Article

Impact of a hygiene intervention on virus spread in an office building

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Abstract

Viral illnesses have a significant direct and indirect impact on the workplace that burdens employers with increased healthcare costs, low productivity, and absenteeism. Workers’ direct contact with each other and contaminated surfaces contributes to the spread of viruses at work. This study quantifies the impact of an office wellness intervention (OWI) to reduce viral load in the workplace. The OWI includes the use of a spray disinfectant on high-touch surfaces and providing workers with alcohol-based hand sanitizer gel and hand sanitizing wipes along with user instructions. Viral transmission was monitored by applying an MS2 phage tracer to a door handle and the hand of a single volunteer participant. At the same time, a placebo inoculum was applied to the hands of four additional volunteers. The purpose was to evaluate the concentration of viruses on workers’ hands and office surfaces before and after the OWI. Results showed that the OWI significantly reduced viable phage concentrations per surface area on participants’ hands, shared fomites, and personal fomites (p = 0.0001) with an 85.4% average reduction. Reduction of virus concentrations on hands and fomites is expected to subsequently minimize the risk of infections from common enteric and respiratory pathogens. The surfaces identified as most contaminated were the refrigerator, drawer handles and sink faucets in the break room, along with pushbar on the main exit of the building, and the soap dispensers in the women's restroom. A comparison of contamination in different locations within the office showed that the break room and women's restrooms were the sites with the highest tracer counts. Results of this study can be used to inform quantitative microbial risk assessment (QMRA) models aimed at defining the relationship between surface contamination, pathogen exposure and the probability of disease that contributes to high healthcare costs, absenteeism, presenteeism, and loss of productivity in the workplace.

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... A number of studies were conducted in laboratories simulating unrealistic washroom conditions, including drying of unwashed or gloved hands covered with model organism solutions (Best et al., 2014;Best and Redway, 2015). Eleven studies were assessed as good quality (Aithinne et al., 2019;Boone and Gerba, 2005;Inkinen et al., 2017;Knowlton et al., 2018;Margas et al., 2013;Mkrtchyan et al., 2013;Mohamed et al., 2015;Snelling et al., 2011;Suen et al., 2019;Verani et al., 2014;Zapka et al., 2011), 16 studies were assessed as fair quality (Boxman et al., 2009a;Breathnach et al., 2012;Carducci et al., 2016;Cooper et al., 2016;Flores et al., 2011;Gormley et al., 2017;Halabi et al., 2001;Harrison et al., 2003;Kanayama Katsuse et al., 2017;Katano et al., 2014;Kurgat et al., 2019;Patrick et al., 2010;Pitt et al., 2018;Sassi et al., 2018;Taylor et al., 2000;Tsunoda et al., 2019), and the remaining 11 studies were assessed as poor quality (Alharbi et al., 2016;Best et al., 2018;Best et al., 2014;Best and Redway, 2015;Best et al., 2012;Boxman et al., 2009a;Gerhardts et al., 2012;Huesca-Espitia et al., 2018;Kimmitt and Redway, 2016;Kouadri, 2020;Repp et al., 2013). ...
... Skin-associated bacteria were found to dominate on surfaces that are routinely touched by hands and unlikely to come into direct contact with other body parts or fluids, while toilet flush handles and seats were typically enriched in pathogens of faecal origin, and bacteria commonly associated with soil were more abundant on toilet floors (Flores et al., 2011). Commonly contaminated surfaces included soap dispensers (Kurgat et al., 2019;Mkrtchyan et al., 2013), while Norovirus, Human Adenovirus and a variety of bacteria including multidrug-resistant opportunistic pathogens (e.g. Pseudomonas aeruginosa) were also detected on toilet bowls, seats, lids, flushing buttons, and brushes in hospitals, restaurants and offices (Boxman et al., 2009b;Breathnach et al., 2012;Cooper et al., 2016;Mkrtchyan et al., 2013;Verani et al., 2014). ...
... Fourteen studies identified contact with contaminated surfaces as a potential route of transmission for infectious diseases associated with bacteria and viruses (Boone and Gerba, 2005;Breathnach et al., 2012;Flores et al., 2011;Gerhardts et al., 2012;Harrison et al., 2003;Huesca-Espitia et al., 2018;Inkinen et al., 2017;Kurgat et al., 2019;Margas et al., 2013;Patrick et al., 2010;Snelling et al., 2011;Suen et al., 2019;Tsunoda et al., 2019;Zapka et al., 2011) (Table 1). Studies varied from ambient microbiome analysis (e.g. ...
Article
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Background The risk of infectious disease transmission in public washrooms causes concern particularly in the context of the COVID-19 pandemic. This systematic review aims to assess the risk of transmission of viral or bacterial infections through inhalation, surface contact, and faecal-oral routes in public washrooms in healthcare and non-healthcare environments. Methods We systematically reviewed environmental sampling, laboratory, and epidemiological studies on viral and bacterial infection transmission in washrooms using PubMed and Scopus. The review focused on indoor, publicly accessible washrooms. Results Thirty-eight studies from 13 countries were identified, including 14 studies carried out in healthcare settings, 10 in laboratories or experimental chambers, and 14 studies in restaurants, workplaces, commercial and academic environments. Thirty-three studies involved surface sampling, 15 air sampling, 8 water sampling, and 5 studies were risk assessments or outbreak investigations. Infectious disease transmission was studied in relation with: (a) toilets with flushing mechanisms; (b) hand drying systems; and (c) water taps, sinks and drains. A wide range of enteric, skin and soil bacteria and enteric and respiratory viruses were identified in public washrooms, potentially posing a risk of infection transmission. Studies on COVID-19 transmission only examined washroom contamination in healthcare settings. Conclusion Open-lid toilet flushing, ineffective handwashing or hand drying, substandard or infrequent surface cleaning, blocked drains, and uncovered rubbish bins can result in widespread bacterial and/or viral contamination in washrooms. However, only a few cases of infectious diseases mostly related to faecal-oral transmission originating from washrooms in restaurants were reported. Although there is a risk of microbial aerosolisation from toilet flushing and the use of hand drying systems, we found no evidence of airborne transmission of enteric or respiratory pathogens, including COVID-19, in public washrooms. Appropriate hand hygiene, surface cleaning and disinfection, and washroom maintenance and ventilation are likely to minimise the risk of infectious disease transmission.
... To better address uncertainty and variability, a Monte Carlo approach is incorporated that represents inputs with probabilistic distributions and simulates several thousand scenarios of exposure, dose, and risk. Distributions representing human behavior and interactions with fomites are taken from relevant literature, and effects of interventions are obtained from a related office tracer study aimed at measuring virus reductions associated with surface disinfection and personal hand hygiene (Kurgat et al. 2019). ...
... Expected reductions of concentrations due to interventions originated from a three-arm MS-2 bacteriophage (ATCC 15597-B1) tracer study conducted in an office building with 80 active employees (Kurgat et al. 2019). A general description of three-arm studies can be found in Evans (Evans 2010), and details on our specific study design and methods can be found in Kurgat et al. (2019). ...
... Expected reductions of concentrations due to interventions originated from a three-arm MS-2 bacteriophage (ATCC 15597-B1) tracer study conducted in an office building with 80 active employees (Kurgat et al. 2019). A general description of three-arm studies can be found in Evans (Evans 2010), and details on our specific study design and methods can be found in Kurgat et al. (2019). MS2 phage has been shown to be a practical surrogate for human viruses due to similar shapes and sizes, and has been established as an effective surrogate for disinfection, transport, and survival of enteric and respiratory viruses (Reynolds et al. 2016, Sassi 2016, Sifuentes et al. 2017. ...
Article
Viral infections are an occupational health concern for office workers and employers. The objectives of this study were to estimate rotavirus, rhinovirus, and influenza A virus infection risks in an office setting and quantify infection risk reductions for two hygiene interventions. In the first intervention, research staff used an ethanol-based spray disinfectant to clean high-touch non-porous surfaces in a shared office space. The second intervention included surface disinfection and also provided workers with alcohol-based hand sanitizer gel and hand sanitizing wipes to promote hand hygiene. Expected changes in surface concentrations due to these interventions were calculated. Human exposure and dose were simulated using a validated, steady-state model incorporated into a Monte Carlo framework. Stochastic inputs representing human behavior, pathogen transfer efficiency, and pathogen fate were utilized, in addition to a mixed distribution that accounted for surface concentrations above and below a limit of detection. Dose-response curves were then used to estimate infection risk. Estimates of percent risk reduction using mean values from baseline and surface disinfection simulations for rotavirus, rhinovirus, and influenza A infection risk were 14.5%, 16.1%, and 32.9%, respectively. For interventions with both surface disinfection and the promotion of personal hand hygiene, reductions based on mean values of infection risk were 58.9%, 60.8%, and 87.8%, respectively. This study demonstrated that surface disinfection and the use of personal hand hygiene products can help decrease virus infection risk in communal offices. Additionally, a variance-based sensitivity analysis revealed a greater relative importance of surface concentrations, assumptions of relevant exposure routes, and inputs representing human behavior in estimating risk reductions.
... A number of studies were conducted in laboratories simulating unrealistic washroom conditions, including drying of unwashed or gloved hands covered with model organism solutions (Best et al., 2014;Best and Redway, 2015). Eleven studies were assessed as good quality (Aithinne et al., 2019;Boone and Gerba, 2005;Inkinen et al., 2017;Knowlton et al., 2018;Margas et al., 2013;Mkrtchyan et al., 2013;Mohamed et al., 2015;Snelling et al., 2011;Suen et al., 2019;Verani et al., 2014;Zapka et al., 2011), 16 studies were assessed as fair quality (Boxman et al., 2009a;Breathnach et al., 2012;Carducci et al., 2016;Cooper et al., 2016;Flores et al., 2011;Gormley et al., 2017;Halabi et al., 2001;Harrison et al., 2003;Kanayama Katsuse et al., 2017;Katano et al., 2014;Kurgat et al., 2019;Patrick et al., 2010;Pitt et al., 2018;Sassi et al., 2018;Taylor et al., 2000;Tsunoda et al., 2019), and the remaining 11 studies were assessed as poor quality (Alharbi et al., 2016;Best et al., 2018;Best et al., 2014;Best and Redway, 2015;Best et al., 2012;Boxman et al., 2009a;Gerhardts et al., 2012;Huesca-Espitia et al., 2018;Kimmitt and Redway, 2016;Kouadri, 2020;Repp et al., 2013). ...
... Skin-associated bacteria were found to dominate on surfaces that are routinely touched by hands and unlikely to come into direct contact with other body parts or fluids, while toilet flush handles and seats were typically enriched in pathogens of faecal origin, and bacteria commonly associated with soil were more abundant on toilet floors (Flores et al., 2011). Commonly contaminated surfaces included soap dispensers (Kurgat et al., 2019;Mkrtchyan et al., 2013), while Norovirus, Human Adenovirus and a variety of bacteria including multidrug-resistant opportunistic pathogens (e.g. Pseudomonas aeruginosa) were also detected on toilet bowls, seats, lids, flushing buttons, and brushes in hospitals, restaurants and offices (Boxman et al., 2009b;Breathnach et al., 2012;Cooper et al., 2016;Mkrtchyan et al., 2013;Verani et al., 2014). ...
... Fourteen studies identified contact with contaminated surfaces as a potential route of transmission for infectious diseases associated with bacteria and viruses (Boone and Gerba, 2005;Breathnach et al., 2012;Flores et al., 2011;Gerhardts et al., 2012;Harrison et al., 2003;Huesca-Espitia et al., 2018;Inkinen et al., 2017;Kurgat et al., 2019;Margas et al., 2013;Patrick et al., 2010;Snelling et al., 2011;Suen et al., 2019;Tsunoda et al., 2019;Zapka et al., 2011) (Table 1). Studies varied from ambient microbiome analysis (e.g. ...
... For example, one publication estimates that fomite transmission accounts for up to 85% of indoor transmission (9). Therefore, technologies and sanitation practices that limit fomite transmission can be a useful tool in combating many disease outbreaks (10,11). ...
... Virus samples were serially diluted in cold IM in 24-well plates. IBV was diluted 10,30,90,270,810,2430,7290, and 21870-fold; CoV 229E was diluted 3,9,27,81,243,729, and 2187-fold. Cell culture media was removed from the 96-well plates and cells were washed once with 100µL IM before 100µL diluted viruses were added. ...
Preprint
Full-text available
Spread of pathogens on contaminated surfaces plays a key role in disease transmission. Surface technologies that control pathogen transfer can help control fomite transmission and are of great interest to public health. Here, we report a novel bead transfer method for evaluating fomite transmission in common laboratory settings. We show that this method meets several important criteria for quantitative test methods, including reasonableness, relevancy, resemblance, responsiveness, and repeatability, and therefore may be adaptable for standardization. In addition, this method can be applied to a wide variety of pathogens including bacteria, phage, and human viruses. Using the bead transfer method, we demonstrate that an engineered micropattern limits transfer of Staphylococcus aureus by 97.8% and T4 bacteriophage by 93.0% on silicone surfaces. Furthermore, the micropattern significantly reduces transfer of influenza B virus and human coronavirus on silicone and polypropylene surfaces. Our results highlight the potential of using surface texture as a valuable new strategy in combating infectious diseases. Importance Disease transmission often occurs through contact with contaminated surfaces, called fomites. Efforts to reduce this method of fomite transmission include surface cleaning, personal hygiene, alteration of habits, and novel technologies to reduce pathogen spread. This manuscript presents a novel method for the consistent contamination of surfaces to mimic the transmission of pathogens via fomites. Using this method, we present a surface texture modeled on shark skin that significantly reduces the transfer of a variety of pathogens, including Staphylococcus aureus , influenza B virus, and human coronavirus 229E. Utilization of novel technologies to limit pathogen spread can enhance existing methods of disease mitigation.
... Frequent cleaning of surfaces with proper cleaning agents [30] and disinfection of hands with alcohol based sanitizers can reduce the transmission of pathogenic agents [31,32] at a greater of phage concentrations of 85.4% [33]. However, sanitizers are volatile chemicals and the effects are relatively short lived due to evaporation, so the best defense for to stop transmission of virus is to ensure public health hygiene and sanitation interventions, such as the use of soap, hand sanitizers, surface disinfectants, and behavior modifi cation [29,34]. ...
... Failure to clean HTSs near the patients on a daily basis was estimated to increase the MRSA transmitted to susceptible patients by approximately 120%. Similarly, in an office building, daily disinfection of highly-touched surfaces had the greatest impact on controlling the MS2 phage concentration on workers' hands, yielding an average reduction in phase concentrations of 41.7% [34], which means that noncompliance of daily disinfection of high-touch surface would lead to an 140% ([1-41.7%]/41.7% = 140%) increase of phage transmitted to workers. ...
Article
Full-text available
Background: An efficient surface cleaning strategy would first target cleaning to surfaces that make large contributions to the risk of infections. Methods: In this study, we used data from the literature about methicillin-resistant Staphylococcus aureus (MRSA) and developed an ordinary differential equations based mathematical model to quantify the impact of contact heterogeneity on MRSA transmission in a hypothetical 6-bed intensive care unit (ICU). The susceptible patients are divided into two types, these who are cared by the same nurse as the MRSA infected patient (Type 1) and these who are not (Type 2). Results: The results showed that the mean MRSA concentration on three kinds of susceptible patient nearby surfaces was significantly linearly associated with the hand-touch frequency (p < 0.05). The noncompliance of daily cleaning on patient nearby high-touch surfaces (HTSs) had the most impact on MRSA transmission. If the HTSs were not cleaned, the MRSA exposure to Type 1 and 2 susceptible patients would increase 118.4% (standard deviation (SD): 33.0%) and 115.4% (SD: 30.5%) respectively. The communal surfaces (CSs) had the least impact, if CSs were not cleaned, the MRSA exposure to Type 1 susceptible patient would only increase 1.7% (SD: 1.3). The impact of clinical equipment (CE) differed largely for two types of susceptible patients. If the CE was not cleaned, the exposure to Type 1 patients would only increase 8.4% (SD: 3.0%), while for Type 2 patients, it can increase 70.4% (SD: 25.4%). Conclusions: This study provided a framework to study the pathogen concentration dynamics on environmental surfaces and quantitatively showed the importance of cleaning patient nearby HTSs on controlling the nosocomial infection transmission via contact route.
... As examples, person-to-person transmission appears critical in this current pandemic, suggesting it is sensible to focus measures where individuals are close together, especially in enclosed spaces, while measures dealing with contamination should focus on widely shared items, such as door handles (e.g. Kurgat et al. 2019). Secondly, achieving broad consensus, for example on expected behaviour in shops would, no doubt, ease the adoption of measures: this is illustrated in the wide acceptance in many countries of rules for social distancing (2 metres, or 6 feet, in the UK). ...
Preprint
Full-text available
There is an immediate global need to reduce SARS-CoV-2 transmission, both in order to manage the ongoing pandemic and to assist with a phased transition to more normal societal conditions. We performed a solution scan to identify societal options for reducing SARS-CoV-2 transmission and spread. We read the literature, consulted experts in different fields, crowd-sourced options using social media, and collated comments on a preprint. Here, we present our current list of 313 possible measures. This list will help individuals, businesses and policy-makers consider a wide range of options to reduce SARS-CoV-2 transmission and spread when designing biosecurity plans. We have developed an online application to help with the initial steps in this process. We encourage testing actions and documenting outcomes, reviewing of the current list, and addition of further options.
... During an infectious disease outbreak, the workplace can play an important role in both spreading the disease [15,16] and helping to stop the spread of disease through workplace practices and policies [1,17]. Understanding the wide range of occupations that could be exposed to infection or disease due to work activities is important for planning risk management and communication to workers, in addition to prioritizing workplace response plans. ...
Article
Full-text available
Introduction With the global spread of COVID-19, there is a compelling public health interest in quantifying who is at increased risk of contracting disease. Occupational characteristics, such as interfacing with the public and being in close quarters with other workers, not only put workers at high risk for disease, but also make them a nexus of disease transmission to the community. This can further be exacerbated through presenteeism, the term used to describe the act of coming to work despite being symptomatic for disease. Quantifying the number of workers who are frequently exposed to infection and disease in the workplace, and understanding which occupational groups they represent, can help to prompt public health risk response and management for COVID-19 in the workplace, and subsequent infectious disease outbreaks. Methods To estimate the number of United States workers frequently exposed to infection and disease in the workplace, national employment data (by Standard Occupational Classification) maintained by the Bureau of Labor Statistics (BLS) was merged with a BLS O*NET survey measure reporting how frequently workers in each occupation are exposed to infection or disease at work. This allowed us to estimate the number of United States workers, across all occupations, exposed to disease or infection at work more than once a month. Results Based on our analyses, approximately 10% (14.4 M) of United States workers are employed in occupations where exposure to disease or infection occurs at least once per week. Approximately 18.4% (26.7 M) of all United States workers are employed in occupations where exposure to disease or infection occurs at least once per month. While the majority of exposed workers are employed in healthcare sectors, other occupational sectors also have high proportions of exposed workers. These include protective service occupations (e.g. police officers, correctional officers, firefighters), office and administrative support occupations (e.g. couriers and messengers, patient service representatives), education occupations (e.g. preschool and daycare teachers), community and social services occupations (community health workers, social workers, counselors), and even construction and extraction occupations (e.g. plumbers, septic tank installers, elevator repair). Conclusions The large number of persons employed in occupations with frequent exposure to infection and disease underscore the importance of all workplaces developing risk response plans for COVID-19. Given the proportion of the United States workforce exposed to disease or infection at work, this analysis also serves as an important reminder that the workplace is a key locus for public health interventions, which could protect both workers and the communities they serve.
... Ihre Verwendung finden sie hierbei bei der Desinfektion von Oberflächen, welche eine zentrale Rolle bei der Infektionsprävention mittels des Multibarrierensystems zwischen der unbelebten Umgebung und dem Patienten zuzuschreiben ist. Allerdings kann von diesen Systemen ebenso eine potentielle Gefährdung ausgehen [11][12][13][14][15][16]. Durch den Gebrauch kontaminierter Systeme können bestimmte Erreger selektiert und unbeabsichtigt in die Umgebung des Patienten eingebracht werden. ...
Article
Zusammenfassung Hintergrund Oberflächendesinfektion zählt zu den elementaren Maßnahmen der Infektionsprävention in Gesundheitseinrichtungen. Die hierfür heutzutage weit verbreiteten Tuchspendersysteme können jedoch aufgrund unterschiedlicher Ursachen mikrobiell kontaminiert sein und bei der Verbreitung von Krankheitserregern eine entscheidende Rolle spielen. Aus diesem Grund müssen diese Systeme sowohl in die routinemäßige Surveillance, als auch im Rahmen nosokomialer Ausbrüche als Infektionsquelle in Betracht gezogen werden. Methodik Die am Universitätsklinikum Leipzig (UKL) verwendeten Tuchspendersysteme wurden von 2016 bis 2018 flächendeckend gemäß der Empfehlung des Verbundes für Angewandte Hygiene (VAH) überprüft. Innerhalb dieses Zeitraums wurden insgesamt 1096 Desinfektionslösungen von Tuchspendersystemen analysiert. Die Bereiche ohne bzw. mit besonderem Infektionsrisiko waren hierbei gleichverteilt repräsentiert. Um die Möglichkeit einer Kontamination durch Dosiergeräte (DG) auszuschließen, wurden die hygienischen Prüfungen auf die 135 dezentral-betriebenen DGs am UKL erweitert. Ergebnisse Grundsätzlich konnte ein Rückgang von kontaminierten Desinfektionslösungen im gesamten Untersuchungszeitraum verzeichnet werden (2016: 31%; 2017: 18%; 2018: 8%). Jedoch wurden sowohl 2017, als auch 2018 mehr Kontaminationen in Bereichen mit besonderem Infektionsrisiko festgestellt. Gezielte Nachuntersuchungen nach Schulungsmaßnahmen im Umgang und Aufbereitung der Systeme ergaben einen Rückgang positiver Desinfektionslösungen auf Stationen mit erhöhten Nachweisen. Das mikrobielle Spektrum wurde von Achromobacter spp. (81%) dominiert, gefolgt von Pseudomonas spp. (10%), Vancomycin-resistente Enterokokken (VRE) (4%) und apathogenen Umwelterregern (5%). Die aus den Dosiergeräten (n=135) entnommenen Lösungen zeigten in 91,1% keinerlei Wachstum. In 8,2% wurden Bacillus spp. und in 0,7% Schimmelpilze nachgewiesen. Schlussfolgerung Als Ursache für die Erregernachweise in Tuchspendersystemen konnte eine Kontamination aus Dosiergeräten, als auch des hierfür verwendeten Trinkwassers ausgeschlossen werden. Es ist davon auszugehen, dass mangelnde Kenntnisse und ein falsches Sicherheitsgefühl beim Umgang mit Desinfektionsmitteln zu inkorrekter Handhabung von Tuchspendersystemen führen.
... In this study, surfaces found to be most contaminated were the refrigerator, drawer handles, sink faucets in the break room, the pushbar on the main exit to the building, communal computer station, desk chair arms and soap dispensers in the women's restrooms. 22 Screening for SARS-CoV-2 involves swabbing suspect items or surfaces and is based on the polymerase chain reaction (PCR) used to test clinical specimens like those from the back of the nose to diagnose people for COVID-19. The method is based on increasing the number of copies of a target gene in order to help determine if a particular DNA fragment is present. ...
... During COVID-19, essential workers, as indicated earlier, could easily become vectors and spread the virus throughout the workplace and beyond. The more protected these workplaces become, the less likely COVID-19 will spread all over the world [13,14]. ...
Article
Background: During the COVID-19 pandemic, it has been essential for some workplaces to stay open. Considering the rapid spread of the virus, interior architectural re-designing of these essential workplaces such as markets, banks, and drugstores is crucial for prevention. The employees, as well as the customers in these workplaces, have a high infection rate. Some precautions need to be taken urgently to prevent the spread of the disease. Some workplaces may have already performed their action plan whereas others have not. Objective: Some practical, rapid, and cost-efficient preventive precautions are presented in this paper for employers to take action in their workplaces. Methods: Two new proposals are advised to be carried out. The contents of these newly designed barriers will be introduced. Results: Some practical and cost-efficient ideas are given within this report. Conclusion: All the preventions proposed in this paper are claimed to reduce the spread of COVID-19 and may save lives around the country as well as the world.
... Research has shown that open-plan offices are associated with increased sick leave [34]. Furthermore, introducing viral material into an office leads to rapid spread to many surfaces, although strict hygiene protocols can significantly reduce transmission [35]. Depending on the relative magnitude of these two trends, demand for office space could either increase or decrease. ...
Article
Full-text available
Attitudes and habits are extremely resistant to change, but a disruption of the magnitude of the COVID-19 pandemic has the potential to bring long-term, massive societal changes. During the pandemic, people are being compelled to experience new ways of interacting, working, learning, shopping, traveling, and eating meals. Going forward, a critical question is whether these experiences will result in changed behaviors and preferences in the long term. This paper presents initial findings on the likelihood of long-term changes in telework, daily travel, restaurant patronage, and air travel based on survey data collected from adults in the United States in Spring 2020. These data suggest that a sizable fraction of the increase in telework and decreases in both business air travel and restaurant patronage are likely here to stay. As for daily travel modes, public transit may not fully recover its pre-pandemic ridership levels, but many of our respondents are planning to bike and walk more than they used to. These data reflect the responses of a sample that is higher income and more highly educated than the US population. The response of these particular groups to the COVID-19 pandemic is perhaps especially important to understand, however, because their consumption patterns give them a large influence on many sectors of the economy.
... This reduction was reduced to 42% when hand hygiene bundles and reminders were not provided. 133 Similar results have been attained with the implementation of a healthy workplace project, involving hand sanitizers, promotional signs, disinfecting wipes, facial tissues, and use instructions/information. 134 Viable particles of the SARS-CoV-2 virus can be detected for up to 72 h following colonization of plastic or stainless steel surfaces, 4 h on copper, and 8 h on cardboard. ...
Article
Full-text available
The single stranded RNA virus SARS-CoV-2 has caused a massive addition to the already leading global cause of mortality, viral respiratory tract infections. Characterized by and associated with early and deleteriously enhanced production of pro-inflammatory cytokines by respiratory epithelial cells, severe COVID-19 illness has the potential to inflict acute respiratory distress syndrome and even death. Due to the fast spreading nature of COVID-19 and the current lack of a vaccine or specific pharmaceutical treatments, understanding of viral pathogenesis, behavioral prophylaxis, and mitigation tactics are of great public health concern. This review article outlines the immune response to viral pathogens, and due to the novelty of COVID-19 and the large body of evidence suggesting the respiratory and immune benefits from regular moderate intensity exercise, provides observational and mechanistic evidence from research on other viral infections that suggests strategically planned exercise regimens may help reduce susceptibility to infection, while also mitigating severe immune responses to infection commonly associated with poor COVID-19 prognosis. We propose that regular moderate intensity exercise should be considered as part of a combinatorial approach including widespread hygiene initiatives, properly planned and well-executed social distancing policies, and use of efficacious facial coverings like N95 respirators. Studies discerning COVID-19 pathogenesis mechanisms, transfer dynamics, and individual responses to pharmaceutical and adjunct treatments are needed to reduce viral transmission and bring an end to the COVID-19 pandemic.
... For example, one publication estimates that fomite transmission accounts for up to 85% of indoor transmission [9]. Therefore, technologies and sanitation practices that limit fomite transmission can be a useful tool in combating many disease outbreaks [10,11]. while contributing to this study. ...
Article
Full-text available
Spread of pathogens on contaminated surfaces plays a key role in disease transmission. Surface technologies that control pathogen transfer can help control fomite transmission and are of great interest to public health. Here, we report a novel bead transfer method for evaluating fomite transmission in common laboratory settings. We show that this method meets several important criteria for quantitative test methods, including reasonableness, relevancy, resemblance, responsiveness, and repeatability, and therefore may be adaptable for standardization. In addition, this method can be applied to a wide variety of pathogens including bacteria, phage, and human viruses. Using the bead transfer method, we demonstrate that an engineered micropattern limits transfer of Staphylococcus aureus by 97.8% and T4 bacteriophage by 93.0% on silicone surfaces. Furthermore, the micropattern significantly reduces transfer of influenza B virus and human coronavirus on silicone and polypropylene surfaces. Our results highlight the potential of using surface texture as a valuable new strategy in combating infectious diseases.
... The workplace is an important source of potential transmission and, as such, can play a crucial role in containing the spread of an infectious disease outbreak. 17,18 Most (75%) US workers are employed in occupations that cannot be done at home. The continuing need for health care, manufacturing, retail, and food services puts approximately 108.4 million workers at increased risk for adverse health outcomes related to working during a pandemic. ...
Article
The coronavirus disease-2019 (COVID-19) pandemic is having a widespread impact on societies across the globe. As part of the effort to control transmission in the United States, many businesses either closed or instituted nonpharmaceutical control measures and allowed only essential workers on-site. During summer and fall of 2020, employers began formulating "return to work" strategies designed to mitigate the risk of transmission among employees. On a population level, several countries implemented national testing and surveillance strategies that proved effective in mitigating citizen-to-citizen transmission and contributed to suppressing COVID-19. A crucial component of many such strategies is population-based testing to identify and engage individuals with asymptomatic or presymptomatic infection, which also is relevant to return-to-work strategies. The authors describe an approach that multisite employers might use to help mitigate transmission of COVID-19 in the workplace. This approach leverages a bioinformatics platform informed by real-time PCR test data at the county and subcounty (eg, Public Use Microdata Area) level, allowing for population-based testing to be selectively targeted for employees in geographies with elevated SARS-CoV-2 positivity. A "Command Center" application integrates data from multiple sources (eg, local infection trends, employee symptom diaries, Bluetooth thermometers) in real time, which can be used to inform decisions regarding surveillance and employee self-isolation or quarantine; a mobile phone-based application provides for rapid, secure communication with employees. This overview is based on peer-reviewed literature and the early experience of a large employer with implementing bioinformatics tools to mitigate the impact of the pandemic on the workplace.
... Una de las vías más comunes de transmisión de las enfermedades infecciosas, se da por medio del contacto con un ambiente expuesto a estos microorganismos infecciosos, como lo son los espacios físicos, personas, superficies, animales, suelos, entre otros (1). En estos "reservorios", los microorganismos (bacterias, hongos y virus principalmente), pueden propagarse por medio de adhesión a partículas microscópicas del polvo del aire, también, pueden propagarse por contacto directo con aerosoles de personas infectadas al toser y estornudar, o indirectamente de superficies contaminadas donde se han suspendido partículas infecciosas, por lo tanto, para los agentes infecciosos es fácil trasladarse y suspenderse en ambientes orgánicos e inorgánicos (9,19). En los reservorios de infección, los agentes infecciosos encuentran condiciones que le permiten sobrevivir y multiplicarse y desde donde puede transmitirse a un hospedero susceptible (1). ...
Research
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Una de las vías más comunes de transmisión de las enfermedades infecciosas es por medio de reservorios de infección. Los sistemas de transporte pueden actuar como reservorios potenciales de patógenos, los reportados con mayor frecuencia en superficies de transportes públicos son Escherichia coli, Staphylococcus aureus, S. coagulasa negativo, Klebsiella spp. y Pseudomonas aeruginosas. El objetivo de este estudio fue establecer la prevalencia bacteriana en superficies táctiles dentro de los autobuses municipales de Chía-Cundinamarca. Se colectaron y analizaron 150 muestras de tres superficies en contacto con las manos: barra, agarre de las sillas y agarre de la ventana de cincuenta autobuses; la colección de la muestra se llevó a cabo por medio de frotis en las superficies. Para la identificación de los microorganismos se implementó tinción de gram y pruebas bioquímicas. Se realizaron antibiogramas con Ceftriaxona, Gentamicina, Azitromicina, Ciprofloxacina. De las muestras aisladas se obtuvo el 33 % Staphylococcus aureus, el 16 % Staphylococcus CN, 14 % Enterobacter, 9 % Shigella spp., Klebsiella spp., 7 % Pseudomonas spp., 15 % Bacillus spp., 0,6 % Proteus spp., Cedecea spp, Tatumella spp., 0,9 % Citrobacter spp., Enterococcus y 0,3 % Streptococcus spp. Se observó mayor prevalencia de bacterias en las muestras tomadas de las barras. En la prueba de sensibilidad, los bacilos gram negativos presentaron una resistencia del 95 % a los antibióticos evaluados, los cocos gram positivos presentaron un 88 % de resistencia y los bacilos gram positivos presentaron un 100% de resistencia a los antibióticos probados. La presencia de los géneros Klebsiella, Enterobacter, Citrobacter y Proteus y casi el 50 % de los aislamientos de bacterias sugieren que los malos hábitos.
... Although users often believe flush handles are the dirtiest touch point in a restroom, sink areas are usually more germ-laden, as this is where bacteria are shed from hands during washing (Lozier, 2016). This was further studied by Kurgat et al. (2019) that showed in an office building the most contaminated areas of the building were the refrigerator, drawer handles, sink faucets, the push bar on the main exit of the building, and the soap dispensers in the women's restroom. ...
Conference Paper
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Owners who are pursing the construction of new commercial and healthcare buildings are very interested in the sustainability, energy efficiency, life cycle costs and cleanliness of their proposed projects. Owners are requiring designers and construction companies to develop innovative strategies to lower their utility use and total cost in their projects. One area of opportunity to meet this owner need is the decision to use either battery-powered or hardwired restroom faucets. Several construction projects of various types and locations were analyzed to determine the total cost of ownership of both types of faucets over a 12-year and 25-year timeframe. The results of the unit cost calculation showed that the battery-powered faucets had a lower cost of ownership at 12 years, while hardwired fixtures installed in intervals of six had the lower cost of ownership over 25 years. Although, when researching actual construction projects, where installation of multipleTo faucets in a row isn't realistic, battery-powered faucets had the lower cost of ownership over the hardwired options in both the 12-year and 25-year timeframes in all building types.
... However, for other pathogens, and hygiene in general, smear infection can be a major means of transmission. Kurgat et al. [11] showed in their study that an hygiene intervention can lead to a significant reduction of pathogen concentrations on surfaces in an office building. In a study by Koch et al. [10] participants watched cooking videos, which differed in the hygiene behavior of the chef depending on the tested condition. ...
Chapter
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Several times a day, we touch our faces and all kinds of surfaces, and often we are not even aware that pathogens are transported via surfaces and our hands. There are already a large number of educational or governmental videos that aim to raise people’s awareness towards health and hygienic behavior, but whether videos simulating the spread of pathogens can really influence people’s behavior and awareness has not been investigated yet. Using a virtual copy of a students’ office room and spatial visualizations of touched surfaces, our approach visually simulates the spread of pathogens of smear infections. In a user study, we show videos with or without visualizations of potentially contaminated surfaces in a students’ office room to participants, and afterwards ask them to describe their own potential subsequent behavior when entering the same room. In addition to open questions, we also use the PPQ to investigate the persuasive potential of our approach. With this approach we investigate the impact of the visualization of potentially contaminated surfaces on people’s behavior and hygiene-oriented attitude. While our results did not reveal a significant effect on the consideration of behavior change assessed by a questionnaire, the participants’ descriptions in the qualitative part of the study show more hygiene-oriented behavior descriptions in the visualization conditions.
... It is therefore important to assess the frequency and characteristics of HEC to identify the degree of exposure and infection risk through this route. In recent years, there has been increasing research on environmental contamination with microorganisms and hand contact with the environment [15][16][17]. However, few studies have been conducted in Korea about HEC in daily life. ...
Article
Objectives: The aim of this study was to describe the characteristics of hand-to-environmental contact (HEC) and to identify the factors influencing HEC behavior in Korean adults' indoor daily life. Methods: Thirty participants were enrolled from January 14 to February 12, 2018 after providing informed consent for being videotaped. Data were collected by recording their indoor daily lives for 2 hours, resulting in 4,732 HEC cases. To ensure the accuracy and reliability of the HEC readings, 3 training sessions were conducted for the videotape readers. Rereading and verifying randomly selected data ensured the validity of intra- and inter-reader readings. Results: The most frequent contact items were phones, papers, computer accessories, and furniture surfaces. The contact density (frequency-duration/min) was highest for category II (items occasionally shared by others, 56.8), followed in descending order by category I (items for individual use, 35.9), and category III (public use items, 3.4). Significant differences in contact density were found according to participants' demographic characteristics. Conclusion: As mobile phones were the most frequent contact item, regular and strict mobile phone cleansing or disinfection strategies are needed, in addition to preventative measures taken for category II and III items. Avoiding sharing personal items with others, refraining from unnecessary HEC, and maintaining strict hand hygiene are recommended.
... Identifying and understanding factors that affect racial disparities in COVID-19 infection rates would help focus efforts to reduce the disproportional impact of the pandemic on certain groups. Work-related exposures are one of the major risk factors in the spread of infectious diseases [11,[13][14][15] such as COVID- 19. For instance, Koh [16] indicated that "COVID-19 is the first new occupational disease to be described in this decade." ...
Article
Background Nationwide, as of 20 June 2021, COVID-19 has claimed more than 599,000 lives and infected nearly 33 million people. Studies have shown that COVID-19 disproportionately affects some racial and ethnic minority groups. This study examined whether certain racial and ethnic groups were overrepresented in occupations with potentially high COVID-19 exposure risks, relative to their share in the total workforce. The study incorporates white collar workers, who to date have not gotten as much attention in terms of workers safety.Methods Using the March and April 2020 Current Population Survey and O*Net data, this study examined whether certain racial and ethnic groups were overrepresented in occupations with potentially high risk of exposure to COVID-19 (exposure to disease and infection at work, inability to maintain physical distancing at work, and inability to work from home) relative to their share in the total workforce.ResultsThe results showed that Black workers were overrepresented in occupations with high potential risk of exposure to disease and infection at work and inability to maintain physical distancing at work. Hispanic workers were overrepresented in occupations where potential risk of inability to work from home was the highest.Conclusion Occupation can be one of the risk factors for the current disproportionately high COVID-19 infection rates among Black and Hispanic workers. COVID-19-related prevention measures at high risk occupations, including providing adequate personal protective equipment, training, working space, and vaccinations, could help to reduce not only the spread of COVID-19 and infectious diseases but also their disproportionately high impact in certain minority racial and ethnic groups.
... doorknobs, refrigerator handles, dishcloths, faucets) or facilitate virus transmission through other uses (e.g. airducts, hospital linen) [3][4][5][6][7][8][9][10][11]. Personal protection equipment such as rubber gloves, N95 particulate respirators, surgical masks, gowns may also act as fomites for viral cross-infection [12]. ...
Article
Adhesion of two viruses – one enveloped (human respiratory syncytial virus, HRSV) and one non-enveloped (human adenovirus 5, HAdV5) – to four fomites (silica, nylon, stainless steel, polypropylene) was quantified and interpreted based on physicochemical properties of viruses and fomites. The selected fomites are tentatively identified as “archetypes” representing groups of materials distinctly different in mechanisms of their interfacial interactions. The surfaces are typified on the basis of their surface energy components including the dispersive (Lifshitz-van der Waals) component and two polar (electron donor and electron acceptor) components. Virus-fomite interactions are predicted using the extended Derjaguin-Landau-Verwey-Overbeek (XDLVO) theory and are experimentally assessed in tests with quartz crystal microbalance with dissipation (QCM-D). Polar interactions (manifested as hydrophobic attraction for all virus-fomite pairs but HAdV5/silica) governed virus attachment to fomites from a solution of high ionic strength typical for a respiratory fluid, while dispersive interactions played a relatively minor role. For both HAdV5 and HRSV, the areal mass density of deposited viruses correlated with the free energy of virus-fomite interfacial interaction in water, ΔGvwf. The dependence of virus-fomite attachment probability on ΔGvwf collapsed into one trend for both HAdV5 and HRSV pointing to the possibility of using ΔGvwf as a predictor of virus adhesion. Fomite rinsing with DI water resulted in a partial virus removal attributable to longer range repulsive electrostatic interactions. The proposed methodology can guide screening and selection of materials that discourage virus adhesion. The information on the efficiency of virus attachment to materials as a function of their surface energy components can help design anti-adhesive surfaces, develop surface cleaning solutions and protocols, and inform transport and fate models for viruses in indoor environments.
... On top of that, whether workers work in a factory or plush office chamber, their exposure to infection hazards also put their family members and coworkers at risk [83]. Considering how infected workers can quickly spread pandemic viruses to their urban residential centers, the workplace must have protective layers to protect workers from virus transmission [84]. ...
Article
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The COVID-19 pandemic has affected human life in every possible way and, alongside this, the need has been felt that office buildings and workplaces must have protective and preventive layers against COVID-19 transmission so that a smooth transition from ‘work from home’ to ‘work from office’ is possible. However, a comprehensive understanding of how the protective environment can be built around office buildings and workspaces, based on the year-long experience of living with COVID-19, is largely absent. The present study reviews international agency regulation, country regulation, updated journal articles, etc., to critically understand lessons learned from the COVID-19 pandemic and evaluate the expected changes in sustainability requirements of office buildings and workplaces. The built environment, control environment, and regulatory environment around office buildings and workplaces have been put under test on safety grounds during the pandemic. Workers switched over to safely work from home. Our findings bring out the changes required to be affected in the three broad environmental dimensions to limit their vulnerability status experienced during the pandemic. Office building designs should be fundamentally oriented to provide certain safety protective measures to the workers, such as touch-free technologies, open working layouts, and workplace flexibilities to diminish the probability of getting infected. Engineering and administrative control mechanisms should work in a complementary way to eliminate the risk of disease spread. Country regulation, agency regulations, and operational guidelines need to bring behavioral changes required to protect workers from the COVID-19 pandemic.
... En del illustrativa forskningsstudier har också gjorts kring hur människor genom beröring förflyttar virus och bakterier i inomhusmiljöer Gerba, 2007, Reynolds et al., 2019). Exempelvis finns försök där forskare har placerat ett simuliämne (typiskt en bakteriofagalltså ett virus som angriper bakterier) på ett dörrhandtag till en arbetsplats eller ett sjukhus (Kurgat et al., 2019). Någon timme senare har de tagit ytprover från handtag, muggar, kopieringsapparater och andra ytor runt om i byggnaden. ...
Article
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Att spridning av sjukdomsframkallande luftvägsvirus kostar samhället enorma resurser har blivit uppenbart för alla under covid-19, men ovälkomna virus har varit människans följeslagare genom hela historien och ständigt uppkommer nya varianter med särskilt hög smittsamhet eller dödlighet. Riskerna har ökat med befolkningstillväxt och globalisering. Samtidigt har våra förutsättningar att skydda oss också blivit bättre genom ökad kunskap och framsteg inom medicin och teknik. Syftet med denna kunskapssammanställning är att beskriva smittvägar, riskfaktorer och skyddsåtgärder för infektiös luftvägssjukdom och därmed bidra till en minskad smittrisk vid arbetsplatser. Mycket av innehållet bygger på forskning om influensa och covid-19, men även en rad andra luftvägsinfektioner är inkluderade. Spridning av virus har här delats upp i tre smittvägar: inandning, direkt deponering och kontakt. Risken för smitta via inandning av virus är särskilt stor när avstånden mellan människor är korta och uppehållstiden lång i lokaler med dålig ventilation. Risken ökar om det också pågår aktiviteter som innebär spridning av virusinnehållande aerosolpartiklar till luften, såsom högt tal eller sång eller vissa medicinska procedurer, eller om den inandade luftmängden är förhöjd, som vid tungt arbete. Virusöverföring via direkt deponering sker när stora smittbärande droppar stänker direkt på en mottagare vid exempelvis hosta. Virusspridning via både inandning och direkt deponering sker på olika sätt genom luften, men benämns här inte ”luftsmitta” eftersom detta begrepp åtminstone enligt klassisk medicinsk indelning syftat på (effektiv) smitta via inandning över avstånd mer än enstaka meter och eftersom det främst använts för sjukdomar som är mycket allvarliga och därför kräver extrema skyddsåtgärder. Smitta via kontakt kan ske antingen via direkt beröring eller genom mellanled, som handtag eller andra ytor. Samtliga tre smittvägar är välbelagda för luftvägsvirus i den vetenskapliga litteraturen, men deras relativa betydelse varierar beroende situation, virustyp och interventioner för att minska smitta. För covid-19 pekar mycket forskning mot att inandning är en dominerande smittväg i många miljöer. Vissa yrkesgrupper, särskilt inom vårdsektorn, löper en förhöjd risk att smittas av luftvägsvirus. En lång rad skyddsåtgärder finns tillgängliga för att på olika sätt minska smittrisker: distans, hygien, fysiska barriärer, ventilation, administrativa åtgärder (exempelvis information, regleringar, kontroller, checklistor) och personlig skyddsutrustning. De flesta av dessa åtgärder har starkt stöd av vetenskapliga studier.
... Some of the study participants also stated that some of the workforce took advantages of the current situation and pretended to be ill in order to take advantages of the two-week quarantine opportunity, and this led to the hard diagnosis of sick employees from non-patient ones; then, both direct and indirect costs are imposed on the company (20). ...
Preprint
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Background: Workplaces play a highly important role in controlling or spreading the prevalence of COVID-19. Therefore, the lack of proper implementation of hygienic protocols in theses environments might increase the risk of getting infected with the COVID-19 among the employees, following the increase of the COVID-19 in the family and community levels. This qualitative study was aimed to explain the challenges of coping with coronavirus crisis in the workplaces. Methods: The present qualitative study was conducted with a conventional content analysis approach. We used the purposeful sampling with maximum diversity in terms of working processes. Data were collected through semi-structured interviews. Interviews were performed to the point of information saturation. MAXQDA software version 10 was used for data management. Results: Through the content analysis of the interviews with the participants, we identified 2 main classes and 9 sub-classes. The main classes included problems and limitations related to the intra-organizational factors (job nature, budget allocation problems, individual factors, disorganization, manpower and equipment, and Lack of commitment and insufficient support of managers) and extra-organizational factors (lack of accessibility to valid information, black market, and inter-sectorial coordination problems). Conclusion: The study findings indicated that organizations and industries face numerous internal and external challenges in coping with the COVID-19 pandemic. Paying attention to the mentioned limitations and attempting to eliminate them; especially, by the governmental organizations, employers, and managers could help in effective confronting the COVID-19 pandemic.
... For example, medical staff and other workers in nursing homes could trigger mass COVID-19 infections as they commute, while hospitalized patients pose relatively lower risks of virus transmission because they are tested before admission. During an infectious disease outbreak, workplaces can play an important role in both spreading the disease [11,12] and helping to halt the spread of disease through proper workplace practices and policies [4,13]. All countries have a General Duty Clause in their regulations, stipulating that employers have an obligation to provide an environment free from recognized hazards that can cause or are likely to cause death or serious harm to their employees (Table 4). ...
Article
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The types of workplaces and occupations with coronavirus 2019 (COVID-19) clusters vary between countries and periods. We aimed to characterize major occupational groups with mass outbreaks of COVID-19 infections in several Asia-Pacific countries. Data on the major occupations or workplaces reporting COVID-19 cases in workplaces from January 2020 to July 2021 was collected from industrial hygiene professionals in nine countries. The proportion of workers accounted for 39.1 to 56.6% of the population in each country. The number of workers covered in the national statistics varies among nations based on their definition of a worker. None of the countries examined here have systematically collected occupational data on COVID-19 illnesses and deaths classified by type of industry, occupation, or job. Most countries experienced COVID-19 clusters among health and social care workers (HSCW) in hospitals or long-term care facilities. The types of occupations or workplaces with virus clusters in some participating countries included prisons, call centers, workplaces employing immigrants, garment facilities, grocery stores, and the military, which differed among countries, except for a few common occupations such as HSCW and those populated by immigrants. Further study is necessary in order to seek ways to control infection risks, including revisions to industrial-health-related laws.
... The checklist was developed based on initial assumptions (as of April 2020) of how SARS-CoV-2 spreads (Centers for Disease Control and Prevention 2020), industrial hygiene guidance on how to prevent spread of biologic hazards in workplaces (U.S. Department of Labor Occupational Safety and Health Administration 2007; Ahmed et al. 2018;Kurgat et al. 2019;Su et al. 2019), and guidance from occupational health agencies about how to keep workers safe during COVID-19 (Washington State Department of Labor and Industries 2020). The full checklist can be found in Appendix A (Supplementary material) and includes questions on the presence or absence of controls such as physical barriers, social distancing markers, masking of customers, and closures of store areas. ...
Article
Utilizing a longitudinal, observational study, grocery store health and safety controls implemented during the COVID-19 pandemic across stores in two cities were characterized. Sixteen stores between Seattle, WA (n = 9) and Portland, OR (n = 7) were visited monthly by the study team from May 2020 to January 2021, and observations of controls were recorded using a standardized checklist in REDCap. The checklist included questions on the presence or absence of controls such as physical barriers, social distancing markers, required masking of customers, cleaning of check-out stands, closures of store areas. Descriptive analyses were conducted to determine the proportion of stores with a certain control each month. Mixed effects logistic regression was used to explore how controls changed over time, and whether differences were observed between cities or by income of the area the store serves. Source control (e.g., mask requirements) and engineering controls (e.g., physical barriers at checkout) were the most common and consistent controls observed across stores and over the study period. Controls such having special hours for vulnerable populations, demarcations on aisles for directionality, and cleaning check-out stands between customers varied significantly over time (p < 0.05 in mixed effects model). Having an employee present to clean baskets and carts, and physical barriers between self-checkouts were significantly more common in stores in areas above the median income (p < 0.05 in mixed effects model). To best protect workers and shoppers from infectious agents, controls should be evidence-based, consistently implemented across grocery stores, and coupled with administrative practices and policies to promote worker wellbeing.
... In another study in Singapore, of 25 first reported cases of coronavirus, 17 cases were infected during occupational exposures (Koh, 2020). Such findings highlight the key role of workplace as a spread venue of diseases during a pandemic (Danovaro-Holliday et al., 2000;Kurgat et al., 2019). Nevertheless, by implementing sanitary practices and policies in the workplace such as public announcements, upgrading of automation systems for teleworking (Morawska et al., 2020;Zhou et al., 2020), and also providing preventive actions instructions and personal protection, the chain of infection among the staffs can be broken (Belingheri et al., 2020;Edwards et al., 2016;Kumar et al., 2013;World Health Organization (WHO), 2020) However, resuming businesses could be challenging because of increased costs of providing a safe workplace (Zhou et al., 2020). ...
Article
According to the health regulations, industrial environments due to the gathering of people are considered as one of the highest-risk places during the COVID-19 pandemic. Thus, planning with regard to health concerns can decisively help in infection control and continuity of businesses during the pandemic. The aim of this study was to evaluate the COVID-19 control management measures in the Sepid-farab Kavir Steel Complex (SKS complex) located in Isfahan province (Iran) using strengths, weaknesses, opportunities, and threats (SWOT) matrix. After a literature review and field surveys, all weak, strong, threatening, and opportunity points were collected and were listed using the internal factor evaluation (IFE) and external factor evaluation (EFE) matrices and then were prioritized and weighted. Next, given the sum of scores of IFE and EFE, the SWOT matrix was constructed, the disease prevention and control strategies in the complex was determined, and finally, experts proposed corrective measures to improve the current situation. The results of the IFE matrix (IFE) analysis showed that in terms of corona control, there are more weaknesses than strengths within the company (the score of this matrix was 201.12). Also the score of 165 on the EFE matrix indicated that external threats were predominant, compared to external opportunities of company. SWOT analysis showed that despite some external problems and challenges, the existence of a favorable internal decision-making system had an important role in developing appropriate health strategies and implementing effective prevention measures in SKS complex against the COVID-19.
Article
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Background: Despite the lack of official COVID-19 statistics, various workplaces and occupations have been at the centre of COVID-19 outbreaks. We aimed to compare legal measures and governance established for managing COVID-19 infection risks at workplaces in nine Asia and Pacific countries and to recommend key administrative measures. Methods: We collected information on legal measures and governance both general citizens and workers regarding infection risks such as COVID-19 from industrial hygiene professionals in nine countries (Indonesia, India, Japan, Malaysia, New Zealand, Republic of the Philippines, Republic of Korea, Taiwan, and Thailand) using a structured questionnaire. Results: A governmental body overseeing public health and welfare was in charge of containing the spread and occurrence of infectious diseases under an infectious disease control and prevention act or another special act, although the name of the pertinent organizations and legislation vary among countries. Unlike in the case of other traditional hazards, there have been no specific articles or clauses describing the means of mitigating virus risk in the workplace that are legally required of employers, making it difficult to define the responsibilities of the employer. Each country maintains own legal systems regarding access to the duration, administration, and financing of paid sick leave. Many workers may not have access to paid sick leave even if it is legally guaranteed. Conclusion: Specific legal measures to manage infectious disease risks, such as providing proper personal protective equipment, education, engineering control measures, and paid sick leave are recommended to be stipulated in occupational safety and health related acts.
Article
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Societal biosecurity, measures built into everyday society to minimize risks from pests and diseases, is an important aspect of managing epidemics and pandemics. We aimed to identify societal options for reducing the transmission and spread of respiratory viruses. We used SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) as a case study to meet the immediate need to manage the COVID-19 pandemic and eventually transition to more normal societal conditions, and to catalog options for managing similar pandemics in the future. We used a ‘solution scanning’ approach. We read the literature; consulted psychology, public health, medical, and solution scanning experts; crowd-sourced options using social media; and collated comments on a preprint. Here, we present a list of 517 possible measures to reduce SARS-CoV-2 transmission and spread. We provide a long list of options for policymakers and businesses to consider when designing biosecurity plans to combat SARS-CoV-2 and similar pathogens in the future. We also developed an online application to help with this process. We encourage testing of actions, documentation of outcomes, revisions to the current list, and the addition of further options.
Article
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This is document that supports national (Ministry of Health of Paraguay) and international guidelines on respiratory protection measures during the COVID-19 pandemic. A narrative review discusses modes of transmission of SARS-Cov-2, universal respiratory protection measures and their key components, use of personal protective equipment, protection levels and what to do in case of exposure. It also describes concepts relating to the scarcity and reallocation of resources, and finally describes the preliminary report of a open clinical trial about teching biosafety issues, carry out in 9 hospitals from Paraguay.
Technical Report
In the context of the COVID-19 Pandemic, Paraguay is still holding back the onslaught, at the time of writing. This narrative review consists of a supplement to the recommendations given by the Ministry of Health of our country, on respiratory protection measures in hospital settings. (Sociedad Paraguaya Neumologia y Programa Nacional de Control del Tabaquismo y de Enfermedades Respiratorias Crónicas)
Article
The persistence of SARS-CoV-2 or its RNA on surfaces, points, or wastewaters may increase the risk of transmission of this virus. Therefore, we conducted this review to discuss the places and surfaces with the highest potential for infection and spread of the SARS-CoV-2 virus. Several common and public areas, hospitals, elevators, public transport, local markets, and surfaces such as public toilets, door handles, untreated and treated wastewaters, wastewater plants, and public washrooms are also considered major points for spreading of SARS-CoV-2. Highly contaminated surfaces or places often have materials or contain items made of materials on which the SARS-CoV-2 virus can persist (e.g., metal, wood, and plastic). For example, SARS-CoV-2 can exist up to 4 days on doorknobs made by those materials. For public places such as public transports, elevators, and local markets, crowding and enclosed spaces are major source for transmission. Several measures such as using copper alloy surfaces instead of metal surfaces, disinfectants, and suitable personal protective equipment have been suggested. Our research could be the basis to help develop studies on the existence and transmissibility of SARS-CoV-2 as well as its RNA to take measures to prevent and limit the harmful effects of COVID-19 pandemic.
Research
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It is proven that visible light (VIS) produces a photodynamic microbicidal effect that determines the eradication of bacteria and viruses, particularly with peak wavelengths in the absorption spectrum band of porphyrin molecules found within microbial cells. By exciting these endogenous porphyrins it is possible to generate Reactive Oxygen Species (ROS) for photolithotrophic and photoorganotrophic reactions, or Reactive Metal Species (RMS) for autotrophy. In both cases, oxidative damage to the microbial cell membrane occurs and, therefore, its death. While studies have always focused on single wavelengths of the visible spectrum and their action on bacteria, particularly at 405nm, a recent technique that uses LED irradiation with a combination of multiple interfering waves of the visible spectrum and with main peak in the 400-420nm range, has shown wide efficacy on both bacteria and viruses, including, for the first time, its ability to inactivate SARS-CoV-2 [70]. In this work, we examine what reactions may occur in microorganisms when they are irradiated with a flux of photons consisting of multiple combined wavelengths. We do so by investigating some selected mechanisms that, through the irradiation of visible light, can contribute to the eradication process of bacteria and viruses.
Article
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Objective: The aim of this study was to determine the efficacy of a multimodal hand hygiene intervention program in reducing health care insurance claims for hygiene preventable infections (eg, cold and influenza), absenteeism, and subjective impact on employees. Methods: A 13.5-month prospective, randomized cluster controlled trial was executed with alcohol-based hand sanitizer in strategic workplace locations and personal use (intervention group) and brief hand hygiene education (both groups). Four years of retrospective data were collected for all participants. Results: Hygiene-preventable health care claims were significantly reduced in the intervention group by over 20% (P < 0.05). Absenteeism was positively impacted overall for the intervention group. Employee survey data showed significant improvements in hand hygiene behavior and perception of company concern for employee well-being. Conclusion: Providing a comprehensive, targeted, yet simple to execute hand hygiene program significantly reduced the incidence of health care claims and increased employee workplace satisfaction.
Article
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Background: Knowledge about influenza transmission in the workplace and whether staying home from work when experiencing influenza-like illness can reduce the spread of influenza is crucial for the design of efficient public health initiatives. Aim: This review synthesizes current literature on sickness presenteeism and influenza transmission in the workplace and provides an overview of sick leave recommendations in Europe for influenza. Methods: A search was performed on Medline, Embase, PsychINFO, Cinahl, Web of Science, Scopus and SweMed to identify studies related to workplace contacts, -transmission, -interventions and compliance with recommendations to take sick leave. A web-based survey on national recommendations and policies for sick leave during influenza was issued to 31 European countries. Results: Twenty-two articles (9 surveys; 13 modelling articles) were eligible for this review. Results from social mixing studies suggest that 20-25% of weekly contacts are made in the workplace, while modelling studies suggest that on average 16% (range 9-33%) of influenza transmission occurs in the workplace. The effectiveness of interventions to reduce workplace presenteeism is largely unknown. Finally, estimates from studies reporting expected compliance with sick leave recommendations ranged from 71 to 95%. Overall, 18 countries participated in the survey of which nine (50%) had issued recommendations encouraging sick employees to stay at home during the 2009 A(H1N1) pandemic, while only one country had official recommendations for seasonal influenza. Conclusions: During the 2009 A(H1N1) pandemic, many European countries recommended ill employees to take sick leave. Further research is warranted to quantify the effect of reduced presenteeism during influenza illness.
Article
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Little is known about the quantitative relationships between a self-recognized exposure to people with symptoms of respiratory (RTI) or gastrointestinal tract infection (GTI) and subsequent occurrence of homologous symptoms in the exposed person. Adult office employees, controls in an intervention trial, reported weekly own symptoms of RTI or GTI and exposures to other persons with similar symptoms. To ascertain the reliability of the self-reported data, the participants received both in-advance training and repeated instructions in the weekly Email requests for reports. The relationship of self-reported exposures to self-reported homologous symptoms during the same or the following week was analyzed including, in the statistical models, cluster effects and longitudinal aspects in the data, seasonality, and cluster-specific baseline values. Altogether 11,644 weekly reports were received from 230 participants during the 16-month duration of the study. The mean age of the reporters was 42.9 years (standard deviation 11.1 years), and the female/male ratio 157/68 (for 5 participants this information was not available). A reported exposure to RTI was associated with an almost 5-fold higher relative risk for a reported homologous infection during the same week (4.9; 95% confidence interval (CI) 4.0 to 5.9), and with a 3-fold risk during the following week (3.3; CI 2.8 to 3.8). For GTI the corresponding figures were 15.1 (CI 10.4 to 21.8) and 4.3 (CI 3.1 to 5.8), respectively. On the other hand, for 24% of the designated RTI episodes, a homologous exposure had been reported during neither the same nor the preceding week. For GTI this figure was even greater (40%). For both RTI and GTI, weeks with a reported exposure were more frequent outside the workplace than only at the workplace (434 versus 262, and 109 versus 41, respectively). A reported exposure to persons with obvious symptoms of RTI or GTI significantly increased the relative risk of reported homologous infection in the exposed adult persons. Yet, a substantial part of reported designated RTI and, especially, GTI episodes occurred without a reported exposure during the same or the previous week. ClinicalTrials.gov with an identifier of NCT00821509 (12 March 2009).
Article
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Influenza is one of the most contagious and rapidly spreading infectious diseases and an important global cause of hospital admissions and mortality. There are some amounts of the virus in the air constantly. These amounts is generally not enough to cause disease in people, due to infection prevention by healthy immune systems. However, at a higher concentration of the airborne virus, the risk of human infection increases dramatically. Early detection of the threshold virus concentration is essential for prevention of the spread of influenza infection. This review discusses different approaches for measuring the amount of influenza A virus particles in the air and assessing their infectiousness. Here we also discuss the data describing the relationship between the influenza virus subtypes and virus air transmission, and distribution of viral particles in aerosol drops of different sizes.
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This report updates the 2009 recommendations by CDC's Advisory Committee on Immunization Practices (ACIP) regarding the use of influenza vaccine for the prevention and control of influenza (CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2009;58[No. RR-8] and CDC. Use of influenza A (H1N1) 2009 monovalent vaccine---recommendations of the Advisory Committee on Immunization Practices [ACIP], 2009. MMWR 2009;58:[No. RR-10]). The 2010 influenza recommendations include new and updated information. Highlights of the 2010 recommendations include 1) a recommendation that annual vaccination be administered to all persons aged >or=6 months for the 2010-11 influenza season; 2) a recommendation that children aged 6 months--8 years whose vaccination status is unknown or who have never received seasonal influenza vaccine before (or who received seasonal vaccine for the first time in 2009-10 but received only 1 dose in their first year of vaccination) as well as children who did not receive at least 1 dose of an influenza A (H1N1) 2009 monovalent vaccine regardless of previous influenza vaccine history should receive 2 doses of a 2010-11 seasonal influenza vaccine (minimum interval: 4 weeks) during the 2010--11 season; 3) a recommendation that vaccines containing the 2010-11 trivalent vaccine virus strains A/California/7/2009 (H1N1)-like (the same strain as was used for 2009 H1N1 monovalent vaccines), A/Perth/16/2009 (H3N2)-like, and B/Brisbane/60/2008-like antigens be used; 4) information about Fluzone High-Dose, a newly approved vaccine for persons aged >or=65 years; and 5) information about other standard-dose newly approved influenza vaccines and previously approved vaccines with expanded age indications. Vaccination efforts should begin as soon as the 2010-11 seasonal influenza vaccine is available and continue through the influenza season. These recommendations also include a summary of safety data for U.S.-licensed influenza vaccines. These recommendations and other information are available at CDC's influenza website (http://www.cdc.gov/flu); any updates or supplements that might be required during the 2010-11 influenza season also will be available at this website. Recommendations for influenza diagnosis and antiviral use will be published before the start of the 2010-11 influenza season. Vaccination and health-care providers should be alert to announcements of recommendation updates and should check the CDC influenza website periodically for additional information.
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Human noroviruses (NoVs) are considered a worldwide leading cause of acute non-bacterial gastroenteritis. Due to a combination of prolonged shedding of high virus levels in feces, virus particle shedding during asymptomatic infections, and a high environmental persistence, NoVs are easily transmitted pathogens. Norovirus (NoV) outbreaks have often been reported and tend to affect a lot of people. NoV is spread via feces and vomit, but this NoV spread can occur through several transmission routes. While person-to-person transmission is without a doubt the dominant transmission route, human infective NoV outbreaks are often initiated by contaminated food or water. Zoonotic transmission of NoV has been investigated, but has thus far not been demonstrated. The presented review aims to give an overview of these NoV transmission routes. Regarding NoV person-to-person transmission, the NoV GII.4 genotype is discussed in the current review as it has been very successful for several decades but reasons for its success have only recently been suggested. Both pre-harvest and post-harvest contamination of food products can lead to NoV food borne illness. Pre-harvest contamination of food products mainly occurs via contact with polluted irrigation water in case of fresh produce or with contaminated harvesting water in case of bivalve molluscan shellfish. On the other hand, an infected food handler is considered as a major cause of post-harvest contamination of food products. Both transmission routes are reviewed by a summary of described NoV food borne outbreaks between 2000 and 2010. A third NoV transmission route occurs via water and the spread of NoV via river water, ground water, and surface water is reviewed. Finally, although zoonotic transmission remains hypothetical, a summary on the bovine and porcine NoV presence observed in animals is given and the presence of human infective NoV in animals is discussed.
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People in developed countries spend approximately 90% of their lives indoors, yet we know little about the source and diversity of microbes in built environments. In this study, we combined culture-based cell counting and multiplexed pyrosequencing of environmental ribosomal RNA (rRNA) gene sequences to investigate office space bacterial diversity in three metropolitan areas. Five surfaces common to all offices were sampled using sterile double-tipped swabs, one tip for culturing and one for DNA extraction, in 30 different offices per city (90 offices, 450 total samples). 16S rRNA gene sequences were PCR amplified using bar-coded "universal" bacterial primers from 54 of the surfaces (18 per city) and pooled for pyrosequencing. A three-factorial Analysis of Variance (ANOVA) found significant differences in viable bacterial abundance between offices inhabited by men or women, among the various surface types, and among cities. Multiplex pyrosequencing identified more than 500 bacterial genera from 20 different bacterial divisions. The most abundant of these genera tended to be common inhabitants of human skin, nasal, oral or intestinal cavities. Other commonly occurring genera appeared to have environmental origins (e.g., soils). There were no significant differences in the bacterial diversity between offices inhabited by men or women or among surfaces, but the bacterial community diversity of the Tucson samples was clearly distinguishable from that of New York and San Francisco, which were indistinguishable. Overall, our comprehensive molecular analysis of office building microbial diversity shows the potential of these methods for studying patterns and origins of indoor bacterial contamination. "[H]umans move through a sea of microbial life that is seldom perceived except in the context of potential disease and decay." - Feazel et al. (2009).
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The advent of molecular techniques and their increasingly widespread use in public health laboratories and research studies has transformed the understanding of the burden of norovirus. Norovirus is the most common cause of community-acquired diarrheal disease across all ages, the most common cause of outbreaks of gastroenteritis, and the most common cause of foodborne disease in the United States. They are a diverse group of single-stranded RNA viruses that are highly infectious and stable in the environment; both symptomatic and asymptomatic infections are common. Through shedding in feces and vomit, norovirus can be transmitted directly through an array of routes: person-to-person, food or the environment. The relative importance of environmental transmission of virus is yet to be fully quantified but is likely to be substantial and is an important feature that complicates control.
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As many respiratory viruses are responsible for influenza like symptoms, accurate measures of the disease burden are not available and estimates are generally based on statistical methods. The objective of this study was to estimate absenteeism rates and hours lost due to seasonal influenza and compare these estimates with estimates of absenteeism attributable to the two H1N1 pandemic waves that occurred in 2009. Key absenteeism variables were extracted from Statistics Canada's monthly labour force survey (LFS). Absenteeism and the proportion of hours lost due to own illness or disability were modelled as a function of trend, seasonality and proxy variables for influenza activity from 1998 to 2009. Hours lost due to the H1N1/09 pandemic strain were elevated compared to seasonal influenza, accounting for a loss of 0.2% of potential hours worked annually. In comparison, an estimated 0.08% of hours worked annually were lost due to seasonal influenza illnesses. Absenteeism rates due to influenza were estimated at 12% per year for seasonal influenza over the 1997/98 to 2008/09 seasons, and 13% for the two H1N1/09 pandemic waves. Employees who took time off due to a seasonal influenza infection took an average of 14 hours off. For the pandemic strain, the average absence was 25 hours. This study confirms that absenteeism due to seasonal influenza has typically ranged from 5% to 20%, with higher rates associated with multiple circulating strains. Absenteeism rates for the 2009 pandemic were similar to those occurring for seasonal influenza. Employees took more time off due to the pandemic strain than was typical for seasonal influenza.
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Diarrhea remains an important cause of morbidity, but until the mid 1990s, hospital admissions for diarrhea in the US adult population were declining. We aimed to describe recent trends in gastroenteritis hospitalizations and to determine the contribution of norovirus. We analyzed all gastroenteritis-associated hospital discharges during 1996-2007 from a nationally representative data set of hospital inpatient stays. Annual rates of discharges by age were calculated. Time-series regression models were fitted using cause-specified discharges as explanatory variables; model residuals were analyzed to estimate norovirus- and rotavirus-associated discharges. We then calculated the annual hospital charges for norovirus-associated discharges. Sixty-nine percent of all gastroenteritis discharges were cause-unspecified and rates increased by ≥ 50% in all adult and elderly age groups (≥ 18 years of age) from 1996 through 2007. We estimate an annual mean of 71,000 norovirus-associated hospitalizations, costing $493 million per year, with surges to nearly 110,000 hospitalizations per year in epidemic seasons. We also estimate 24,000 rotavirus hospitalizations annually among individuals aged ≥ 5 years. Gastroenteritis hospitalizations are increasing, and we estimate that norovirus is the cause of 10% of cause-unspecified and 7% of all-cause gastroenteritis discharges. Norovirus should be routinely considered as a cause of gastroenteritis hospitalization.
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Norovirus, the most commonly identified cause of both sporadic cases and outbreaks of infectious diarrhoea in developed countries, exhibits a complex epidemiology and has a strong wintertime seasonality. Viral populations are dynamic and evolve under positive selection pressure. Time series-adapted Poisson regression models were fitted to daily counts of laboratory reports of norovirus in England and Wales from 1993 to 2006. Inverse linear associations with daily temperature over the previous seven weeks (rate ratio (RR) = 0.85; 95% CI: 0.83 to 0.86 for every 1 degrees C increase) and relative humidity over the previous five weeks (RR = 0.980; 95% CI: 0.973 to 0.987 for every 1% increase) were found, with temperature having a greater overall effect. The emergence of new norovirus variants (RR = 1.16; 95% CI: 1.10 to 1.22) and low population immunity were also associated with heightened norovirus activity. Temperature and humidity, which may be localised, had highly consistent effects in each region of England and Wales. These results point to a complex interplay between host, viral and climatic factors driving norovirus epidemic patterns. Increases in norovirus are associated with cold, dry temperature, low population immunity and the emergence of novel genogroup 2 type 4 antigenic variants.
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The environment provides points for control of pathogens spread by food, water, hands, air, or fomites. These environmental transmission pathways require contact network formulations more realistically detailed than those based on social encounters or physical proximity. As a step toward improved assessment of environmental interventions, description of contact networks, and better use of environmental specimens to analyze transmission, an environmental infection transmission system model that describes the dynamics of human interaction with pathogens in the environment is presented. Its environmental parameters include the pathogen elimination rate, μ, and the rate humans pick up pathogens, ρ, and deposit them, α. The ratio, ρN/μ (N equals population size), indicates whether transmission is density dependent (low ratio), frequency dependent (high ratio), or in between. Transmission through frequently touched fomites, such as doorknobs, generates frequency-dependent patterns, while transmission through thoroughly mixed air or infrequently touched fomites generates density-dependent patterns. The environmental contamination ratio, α/γ, reflects total agent deposition per infection and outbreak probability, where γ is defined as the recovery rate. These insights provide theoretical contexts to examine the role of the environment in pathogen transmission and a framework to interpret environmental data to inform environmental interventions.
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We tested the survival of the Wa strain of human rotavirus on the hands of volunteers and also studied infectious virus transfer between animate and inanimate (stainless steel disks) surfaces. The virus was diluted in a 10% suspension of feces, and 10 microliters (1 X 10(3) to 4 X 10(4) PFU) was placed on each of the four fingerpads of the left hand. One milliliter of 20% tryptose phosphate broth in Earle balanced salt solution was used for virus elution from each fingerpad, and the hands were disinfected with 70% ethanol before they were washed with an antiseptic soap and water. At 20, 60, and 260 min after inoculation, approximately 57, 43, and 7%, respectively, of the input infectious virus could be recovered. For virus transfer, the inoculum (2 X 10(4) to 8 X 10(4) PFU) was allowed to dry, and the donor surface was kept in contact with the recipient surface for 10 s at a pressure of approximately 1 kg/cm2. At 20 and 60 min after virus inoculation, 16.1 and 1.8%, respectively, of the input infectious virus could be transferred from the contaminated hand to a clean disk; when a clean hand was pressed against a contaminated disk, virus transfer was 16.8 and 1.6%, respectively. Contact between a contaminated and a clean hand 20 and 60 min after virus inoculation resulted in the transfer of 6.6 and 2.8%, respectively, of the input infectious virus. These findings indicate the potential vehicular role for human hands in the spread of rotaviral infections.
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To assess the risks and benefits of antibiotic treatment in children with symptoms of upper respiratory tract infection (URTI). Quantitative systematic review of randomised trials that compare antibiotic treatment with placebo. Twelve trials retrieved from a systematic search (electronic databases, contact with authors, contact with drug manufacturers, reference lists); no restriction on language. The proportion of children in whom the clinical outcome was worse or unchanged; the proportion of children who suffered complications or progression of illness; the proportion of children who had side effects. 1699 children were randomised in six trials that contributed to the meta-analysis. Six trials were not used in the meta-analysis because of different outcomes or incomplete data. Clinical outcome was not improved by antibiotic treatment (relative risk 1.01, 95% confidence interval (CI) 0.90 to 1.13), neither was the proportion of children suffering from complications or progression of illness (relative risk 0.71, 95% CI 0.45 to 1.12). Complications from URTI in the five trials that reported this outcome was low (range 2-15%). Antibiotic treatment was not associated with an increase in side effects compared with placebo (relative risk 0.8, 95% CI 0.54 to 1.21). In view of the lack of efficacy and low complication rates, antibiotic treatment of children with URTI is not supported by current evidence from randomised trials.
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An outbreak of gastroenteritis followed a meal in a large hotel during which one of the diners vomited. The clinical features of the illness suggested Norwalk-like virus (NLV, small round structured virus) infection, and this was confirmed by electron microscopy and reverse transcriptase polymerase chain reaction (RT-PCR) of stool samples. Further characterization of the virus by nucleotide sequence analysis of the PCR amplicons revealed identical strains in all the affected individuals. The foods served at the meal could not be demonstrated to be the cause of the outbreak. Analysis of attack rates by dining table showed an inverse relationship with the distance from the person who vomited. No one eating in a separate restaurant reported illness. Transmission from person-to-person or direct contamination of food seems unlikely in this outbreak. However, the findings are consistent with airborne spread of NLV with infection by inhalation with subsequent ingestion of virus particles.
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Viral respiratory tract infection (VRTI) is the most common illness in humans. Despite the high incidence, the economic impact of non-influenza-related VRTI has not been rigorously explored. Our objectives were to obtain an updated incidence of non-influenza-related VRTI in the United States and to quantify the health care resource use (direct costs) and productivity losses (indirect costs) associated with these infections. A nationwide telephone survey of US households (N = 4051) was conducted between November 3, 2000, and February 12, 2001 to obtain a representative estimate of the self-reported incidence of non-influenza-related VRTI and related treatment patterns. Direct treatment costs measured included outpatient clinician encounters, use of over-the-counter and prescription drugs, and associated infectious complications of non-influenza-related VRTI. Absenteeism estimates for infected individuals and parents of infected children were extrapolated from National Health Interview Survey data. Of survey respondents, 72% reported a non-influenza-related VRTI within the past year. Respondents who experienced a self-reported non-influenza-related VRTI averaged 2.5 episodes annually. When these rates are extrapolated to the entire US population, approximately 500 million non-influenza-related VRTI episodes occur per year. Similarly, if the treatment patterns reported by the respondents are extended to the population, the total economic impact of non-influenza-related VRTI approaches $40 billion annually (direct costs, $17 billion per year; and indirect costs, $22.5 billion per year). Largely because of the high attack rate, non-influenza-related VRTI imposes a greater economic burden than many other clinical conditions. The pending availability of effective antiviral therapies warrants increased attention be paid to this common and expensive illness.
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Recurrent epidemics of influenza are observed seasonally around the world with considerable health and economic consequences. A key quantity for the control of infectious diseases is the reproduction number, which measures the transmissibility of a pathogen and determines the magnitude of public health interventions necessary to control epidemics. Here we applied a simple epidemic model to weekly indicators of influenza mortality to estimate the reproduction numbers of seasonal influenza epidemics spanning three decades in the United States, France, and Australia. We found similar distributions of reproduction number estimates in the three countries, with mean value 1.3 and important year-to-year variability (range 0.9-2.1). Estimates derived from two different mortality indicators (pneumonia and influenza excess deaths and influenza-specific deaths) were in close agreement for the United States (correlation=0.61, P60%) in healthy individuals who respond well to vaccine, in addition to periodic re-vaccination due to evolving viral antigens and waning population immunity.
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We investigated the impact of a customized alcohol-based instant hand sanitizer hand-hygiene regimen in an Army basic training setting. The entire population at the U.S. Army Field Artillery Training Center, Fort Sill, Oklahoma, participated in the 13-week prospective cohort study between January 18, 2005 and April 18, 2005. Two training battalions were randomly assigned to the control group, one to the primary intervention group (customized Purell Instant Hand Sanitizer regimen, education, reinforcement) and one to the secondary intervention group (customized Purell Instant Hand Sanitizer regimen). When compared to the control group, intervention groups experienced 40% less respiratory illness (p < 0.001), 48% less gastrointestinal illness (p < 0.02), 44% less lost training time (p < 0.001), and 31% fewer health care encounters (p < 0.001). These findings suggest that this intervention is capable of significantly reducing illness in this setting and has the potential to help reduce absenteeism in the military workforce as a whole.
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Multiple gastroenteritis outbreaks occurred between 25 and 31 July 2006 in 10 workplace canteens in south-western Finland. One vegetable processing plant provided raw vegetables to all the canteens. We conducted cohort studies in the three most visited canteens and environmental investigations in the kitchens and the plant. Patients' stools, food, water and environmental samples were tested for enteric bacteria and viruses. Of the three canteens, 150/273 respondents (response rate 82%) had gastroenteritis. Consumption of mixed raw vegetables was significantly associated with the illness but no single vegetable explains the outbreak. An identical norovirus GII.1 genotype was detected from all genotyped patient samples. Water, food, and environmental samples were negative for norovirus. The facilities had appropriate hygienic conditions and no staff member had gastroenteritis prior to the outbreak. Tracing back the vegetables to the farm level proved unsuccessful. This was the largest foodborne norovirus outbreak in Finland.
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Background: Extensive data suggests that hand hygiene is a critical intervention for reducing infectious disease transmission in the clinical setting. However, it is unclear whether hand hygiene is effective at cutting down on infectious illnesses in non-clinical workplaces. The aim of this review is to assess the current literature concerning the effects of hand-washing interventions on infectious disease prevention among employees in nonclinical, office-based workplaces. Methods: In compiling this review, PubMed, Scopus, and Business Source Premier were examined for studies published from 1960 through 2016. Results: Eleven studies (eight experimental, two observational, one a simulation) were identified as eligible for inclusion. Hand-hygiene interventions at various levels of rigor were shown to reduce self-reported illness symptoms. Conclusions: Hand hygiene is thought to be more effective against gastrointestinal illness than it is against respiratory illness, but no clear consensus has been reached on this point. Minimal hand-hygiene interventions seem to be effective at reducing the incidence of employee illness. Along with reducing infections among employees, hand-hygiene programs in the workplace may provide additional benefits to employers by reducing the number of employee health insurance claims and improving employee morale. Future research should use objective measures of hand hygiene and illness, and explore economic impacts on employers more fully.
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The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission ofpathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231-43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.
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Viral illnesses like gastroenteritis and the common cold create a substantial burden in the workplace due to reduced productivity, increased absenteeism, and increased health care costs. Behaviors in the workplace contribute to the spread of human viruses via direct contact between hands, contaminated surfaces and the mouth, eyes, and/or nose. This study assessed whether implementation of the Healthy Workplace Project (HWP) (providing hand sanitizers, disinfecting wipes, facial tissues, and use instructions) would reduce viral loads in an office setting of approximately 80 employees after seeding fomites and the hands of volunteer participants with an MS-2 phage tracer. The HWP significantly reduced viable phage detected on participants' hands, communal fomites, and personal fomites (p<0.010) in office environments and presents a cost-effective method for reducing the health and economic burden associated with viral illnesses in the workplace.
Article
To our knowledge, no studies to date demonstrate potential spread of microbes during actual emergency medical service (EMS) activities. Our study introduces a novel approach to identification of contributors to EMS environment contamination and development of infection control strategies, using a bacteriophage surrogate for pathogenic organisms. Bacteriophage ΦX174 was used to trace cross-contamination and evaluate current disinfection practices and a hydrogen peroxide (H2O2) wipe intervention within emergency response vehicles. Prior to EMS calls, 2 surfaces were seeded with ΦX174. On call completion, EMS vehicle and equipment surfaces were sampled before decontamination, after decontamination per current practices, and after implementation of the intervention. Current decontamination practices did not significantly reduce viral loads on surfaces (P = .3113), but H2O2 wipe intervention did (P = .0065). Bacteriophage spread to 56% (27/48) of sites and was reduced to 54% (26/48) and 40% (19/48) with current decontamination practices and intervention practices, respectively. Results suggest firefighters' hands were the main vehicles of microbial transfer. Current practices were not consistently applied or standardized and minimally reduced prevalence and quantity of microbial contamination on EMS surfaces. Although use of a consistent protocol of H2O2 wipes significantly reduced percent prevalence and concentration of viruses, training and promotion of surface disinfection should be provided. Published by Elsevier Inc.
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Approximately 50% of norovirus cases in the United States occur in long-term care facilities; many incidences of rotavirus, sapovirus, and adenovirus also occur. The primary objectives of this study were to demonstrate movement of pathogenic viruses through a long-term care facility and to determine the impact of a hygiene intervention on viral transmission. The coliphage MS-2 was seeded onto a staff member's hands, and samples were collected after 4 hours from fomites and hands. After 3 consecutive days of sample collection, a 14-day hygiene intervention was implemented. Hand sanitizers, hand and face wipes, antiviral tissues, and a disinfectant spray were distributed to employees and residents. Seeding and sampling were repeated postintervention. Analysis of the pre- and postintervention data was performed using a Wilcoxon signed-rank test. Significant reductions in the spread of MS-2 on hands (P = .0002) and fomites (P = .04) were observed postintervention, with a >99% average reduction of virus recovered from both hands and fomites. Although MS-2 spread readily from hands to fomites and vice versa, the intervention reduced average MS-2 concentrations recovered from hands and fomites by up to 4 logs and also reduced the incidence of MS-2 recovery. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Article
The concept of aerosol transmission is developed to resolve limitations in conventional definitions of airborne and droplet transmission. The method was literature review. An infectious aerosol is a collection of pathogen-laden particles in air. Aerosol particles may deposit onto or be inhaled by a susceptible person. Aerosol transmission is biologically plausible when infectious aerosols are generated by or from an infectious person, the pathogen remains viable in the environment for some period of time, and the target tissues in which the pathogen initiates infection are accessible to the aerosol. Biological plausibility of aerosol transmission is evaluated for Severe Acute Respiratory Syndrome coronavirus and norovirus and discussed for Mycobacterium tuberculosis, influenza, and Ebola virus. Aerosol transmission reflects a modern understanding of aerosol science and allows physically appropriate explanation and intervention selection for infectious diseases.
Article
ABSTRACT Although the number of illnesses resulting from indirect viral pathogen transmission could be substantial, it is difficult to estimate the relative risks because of the wide variation and uncertainty in human behavior, variable viral concentrations on fomites, and other exposure factors. The purpose of this study was to evaluate the micro-activity approach for assessment of microbial risk by adapting a mathematical model to estimate probability of viral infection from indirect transmission. To evaluate the model, measurements of phage loading on fomites and hands collected before and after implementation of a Healthy Workplace Project(TM) intervention were used. Parameter distributions were developed from this data, as well as for micro-activity rates, contact surface areas, phage transfer efficiencies, and inactivation rates. Following the Monte Carlo simulations (n = 1,000), the estimated phage loading on hands was not significantly different from the loading of phage on hands measured in the experimental trials. The model was then used to demonstrate that the Healthy Workplace Project(TM) intervention significantly reduced risk of infection by 77% for rotavirus and rhinovirus. This is the first published study to successfully evaluate a model focused on the indirect transmission of viruses via hand contact with measured data and provide an assessment of the micro-activity approach to microbial risk evaluation.
Article
The goals of this study were to observe the spread of viruses in a hotel setting and to assess the effectiveness of a hygiene intervention in reducing their spread. Selected fomites in one hotel room were inoculated with bacteriophage ϕx-174, and fomites in a conference center within the same hotel were inoculated using bacteriophage MS2. Cleaning of the contaminated room resulted in the spread of viruses to other rooms by the housekeeping staff. Furthermore, viruses were transferred by hotel guests to the conference center and a communal kitchen area. Additionally, conference attendees transferred viruses from the conference center to their hotel rooms and a communal kitchen area. This study demonstrated how viruses can be spread throughout a hotel setting by both housekeepers and guests. A hygiene intervention, which included providing hand hygiene products and facial tissues to the guests and disinfecting solutions with disposable wipes to the housekeeping staff, was successful in reducing the spread of viruses between the hotel guest rooms and conference center. The hygiene intervention resulted in significantly reduced transfer of the ϕx-174 between the contaminated hotel room and other hotel rooms, communal areas, and the conference center (p = 0.02).
Chapter
Noroviruses are the leading cause of epidemic non-bacterial gastroenteritis worldwide. Despite their discovery over three decades ago, little is known about the host immune response to norovirus infection. The purpose of this chapter is to review the field of norovirus immunology and discuss the contributions of outbreak investigations, human and animal challenge studies and population-based studies. This chapter will survey both humoral and cellular immunity as well as recent advances in norovirus vaccine development.
Article
Virus transfer between individuals and fomites is an important route of transmission for both gastrointestinal and respiratory illness. The present study examines how direction of transfer, virus species, time since last handwashing, gender, and titre affect viral transfer between fingerpads and glass. Six hundred fifty-six total transfer events, performed by 20 volunteers using MS2, φX174, and fr indicated 0·23 ± 0·22 (mean and standard deviation) of virus is readily transferred on contact. Virus transfer is significantly influenced by virus species and time since last handwashing. Transfer of fr bacteriophage is significantly higher than both MS2 and φX174. Virus transfer between surfaces is reduced for recently washed hands. Viruses are readily transferred between skin and surfaces on contact. The fraction of virus transferred is dependent on multiple factors including virus species, recently washing hands, and direction of transfer likely because of surface physicochemical interactions. The study is the first to provide a large data set of virus transfer events describing the central tendency and distribution of fraction virus transferred between fingers and glass. The data set from the study, along with the quantified effect sizes of the factors explored, inform studies examining role of fomites in disease transmission.
Article
Acute respiratory illnesses (ARI), comprising influenza-like illness (ILI) and other wintertime respiratory illnesses (ORI), impose substantial health and economic burdens on the United States. Little is known about the impact of ILI among household members (HHM), particularly children, on employees' productivity. To quantify the impact of employee and HHM-ILI and ARI on employee productivity, a prospective, observational cohort study was conducted among employees from three large US companies. Employees who had at least one child living at home (N=2013) completed a monthly survey during the 2007-2008 influenza season, reporting the number of days missed from work and hours of presenteeism due to: (1) personal ILI, (2) HHM-ILI, and (3) personal and HHM-ARI. Employee ILI ranged from 4.8% (April) to 13.5% (February). Employees reporting ILI reported more absences than employees not reporting ILI (72% vs 30%, respectively; P<0.001). Overall, 61.2% of employees surveyed had at least one child with an ILI; these employees missed more days of work due to HHM illness than employees without an ARI-ill child (0.9 days vs 0.3 days, respectively; P<0.001). Employees with ILI were less productive, on average, for 4.8h each day that they worked while sick, 2.5h of which was attributable to ILI. HHM illnesses accounted for 17.7% (1389/7868 days) of employee absenteeism, over half of which was due to HHM-ARI. ILI causes a significant amount of employee absence. Household members, particularly children, comprise a sizable proportion of general illness and injury-related employee absences.
Article
Seasonal influenza is a prevalent and highly contagious acute respiratory disease that, year on year, results in increased morbidity and mortality on a global scale. Because of the widespread and debilitating nature of the disease, annual influenza epidemics result in substantial workplace absenteeism, and the associated cost of lost productivity is a significant component of the substantial financial burden of the disease to society. The objective of this review was to identify studies that had attempted to quantify the impact of influenza upon otherwise healthy adults in terms of working days lost associated with an episode of influenza. Studies were included if they reported estimates of working days lost due to clinical, physician and/or self-diagnosis in adult patients or their dependants, or where this figure could be estimated from the data. Searches were conducted in MEDLINE, EMBASE, BIOSIS and the Cochrane Collaboration for articles published since 1995 in English, French or German. Of the 289 papers identified in the search, 28 (9.7%) met the inclusion criteria. The studies, involving study sites in North America, Western Europe, Asia and Australia, were categorized into three groups: (i) those reporting influenza diagnoses confirmed by laboratory testing, i.e. studies where influenza was the unambiguous cause of the working days lost (n = 7 studies reported in ten publications); (ii) those where influenza was confirmed by a physician without an accompanying laboratory test (n = 4 studies); and (iii) those where influenza was self-reported by study participants (n = 14 studies). Qualitative reporting of results was performed because of the large degree of heterogeneity observed between studies, potentially complicating the interpretation of any meta-analysis. The results from studies involving a laboratory-confirmed influenza diagnosis suggested that the mean number of working days lost ranged between 1.5 and 4.9 days per episode. Those papers that detailed working days lost per episode following physician diagnosis of influenza reported a range of 3.7–5.9 days per episode. Finally, estimates from papers reporting working days lost per episode of self-reported influenza ranged from <1 day to 4.3 days per episode. Influenza imposes a significant burden on society, and this review highlights the significant economic impact it causes, i.e. the loss of productivity caused by both absenteeism and by staff functioning at reduced capacity even after they have returned to work. A number of prophylaxis and treatment options exist for influenza and should be given serious consideration in an attempt to reduce the economic burden on society.
Article
To investigate the transmission of influenza viruses via hands and environmental surfaces, the survival of laboratory-grown influenza A and influenza B viruses on various surfaces was studied. Both influenza A and B viruses survived for 24–48 hr on hard, nonporous surfaces such as stainless steel and plastic but survived for <8–12 hr on cloth, paper, and tissues. Measurable quantities of influenza A virus were transferred from stainless steel surfaces to hands for 24 hr and from tissues to hands for up to 15 min. Virus survived on hands for up to 5 min after transfer from the environmental surfaces. These observations suggest that the transmission of virus from donors who are shedding large amounts could occur for 2–8 hr via stainless steel surfaces and for a few minutes via paper tissues. Thus, under conditions of heavy environmental contamination, the transmission of influenza virus via fomites may be possible.
Article
This large population-based study using the UK-based General Practice Research Database was conducted to quantify influenza-related physician visits, clinical complications of and risk factors for influenza, and related drug use in all age groups from 1991 to 1996. A total of 141,293 subjects who had one or more diagnoses of influenza or influenza-like illness during the study period as well as the same number of age-, sex-, practice and calendar time-matched controls were identified. Adults aged 15-64 years had the highest influenza incidence rate. The risk of getting influenza was particularly increased for subjects with chronic respiratory conditions (asthma or chronic obstructive pulmonary disease, odds ratio 1.65, 95% confidence interval 1.60-1.70). Subjects with influenza were more likely to have a diagnosis of clinical complications than control subjects (relative risk 3.4, 95% confidence interval 3.3-3.6). The risk of developing clinical complications was highest for children and was elevated for subjects with certain underlying chronic conditions. In absolute terms, otherwise healthy adults (15-64 years) accounted for the greatest proportion of all influenza-related physician visits as well as clinical complications in this study population. Of the 141,293 subjects with influenza, 83,911 (59.4%) received drugs on prescription. The most frequently prescribed drugs were antibiotics (45.2%), followed by antipyretics/analgesics (22.5%). Influenza patients were approximately six times more likely to use drugs on prescription than controls. This analysis may lead to further analyses on the economic impact of influenza and the contribution of different population groups to that burden.
Article
Health-related productivity assessments typically focus on chronic conditions; however, acute conditions, particularly colds, have the potential to cause substantial health-related productivity losses because of their high prevalence in working-age groups. This article presents the findings of a study conducted to estimate productivity loss due to cold by using a telephone-administered survey that measured three sources of loss: absenteeism, on-the-job productivity, and caregiver absenteeism. Each cold experienced by a working adult caused an average of 8.7 lost work hours (2.8 absenteeism hours; 5.9 hours of on-the-job loss), and 1.2 work hours were lost because of attending to children under the age of 13 who were suffering from colds. We conclude that the economic cost of lost productivity due to the common cold approaches $25 billion, of which $16.6 billion is attributed to on-the-job productivity loss, $8 billion is attributed to absenteeism, and $230 million is attributed to caregiver absenteeism.
Article
A reverse transcriptase polymerase chain reaction assay was used to study the transfer of Norovirus (NV) from contaminated faecal material via fingers and cloths to other hand-contact surfaces. The results showed that, where fingers come into contact with virus-contaminated material, NV is consistently transferred via the fingers to melamine surfaces and from there to other typical hand-contact surfaces, such as taps, door handles and telephone receivers. It was found that contaminated fingers could sequentially transfer virus to up to seven clean surfaces. The effectiveness of detergent- and disinfectant-based cleaning regimes typical of those that might be used to decontaminate faecally contaminated surfaces and reduce spread of NV was also compared. It was found that detergent-based cleaning with a cloth to produce a visibly clean surface consistently failed to eliminate NV contamination. Where there was faecal soiling, although a combined hypochlorite/detergent formulation at 5000 ppm of available chlorine produced a significant risk reduction, NV contamination could still be detected on up to 28% of surfaces. In order consistently to achieve good hygiene, it was necessary to wipe the surface clean using a cloth soaked in detergent before applying the combined hypochlorite/detergent. When detergent cleaning alone or combined hypochlorite/detergent treatment failed to eliminate NV contamination from the surface and the cleaning cloth was then used to wipe another surface, the virus was transferred to that surface and to the hands of the person handling the cloth. In contrast, were surfaces where contaminated with NV-infected faecal suspension diluted to 1 in 10 and 1 in 80, intended to simulate surfaces that have become contaminated after secondary transfer, treatment with a combined bleach/detergent formulation, without prior cleaning, was sufficient to decontaminate surfaces and prevent transfer.
Article
Employers are beginning to realize that they face a nearly invisible but significant drain on productivity: presenteeism, the problem of workers' being on the job but, because of illness or other medical conditions, not fully functioning. By some estimates, the phenomenon costs U.S. companies over 150 billion dollars a year--much more than absenteeism does. Yet it's harder to identify. You know when someone doesn't show up for work, but you often can't tell when, or how much, poor health hurts on-the-job performance. Many of the health problems that result in presenteeism are relatively benign. Research in this emerging area of study focuses on such chronic or episodic ailments as seasonal allergies, asthma, headaches, depression, back pain, arthritis, and gastrointestinal disorders. The fact is, when people don't feel good, they simply don't perform at their best. Employees who suffer from depression may be fatigued and irritable--and, therefore, less able to work effectively with others. Those with migraine headaches who experience blurred vision and sensitivity to light, not to mention acute pain, probably have a hard time staring at a computer screen all day. A number of companies are making a serious effort to determine the prevalence of illnesses and other medical conditions that undermine job performance, calculate the related drop in productivity, and find cost-effective ways to combat that loss. Indeed, researchers have discovered that presenteeism-related declines in productivity sometimes can be more than offset by relatively small investments in screening, treatment, and education. So organizations may find that it pays to make targeted investments in employees' health care--by covering the cost of allergy medication, for instance, or therapy for depression.
Article
The purpose of this state-of-the-science review was to identify strategies and household-level interventions for public health nurses to help prevent the acquisition and spread of viral upper respiratory infections (URI) in the community. Even though viral URI are a major global economic and social problem, surprisingly little research has been conducted to attempt to prevent them or reduce their transmission, probably because URI (with the exception of epidemic influenza) are generally considered to be mild and self-limited. Based on the research to date, public health nurses can use several promising strategies for prevention: (a) provide more tailored educational messages regarding preventive strategies such as vaccination, hand hygiene, spatial separation of infected household members, avoidance of antibiotics to treat viral URI, and environmental cleaning (e.g., for toys or other shared items), which are delivered personally rather than passively (e.g., pamphlets placed in a waiting room); (b) use each patient encounter in any setting to encourage influenza vaccination for relevant risk groups; (c) encourage use of alcohol hand sanitizers by household members during the cold and flu season; and (d) provide opportunities for skill development for adult and child household members (e.g., cover your cough, when to seek care or an antibiotic).
Article
Human noroviruses (NoVs) are a significant cause of nonbacterial gastroenteritis worldwide, with contaminated drinking water a potential transmission route. The absence of a cell culture infectivity model for NoV necessitates the use of molecular methods and/or viral surrogate models amenable to cell culture to predict NoV inactivation. The NoV surrogates murine NoV (MNV), feline calicivirus (FCV), poliovirus (PV), and male-specific coliphage MS2, in conjunction with Norwalk virus (NV), were spiked into surface water samples (n = 9) and groundwater samples (n = 6). Viral persistence was monitored at 25°C and 4°C by periodically analyzing virus infectivity (for all surrogate viruses) and nucleic acid (NA) for all tested viruses. FCV infectivity reduction rates were significantly higher than those of the other surrogate viruses. Infectivity reduction rates were significantly higher than NA reduction rates at 25°C (0.18 and 0.09 log10/day for FCV, 0.13 and 0.10 log10/day for PV, 0.12 and 0.06 log10/day for MS2, and 0.09 and 0.05 log10/day for MNV) but not significant at 4°C. According to a multiple linear regression model, the NV NA reduction rates (0.04 ± 0.01 log10/day) were not significantly different from the NA reduction rates of MS2 (0.05 ± 0.03 log10/day) and MNV (0.04 ± 0.03 log10/day) and were significantly different from those of FCV (0.08 ± 0.03 log10/day) and PV (0.09 ± 0.03 log10/day) at 25°C. In conclusion, MNV shows great promise as a human NoV surrogate due to its genetic similarity and environmental stability. FCV was much less stable and thus questionable as an adequate surrogate for human NoVs in surface water and groundwater.
Norovirus outbreak in an elementary school-District of Columbia
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Prevention and control of influenza: recommendations of the
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Harper, S.A., Fukuda, K., Uyeki, T.M., Cox, N.J., Bridges, C.B., 2004. Prevention and control of influenza: recommendations of the. Advisory Committee on Immunization Practices (ACIP) 53, 1-40.
Viral infections acquired indoors through airborne, droplet or contact transmission
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La Rosa, G., Fratini, M., Della Libera, S., Iaconelli, M., Muscillo, M., 2013. Viral infections acquired indoors through airborne, droplet or contact transmission. Ann. Ist. Super Sanita 49, 124-132. https://doi.org/10.4415/ANN-13-02-03.