Hand hygiene in Nepal

Background: Hand hygiene is one of the most effective preventive measures in the transmission of infection. Proper hand hygiene strategies in health care facilities can reduce nosocomial infections and antimicrobial resistance.

Objectives: This study aims to assess the baseline hand hygiene skills among health care workers and the impact of education and training on it. Design: Interventional cross-sectional single center study.

Method: It was conducted among 181 health care workers of Alka Hospital Pvt. Ltd. During both pre and post-test, participants were asked to perform hand hygiene with soap and water as per WHO guidelines. Pretest was conducted to assess baseline skills of health care workers regarding hand hygiene. An observer would score whether each of the steps were performed correctly, using a checklist. It was followed by intervention in the form of training, education and demonstration of hand hygiene. Post-test was conducted to assess the changes in skills after intervention. Results: There was an overall improvement in the hand washing skills post intervention indicated by an increase in median score, which was 8 for pre-intervention and 9 for post-intervention.

Doctors and nurses had better practice regarding hand hygiene in comparison to other participants. Those participants who had prior training on infection prevention and control, were found to have better hand hygiene skills post-intervention.

Conclusion: Training and educational interventions are the effective tools to improve hand hygiene skills of the health care workers. Performing such interventions at regular intervals can be helpful. Keywords: hand hygiene, health care workers, training and education.

Hand hygiene skills of the health care workers and the effect of training and educational intervention: A single center cross-sectional study

Bangladesh Critical Care Journal

Gentle Sunder Shrestha*1 , Manjit Shrestha2 , Roshan Sharma2 , Ramchandra KC3 , Bibeka Shrestha4 , Rojika Pradhan5 , Pankaj Joshi

DOI: https://doi.org/10.3329/bccj.v9i1.53050


Warm water followed by acid spray reduces STECs on veal carcasses

Effective antimicrobial intervention strategies to reduce Shiga toxin–producing Escherichia coli (STEC) risks associated with veal are needed.

bob.veal.carcassThis study evaluated the efficacy of lactic acid (4.5%, pH 2.0), Citrilow (pH 1.2), and Beefxide (2.25%, pH 2.3) for reducing STEC surrogates on prerigor and chilled bob veal carcasses and monitored the effects of these interventions on chilled carcass color.

Dehided bob veal carcasses were inoculated with a five-strain cocktail of rifampin-resistant, surrogate E. coli bacteria. E. coli surrogates were enumerated after inoculation, after water wash, after prechill carcass antimicrobial spray application, after chilling for 24 h, and after postchill carcass antimicrobial spray application; carcass color was measured throughout the process. A standard carcass water wash (∼50°C) reduced the STEC surrogate population by 0.9 log CFU/cm2 (P ≤ 0.05). All three antimicrobial sprays applied to prerigor carcasses delivered an additional ∼0.5-log reduction (P ≤ 0.05) of the surrogates. Chilling of carcasses for 24 h reduced (P ≤ 0.05) the surrogate population by an additional ∼0.4 log cycles. The postchill application of the antimicrobial sprays provided no further reductions. Carcass L*, a*, and b* color values were not different (P > 0.05) among carcass treatments. Generally, the types and concentrations of the antimicrobial sprays evaluated herein did not negatively impact visual or instrumental color of chilled veal carcasses.

This study demonstrates that warm water washing, followed by a prechill spray treatment with a low-pH chemical intervention, can effectively reduce STEC risks associated with veal carcasses; this provides processors a validated control point in slaughter operations.

Evaluating the efficacy of three U.S. Department of Agriculture–approved antimicrobial sprays for reducing Shiga toxin–producing Escherichia coli surrogate populations on bob veal carcasses

Journal of Food Protection®, Number 6, June 2016, pp. 896-1055, pp. 956-962(7)

J. Sevart; N. Baumann; H.Thippareddi; T. A. Houser; J. B. Luchansky; A. C. S. Porto-Fett; D. B. Marx; G. R. Acuff; R. K. Phebus



What works best? Food safety education interventions

Participants were placed in one of three interventions: positive deviance group (PD), standard reading material group (Standard) and story reading material group (Story). After the interventions, all participants reported significant self-reported knowledge gain. Participants in the diabetics group raised their mean score from 3.6 to 4.0 (p<0.05, t-test two tailed), with positive deviance intervention, and pregnant women raised from 3.6 to 3.8 (p<0.05, t-test two tailed).

food.safe.story.jauce.pregWhen asked to list the three most useful things they learned from this program, most participants responded ‘washing hands’, ‘cooking temperature’, ‘2-hour rule of refrigerating’, ‘refrigerator temperature’. Many participants also listed ‘not thaw on the counter’, ‘using shallow  container for refrigerator storage’. Nearly 10% of pregnant women mentioned that they learned that pregnant women were at increased risk of foodborne illness, including Listeria.

Of those pregnant women, six responses were from the Story intervention, and two from the PD intervention. Only six participants from the diabetes group listed that they learned they personally were at increased risk for foodborne illness, three from Story, and three from PD. Some reported that they learned that some of their practices were not recommended, such as rinsing meat/poultry before cooking (from Diabetics group Standard intervention). Responses from PD intervention group were more specific and including more detail techniques than the other two interventions, like ‘wash cantaloupe before cutting’, ‘wash cuties (an orange)’, and ‘freezing does not kill bacteria’.

Across the interventions, the PD intervention tended to have the greatest increase of

participants’ self-efficacy, self-risk assessment, and knowledge gain. This preliminary study suggests that PD intervention is a promising food safety education module, especially for high-risk population.

Some study limitations merit comment. These study results were based on self-report survey data. Future research may benefit from observational research, which can validate the compliance of self-reported food safety behavior. Additionally, the relatively small sample size reduced the power of the analysis, and many of the comparison differences were not statistically significant. Future research needs to include a larger sample size and use a randomizing sampling process, in order to generalize findings to a larger population.

Future research efforts are needed to develop an effective food safety educational curriculum targeting people with diabetes, pregnant women and other immunocompromised patients, and delivered by health professional, like physicians, nurses and dieticians. This will facilitate health professionals’ ability to provide information about food safety to their patients and hereby help protect high-risk population from foodborne illness.

Yaohua Feng, Christine Bruhn, and David Marx. 2016. Evaluation of different food safety education interventions.

British Food Journal, Volume 118, Issue 4, February 2016, http://dx.doi.org/10.1108/BFJ-10-2015-0372


Handwashing intervention in daycares doesn’t reduce illness

Either the employees were already real good at hand hygiene, or the interventions didn’t resonate with people.

dirty.jobs.daycare.e.coliInfections are common in children attending daycare centres (DCCs). We evaluated the effect of a hand hygiene (HH) intervention for caregivers on the incidence of gastrointestinal and respiratory infections in children. The intervention was evaluated in a two-arm cluster randomized controlled trial.

Thirty-six DCCs received the intervention including HH products, training sessions, and posters/stickers. Thirty-five control DCCs continued usual practice. Incidence of episodes of diarrhea and the common cold in children was monitored by parents during 6 months. Using multilevel Poisson regression, incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were obtained. Diarrheal incidence was monitored in 545 children for 91 937 days. During follow-up, the incidence was 3·0 episodes per child-year in intervention DCCs vs. 3·4 in control DCCs (IRR 0·90, 95% CI 0·73–1·11). Incidence of the common cold was monitored in 541 children for 91 373 days. During follow-up, the incidence was 8·2 episodes per child-year in intervention DCCs vs. 7·4 in control DCCs (IRR 1·07, 95% CI 0·97–1·19).

In this study, no evidence for an effect of the intervention was demonstrated on the incidence of episodes of diarrhea and the common cold.

A hand hygiene intervention to reduce infections in child daycare: a randomized controlled trial

Epidemiology and Infection / Volume 143 / Issue 12 / September 2015, pp 2494-2502

P. Zomer, V. Erasmus, C. W. Looman, A. Tjon-A-Tsien, E. F. Van Beeck, J. M. De Graaf, A. H. E. Van Beeck, J. H. Richardus and H. A. C. M. Voeten


STEC on beef; Texas A&M investigators develop research to reduce dangerous E. coli

Texas A&M investigators are part of a research effort working on ways to inhibit the growth of Shiga-toxin producing E. coli (STEC) on beef.

Carolina Gonzalez, a graduate student at TAMU, studied the use of fermentative microorganisms to produce natural antimicrobial compounds that can inhibit the growth of STEC on beef top sirloins.

beef.processingUsing this methodology, Gonzalez was able to reproduce the production of lactic acid by these organisms on beef surfaces during product aging, which will help producers understand how the non-pathogenic microorganisms can inhibit the growth of pathogenic microbes on major pieces of beef before preparation.

Tamra Tolen, a Ph.D. student, studied the ability of different plant-derived, antimicrobial essential oils such as clove and oregano to not only to restrain the growth of STEC on ground beef, but also exhibit antimicrobial properties. Such essential oils are identified as generally safe by the U.S. Food and Drug Administration and U.S. Department of Agriculture Food Safety Inspection Service, and may be particularly relevant in both beef transportation and retail.

The results of the new research will be presented at the 2014 Governor’s Conference/STEC CAP Annual Conference May 27-29, in Lincoln, Neb. Attendees at the conference will also discuss progress in prevention and control of microbials. “The Texas A&M AgriLife Research team is pleased to have the opportunity to collaborate with such a prestigious research group working to help assure the safety of our food,” said Dr. Gary Acuff, director of the Texas A&M Center for Food Safety in College Station and one of the collaborative research team members.

beef.stec“The long-term goal of the project is to reduce the occurrence and public health risks from Shiga toxin-producing E. coli in beef, while preserving an economically viable and sustainable beef industry,” said Dr. Rod Moxley, project director from the University of Nebraska-Lincoln. “This can only be accomplished by a multi-institutional effort that brings together complementary teams of the nation’s experts whose expertise spans the entire beef chain continuum and then sharing the research findings through conferences such as this.”

Texas A&M is one of the 15 universities engaged in STEC research, which was funded by a five-year, $25 million grant from the U.S. Department of Agriculture.

One dead man, one naked man extricated from Colorado exhaust vents last week

Last Thursday morning, 49-year-old electrician Michael Goodspeed was found dead in an exhaust vent of a restaurant in Steamboat Springs, CO.

The Associated Press reports,

Goodspeed became wedged in a tapering section of the vent. The Routt County Coroner says it appears Goodspeed died of "positional asphyxiation".

Goodspeed and his coworkers were staying at the restaurant while doing work there before it officially opened. He climbed into the vent in an attempt to enter the restaurant after he was apparently locked out.

The next day, the manager of a Blackjack Pizza in Denver—about 150 miles away—discovered a younger man close to meeting the same fate.

According to the Denver Post, 21-year-old Andrew Baca was found dangling above the oven yelling, “Help me, help me,” after being stuck in a vent for five to six hours. 

Firefighters were able to extricate Baca from the vent with only minor cuts and abrasions, though his clothes were removed in the rescue effort.

Police said the intruder, though lucky to be alive, was being held for investigation of burglary and criminal mischief.

The AP noted that the restaurant was closed later that day. It is unknown whether this was by order of the police force or the health department.

Intervention: it’s not just a bad TV show, it’s a new type of restaurant inspection enforcement

Gee’s Garden Bistro, 1145 N. Alvernon Way, Tuscon, Arizona, failed an unannounced restaurant inspection July 17. And a re-inspection July 27; and Aug. 8 and Aug. 21.

So the Pima County Health Department tried a new strategy – intervention.

Sharon Browning, director of Pima County’s Consumer Health and Food Safety unit, told the Tucson Citizen that Gee’s is the first restaurant to go through the county’s intervention program, devised in 2002, stating,

"It’s not like a last resort, but it’s close. We’re trying to allow these people to stay open while they make significant changes, and it’s a tool that’s been in our toolbox, but one we’d never used until now."

The intervention period will include unannounced inspections at irregular intervals through January, at which point the restaurant could regain its regular license or have it revoked.