IFH Newsheet October 2014
IFH Newsheet October 2014
1. Latest from IFH
2. Focus on laundry
3. Other news and new research
4. “Hygiene hypothesis” and hygiene – latest news
5. Antibiotic resistance and hygiene
6. New resources
7. Upcoming events
Get the latest news & research as it happens – Follow IFH on Twitter @IFH_homehygiene
1. Latest from IFH
New IFH report: Are antibiotics a contributory factor to the rise in allergic and other Chronic Inflammatory Diseases?
A key strategy being used to tackle the global problem of antibiotic resistance is the control of antibiotic prescribing. If, as seems likely, antibiotic overprescribing is also a causative factor in the rising levels of inflammatory diseases such as asthma, eczema, hay fever and so on, this provides a further argument which could be used to discourage parents from seeking antibiotic treatments for their children for minor infections, or for infections which are viral in origin.
This new IFH report reviews the epidemiological studies (more than 40) which have evaluated the possible link between antibiotic usage and the development, primarily of asthma, but also eczema, cow’s milk allergy and irritable bowel syndrome (IBS). Although there is still much concern and discussion that there may have been some overestimation of the association, due to confounding factors such as reverse causation, many or most workers now agree that there is strong evidence that antibiotic usage during pregnancy or the neonatal period, is a contributory factor in the development of these diseases, although the extent of this association is not clear, and certainly other factors are also involved.
A potential explanation for this effect is that broad spectrum antibiotics alter the gut microbiota, which in turn affect the maturing immune system in a way that promotes allergic disease development. This concept has its origins within the so-called “hygiene hypothesis. The two more recent, and now more widely accepted, theories about this concept are that the human body requires exposure to a broad range of microbes, particularly during early development, but that these are the largely non harmful microbes which make up the microbiota of our human (gut, skin etc), animal and natural environments. The IFH report also reviews animal studies, which increasingly support the concept of a link between early-life antibiotic use and development of allergic diseases and are beginning to reveal the mechanisms by which this can occur.
The report can be found at: http://www.ifh-homehygiene.org/review/are-antibiotics-contributory-facto...
2. Focus on laundry
Is low temperature laundering hygienic?
Whilst reducing domestic laundering temperatures can make a significant contribution to reducing domestic energy consumption, it is important to question the possible adverse impact on the hygiene effectiveness of the laundering process.
A newly published study by Professor Bockmuhl and colleagues at the University of Bonn and the Rhine-Waal University of Applied Sciences is a systematic evaluation of the impact of wash cycle time, temperature and detergent formulation on the hygiene effectiveness of domestic laundering. The study demonstrates that it should be possible to compensate for the loss of hygiene effectiveness of laundering at lower temperatures by using detergents with activated oxygen bleach or by extending the wash cycle time.
The study is published online at: http://onlinelibrary.wiley.com/doi/10.1111/jam.12647/abstract
Are your dirty bedsheets an infection risk to your family?
A UK YouGov survey of people’s habits shows that only one third say they change sheets once a week, whilst 37% of 18-24 year-olds change sheets just once a month, and only 16% were weekly washers. One in ten confessed they didn’t bother to throw their linen in the washing machine more than once a month. Asked when they considered unwashed sheets to become unhygienic, half said between 2 and 3 weeks. As to when they became ‘disgusting’, women said 5 weeks on average, while men said 6.
The older we get, the fussier we get. Among the over-60s, 42% laundered sheets weekly, and only 14% left bedding more than 3 weeks without a wash.
The IFH review of the scientific data indicates that clothing and household linens can spread infections, although the risks are probably less than those associated with poor hand hygiene and poor food hygiene. Nevertheless, laundry hygiene is an important component of families’ hygiene routines, particularly in a large household group, who all share the same washing machine. Germs spread from dirty to clean items in the wash cycle, which can spread infections from one family member to another.
Contamination levels increase with wear or usage time, and the more contaminated that items in the wash load are, the greater the risk becomes that laundering, particularly at low temperatures will fail to make them hygienically clean.
Also, skin cells and sweat, which build up on sheets, attract dust mites. The mites, though otherwise harmless, produce droppings containing allergens that can trigger asthma, rhinitis and itching eyes.
The IFH report can be found at: http://www.ifh-homehygiene.org/review/effectiveness-laundering-processes....
A fact sheet with advice on laundry hygiene can be found at: http://www.ifh-homehygiene.org/factsheet/clothing-household-linens-laund...
Cleaning cloths and the spread of infection – a new study
Over the years, various studies have documented the common occurrence of large populations of bacteria surviving in kitchen sponges and dishcloths. These items readily pick up bacteria from surfaces where the moist environment and collected food residues create ideal conditions for their survival. Other studies have shown that contaminated kitchen sponges and dishcloths play a role in spreading contamination to other surfaces and to the hands.
This new study by Dr Charles Gerba and colleagues at the University of Arizona investigated the occurrence of bacteria in towels used to dry dishes, hands and other surfaces in the domestic kitchen. A total of 82 kitchen hand towels were collected from households in five major cities in the United States and Canada.
Results showed that all kitchen towels for the 5 cities had a total count at least 1 × 103 CFU/towel up to 1 × 109 CFU/towel or more for some samples. Escherichia coli was found in 25.6% of towels with counts up to 1 × 104 CFU/towel observed in some cities. The presence of E. coli is important because it is strongly suggestive that the cloth had become contaminated with organisms from human or animal sources, or from contaminated raw food such as poultry. Lower total numbers occurred in towels that were washed less.
E. coli numbers also were related to the frequency of washing, with numbers on towels being lower the more often they were washed. The age of the towels and the number of days since they were last washed did not influence the concentration of bacteria in them. These results demonstrate the importance of good hygiene for cleaning utensils used in the home. The study is published in Food Protection Trends 2014;34:214-217.
An IFH hygiene advice sheet, “Look after your cleaning cloths and they will look after you”, can be found at: http://www.ifh-homehygiene.org/factsheet/look-after-cleaning-cloths-your-home-%E2%80%93-and-they-will-look-after-you
3. Other news and new research
Hygiene Week 2014 – a report from the Danish Council for Better Hygiene
A longstanding challenge in hygiene promotion has been the issue of people’s interest – the notion, that consumers, citizens, and media simply weren’t interested in hygiene. Well, the times they are a-changin’!This year the Council for Better Hygiene in Denmark held our sixth consecutive bi-national Hygiene Week. This has evolved from small beginnings in 2009 into a major event known to (and featuring contributions from) professionals, municipalities, hospitals and the media. Since starting with 7 Danish active municipalities and 2 hospitals in 2009 the event has grown to include 48 Danish municipalities, all 5 Danish hospital regions and 21 Swedish municipalities. It has also triggered an explosion of interest and activities at a local level in all kinds of institutions, schools and workplaces.
We have now managed to engage healthcare professionals, their co-workers, local citizens, consumers, and journalists to a point where hygiene activities and the key messages are now seen as a natural part of a healthy lifestyle. This has been achieved by promoting good hygiene messages, plus providing lots of free, easy-to-use campaign materials, and good advice and ideas on activities, handling media contacts and strengthening inter-departmental cooperation.A possible downside is the gigantic growth in the amount of information and practical advice we are being asked for – on all areas from basic “how-to” to risk assessments. We face a constant challenge of giving good answers to tough questions in areas where we simply don’t know as much as we would like, since research on a wide range of hygiene questions is still catching up.
Focusing on new arenas – In 2014 we focused on hygiene policies and the efficacy of these in well-established settings but also in less common arenas. Why is it that most office workplaces (in northern Europe anyway) face the same challenge of flu, colds, and stomach ailments every year come October-November-December – yet almost no employers consider their policies (or indeed even have them) on targeted hygiene? Productivity, performance and sick leave is a key focus of public campaigns on working environment and employment – yet these campaigns often fail to look at communicable diseases, considering only stress, exercise, and ”good management”.
Also, should schools not consider having a strategy towards better hygiene? We know that better hand hygiene improves attendance – and a lot of schools struggle to deliver good toilet facilities that pupils will actually use as intended. Yet not very many teachers consider hygiene (teaching or using) in their work.
In the Council for Better Hygiene, we set challenging goals and dare to push hygiene a bit further every year. 2014 was no exception and we hope to set new records for the Hygiene Week in 2015 – people are certainly interested now.
Dishwashers identified as a source of Legionella in Japan
Researchers in Japan found Legionella bacteria in hospital staff areas during a 2011 water inspection, which lead them to conduct studies to determine whether contamination was a widespread problem.
They conducted a retrospective study of 5 years of patient medical records from 2006 to 2011, and an environmental building inspection to identify areas of contamination in the water system. They found no evidence of patient infections during the investigation period. They collected specimens from 17 faucets in the inpatient and staff areas and from the 14 dishwasher connections that were all in the staff areas. Five of the 17 faucets and seven of the 14 dishwasher connectors were contaminated with Legionella. The five contaminated faucets were connected to the same hot water pipelines as the seven dishwashers. The L. pneumophila SG6 strains isolated from the faucets and dishwashers were identified using PCR. Although the presence of legionella in domestic showerhead units or dishwashers is unlikely to be a problem in households where family members are generally healthy, it is a potential risk where one or more family members are immune-compromised.
Source: Yoshida M. Abstract K-1677. Presented at: Interscience Conference on Antimicrobial Agents and Chemotherapy; Sept. 5-9, 2014; Washington, D.C.
How to control the spread of viruses from the office to your hotel room
New data presented by Dr Gerba at the 2014 ICAAC conference in the USA, using tracer viruses, showed that contamination of a single doorknob or table top results in the spread of viruses throughout office buildings, hotels, and healthcare facilities. Within 2 to 4 hours, the viruses could be detected on 40–60% of workers and visitors in the facilities, and on commonly touched objects.
In the office, the first area contaminated was the coffee break room. Viruses also traveled from room-to-room as hotel staff cleaned the rooms. Using EPA-approved disinfecting wipes registered by EPA as effective against viruses like norovirus and flu, along with hand hygiene, reduced virus spread by 80 to 99%.
The results show that simple interventions on high touch areas (tv remotes, door knobs, sink faucet handles, toilet flush handles and telephones) significantly reduce the spread of viruses.
4. “Hygiene hypothesis” and hygiene – latest news
The “hygiene hypothesis” is a misnomer – long live the biome depletion hypothesis!
In a new article published in the BMJ, Professor William Parker, Duke University, North Carolina, suggests “Biome depletion” is a better term for how immune function is undermined in industrialised societies.
He argues that the term “hygiene hypothesis” has become a highly misleading misnomer because hygiene today is associated much more with “handwashing and the use of a dust mop” rather than the revolutionary 20th century technological advances such as sewer systems and water treatment facilities which were the early causes of microbiome depletion in Western culture.
He says “allergies and autoimmune diseases are not caused by “hygiene” as people now think of it. On the contrary, lack of handwashing often results in an increased incidence of acute respiratory infections, many of which exacerbate rather than mitigate allergy and autoimmunity. Rather, modern hygienic practices often alleviate, not increase, allergy, by reducing levels of allergens produced by dust mites, cockroaches, mould etc”.
He also argues that the issues arising from inaccurate term “hygiene hypothesis” are now compounded because “biome depletion” can no longer be considered a hypothesis. So, not only is the underlying cause of allergy and autoimmunity unrelated to hygiene as we currently understand it, but our understanding of the cause ceased to be a hypothesis some years ago.
He also raises the concern that inaccurate use of the term “hygiene hypothesis” in connection with dreaded immune diseases gives credence to the view that hygiene is not beneficial. This potentially undermines public health efforts aimed at avoiding the spread of infectious disease. Equally importantly, the term diverts attention from the intuitive solution to the problem of biome depletion: biome enrichment or restoration.
The article can be found at: BMJ 2014;349:g5267 doi: 10.1136/bmj.g5267 (Published 26 August 2014).
Understanding the microbes in our homes
A new study by Dr Jack Gilbert and his team shows how new techniques are helping us to understand how microbes (both harmful and non-harmful) move around our homes and how we interact with them. This is important because we increasingly realise that the bacteria that colonise humans and our built environments have the potential to influence our health in a positive manner as well as by causing disease.
In this study, the microbial community (microbiome) associated with 7 families and their homes over 6 weeks were assessed, including 3 families that moved house. The types of microbes differed substantially among homes, and were largely sourced from the humans living there. Humans were also identified as the most important vector of microbes in each home. Potential human pathogens observed on a kitchen counter could be matched to the hands of occupants. After a house move, a microbial community similar to the one in the old house was rapidly established, again suggesting colonisation by the family’s microbiota.
The publication can be found at: http://www.sciencemag.org/content/345/6200/1048.short
Germs in the office often found on keyboards and at coffee stations
An article published in the Wall St Journal on September 30 is an interesting example of the confused and misleading discussions in the media between too much or too little exposure to microbes.
The article refers to new research at the University of Arizona that shows how easily a virus can spread from a contaminated push-plate door at an office building entrance. Within two hours, the virus had contaminated the restroom coffee pot, microwave button and fridge door handle – and then spread to restrooms, individual offices and cubicles. There, researchers found, the virus had contaminated phones, desks and computers.
By four hours, they found the virus on more than 50% of the commonly touched surfaces and on the hands of about half of the employees in the office. By giving employees hand sanitizer and disinfectant wipes to use, detection of the virus on people's hands was reduced from 39% to 11%.
The article then goes on to quote a scientist who is working on the hygiene/biome depletion hypothesis who says he generally doesn't recommend hand sanitizers and disinfectant wipes because they kill good bacteria, which can help protect against bad bacteria. Exceptions, he says, are in “hospitals and during flu season”. He adds, “In our desire to get rid of bad bugs we're also getting rid of good bugs."
Surely however - on the basis of what we now know about the so called hygiene hypothesis, the question we urgently need to ask is “How do we re-engage with the ‘good guys’ and minimise exposure to the ‘bad guys?’”
It’s not that we need more or less hygiene or cleanliness; what we need is targeted hygiene. In other words, the focus should be on hand hygiene, food hygiene, respiratory hygiene, etc – where the ‘bad guys’ are most usually circulating – at times when there is a risk and not just when someone is infected or immune-compromised.
Killing a few resident good bacteria on the hands, at the times that matter, is not a problem but very important to eliminate the “transient pathogens” and thereby reduce risks of food, GI and respiratory, etc., infections. How can we get the concept of targeted hygiene across?
5. Antibiotic resistance and hygiene
Promoting hygiene in home and everyday life settings as a means to tackle antibiotic resistance
One of the key strategies in tackling this problem, alongside antibiotic stewardship and developing new antimicrobials, is a greater emphasis on improving our infection prevention and control practices to prevent the spread of resistant strains.
Strategy documents are now being drawn up, both nationally (see below) and internationally (WHO) to put these measures into effect. If you examine these documents, however, the emphasis is almost exclusively on preventing spread of resistant strains in healthcare settings. There is little or no mention of applying these strategies in “home and everyday life settings.
Promoting hygiene at home and community level addresses the resistance problem in 2 ways. Firstly it can reduce the incidence of infection and the numbers of patients seeking courses of antibiotics from their doctor. Secondly it can reduce the silent spread of resistant strains within the healthy population.
If it is correct that many or most healthcare associated infections are infections which source from the patients own body flora, then, as the carriage of resistant strains in the healthy community increases, so does the incidence of resistant healthcare infections. Why is this community aspect being ignored?
Simple measures, like ensuring that underclothing, socks, towels and bedlinen are laundered in a manner which ensures that they are made not just clean but hygienically clean can ensure that resistant skin and bowel strains are not spread amongst household members. Unlike handwashing, you don’t have to persuade people to launder their clothes!
An IFH review of the data on prevalence and spread of antibiotic resistant strains in the community can be found at http://www.ifh-homehygiene.org/review/spread-antibiotic-resistant-strain....
Tackling antimicrobial resistance: UK government response (Sep 2014)
The UK Department of Health has published the government response to the House of Commons Science and Technology Committee report “Ensuring access to working antimicrobials”. It can be found at: https://www.gov.uk/government/publications/tackling-antimicrobial-resist....
The report identifies a number of areas where further action is required to build on the call for action to address human and environmental aspects of antimicrobial resistance that was set out in the UK Antimicrobial Resistance Strategy document (https://www.gov.uk/government/publications/uk-5-year-antimicrobial-resis...). The 2014 report will contribute to the work being carried out to develop an action plan, which will be published in November 2014.
USA National Strategy for combating antibiotic resistant bacteria (Sep 2014)
This National Strategy is the basis of a 2014 Executive Order on Combating Antibiotic Resistance, as well as the basis for a forthcoming National Action Plan that directs Federal agencies to accelerate the US response to the growing threat of antimicrobial resistance.
The National Strategy outlines five interrelated goals for action by the United States Government in collaboration with partners in healthcare, public health, veterinary medicine, agriculture, food safety, and academic, Federal, and industrial research.
The goals include: slowing the emergence of resistant bacteria and preventing the spread of resistant infections. The report can be found at http://www.cdc.gov/media/dpk/2014/dpk-carb.html
6. New resources
Many Hands: Harmonising Capacity, Knowledge and Documentation in Sanitation and Hygiene
Organised by WSSCC, the November 2013 meeting brought together key partners from the sector, including Plan International, WaterAid, UNICEF, etc. Participants at the meeting considered what water, sanitation and hygiene, or WASH-related capacity building remains to be achieved in the dynamic environments of Asia and Africa. They also looked at what documentation, learning and knowledge systems are required to achieve this goal, agreeing on a number of steps for moving forward.
7. Upcoming events
International Infection Prevention Week #11PW, Oct 19–25
In recognition of the importance of infection prevention and the role consumers can play to stay safe when they visit a healthcare facility, IFH has partnered with APIC to promote International Infection Prevention Week (IIPW), October 19–25.
To celebrate IIPW and this year’s theme of antibiotic resistance, APIC has expanded the resources and activities for both patients and healthcare professionals found on the “Infection Prevention and You” website (www.apic.org/infectionpreventionandyou). The campaign features a new “ABCs of Antibiotics” infographic illustrating antibiotic resistance and the top 5 questions consumers should ask their healthcare providers about antibiotics.
European Antibiotic Awareness Day, November 18
European Antibiotic Awareness Day is an annual European public health initiative to raise awareness about the threat to public health of antibiotic resistance and prudent antibiotic use. The latest data confirms that across the European Union the number of patients infected by resistant bacteria is still increasing. To learn more about national campaigns and obtain campaign materials go to http://ecdc.europa.eu/en/eaad/Pages/Home.aspx
Get Smart About Antibiotics Week, November 17–23, 2014 – Help CDC raise awareness
During November 17–23, 2014, CDC will observe the annual Get Smart About Antibiotics Week. As in past years, the effort will coordinate work of CDC’s Get Smart: Know When Antibiotics Work campaign.
CDC has produced a fact sheet, “CDC Resources on Outpatient Antibiotic Use”, which is designed for the General Public and Health Care Professionals. These materials are designed to help audiences understand the importance of using antibiotics correctly in community and outpatient settings, the health threat of antibiotic resistance, and how to get symptom relief when antibiotics are not needed. It also features materials which can be used to help CDC raise awareness about this important public health issue, during “Get Smart About Antibiotics Week”. The fact sheet can be downloaded from: http://www.ifh-homehygiene.org/factsheet/cdc-resources-outpatient-antibi....
Publication Type: Newsletter