Hygiene, Volume 3, Issue 2 (June 2023) – 10 articles

The reduced life cycle of electrical goods has contributed to a fast-growing occupational and environmental health issue arising from increased electronic waste (e-waste) in most developing countries. E-waste is processed informally in these countries, and in most cases, it is beyond the reach of official governance and is characterized by a lack of regulation, structure, and any form of license to operate. Assessing the implications of e-waste recycler safety knowledge, awareness, and practice levels is seen as a panacea for developing tailored interventions. We performed a cross-sectional study among 323 e-waste workers located in Agbogbloshie waste dumpsite, Accra, Ghana, to measure their knowledge, awareness, and practice, as well as their perceived safety and behavioral control. A significant negative correlation was found between participants safety knowledge and their safety practices (r (323) = −0.19, p < 0.01), as well as a similar correlation with perceived safety control among the study group (r (323) = −0.27, p < 0.01). In addition, the hygiene rating among the group was adjudged poor as there was no established relationship found with their perceived safety control. To help bridge the gap around e-waste workers safety knowledge, awareness, and practices, it is pertinent for local and international players to take into consideration the shared values and beliefs among the group and work alongside the group in developing a set of policies that will help improve their safety and health. Full article

Foodborne diseases pose a primary global health concern, affecting people across high- and low-income countries, with the less privileged often suffering the most. This research proposes the adoption of a Hygiene Rating Scheme (HRS) to help customers make informed decisions about where and what to eat. The scheme has already demonstrated success in countries such as the United States, Northern Ireland, Wales, and England in reducing the risk of foodborne diseases. This article highlights the significance of Nigeria embracing the HRS and its potential to combat foodborne diseases. Adopting the scheme will incentivize food business owners to improve their sanitary conditions and food quality by implementing Good Manufacturing Practices (GMPs). The scheme’s transparent inspection results make it easier for customers to choose higher-rated outlets, reducing the cost of disease outbreaks and promoting public health. In conclusion, the HRS provides a practical solution to addressing the issue of foodborne diseases and promoting food safety. Full article

With the increased uptake of the COVID-19 vaccination in 2021, universities resumed face-to-face classes and clinical placements. However, even with incentives, some individuals chose not to receive a vaccination due to personal beliefs and other reasons. Understanding motivations for vaccination uptake or vaccine hesitancy is important to help develop future public health strategies. Therefore, a cross-sectional online survey was carried out among students and staff in a UK university to assess the level of vaccination and explore their views on the acceptability of incentives that may encourage uptake. Almost three quarters (74.4%) of the sample had received at least one dose of a COVID-19 vaccine with a higher proportion of staff receiving a vaccine compared to students (80.0% vs. 70.6%, p < 0.001). Vaccine hesitancy or refusal was due to the perceived lack of research and knowledge of the potential long-term effects at the time of vaccination, religious, personal and ethical beliefs and feeling like vaccinations should not be used to restrict social events, travel and medical challenges. This study shows that university staff and students had a relatively high uptake of the COVID-19 vaccination. However, the findings indicate that nearly 20 percent were unsure or unwilling to take the vaccination, therefore suggesting that clearer information and motivational strategies are needed to support the roll out of new vaccines. Full article

The disinfection procedures aim to reduce the microbial load, but there are doubts about the risks of contamination spreading into the lumens of devices, such as three-way stopcocks (3-WS). This study aimed at an in vitro evaluation of the antibacterial procedure of manual friction of 3-WS intentionally contaminated and to determine the solution dispersion into the lumens. Laboratory experiments were developed in two steps: evaluation of bacterial spread through intentional contamination with Staphylococcus aureus and Pseudomonas aeruginosa, and alcohol dispersion into the 3-WS lumens. After manual friction of the 3-WS with saline solution at 0.85% (w/v) [control group], S. aureus and P. aeruginosa were isolated in the lumens of 55.6% and 27.8% of the devices, respectively. However, after the disinfection of the 3-WS with ethyl alcohol at 70% (w/v), there was no bacterial contamination in the lumens of the 3-WS. On the other hand, the solution dispersion (dye) into the lumens was evidenced by two different techniques: Durham tubes (5.6%) and swabs (46.3%). The manual friction of the 3-WS with ethyl alcohol at 70% demonstrated antibacterial efficacy, but it refers to reflections on the risk of solution diffusion into the venous network and the inherent clinical practice situations and patient safety. Full article

As the COVID-19 pandemic begins to abate and national public health systems are treating the SARS-CoV-2 virus as endemic, many public health measures are no longer mandated but remain recommended with voluntary participation. One of these is the wearing of fitted face masks, initially mandated to contain, or at least slow, the spread of SARS-CoV-2, which is primarily transmitted via aerosols emitted while breathing, coughing, or sneezing. Although the habit of once wearing fitted face masks recedes into memory for much of the population, so does the knowledge of the various types of masks that were once en vogue. To create a record for the future, this paper provides the first comprehensive documentation of the nature and range of fitted facemasks that circulated during the COVID-19 pandemic. Full article

This scoping review addresses bacterial contamination of antiseptics, low-level disinfectants, and hand hygiene products in healthcare settings in high-income countries. Over 70 years, 114 articles were found: 68 outbreaks, 13 pseudo-outbreaks and 33 cross-sectional surveys. Outbreaks affected median 29 (1–151) patients, extended for 26 (1–156) weeks and had a case fatality of 0.0% (0.0–60.0%). Most (72.8%) (pseudo-)outbreaks were caused by water-based chlorhexidine (CHG), quaternary ammonium compounds (QUAT) and the combination CHG–QUAT. Contaminating bacteria were nonfermentative Gram-negative rods (87.6% (pseudo-)outbreaks), mainly Burkholderia cepacia, Pseudomonas aeruginosa and Achromobacter spp.) and Enterobacterales (29.6%, 24/81), mostly Serratia spp.). Risk factors were at the level of the bacteria (natural resistance to CHG and QUAT), containers (design and functioning, presence of cork and cotton, biofilm formation), preparation (nonsterile water, overdilution) and practices (too long expiry dates, inappropriate container reprocessing, topping up of containers and deviation from procedures). Transmission occurred through direct contact (antiseptics), contact with semicritical items (disinfectants) and were handborne (soaps). During recent decades, reports of soap contaminated with Enterobacterales emerged and nationwide outbreaks of intrinsically contaminated CHG occurred. Outstanding issues comprise intrinsic contamination, implementation of antiseptic stewardship, the role of unit doses and sterile products, transmission studies, biofilm control and understanding healthcare providers’ perceptions. Full article

Ozone is a triatomic allotropic modification of oxygen with very high oxidation potential and strong antimicrobial properties, and can be used as a disinfecting agent. The aim of this work was to investigate the effectiveness of gaseous ozone in reducing the number of bacteria and the total biomass of E. coli biofilm using different methods of quantification and detection. Biofilm of all tested clinical isolates and standard strain was grown on ceramic tiles with dimensions of 1.0 × 1.0 cm over 24 h. These plates were then treated with gaseous ozone for 1 h. After washing, CFU/cm² was determined, ATP bioluminescence was measured with a luminometer, and the total biomass reduction was measured after crystal-violet staining. Gaseous ozone proved to be very effective in destroying the created bacterial biofilm on ceramic tiles. Treatment caused a reduction in total bacteria number of up to 2.00 log₁₀CFU/cm², followed by a reduction in total biomass of up to 61.40%. Inhibition rates varied from 35.80% to 99.41%, depending on the method of quantification used. All methods used in this study are effective in determining the anti-biofilm activity of gaseous ozone, but more research is needed. Full article

We conducted a systematic review of healthcare-associated outbreaks and cross-sectional surveys related to the contamination of antiseptics, disinfectants, and hand hygiene products in healthcare settings in low- and middle-income countries (PROSPERO CRD42021266271). Risk of bias was assessed by selected items of the ORION and MICRO checklists. From 1977 onwards, 13 outbreaks and 25 cross-sectional surveys were found: 20 from Asia and 13 from Africa. Products most associated with outbreaks were water-based chlorhexidine, chlorhexidine-quaternary ammonium compound combinations (7/13), and liquid soap products (4/13). Enterobacterales (including multidrug-resistant Enterobacter cloacae, Klebsiella pneumoniae, and Serratia marcescens) and non-fermentative Gram-negative rods were found in 5 and 7 outbreaks and in 34.1% and 42.6% of 164 isolates, respectively, from cross-sectional surveys. Risk factors included preparation (place, utensils, or tap water high and incorrect dilutions), containers (reused, recycled, or inadequate reprocessing), and practices (topping-up or too long use). Potential biases were microbiological methods (neutralizers) and incomplete description of products’ identity, selection, and denominators. External validity was compromised by low representativeness for remote rural settings and low-income countries in sub-Saharan Africa. Outstanding issues were water quality, biofilm control, field-adapted containers and reprocessing, in-country production, healthcare providers’ practices, and the role of bar soap. A list of “best practices” to mitigate product contamination was compiled. Full article

The aim of this study was to assess the associations between HIV status, SARS-CoV-2 infection, increase in use of psychoactive substances and oral ulcers among people who use psychoactive substances. This was a secondary analysis of the data of 1087 people who used psychoactive substances collected during the first wave of the COVID-19 pandemic. The data extracted were confounding (age, sex, the highest level of education attained, employment status, emotional distress status), dependent (oral ulcers) and independent (SARS-CoV-2 infection, increase in alcohol consumption, smoking and use of other psychoactive substances, living with HIV) variables. A multivariate logistic regression model was constructed to determine the associations between the dependent and independent variables after adjusting for the confounding variables. Participants who had a history of SARS-CoV-2 infection (AOR:10.37) and people living with HIV (AOR:1.91) had higher odds of reporting oral ulcers. The finding suggests that people who used psychoactive substances, had COVID-19 and lived with HIV were at increased risk for oral ulcers during the first wave of the COVID-19 pandemic. Increased use of psychoactive substances was not associated with a significant increase in the risk for oral ulcers. Further research is needed to better understand the reasons for these findings. Full article

Good access and appropriate use of Water, Sanitation and Hygiene (WASH) is important in the control, elimination and eradication of a number of neglected tropical diseases (NTDs). Poor WASH access and use may explain continued high trachoma prevalence in Nabilatuk district, Uganda. This study aimed to investigate the level of WASH access and use through different WASH data collection methods and the triangulation of their results. A mixed-methods cross-sectional study was conducted in 30 households in Nabilatuk district, from 10 households in each of three nomadic villages. The data collection methods used were: (1) direct observations of routine WASH behaviours; (2) structured quantitative household questionnaires; (3) demonstrations of specific WASH behaviours. With regards to access, observations indicated less WASH access and use compared with questionnaire responses: the questionnaire indicated all households had access to an improved water source, but 70% had a >30-min round-trip, and no households had access to an improved latrine, whereas some observations indicated longer water collection times. In terms of behaviour, there were also differences between the data collection methods, with demonstrations revealing knowledge of good practice, such as thorough handwashing, but this was not routinely observed in the observations. Further systematic investigation of barriers to appropriate WASH access and use in the local context is needed, as is the development of feasible, valid and reliable WASH access and use assessment methods for use in national NTD programmes. Full article