Hygiene

Healthcare-associated infections remain a major public health challenge, and primary health care (PHC) plays a critical role in preventing and interrupting transmission within communities. This study assessed knowledge and self-reported adherence to Standard Precautions and Transmission-Based Precautions among nursing professionals working in PHC. The findings were subsequently interpreted through the conceptual perspective of Infection Containment Readiness (ICR). A cross-sectional census study was conducted in 16 PHC units in Mato Grosso do Sul, Brazil, including 75 eligible nursing professionals. Knowledge was assessed using a validated instrument comprising 47 items distributed across five domains, while adherence was evaluated through 12 self-reported practice indicators. Overall knowledge was satisfactory, with a mean accuracy rate of 78.9%. Higher performance was observed in medication safety and sharps disposal (92.0%), glove use (81.8%), and hand hygiene (77.0%), whereas lower scores were identified in risk recognition (75.6%) and respiratory precautions and cough etiquette (68.2%). Important misconceptions were identified regarding tuberculosis transmission and respiratory infection control. Self-reported adherence was heterogeneous, particularly for respiratory protection measures, tuberculosis-related practices, glove use during capillary blood glucose testing, and participation in continuing education activities. Based on the observed findings and current infection prevention literature, we propose a hypothesis-generating conceptual framework for interpreting ICR in PHC. These findings suggest that strengthening infection prevention in PHC requires strategies that address not only knowledge acquisition but also risk recognition, contextual decision-making, and organizational support for preventive practices. Full article

This scoping review represents the first of 2020–2025, peer-reviewed publications investigating the possible relationships among burnout, nutrition, and nutrition/food literacy during and following the COVID-19 pandemic. The main conceptual insight is that these relationships are addressed only incidentally in existing research. Searches on 9 January 2026 were of the keywords (burnout OR job stress) AND (nutrition OR diet OR eating pattern OR food intake) AND (nutrition literacy OR food labeling) AND (food literacy OR health literacy). An eight-database search produced 160 returns. The included reports from these searches were from Google Scholar alone (n = 6). The addition of four relevant reports from a previous search of “burnout AND nutrition AND (nutrition literacy OR food literacy)” increased the included studies to ten. Although 2020 was the lower date limit, publication of the results was between 2023 and 2025. The finding is that research conducted during this period reports co-occurring issues of burnout, nutrition, and nutrition/food literacy in specific populations. The primary discovery is that assessing the relationships among these terms was not the aim of the included studies. This lack of dedicated research on this topic presents an opportunity for burnout and nutrition researchers to investigate these relationships intentionally. Full article

Background: The widespread use of online review platforms has transformed how patients evaluate healthcare providers and has created a valuable source of patient-generated feedback on healthcare quality. Negative online reviews provide valuable insights into patient experiences and sources of dissatisfaction. This narrative review aimed to synthesize the main themes and concerns expressed in negative online patient reviews across healthcare and dentistry and to explore recurring patterns reported in the available literature. Methods: A narrative literature search was conducted between January 2015 and May 2026. Results: Twenty-two studies were included in the narrative synthesis. Negative online reviews reflected multiple dimensions of the patient experience, including interpersonal, communication, organizational, financial, and clinical concerns. Although the relative prominence of these themes varied across healthcare settings and specialties, dental studies more frequently emphasized treatment expectations, professional trust, and perceived value for money. Conclusions: The findings indicate that patient dissatisfaction expressed in negative online reviews is multidimensional and cannot be interpreted solely through clinical outcomes. Rather than establishing the relative importance of different determinants of patient satisfaction, this review characterizes the themes most commonly expressed in negative online reviews. As a complementary source of patient-generated insights, online reviews may inform patient-centered quality improvement initiatives and support improvements in healthcare service delivery. Full article

This study aimed to evaluate medical students’ hand hygiene knowledge at Balqa Applied University. A cross-sectional study was conducted using the World Health Organization Hand Hygiene Knowledge Questionnaire for Health-Care Workers. Knowledge scores were calculated based on correct responses, and independent-samples t-tests were used to examine differences in knowledge scores between groups. A total of 292 medical students participated. The mean knowledge score was 14.5 ± 2.7 out of 25. Most students demonstrated moderate knowledge (70.9%), while 24.0% had poor knowledge and 5.5% had good knowledge. Knowledge scores did not differ significantly by sex, medical year, or routine use of alcohol-based handrub (p > 0.05). However, students who had received formal hand hygiene training or education achieved significantly higher scores (p = 0.023). Overall, medical students demonstrated a moderate level of hand hygiene knowledge, and formal training or education was associated with better knowledge, emphasizing the value of incorporating hand hygiene education and training into medical curricula. Full article

Background: Toxoplasmosis is a globally prevalent zoonotic infection caused by Toxoplasma gondii, with potentially severe consequences for pregnant women, foetuses, and immunocompromised individuals. Despite its public health importance, epidemiological data on T. gondii infection in Kuwait remain limited and restricted to selected population groups. This study assessed the seroprevalence of T. gondii among community-based adult participants in Kuwait and examined potentially associated risk factors. Methods: A cross-sectional study was conducted in September 2024 in Kuwait City and Jahra governorates. Serum samples from a convenience sample of 200 adults attending governmental polyclinics were screened for T. gondii IgM and IgG antibodies using VIDAS ELISAassays, with IgG-positive samples further analysed for IgG avidity. Demographic and exposure data were collected using structured questionnaires. Univariable and multivariable associations between demographic and exposure-related factors and IgG seropositivity were statistically evaluated. Results: The overall IgG seroprevalence was 11.5% (23/200), with no significant difference between governorates. All samples were IgM-negative, and all IgG-positive and equivocal samples showed high avidity. Age >40 years was associated with seropositivity in univariable analysis, but this association was not significant after adjustment (aOR = 2.21, 95% CI: 0.88–5.89; p = 0.092). No significant associations were observed with sex, nationality, educational level, travel history, cat ownership, or contact with stray cats. Conclusions: Among the participating community-based adults in Kuwait, T. gondii seroprevalence was lower than that reported in several regional studies, with serological findings consistent with past rather than recent infection. No demographic or exposure-related factor was independently associated with seropositivity. Larger population-based studies specifically powered to investigate risk factors and incorporating dietary, occupational, environmental, and migration-related exposures are needed to better characterise transmission pathways and inform targeted One Health surveillance and prevention strategies. Full article

This study investigated the microbiological quality of “aguas frescas” (fresh fruit drinks) by using fecal coliform and E. coli as microbiological indicators of food safety culture in three types of markets: those with reputable established quality systems (RMQSs), those of reputable brands governed solely by NOM-251 (RMNs), and popular markets (PMs). Additionally, other hygiene aspects outlined in the Mexican regulation NOM-251 were evaluated. Results showed that 100% of samples from RMQS met the permissible limits for both parameters. In contrast, 53% of RMN samples and 75% of PM samples were non-compliant for fecal coliforms. Similarly, non-compliance with E. coli was observed in 40% of RMN and 51% of PM samples. These findings highlight a clear disparity in “aguas frescas” quality across different market types. Moreover, a lack of food hygiene practices was detected in those RMN and PM establishments. Lower compliance rates were observed for the use of face masks (60%), hairnets (43%), and gloves (30%). Certain aspects of the study demonstrated deficiencies in food handling, encompassing both preparation and preservation methods. The data highlight a need for improved training and enforcement of hygiene practices. Full article

Background: Rickettsioses are emerging diseases worldwide caused by intracellular bacteria of the genus Rickettsia. In recent years, these diseases have caused deaths in northwestern Mexico, particularly cases of Rocky Mountain spotted fever (RMSF). While ticks are considered the primary vector for RMSF, other possible vectors of rickettsioses, such as fleas, lice, and mosquitoes, coexist with reservoirs, including dogs, cats, and other domestic animals that may interact with humans. This study aimed to detect the presence of Rickettsia spp., including spotted fever group (SFG) Rickettsia, in arthropod vectors not previously reported in northwestern Mexico using real-time polymerase chain reaction (qPCR). Methods: Ticks, fleas, lice, and mosquitoes were collected from dogs, cats, guinea pigs, and humans. qPCR was used to detect Rickettsia spp. and SFG Rickettsia. Results: Rickettsia spp. were detected in dog ticks (Rhipicephalus sanguineus) and cat fleas (Ctenocephalides felis), with pooled positivity rates of 13.5% and 22.2%, respectively. Conclusions: These results suggest that ticks and fleas are the main arthropod vectors involved in transmitting Rickettsia spp. in northwestern Mexico. Full article

Self-ear cleaning is widespread in Saudi Arabia, yet public knowledge about proper ear hygiene and associated risks remains variable. This study aimed to assess knowledge, attitudes, and practices regarding self-ear cleaning among adults in the Northern Border Region and to situate the findings within the context of previous studies from other Saudi regions. A cross-sectional online survey was conducted among 534 adults (ages 18–60) residing in the Northern Border Region of Saudi Arabia. Data were collected using a validated questionnaire that assessed sociodemographic characteristics, knowledge, attitudes, practices, and self-reported complications related to self-ear cleaning. Knowledge was evaluated using 8 items, with 1 point per correct response (total score 0–8), and good knowledge was defined as ≥5 correct responses. Most participants (89.1%) reported practicing self-ear cleaning, predominantly using cotton buds (73.7%). Although many recognized potential harms (81.4% believed cotton buds could push wax deeper and 78.1% were aware of the risk of eardrum perforation), 64.1% still believed regular self-ear cleaning was necessary, indicating a knowledge–practice gap. Reported complications included otitis externa (50.6%), pain (44.0%), and bleeding (18.9%). In multivariable logistic regression, higher knowledge was independently associated with postgraduate education, healthcare employment, non-smoking status, and a history of hearing problems. Comparative synthesis with previous surveys from other Saudi regions revealed broadly similar prevalence, preferred tools, and complications, suggesting that self-ear cleaning is a common and often risky behavior nationwide. In conclusion, self-ear cleaning is prevalent in the authors’ region despite substantial awareness of its risks, and a persistent knowledge–practice gap was observed. While the cross-sectional, convenience-sample design limits causal inference and generalizability, these region-specific findings may help inform targeted educational messages and future interventional studies aimed at promoting safer ear hygiene and reducing avoidable ear-related morbidity in similar settings. Full article

Transport cages used for live poultry constitute a major source of cross-contamination in slaughterhouses, particularly regarding Salmonella spp. The aim of this study was to evaluate the improvement of washing parameters—specifically temperature and detergent conductivity—in reducing Salmonella contamination as well other microbial parameters in turkey transport cages under industrial conditions. Six washing conditions were tested by combining three temperatures (40, 45, and 60 °C) and different detergent conductivities (0–4 mS/cm), using an alkaline chlorinated detergent. Microbiological analyses included Salmonella spp. and indicators such as mesophilic aerobic bacteria and Enterobacteriaceae, assessed before and after washing at three time points during the processing day. High initial contamination levels were observed in all cases. Results demonstrated a clear synergistic effect between temperature and detergent conductivity. The treatment at 60 °C and 2 mS/cm provided the most effective balance, achieving total elimination of Salmonella and significant reductions in indicator microorganisms without the need for maximum detergent concentration. Increasing conductivity beyond this level did not lead to substantial improvements. These findings support the optimization of washing parameters as a key prerequisite program within HACCP systems in poultry slaughterhouses. Full article

Quality management and internal audit are important components of patient safety, regulatory compliance, and service quality in dental practice. This narrative review examined the current status of quality management and internal audit in Romanian dental settings and explored challenges and future development opportunities in relation to European quality standards. A narrative review of the literature was conducted using PubMed, Scopus, Web of Science, and Google Scholar, complemented by an analysis of Romanian regulatory documents relevant to dental practice. The reviewed evidence suggests that quality management in Romanian dental services remains largely focused on regulatory compliance, particularly infection control and documentation requirements. Internal audit is rarely implemented as a structured tool for continuous quality improvement, while the lack of standardized audit frameworks and quality indicators limits objective performance evaluation. Additional challenges include variability in organizational resources, limited audit-related training, and uneven digital integration. Strengthening internal audit procedures and developing standardized quality-management frameworks may support continuous quality improvement and closer alignment with European quality standards. Full article

Environmental contamination represents an important risk factor for the transmission of healthcare-associated pathogens in both human and veterinary medicine. In equine hospitals, open stable environments and high patient turnover may further increase the risk of microbial spread. The aim of this study was to evaluate the hygiene status of an equine referral hospital and to assess the effect of implementing standardized cleaning and disinfection procedures combined with targeted staff training on environmental microbial burden. Surface samples were collected using agar contact plates from predefined environmental surfaces in surgical areas, examination rooms, and stable units of an equine clinic. Sampling was conducted during three investigation periods: prior to intervention, after implementation of revised cleaning protocols and staff training, and during a later follow-up assessment. Colony-forming units (CFU) were quantified and categorized into an ordinal contamination scale (0–4) to enable standardized statistical analysis. Furthermore, delta values were calculated for every sampling period, describing the reduction in the environmental microbial burden. Pre- and post-cleaning microbial burdens were compared using nonparametric statistical methods. A total of 76 locations were sampled before and after cleaning and disinfection in sampling period 1 and 2; in sampling period 3, sample collection focused on sensitive surfaces, and 21 locations were sampled. Bacterial contamination varied considerably between functional areas, with the highest baseline contamination consistently observed in stable environments. Examination and surgical areas showed heterogeneous contamination patterns, particularly on high-touch surfaces, such as keyboards, switches, and door handles. In sampling periods 1 and 2, cleaning and disinfection significantly reduced microbial burden. The delta values in sampling period 2 were significantly lower than the delta values in both sampling period 1 and sampling period 3. These findings demonstrate that environmental contamination in equine hospitals is highly variable and influenced by surface type, clinical workflow, and proximity to patients. Structured hygiene interventions, including standardized cleaning protocols and continuous staff education, can significantly improve environmental hygiene and should be integrated into infection prevention programs in veterinary clinical facilities. Full article

The occupational health implications of solar photovoltaic (PV) recycling remain critically under-investigated. This study assessed occupational exposure across the PV recycling value chain in Taiwan, evaluating primary mechanical dismantling and downstream reuse sectors (glass milling and controlled low-strength material [CLSM] batching). Area and personal samples were analyzed for total dust, respirable dust, and trace heavy metals. Results indicated that primary mechanical crushing yielded relatively low ambient dust and negligible toxic heavy metal (e.g., Pb, Cd) aerosols, attributed to the macroscopic ductility of metallic ribbons and EVA shock-absorbing properties. Conversely, a critical “hazard transfer” phenomenon was empirically identified downstream, where intensive secondary grinding and aggregate blending in the downstream reuse sector (glass milling and CLSM batching) systematically shifted the aerodynamic particle size distribution, causing the respirable dust fraction to surge to 38.9–72.6%. The pursuit of zero-waste material circularity inadvertently amplifies highly dispersive, respirable dust hazards in downstream sectors, necessitating targeted occupational exposure controls. Full article

Objectives: Inadequate access to safe water, sanitation, and hygiene (WASH) continues to drive infectious diseases, malnutrition, and educational disparities, particularly among vulnerable populations. This systematic review examined WASH intervention strategies implemented in Malaysia between 2014 and 2025, focusing on shifts in hygiene-related knowledge, attitudes and practices (KAP), health outcomes, infrastructure improvements, and implementation challenges. Methods: A comprehensive search across five databases (Science Direct, PubMed, Scopus, Web of Science, and Google Scholar) identified twelve eligible studies targeting schools, healthcare settings, and rural or Indigenous communities. Results: Education-based interventions predominated (n = 10), often employing participatory and theory-driven approaches grounded in the Health Belief Model or Information–Motivation–Behavioural Skills framework. Evidence revealed significant improvements in KAP, particularly when digital, gamified, or storytelling elements were integrated. Community-led and caregiver-inclusive models demonstrated greater behavioural adoption and retention. Thematic analysis identified several implementation challenges, which include (i) sole reliance on self-reported outcomes with limited use of objective indicators, (ii) short intervention durations (<2 months) that limit long-term impact, and (iii) lack of policy and curriculum integration. Conclusions: Findings underscore the need for culturally tailored, longitudinal, and system-embedded interventions that combine behavioural theory with infrastructure investment. Integrating WASH initiatives into Malaysia’s health and education frameworks could advance Sustainable Development Goal 6, ensuring scalable and equitable improvements in hygiene literacy, community resilience, and public health outcomes. Full article

Infection prevention and control (IPC) is imperative to ensuring patient safety; however, public hospitals in Limpopo Province suffer from poor infrastructure, lack of education, and lack of surveillance. The purpose of this research was to evaluate the performance of IPC programs within Limpopo Province and develop an evidence-based improvement strategy using the WHO Multimodal Framework. A mixed-methods research approach was used over three different phases. In Phase I, retrospective data on IPCAF were collected on all 41 public hospitals. In Phase II, semi-structured interviews were conducted with six IPC nurses. Descriptive statistics (medians and interquartile ranges) were used for quantitative analysis, while qualitative data were analyzed using thematic analysis in ATLAS.ti. An evidence-informed strategy was formulated in Phase III. Overall IPC program performance was moderate (median IPCAF score: 618.0/800), with 58.5% of hospitals having advanced status, 39.0% intermediate status, and 2.4% basic status. The most poorly performing component was workload/staffing (CC7: 60.0). Districts scored between 576.2 (Capricorn) and 636.0 (Mopani). Lack of standardized education, understaffing, and role ambiguity were the main barriers identified. The strategy uses the “Build It, Teach It, Check It, Sell It, Live It” framework. Full article

Background: Open defecation (OD) has remained a threat to the attainment of SDG 6 (sanitation and hygiene). This study measured the level of exposure to the “Clean Nigeria, Use the Toilet” campaign against open defecation, determined the level of public knowledge about open defecation-related harms and diseases, ascertained the public attitude towards open defecation, and established the prevailing defecation practices and the perceived barriers to toilet usage in Ebonyi state, the most prevalent OD state in Nigeria. Methods: The study employed a survey design, using a structured questionnaire for data collection. The multi-stage sampling technique was employed in selecting the respondents from two randomly selected Local Government Areas (LGAs) in the state. Analysis was conducted using 384 valid responses. Results: The results were presented in simple percentage frequency tables and interpreted through the descriptive method, while the Chi-Square test was used to analyse the formulated hypotheses, using the decision rule of p < 0.05. The findings show a high level of awareness of the campaign against open defecation, through the radio and community engagements by environmental activists/NGOs, even though regular access to such information was limited. The results also showed inadequate knowledge of the public health implications of open defecation, whereas good knowledge of environmental consequences was reported. The study found favourable attitudes toward OD practice and persistent open defecation, and major barriers to toilet usage include the high cost of toilet construction, lack of access to toilet facilities, poor sanitation and management of available toilets, and perceived risks of contracting infection from public toilets. However, the Chi-Square values showed that the SBCC campaign was significantly associated with knowledge, attitude, and practice (p < 0.05). Conclusions: The study concluded that localised, culturally relevant and socio-demographically targeted communication interventions, grassroot advocacy, community watch, and neighbourhood taskforce on open defecation, in addition to the provision of aids for the construction of modern toilets with water facilities, are required to combat open defecation in Ebonyi and related contexts in Nigeria. Full article

The increasing demand for safe, minimally processed, and sustainable food preservation strategies has intensified interest in light-activated antimicrobial systems derived from natural sources. This review examines the application of plant-derived photoactive compounds as functional agents that generate reactive species upon illumination, thereby facilitating effective microbial inactivation. Emphasis is placed on the diversity of phytochemicals exhibiting light-responsive properties, their mechanisms of action, and the factors influencing their efficacy, including physicochemical characteristics, environmental conditions, and formulation strategies. The review further discusses the role of delivery systems in improving the stability, solubility, and bioavailability of these photoactive compounds, as well as the influence of food matrix complexity on treatment performance. Applications across a range of food systems, including fresh produce, animal-derived products, and food packaging materials, are evaluated to demonstrate their practical relevance in food preservation. In addition, current challenges are critically highlighted, including variability in plant extract composition, limited understanding of photosensitiser behaviour within complex food matrices, restricted light penetration, and challenges associated with standardisation and scalability. This work provides an overview of emerging natural photoactive systems and their potential to advance safer and environmentally sustainable food preservation technologies. Full article

Background: Food contamination in institutional food service settings remains a significant public health concern, particularly where large numbers of consumers are exposed daily. This study aimed to assess chemical and microbiological contamination, evaluate food handlers’ knowledge, attitudes, and practices (KAP), and identify contamination patterns in university food outlets. Methods: A cross-sectional study was conducted across all 77 food outlets within a university in northern Thailand. KAP was assessed using a structured questionnaire, while chemical and microbiological contamination were evaluated using standard screening methods. Results: Food handlers demonstrated generally high KAP scores; however, microbiological contamination was still observed, including Escherichia coli on food handlers’ hands (27.3%) and food-contact utensils (14.3%), as well as Salmonella spp. in ready-to-eat food (6.5%). In contrast, chemical contamination was rarely detected in screening tests. Moreover, cluster analysis identified four distinct contamination patterns, indicating heterogeneity in contamination risk across outlets. Conclusions: These findings suggest that reported food safety practices may not fully prevent contamination and that food safety management should incorporate both behavioral and operational controls to effectively reduce contamination risks in institutional settings. Full article

Background: Healthcare-associated infections (HAIs) and antimicrobial resistance are major global public health challenges, influenced by patient clinical complexity and prescribing practices. Methods: Three-point prevalence surveys (PPSs) were conducted (P1: November 2024; P2: June 2025; P3: November 2025), involving 456 patients at the University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy. Results: The prevalence of HAIs fluctuated between 3.1% (P1) and a peak of 6.1% (P2), before decreasing to 1.9% (P3), correlating with the presence of multidrug-resistant pathogens in critical care areas. The prevalence of antibiotic use remained stable (~48%), with a decrease in carbapenem use (from 12% to 9%). A decline in ‘unknown’ McCabe scores from 24.6% to 6.8% (p < 0.001) was also observed, suggesting an improvement in completeness of prognostic data, although changes in data collection practices may also have contributed to this change. Conclusions: We showed an association between clinical severity, prolonged hospitalization, invasive device use, and infection risk in a single tertiary-care hospital, within an exploratory, cross-sectional framework. Despite high healthcare pressure, improvements were observed in antimicrobial stewardship and clinical surveillance. Future strategies should focus on optimal device management and on extending surveillance activities to medical wards with increasing patient complexity. Full article

Human norovirus is a leading cause of acute gastroenteritis, with prevention largely dependent on individual hygiene behaviors. Understanding the cognitive determinants of these behaviors is essential for designing effective prevention strategies; however, validated hygiene-specific measures grounded in behavioral theory remain limited. This study presents an initial, exploratory examination of Protection Motivation Theory constructs, some of which overlap with core principles of Social Cognitive Theory, as they relate to hygiene behaviors for human norovirus prevention. Survey data were collected from a sample of college students, and principal component analysis was used to examine the dimensionality and internal structure of theory-informed scale items. Sampling adequacy was supported by Kaiser–Meyer–Olkin indices indicating acceptable to meritorious suitability for exploratory analysis. Results revealed coherent component structures for threat and coping appraisal constructs, while a distinct response cost component did not emerge. Item retention decisions were guided by both statistical criteria and theoretical interpretability. Findings are discussed within the context of early-stage scale development, with attention to implications for theory-informed measurement refinement and future validation efforts. This preliminary work provides a foundation for advancing the assessment of hygiene behaviors relevant to human norovirus prevention. Full article