IFH June 2017 Newsheet
1. New publications from IFH
- A unified framework for developing effective hygiene procedures
- The hygiene hypothesis misnomer impacts on tackling antibiotic resistance
2. e-bug – evaluation of educational resources
3. Hand hygiene – new insights
4. Update on laundry
5. New review of the hygiene hypothesis
6. Effective disinfectants vital to food hygiene assurance food hygiene
1. New Publications from IFH
Review: A unified framework for developing effective hygiene procedures for hands, environmental surfaces & laundry in healthcare, domestic, food handling etc settings.
Hygiene procedures for hands, surfaces and fabrics are central to preventing spread of infection in settings including healthcare, food production, catering, agriculture, public settings, and home and everyday life. They are used in hand hygiene, clinical procedures, decontamination of environmental surfaces, respiratory hygiene, food handling, laundry hygiene, toilet hygiene and so on. Although the principles are common to all, approaches currently used in different settings are inconsistent. A concern is the use of inconsistent terminology which is misleading, especially to people we need to communicate with such as the public or cleaning professionals.
This paper reviews data on current approaches, alongside new insights to developing hygiene procedures. Using this data, Bloomfield, Carling and Exner propose a more scientifically-grounded framework for developing procedures that maximize protection against infection, based on consistent principles and terminology, and applicable across all settings.
A key feature is use of test models which assess the state of surfaces after treatment rather than product performance alone. This allows procedures that rely on removal of microbes to be compared with those employing chemical or thermal inactivation. This makes it possible to ensure a consistent “safety target level” is achieved regardless of the type of procedure used, and allows us deliver maximum health benefit whilst ensuring prudent usage of antimicrobial agents, detergents, water and energy.
The paper is available open access on line: GMS Hyg Infect Control. 2017;12:Doc08. DOI: 10.3205/dgkh000293, URN: urn:nbn:de:0183-dgkh0002937 at http://www.egms.de/en/journals/dgkh/2017-12/dgkh000293.shtml
Feature article - The hygiene hypothesis misnomer and its potential impact on strategies to tackle antibiotic resistance
In the latest newsletter from the Alliance for Prudent Use of Antibiotics, Elizabeth Scott and Sally Bloomfield look at how ongoing obsession with the so-called hygiene hypothesis is undermining confidence in hygiene and affecting strategies to tackle antibiotic resistance. Hygiene has a key part to play in tackling resistance by reducing the numbers of people seeking antibiotic treatment. The evidence now shows that hygiene, as the public understands it, is not the underlying cause of the rise in allergic and other inflammatory diseases. The evidence now indicates that the problem is most probably the combined result of lifestyle, medical and public health changes which, particularly in early life, deprive us of exposure to microbial “Old Friends”. These “Old Friends” are not pathogens (as argued by the hygiene hypothesis) but the largely non-harmful species which inhabit the human gut and our natural environment. Changes implicated in depriving us of OF exposure include sanitation, clean water and food, C-section rather than vaginal childbirth, bottle rather than breast feeding, fewer siblings, urbanisation and less outdoor activity. Since communication between “OFs” and the immune system is mediated by the human microbiome, excessive antibiotic use and altered diet can affect the microbiome and further increase inflammatory disease risks. The idea that “home and personal cleanliness” are the culprits is not supported by the evidence.
The question then is how to connect with our microbial world, whilst at the same time protecting against infectious diseases. One thing is clear - we need a smarter approach to hygiene. We need to understand that hygiene is more than “keeping ourselves and our living environment clean”. It is based on understanding the key routes of infection transmission, and targeting hygiene practices in the places and at the times that matter to break the “chain of infection”, particularly at times associated with food, respiratory, hand and toilet hygiene, and homecare nursing etc. The article concludes that attitudes to hygiene will not change until we dispel public misconceptions about the hygiene hypothesis, hygiene, cleanliness and germs.
2. Latest from e-bug: Evaluation of educational resources to teach children and young people about hygiene, the spread of infection and antibiotics
The e-Bug team at Public Health England have recently published two evaluations of their educational resources. The e-Bug peer education workshops were evaluated in 4 schools across South West England, with over 1000 students taking part. Secondary school students were trained to become peer educators and deliver the e-Bug educational activities to their peers. The study found the activities were able to significantly improve knowledge for all topics covered, and teachers reported positive behaviour changes for those students who acted as peer educators. The published article can be found here.
In the second study, three e-Bug online educational games were evaluated with before and after knowledge questionnaires. The study found two of the games were able to increase knowledge and the results have been used to make updates and improvements to the games. The published article can be found here.
3. Hand hygiene – new insights
Insights into the controversy over the effectiveness of antimicrobial soap: Future prospects
In a short review Kim, and Rhee discuss current controversy over antibacterial soaps. Firstly they discuss reasons why some studies show significant difference in bactericidal effects between plain and antibacterial soap, whilst others do not.
Secondly they comment on the FDA final rule on the effectiveness and safety of antibacterial soap, which will come into effect from September 2017. FDA have concluded that, based on the lack of scientific evidence for the effectiveness of antibacterial soap, the risks posed by antibacterial soaps (the negative effects of antiseptic active ingredients on human health and the environment, such as antibiotic resistance, acute/chronic toxicity, endocrine disruption, allergies, and bioaccumulation) outweighs their benefits; thus consumer antiseptic products containing one or more of 19 ingredients, including cloflucarban, triclocarban, and triclosan, can no longer be marketed.
Finally they discuss the need for more research into the efficacy of antibacterial soaps containing a variety of antiseptic active ingredients in order to develop safer and more effective active antiseptic ingredients with a view to using them to replace controversial ingredients. The say “Continuing research into antimicrobial soap will contribute toward the establishment of appropriate regulations and standards for their use in antibacterial soap in personal care settings, and it is expected that this will further improve personal health.
Cold water just as good as hot for handwashing
Don Shaffner and colleagues report a useful new study on the effectiveness of handwashing with soap - but yet again – media reporting shows we simply do not understand how hand washing works. Reports in the Sun, Mail and Express say: “Antibacterial handwash is NO better than soap – and cold water kills as many germs as hot, experts claim”.
The scientific basis of handwashing is that soap helps to detach microbes (and dirt) from the hands which are then removed from the hands by rinsing them under running water. To kill bacteria in any numbers, we need to use temperatures of 60°C or more - which the hands cannot tolerate. There is very little data, but what there is suggests that soap has some bactericidal action, but relatively little and only against some types of organisms. The basis of CDC recommendations to wash hands in warm water is that it works better to remove dirt, food, etc, but this new study shows that – although this may be true – it does not increase the numbers of bacteria removed from the hands by handwashing with soap. The study found that using colder water (15°C) was just as effective as using hot water (38°C), and antibacterial soap was not significantly more effective than plain soap. It also found washing your hands for slightly longer – 30 seconds as opposed to 15 seconds – is more effective at getting rid of the bacteria – so friction is important.
Looking at responses from Daily Mail readers, shows that many people assume that handwashing with soap works by killing the bacteria – despite the lack of evidence to support this. Readers comments also showed another source of confusion – people don’t know how alcohol hand gels work either. One reader said “ As long as you use plenty of soap you’ll have clean hands, it always makes me smile when I see people using antibacterial gel instead of washing their hands , they might be germ free but they are still filthy dirty”....
4. Update on laundry
Low temperature laundering may not be effective in removing fungal contamination from socks
Athlete’s foot (Tinea pedis) is a common chronic skin disease. In early 2013, IFH carried out a review of studies of the hygiene effectiveness of laundering, which showed that relatively few studies examined efficacy against fungal contamination. This study evaluated the efficacy of domestic laundering at different temperatures in the eradication of fungal pathogens from contaminated socks. Samples from 81 socks worn by patients suffering from tinea pedis were laundered at either 40°C or 60°C. Socks washed at 40°C revealed 29 (36%) positive fungal cultures, of which 14 came from the toe and 15 from the heel. Trichophyton rubrum was isolated in 4 specimens, and Aspergillus spp. were found in 20 (70%) specimens. Samples from the same socks washed at 60°C revealed 5 (6%) positive fungal cultures, of which three came from the toe and two from the heel. Only Aspergillus spp. were detected. Yeasts were eradicated at 40°C. The authors concluded that, contravening current trends for energy saving and environmental protection, laundering at low temperatures is not effective in eradicating fungal pathogens, which requires high-temperature laundering at 60°C.
Boaz Amichai, Marcelo H. Grunwald, Batya Davidovici, Renata Farhi , Avner Shemer. The effect of domestic laundry processes on fungal contamination of socks. International Journal of Dermatology. 2013,Volume 52, Issue 11, pages 1392–1394. DOI: 10.1111/ijd.12167
5. New review of the hygiene hypothesis
This mini-review summarizes current knowledge and experimental evidence for the potential of bacteria and their metabolites to be used for the prevention of asthma and allergic diseases.
It gives an up to date review of the epidemiological studies show that reduced exposure to environmental bacteria in early life (e.g birth by caesarean section, being formula-fed, growing up in an urban environment or with less contact to various persons) is associated with an increased risk to develop allergies and asthma later in life. Conversely, a reduced risk for asthma is consistently found in children growing up on traditional farms, thereby being exposed to a wide spectrum of microbes. However, clinical studies are still rare and to some extent contradicting.
The paper looks current, but incomplete understanding of the mechanisms by which environmental microbes influence development of the human microbiome and the immune system and the importance of gaining a better understanding of this issue to enable development of novel preventative approaches that are based on the early modulation of the host microbiota and immunity.
Jatzlauk G, Bartel S, Heine H, Schloter M, Krauss‐Etschmann S. Influences of environmental bacteria and their metabolites on allergies, asthma and host microbiota. Allergy. 2017 Jun 10. doi: 10.1111/all.13220
6. Effective disinfectants vital to assure food hygiene through the food chain
There is concern that food hygiene /safety must not be compromised when considering the future regulation of microbiocides.
EU agreement has been reached for an interim (three year) approach that says food hygiene /safety must not be compromised when considering the future regulation of biocides. More appropriate European biocides regulation (BPR) has been secured, in the medium term at least, following several years concerted lobbying co-ordinated by CFA and endorsed by the UK’s HSE, FSA and the European Commission.
Peter Woodhead, member of the Food & Biocides Industry Group (FBIG) said: “This is an astonishing win. It is a victory for common sense. FBIG is now working on the future of Plant Protection Products legislation to ensure it is not in conflict with the BPR and does not ignore food safety/hygiene.”
FBIG has developed guidance on the use of biocides in cleaning and disinfection, and is leading lobbying in the UK and with the European Commission.
Publication Type: Newsletter