Article

Hand Washing Practices in a College Town Environment

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Abstract

Many people do not wash their hands when the behavior in which they engage would warrant it. Most research of hand washing practices to date has taken place in high-traffic environments such as airports and public attraction venues. These studies have established a persistent shortcoming and a gender difference in hand washing compliance. Using field observations of 3,749 people in a college town environment, the research described in this article replicates and extends earlier work while identifying potential environmental and demographic predictors of hand washing compliance. Additionally, the authors’ research suggests that proper hand washing practices, as recommended by the Centers for Disease Control and Prevention, are not being practiced. Finally, the authors’ research raises a question as to the accuracy of earlier measurements of “proper” hand washing practices, suggesting that compliance rates are inflated. The results can help increase hand washing rates for the general public and thus decrease the risk of transmitting disease.

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... Also, hand disinfection may lead to bacteria developing antibiotic resistances [4], which is why hand washing should be preferred over hand disinfection in everyday life. However, Borchgrevink, Cha and Kim [49], who conducted field observations of 3,749 people in restrooms located across a college town, found that less than 6% of people washed their hands for longer than 15 seconds. Thus, they conclude that the general guidelines as recommended by the Centers for Disease Control and Prevention are not being practiced. ...
... Based on observing 120 subjects, they found that 42% of the female and 52% of the male participants did not wash their hands at all when using a public bathroom. Such gender differences have been found consistently across different studies [49]. ...
... Similar to physical activity, this context is among the most relevant in persuasive technology research [145]. Encouraging people to take enough time to wash their hands effectively is important, since people generally do not wash their hands for long enough [49], even though it has been shown to be one of the most effective ways of preventing the spread of diseases [178]. The measuring unit detects whether water is running and whether hands are present, and sends this information to the mobile application. ...
Thesis
Gamification, the use of game elements in non-game contexts, has been shown to help people reaching their goals, affect people's behavior and enhance the users' experience within interactive systems. However, past research has shown that gamification is not always successful. In fact, literature reviews revealed that almost half of the interventions were only partially successful or even unsuccessful. Therefore, understanding the factors that have an influence on psychological measures and behavioral outcomes of gamified systems is much in need. In this thesis, we contribute to this by considering the context in which gamified systems are applied and by understanding personal factors of users interacting with the system. Guided by Self-Determination Theory, a major theory on human motivation, we investigate gamification and its effects on motivation and behavior in behavior change contexts, provide insights on contextual factors, contribute knowledge on the effect of personal factors on both the perception and effectiveness of gamification elements and lay out ways of utilizing this knowledge to implement personalized gamified systems. Our contribution is manifold: We show that gamification affects motivation through need satisfaction and by evoking positive affective experiences, ultimately leading to changes in people's behavior. Moreover, we show that age, the intention to change behavior, and Hexad user types play an important role in explaining interpersonal differences in the perception of gamification elements and that tailoring gamified systems based on these personal factors has beneficial effects on both psychological and behavioral outcomes. Lastly, we show that Hexad user types can be partially predicted by smartphone data and interaction behavior in gamified systems and that they can be assessed in a gameful way, allowing to utilize our findings in gamification practice. Finally, we propose a conceptual framework to increase motivation in gamified systems, which builds upon our findings and outlines the importance of considering both contextual and personal factors. Based on these contributions, this thesis advances the field of gamification by contributing knowledge to the open questions of how and why gamification works and which factors play a role in this regard.
... Research suggests that washing hands for 15-20 seconds is most effective [18] and many countries and organizations such as the Centers for Disease Control and Prevention followed this recommendation [8]. However, it was found that less than 6% of people follow this recommended duration [5]. Furthermore, a study by Wirthlin Worldwide and Bayer Pharmaceutical [31] found that 32% of subjects did not wash their hands at all after using public restrooms. ...
... Consequently, research has been carried out about hand washing practices and how to change people's attitude or behavior toward washing hands properly. Consistently, studies report differences in hand washing practices between male and female subjects [5]. Johnson et al. [19] conducted observational studies in public restrooms and found that 61% of the women and only 37% of male subjects washed their hands after restroom use. ...
... We expect that the presence of our system might lead to similar effects. Borchgrevinket al. [5] report findings from a study of hand washing practices conducted in a college town environment, where the effect of using signs encouraging hand washing was investigated. They found that when signs were present in a restroom, the average washing time (which is considered a key factor for proper hand washing) climbed from 6.50 to 7.08 seconds on average. ...
Conference Paper
Washing hands is important for public health as it prevents spreading germs to other people. One of the most important factors in cleaning hands is the hand washing duration. However , people mostly do not wash their hands for a long enough time leading to infections and diseases for themselves and others. To counter this, we present "Germ Destroyer", a system consisting of a sensing device which can be mounted on the water tap and a mobile application providing gameful feedback to encourage users to meet the recommended duration. In the mobile application, users kill germs and collect points by washing their hands. Through a laboratory study (N=14) and a 10-day in-the-wild study (363 hand washing sessions), we found that Germ Destroyer enhances the enjoyment of hand washing, reduces the perceived hand washing duration, almost doubles the actual hand washing duration, and has the potential to reduce the risk of infection.
... Hand hygiene has been identified and acknowledged as the most effective intervention to lower the transmission of pathogens in school community ( Morton & Schultz, 2004 ( 2007), hand washing is the single most effective practice a person can adopt to reduce the spread of infectious diseases and they further report that failure to sufficiently wash hands contributes to nearly 50% of all food-borne illness outbreaks. A study led by Borchgrevink, Cha, and Kim ( 2013) reported that only 5% of people washed their hands enough to kill infectious pathogens and illness-causing germs after using the toilets, as most people splash-and-go when it comes to hand washing. The same study also found that 33% of hand washers did not use soap and 10% skipped hand washing altogether. ...
... Therefore, the government should promote COVID-19 information and public policies among people, especially those belonging to higher age groups, to maintain protective behaviours after vaccination and prevent severe illness and death. Regarding other protective behaviours, the study at Southern U.S. university revealed that 31.4% of college students did not practice frequent handwashing during the COVID-19 pandemic compared to 33.1-61.5% reported in the pre-COVID-19 era; handwashing in early adults remains a matter of concern in these times [35,36]. ...
Article
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Abstract Background Protective behaviours (e.g., mask-wearing, handwashing, avoiding social gatherings) and mass vaccination are effective ways to control the coronavirus disease 2019 (COVID-19) pandemic. Previous studies found that people who get vaccinated may change their protective behaviours. The Thai government has endorsed several mix-and-match vaccine regimens to eliminate the insufficiency of each vaccine brand. This study aimed to determine levels of protective behavioural changes after COVID-19 vaccination and its relationship with various vaccine regimens in Thailand. Methods A descriptive cross-sectional study was conducted between September 13, 2021, and January 14, 2022. Data were collected using an online questionnaire distributed via social media platforms and posters in public places in Thailand. The questionnaire comprised six items for demographic characteristics, seven items for COVID-19 vaccine regimens, and four items for protective behaviours. The vaccinated Thai population aged ≥ 18 years were surveyed. Statistical analyses included a Chi-squared test, Wilcoxon signed rank test, and multivariate logistic regressions. Results Of the 469 participants, more than half were females (67.4%), single (57.4%), and lived in an urban area (67.2%). Significant differences were observed with regard to median scores in handwashing (5.0 vs. 5.0, p-value
... For example, the CDC and WHO recommend handwashing for at least 15 s before or after engaging in high-risk activities (e.g., after using the restroom, after coughing or sneezing, before handling food) to remove germs and prevent viral contagion to others (Centers for Disease Control and Prevention, 2020;World Health Organization, 2009). However, a study from Michigan State University found that many people do not comply with even these basic recommendations (Borchgrevink et al., 2013). Specifically, they found that men and women washed their hands on average for 6.27 and 7.07 s after using the restroom, respectively, and many individuals skipped handwashing altogether. ...
Article
The COVID-19 pandemic threatened employees’ health and safety more than any event in recent years. Although millions of employees transitioned to working from home to mitigate infectious disease exposure, many worksites re-opened amid the pandemic as high infection rates persisted longer than expected. Safety guidelines were issued by the Centers for Disease Control and Prevention, the World Health Organization, and other national initiatives to improve the health and safety of employees returning to on-site work. The current work addresses predictors of infection control safety behaviors in a general working population that largely lacks infection control training and expertise. Drawing from Neal and Griffin’s model of safety behavior, we investigated organizational factors (i.e., perceived safety climate, safety-related organizational constraints, occupational risk of COVID-19 exposure) and individual factors (i.e., infection control safety attitudes, conscientiousness, and risk aversion) associated with employees’ infection control safety behaviors shortly after returning to on-site work during the pandemic. Survey results from 89 full-time employees across industries demonstrated that the organizational and individual factors accounted for 51.19 percent of the variance in employees’ infection control safety behaviors. Organizational factors accounted for 49.02 percent of the explained variance, and individual factors accounted for 50.98 percent of the explained variance. Conscientiousness, perceived safety climate, safety-related organizational constraints, and infection control safety attitudes explained significant variance in employees’ infection control safety behaviors, while the occupational risk of COVID-19 exposure and risk aversion did not. Organizations may benefit from considering employees’ conscientiousness and safety attitudes during employee selection as well as enhancing their organization’s safety climate and mitigating safety-related organizational constraints.
... However, the nearly universal compliance may be overreported. Borchgrevink, Cha, and Kim (2013) found people typically do not wash their hands as frequently as they report. The survey question is also non-specific, as it does not clarify whether the increase is overall or only after certain activities and captures the increase since before the pandemic rather than the absolute level of hand washing. ...
Article
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The COVID-19 pandemic has required the adoption of precautionary health behaviours to reduce the risk of infection. This study examines adherence, as well as changes in adherence, to four key precautionary behaviours among Canadian adults: wearing face masks, social distancing, hand washing, and avoiding large crowds. Data are drawn from Series 3 and 4 of the nationally representative Canadian Perspectives Survey Series, administered by Statistics Canada in June and July 2020. We calculate overall adherence levels as well as changes over time. Logistic regression models estimate each behaviour as a function of demographic and socioeconomic characteristics in order to identify adherence disparities across population segments. We find a nearly universal increase in precautionary behaviours from June to July in mask wearing (67.3% to 83.6%), social distancing (82.4% to 89.2%), and avoiding crowds (84.1% to 88.9%); no significant change occurred for the frequency of hand washing. We observe significant disparities in adherence to precautionary behaviours, especially for mask-wearing, in June; women, older, immigrant, urban, and highly educated adults were significantly more likely to adhere to precautionary behaviours than men, younger, Canadian-born, rural, and low-educated adults. By July 2020, these disparities persisted or slightly attenuated; women, however, had consistently higher adherence to all behaviours at both time points. These findings have substantial implications for policy and potential public health interventions.
... Centres for Disease Control and Prevention (CDC) [2], revealed that almost 50% of all foodborne illness outbreaks occur due to failing to wash or insufficiently washing hands. A review from 1975 to 1998 showed that unwashed hands of infected food workers are responsible for transmitting pathogens on food and resulting in 93% of the foodborne disease outbreaks [2,3]. Additionally, diarrheal disease risks can be reduced by more than 40% when hands washed with soap and that hand washing interventions could save one million lives annually [4]. ...
Article
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Background Hand hygiene has being considered as one of the primary measures to improve standards and practice for hospital care and to minimize the transmission of nosocomial pathogens. There is substantial evidence that incidence of hospital acquired infections is reduced by applying hand antisepsis. Regarding hand hygiene and public concern, hand washing has revealed that 85% of the observed adults wash their hands after using public toilets. Objective To compare the efficacy of hand rubbing with an alcohol based solution versus conventional hand washing with antiseptic and non-antiseptic soaps in reducing bacterial counts using different hand hygiene techniques. Methods Ninety-three volunteers took part in this study; 57 from Tripoli Medical Center (TMC); 16 from school; 11 from bank; and 9 from office. All volunteers performed six hand hygiene techniques, immediately before and after a volunteer practice activity: hand washing with non-antiseptic soap for 10 and 30 second (s); hand washing with antiseptic soap for 10, 30 or 60 s; and alcohol-based hand rub. A total of 864 specimens were taken: 432 before and 432 after volunteer's hand hygiene. The fingertips of the dominant hand for each volunteer were pressed on to agar for culture before and after each hand hygiene technique. Plates were incubated at 37 o C, and colony-forming units were counted after 48 hours and pathogenic bacteria were identified. Results Results showed that 617 specimens (71.41%) were positive for bacterial growth. 301 (48.78%) were from TMC, 118 (19.12%) were from office; 107 (14.34%) were from school and 91 (14.75%) were from bank. Conclusion Both antiseptic and non–antiseptic soaps did not work properly in reducing bacterial counts of worker’s hands at all places of study, but significantly improved by an application of alcohol based gel.
... According to the FDA, which is responsible for regulation of foods, drugs, cosmetics, medical devices, and similar products, there is no evidence that antibacterial soaps are more effective than nonantibacterial soap and water (FDA 2016). This is likely because the contact time during typical hand washing (an average of 6 s) is too short to deliver measurable benefits (Borchgrevink et al. 2013) and because the antibacterial ingredient is highly diluted during the washing process. ...
Article
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The Florence Statement on Triclosan and Triclocarban documents a consensus of more than 200 scientists and medical professionals on the hazards of and lack of demonstrated benefit from common uses of triclosan and triclocarban. These chemicals may be used in thousands of personal care and consumer products as well as in building materials. Based on extensive peer-reviewed research, this statement concludes that triclosan and triclocarban are environmentally persistent endocrine disruptors that bioaccumulate in and are toxic to aquatic and other organisms. Evidence of other hazards to humans and ecosystems from triclosan and triclocarban is presented along with recommendations intended to prevent future harm from triclosan, triclocarban, and antimicrobial substances with similar properties and effects. Because antimicrobials can have unintended adverse health and environmental impacts, they should only be used when they provide an evidence-based health benefit. Greater transparency is needed in product formulations, and before an antimicrobial is incorporated into a product, the long-term health and ecological impacts should be evaluated. https://doi.org/10.1289/EHP1788.
... Poor hygiene habits of handlers and guests could be one of the possible reasons. A study by the University of Michigan of 3,749 people [21] ensures that only 5% of the people going to the toilet wash their hands long enough to kill disease-causing organisms. It also ensures that 33% do not use soap, and 10% do not even wash them. ...
Article
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Restaurant menus could represent a source of cross contamination between consumers' hands and food due to the daily manipulation, being a possible vector of certain food borne diseases if not cleaned and disinfected on a regular basis. To the question if those menus are included in daily cleaning protocols, the present study aims to demonstrate the actual bacterial contamination present in their surface. For this purpose, twelve menus from Basque Culinary Center's historical archive made on plastic material and paper/paperboard material are tested in order to find any presence of aerobic microorganisms. In addition, twelve plastic menus from several restaurants in San Sebastian (Spain), which were currently in use, were also sampled to detect presence of aerobic microorganisms, specifically E.coli and S. aureus. Unable to find paper menus in restaurants, the question of whether plastic material is a really hygienic option arises. Therefore, a follow-up study is designed, consisting inoculation of two different types of menu materials (plastic and paper/paperboard) with a known concentration of E. coli and S. aureus to determine bacterial survival at different times. This second part of the study intends to demonstrate material would be the most appropriate in restaurant menus due to its ability to maintain a minimum level of contamination and bacterial persistence.
... However, even in areas where adequate hand washing stations are available, proper hand hygiene practices are dependent on pupils' knowledge and attitudes towards hygiene (ibid). Globally, several studies (Scott and Vanick, 2007; Borchgrevink et al, 2013; Xuan and Hoat, 2013) have investigated the availability of hand washing stations in schools but has not exhaustively examined whether the availability of handwashing stations and education on hand hygiene imply proper hand hygiene practices among school children. In order to contribute to the existing body of knowledge in this regard, this study generally examines the level of knowledge on hand washing with soap, provision of hand washing stations and practice of hand washing with soap among primary school pupils. ...
Article
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This paper generally examines the level of knowledge and practice of hand washing with soap (HWWS) among basic school pupils and the existing challenges. The study employed structured questionnaires, interviews and spot observations to obtain relevant information from 162 pupils and 20 head teachers from 20 primary schools in Ofankor, in the Ga East Municipality, Ghana. The pupils comprising of equal proportion of boys and girls were purposively selected from the lower and upper primary grades. Most pupils (87%) reported being educated on HWWS but 73% reported actually practicing HWWS after visiting the toilet. Protection from illnesses was generally mentioned (60%) as the major importance of HWWS. Apparently, pupils who claimed to be educated on HWWS are more likely to wash their hands after visiting the toilet and before eating as compared to those who have not been educated (χ2= 4.17; p < 0.05). Younger pupils (lower primary) are reportedly more likely to wash their hands after visiting the toilet and before eating as compared to older pupils (upper primary) (χ2 = 13.40; p < 0.05). Conversely, no statistically significant association (χ2 = 2.96; p > 0.05) was found between gender and these two critical moments for HWWS. Although pupils have good knowledge of HWWS, hand washing stations in the schools are not only sub-standard but also inadequate and soap provision is infrequent. The best practices to ensure effective implementation of hand hygiene programme in schools are discussed in detail in the paper.
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Although handwashing is an effective way to prevent infections, there is scarce evidence on predictors of handwashing during a pandemic. This paper aims to identify behavioral and demographic predictors of handwashing. The study surveyed 674 adults in Malaysia in May 2020. Time spent on social media predicted handwashing contingent on gender and number of children. More time spent on social media was positively associated with handwashing for males with three or more children. However, for males without children, social media use was negatively associated with handwashing. The association was not significant for males with one or two children. For females, more time spent on social media was significantly linked to more handwashing only for females with one child. Gender, a traditional predictor of handwashing, was a useful predictor only for those who spend more than three hours per day on social media and had at most one child. Number of children was a novel negative predictor for males who did not use social media and who averaged one hour per day on social media, a positive predictor for males who spent lots of time on social media, but not a predictor for females. In sum, social media use predicts handwashing, and is thus a helpful variable for use in targeted health communication during a pandemic – particularly through social media. Further, more conventional predictors like gender and number of children exhibit contingency effects with social media use and must thus be jointly considered with it.
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Clinicians can encounter sex and gender disparities in diagnostic and therapeutic responses. These disparities are noted in epidemiology, pathophysiology, clinical manifestations, disease progression, and response to treatment. This Review discusses the fundamental influences of sex and gender as modifiers of the major causes of death and morbidity. We articulate how the genetic, epigenetic, and hormonal influences of biological sex influence physiology and disease, and how the social constructs of gender affect the behaviour of the community, clinicians, and patients in the health-care system and interact with pathobiology. We aim to guide clinicians and researchers to consider sex and gender in their approach to diagnosis, prevention, and treatment of diseases as a necessary and fundamental step towards precision medicine, which will benefit men's and women's health.
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In December 2019, a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related epidemic was first observed in Wuhan, China. In 2020, owing to the highly infectious and deadly nature of the virus, this widespread novel coronavirus disease 2019 (nCOVID-19) became a worldwide pandemic. Studies have revealed that various environmental factors including temperature, humidity, and air pollution may also affect the transmission pattern of COVID-19. Unfortunately, still, there is no specific drug that has been validated in large-scale studies to treat patients with confirmed nCOVID-19. However, remdesivir, an inhibitor of RNA-dependent RNA polymerase (RdRp), has appeared as an auspicious antiviral drug. Currently, a large-scale study on remdesivir (i.e., 200 mg on first day, then 100 mg once/day) is ongoing to evaluate its clinical efficacy to treat nCOVID-19. Good antiviral activity against SARS-CoV-2 was not observed with the use of lopinavir/ritonavir (LPV/r). Nonetheless, the combination of umifenovir and LPV/r was found to have better antiviral activity. Furthermore, a combination of hydroxychloroquine (i.e., 200 mg 3 times/day) and azithromycin (i.e., 500 mg on first day, then 250 mg/day from day 2–5) also exhibited good activity. Currently, there are also ongoing studies to evaluate the efficacy of teicoplanin and monoclonal and polyclonal antibodies against SARS-CoV-2. Thus, in this article, we have analyzed the genetic diversity and molecular pathogenesis of nCOVID-19. We also present possible therapeutic options for nCOVID-19 patients.
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Virtual reality technology has been positioned as a useful tool for the promotion of public health. This study explored how exposure to a virtual reality handwashing promotion video influences users’ handwashing intention. Structural equation modeling analysis with data collected from college students in South Korea revealed that presence in the virtual reality environment was positively correlated with flow. We also found that flow played an important role in increasing levels of message acceptance and fear responses related to the content of the handwashing promotion video. Moreover, the greater the level of message acceptance of the handwashing promotion content, the more favorable users’ attitude toward handwashing. This, in turn, helped facilitate handwashing intention. The findings of the current study further our understanding of the psychological mechanism driving the impact of virtual reality as a health promotion tool for fostering people’s intention to engage in preventive health behavior.
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Nepali people are one of the ethnic minority immigrants of Hong Kong. This epidemiological investigation aims to determine and compare the knowledge level and hand hygiene (HH) behaviour of the Nepali people and the population of their host country (i.e., native Chinese population of Hong Kong). A total of 1008 questionnaires were collected via an online platform. The overall knowledge level of the native population towards HH was considerably higher than that of the Nepali respondents. Lower levels of knowledge in young and older people were noted. Reduced HH knowledge was also observed in people with low educational level or with comorbid illness(es). Significant differences between groups were noted in the self-reported hand washing behaviours. Regarding hand drying, more Nepalese than native Chinese respondents always/sometimes dried their hands on their clothing irrespective whether after performing handwashing in public washrooms or at home. Misconceptions and suboptimal practices on HH were prevalent in the two populations. The findings of this comparative study offer valuable information for the development of culturally sensitive health educational programs to enhance HH practices for the ethnic minorities and native Chinese population.
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As the number of air travelers grows, the need for a clean environment has become important during air travel. This study assessed passenger perceptions of cleanliness in airplanes. Using attributes from prior research, this study was able to extract three cleanliness dimensions and found that the most important cleanliness dimensions were food & flight attendants and lavatory. The importance of cleanliness was greater for females, older, and less experienced passengers. Almost one-third of the respondents reported taking active measures during air travel to prevent themselves from becoming sick. Results offer theoretical and practical contributions to the airline industry.
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AimsSmall children are expected to be abstinent from alcohol, and children’s hair is frequently used as the blank matrix for calibration of the alcohol consumption marker ethyl glucuronide (EtG). The basal EtG concentrations of total abstainers were described to be 0.3–2.1 pg/mg (Pirro et al. 2013). It is examined whether this assumption is valid for children from families with addiction background.Methods In a social support system for families with drug and/or alcohol addicted parents, 161 hair samples from 126 children (age 1–14 years, hair segment 0–3 cm) were analyzed for EtG by a validated LC-MS/MS method (LOD 0.56 pg/mg, LLOQ 2.3 pg/mg). For comparison, ethyl palmitate (EtPa) was measured and hair samples from parents were included. EtG ≥ 3 pg/mg was considered as an alarming result for children.Results and discussionEtG concentrations between 3.0 and 42.6 pg/mg (mean 9.55 pg/mg, median 6.40 pg/mg) were measured for 25 samples (15.5%, age 22 × 1–5 years, 3 × 9–11 years). Elevated EtPa (0.15–0.46 ng/mg) was found in 6 samples and cocaethylene (0.02–0.07 ng/mg) was detected in 5 samples with high cocaine findings. Hair results of one or both parents indicated drug abuse in 12 from 14 cases (85.7%) if both parents were tested.Conclusion Although accidental or voluntary intake of alcoholic beverages cannot be excluded, the external contamination of children’s hair by EtG-containing wine and sweat or urine of the alcohol abusing parents is assumed to be the most probable explanation for the positive EtG results in hair of 1–5-year-old children.
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Background: Hand hygiene is cost-effective and has been recognized as an effective measure in the control of communicable diseases. The main aim of this study is to evaluate the hand washing knowledge, practices, and skills of students in both private and public institutions of higher learning. Methods: This was an institution-based cross-sectional study that included a mix of 577 university students from different disciplines (49.6% males and 50.4% females) with a mean age of 21.8 ± 3.5 years. Departments were selected at random, and the quota sampling technique was used to select the study participants. Hand washing knowledge, practices, and skills scores were assessed using a structured questionnaire. The differences in scores were further quantified across different factors using multiple quantile regression analysis. Results: The prevalence of hand washing with soap was 10.7%. Also, the majority of the study participants (75.2%) had a poor hand washing practices score. Age ≥29 years was associated with a 6.3% lower median hand washing knowledge score (p=0.039). Also, being in the public institution was significantly associated with 6.3%, 36.0%, and 10.0% lower median hand washing knowledge (p=0.021), practices (p < 0.001), and skills (p=0.025) scores, respectively. In addition, being a medical student (p=0.029) and washing hands ≥ six times a day (p=0.008) were significantly associated with an increase in the median hand washing knowledge score of 6.3% and 18.7%, respectively. Conclusions: Educational interventions need to be carried out to create awareness of the importance of hand washing and also to enhance the hand washing knowledge, practices, and skills of university students.
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The risk for a global transmission of flu-type viruses is strengthened by the physical contact between humans and accelerated through individual mobility patterns. The Air Transportation System plays a critical role in such transmissions because it is responsible for fast and long-range human travel, while its building components-the airports-are crowded, confined areas with usually poor hygiene. Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) consider hand hygiene as the most efficient and cost-effective way to limit disease propagation. Results from clinical studies reveal the effect of hand washing on individual transmissibility of infectious diseases. However, its potential as a mitigation strategy against the global risk for a pandemic has not been fully explored. Here, we use epidemiological modeling and data-driven simulations to elucidate the role of individual engagement with hand hygiene inside airports in conjunction with human travel on the global spread of epidemics. We find that, by increasing travelers engagement with hand hygiene at all airports, a potential pandemic can be inhibited by 24% to 69%. In addition, we identify 10 airports at the core of a cost-optimal deployment of the hand-washing mitigation strategy. Increasing hand-washing rate at only those 10 influential locations, the risk of a pandemic could potentially drop by up to 37%. Our results provide evidence for the effectiveness of hand hygiene in airports on the global spread of infections that could shape the way public-health policy is implemented with respect to the overall objective of mitigating potential population health crises.
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Proper drying of hands after washing is an integral part of hand hygiene. An experimental study on 30 subjects using multiple comparisons of six hand drying methods including 1) drying on own clothes, 2) drying with one paper towel, 3) drying with two paper towels, 4) drying with a warm air dryer while holding hands stationary for 20 s, 5) drying with a warm air dryer while hand rubbing for 20 s, and 6) drying with a jet air dryer until complete dryness was achieved. It aimed to determine the effectiveness of different hand drying methods for removing bacteria from washed hands, so as to identify the optimum method using minimum resources. Our study demonstrated that the use of jet air dryers is the best method to eliminate bacteria on hands, whereas drying hands on one’s own clothes is the least effective. Drying hands in a stationary position could remove more bacteria than rubbing hands when using a warm air dryer for 20 s, which mimics people’s usual hand-drying practice. No significant difference in bacteria reduction was detected between the use of one or two paper towels for hand drying; therefore, using fewer resources is recommended to maintain environmental sustainability.
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e outbreak of severe acute respiratory syndrome (SARS) claimed the lives of 286 Hong Kong people in 2003. Since then, the Hong Kong government has been promoting the benefits of proper hand hygiene. ere are few studies that explore the general quality of handwashing and the hand-hygiene practices of the public of Hong Kong; given this, the aim of this study is to explore this neglected topic. is study is a quantitative study that was conducted in January 2018. e results show that the majority of participants only wash their hands after using the toilet (87%) or handling vomitus or faecal matter (91%). e mean duration of handwashing was 36.54 seconds (SD � 18.57). e areas of the hand most neglected during handwashing were the fingertips (48.1%), medial area (30.5%), and back of the hand (28%). A multiple logistic regression shows that participants who have reached third-level education or higher often tend to be more hand hygienic than those who have not reached third-level education (p ≤ 0.001, B � 1.003). us, participants aged 30 and above tend to neglect 5 more areas of the hand than those aged below 30 (p � 0.001, B � 4.933).
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The human palm has been identified as one of the richest habitats for human microbial accommodation making hand hygiene essential to primary prevention of infection. Since the hand is in constant contact with fomites which have been proven to be mostly contaminated, building hand hygiene habits is essential for the prevention of infection. This research was conducted to assess the hand hygiene habits of Ghanaian youths in Accra. This study used a survey as a quantitative method of research. The findings of the study revealed that out of the 254 participants who fully answered the questionnaire, 22% had the habit of washing their hands after outings while only 51.6% had the habit of washing their hands after using the bathroom. However, about 60% of the participants said they sometimes ate with their hands while 28.9% had the habit of eating with the hand very often, a situation that put them at risk of infection from their hands since some participants had poor handwashing habits; prompting the need for continuous education on hand hygiene.
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Introduction: Environmental conditions in households and behaviors serve to increase the risk of Malaria and diarrhea diseases which are among the top killers of children under the age of five in developing countries. Materials and Methods: A cross sectional descriptive study amongst caregivers of under-five children in Enugu urban slums. Selected by multistage sampling. Data were collected using interviewer administered questionnaire and observation checklist. Analyzed using SPSS. Result: Mean age was 1.24 ± 0.47. Most caregivers were child's mother aged 20 to 29 years. 107 (47.0%) sourced their drinking water from protected well; only 71 (31.0%) purified it before giving it to the child. Soap was available in 98% of the households but was used for other purposes than hand washing. 55% disposed of refuse by open dumping. Perceived causes of diarrhea were bad water 69%, spoilt food 54%, germs 55%. Cause of malaria was from the sun 4%, oily food 13%. Only 35% took a sick child to a health centre, 44% gave drugs at home, 41% gave Oral Rehydration Solution, 26% gave zinc tablets, 17% went to the Patent medicine dealer/laboratory and 0.9% went to prayer houses. Only 46% of the children slept under ITNs. Conclusion: Most of the observed environmental health behaviors are risky to the health of children. If reduction of morbidity and mortality from malaria and diarrhea is to be achieved, there's need to improve the environmental sanitation of the households in urban slums.
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Background The hand hygiene (HH) behaviour of the general public and its effect on illnesses are issues of growing importance. Gender is associated with HH behaviour. HH efficiency is a combination of washing efficiency and hand drying, but information about the knowledge level and HH behaviour of the general public is relatively limited. The findings of this cross-sectional study can substantially contribute to the understanding on the knowledge gap and public behaviour towards HH, thereby providing information on gender-specific health promotion activities and campaigns to improve HH compliance. Methods An epidemiological investigation by using a cross-sectional study design on the general public was conducted either via an online platform (SurveyMonkey) or paper-and-pen methods. The hand-washing and -drying questionnaire was used for data collection. Results A total of 815 valid questionnaires were collected. Majority of the respondents can differentiate the diseases that can or cannot be transmitted with poor HH, but the HH knowledge of the respondents was relatively inadequate. The female respondents had a significantly better HH knowledge than male respondents. The multiple regression analysis results also indicated that females had a significantly higher knowledge score by 0.288 towards HH than males after adjusting for age and education level. Although the majority of the respondents indicated that they performed hand cleaning under different specific situations, they admitted only using water instead of washing their hands with soap. More males than females dried their hands on their own clothing, whereas more females dried their hands through air evaporation. The average time of using warm hand dryers was generally inadequate amongst the respondents. Conclusions Being a female, middle-aged and having tertiary education level are protective factors to improve HH knowledge. Misconceptions related to the concepts associated with HH were noted amongst the public. Self-reported practice on hand drying methods indicated that additional education was needed. The findings of this study can provide information on gender-specific health promotion activities and creative campaigns to achieve sustained improvement in HH practices.
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Background Many people use handwashing and hand-drying facilities in public washrooms under the impression that these amenities are hygienic. However, such facilities may be potential sites for the transmission of pathogenic bacteria. This study aimed to examine the hygiene facilities provided including handwashing and hand-drying facilities in public washrooms. Total bacterial counts and species identification were determined for hand-drying facilities. Antimicrobial susceptibilities were performed. Methods The bacterial contamination levels of 55 public washrooms ranging in category from low class communities to high end establishments, were examined. The hygienic environment and facilities of the washrooms were analysed using an electronic checklist to facilitate immediate data entry. Pre-moistened sterile swabs were used to collect samples from areas around the outlet of paper towel dispensers, air outlet of air dryers, exit door handles and paper towels in the washrooms. Total bacterial counts were performed and isolates identified using matrix-assisted laser desorption ionisation time-of-flight mass spectrometry. Antimicrobial susceptibility was determined by disk diffusion. Results The high and middle-income categories washrooms generally had cleaner facilities and environment followed by those in low categories. Fifty-two bacterial species were identified from the 55 investigated washrooms. Over 97% of the pathogenic Staphylococcus spp. tested were resistant to at least one first-line antimicrobial therapeutic agent, including penicillin, cefoxitin, erythromycin, co-trimoxazole, clindamycin and gentamicin, and 22.6% demonstrated co-resistance to at least three antimicrobial agents, with co-resistance to penicillin, erythromycin and clindamycin being the most common. Conclusion Our findings suggest that hand-drying facilities in public washrooms can act as reservoirs of drug-resistant bacteria. The importance of frequent cleaning and maintenance of public washrooms to promote safe hand hygiene practices for the public are emphasised. Electronic supplementary material The online version of this article (10.1186/s13756-019-0500-z) contains supplementary material, which is available to authorized users.
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Proper handwashing is a simple, cost effective means for reducing the risk of foodborne disease transmission. Low compliance rates are often observed among food handlers, and a wide range of interventions have attempted to increase compliance, often with little success. Promoting lasting behavior change is difficult, and theoretical models like the Intervention Ladder developed by the Nuffield Council on Bioethics function as useful paradigms to help guide and promote behavior change. While the Intervention Ladder was developed to address issues like infectious disease, obesity, and drug use, it is applicable to the food industry with regards to promoting food safety practices like handwashing. The aim of this review is to expand on the Intervention Ladder and describe its application in the food industry. We believe the Intervention Ladder can serve as a model to benefit food industry stakeholders through providing strategies to promote handwashing compliance. We have modified the original model to include various levels of employee freedom that might impact which strategy is most appropriate depending on the circumstances. Limitations for each strategy are also considered, and directions for future research are included to help guide and expand the knowledge base of food safety behavior change strategies.
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Greywater (GW), domestic wastewater excluding the streams generated by toilets and kitchens, can serve as an alternative water source. The main options for GW reuse are toilet flushing and garden irrigation, both generating aerosols. These may transmit inhalable pathogens like Legionella and present a potential health risk. This study quantified the health risk that may arise from inhalation of Legionella-contaminated aerosols due to non-potable GW reuse. Data on Legionella concentrations in potable water and GW was collected. Then, Quantitative Microbial Risk Assessment (QMRA) was performed for two possible exposure scenarios: garden irrigation and toilet flushing. This was performed while considering Legionella seasonality. In order to determine the safety of GW reuse regarding Legionella transmission, the obtained results were compared with estimated tolerable risk levels of infection and of disease. Both limits were expressed as Disability-Adjusted Life Years index (DALY) being 10(-4) and 10(-5), respectively. The QMRA revealed that the annual risk associated with reuse of treated and chlorinated GW for garden irrigation and toilet flushing was not significantly higher than the risk associated with using potable water for the same two purposes. In all studied scenarios, the health risk stemming from reusing treated and chlorinated GW was acceptable regarding Legionella infection. In contrast, reuse of untreated or treated but unchlorinated GW should not be practiced, as these are associated with significantly higher health risks.
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Obsessive-compulsive disorder (OCD) related contamination concerns are often associated with excessive handwashing. Less is known about other hygiene-related behaviors (HRBs) in OCD. In contrast, extensive public health research has examined the frequency and duration of personal (e.g., handwashing) and household (e.g., scrubbing tub/shower) HRBs in community members. The present study connected these literatures by examining self-reported HRB frequency and duration in 25 patients with OCD with predominant contamination-related symptoms, 95 patients with social anxiety disorder, 36 patients with panic disorder with agoraphobia, and 31 nonclinical community members. Participants reported the frequency or duration of common HRBs. Patients with OCD reported greater frequency of daily handwashing, but the groups did not differ with respect to the frequency/duration of other HRBs or the overall frequency/duration of HRBs. A minority of participants in all groups had high levels of engagement in at least one hygiene-related activity, and within each group, different psychological factors were associated with high hygiene engagement. These findings suggest that for many patients with OCD and contamination concerns, the frequency of handwashing is heightened, whereas frequencies/durations of other HRBs are similar to those for people without OCD. More research is needed on the mechanisms associated with high hygiene engagement.
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Foam soaps are aerosolized liquid soaps dispensed through a special pump mechanism. Currently there are no studies comparing liquid soap with foam soap in regard to efficacy of reducing hand microbial burden. In 3 separate experiments and with 2 different brands of foam soap, it was observed that nonantimicrobial foam soap was not as effective in reducing hand bacterial load as the liquid soap.
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Background. In designing digital interventions for healthcare,it is important to understand not just whether interventions work but also how and for whom—including whether individual intervention components have different effects, whether a certain usage threshold is required to change behavior in each intervention and whether usage differs across population subgroups. Purpose We investigated these questions using data from a large trial of the digital PRimary care trial of a website basedInfection control intervention to Modify Influenza-like illness and respiratory tract infection Transmission) (PRIMIT) inter-vention, which aimed to reduce respiratory tract infections(RTIs) by increasing hand hygiene behavior. Method. Baseline and follow-up questionnaires measured be-haviors, intentions and attitudes in hand hygiene. In conjunc-tion with objective measures of usage of the four PRIMITsessions, we analysed these observational data to examinemechanisms of behavior change in 8993 intervention users. Results. We found that the PRIMIT intervention changed be-havior, intentions and attitudes, and this change was associ-ated with reduced RTIs. The largest hand hygiene changeoccurred after the first session, with incrementally smallerchanges after each subsequent session, suggesting that en-gagement with the core behavior change techniques includedin the first session was necessary and sufficient for behaviorchange. The intervention was equally effective for men andwomen, older and younger people and was particularly effec-tive for those with lower levels of education. Conclusions. Our well-powered analysis has implications forintervention development. We were able to determine a ‘minimum threshold’ of intervention engagement that is required for hand hygiene change, and we discuss the potential impli-cations this (and other analyses of this type) may have for further intervention development. We also discuss the appli-cation of similar analyses to other interventions.
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Background: Handwashing (HW) compliance, although an effective means of limiting childhood illness, remains low among personnel in early childhood centers (ECCs). Our study determined HW compliance and efficacy of ECC personnel. Methods: Surveillance cameras were used to determine HW opportunities, compliance, occurrences, and effectiveness based on child-care oriented criteria. Results: We observed 349 HW triggering events, with 14 events per hour; a median of 2 personnel (caregivers, paraprofessional aides, or parents) were present at any given time period. Compliance was 30% (caregivers), 11% (paraprofessional aides), and 4% (parents), with an overall compliance of 22%. Between-room and between-age groups of children being cared for and compliance of caregivers and paraprofessional aides were not found to be significantly different (P < .05). For all personnel between the 10 different rooms, the median compliance was 20.2% (95% confidence interval, 8%-35%). Only 7% of personnel taking care of 2- to 3-year-old children washed their hands, the lowest compliance per age group. Of all steps in HW, paper towel usage had the highest compliance, with a 97% adherence, whereas turning off the faucet with a paper towel was the lowest at 17%. Conclusions: Methods and strategies need to be developed to increase compliance. Current technology provides an effective means of gathering data for determining HW compliance in ECCs.
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A cross-sectional analytic study was done to determine the self-reported prevalence of proper hand washing practice among mothers and its relationship with the occurrence of diarrhoea among family members in Mandalay during 2011. Altogether 829 mothers (one from each household) from Chan-Aye-Tharzan and Mahar-Aung-Myay townships were selected by using systematic random sampling procedure. Face to face interview method was used to collect the necessary data. The prevalence of proper hand washing practice as reported among mothers was almost 80% (95% CI = 76.6%, 82.1%) but the occurrence of diarrhoea reported among her family members including herself within past one year was 18.2% (95% CI = 15.7%, 20.9%). Family income (p = 0.006) and education status (p = 0.048) were found to have significant effects on reported practices of proper hand washing. Moreover, proper hand washing practice by mothers was found to have significant effect on the occurrence of diarrhoea among all family members including herself (p < 0.001). It was apparent that if the mother washed her hands properly, the annual occurrence of diarrhoea would be reduced among the whole family (48% of current occurrence), among other family members (53%) and herself (50%). Although proper hand washing practice among mothers is satisfactory, habit of this hygienic behavior should be promoted in the whole country to prevent episodes of diarrhoea especially given priority to low income households and mothers with low education status.
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In numerous medical reports and scientific papers, it is unequivocally stated that dirty hands increase the risk of gastrointestinal, respiratory and skin infections. The aim of the present study was to assess hand hygiene practices in Silesia, Poland. In 2012, 400 persons were observed in public toilets located in shopping centres of Silesia. Disguised, participant and controlled observations were used. Results indicated that women wash their hands more frequently and longer than men. Women washed their hands for 10.2 (standard deviation (SD)¼ 7.3) s on average, while men devoted an average of 8.2 (SD ¼ 5.8) s to this activity. Men dried their hands for about 3 s longer and used soap more frequently than women. The study also revealed a significant relationship between the correctness of the hand-washing procedure and the place of observation (p <0.05). Based on the research and available literature, it can be concluded that health activities promoting the hand-washing procedure need to be introduced in Poland.
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Purpose – Foodborne illnesses are often related to raw and cooked poultry and meat, eggs, and their products. Consumer practices related to these foods have been studied in many countries, however, little comparison has been made among different countries. The purpose of this paper is to characterize consumers’ purchase, storage, handling, and preparation of poultry products and eggs in four European countries: Russia, Estonia, Italy, and Spain. Design/methodology/approach – Approximately 100 selected consumers in each location completed a questionnaire that included sections about poultry products and eggs purchase temperatures and locations, storage locations such as refrigerator, freezer, or cabinet, and preparation such as washing eggs and poultry before cooking, and the use of cutting boards. Findings – Although educating consumers in European countries is common, some food safety aspects may need to be additionally addressed. The results indicated differences in purchase and storage practices of raw eggs. In Russia and Estonia consumers who participated in the study purchased both refrigerated and room temperature eggs whereas in Italy (84 percent) and Spain (87 percent) eggs typically were purchased at room temperature. However, almost all consumers in all countries stored eggs in the refrigerator. In Russia 70 percent of the consumers who participated in the study immediately froze raw meat, poultry, or seafood after purchase; while in other countries about a quarter of the consumers froze the raw meat.
Thesis
Mobile phones are daily used and in a frequent manner. There is no awareness in the general public of their potential to be a reservoir of specific bacteria. The use of touch screen mobile phones is exponentially growing and the hospital outbreaks with touch screens as contamination source is more frequently being registered. Touch screens are not perceived as a method of transmission of potentially pathogenic and antibiotic resistant bacteria, thus posing as a health risk due to being overlooked in terms of disinfection standards in healthcare settings. Bacteria are acquiring resistance to various antibiotics, possibly becoming multiresistant such as HA-MRSA. This poses a public health risk when faced with the possibility that these bacteria can adhere and remain on mobile phones over a great length of time. These devices may serve as vector of transmitting bacteria to their owners and third parties. This is even more preoccupying when individuals are healthcare professionals. This study aimed to identify and quantify the bacteria present on mobile phones and the hands of their users. The bacteria were submitted to antibiotic screening and MRSA were selected and genotypically characterized, and the SCCmec element typified. Bacillus spp. was detected in 7.5% of the individuals and in 28% of the mobile phones, hemolytic bacteria were detected in 82% of the individuals, Staphylococcus spp. in 96.5%, S. aureus in 82%, Enterobacteriaceae in 1% and MRSA in 6%. Erythromycin resistance in staphylococci was verified to be 44.7% in general. Oxacillin and Clindamycin resistance was 12.5% and 9.8%, respectively. 0.8% of the screened bacteria were multiresistant, and 3.3% of the individuals presented multiresistant bacteria on their hands. Four samples were identified as being MRSA, all multiresistant and from those, two samples were presumptively identified as SCCmec type II and SCCmec type III, both HA-MRSA. Male individuals have "dirtier" hands than female students in terms of potential pathogenic bacteria. Various factors such as, keyboard type, hand and mobile phone hygiene, nail length, manicure type and presence, taking device to the bathroom, owning pets and hand washing have influence on the bacterial count of the hands. Mobile phones can serve as reservoirs of specific bacterial that may be pathogenic and multiresistant to antibiotics, and should be publically perceived as a possible contamination source.
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Veterinary students can be exposed to environmental infectious agents in school that may include zoonotic pathogens. Encouraging effective hand hygiene can minimize the spread of zoonoses and promote public health and the One Health concept among veterinary students. The purpose of this study was to determine if a campaign could improve hand hygiene among veterinary students at extracurricular meetings serving meals. Nine Kansas State University College of Veterinary Medicine (KSU-CVM) extracurricular organizations participated in the study, sanitizer was provided at each meeting, and baseline hand-hygiene data were observed. A hand-hygiene opportunity was defined as any student observed to approach the buffet food line. Sanitizer use (yes/no) and gender (male/female) were recorded. Campaign interventions included a 3.5-minute educational video and a novel motivational poster. The video was presented to all first-year, second-year, and third-year veterinary students. Posters encouraging hand sanitization were displayed on doors and tables alongside sanitizers at each meeting. Observational hand-hygiene data were collected immediately after introduction of interventions and again 3 months later. Environmental sampling for presence of bacteria in and around meeting locations was also performed. Observed hand hygiene was lowest during baseline (11.0%±1.7), improved significantly post-intervention (48.8%±3.2), and remained improved at 3-month follow-up (33.5%±4.0). Females had higher probability of hand sanitizing (35.9%±2.2) than males (21.4%±2.4) (p<.01). Clostridium perfringens was isolated from 2/42 samples, and Salmonella spp. were isolated from 4/42 samples. A short-term public health campaign targeting veterinary students successfully improved hand hygiene before meals.
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The polychlorinated aromatic antimicrobials triclosan and triclocarban are in widespread use for killing microorganisms indiscriminately, rapidly, and by nonspecific action. While their utility in healthcare settings is undisputed, benefits to users of antimicrobial personal care products are few to none. Yet, these latter, high-volume uses have caused widespread contamination of the environment, wildlife, and human populations. This feature article presents a timeline of scientific evidence and regulatory actions in the U.S. concerning persistent polychlorinated biocides, showing a potential path forward to judicious and sustainable uses of synthetic antimicrobials, including the design of greener and safer next-generation alternatives.
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Numerous studies have found that individuals are more likely to comply with social norms when in the presence of others. To test the hypothesis that restroom hygiene norms would be influenced by the presence or absence of others, 93 male participants were observed in a restroom to see if there were any differences in their hand-washing behavior when someone else versus no one else was present. While 90% of the men washed their hands while in the presence of others, only 44% did so when alone; thus, the evidence supported our hypothesis. The implications of these results are discussed.
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Handwashing is thought to be effective for the prevention of transmission of diarrhoea pathogens. However it is not conclusive that handwashing with soap is more effective at reducing contamination with bacteria associated with diarrhoea than using water only. In this study 20 volunteers contaminated their hands deliberately by touching door handles and railings in public spaces. They were then allocated at random to (1) handwashing with water, (2) handwashing with non-antibacterial soap and (3) no handwashing. Each volunteer underwent this procedure 24 times, yielding 480 samples overall. Bacteria of potential faecal origin (mostly Enterococcus and Enterobacter spp.) were found after no handwashing in 44% of samples. Handwashing with water alone reduced the presence of bacteria to 23% (p < 0.001). Handwashing with plain soap and water reduced the presence of bacteria to 8% (comparison of both handwashing arms: p < 0.001). The effect did not appear to depend on the bacteria species. Handwashing with non-antibacterial soap and water is more effective for the removal of bacteria of potential faecal origin from hands than handwashing with water alone and should therefore be more useful for the prevention of transmission of diarrhoeal diseases.
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To better quantify the impact of foodborne diseases on health in the United States, we compiled and analyzed information from multiple surveillance systems and other sources. We estimate that foodborne diseases cause approximately 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths in the United States each year. Known pathogens account for an estimated 14 million illnesses, 60, 000 hospitalizations, and 1,800 deaths. Three pathogens, Salmonella, Listeria, and Toxoplasma, are responsible for 1,500 deaths each year, more than 75% of those caused by known pathogens, while unknown agents account for the remaining 62 million illnesses, 265,000 hospitalizations, and 3,200 deaths. Overall, foodborne diseases appear to cause more illnesses but fewer deaths than previously estimated.
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After different methods of hand preparation, volunteers rolled segments of sterile central venous catheter between their fingertips, and bacterial transfer was evaluated by standardized quantitative culture. The number of bacteria transferred differed between methods (P<0.001). Comparisons were made with the control group (no preparation at all; median, third quartile and maximum count=6.5, 24, 55). Bacterial transfer was greatly increased with wet hands (1227, 1932, 3254; P<0.001). It was reduced with a new rapid method, based on thorough drying with a combination of 10 s using a cloth towel followed by either 10 or 20 s with a hot‐air towel (0, 3, 7 and 0, 4, 30, respectively; P=0.007 and 0.004, respectively). When asked to follow their personal routines, 10 consultant anaesthetists used a range of methods. Collectively, these were not significantly better than control (7.5, 15, 55; P=0.73), and neither was an air towel alone (2.5, 15, 80; P=0.176) nor the hospital’s standard procedure (0, 1, 500; P=0.035). If hand preparation is needed, an adequate and validated method should be used, together with thorough hand drying. Br J Anaesth 2001; 87: 291–4
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Improvement of food worker hand washing practices is critical to the reduction of foodborne illness and is dependent upon a clear understanding of current hand washing practices. To that end, this study collected detailed observational data on food worker hand washing practices. Food workers (n = 321) were observed preparing food, and data were recorded on specific work activities for which hand washing is recommended (e.g., food preparation, handling dirty equipment). Data were also recorded on hand washing behaviors that occurred in conjunction with these work activities. Results indicated that workers engaged in approximately 8.6 work activities per hour for which hand washing is recommended. However, workers made hand washing attempts (i.e., removed gloves, if worn, and placed hands in running water) in only 32% of these activities and washed their hands appropriately (i.e., removed gloves, if worn, placed hands in running water, used soap, and dried hands) in only 27% of these work activities. Attempted and appropriate hand washing rates varied by work activity--they were significantly higher in conjunction with food preparation than other work activities (46 versus < or = 37% for attempted hand washing; 41 versus < or = 30% for appropriate hand washing) and were significantly lower in conjunction with touching the body than other work activities (13 versus > or = 27% for attempted hand washing; 10 versus > or = 23% for appropriate hand washing). Attempted and appropriate hand washing rates were significantly lower when gloves were worn (18 and 16%) than when gloves were not worn (37 and 30%). These findings suggest that the hand washing practices of food workers need to be improved, glove use may reduce hand washing, and restaurants should consider reorganizing their food preparation activities to reduce the frequency with which hand washing is needed.
Article
This research looks at hand-washing behavior of students at a large regional university. The authors observed how hand-washing behavior varies by race, gender, having an observer present, and time of day. Of the 184 students observed, most (103) were men. The majority (107) of those observed were whites; while 77 fell in the other race category. Of 184 observations, 86 were not “observed” by another in the bathroom. Observations were made in the morning and afternoon. Utilizing social deprivation theory, the authors hypothesized that women and minorities would be more likely than others to wash their hands. The data provide empirical support for this proposition. Further, having an observer present made it more likely that a person would wash his or her hands.
Article
We pretested interventions derived from different domains of behavior change theory to determine their effectiveness at increasing hand washing with soap in a natural setting. We installed wireless devices in highway service station restrooms to record entry and soap use. Two text-only messages for each of 7 psychological domains were compared for their effect on soap-use rates. We collected data on nearly 200 000 restroom uses. The knowledge activation domain was most effective for women, with a relative increase in soap use of 9.4% compared with the control condition (P = .001). For men, disgust was the most effective, increasing soap use by 9.8% (P = .001). Disgust was not significantly better than the control condition for women, nor was knowledge activation for men. Messages based on social norms and social status were effective for both genders. Our data show that unobtrusive observation of behavior in a natural setting can help identify the most effective interventions for changing behaviors of public health importance. The gender differences we found suggest that public health interventions should target men and women differently.
Article
We describe handwashing practices, the association of handwashing with upper respiratory and gastrointestinal symptoms, and the effects of gender on handwashing practices among male (n = 215) and female (n = 243) college students. Self-reported frequency of handwashing was not associated with infectious illness symptom reporting. Only a small proportion of males (10%) and females (7%) reported "always" washing their hands before eating. Females were more likely than males to always wash their hands after urinating (69% vs 43%; P < .0001) and after a bowel movement (84% vs 78%; P = .14). Identifying new strategies to increase handwashing may help prevent infectious disease transmission in residence hall environments.
Article
This paper presents a general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies. The procedure essentially involves the construction of functions of the observed proportions which are directed at the extent to which the observers agree among themselves and the construction of test statistics for hypotheses involving these functions. Tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interobserver agreement are developed as generalized kappa-type statistics. These procedures are illustrated with a clinical diagnosis example from the epidemiological literature.
Article
To assess the effects of an automated sink on handwashing practices and attitudes of staff. Quasi-experimental crossover design. Two high-risk patient care areas, one postanesthesia recovery room (Site 1), and one neonatal intensive care unit (Site 2) in two tertiary care hospitals. All patient care staff on study units; approximately 55 individuals. An automated sink was installed to replace one handwashing sink for about five weeks; the sink was then crossed-over for an equivalent time period to the other location. Handwashing practices of all unit staff were observed in three two-hour observation periods/week. Questionnaires were distributed to staff two weeks after sink installation and at the study's end. One thousand, six hundred ten handwashes were observed. Handwashing practices differed significantly by site. For both sites, hands were washed significantly better but significantly less often with the automated sink (all p less than .001). Staff expressed negative attitudes, however, about certain features of the sink, and these negative attitudes increased over the study period. Automated devices must be flexible enough to allow adjustments based on staff acceptance. Application of new technology to improve hand hygiene requires a multifaceted approach to behavior change.
Article
A model for contact transfer of micro-organisms by hand has been extended to include representatives of bacterial species responsible for a majority of hospitalacquired infections. The ability of the organisms to transfer from contaminated fabrics to hands and from hands to sterile fabrics was measured, as was their ability to survive on the skin of the hands. There were differences between the species. Staphylococcus saprophyticus transferred well to the hand but not as well from hand to fabric as the other species; it survived well on skin. Pseudomonas aeruginosa, Klebsiella aerogenes and Serratia marcescens transferred moderately well overall and also survived on the skin. These results were in contrast to those obtained with a strain of Escherichia coli and one of Streptococcus pyogenes . The contact transfer model was used to investigate the use of small volumes of alcohol in preventing transfer via the hands. An alcohol handrub of either 0·3 ml 80% ethanol or 0·3 ml 70% isopropanol gave reductions in transfer slightly less than that of a soap and water wash. Raising the volume, and consequently the contact time, to 0·5 ml 70% isopropanol gave a 14000-fold reduction in transfer, statistically indistinguishable from that of a thorough soap and water wash (9800-fold reduction).
Article
Few interventions to influence handwashing have had measurable effects. This prospective quasi-experimental study was designed to address predisposing, enabling, and reinforcing factors to improve frequency of handwashing. Over a 12-month time period, a multifaceted intervention including focus group sessions, installation of automated sinks, and feedback to staff on handwashing frequency was implemented in one intensive care unit; a second unit served as a control. Dependent variables observed were handwashing frequency and self-reported practices and opinions about handwashing. Study phases included baseline, three phases of about 2 months each in duration in which sink automation was incrementally increased, and follow-up 2 months after intervention. During 301 hours of observation, 2624 handwashings were recorded. Proportion of times hands were washed varied by indication, ranging from 38% before invasive procedures to 86% for dirty-to-clean procedures (p < 0.00001). Although there were some significant differences between experimental and control units in handwashing during the study, these differences had returned to baseline by the 2-month follow-up. There were no significant differences in self-reported practices and opinions from before to after intervention nor between units. Intensive intervention, including feedback, education, and increased sink automation, had minimal long-term effect on handwashing frequency.
Article
Handwashing is one of the most important control measures for preventing the spread of bacteria. Although young children are taught the procedure through different types of behavior modification, its effect has not been measured in older children. We have documentation that adults and health care workers have a compliance rate of only 50% with this basic control measure. This article reports on the compliance rate, duration, and handwashing techniques used by middle and high school students after using the bathroom.
Article
We report here a new and critical determinant of the effectiveness of hand hygiene procedures, namely the amount of residual moisture left on the hands after washing and drying. When samples of skin, food and utilities were touched with wet, undried hands, microbial numbers in the order of 68000, 31000 and 1900 respectively translocated to these representative surfaces. Bacterial numbers translocating on touch contact decreased progressively as drying with an air or cloth towel system removed residual moisture from the hands. A 10 s cloth towel-20 s air towel protocol reduced the bacterial numbers translocating to skin, food and utilities on touch contact to 140, 655 and 28 respectively and achieved a 99.8, 94 and 99% reduction in the level of bacterial translocation associated with wet hands. Careful hand drying is a critical factor determining the level of touch-contact-associated bacterial transfer after hand washing and its recognition could make a significant contribution towards improving handcare practices in clinical and public health sectors.
Article
To determine whether hand washing would increase with sustained feedback based on measurements of soap and paper towel consumption. Prospective trial with a nonequivalent control group. Open multibed rooms in the Omaha Veterans Affairs Medical Center's Surgical Intensive Care Unit (SICU) and Medical Intensive Care Unit (MICU). Unit staff. Every weekday from May 26 through December 8, 1998, we recorded daytime soap and paper towel consumption, nurse staffing, and occupied beds in the SICU (intervention unit) and the MICU (control unit) and used these data to calculate estimated hand washing episodes (EHWEs), EHWEs per occupied bed per hour, and patient-to-nurse ratios. In addition, from May 26 through June 26 (baseline period) and from November 2 through December 8 (follow-up period), live observers stationed daily for random 4-hour intervals in the MICU and the SICU counted actual hand washing episodes (CHWEs). The intervention consisted of posting in the SICU, but not in the MICU, a graph showing the weekly EHWEs per occupied bed per hour for the preceding 5 weeks. Directly counted hand washing fell in the SICU from a baseline of 2.68+/-0.72 (mean +/- standard deviation) episodes per occupied bed per hour to 1.92+/-1.35 in the follow-up period. In the MICU, episodes fell from 2.58+/-0.95 (baseline) to 1.74+/-0.69. In the MICU, the withdrawal of live observers was associated with a decrease in estimated episodes from 1.36+/-0.49 at baseline to 1.01+/-0.36, with a return to 1.16+/-0.50 when the observers returned. In the SICU, a similar decrease did not persist throughout a period of feedback. Estimated hand washing correlated negatively with the patient-to-nurse ratio (r = -0.35 for the MICU, r = -0.46 for the SICU). Sustained feedback on hand washing failed to produce a sustained improvement. Live observers were associated with increased hand washing, even when they did not offer feedback. Hand washing decreased when the patient-to-nurse ratio increased.
Article
Handwashing has been recognized as a critical factor in infection control policies. Whereas handwashing compliance among health care workers and school-aged students has been previously documented, practices among college students remain relatively unknown. The objective of this study was to determine handwashing compliance of female college students after using the bathroom. A researcher situated in a toilet stall unobtrusively observed handwashing compliance among 100 female students. Most students (63%) washed their hands, 38% used soap, 32% washed with soap for 5 or more seconds, but only 2% washed their hands with soap for 10 or more seconds. Fewer students left without handwashing when someone else was present in the sink area (9%) than when they were alone (45%) (P =.002). Substantial bacterial colony counts were found on a female bathroom sink faucet and toilet seat confirming the need for programs to increase handwashing compliance. Potential strategies to optimize infection control include harnessing the influence of peer pressure on handwashing and the installation of motion-activated faucets, disposable seat covers, and exit doors that can be pushed open. These results should be confirmed in a larger study that includes both male and female college students.
Article
We set out to determine the impact of washing hands with soap on the risk of diarrhoeal diseases in the community with a systematic review with random effects meta-analysis. Our data sources were studies linking handwashing with diarrhoeal diseases. Seven intervention studies, six case-control, two cross-sectional, and two cohort studies were located from electronic databases, hand searching, and the authors' collections. The pooled relative risk of diarrhoeal disease associated with not washing hands from the intervention trials was 1.88 (95% CI 1.31-2.68), implying that handwashing could reduce diarrhoea risk by 47%. When all studies, when only those of high quality, and when only those studies specifically mentioning soap were pooled, risk reduction ranged from 42-44%. The risks of severe intestinal infections and of shigellosis were associated with reductions of 48% and 59%, respectively. In the absence of adequate mortality studies, we extrapolate the potential number of diarrhoea deaths that could be averted by handwashing at about a million (1.1 million, lower estimate 0.5 million, upper estimate 1.4 million). Results may be affected by the poor quality of many of the studies and may be inflated by publication bias. On current evidence, washing hands with soap can reduce the risk of diarrhoeal diseases by 42-47% and interventions to promote handwashing might save a million lives. More and better-designed trials are needed to measure the impact of washing hands on diarrhoea and acute respiratory infections in developing countries.
Article
Handwashing after using the restroom is generally poor across the population, and one common method used to increase the frequency of handwashing is to place signs reminding individuals to wash their hands. The current study examined the association between the absence and presence of signs reminding one to wash their hands and handwashing in public restrooms. Signs prompting handwashing behavior remind restroom patrons of acceptable behavior, and the presence of these signs is hypothesized to be associated with an increase in handwashing. Observation of 175 individuals (95 women and 80 men) using public restrooms on a university campus indicated that 61% of the women and 37% of the men observed washed their hands, e.g., washing hands with soap, in the absence of the sign, and 97% of the women and 35% of the men observed washed their hands in the presence of the sign. Further, 53% of the men and 38% of the women observed rinsed their hands, e.g., washing hands without soap, in the absence of the sign, and 55% of the men and 2% of the women observed rinsed their hands in the presence of the sign. Results are discussed in terms of possible factors associated with sex differences in handwashing and the absence and presence of visual prompts for handwashing behavior.
Article
Four hundred posters on passive smoking were placed on billboards in the streets of Geneva, Switzerland, for 2 weeks in 2001. We conducted a postal survey before and immediately after the campaign, in Geneva and Neuchatel. The Geneva sample (n = 834) was exposed to the campaign while the Neuchatel sample (n = 1121) acted as a control group. Following the poster campaign, 36% of respondents in Geneva reported having seen posters about smoking prevention, compared to 18% beforehand (P < 0.001). Corresponding figures in Neuchatel were 18% (after) and 13% (before). The difference in before-after change between the target and control groups was significant (P < 0.001). The poster had no effect on cigarette consumption or intention to quit. The poster was widely seen and remembered by the target audience, but the campaign was probably too short and isolated to have an impact on smoking behaviour.
Are Americans washing their hands? Retrieved from http://www.qsrmagazine.com/news/are-americans-washing- their-hands Thumma The association between hand washing practices and illness symptoms among college students living in a university dormitory
  • Qsr Magazine
  • J Aiello
  • A E Foxman
QSR Magazine. (2009). Are Americans washing their hands? Retrieved from http://www.qsrmagazine.com/news/are-americans-washing- their-hands Thumma, J., Aiello, A.E., & Foxman, B. (2008). The association between hand washing practices and illness symptoms among college students living in a university dormitory. American Journal of Infection Control, 37(1), 70–72.
Another U.S. airport travel hazard—dirty hands Retrieved from http://www.eurekalert. org/pub_releases/2003-09/asfm-aua091103 Limited impact of sustained simple feedback based on soap and paper towel consumption on the frequency of hand washing in an adult intensive care unit
  • M Rich
  • E Turner
  • P Arnold
American Society for Microbiology. (2003). Another U.S. airport travel hazard—dirty hands. Retrieved from http://www.eurekalert. org/pub_releases/2003-09/asfm-aua091103.php Bittner, M., Rich, E., Turner, P., & Arnold, W. (2002). Limited impact of sustained simple feedback based on soap and paper towel consumption on the frequency of hand washing in an adult intensive care unit. Infection Control Hospital Epidemiology, 23(3), 120–126.
Hand washing behavior of women in public restrooms
  • M C Hayes
Hayes, M.C. (2002). Hand washing behavior of women in public restrooms. Missouri Western State University. Retrieved from http:// clearinghouse.missouriwestern.edu/manuscripts/371.php
Hand washing: Clean hands save lives
Centers for Disease Control and Prevention. (2012). Hand washing: Clean hands save lives. Retrieved from http://www.cdc.gov/ handwashing/
Survey of hand washing behavior (trended): Prepared for the American Microbiology Society and the American Cleaning Institute
  • Harris Interactive
Harris Interactive. (2010). Survey of hand washing behavior (trended): Prepared for the American Microbiology Society and the American Cleaning Institute. Retrieved from http://www.microbeworld.org/ images/stories/washup/2010_handwashing_behavior_survey.pdf
Gender differences in hand washing behavior associated with visual behavior prompts
  • H D Johnson
  • D Sholoscky
  • K L Gabello
  • R V Ragni
  • N M Ogonosky
Johnson, H.D., Sholoscky, D., Gabello, K.L., Ragni, R.V., & Ogonosky, N.M. (2003). Gender differences in hand washing behavior associated with visual behavior prompts. Perceptual and Motor Skills, 97(3), 805-810.
Effect of an automated sink on hand washing practices and attitudes in high-risk units
  • E Larson
  • A Mcgeer
  • Z Quiaishi
Larson, E., McGeer, A., & Quiaishi, Z. (1991). Effect of an automated sink on hand washing practices and attitudes in high-risk units. Infection Control Hospital Epidemiology, 12(7), 422-428.
Touch contamination levels during anaesthetic procedures and their relationship to hand hygiene procedures: A clinical audit
  • A Merry
  • E Millder
  • G Findon
  • C Webster
  • S Neff
Merry, A., Millder, E., Findon, G., Webster, C., & Neff, S. (2001). Touch contamination levels during anaesthetic procedures and their relationship to hand hygiene procedures: A clinical audit. British Journal of Anaesthesia, 87(2), 291-294.
Are Americans washing their hands?
  • Qsr Magazine
QSR Magazine. (2009). Are Americans washing their hands? Retrieved from http://www.qsrmagazine.com/news/are-americans-washingtheir-hands