrhoeal diseases [12][13][14][15][16]. Curtis and Caimcross in a systematic review, projected that interventions to promote hand washing might save a million lives per annum and suggested that the promotion of hand washing with soap in homes in developing countries should become a public health intervention of choice [16]. ...
History of hand washing as an intervention to reduce morbidity and mortality in hospitals dates back to early 1800’s and the practise has yielded good results. Increasing evidence suggesting that hand washing significantly reduced the risk of respiratory tract infections and diarrhoeal diseases, lead to the promotion of hand washing in homes as a public health intervention of choice with well documented impact.
Simple indicators of hand washing compliance need to be developed and validated to enable evaluation of the impact of the interventions to promote hand washing in the community. Majority of tools that have been developed for evaluating hand hygiene practices are only suited for health care facilities. Presented is a scoring scale developed to grade the level of hand washing practise of mothers.
Mothers who consented to take part in a study were asked to say the instances when they washed their hands during the day. The responses were documented and subsequently entered into Microsoft access database. The various answers provided by the mothers were weighted by the investigator against the backdrop of likelihood of transmission of pathogens to assign categories and scores, and a scoring scale developed.
The instances of hand washing put forward by the mothers in the data from which this scoring scale is derived corresponded largely to the recommendation by CDC on when hands should be washed. The scale was able to clearly separate the mothers into distinct grades of hand washing practise; poor, fair and good based on the answers they provided. This scoring scale is useful in evaluating the effectiveness of public health interventions to promote hand washing.
... As far as influenza is concerned, the above said commercial products recorded with minimum or free of adverse side effects. COLD-FX ® (CVT-E002) verified with high safety profile [75], however, fewer effects like the gastrointestinal, nervous, cardiovascular problem with the limitation for pregnant or breast-feeding women, and showed the interaction effect of the drug warfarin [76]. CYS-TUS052 ® proved effective without toxic side effects [45]. ...
Background
Influenza infection always poses a threat to human and animal health. Vaccines and antiviral drugs are recommended to deal with the situation. The drawback of these remedial agents made the scientist change their focus on an alternative therapy. The anti-influenza effects of plants have been extensively studied, and many pharmaceutical companies have prepared their products on this basis.
Main body
The present review documents the successfully launched anti-influenza commercial products. In specific, it exposes the scientifically validated and evidence-based supporting inhibitory action of influenza and its strains.
Conclusion
This review highlighted the efficacy of the commercial products which effectively combat influenza. It provides a complementary strategy to deal with the worst-case scenario of flu. Meanwhile, to face the emerging strains, brand new products are in great necessity besides prevailing and available drugs.
... International recommendations on regular hand cleansing are based on data demonstrating protection against the transmission of respiratory viruses in general. [15][16][17][18][19] A meta-analysis of six studies performed during the 2003 SARS-CoV-1 epidemic found that frequent handwashing (> 10 times daily) was associated with significantly reduced transmission (odds ratio (OR) 0.45; 95% confidence interval (CI): 0.36-0.57). 16 A recent Cochrane review noted a more modest benefit from handwashing in preventing respiratory illness (OR: 0.89; 95% CI: 0.84-0.95); the included studies were highly heterogeneous, but the overall effect size was statistically significant. ...
The severe acute respiratory syndrome coronavirus 2 pandemic has necessitated enhanced protection against viral transmission among healthcare professionals, particularly relating to handwashing and personal protective equipment. Some of these requirements may persist for years to come. They bring associated concerns around skin hygiene and general care, with damage to the face and hands now a well-documented consequence among healthcare professionals. This review assesses optimal skin care during the severe acute respiratory syndrome coronavirus 2 pandemic and in the “new normal” that will follow, identifies current knowledge gaps, and provides practical advice for the clinical setting. Regular, systematic hand cleaning with soap and water or an alcohol-based hand rub (containing 60%–90% ethanol or isopropyl alcohol) remains essential, although the optimal quantity and duration is unclear. Gloves are a useful additional barrier; further studies are needed on preferred materials. Moisturization is typically helpful and has proven benefits in mitigating damage from frequent handwashing. It may be best practiced using an alcohol-based hand rub with added moisturizer and could be particularly important among individuals with pre-existing hand dermatoses, such as psoriasis and eczema. Face moisturization immediately prior to donning a mask, and the use of dressings under the mask to reduce friction, can be helpful dermatologically, but more work is required to prove that these actions do not affect seal integrity. Nonetheless, such measures could play a role in institutional plans for mitigating the dermatologic impact of transmission control measures as we exit the pandemic.
... Several studies have been conducted to assess the effect of handwashing on the rate of airway infections with positive results, in different population contexts such as the university, geriatric homes, and military barracks [12][13][14]. Meta-analysis studies report conflicting results ranging from an effect on decreased respiratory symptoms and diseases such as influenza [15], to a non-significant effect on laboratory-confirmed influenza reduction (RR=0.82; ...
... For example, hygiene behaviour change is more likely to break disease transmission in households, whereas investments in infrastructure such as drains and excreta disposal systems are more likely to affect disease transmission in public spaces (Cairncross et al., 1996). Factors of control are likely to be weaker in community settings than institutional settings, such as schools and day care centres, where simple hygiene messaging and "behavioural nudges" are more likely to be effective (e.g., Ryan et al. 2001). The four main spaces in which WASH technologies are provided are the home and yard (for use by an individual household), the community (spaces shared by two or more households, including fields, streets and places of work, commerce and recreation), at school, and at a health facility. ...
Background
Lack of access to and use of water, sanitation and hygiene (WASH) cause 1.6 million deaths every year, of which 1.2 million are due to gastrointestinal illnesses like diarrhoea and acute respiratory infections like pneumonia. Poor WASH access and use also diminish nutrition and educational attainment, and cause danger and stress for vulnerable populations, especially for women and girls. The hardest hit regions are sub‐Saharan Africa and South Asia. Sustainable Development Goal (SDG) 6 calls for the end of open defecation, and universal access to safely managed water and sanitation facilities, and basic hand hygiene, by 2030. WASH access and use also underpin progress in other areas such as SDG1 poverty targets, SDG3 health and SDG4 education targets. Meeting the SDG equity agenda to “leave none behind” will require WASH providers prioritise the hardest to reach including those living remotely and people who are disadvantaged.
Objectives
Decision makers need access to high‐quality evidence on what works in WASH promotion in different contexts, and for different groups of people, to reach the most disadvantaged populations and thereby achieve universal targets. The WASH evidence map is envisioned as a tool for commissioners and researchers to identify existing studies to fill synthesis gaps, as well as helping to prioritise new studies where there are gaps in knowledge. It also supports policymakers and practitioners to navigate the evidence base, including presenting critically appraised findings from existing systematic reviews.
Methods
This evidence map presents impact evaluations and systematic reviews from the WASH sector, organised according to the types of intervention mechanisms, WASH technologies promoted, and outcomes measured. It is based on a framework of intervention mechanisms (e.g., behaviour change triggering or microloans) and outcomes along the causal pathway, specifically behavioural outcomes (e.g., handwashing and food hygiene practices), ill‐health outcomes (e.g., diarrhoeal morbidity and mortality), nutrition and socioeconomic outcomes (e.g., school absenteeism and household income). The map also provides filters to examine the evidence for a particular WASH technology (e.g., latrines), place of use (e.g., home, school or health facility), location (e.g., global region, country, rural and urban) and group (e.g., people living with disability). Systematic searches for published and unpublished literature and trial registries were conducted of studies in low‐ and middle‐income countries (LMICs). Searches were conducted in March 2018, and searches for completed trials were done in May 2020. Coding of information for the map was done by two authors working independently. Impact evaluations were critically appraised according to methods of conduct and reporting. Systematic reviews were critically appraised using a new approach to assess theory‐based, mixed‐methods evidence synthesis.
Results
There has been an enormous growth in impact evaluations and systematic reviews of WASH interventions since the International Year of Sanitation, 2008. There are now at least 367 completed or ongoing rigorous impact evaluations in LMICs, nearly three‐quarters of which have been conducted since 2008, plus 43 systematic reviews. Studies have been done in 83 LMICs, with a high concentration in Bangladesh, India, and Kenya. WASH sector programming has increasingly shifted in focus from what technology to supply (e.g., a handwashing station or child's potty), to the best way in which to do so to promote demand. Research also covers a broader set of intervention mechanisms. For example, there has been increased interest in behaviour change communication using psychosocial “triggering”, such as social marketing and community‐led total sanitation. These studies report primarily on behavioural outcomes. With the advent of large‐scale funding, in particular by the Bill & Melinda Gates Foundation, there has been a substantial increase in the number of studies on sanitation technologies, particularly latrines. Sustaining behaviour is fundamental for sustaining health and other quality of life improvements. However, few studies have been done of intervention mechanisms for, or measuring outcomes on sustained adoption of latrines to stop open defaecation. There has also been some increase in the number of studies looking at outcomes and interventions that disproportionately affect women and girls, who quite literally carry most of the burden of poor water and sanitation access. However, most studies do not report sex disaggregated outcomes, let alone integrate gender analysis into their framework. Other vulnerable populations are even less addressed; no studies eligible for inclusion in the map were done of interventions targeting, or reporting on outcomes for, people living with disabilities. We were only able to find a single controlled evaluation of WASH interventions in a health care facility, in spite of the importance of WASH in health facilities in global policy debates. The quality of impact evaluations has improved, such as the use of controlled designs as standard, attention to addressing reporting biases, and adequate cluster sample size. However, there remain important concerns about quality of reporting. The quality and usefulness of systematic reviews for policy is also improving, which draw clearer distinctions between intervention mechanisms and synthesise the evidence on outcomes along the causal pathway. Adopting mixed‐methods approaches also provides information for programmes on barriers and enablers affecting implementation.
Conclusion
Ensuring everyone has access to appropriate water, sanitation, and hygiene facilities is one of the most fundamental of challenges for poverty elimination. Researchers and funders need to consider carefully where there is the need for new primary evidence, and new syntheses of that evidence. This study suggests the following priority areas: Impact evaluations incorporating understudied outcomes, such as sustainability and slippage, of WASH provision in understudied places of use, such as health care facilities, and of interventions targeting, or presenting disaggregated data for, vulnerable populations, particularly over the life‐course and for people living with a disability;
Improved reporting in impact evaluations, including presentation of participant flow diagrams; and
Synthesis studies and updates in areas with sufficient existing and planned impact evaluations, such as for diarrhoea mortality, ARIs, WASH in schools and decentralisation. These studies will preferably be conducted as mixed‐methods systematic reviews that are able to answer questions about programme targeting, implementation, effectiveness and cost‐effectiveness, and compare alternative intervention mechanisms to achieve and sustain outcomes in particular contexts, preferably using network meta‐analysis.
... Hence, alone contact transmission may not be as important as influenza virus survives on hand for less than five minutes. Although hand washing has been demonstrated to reduce transmission of respiratory illness, but there is no specific scientifically based evidence which shows clear benefits of repeated hand washing for several times a day during epidemics [77,78]. However, as a precautionary tool, especially in health care facilities or hospital, it is advisable for health care staff to wash their hand while dealing with sick patients. ...
During December 2019, a rapid increase in the number of SARS-CoV-2 (COVID-19) cases was reported worldwide. We investigated several factors for rapid increase in SARS-COV-2. Genomic sequence reveals that domestic and wild animals were likely ancestors and zoonotic source for SARS-CoVs, MERS-CoVs, and SARS-CoV-2; these viruses replicated in animals and humans during past several decades, exhibiting diverse mutations and self-limiting diseases except during outbreaks. SARS-CoV-2 has been retrospectively isolated in different studies in August 2019, several months before Wuhan reported. Hence, there is a possibility that viruses went undetected and infecting sub-clinically, in past several years, and SARS-CoV-2 antigens and neutralizing antibodies may have been present in humans since years. All SARS-CoVs are basically respiratory viruses, spread by droplets, hence droplet precautions are essential. Furthermore, silent phase of transmission (asymptomatic/subclinical) can be beneficial for humans. Lack of symptoms eventually lessen virus transmission and reduce the pathogen's long-term survival and provide strong humoral herd immunity (with sropositivity and diverse antibodies) up to several years and during epidemics. RT-PCR has low sensitivity and specificity, carries a high risk of handling live virus antigens, and requires difficult protocols. As viral load also sharply declines after few days of onset of infection, this technique might overlook infection. Furthermore, SARS-CoV-2 infection may be present in blood when oropharyngeal swabs are negative by RT-PCR. Conversely, antibodies against SARS-CoVs develop robustly in by reduced amount of antigens and ELISA for diagnosing antibodies demonstrates 100% specificity and 100% sensitivity, even in clinically asymptomatic individuals. These antibodies can be used for serologic surveys, monitoring and screening. Furthermore, screening tests for SARS-COV-2 should be avoided in unhygienic public places by nasopharyngeal swabs, which carry a high risk of further transmission, co-infection or super-infection. If above mentioned factors and Infection control policy is followed, SARS-CoV-2 pandemic can be controlled effectively.
... The toilet use situation in the provision can promote unhygienic conditions that can herald the epidemic of faecal related diseases among inmates, as observed by. 25,26 The effectiveness of handwashing at critical periods in reducing diarrhoea episodes 27,28 and acute respiratory infections 28,29 are not in doubt, though over two-thirds (68.1%) respondents perceived that hand washing could not prevent diseases, while almost half (48%) agreed that frequent hands washing with soap and water, will reduce the risk of infectious diseases in our study. This is similar to findings that hands were washing after defecation and before meals was scarcely practised by inmates in Owerri prison. ...
Context: The study was conducted in a maximum‑security prison in southwest Nigeria, where inmates were held in lawful custody by a court
of competent jurisdiction. The inmates are vulnerable, and their health is conditioned not only on their nutrition and health‑care services but
also on available water and sanitation services, personal and collective hygiene behaviour, within the prison environment.
Aim: The study assessed the living and sanitary conditions and hygiene practices of inmates in a maximum‑security prison in Nigeria.
Settings and Design: The study was descriptive, cross‑sectional in design and elicited information on knowledge, attitude and hygiene practice
of consented prison inmates.
Methods: The questionnaire response was 94.8% and was identified through a multistage sampling technique and inmates were stratified by
detention status with the minimum sample allocated by the proportional to size method. Systematic sampling was used for serial recruitment
without replacement. The data collection tool was a validated, semi‑structured, interviewer‑administered questionnaire.
Statistical Analysis Used: Knowledge and attitudes were measured on a 24‑ and 55‑point scales and rated as poor (≤11) and good (>11);
negative (≤33) and positive (>33), respectively. Summary data were presented by descriptive, Chi‑square and logistic regression at P < 0.05.
Results: Inmates mean age was 31.6 ± 8.2 years and mostly, males (98.3%) with 47.2% and 50.8% respectively married and completed
secondary education. The main water source to inmates was hand‑dug wells, while all‑male conveniences were dirty. The major illnesses were
malaria, ringworm and diarrhoea. In addition, sanitary knowledge was a significant predictor of attitude towards hygiene practices (OR: 0.52,
95% CI: 0.298‑0.905).
Conclusions: The good knowledge and positive attitudes of inmates contrast poor sanitary conditions, perhaps due to poor sanitation and
hygiene infrastructure and overcrowding conditions.
... Esta medida podría salvar más vidas que cualquier vacuna, reducir la mortalidad por diarreas en un 50% 1 y un 25% de las muertes por infecciones respiratorias agudas. 3,15 A nivel mundial se ha reportado que más de 1.4 millones de personas han contraído una infección en el hospital, por lo que se insiste que el lavado de manos con agua y jabón es el método más efi caz y más barato para prevenir muchas enfermedades infecciosas. 16,17 Serguey Kolesnikov miembro de la Academia de Ciencias Médicas de Rusia, en el 2010 reportó que las epidemias descendieron notablemente tras la aparición del jabón, el cual apareció relativamente hace poco, pero parece que lo usamos durante siglos. ...
El lavado de manos con agua y jabón es una de las maneras más efectivas y económicas para prevenir las enfermedades infecciosas, nosocomiales y mejorar la seguridad del paciente. La prevalencia de morbilidad por gastroenteritis e infecciones respiratorias en los niños son la principal causa de demanda en la consulta externa y de hospitalización; éstas enfermedades se pueden prevenir con tan solo lavarse las manos con agua y jabón. Así mismo Serguey Kolesnikov reportaron que las epidemias descendieron notablemente tras la aparición del jabón. En mayo de 2007, la Organización Mundial de la Salud publicó el documento “Nueve soluciones para la seguridad del paciente”, con el propósito de reducir los daños relacionados con la atención sanitaria que afectan a millones de pacientes en todo el mundo. Dentro de las “Nueve soluciones para la seguridad del paciente” se planteó como novena solución, mejorar la higiene de las manos para prevenir las infecciones asociadas en la atención de la salud. Por su lado, la Organización Mundial de la Salud calculó, que si médicos y enfermeras se lavaran las manos regularmente durante su jornada de trabajo, se evitarían en todo el mundo 1.4 millones de casos de infecciones adquiridas en hospitales y otros centros sanitarios por día, por lo que es necesario seguir exhortando a la población, así como al personal de salud, a conocer la técnica del lavado de manos, porque con esta labor conjunta se podría prevenir muchas enfermedades, infecciones y salvar muchas vidas.
... Physical interventions such as social distancing [10,11], wearing face masks [12] and implementing strict hygiene measures [13] reduce the rate of infection by reducing the transfer of respiratory viruses from infectious to susceptible persons through contact, droplets, or aerosols [14]. These interventions not only lower the chance of infection but also quantitatively reduce the viral inoculum received by the recipient [15,16] and may change the route of transmission [17] from direct droplet transmission in close proximity to the infecting person [18] to indirect transmission via contaminated surfaces [19]. ...
Background: Social distancing and stringent hygiene seem effective in reducing the number of transmitted virus particles, and therefore the infectivity, of coronavirus disease 2019 (COVID-19) and could alter the mode of transmission of the disease. However, it is not known if such practices can change the clinical course in infected individuals.
Methods: We prospectively studied an outbreak of COVID-19 in Switzerland among a population of 508 predominantly male soldiers with a median age of 21 years. We followed the number of infections in two spatially separated cohorts with almost identical baseline characteristics with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) before and after implementation of stringent social distancing.
Results: Of the 354 soldiers infected prior to the implementation of social distancing, 30% fell ill from COVID-19. While no soldier in a group of 154, in which infections appeared after implementation of social distancing, developed COVID-19 despite the detection of viral RNA in the nose and virus-specific antibodies within this group.
Conclusions: Social distancing not only can slow the spread of SARS-CoV-2 in a cohort of young, healthy adults but can also prevent the outbreak of COVID-19 while still inducing an immune response and colonizing nasal passages. Viral inoculum during infection or mode of transmission may be key factors determining the clinical course of COVID-19.
... Hence, alone contact transmission may not be as important as influenza virus survives on hand for less than five minutes. Although hand washing has been demonstrated to reduce transmission of respiratory illness, but there is no specific scientifically based evidence which shows clear benefits of repeated hand washing for several times a day during epidemics [ 77,78]. However, as a precautionary tool, especially in health care facilities or hospital, it is advisable for health care staff to wash their hand while dealing with sick patients. ...
Since December 2019, a rapid increase in the number of SARS-CoV-2 (COVID-19) cases was reported worldwide, despite strict infection control and lock down measures. Current paper investigated the actual facts behind this rapid increase in the number of cases. Study of genomic sequence reveals that domestic and wild animals were likely ancestors and zoonotic source for SARS-CoVs, MERS-CoVs, and SARS-CoV-2. Strong evidence suggest that these viruses already existed and replicated in animals and humans during past several decades, exhibiting diverse mutations, evolutions and self-limiting diseases, except during outbreaks. Serious zoonotic reservoir investigations are required to investigate animal transmission of SARS-CoVs and SARS-CoV-2 to limit current pandemic. This might be the reason of increasing number of cases via animals. SARS-CoV-2 has been retrospectively isolated in different studies in August 2019, several months before Wuhan announced. Hence, there is a possibility that viruses existed, went undetected, infecting subclinically, in past several years, and SARS-CoV-2 antigens and neutralizing antibodies may have been present in humans since long time. This might be another reason of increasing number of cases by screening as mass screening and antigen or antibody testing was not carried out in the past years. Randomized controlled trials are required to investigate human to human transmission by touch, as the current evidence is limited with conflicting results. As all SARS-CoVs are basically respiratory viruses, droplet precautions and infection control measures are essential, especially for hospital staff. Increased number of SARS-CoV-2 asymptomatic, or subclinical cases are detected worldwide. This silent phase of transmission can be beneficial for humans. Lack of symptoms eventually lessen virus transmission and reduce the pathogen's long-term survival and provide humoral herd immunity up to several years. Hence, seropositivity with diverse antibodies develops against mutating SARS-CoVs which will confer strong immunity during epidemics. Strategies such as identification, contact tracing and quarantine are costly and practically difficult. Hence, asymptomatic persons can continue their work with droplet precautions and standard infection control procedures, while symptomatic or sick persons can isolate themselves in their homes without the need for strict quarantine until clinical recovery, with reduced hospital visits and minimizing chances of hospital acquired infections. RT-PCR has low sensitivity and specificity, carries a high risk of handling live virus antigens, and requires difficult protocols. As viral load also sharply declines after few days of onset of infection, this technique might overlook infection. Furthermore, SARS-CoV-2 infection may be present in blood when oropharyngeal swabs are negative by RT-PCR. Additionally, RT-PCR usually gives false negative and false positive results and must be interpreted cautiously. This might be again a reason of increasing number of cases by false positive RT-PCR reporting. Moreover, antibodies against SARS-CoVs develop robustly in serum even by reduced amount of antigens. In contrast to RT-PCR, ELISA for diagnosing antibodies against SARS-CoV-2 demonstrates 100% specificity and 100% sensitivity, even in clinically asymptomatic individuals. These antibodies can be used for serologic surveys, monitoring and screening. However, screening tests for SARS-COV-2 should be avoided in unhygienic public places by nasopharyngeal swabs, which carry a high risk of further transmission, co-infection or superinfection. Such highly infectious virus must be isolated and tested in highly sterilized laboratory. Further strict international laws and policies are required to stop the possible spread of experimental viruses, biological warfare and bioterrorism.
... Plusieurs études ont montré un impact du lavage des mains sur la diminution de la transmission des virus respiratoires, mais l'impact sur la transmission du virus grippal n'a pas été particulièrement étudié. (Carabin et al., 1999 ;Dyer et al., 2000 ;Falsey et al., 1999 ;Larson et al., 2004 ;Luby et al.,2005 ;Ponka et al.,2004 ;Roberts et al., 2000 ;Ryan et al., 2001 ;Uhari et Mottonen, 1999 ;White et al., 2003). ...
Ventilation des bâtiments en cas de pandémie
L'Afsset actuellement l'Anses.
L’afsset, Agence française de sécurité sanitaire de l’environnement et du travail, propose des recommandations à mettre en oeuvre en cas de pandémie par le virus Influenza A de sous-type H1N1, au niveau des systèmes de ventilation des bâtiments afin de limiter la diffusion des virus.
... Only vigor and fatigue were considered in our study since they have been reported to clearly change in overreached conditions, while the other negative moods have increased or presented no change. 4,19,25,26 We did not take into account URTIs as a criterion of OR since the military environment poses a high risk for even otherwise healthy adults to develop respiratory illnesses, 27,28 and possible epidemics in wintertime could lead to an overestimation of OR among conscripts. ...
Impact statement:
The diagnosis of overtraining syndrome and overreaching poses a great challenge. Military training aims at improving the physical performance of the conscripts, but an excessive training load could also lead to overreaching. This study of Finnish conscripts provides new insights into the pathophysiology of overreaching and overtraining through amino acids concentrations. In addition to confirming the possible use of plasma glutamine/glutamate concentration to indicate and predict overreaching, we made a novel finding, i.e. low alanine and arginine concentrations might have a role in performance decrement and fatigue related to overreaching. Moreover, this study is the first to show the possible association between amino acids with putative neuronal properties and overreaching. Thus, the present findings might help to detect and prevent overreaching and offer a reliable diagnostic approach. In order to avoid overreaching, military training should be planned more periodically and individually, especially during the first four weeks of military service.
... [7] Hand washing is very important for youngsters and adolescents, as these age groups are the most vulnerable to infections gained from unwashed hands. [8] School children are particularly vulnerable to neglect of basic personal hygiene due lack of knowledge and practice. [9] Poor knowledge, practice of and attitudes to personal hygiene such as hand washing play major roles in the high incidence of communicable diseases and therefore has negative consequences for a child's long term overall development. ...
Introduction: Medical evidence suggests that contaminated hands are the main transmitters of disease. Hand washing is reflected as effective hygiene promotion activities for public health in the whole world. Aim: This study aimed to determine the effectiveness of hand washing education on knowledge regarding hand washing and its importance among adolescence in selected schools. Materials & methods: A quantitative research approach with Pre-experimental one group pretest and posttest design was used to conduct the study in selected schools of Uttar Pradesh. Non-probability purposive sampling technique was employed to select 40 adolescence. A self-structured knowledge questionnaire containing 30 items were used for assessing the level of knowledge among the subjects. Data were analyzed using SPSS version 25. Results: The mean score of the adolescence in pretest 10.2±4.1 is lesser than the mean score in posttest 20.2±4.3, t-value 18.8 which is significant P = 0.001. There was an association found between the levels of knowledge among the adolescence with their mother's education. Conclusion: The study is concluded that hand washing education is effective to enhance knowledge among adolescence regarding hand washing and its importance. Attitude and practice of adolescence regarding hand washing also can be assessed in future studies.
... Hand hygiene prevents infection. For example, hand washing at least 5 times per day among Navy recruits resulted in a 45% decrease in respiratory disease rates [14]. Of course, hand hygiene is difficult when one is denied access to soap and facilities for basic personal hygiene. ...
... 5 Good hand hygiene is important for children and adolescents, as these groups are the most susceptible to infections that spread due to unwashed hands. 6 Various studies have shown that the prevalence of good oral and hand hygiene varies in schoolchildren from different sociodemographic backgrounds, localities, and other factors. 3,[7][8][9][10][11] For Malaysia, there is a lack of information on the prevalence and relationship between sociodemographic characteristics and oral and hand hygiene practices. ...
This cross-sectional national survey aimed to determine the prevalence of oral and hand hygiene practices as well as associations between sociodemographic characteristics and oral and hygiene practice among adolescents aged 13 to 17 years during the past 30 days. A validated self-administered bilingual questionnaire adapted from the Malaysian Global School Health Survey with computer-scanable answer sheets was distributed to 30 823 adolescents attending government secondary schools in Malaysia; and 89.2% responded to the questionnaire given. More than 80% (87.1%; 95% confidence interval [CI] = 86.24-87.96) of the adolescents reported that they had brushed their teeth at least twice daily and had always washed their hands after using the toilet (86.6%; 95% CI = 85.85-87.36). The odds of adolescents who brushed their teeth at least 2 times daily and washed their hands after using the toilet was significantly associated with sociodemographic characteristics. This study highlights the need to further improve the effectiveness of current oral health promotion programs with consideration for sociodemographic characteristics.
... It would be helpful if hospitals in the Asokore Mampong district are well equipped to handle such cases in the future. Ryan, Christian, and Wohlrabe (2001) opined that patients with confirmed or suspected swine influenza infection should be placed in a singlepatient room with the door kept closed. It would, therefore, be helpful to also isolate or quarantine persons with this virus in future outbreaks. ...
Swine Flu or Influenza A (H1N1) is caused by one of several swine
influenza A strains and its highly contagious. The transmission of the virus is from person-to-person and is similar to how seasonal influenza spreads. This report describes an Influenza A Virus (H1N1) outbreak in Asokore Mampong Sub-Municipal.
Ninety-six (96) people were infected by the Influenza A (H1N1), and four (4) of them died. Those who died were lodging at the Sadler house; Jubilee House and Yaa Achiaa House. Three (3) health staff at KNUST hospital emergency unit were also infected, but they were treated and discharged. Three (3) of those who died as
a result of the outbreak were males. An outbreak of H1N1 influenza type A caused by the H1N1 pdm09 virus on the campus of Kumasi Academy (KUMACA) led to Ninety-six (96) people becoming infected and four (4) dying. Several steps were taken by a national and regional multi-sectoral team from the World Health Organization, Ghana Health Service HQ as well as the Regional Health Directorate to manage the situation. Health education on H1NI must be intensified and sustained
in the municipality as well as disease surveillance.
... 52 Other than vaccinations which all soldiers receive on entry to service, annually, and for specific military deployments, 53 effective primary prevention for respiratory infections appear to include personal hygiene (especially hand washing), sufficient barracks ventilation, adequate living space, and cohorting (i.e., isolation of groups or individuals). [54][55][56][57] Limitations ...
Introduction
The Special Forces Assessment and Selection (SFAS) is an extremely physically and mentally demanding 19- to 20-day course designed to determine whether Soldiers are qualified to enter the Special Forces Qualification Course. As a first step to understand medical problems during SFAS, this study examined injuries, illnesses, and activities associated with injuries during the course.
Materials and Methods
Medical events during the SFAS course were compiled from Sick Call Trackers (a log of medical encounters maintained by medical personnel in the field) and Chronology of Medical Care (Standard Form 600). Descriptive statistics were calculated for each injury and illness and injuries were compiled by the activities performed when the injuries occurred.
Results
Of the 800 Soldiers who volunteered for the study, 38% (n = 307/800) and 12% (n = 97/800) experienced one or more injuries and/or illnesses, respectively. The most common injuries were blisters and abrasions/lacerations with incidences of 20% (n = 158/800) and 13% (104/800), respectively. The most common illnesses were respiratory infections, other infections, contact dermatitis, and allergies with incidences of 7% (n = 57/800), 2% (n = 14/800), 2% (n = 14/800), and 2% (n = 13/800), respectively. Among all injuries recorded (n = 573), the most common were blisters (46%), abrasions/lacerations (24%), pain (not otherwise specified) (19%), tendonitis (3%), and sprains (3%). Among all illnesses recorded (n = 133), the most common were respiratory infections (56%), allergies (11%), contact dermatitis (11%), and other infections (11%). Most injuries were experienced during land navigation (44%), team events (20%), and foot marching (11%), running (6%), and the obstacle course (5%), but when the estimated time involved for each event was considered, activities with the highest injury rates were the obstacle course (65 injuries/hr), running (27 injuries/hr), the Combat Readiness Assessment (activity involving combat-related tasks) (20 injuries/hr), and foot marching (16 injuries/hr).
Conclusion
The major limitations of this investigation were: 1) the low specificity with regard to many of the diagnoses/complaints; and 2) the fact that the medical problems reported here are only those seen by medical care providers and are likely an underestimate of the total morbidity in the SFAS course. Soldiers often self-treat and some may be reluctant to see medical personnel because of how it might affect their rating in the course. Nonetheless, this investigation alerts medical personnel to the injuries and illnesses to expect, and public health workers and leadership with activities to target for injury prevention measures during SFAS.
... Hands can be contaminated with feces, body fluids, and inanimate objects; it is also a common mode of transmission for gastrointestinal and respiratory infections [5]. Hand washing is especially important for children, as these age groups are the most susceptible to infections gained from unwashed hands [6]. In addition, due to the close proximity of children in schools, there is a high risk for the spread of infectious disease. ...
... The URI and ILI rates in our study are nonetheless comparable with those reported by other studies in the United States. [16][17][18] Despite this, we found low rates of clinical influenza A in this minimally vaccinated population. Possible reasons for this could be exposure to circulating influenza strains before recruits entering the training camps. ...
Military recruits are at high risk of respiratory infections. However, limited data exist on military populations in tropical settings, where the epidemiology of respiratory infections differs substantially from temperate settings. We enrolled recruits undertaking a 10-week military training at two Royal Thai Army barracks between May 2014 and July 2015. We used a multiplex respiratory panel to analyze nose and throat swabs collected at the start and end of the training period, and from participants experiencing respiratory symptoms during follow-up. Paired sera were tested for influenza seroconversion using a hemagglutinin inhibition assay. Overall rates of upper respiratory illness and influenza-like illness were 3.1 and 2.0 episodes per 100 person-weeks, respectively. A pathogen was detected in 96% of samples. The most commonly detected microbes were Haemophilus influenzae type B (62.7%) or non-type B (58.2%) and rhinovirus (22.4%). At baseline, bacterial colonization was high and included H. influenzae type B (82.3%), H. influenzae non-type B (31.5%), Klebsiella pneumoniae (14.6%), Staphylococcus aureus (8.5%), and Streptococcus pneumoniae (8.5%). At the end of follow-up, colonization with H. influenzae non-type B had increased to 74.1%, and S. pneumoniae to 33.6%. In the serology subset, the rate of influenza infection was 3.4 per 100 person-months; 58% of influenza infections resulted in clinical disease. Our study provides key data on the epidemiology and transmission of respiratory pathogens in tropical settings. Our results emphasize the need for improved infection prevention and control in military environments, given the high burden of illness and potential for intense transmission of respiratory pathogens.
... Access to an adequate quantity of running water is associated with better health [3,[15][16][17][18][19][20]. This survey indicates that although waterborne diseases are reported to public health authorities in most places throughout the Arctic, few water-washed diseases are. ...
As part of a project endorsed by the Arctic Council’s Sustainable Development Working Group (SDWG), a survey was conducted to describe the current status of water, sanitation and hygiene (WASH) services in the Arctic region. The English language internet-based survey was open from April to September, 2016 and drew 142 respondents from seven Arctic nations. Respondents provided information on access to WASH services, notification requirements for water-related infectious diseases, and examples of environmental- or climate-change related events that impact the provision of WASH services. Many remote Arctic and sub-Arctic residents lack WASH services, and these disparities are often not reflected in national summary data. Environmental changes impacting WASH services were reported by respondents in every Arctic nation. Participants at an international conference co-sponsored by SDWG reviewed these results and provided suggestions for next steps to improve health of Arctic residents through improved access to water and sanitation services. Suggestions included ongoing reporting on WASH service availability in underserved populations to measure progress towards UN Sustainable Development Goal #6; evaluations of the health and economic consequences of disparities in WASH services; and Arctic-specific forums to share innovations in WASH technology, improved management and operations, and adaptation strategies for environmental or climate change.
... El lavado de las manos representa la clave de supervivencia siendo más preocupante en la niñez y la tercera edad, quienes son identificados en las unidades asistenciales de salud como los grupos de edades más vulnerables (Alba, Fajardo & Papaqui, 2010). Ryan, Christian & Wohlrabe (2001) señalan que el lavado de las manos como medida preventiva, puede ser más efectiva que cualquier vacuna y con ello salvar vidas donde por ejemplo; la falta de lavado de manos resultó una de las principales causas de morbilidad por gastroenteritis e infecciones respiratorias en niños (Shahid et al. 1996;Curtis & Cairncross, 2003). ...
La eliminación de agentes patógenos en las manos constituye la premisa fundamental en el personal asistencial de salud para el control de las infecciones. El objetivo del presente estudio fue evaluar la higienización del lavado de manos para disminuir la infección hospitalaria dada la ejecución de un sistema de gestión de calidad en el Hospital Base III-EsSalud de Juliaca-Puno. El estudio se realizó durante dos periodos: enero-noviembre/2015 y enero-noviembre/2016, respectivamente. Se observaron a nueve profesionales asistenciales de salud pertenecientes al Servicio de Hospitalización - Cirugía, a quienes se seleccionaron mediante un muestreo probabilístico aleatorio. Para ello, se realizó, inicialmente, un diseño biomédico de estudio longitudinal observacional de intervenciones deliberadas no controladas y posteriormente, un diseño biomédico de estudio longitudinal retrospectivo con intervención deliberada, atendiendo a la implementación de un sistema de gestión de la calidad con modificación sobre la duplicidad en la frecuencia del lavado de manos y 30 segundos más de exposición con respecto a lo indicado por la norma regulatoria sanitaria. Se mostró al comparar los grupos de observación mediante el análisis de la prueba t-students, diferencias estadísticamente significativas (p≤0.05) para el promedio de la frecuencia y el tiempo de higienización del lavado de manos. Se concluyó que, el sistema de gestión de calidad posibilitó, la concientización sobre el cumplimiento de procedimientos referidos a la higienización del lavado de manos, además, de disminuir el riesgo de las infecciones hospitalarias cuando el control sobre la frecuencia y el tiempo de exposición fueron mayores.
... Secondary control measures have included reducing crowding, aligning trainees' beds head-to-foot, making frequent hand washing a requirement, increasing air exchanges, and keeping contact between different cohorts of recruits to a minimum (cohorting). [340][341][342] Although interventions like frequent hand washing 340 caused a 45% reduction in upper respiratory tract infections among trainees, the numerous attempted interventions fell far short of the effectiveness of administering adenovirus vaccines in reducing ARD. ...
... Frequent hand-washing and correct respiratory hygiene have proved to be effective in preventing acute respiratory diseases, including influenza. [7][8] However, vaccines are the cornerstone for preventing influenza and its consequences and influenza vaccination is still the main tool for preventing the spread of influenza. ...
There is potential for influenza vaccine programmes to make a substantial impact on the disease burden. The World Health Organization (WHO) has identified young children, pregnant women, persons with chronic medical conditions, and the elderly as being at risk for severe influenza disease and therefore important groups to be considered for influenza vaccination. Applying the methodology of scoping review of grey and scientific literature we described the European and the US approach to influenza vaccine prevention. Although vaccination remains the most effective means of reducing the incidence and severity of influenza, vaccine uptake in many European countries remains suboptimal (i.e. 45.5% in the elderly, 24% in health care workers, from 49.8% in patients with chronic medical conditions, median 23.6% in pregnant women) and vaccine strategies are not harmonized in particular with regard to vaccinating healthy children. Whereas in the US the vaccine strategies are more standardized across states and vaccine coverage are higher than those reported in EU on average.
The integration of different strategies is crucial in order to increase influenza vaccine coverage: public health authorities should encourage healthcare workers to vaccinate themselves, as target category, and to recommend seasonal influenza vaccination to people in the target groups; there should also be structured communication campaigns on influenza and influenza vaccines, directed specifically at these target groups, and an adequate and sustainable funding is also an important factor to achieve higher vaccination coverage rates.
... Hand washing can reduce the spread of infections obtained by external contact, eliminating between 12% and 40% of all gastrointestinal diseases and over 20% of all infections [1,2,3,4,5]. Proper hand hygiene involves the use of soap and warm, running water, rubbing hands vigorously for at least 20 seconds. ...
... 10 Implementating hand sanitation programs has significantly reduced communicable diseases in many congregate settings, including schools, 11,12 university campuses, 13 health care facilities, 9,[14][15][16] and military bases. 7,17 Hand sanitizers have proved useful in decreasing transmission of some resistant microorganisms and preventing cross-transmission of bacteria from person to person. 18 Even with alcohol-based hand sanitizers, compliance with hand hygiene remains problematic. ...
Background:
Using hand sanitizers can reduce bacterial contamination and is an efficient and inexpensive method of preventing infections. The purpose of this study was to explore the behavioral intention (low and absolute), attitudes, subjective norms, and perceived behavioral control of hand sanitizer use among US Army soldiers.
Methods:
A questionnaire was developed following an expert panel (N = 5) review and 2 pilot studies (N = 35) to ensure questionnaire validity and clarity. Surveys were distributed among nontrainee soldiers during lunch periods. A total of 201 surveys were collected.
Results:
Results indicated that attitudes, subjective norms, and perceived behavioral controls explained 64% of the variance in behavioral intention. Attitude remained the strongest predictor of behavior (β = 0.70, P < .01), followed by subjective norms (β = 0.18; P < .01), with significant differences between low and absolute intenders.
Conclusions:
Soldiers with absolute intention to use hand sanitizers hold significantly different behavioral and normative beliefs than low intenders. Other soldiers create negative social pressure about using hand sanitizers, indicating that if other soldiers use hand sanitizers, they will refuse to do so. Intervention to ensure use of hand sanitizer should focus on strengthening behavioral and normative beliefs among low intenders. This should increase the overall well being of the military.
... Availability and use of hygiene interventions have been shown effective in the disruption of both direct contact and surface-mediated microbial transmission in school and hospital environments (Liu et al. 2009;Bright et al. 2010;Bloomfield et al. 2016). Preventive measures such as hand washing (Ryan et al. 2001;Curtis and Cairncross 2003) and use of hand sanitizers (Sandora et al. 2005), as well as antimicrobial wipes and cleaners (Kochar et al. 2009), have been demonstrated to reduce gastrointestinal and respiratory infectious disease incidence. In addition, proper uses of disposable surgical masks and facial tissues have been used to reduce transmission of respiratory infections through aerosolization. ...
The purpose of this study was to validate the use of adenosine triphosphate (ATP) for evaluating hygiene intervention effectiveness in reducing viral dissemination in an office environment. The bacterial virus MS-2 was used to evaluate two scenarios, one where the hand of an individual was contaminated and another where a fomite was contaminated. MS-2 was selected as a model because its shape and size are similar to many human pathogenic viruses. Two separate experiments were conducted, one in which the entrance door push plate was inoculated and the other in which the hand of one selected employee was inoculated. In both scenarios, 54 selected surfaces in the office were tested to assess the dissemination of the virus within the office. Associated surface contamination was also measured employing an ATP meter. More than half of the tested hands and surfaces in the office were contaminated with MS-2 within 4 h. Next, an intervention was conducted, and each scenario was repeated. Half of the participating employees were provided hand sanitizer, facial tissues, and disinfecting wipes, and were instructed in their use. A significant (p < 0.05) reduction was observed in the number of surfaces contaminated with virus. This reduction in viral spread was evident from the results of both viral culture and the surface ATP measurements, although there was no direct correlation between ATP measurements with respect to viral concentration. Although ATP does not measure viruses, these results demonstrate that ATP measurements could be useful for evaluating the effectiveness of hygiene interventions aimed at preventing viral spread in the workplace.
... Preventive measures to limit the spread of influenza include both individual and public health interventions. Frequent hand-washing and correct respiratory hygiene have proved to be effective in preventing respiratory illnesses, including influenza [3,4]. However, influenza vaccination is still the main tool for preventing the spread of influenza spread and limiting the burden on public health. ...
Influenza is a public health priority in Europe. The impact of influenza pandemics on public health is very high, but seasonal influenza also constitutes an important burden in terms of hospitalisation and excess deaths. Influenza vaccination is a fundamental pillar of disease prevention. In the absence of a clear decision-making process for vaccination policies, EU institutions have, in recent years, fostered collaboration among Member States. Such collaboration was closer during the 2009 pandemic, which constituted a clear cross-border threat to EU citizens' health. The EU institutions have been supporting national vaccination programmes by providing evidence of the effectiveness and safety of influenza vaccination. Decision 1082/2013 was a major step toward EU collaboration, in that it highlighted the role of pandemic vaccination in the field of preparedness and emergency response, in which concerted action is clearly valuable.
... Hand washing is especially important for children and adolescents, as these age groups are the most susceptible to infections gained from unwashed hands [2]. In addition to this due to the close proximity of children in schools and child care settings, there is a high risk for the spread of infectious disease. ...
Introduction: Proper hand washing is one of the simplest, most affordable and effective means of stopping the spread of infection via feces, body fluids, and inanimate objects. Hand washing is especially important for children and adolescents, as these age groups are the most susceptible to infections gained from unwashed hands. In addition to this due to the close proximity of children in schools and child care settings, there is a high risk for the spread of infectious disease. Proper hand washing also improves learning and teaching processes by reducing absenteeism.
... Promotion of hand hygiene (ie, frequent handwashing, use of hand sanitizer) among military recruits was associated with 40%-45% reductions in respiratory illness. 5,6 While the primary focus of our trial was SSTI prevention, it is likely that overall improvement in personal hygiene practices, namely handwashing, interrupted the transmission of respiratory pathogens and prevented secondary ARI cases in this vulnerable population. 7 This investigation had both strengths and weaknesses. ...
Reduction in Acute Respiratory Infection Among Military Trainees: Secondary Effects of a Hygiene-Based Cluster-Randomized Trial for Skin and Soft-Tissue Infection Prevention - Volume 37 Issue 9 - Eugene V. Millar, Carey D. Schlett, Natasha N. Law, Wei-Ju Chen, Michael J. D’Onofrio, Jason W. Bennett, David R. Tribble, Michael W. Ellis
... The Membrane Stability Index (MSI) was calculated as: Salt Tolerance Index (STI) of plants to different EC levels were determined according to Shetty et al. (1995) method. Phosphorus was determined by molybdovanadate method (Ryan et al., 2001); calcium and magnesium by complexometric; sodium and potassium were measured with flame photometry method (Page et al., 1982). ...
Salinity is a major abiotic stress that reduces crop productivity in arid and semiarid soils. About 25% of the country’s arable land is affected by different levels of salt. A considerable part of this land is under wheat cultivation each year as the country’s most important crop. ACC deaminase producing bacteria increase plant resistance to stress condition by reducing stress ethylene in a variety of environmental stresses such as salinity. In this study, 167 halotolerant bacterial strains were isolated from the saline habitats and screened for growth at different NaCl concentrations. These halotolerant bacterial strains were then tested for 1 AminoCyclopropane-1-Carboxylic acid (ACC) deaminase activity. Among six isolates of halotolerant bacteria containing ACC deaminase, the K78 strain produced the highest level of this enzyme. Phylogenetic analysis of the 16S rRNA gene sequence of this bacterium indicated that this strain belonged to Bacillus mojavensis. Inoculation of Bacillus mojavensis to salt stressed wheat plants produced an increase in root and shoot weight, chlorophyll content, and nutrient uptake in comparison with the un-inoculated soils. In summary, this study indicates that the use of ACC deaminase-producing halotolerant bacteria mitigates salinity stress effects on growth of wheat plants by reducing salt-stress-induced ethylene production.
The consensus-based guideline “hand antisepsis and hand hygiene” for Germany has the following sections: Prevention of nosocomial infections by hygienic hand antisepsis, prevention of surgical site infections by surgical hand antisepsis, infection prevention in the community by hand antisepsis in epidemic or pandemic situations, hand washing, selection of alcohol-based hand rubs and wash lotions, medical gloves and protective gloves, preconditions for hand hygiene, skin protection and skin care, quality assurance of the implementation of hand hygiene measures and legal aspects.
The guideline was developed by the German Society for Hospital Hygiene in cooperation with 22 professional societies, 2 professional organizations, the German Care Council, the Federal Working Group for Self-Help of People with Disabilities and Chronic Illness and their Family Members, the General Accident Insurance Institution Austria and the German-speaking Interest Group of Infection Prevention Experts and Hospital Hygiene Consultants.
Influenza has had a significant impact on society and human health and may have had a similar impact in earlier historical times, if post-hoc diagnoses are correct. Significant progress has been made within diagnostics, vaccines, treatment, and infection control practices for influenza, which has resulted in improved control of this virus at both the seasonal epidemic and pandemic levels. Despite advances in knowledge of influenza, it is important that we continue to improve access to healthcare and address disparities between many populations. Poor outcomes occur when people infected with influenza have less access to healthcare or refuse it. With improved understanding of viral evolution, it is also critical for public health agencies to plan for continual future influenza epidemics and pandemics.
Objectives
The objective of this study was to assess the awareness, perception, and myths regarding H1N1 virus among the dentists.
Material and Methods
The present study was a descriptive, cross-sectional, closed ended, self-administered, and anonymous questionnaire-based study. The survey questions were developed with information collected from the Center for Disease Control and Prevention, World Health Organization (WHO), Center for Infectious Disease Research and Policy, and by literature review. To evaluate each subject’s level of knowledge, a score system was used. Responses from participants were coded, with a “1” denoting a right response and a “2” denoting each wrong answer.
Results
On assessing the awareness about H1N1 amongst the dentists of North India, it was found that 99.5% ( n = 398) dentists were well aware of the infection. About 93.75% ( n = 375) dentists knew about the symptoms of H1N1. On assessing the knowledge about treatment modalities, 218 (54.5%) dentists said that investigation facilities for H1N1 were available in their city.
Conclusion
Knowledge regarding the mode of spread, vaccination and treatment measures about H1N1 influenza should be made available at masses, is necessary to enable everyone – not just dentists – to guard against future pandemics caused by the same virus or by another influenza species.
Assessment of the risk of bias is an essential component of any systematic review. This is true for both nonrandomized studies and randomized trials, which are the main study designs of systematic reviews. The Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS) was developed in 2013 and has gained wide usage as a risk-of-bias assessment tool for nonrandomized studies. Four risk-of-bias assessment experts revised it by reviewing existing assessment tools and user surveys. The main modifications included additional domains of selection and detection bias susceptible to nonrandomized studies of interventions, a more detailed consideration of the comparability of participants, and more reliable and valid outcome measurements. A psychometric assessment of the revised Ro- BANS (RoBANS 2) revealed acceptable inter-rater reliability (weighted kappa, 0.25 to 0.49) and construct validity in which intervention effects of studies with an unclear or high risk of bias were overestimated. The RoBANS 2 has acceptable feasibility, fair-to-moderate reliability, and construct validity. It provides a comprehensive framework for allowing authors to assess and understand the plausible risk of bias in nonrandomized studies of interventions.
Objective The aim of this study was to understand the level of handwashing knowledge, and handwashing practices as well as to determine the availability of handwashing facilities in the schools.
Materials and Methods A survey was conducted on 17th October 2019 to determine the availability of handwashing facilities along with the level of handwashing knowledge and practices among school students of Borsojai High School situated in Kamrup Metropolitan City, Guwahati, Assam. The study population consisted of randomly selected students of 9th and 10th classes during the academic year 2019 to 2020. The quantitative data were analysed using the IBM-SPSS, version 20.0.
Result Fifty-six school students from classes 9 to 10th of mean age 15.53 years participated in the current study. It is evident that school-aged students have sufficient knowledge of handwashing, and they widely recognise the importance of handwashing (94.6%) to prevent diseases (39.3%) and to remove germs (48.2%).
Conclusion To encourage hand hygiene in school students, parents can also be sensitised through the parents teacher meeting. This will improve the health and reduce the absenteeism from school due to infectious diseases.
The purpose of the study was to aware students of hand hygiene and also aware of the negative effects of washing hands without soap. Students of public primary schools were the population of the study. The school was selected by means of convenient sampling while participants were selected by purposive sampling. So, for this purpose seminars have been conducted to make students aware of hand cleanliness. For one week different activities were conducted to make students habitual and adopt the habits of washing hands in their daily routine and in their schools after playing games and after using the washroom. Pre and post-intervention views have been taken from the teachers and students. Views of the participants indicated that organizing the seminar with practical activities was an effective practice to create awareness among students regarding hands cleanliness. This was a novel study as it explored the basic hygiene issues at the primary level and proposed a solution through intervention. The awareness created by this study will be useful for the general health improvement of students. It will make teachers realize the importance and advantages of hygiene for the general health of students.
Background:
Hand hygiene, a simple and low-cost measure, remains the leading intervention for reducing the burden related to healthcare-associated infections (HAIs). While many interventions have been tested to improve staff hand hygiene compliance, hospital visitors continue to have low compliance rates, which increase the risk of HAIs and resistant organisms' transmission into hospitals and out to the community.
Aim:
To assess the effectiveness of educational speech intervention (ESI) in increasing hand hygiene compliance rate among hospital visitors.
Methods:
This interventional study was conducted from March to June 2019 in an inpatient unit of a large academic hospital. Visitor hand hygiene compliance was observed before and after implementation of ESI. ESI provided to the visitors in the intervention phase was to remind them about the importance of hand hygiene and the proper method to clean hands. Post-intervention data were collected using the survey questionnaires. Unpaired t-test compared the hand hygiene compliance rate before and after the intervention.
Findings:
Baseline hand hygiene compliance rate was 9.73% while hand hygiene compliance rate post-intervention increased to 87.06% (p<0.001). Barriers to hand hygiene compliance included both hands occupied, improper location of hand hygiene supplies, past habit, and inadequate knowledge on visitors' role in preventing spread of infections. Visitors preferred being reminded about hand hygiene by verbal reminder (57%), followed by signage (38%), and wristband notices (5%).
Conclusion:
The ESI substantially increased visitors' hand hygiene compliance rate. Further studies are warranted to assess the sustainability of ESI and address other barriers to visitors' hand hygiene compliance.
There are no specific treatment drugs and vaccine for Hand Foot and Mouth Disease (HFMD). Taking effective preventive measures is particularly important for control of HFMD infection. The objective of this study is to evaluate the effect of intervention of intensive education on hand hygiene on HFMD.
We randomized 64 villages into intervention and control groups in Handan, Hebei province, China. Parents and caregivers of children 6 to 40 months age group in intervention villages received intensive education on hand hygiene. Control group received general education. The intervention period was from April 1 to July 31, 2011 and April 1 to July 31, 2012. We measured and compare the knowledge and incidences of HFMD between 2 groups.
We collected 6484 questionnaires, including 3583 in the intervention group [response rate: 96% (3583/3726)] and 2901 in the control group [response rate: 90% (2901/3224)]. We observed that hand washing habit of children and parent, knowledge of HFMD of parents, children's daily cleaning habits scores improved in the intervention group and higher than that in the control group at both the end of year 1 (April 1–July 31, 2011)and year 2 (April 1–July 31, 2012). The incidence of HFMD (2.1%) in intervention group was significantly lower than that in control group (4.2%) at year 2 (χ² = 22.138, P <.001). The positive percent of coli-form on the hand swabs in intervention group (2.00%) were significantly lower than that in control group (9.45%) at the end of year 2.
The intervention of intensive education on hand hygiene effectively improved the personal hygiene both of children and parents, as well as reduced the incidence of HFMD. We suggested expanding the intervention measures in community to prevent HFMD.
Acute respiratory disease (ARD) due to adenoviruses caused significant morbidity in military training populations. Since 1971 ARD has been controlled by the use of live, enteric-coated, adenovirus (ADV) types 4 and 7 vaccines. This immunization program overcame significant problems in vaccine development. Due to a production delay, military training posts stopped ADV vaccine administration in spring 1994. The delivery of ADV vaccine resumed in late February 1995, but another production delay is anticipated. A generation of military medical people have not been exposed to the significant morbidity caused by adenoviruses and are unaware of the effectiveness of the ADV vaccine. ARD morbidity before ADV vaccines, the ADV vaccine development program, and current issues regarding the control of ARD due to adenoviruses in the military are discussed.
Emerging respiratory disease agents, increased antibiotic resistance, and the loss of effective vaccines threaten to increase the incidence of respiratory disease in military personnel. We examine six respiratory pathogens (adenoviruses, influenza viruses, Streptococcus pneumoniae, Streptococcus pyogenes, Mycoplasma pneumoniae, and Bordetella pertussis) and review the impact of the diseases they cause, past efforts to control these diseases in U.S. military personnel, as well as current treatment and surveillance strategies, limitations in diagnostic testing, and vaccine needs.
Adenovirus vaccines have greatly reduced military respiratory disease morbidity since the 1970s. However, in 1995, for economic
reasons, the sole manufacturer of these vaccines ceased production. A population-based adenovirus surveillance was established
among trainees with acute respiratory illness at 4 US military training centers as the last stores of vaccines were depleted.
From October 1996 to June 1998, 1814 (53.1%) of 3413 throat cultures for symptomatic trainees (78% men) yielded adenovirus.
Adenovirus types 4, 7, 3, and 21 accounted for 57%, 25%, 9%, and 7% of the isolates, respectively. Unvaccinated trainees were
much more likely than vaccinated trainees to be positive for types 4 or 7 (odds ratio [OR] = 28.1; 95% CI, 20.2–39.2). Two
training centers experienced epidemics of respiratory disease affecting thousands of trainees when vaccines were not available.
Until a new manufacturer is identified, the loss of orphaned adenovirus vaccines will result in thousands of additional preventable
adenovirus infections.
Prophylactic administration of 5 ml of gamma globulin resulted in a significant degree of protection (P=0.03) against acute respiratory disease (ARD) primarily of adenoviral etiology, but not against milder "common cold"-like illness. No difference in the efficacy was noted between "hyperimmune" gamma globulin (HIGG) (obtained from individuals convalescing from ARDs acquired in the same environment) and standard gamma globulin (SGG). The degree of protection against ARD afforded by gamma globulin was less than that obtained with adenovirus vaccination. In addition, some antagonism in terms of diminished protection was noted in the prophylactic efficacy of adenovirus vaccine and gamma globulin when these were administered concurrently. There was no long-range interference with the development of acquired immunity, however, as reflected by complement fixing antibody titers.
Significant effects of upper respiratory illness on academic performance in U.S. Navy basic training were demonstrated. These effects were half as large as the effects of general intellectual ability, as measured by the AFQT, on performance. Combined with prior evidence from laboratory studies, the findings provide a strong basis for inferring that naturally-occurring upper respiratory infections significantly impair cognitive performance and learning. These disease effects should be considered in models to predict performance. Keywords: Performance, Illness, Navy men, Basic training, Anatomy, Medical research, Upper respiratory infections, URI, GSR.
Hand hygiene is the most effective measure to prevent cross-transmission of microorganisms. Adequate hand hygiene can be achieved
by standard handwashing—with water alone or with soap—or by the use of an alcoholbased hand-rub solution. Despite considerable
efforts, compliance with this simple infection-control measure remains low. Factors predicting non-compliance have been extensively
studied, and include physician status, procedures associated with a high risk of cross-transmission, and an important workload.
Future interventions to improve compliance should consider complex behavioral theories and the use of multimodal and multidisciplinary
strategies. We believe that one of the key components of these interventions should be the wide use of alcoholbased hand-rub,
which is microbiologically effective and less time-consuming than standard handwashing.
Handwashing is acknowledged as a critical factor in the prevention of nosocomial infection. Nonetheless, health care personnel often wash their hands inadequately. The purpose of this study was to examine the flora of hands and the frequency of handwashing of physicians working in primary care pediatric community clinics. The fingers of the dominant hand of 55 physicians working in 12 clinics were sampled for bacterial cultures. Only 354/720 (49%) of the expected handwashings by 17 board-certified pediatricians were recorded as having been performed. None of them washed their hands after each contact with an examined child. All physicians' hands were found to be contaminated with microorganisms. Staphylococcus species were isolated from 47 (85.4%) of the physicians' hands. Methicillin-resistant Staphylococcus aureus was found on the hands of 9.1% of the physicians. Such contaminated hands may serve as a potential vector of community-acquired infection with highly resistant organisms. Compliance with handwashing recommendations among these physicians was low. An active educational infection control program must be introduced in ambulatory pediatric community clinics.
Naval Hospital Great Lakes, Branch Medical Clinic, Recruit Training Command is the Navy's only recruit inprocessing point in the country. The clinic will medically inprocess approximately 54,000 new Navy recruits this year. In fiscal year 1995, the clinic inprocessed approximately 44,000 recruits, 35,000 males and 9,000 females. The Navy Medical Department is very concerned about total Navy recruit health. This includes a check on the present state of health of all sailors and teaching sailors how to stay healthy and take care of themselves during their naval careers. Navy medicine is also an integral part of the recruit training experience. Recruit training at Great Lakes is 9 weeks in duration. This article will describe the Navy's recruit medical inprocessing procedure to include the Sailor's Health Inventory Program, the Navy/Air Force Medical Entrance Test, immunizations, optometry, audiology, wellness education, gynecological examinations, medical assessment, and laboratory tests.
Rhinovirus was transmitted from experimentally infected volunteers (donors) to susceptible recipients and the efficiencies of spread by hand-to-hand contact and large- and small-particle aerosols compared. Transmission of infection was very efficient by the hand route: 11 of 15 hand-contact exposures initiated infection, compared with one of 12 large-particle (P less than 0.005) and none of 10 small-particle (P less than 0.005) exposures. Rhinovirus was present in nine of 18 (50%) nasal swab specimens, 28 of 43 (65%) hand rinses, and seven of 18 (39%) saliva specimens of donors; geometric mean titers of positive specimens were 10(1.5), 10(1.4), and 10(1.2) tissue culture infectious dose 50/ml (TCID 50/ml), respectively. Rhinovirus was present in 20 of 43 (46%) recipient hand rinses, with a geometric mean titer of 10(1.4)TCID50/ml. Virus on donors' hands was transferred to recipients' fingers during 20 of 28 (71%) 10-second hand-contact exposures. These findings support the concept that hand contact/self-inoculation may be an important natural route of rhinovirus transmission.
In closely confined populations, in which epidemics of Streptococcus pyogenes infection are common, penicillin G benzathine has long been used prophylactically to reduce morbidity from this pathogen. We report on our investigations of the effectiveness of penicillin G benzathine prophylaxis at a military recruit camp.
We prospectively studied the rates of pharyngeal colonization and infection by S. pyogenes among 736 male U.S. Marine Corps recruits from January through March 1989. Throat swabs for culture, clinical data, and questionnaire data were obtained during six examinations at intervals of two weeks. Serum samples obtained before training, after training, and from acutely ill recruits were analyzed with use of an antistreptolysin O microtitration technique.
Although 93 percent of the recruits received prophylaxis with two intramuscular injections of 1.2 million units of penicillin G benzathine each (administered 30 to 39 days apart), 33 percent of the recruits were colonized by S. pyogenes, and 42 percent had infection (as defined by a two-dilution increase in the antistreptolysin O titer). Thirty-seven percent of 265 recruits who reported a sore throat and were infected with S. pyogenes did not seek medical attention. The recruits who were allergic to penicillin (7 percent of the total), who received no prophylaxis, were more likely to be colonized; an increased risk of colonization and infection among the nonallergic recruits was associated with the presence of a higher percentage of allergic recruits in the platoon. After the study was completed, all recruits who were allergic to penicillin were prescribed 250 mg of oral erythromycin twice daily (a total daily dose of 500 mg) for 60 days. Subsequently, the average weekly rate of clinically evident S. pyogenes pharyngitis fell by more than 75 percent.
If the prevention of S. pyogenes infection is to be effective in closely confined populations such as military recruits, prophylactic antibiotics must be administered to all members of the population. Exempting those who are allergic to penicillin may create a bacterial reservoir from which infection can be transmitted to nonallergic members of the population.
Airborne transmission of infectious agents and associations of indoor air pollutants with respiratory illnesses are well documented. We hypothesized that energy conservation measures that tighten buildings also increase risks of respiratory infection among building occupants. At four Army training centers during a 47-month period, incidence rates of febrile acute respiratory disease were compared between basic trainees in modern (energy-efficient design and construction) and old barracks. Rates of febrile acute respiratory disease were significantly higher among trainees in modern barracks (adjusted relative risk estimate, 1.51; 95% confidence interval, 1.46 to 1.56), and relative risks were consistent at the four centers. These results support the hypothesis that tight buildings with closed ventilation systems significantly increase risks of respiratory-transmitted infection among congregated, immunologically susceptible occupants.
This article summarizes a critical analysis of 18 studies that examined the link between hand washing and infection. Although several factors made it difficult to evaluate the effect of hand washing, the authors conclude that (1) hand washing can add incremental value to infection-control strategies in acute care settings, (2) patient hand hygiene may influence infection rates, and (3) the effect of "ideal" hand washing on nosocomial infection rates is unlikely to be quantifiable.
A handwashing program for elementary school students was developed and implemented by the school nurse in a suburban elementary school. The program consisted of surveying teachers, inspecting handwashing facilities, and providing classroom presentations and follow-up activities. Absenteeism records indicated a significant decrease in absenteeism for illness during the two months following the presentations.
The purpose was to determine the effectiveness of an instructional program on handwashing. The hypothesis stated that an instructional program on germs and handwashing in child care could significantly reduce the spread of infectious diseases in the test center.
A longitudinal study was conducted in a field setting with a test group and a control group of 3- to 5-year-old children and their teachers in two similar child care settings. For 21 weeks illnesses and symptoms of infectious diseases were assessed with a health assessment checklist. The test group received a developmentally appropriate instructional program on germs and handwashing. The teachers in the test group attended workshops on infectious diseases and handwashing. The control group maintained their usual handwashing procedures.
At weeks 1 through 11 benchmark data were collected. At weeks 12 through 21, peak cold and flu season, the test group had significantly fewer colds than the control group (chi-squared analysis, 4.338, 1 df, p < .05); thus the hypothesis was confirmed.
Handwashing has been recognized as one way to manage the spread of infectious diseases in child care centers. Handwashing helped to reduce colds at the test center where frequent and proper handwashing practices were incorporated into the curriculum through an intervention program.
Hand washing prevents communicable illness. We evaluated the effect of a mandatory, scheduled hand-washing program in elementary school children on absenteeism due to acute communicable illness.
The study was conducted at Trombley Elementary School in Grosse Pointe Park, Mich. The intervention group, approximately half of the school children (n = 143, including all grades 1-5), washed their hands a minimum of four scheduled times a day. The control group (n = 162) continued hand-washing practices as usual.
Of the 37 school days examined, children in the hand-washing group were absent fewer days than the control group due to all acute communicable illness (relative risk = .75). There were less days of absence due to gastrointestinal symptoms (relative risk = .43). The difference in absence due to respiratory symptoms was not statistically significant.
A scheduled hand-washing program will reduce acute communicable (gastrointestinal) illnesses in elementary school-age children.
To evaluate the effectiveness of various scrub techniques in reducing bacterial skin flora, the present study was developed in three stages.
Each stage involved fingertip bacterial colony counts measured before, immediately after and 30 min after a variety of handwashing techniques using 10% povidone iodine solution. The first compared 1, 2 or 3 non-timed washes from fingertips to elbows in 10 volunteers. The second compared two volunteers scrubbing for equal durations with or without friction rubbing, while the third involved 15 volunteers who each scrubbed for different time intervals.
The first stage showed that a single wash episode failed to provide lasting bacterial colony count reductions on fingertip cultures. The second showed that enduring colony count reductions occur whether friction rubbing of the hands was used or not, and the third showed that a 30 s wash was as effective as washing for longer periods in reducing fingertip flora.
These findings suggest that prolonged vigorous pre-operative scrubbing is unnecessary, although more than a cursory wash is required to produce lasting fingertip antisepsis.
Acute upper respiratory infections are common in children who attend child care, and preventing transmission of disease in this setting depends on actions by child care staff. We set out to discover whether transmission of respiratory infections in child care could be reduced by improved infection control procedures.
We performed a cluster, randomized, controlled trial of an infection control intervention conducted in child care centers in 1 city in Australia. The intervention was training of child care staff about transmission of infection, handwashing, and aseptic nosewiping technique. Implementation of the intervention was recorded by an observer. Illness was measured by parent report in telephone interviews every 2 weeks.
There were 311 child-years of surveillance for respiratory symptoms. By multivariable analysis, there was no significant reduction in colds in intervention center children across the full age range. However, a significant reduction in respiratory illness was present in children 24 months of age and younger. When compliance with infection control practices was high, colds in these children were reduced by 17%.
This trial supports the role of direct transmission of colds in young children in child care. The ability of infection control techniques to reduce episodes of colds in children in child care was limited to children 24 months of age and under.
Handwashing practices are persistently suboptimal among healthcare professionals and are also stubbornly resistant to change. The purpose of this quasi-experimental intervention trial was to assess the impact of an intervention to change organizational culture on frequency of staff handwashing (as measured by counting devices inserted into soap dispensers on four critical care units) and nosocomial infections associated with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). All staff in one of two hospitals in the mid-Atlantic region received an intervention with multiple components designed to change organizational culture; the second hospital served as a comparison. Over a period of 8 months, 860,567 soap dispensings were recorded, with significant improvements in the study hospital after 6 months of follow-up. Rates of MRSA were not significantly different between the two hospitals, but rates of VRE were significantly reduced in the intervention hospital during implementation.
Several studies have indicated a connection between handwashing and illness-related absenteeism in school settings. The difficulty of ensuring consistent and effective handwashing among student populations has also been noted. The purpose of this study was to assess the effectiveness of the use of an alcohol gel hand sanitizer in the classroom to help decrease the illness-related absentee rate for elementary school students.
This study involved 5 individual school districts, 16 individual schools, and more than 6000 students in Delaware, Ohio, Tennessee, and California. Individual schools in each district were paired into product and control groups. In the product group schools, an alcohol gel hand sanitizer was used by the students and staff when entering and leaving the classroom. Absenteeism due to infection was recorded, and the data were statistically analyzed.
The overall reduction in absenteeism due to infection in the schools included in this study was 19.8% for schools that used an alcohol gel hand sanitizer compared with the control schools (P <.05). Data from the school system with the largest teacher population (n = 246) showed that teacher absenteeism decreased 10.1% (trend) in the schools where sanitizer was used.
Elementary school absenteeism due to infection is significantly reduced when an alcohol gel hand sanitizer is used in the classroom as part of a hand hygiene program.
BACKGROUND AND HYPOTHESES: A substantial percentage of school absenteeism among children is related to transmissible infection. Rates of transmission can be reduced by hand washing with soap and water, but such washing occurs infrequently. This study tested whether an alcohol-free instant hand sanitizer (CleanHands) could reduce illness absenteeism in school-age children.
A 10-week, open-label, crossover study was performed on 420 elementary school-age children (ages 5-12). Students were given a brief orientation immediately prior to the start of the study on the relationship of germs, illness, and hand washing. Each student in the treatment group then received the test product in individual bottles, with instructions to apply one to two sprays to the hands after coming into the classroom, before eating, and after using the restroom, in addition to their normal hand washing with soap and water. The control group was instructed to continue hand washing as normal with non-medicated soap. After 4 weeks of treatment and a 2-week wash-out period, the control and experimental groups were reversed. Data gathered on absenteeism were classified as gastrointestinal or respiratory related and normalized for nonillness-related absenteeism and school holidays.
Compared to the hand washing-only control group, students using CleanHands were found to have 41.9% fewer illness-related absence days, representing a 28.9% and a 49.7% drop in gastrointestinal- and respiratory-related illnesses, respectively. Likewise, absence incidence decreased by 31.7%, consisting of a 44.2% and 50.2% decrease in incidence of gastrointestinal- and respiratory-related illnesses, respectively. No adverse events were reported during the study.
Daily use of the instant hand sanitizer was associated with significantly lower rates of illness-related absenteeism.
Hand hygiene prevents cross infection in hospitals, but compliance with recommended instructions is commonly poor. We attempted to promote hand hygiene by implementing a hospital-wide programme, with special emphasis on bedside, alcohol-based hand disinfection. We measured nosocomial infections in parallel.
We monitored the overall compliance with hand hygiene during routine patient care in a teaching hospital in Geneva, Switzerland, before and during implementation of a hand-hygiene campaign. Seven hospital-wide observational surveys were done twice yearly from December, 1994, to December, 1997. Secondary outcome measures were nosocomial infection rates, attack rates of methicillin-resistant Staphylococcus aureus (MRSA), and consumption of handrub disinfectant.
We observed more than 20,000 opportunities for hand hygiene. Compliance improved progressively from 48% in 1994, to 66% in 1997 (p<0.001). Although recourse to handwashing with soap and water remained stable, frequency of hand disinfection substantially increased during the study period (p<0.001). This result was unchanged after adjustment for known risk factors of poor adherence. Hand hygiene improved significantly among nurses and nursing assistants, but remained poor among doctors. During the same period, overall nosocomial infection decreased (prevalence of 16.9% in 1994 to 9.9% in 1998; p=0.04), MRSA transmission rates decreased (2.16 to 0.93 episodes per 10,000 patient-days; p<0.001), and the consumption of alcohol-based handrub solution increased from 3.5 to 15.4 L per 1000 patient-days between 1993 and 1998 (p<0.001).
The campaign produced a sustained improvement in compliance with hand hygiene, coinciding with a reduction of nosocomial infections and MRSA transmission. The promotion of bedside, antiseptic handrubs largely contributed to the increase in compliance.
Handwashing is widely accepted as being key to the prevention of hospital-acquired infection but the frequency of handwashing by healthcare workers has been found to be low. A systematic critical literature review was conducted to establish the effectiveness of interventions aimed at increasing compliance with handwashing in healthcare workers. The results showed that one-off educational interventions have a very short-term influence on handwashing behaviour. Use of strategically placed reminders, or asking patients to remind staff of the need to conduct handwashing can have a modest but more sustained effect. Feedback of performance can increase levels of handwashing but if feedback is not repeated regularly, then this effect is not maintained over long periods. Automated sinks increase the quality of handwashing but healthcare workers can be discouraged from using these because of the additional time involved. Provision of moisturized soaps appears to make little difference to handwashing behaviour but providing 'dry' hand rubs near patient beds may lead to a minimal increase in the frequency with which staff decontaminate their hands. Multifaceted approaches which combine education with written material, reminders and continued feedback of performance can have an important effect on handwashing compliance and rates of hospital-acquired infection.
There is limited information on how military women manage feminine hygiene practices in combat and noncombat environments. The purpose of this study was to describe feminine hygiene practices of military women in deployed and noncombat (normal) environments. A nonexperimental descriptive research design was used. The study used a survey questionnaire, the Deployed Female Health Practice Questionnaire, which was developed specifically for military women to report their experiences with hygiene issues. Significant differences between deployed and normal environments were found in the areas of types of menses management products used and in douching and handwashing practices. Continuing education about safe feminine hygiene practices will help military women cope better in deployed (field) environments. Recommendations suggest further study on intervention strategies for hygiene management practices.
This annual report presents national estimates, based on data from the National Health Interview Survey (NHIS), on the incidence of acute conditions, percent of medically attended acute conditions, number of disability days, episodes of persons injured and associated activity restriction, persons with activity limitation due to chronic conditions, restricted activity days associated with acute and chronic conditions, physician contacts and short-stay hospitalizations, as well as prevalence of chronic conditions and respondent assessed health status. This edition includes a section on trends in health statistics for 1982-96.
NHIS is a multistage probability sample survey conducted annually by interviewers of the Bureau of the Census for the National Center for Health Statistics. Data is collected during in-home interviews of the civilian noninstitutionalized U.S. population. Data collection procedures were similar from 1982 through 1996, but were changed after 1996.
In 1996 there were 163.5 acute conditions per 100 persons, (67.9% were medically attended) and 624.0 associated days of restricted activity per 100 persons. Of acute injuries, 91.4% were medically attended. The highest rates for chronic conditions per 1000 persons included arthritis (127.3), sinusitis (125.5), deformity and orthopedic impairment (111.6), and high blood pressure (107.1). Activity limitation due to chronic conditions was reported by 14.4% of persons. There were six physician contacts per person per year and 7.3% of the population had a hospitalization in the past year. During 1982-96, the prevalence of asthma increased and the rate and duration of hospitalizations decreased.
Scheduled handwashing in an elementary school population Kimel LS. Handwashing education can decrease illness absenteeism
- Hess D Master
- Sh Longe
- Dickson
Master D, Hess Longe SH, Dickson H. Scheduled handwashing in an elementary school population. Fam Med 1997;29(5):336 –9. 24. Kimel LS. Handwashing education can decrease illness absenteeism. J Sch Nurs 1996;12(2):14 –16.
Clean Hands Campaign survey
- American Society
American Society for Microbiology. Clean Hands Campaign survey. Interscience Conference on Antimicrobial Agents and Chemotherapy, Toronto, Canada, September 17–20, 2000.
Naval Medical Research Unit Number 4. The prophylaxis and treatment of acute respiratory diseases with antihistamine drugs
U.S. Naval Medical Research Unit Number 4. The prophylaxis and treatment of acute respiratory diseases with antihistamine drugs. J Lab Clin Med
1950;36:555–90.
Naval Medical Research Unit Number 4. The use of triethylene glycol vapor for control of acute respiratory diseases in Navy recruits
U.S. Naval Medical Research Unit Number 4. The use of triethylene glycol
vapor for control of acute respiratory diseases in Navy recruits. Am J Hyg
1952;55:203–29.
The etiology, the concept and the prophylaxis of childbed fever [Murphy FP, trans]. Birmingham, AL: Classics of Medicine Library
- If Semmelweiss
Semmelweiss IF. The etiology, the concept and the prophylaxis of childbed
fever [Murphy FP, trans]. Birmingham, AL: Classics of Medicine Library,
1981 [original work published 1861].