Hygiene

Legionella bacterium has the aquatic environment as its natural reservoir. In humans, it can cause a form of interstitial pneumonia called legionellosis which can be transmitted by inhalation of contaminated water aerosols. Legionella infection occurs more frequently in certain more susceptible population groups, including smokers, alcoholics, men, the elderly, as well as people with acquired immunodeficiency syndrome, hematological cancers, and diabetes mellitus. This study aimed to evaluate the effectiveness of the new Italian National Guidelines for the prevention of Legionella colonization in water systems application by analyzing the environmental monitoring data of Legionella carried out in healthcare facilities in the Campania region from 2019 to 2022. The secondary objectives were to estimate the most observed serogroups of L. pneumophila and to analyze the possible link between water temperature and the presence of Legionella, respectively. From our data, it emerged that in 2019, 41.1% of the examined facilities were contaminated by the Legionella genus; in 2020, the contamination percentage was 42.9%; in 2021, it was 54.5%; in 2022, it was 45.5%. Instead, the Legionella positivity rate decreased from 2019 (54.3%) to 2022 (52.4%), suggesting a possible positive influence of more restrictive prevention and control measures. The prevalent species was Legionella pneumophila, particularly serogroup 1; water temperature was the risk factor implicated in Legionella contamination. Full article

Background: Respiratory viruses spread through airborne droplets and aerosols, causing highly contagious acute respiratory syndromes in humans. This study evaluated the antiviral potential of vapours of catmint-oil-based formulations against respiratory viruses. Methods: The antiviral activity of formulations with or without catmint oil (CO) in solution or in aerosolised form was determined against influenza virus H1N1 ATCC VR-1469 and mouse hepatitis virus (MHV-1) ATCC/VR261. In solution, both viruses were exposed to CO formulations for 2–3 h. In aerosolised form, H1N1 was exposed to formulations for 2 min in a closed cylinder and MHV-1 for 10 min in a booth. The antiviral effect of the formulations was evaluated by growing H1N1 in a Madin–Darby canine kidney (MDCK; ATCC-CRL-2936) and MHV-1 in A9 ATCC/CCL 1.4 cells using TCID50 and a plaque assay, respectively. Transmission electron microscopy (TEM) was conducted to investigate the mode of action of the formulations. Results: In solution, the formulation containing hydrogenated CO (HCO), bromelain, N-acetylcysteine and Tween 20 (Formulation (1)) reduced the viability of H1N1 by 2.6 ± 0.07 log₁₀ (p = 0.025) and MHV-1 by 4.5 ± 0.14 log₁₀ (p = 0.014) within 2–3 h. In vapourised form, Formulation (1) produced similar antiviral effects against H1N1, reducing it by 3.00 ± 0.07 log₁₀ (p = 0.002) within 2 min, and Formulation (1) produced a 3.00 ± 0.07 log₁₀ reduction of MHV-1 (p < 0.001) within 10 min (the minimum time needed to detect infective viral particles in the experimental set-ups). Formulation (3) (without bromelain) reduced H1N1 by 1.57 ± 0.14 log₁₀ (p = 0.008) after 2 min and MHV-1 by 1.3 ± 0.04 log₁₀ (p = 0.057) after 10 min. In the absence of catmint oil (Formulation (4)) or in the absence of catmint oil and bromelain (Formulation (5)), there were only slight reductions in the viability of aerosolised H1N1 (1.00 ± 0.14 log₁₀, p = 0.046; <1 log₁₀, p = 0.966, respectively) and MHV-1 (1.07 ± 0.02 log₁₀, p = 0.013; 0.16 ± 0.03 log₁₀, p = 0.910, respectively). The TEM analysis showed that the formulation disrupted the H1N1 envelopes and caused a reduction in size of the viral particles. Conclusions: The catmint-oil-based formulations reduced the H1N1 and MHV-1 by disrupting the vial envelopes. Full article

The human oral microbiome plays a vital role in maintaining oral and systemic health. This diverse microbial community includes over 700 bacterial species, some of which are implicated in developing systemic diseases, particularly cardiovascular diseases (CVDs). Research highlights a strong association between periodontal disease and increased cardiovascular risk, suggesting that good oral hygiene practices may reduce the incidence of CVDs. Porphyromonas gingivalis and Fusobacterium nucleatum drive chronic inflammation in periodontal disease; these bacteria can extend beyond the mouth and contribute to systemic inflammatory responses. The inflammatory factors, including C-reactive protein (CRP), interleukins (IL-1, IL-6), and tumor necrosis factor-alpha (TNF-α), damage blood vessels, impair endothelial functions, and promote atherosclerosis, all key events in CVD progression. Additionally, oral pathogens may accelerate plaque formation in arteries, increasing the risk of ischemic heart and brain diseases. Studies show a 28% increased risk of heart disease in individuals with periodontal disease. Treating periodontal disease can improve endothelial function and reduce inflammatory markers, emphasizing oral health management as a potential preventive strategy for CVD. Public health initiatives that emphasize oral hygiene and early periodontal disease treatment are crucial for broader cardiovascular care. Full article

Background: Lead compounds are chemicals of high toxicological concern and are suspected to interact with the thyroid axis. Method: A cohort study was carried out involving 70 workers from a petrochemical company exposed to inorganic lead compounds. All recruited workers were given a clinical anamnestic questionnaire aimed at characterizing their endocrine and thyroid status. A blood test was conducted to dose the amount of lead, thyroid hormones (FT3, FT4, TSH), and antibodies (TGAb and TPOAb). Samples were stratified according to working seniority and lead exposure levels. A regression study was conducted to highlight trends in hormones and antibodies versus lead levels. Results: Most of the dosages are within the normal ranges. The regression study showed how higher lead values are correlated with a reduction in TSH and an increase in FT3 and FT4. There is a statistically significant increase in TPOAb in the most exposed workers. Conclusions: The trends of thyroid hormones may suggest a tendency towards hyperthyroidism for higher lead exposure, while the increase in TPOAb could indicate a greater predisposition to the development of autoimmune thyroid diseases. Full article

Intermediate cluster disinfection plays a vital role in preventing the transmission of mastitis pathogens during milking. This study evaluates the efficacy of different disinfection methods on teat liners through a randomized controlled field trial conducted on three dairy farms in Germany. The treatments assessed included dipping the liners in water, peracetic acid solution (PAS, 0.1%), and plasma-activated buffered solution (PABS). Total bacterial count (TBC) and the bacterial load of presumptive Staphylococcus (S.) aureus were measured using the wet–dry swab method. The results showed that PAS significantly reduced both TBC and S. aureus by 90% and 99%, respectively. PABS also demonstrated a significant reduction in the bacterial load of S. aureus. In contrast, dipping in water had no significant effect on either TBC or S. aureus bacterial counts. This study suggests that while PAS is the more effective disinfectant, PABS may offer an alternative with some antimicrobial activity. Further research on intermediate cluster disinfection in general is necessary to optimize its application and assess its long-term effectiveness in dairy farming practices. Full article

Endocyn is a root canal irrigant with a stable formulation of hypochlorous acid (HOCl), and should have significant antimicrobial effects. However, there are no available studies that evaluate these effects on different types of bacterial species. In this prospective in vitro study, bacterial species were grown with and without the addition of Endocyn to measure the effects on the Gram-positive bacteria Actinomyces naeslundii, Lactobacillus acidophilus, Streptococcus gordonii, and Streptococcus mutans, as well as the Gram-negative bacteria Porphyromonas gingivalis, Fusobacterium nucleatum, and Veillonella parvula. Turbidity was measured at 24 h, and the differences between the baseline and experimental treatments were measured using two-tailed Student’s t-tests and verified using ANOVA. Gram-positive bacteria were inhibited in the range of −8.2% to −35.5%, p = 0.14 to p = 0.004, while Gram-negative bacteria were inhibited in the range of −16.7% to −41.4%, p = 0.04 to p = 0.001, which were similar to the effects of 5% NaOCl (bleach). These data demonstrated that Gram-positive bacteria were somewhat resistant to Endocyn at lower levels but were inhibited at all higher concentrations, while Gram-negative bacteria were susceptible to Endocyn at all levels, and increased at higher concentrations. These results provide clinically relevant data regarding the efficacy of this disinfectant against common oral pathogens (and commensal bacteria), and are important as they provide evidence regarding public health and the environmental safety of clinical protocols regarding endodontic hygiene. Full article

The literature has identified several common acute and chronic complications associated with periodontal health during pregnancy, such as gingivitis, recession, periodontitis, and changes in systemic health, such as gestational diabetes, which may act as additional risk factors for chronic periodontal disease. Are the general public and health care providers aware of the potential risks of systemic and intrauterine inflammation caused by bacteria from the oral microbiota entering the bloodstream through inflamed gingival tissue and affecting the fetoplacental unit, leading to complications, such as preterm birth and reduced prenatal growth? A questionnaire-based survey, conducted between January 2023 and June 2023, aimed to assess patients’ personal oral hygiene practices and their understanding of the link between pregnancy and periodontal health. A total of 826 people completed a questionnaire for this study. The majority of women surveyed (86.9%) were not pregnant, but 77.7% had at least one child. The majority of women believed in good oral hygiene during pregnancy but lacked knowledge about how oral care can affect pregnancy outcomes. Full article

The customization and handling of implant abutments in prosthetic laboratories can lead to microbial contamination, requiring disinfection before clinical use. This study evaluated cross-contamination in abutments from three prosthetic laboratories, identifying microorganisms and assessing the disinfection efficacy of 2% chlorhexidine digluconate (2% CL) and ultraviolet C (UV-C) radiation. Sixty abutments were analyzed, with contamination detected in 83%, predominantly Enterococcus faecalis (34.2%) and Staphylococcus epidermidis (17.8%). Post-disinfection, CFU reduction was 92% (UV-C) and 93% (CL), confirmed by the Wilcoxon test (Z = −4.373; p < 0.001). A comparative analysis using the Kruskal–Wallis test showed no significant difference between the two methods (p > 0.05). These findings confirm that both UV-C and CL effectively reduce microbial load, providing reliable disinfection protocols for clinical practice. Full article

Background: Microscopy is the conventional method for the identification of gastrointestinal parasitic pathogens in fecal specimens; however, it presents numerous challenges, including high technical expertise burden, multiple staining procedures, and prolonged turnaround time. Molecular methods provide higher throughput and potentially higher sensitivity and specificity. Methods: We validated a commercial, automated DNA extraction platform and multiplex parasitic real-time PCR panel (Seegene Allplex^TM GI-Parasite Assay) detecting six protozoal pathogens: Blastocystis hominis (Bh), Cryptosporidium spp., Cyclospora cayetanensis (Cc), Dientamoeba fragilis (Df), Entamoeba histolytica (Eh), and Giardia lamblia (Gl) in unpreserved fecal specimens submitted for diagnostic parasitology. Microscopy was the reference standard for all organisms, with stool ELISA as an additional reference assay for Eh. Results: Among 461 unpreserved fecal specimens, sensitivity, specificity, positive predictive and negative predictive values of the enteric multiplex for fresh specimens were as follows: 93%, 98.3%, 85.1%, 99.3% for Bh; 100% for all measures in Cryptosporidium and Cc; 100%, 99.3%, 88.5%, 100% for Df; 33.3%, 100%, 100%, 99.6% for Eh; and 100%, 98.9%, 68.8%, 100% for Gl, respectively. With the addition of 17 frozen specimens, the sensitivity for Eh increased to 75%. On a per-batch basis, the molecular platform reduced pre-analytical and analytical testing turnaround time by 7 h. Conclusions: The enteric multiplex platform provides a useful diagnostic tool for clinically relevant enteric protozoa, including Cryptosporidium spp., Cyclospora cayetanensis, Dientamoeba fragilis, and Giardia lamblia. Further evaluation of the assay is required for Entamoeba histolytica prior to clinical use; however, given the widespread availability of confirmatory serology and stool antigen testing for E. histolytica, such performance limitations are of lesser concern. Full article

Maintaining proper hand hygiene is crucial in preventing the spread of infections and other communicable diseases. It is imperative to determine the factors that affect the likelihood of initiating and maintaining the recommended handwashing behavior, especially during a pandemic. This quantitative, secondary study employed a latent profile analysis (LPA) to identify the different attitudes toward behavior change based on the Multi-Theory Model (MTM) framework in the context of following the guidelines provided by the Centers for Disease Control and Prevention (CDC) during the COVID-19 pandemic. Data were collected from 602 college students at a large university in the southern region of the United States (U.S.) in 2020. Seven distinct profiles were identified, each reflecting unique attitudes toward following the recommended handwashing guidelines. Age (p < 0.01) and gender (p < 0.01) disparities were observed between profiles. This study is the first to apply LPA within the MTM framework and provides new insights for the development of targeted interventions based on the construct score profile. Full article

Throughout history, humans have sought to drink water that is good for their health, according to the knowledge of the time. Hippocrates’ definition of water quality, “good water should be clear, light, aerated, without any perceptible odor or taste, warm in winter and cold in summer”, remained virtually unchanged until 1887, when it was added that water should dissolve soap and foam well, be clear and colorless, have a pleasant taste, leave no large deposits after boiling, and cook vegetables and wash clothes well. This definition guided all treatments to remove the substances responsible for cloudiness, odor and discoloration, as well as the choice of resources: clear water and water with low mineral content. The discoveries by Pasteur and Koch led to the addition of microbiological criteria, like the absence of pathogens, and the definition of microbiological indicators. Throughout the 20th century, advances in scientific knowledge in microbiology, chemistry and toxicology led to major progress in treatment methods. These filtration and disinfection treatments are described here according to their historical implementation. Due to progress in numerous areas, e.g., both chemical and microbiological analytical detection limits, speed of information flow and origins of certain diseases that are discovered to be waterborne, the consumer is now exposed to anxiety-provoking news (microplastics, eternal pollutants (cf. per- and polyfluoroalkyl substances (PFASs)), drugs, pesticides residues, etc.). Thus, the consumer tends to lose confidence in tap or bottled water and turn to buying home purifiers. Drinking water treatment will continue to evolve with more sophisticated processes, as analytical progress enables us to expect further developments. Full article

Artificial intelligence (AI) is one of the most promising technological advancements that have revolutionized the healthcare sector (medicine and dentistry). AI and its subsets, such as machine learning (ML), artificial neural networks (ANNs), and deep learning (DL), are being used in dentistry for data recording and management, patient education, radiographic interpretation, diagnosis, and treatment plans. AI and ML tools are commonly employed to improve oral hygiene and patient compliance. This narrative review paper discusses the innovations in AI-based plaque control aids (toothbrushes and interdental aids) that have improved overall health and patients’ hygiene compliance. We performed a literature search using different databases using the following keywords: “Artificial intelligence or machine learning or robots or robotics” AND “Toothbrush OR Smart toothbrush”. We included all the studies evaluating the use of any smart toothbrush, AI, or robotics for oral hygiene, plaque control, and patient education. AI-based smart toothbrushes helped patients to brush effectively by indicating the amount of pressure and the time taken for brushing, along with providing feedback on their brushing performance. Many microrobots can even recognize and automatically remove biofilm. Some AI-based smart toothbrushes are beneficial for children, patients with disabilities lack of manual dexterity, and neurological disorders. However, dental professionals choose AI-based smart toothbrushes for patients with poor oral hygiene and poor compliance for more effective control of oral diseases and to provide better health. Full article

In its broadest sense, the mountain environment represents a setting useful for promoting health. This Italian project, conceived and applied in the Dolomites, aims to encourage multi-sector preventive public health policies; improve refuge hygiene; strengthen safety requirements; and implement projects aimed at promoting health. With the support of healthcare workers (HCWs) of the Prevention Department and other professionals in this field, 27 establishments in the Alpine territory have joined the project, benefiting from being recognized as a “Healthy and Safe Refuge” at the end of the quality improvement process. This process consisted of a documentary assessment, an on-site evaluation, and an assessment of analytical evidence relating to parameters investigated by both HCWs and refuge managers according to specific protocols. Data were collected from a specific database via an application to join the project and from sampling reports of parameters investigated for evaluating the quality of water intended for human consumption. The outdoor Alpine environment has recently witnessed extraordinary development and must continue to meet all health and safety requirements, especially in view of a global event—the Olympic Games—that will be hosted in the Dolomites area in 2026. Full article

Aspergillus spp. are ubiquitous fungi present in soil, organic debris, water, decaying vegetation and dust produced in renovation and/or building work. Several studies have shown the presence of aspergilli in various healthcare environments. Typically, thousands of fungal spores are inhaled every day, but if spore clearance fails (typically in immunocompromised patients), fungi can grow and invade lung tissue, causing invasive aspergillosis (IA) which is one of the most frequent infections in highly immunocompromised patients. Aspergillus fumigatus is the most common species involved; this species can be attributed to about 80% of the cases of aspergillosis. According to the WHO, Aspergillus fumigatus is one of four critical priority fungi. The first-line treatment of diseases caused by Aspergillus, in particular IA, is based on triazole antimycotics. Unfortunately, resistance to antimycotics is increasing, partly due to their widespread use in various areas, becoming a significant concern to clinicians who are charged with caring for patients at high risk of invasive mycoses. A recent WHO report emphasised the need for strategies to improve the response, and in particular strengthen laboratory capacity and surveillance, support investment in research and strengthen public health interventions for the prevention and control of fungal infections through a One Health approach. Full article

The spread of methicillin-resistant Staphylococcus aureus (MRSA) in community settings, including fitness/exercise centers, remains relevant for public health. MRSA, a cause of severe infections in some, can be transmitted through shared equipment and skin contact. Understanding its prevalence and the frequency of antibiotic resistance in such environments can be useful for informing hygiene and intervention strategies. For investigating, multiple environmental swabs were collected from 14 different sites within a fitness facility, including equipment and locker rooms. Samples were collected for characterizing the prevalence of staphylococci (including MRSA), E. coli, and carbapenem-resistant Enterobacterales (CRE). Isolated colonies were identified biochemically and evaluated for antibiotic resistance. Logistic regression was applied to assess risk across different surfaces. Among 42 samples, the highest prevalence of Staphylococcus spp. was on locker room surfaces. S. aureus was prevalent on locker room floors and benches. Non-S. aureus species, such as S. saprophyticus and S. haemolyticus, were common. Resistance to oxacillin and penicillin was widespread, particularly among non-S. aureus species. E. coli was detected once, and CRE was not detected. Fitness center surfaces can harbor staphylococci, including MRSA. The results obtained corroborate other studies finding notable antibiotic resistance among staphylococci from fitness center surfaces. Hygiene improvements, including personal hygiene actions, are essential for reducing transmission risks. Full article

The lack of social determinants of health has significantly influenced COVID-19 mortality; however, the few studies that have investigated the relationship among social capital, vulnerability, and COVID-19 mortality have either shown mixed directions of association or were not conducted at a larger scale on the state level. Our study aimed to fill this research gap. We aimed to test the association of comprehensive vulnerability and social capital measures and COVID-19 mortality in 50 states in the U.S. during the first year of the pandemic. We hypothesized that states with low social capital would register the highest mortality rates and high vulnerability would be proportional to a high number of deaths due to COVID-19 in the U.S. Methods: Our ecological analytic study used aggregate secondary data from nine open access databases. The outcome was COVID-19 mortality (January 2020 to July 2021). The main exposures were social capital and social vulnerability. We also tested 28 covariates and selected socioeconomic variables at the state level. Statistical analysis consisted of a multivariate technique factor analysis and a bivariate Local Indicators of Spatial Association (LISA) analysis. Findings: Social capital (SCI) and social vulnerability (SVI) explained 57% of the COVID-19 mortality rate variation (R² adjusted = 0.57). This analysis resulted in a statistically significant model (p ≤ 0.001), where SCI (β = 23.256, t = 2.649, p = 0.011) and SVI (β = 150.316, t = 4.235, p = 0.001) were predictors for COVID-19 mortality in the investigated period. Full article

This study assessed raw vegetable sanitizing in Brazilian schools and identified barriers to standards. This experimental and quantitative study was conducted in 12 school food services in the Federal District (Brazil) public primary education institutions. Microbiological analyses were conducted with vegetable samples (before and after sanitizing) and water used in the sanitization process, collected before the process. The Petrifilm^®E. coli/Coliform Count Plates and COLIlert methods were used to evaluate vegetables and water samples, and a checklist of good practices was applied in each school food service to identify barriers to proper sanitization. Thirty-five samples of raw vegetables were offered to students, 32 samples of water, and 17 hygiene processes were evaluated. The results indicate that 76.5% (n = 13) of hygiene processes were considered unsatisfactory, with an average increase of 5.8 log CFU g⁻¹ (DV = 7.4) in the initial microbial load in 47.1% (n = 8) of the evaluated processes; moreover, 33.3% (n = 6) of the samples exceeded the tolerable limit, with an average value above 1.5 × 10³ CFU/g. Attention to food handler training and necessary organizational changes is essential to ensure safe food and promote healthy student eating habits, highlighting the importance of strengthening basic hygiene practices and following the parameters for sanitizing vegetables. Full article

Parental willingness is a prerequisite for childhood immunization. This study evaluated whether parental vaccination readiness and willingness, measured using the modified Japanese 7C Vaccination Readiness Scale, predicted vaccination behavior. In December 2021, 2 months before the approval of COVID-19 vaccines for children aged 5–11 years in Japan, 1190 parents of children in this age group were surveyed regarding their intention to vaccinate their children against COVID-19. The survey utilized an online version of the modified 7C Vaccination Readiness Scale, comprising seven components: Confidence, Complacency, Constraints, Calculation, Collective Responsibility, Compliance, and Conspiracy. The modified 7C components were analyzed for model fit and their association with parental intention using structural equation modeling. The scale demonstrated good model fit (goodness-of-fit index: 0.98), with high standardized factor loadings for parental readiness (factor loadings: 0.84). In January 2024, the same parents were surveyed about their children’s COVID-19 vaccination status (valid responses: 536). The relationship between the components of the modified 7C scale and actual vaccination behavior was examined. Parents with low readiness to vaccinate their children against COVID-19 exhibited a significantly higher non-vaccination rate. These findings suggest that the modified 7C scale could support the development of targeted interventions to improve childhood vaccination uptake. Full article