Health Risks, Preventive Behaviours and Respiratory Illnesses at the 2019 Arbaeen: Implications for COVID-19 and Other Pandemics

COVID-19 poses grave challenges for mass gatherings. One of the world’s largest annual gatherings, Arbaeen, occurs in Iraq. We studied respiratory symptoms and risk and protective factors using representative sampling of Arbaeen pilgrims in 2019 to inform prevention of COVID-19 transmission. Structured sampling was used to recruit walking pilgrims. A questionnaire asked about respiratory symptoms, risk, and preventive factors, including hygiene-related resources of toilet facilities. The commonest symptom reported by the 1842 participants (63.3% male, 36.7% female) was cough (25.6%). Eating in mawkibs (rest areas) with indoor kitchens and drinking only packaged water were associated with lower risk of cough (AOR = 0.72, CI = 0.56–0.94; AOR = 0.60; CI = 0.45–0.78, p < 0.05). Facemask use was associated with increased risk of cough (AOR = 2.71, CI = 2.08–3.53, p < 0.05). Handwashing was not protective against cough, or against (one or more of) cough, fever, or breathlessness in multivariate analysis. Toilet facilities often lacked running water (32.1%) and soap (26.1%), and had shared hand towels (17%). To reduce risk of respiratory infections including COVID-19 during Arbaeen or other mass gatherings, needs include running water, soap, and hygienic hand drying options or hand sanitiser. Education on proper handwashing and facemask approaches and monitoring around food preparation and eating spaces are needed.

From the hospital toilet to the ward: A pilot study on microbe dispersal to multiple hospital surfaces following hand drying using a jet air dryer versus paper towels

Using a bacteriophage to represent microbial contamination, we investigated virus transmission to the hospital environment following hand drying. The use of paper towels resulted in lower rates of virus contamination on hands and clothing compared with a jet air dryer and, consequently, lower contamination of multiple hospital surfaces.

Assessment of the Knowledge and Practice of Handwashing among Healthcare Workers in a Tertiary Hospital in Ekiti, Southwestern Nigeria

Background: The most common means of transmission of Healthcare-Associated Infections (HAIs) is the contaminated hand of Healthcare Workers (HCWs), proper handwashing by HCWs is the best method of halting this transmission, however, there is poor adherence to the practice of the simple handwashing procedure in many health facilities. Aims: To assess the knowledge and practice of proper handwashing, to identify the factors impeding adherence to its good practice among HCWs and to identify the handwashing and hand drying facilities available to these HCWs. Study Design: This is a descriptive cross-sectional study. Place and Duration of Study: The study was carried out at Federal Teaching Hospital, Ido-Ekiti (FETHI), Southwestern Nigeria between July 2020 and December 2020. Methods: The study involved 328 randomly selected HCWs. Data was collected using pretested self administered questionnaires, entered into Microsoft Excel 2016 and analyzed by SPSS version 23. Results: Only 31.10% of respondents had good knowledge of handwashing while 80.18% had good practice of handwashing. Longer stay in service and being a doctor or nurse were associated with good knowledge and good practice of handwashing. Only 16.46% of respondents had previous training on handwashing within 3 years prior to this study. Previous training on handwashing was associated with good knowledge of handwashing (P=.001). Up to 68.60% of respondents used stored water and soap for handwashing. The most common hand drying facility reported in the study was common towel, no respondent ever used paper towel. The most common reason given for poor adherence to handwashing practices was the busy schedule. Conclusion: Hospital managers must prioritize the regular provision of handwashing and hand drying facilities for their centre, in addition to organizing regular hand hygiene training for HCWs, to improve their knowledge and practice of handwashing and thus reduce the rate of HAIs

Environmental and economic sustainability in public contexts: the impact of hand-drying options on waste management, carbon emissions and operating costs

Due to the high density of users hosted everyday, public buildings are important producers of waste and emissions of greenhouse gases (GHGs). Public restrooms play an underrated role in waste generation and GHG emissions, especially if paper towels are used as the hand-drying method. The choice of the hand-drying method (i.e., paper towels vs. electrical hand dryers) also affects the economic balance of a public institution, involving costs for the purchase of hand-drying materials/apparatuses, energy and waste disposal. The present paper aims at evaluating the economic and environmental impact of the introduction of electrical hand dryers (alternative scenario) in place of paper towels (reference scenario) in a public building. The paper presents a solid methodology, based on a numerical experiment approach, to identify a decision criterion for establishing the economical convenience of adopting the alternative scenario in public restrooms. Key factors affecting the choice between the proposed alternatives are presented and discussed in a dedicated sensitivity analysis. From the environmental point of view, this study evaluates the impact of each scenario in terms of GHG emissions, related to multiple waste treatment options and different electric grid mixes. Based on the experimental assumptions, the method allowed concluding that the alternative scenario becomes economically convenient when the number of daily usages (N) is > 57 ± 4. The environmental convenience of the alternative scenario is visible even at N < 10. The method here described can be successfully used to support strategic decisions for cost optimization and environmental mitigation in institutional buildings.

Microbiological Assessment of the Different Hand Drying Methods and Washroom Environment Cross-Contamination

Proper hand drying is a fundamental part of the hand hygiene process looking at optimizing the elimination of potentially pathogenic microbes. This research compared the effectiveness of three different hand drying methods—paper towels, the use of warm air dryers in stationary hands position, and the use of air drying while hand rubbing—and their potential for cross-contamination of other users and the surrounding environment. One hundred sixty samples were collected from finger pads and palms, before and after drying. The outlet of the air dryers, air current emitted from the air dryers, and washroom environment air were also tested. The study reported that paper towels were more successful in eliminating bacteria and lead to less contamination to the washroom environment compared to the air dryers. The average number of bacteria obtained from volunteers using hand air dryer while hand rubbing was significantly higher than drying with air dryer while holding hands stationary. Plates exposed to the turned-off dryer for 5 minutes gave an average of only 25 colonies/plate, while plates exposed to the air outlet of the turned-on warm air dryers provided 292 colonies/plate. Placing Petri dishes at least one meter away from the dryer in the washroom for 30 minutes gave 72.5 colonies/plate. The current research also documented frequent contamination of public washroom environments and showed dissemination of potential pathogens, including Escherichia coli (E. coli), Klebsiella species, Bacillus cereus (B. cereus), Staphylococcus aureus (S. aureus), and coagulase-negative Staphylococci. Over 70.0% of Staphylococci were resistant to at least three antibiotics and 50.0% revealed coresistance to at least four antibiotics including penicillin, erythromycin, clindamycin, and co-trimoxazole. The method of hand drying may serve as a risk factor of cross-contamination from users to the environment and subsequent users and as reservoirs of drug-resistant bacteria in public washrooms.

COVID-19 and hand hygiene: the vital importance of hand drying

The significance of hand hygiene for preventing the transmission of microorganisms and reducing the spread of infection has been brought into sharp focus following the global coronavirus (COVID-19) pandemic. In the months since the initial outbreak, international public health campaigns and practitioner education has concentrated on hand washing and hand sanitising, with very little reference to hand drying, if any at all. However, hand drying is integral to effective hand hygiene, and is important in controlling the spread of microorganisms and maintaining healthy skin integrity. This research commentary will focus on two issues of importance with regards to hand drying: microbial transmission and skin irritation, with implications for healthcare practitioners and practice considered. It is argued that a more holistic approach to hand hygiene must be the ambition if health professional and public behaviour is to become embedded and sustained.

Assessment of compliance of butcher shops with food safety practices in Rungwe district Tanzania

The present study examined the compliance of butcher shops to food safety practices. The study was done based on a survey of 61 respondents randomly sampled from 61 butchers in Rungwe district. Data were analyzed using IBM SPSS Statistics version 20 using descriptive statistics. The results indicated that the butcher environment and physical conditions had an average compliance score of 50.8%, the overall average awareness score on foodborne illnesses and hygienic practices was 65% whereas cleaning and sanitization had an overall average compliance score of 41.9%. Personal hygiene which was evaluated in terms of clothing, hands and individual health recorded 75.4% and 68.9% compliance scores for proper handwashing and drying respectively. The common hand drying practices involved the use of clean towels (62.8%) and disposable paper towels (11.5%), even so, 26.2% did not dry their hands at all. The use and cleanliness of aprons were adhered to by 93.7% of the respondents. Cross-contamination was deemed likely among 45.9% butchers due to non-separation and storage of spare clothes in the butchers. The common handling and storage practices was that of suspending meats on hooks at room temperatures (93.4%) with only 4.9% of butchers suspending on hooks at refrigeration temperature. This suggests none chilling of surplus meat at the end of the day sale by the majority of butchers. The compliance of butcher shops to food safety practices was generally modest which could be attributed to illiteracy in food safety and lack of proper meat handling and storage facilities.

Effect of Observational Evaluation of Food Safety Curricula on High School Students' Behavior Change

ABSTRACT High school students have limited food safety knowledge and lack safe food handling skills. However, youth of high school age are frequently employed in food service and will prepare food for themselves. This study was conducted to evaluate the effectiveness of a food safety educational intervention for changing students' food handling behaviors, and the theory of planned behavior was used to construct factors that contribute to behavior change. A combination of stationary and wearable (GoPro) cameras was used to observe the food handling practices of high school students in key areas, including food thermometer use, hand washing and hand drying, glove changing, and environmental cleaning. The percentage of correct food handling techniques was measured categorically, and the number of groups who complied with thermometer use and environmental cleaning guidelines was recorded. The percentage of students using correct hand washing, hand drying, and glove changing techniques significantly increased in the postobservation cooking session. However, the percentage of correct hand washing and glove changing events remained &lt;50% for certain subcategories: hand washing time (38%), hand washing after handling raw produce (36%) and touching skin (20%), changing gloves after gloves became contaminated or torn (47%), and washing hands between glove changes (15%). Students modified their behaviors to comply with subjective norms related to the study, including instructor expectations, but some students did not plan to change the behaviors they practiced at home. Students cited food handling behaviors they observed their parents using when making decisions about how to prepare food. This study highlights the need for the development of food safety educational interventions that encourage safe food handling skills and address influences from key subjective norm groups. HIGHLIGHTS

Knowledge Level and Hand Hygiene Practice of Nepalese Immigrants and Their Host Country Population: A Comparative Study

Nepali people are one of the ethnic minority immigrants of Hong Kong. This epidemiological investigation aims to determine and compare the knowledge level and hand hygiene (HH) behaviour of the Nepali people and the population of their host country (i.e., native Chinese population of Hong Kong). A total of 1008 questionnaires were collected via an online platform. The overall knowledge level of the native population towards HH was considerably higher than that of the Nepali respondents. Lower levels of knowledge in young and older people were noted. Reduced HH knowledge was also observed in people with low educational level or with comorbid illness(es). Significant differences between groups were noted in the self-reported hand washing behaviours. Regarding hand drying, more Nepalese than native Chinese respondents always/sometimes dried their hands on their clothing irrespective whether after performing handwashing in public washrooms or at home. Misconceptions and suboptimal practices on HH were prevalent in the two populations. The findings of this comparative study offer valuable information for the development of culturally sensitive health educational programs to enhance HH practices for the ethnic minorities and native Chinese population.