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CONTENTS
1. New IFH materials and publications
2. New E-bug resource
3. MRSA and the importance of laundry hygiene: new research
1. New IFH materials and publications
Breaking the chain of infection - Preventing spread of infections in home and everyday life
October 16th-22nd was International Infection Prevention week. To address this year’s theme “ Breaking the Chain of Infection” IFH produced a simple online elearning resource. We felt that this was a "not to be missed" opportunity to get this simple concept over to the public (and infection control professionals), who find it quite hard to understand - but forms the essential foundation for understanding effective hygiene in home and everyday life - and elsewhere. The resource is intended to help people to visualise how infections are spread and how to break the chain of infection through targeted Hygiene.
Reducing this burden of infection and preventing the spread of antibiotic resistant strains cannot happen without reducing the spread of harmful microbes in our homes and everyday lives. Preventing infections must be everyone’s responsibility.
Every effort has been made to write this material in simple non- technical language, so that it can be understood by everyone.
The hygiene hypothesis misnomer – restoring confidence in hygiene
The July 2016 issue of Perspectives in Public Health takes an objective view of ongoing research showing that the hygiene hypothesis – the idea that allergies are the price we are paying for our “modern obsession with cleanliness – is a misleading misnomer which is undermining attitudes to hygiene at a time when antibiotic resistance threatens our ability to treat infections. These conclusions are set out in this issue, in a review (available open access) which summarises the consensus findings of six experts who presented at a joint conference organised by the Royal Society for Public Health and the International Scientific Forum on Home Hygiene in February 2016, together with articles from other contributors.
In a guest editorial Professor Sally Bloomfield concludes “Microbiome science shows us that our microbiome constitutes an organ, as essential to health, as our liver and kidneys. To tackle diseases related to immune dysfunction - as well as preventing infectious diseases - in future, we are all, health agencies and the public alike, going to have to view our microbial world very differently”.
A simple guide to healthy living in a germy world – the hygiene hypothesis misnomer
We are frequently asked to explain the latest thinking about the relationship between reduced microbial exposure and the rise in allergies and other inflammatory diseases – and the idea that we have become “too clean for our own good”.
In response to this IFH has produced an online resource which explains, in simple language, the hygiene hypothesis misnomer and the Old Friends Mechanism. It also sets out to answer the question “How can we reconnect with our microbial world whilst at the same time protecting ourselves against infectious diseases.
2. New ebug resource
Beat the Bugs – new interactive resource for learning about hygiene in home and everyday life
e-Bug and Kingfisher Treasure Seekers have developed a six week community hygiene course called "Beat the Bugs". The course aims to increase awareness and change behaviour around hygiene and antibiotic use. The course is designed to be delivered by community groups for community groups, and comprises of six fun, visual and interactive sessions covering: an introduction to microbes, hand and respiratory hygiene, food hygiene, oral hygiene, antibiotics and a final session on self-care and action planning for the future.
The course is suitable for a range of community groups including adult’s with learning difficulties and younger audiences such as girl guiding, scouts, and youth groups.
Visit www.e-Bug.eu/Beat-The-Bugs to download the course or email e-Bug@phe.gov.uk to hear about free Beat the Bugs training.
3. MRSA and the importance of laundry hygiene: new research
Spread of MRSA and MSSA in the community
A report from MRSA Action UK shows the importance of preventing spread of MSSA and MRSA in the home and everyday life. Latest figures show 65% of MRSA bloodstream infections arising in UK hospitals were due to causes outside hospitals. Figures show increased numbers of infections caused by Staph. aureus, including meticillin sensitive strains (MSSA). This coincides with the 2014 decision to abandon screening of patients entering hospitals. There were 8,767 cases of MSSA reported in primary care settings 5 years ago, rising to 10,584 in 2016. It is unclear what proportion were due to lapses in care or unrelated to healthcare, but in terms of tackling antibiotic resistance, this is a worrying trend if more antibiotics are needed to tackle the infections”.
Clothing and linens – an under recognised vector for MRSA transmission?
This new study suggests that clothing and linens are an under recognised vector for transmission of MRSA from a person who is infected or is an MRSA carrier. The study examined a hospital laundry facility for the presence of MRSA on environmental surfaces and among personnel. MRSA was identified in 33/120 (28%) samples from the dirty and 3/120 (3%) samples from the clean environmental areas of the laundry facility. Five different employees were MRSA positive, 4/8 (50%) from the dirty: and 1/15 (6.7%) from the clean, but there was a 10-fold higher MRSA carriage 6/22 (27%) dirty vs 1/38 (2.6%) clean when all 50 human samples were combined.
The data from these 2 studies suggests that tackling MRSA cannot be achieved without also reducing circulation in the community. An IFH review has documented recent studies showing the extent of the silent spread of antibiotic resistant strains in the healthy community Staph. aureus (MRSA or MSSA) is continuously shed on skin particles from a carrier or infected person. The study shows the importance of ensuring the hygiene efficacy of machine laundry cycles for all items which come into close contact with the human skin surface - even when laundering at low temperatures.
So - why are we lowering domestic laundry temperatures, without any regard to the the potential impact on hygiene effectiveness?
Hygiene effectiveness of low temperature laundering – new study
In recent years, there has been a trend to apply lower temperatures (≤40°C) in household laundering as a means to reduce household energy consumption. In a 2014 study, Dirk Bockmuhl and co-workers confirmed that laundering at temperatures of 40°C or below is associated with a significant reduction in hygiene effectiveness. They demonstrated however that there is potential to compensate for the loss of efficacy, either using detergents with activated oxygen bleach (AOB) or extending wash cycle times.
In a new 2016 study, in order to better understand how microbicidal action contributes to laundry hygiene, suspension test methods were used to evaluate the microbicidal action of heat, detergents and AOB. The results confirm that heat makes a significant contribution to the hygiene efficacy of laundering at 60°C, producing 1 to 3 log kill when the temperature is maintained for at least 15 min. By contrast, heat has little microbicidal effect at temperatures of 40°C or below. This means that hygiene efficacy at temperatures of 40°C or less is almost entirely dependent on removal of microbes during the wash and rinse cycles, although the suspension tests data suggested that the detergent may contribute some limited microbicidal action.
Where detergents containing AOB are used, the AOB contributes a significant microbicidal action even at laundering temperatures of 20°C, although the extent of the effect varies with the test strain and temperature. It was concluded that further work is needed to determine whether and how hygiene effectiveness equivalent to that at 60°C across both fungal and bacterial strains might be achievable by machine laundering at lower temperatures. The importance of sustaining hygiene efficacy during laundering is argued in a 2011 IFH review.
