Is our obsession with hand sanitisers doing us more harm than good?

Itʼs no secret that Donald Trump is a fan of Fox News, the American news channel whose hosts the President regularly sits down to do interviews with. However, one such host, Pete Hegseth, probably wonʼt be getting a handshake from the president any time soon.

“I donʼt really wash my hands ever,” Hegseth announced on air this week. “Germs are not a real thing. I canʼt see them, therefore theyʼre not real.”

Twitter erupted, while the president probably made a mental note to avoid shaking hands with Hegseth, one of his most vocal supporters, ever again. A self-confessed “germaphobe”, Trump has already admitted avoiding handshakes and is regularly caught on camera being handed small bottles of hand sanitiser by White House staff.
Robbie Williams was caught on camera doing the same (and looking quite squeamish) after performing Auld Lang Syne with audience members during a New Yearʼs Eve gig at Westminsterʼs Central Hall.

But Trump and Williams are far from alone. Sales of hand sanitisers have skyrocketed in the last ten years, along with antibacterial hand soaps and wipes, and recent data from Mintel found a third of us buy a bottle of hand sanitiser every month.

No longer the preserve of hospitals (the first hand sanitiser was invented by an American nurse in 1966 after discovering alcohol, when delivered through a gel, removed germs without soap and water), theyʼre now found in handbags, homes and on desks across the UK.

So, when did we become a nation of germ-fighters? And is it doing us any good?

“Of course you should wash your hands regularly,” says Tim Spector, a professor of genetic epidemiology at Kingʼs College London and author of The Diet Myth. “However, we seem to have developed an obsession with hygiene that, along with antibiotics, is decreasing our gut diversity and having an impact on our microbes and gut health.

“Children who grow up on farms have about a third less allergy risk. People who have pets, and those who come from large, poor families also have fewer allergies. The theory goes, if youʼre exposed to microbes from an early age, and have a healthy exposure to them in general, your immune system is exercised and trained to deal with harmful germs. Having friendly microbes on your skin and in your gut improves how your immune system responds to real threats.”

Speaking of threats, Professor Spector says headlines about SARS, Swine Flu and ebola have driven fears weʼre under siege from infection, when we should be more worried about the connection between overzealous clearning and poor gut health, which is linked to obesity and allergies.

“Of course, thereʼs a middle ground. If youʼre a chef, or work in a hospital, or youʼre on a cruise where thereʼs an outbreak of vomiting and diarrhoea, then it pays to be cautious. But the average person just needs to wash their hands with soap and hot water when required.”

“I find it scarcely believable that Pete Hegseth doesnʼt wash his hands,” says Professor John Oxford, a virologist at the Queen Mary School of Medicine. “Iʼve spent my life looking down microscopes and I can assure you that germs are very real.

“The first doctor who championed hand washing was a Hungarian called Ignaz Semmelweis, who in 1846 questioned why so many mothers on the maternity ward where he worked were dying. He realised doctors were performing autopsies and then delivering babies straight after. He ordered staff to wash their hands and death rates dropped. So hand washing is an important tool in public health.”

Though soap and hot water will do, thereʼs now a commercial edge to cleanliness too: “One hundred years ago, there werenʼt hundreds of cleaning products, bleaches, anti-bac sprays and hand sanitisers in our homes and lining supermarket shelves,” says Professor Spector. “Our kitchens didnʼt look like gleaming intensive care units. Our natural, friendly, healthy microbes are being washed, scrubbed and sanitised away so our immune systems have nothing to fight against.”

Indeed, so-called ‘clean-fluencersʼ (clean influencers) such as Mrs Hinch (1.8m followers and counting) are all over Instagram telling us how to keep our homes spotlessly clean, which, combined with the Marie Kondo effect means weʼre vulnerable to the idea we need to be as clean as possible – and never more so than when it comes to protecting our childrenʼs health. The child hand sanitiser market (unheard of 20 years ago) is rising, you can now buy antibacterial nappy sacks, and most mumsʼ nappy bags contain mini pots of hand sanitisers.

“Thereʼs been a huge rise in all types of allergies among children in the last 40 years,” says Professor Spector. “Somethingʼs going on. So while hand washing after nappy changing and going to the toilet should be encouraged, children should be allowed to play in the dirt, stroke pets and climb trees without worrying too much.
Otherwise, the danger is that we’re just ” replacing one problem – the risk of infection – for an altogether different one.”

By Maria Lally
February 12th 2019

https://www.telegraph.co.uk/health-fitness/body/obsession-hand-sanitisers-us-harm-good/


Resistente bakterier blir med hjem fra ferien

Når vi reiser på ferie, bidrar vi til at resistente mikrober reiser verden rundt. Sykehusbesøk og antibiotikakur gir størst risiko.

Du kan bære dem med deg på huden eller i tarmen, og du kan ha dem med deg helt uten at du vet det. Og de kan bli lenger enn du aner.

En studie av 2000 nederlendere som reiste på utenlandstur, viste at hele 35 prosent av dem brakte med seg resistente tarmbakterier hjem.

Av dem som hadde vært i India eller landene rundt, bar hele 75 prosent av dem med seg resistente bakterier hjem. Dette var bakterier som er helt normalt å ha i tarmen, og ga ingen symptomer. Hadde disse nederlenderne ikke vært med i denne studien, ville de ikke visst at de hadde med seg slike bakterier fra turen.

Aller størst risiko
Men disse bakteriene som normalt finnes i tarmen, kan gi resistens-gener videre til sykdomsfremkallende bakterier i neste omgang. Og da er du ille ute. Da virker ikke de vanlige antibiotikaene lenger. Og 12 prosent av de reisende ga også de resistente bakteriene videre til andre personer i husholdningen.

Det som klart ga aller størst risiko for å bli bærer av resistente tarmbakterier (ESBL), var å ta en antibiotikakur under reisen. Men det var ikke likegyldig hva slags antibiotika de tok. Antibiotika som Ciprofloxacin ga klart høyest risiko, mens penicilliner ga mindre risiko. Diaré og kronisk tarmsykdom ga også økt risiko for å bli bærer av resistente bakterier.

Fakta: Dette gir økt risiko
Dette gir økt risiko for at man bærer med seg resistente bakterier hjem fra ferie i utlandet:

• Å bli innlagt på sykehus i utlandet.
• Å ta antibiotika på turen.
• Å få diaré under reisen. Risikoen øker hivs du tar antibiotika mot diareen, og risikoen blir enda større hvis du tar stoppende midler som for eksempel loperamid eller imodium.
• Reise utenfor Nord-Europa, Nord-Amerika og Australia. Særlig til det indiske subkontinent, men også i Sør- og Øst-Europa er forekomsten av resistens høy.

Men det som er det positive i denne studien, er at de fleste kvittet seg med de resistente bakteriene ganske raskt. Etter en måned hadde over halvparten kvittet seg med de resistente bakteriene. Men 11 prosent var fortsatt bærere et år etter. Antibiotikakurer gjennom året, kronisk stamsykdom og nye reiser var igjen risikofaktorer som gjorde at bærerskapet kunne vare ved.

Sykehus er verst
Det som helt klart gir høyest risiko for å bli bærer av multiresistente bakterier, er å bli innlagt på sykehus i utlandet.

Men du trenger ikke å reise til eksotiske land for at denne risikoen skal bli høy. Folkehelseinstituttet meldte nylig om et utbrudd av hyperresistente (KPB – karbapenemaseproduserende) bakterier med over 350 smittede pasienter ved syv sykehus i Italia.

Det Europeiske smitteverninstituttet melder om raskt økende forekomst av disse svært resistente bakteriene i Sør- og Øst-Europa, og de melder stadig nye utbrudd på sykehus.

I USA har én person nylig dødd og syv andre blitt syke av bakterier med denne typen hyperresistens etter å ha reist til Mexico for slankeoperasjon. Nå advarer delstaten Utah på sine nettsider folk mot disse helsereisene og mot den konkrete kirurgen som utførte disse inngrepene.

Fakta: Dette er resistente bakterier
Resistens gjør ikke bakteriene nødvendigvis mer sykdomsfremkallende, men mostanddyktige mot antibiotika. Ved multiresistents er bakteriene motstandsdyktige mot flere antibiotika.

Typer resistens:
MRSA – Methicillinresistente Staphylococus aureus: En type resistens som finnes hos gule stafylokokker. Stafylokokker er normalt en del av floraen på huden vår, men kan også gi sårinfeksjoner, og kommer de inn i blodet gir de alvorlige og livstruende infeksjoner. Når de bærer resistensgenet MRSA, vil slike infeksjoner bli vanskelig å behandle, fordi de antibiotika man da må behandle med, virker dårligere og har mer bivirkninger.

ESBL – Extended spectrum betalactamase: En type resistens som finnes hos en rekke tarmbakterier og noen bakterier som lett etablerer seg på utstyr og overflater i sykehus. Blant disse bakteriene finnes både sykdomsfremkallende bakterier og normalfloraen i tarmen. Denne type resistens kan også påvises i urin ved urinveisinfeksjon.

Når bakterier innen denne gruppen blir ekstra resistente kalles det ESBL-CARBA/KPB – Karbapenemase produserende bakterier. Disse er resistente mot nesten alle typer antibiotika, også de mest bredspektrede midlene vi har. Her må legene ofte ty til gamle og mindre effektive antibiotika med en rekke til dels alvorlige bivirkninger. Og når disse heller ikke virker: Da kan vi risiker å stå igjen uten behandlingsmuligheter.

VRE/LRE – vancomycin- eller linezolid resistente enterokokker: Enterokokker er også en bakterie som finnes normalt i tarmen, men kan gi sykdom i bl.a. i urinveier og i blodbanen. Det er i utgangspunktet få antibiotika som virker på denne bakterien, så når den i tillegg blir resistent mot disse få, blir den svært vanskelig å behandle. Denne bakterien har tidligere forårsaket utbrudd på norske sykehus.

Advarer mot helsereiser
Folkehelseinstituttet advarte mot å reise til utlandet for helsetjenester i en oppdatering tidligere i sommer. De ber deg unngå helsebehandling, inkludert tannbehandling, i utlandet dersom du kan få utført den samme behandlingen her til lands.

De anbefaler god håndhygiene og god kjøkkenhygiene for å unngå å plukke opp resistente bakterier, men fraråder ikke å reise. De understreker også at hvis du blir syk under reisen, må du ikke nøle med å oppsøke helsetjenester når du trenger det.

Hvem testes?
Pasientene som har størst risiko for å være bærer av resistente bakterier, isoleres og testes med både nese, hals, hud og avføringsprøve ved innleggelse på norske sykehus. Dette gjelder blant annet alle som har vært i kontakt med helsetjenesten i land utenfor Norden siste 12 månedene, for å unngå at resistens spres på sykehuset til andre og mer sårbare pasienter.

Bakteriene florerer
Men verst er selvfølgelig denne utviklingen for dem som bor i landene med høy forekomst av resistens, og som ikke har tilgang på andre helsetester enn sykehus hvor sykehusinfeksjoner med resistente bakterier florerer.

En organisasjon som har merket dette i sitt arbeid, er Leger Uten Grenser. De beskriver på sine nettsider en situasjon hvor nyere «siste utvei»-antibiotika er dyrere, og i mange mellom- og lavinntektsland kan disse være vanskelig å få tak i. Offentlige sykehus får ikke tak i riktig type antibiotika til pasienter som ikke kan betale selv, og de får ikke gitt pasientene sine fullgod behandling.
Leger Uten Grenser oppgir at årsakene til denne utviklingen er uregulert salg av antibiotika over disk uten krav om resept fra lege, dårlig smittevernkontroll i helsetjenesten, antibiotika av dårlig kvalitet på apotekene, dårlig forskrivningspraksis hos leger og mangel på diagnostisk utstyr, i tillegg til dårlig opplæring av pasientene.

Varsko om antibiotika
Tenkt deg om før du tar antibiotika mot en lett diaré på turen. Å ta toppende midler gir også økt risiko, ifølge en finsk studie. Å ta begge deler på én gang er enda verre.

Det beste er kanskje å la den gå over av seg selv for ikke å risikere å bære med deg resistente bakterier hjem. Skulle du da få en alvorlig infeksjon på toppen, kan den bli vanskelig å behandle.

Personer med alvorlig kronisk sykdom som har høy risiko for å måtte søke helsehjelp under turen, bør også være klar over risikoen for å bli smittet med multiresistente bakterier ved et sykehusopphold i utlandet. Har de også nedsatt immunforsvar, risikerer å få en infeksjon det kan bli vanskelig å bli kvitt.

Øyunn Holen Overlege, spesialist i infeksjonsmedisin Folkehelseinstituttet

Fakta: Dette er et Viten-innlegg fra Aftenposten
Viten er Aftenpostens satsing på forskning og vitenskap, der forskere fra hele landet bidrar med artikler.
Viten-artikler publiseres i Aftenpostens papirutgave tirsdager og torsdager, i tillegg til nettartikler på ap.no/viten.


Import and spread of extended- spectrum β-lactamase-producing Enterobacteriaceae by international travellers (COMBAT study): a prospective, multicentre cohort study

BACKGROUND:

International travel contributes to the dissemination of antimicrobial resistance. We investigated the acquisition of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) during international travel, with a focus on predictive factors for acquisition, duration of colonisation, and probability of onward transmission.

METHODS:

Within the prospective, multicentre COMBAT study, 2001 Dutch travellers and 215 non-travelling household members were enrolled. Faecal samples and questionnaires on demographics, illnesses, and behaviour were collected before travel and immediately and 1, 3, 6, and 12 months after return. Samples were screened for the presence of ESBL-E. In post-travel samples, ESBL genes were sequenced and PCR with specific primers for plasmid-encoded β-lactamase enzymes TEM, SHV, and CTX-M group 1, 2, 8, 9, and 25 was used to confirm the presence of ESBL genes in follow-up samples. Multivariable regression analyses and mathematical modelling were used to identify predictors for acquisition and sustained carriage, and to determine household transmission rates. This study is registered with ClinicalTrials.gov, number NCT01676974.

FINDINGS:

633 (34·3%) of 1847 travellers who were ESBL negative before travel and had available samples after return had acquired ESBL-E during international travel (95% CI 32·1-36·5), with the highest number of acquisitions being among those who travelled to southern Asia in 136 of 181 (75·1%, 95% CI 68·4-80·9). Important predictors for acquisition of ESBL-E were antibiotic use during travel (adjusted odds ratio 2·69, 95%CI 1·79-4·05), traveller’s diarrhoea that persisted after return (2·31, 1·42-3·76), and pre-existing chronic bowel disease (2·10, 1·13-3·90). The median duration of colonisation after travel was 30 days (95% CI 29-33). 65 (11·3%) of 577 remained colonised at 12 months. CTX-M enzyme group 9 ESBLs were associated with a significantly increased risk of sustained carriage (median duration 75 days, 95% CI 48-102, p=0·0001). Onward transmission was found in 13 (7·7%) of 168 household members. The probability of transmitting ESBL-E to another household member was 12% (95% CI 5-18).

INTERPRETATION:

Acquisition and spread of ESBL-E during and after international travel was substantial and worrisome. Travellers to areas with a high risk of ESBL-E acquisition should be viewed as potential carriers of ESBL-E for up to 12 months after return.

FUNDING:

Netherlands Organisation for Health Research and Development
(ZonMw).

Copyright © 2017 Elsevier Ltd. All rights reserved.


Millions of health-care facilities lack WASH services

Proper water, sanitation, and hygiene are vital for infection prevention and curbing antimicrobial resistance, yet millions of centres lack even basic facilities. Talha Burki reports.

896 million people worldwide rely on health-care facilities with no water service, according to a joint report by WHO and UNICEF. The authors also noted that 1·5 billion people use facilities with no sanitation, and that every year 17 million women in the world’s poorest countries give birth in health-care centres with inadequate water, sanitation, and hygiene (WASH).

The report, which is the first of its kind, offers baseline estimates for national, regional, and global provision of WASH in health care. It also examined waste management services and environmental cleaning, although for cleaning in particular there are very few data. Services were categorised as basic, limited, or non-existent. For water, a basic service implies that there is an improved source such as a piped supply on the premises. For sanitation, it implies that the facilities are designed to ensure that people do not come into contact with excreta and that there are male and female toilets and a dedicated staff toilet. A basic hygiene service means that there are working hand hygiene facilities, either soap and water or alcohol-based hand rub, at points of care and near toilets.

Most countries do not collect data on the basis of the definitions outlined in the report. For global coverage of basic services, there was enough information to provide estimates for only water (75% of health-care facilities worldwide have basic water services). Nonetheless, the available data, which are for 2016, are sufficient to raise concern. One in eight health-care centres has no water service at all, one in five has no sanitation, and one in six has no hygiene services. There is wide variation within countries, regions, and continents. Hospitals tend to be better served than other health-care facilities, and urban institutions do better than rural ones. Only 30% of health-care centres in Ethiopia have basic water services; in Zimbabwe, the proportion stands at 81%. 64% of centres in China lack adequate hand hygiene facilities.

Moreover, while limited or non-existent WASH services in health care present an obvious danger, basic services do not necessarily equate to safe services. A flush toilet connected to a sewer qualifies as a basic service, for example, but the toilet still needs to be regularly cleaned, and users need somewhere to wash their hands. Even if a facility has piped water, it can still be unfit for consumption. The report cites a 2016 survey in Lebanon, which found that a quarter of health-care centres with basic water services had faecally contaminated water. “If you have water, but you do not have sanitation, then the human waste will get into the water”, said Maria Neira (WHO, Geneva, Switzerland). Water supplies can also be interrupted, forcing people to resort to storage tanks, which have an increased risk of contamination.

Neira believes that prioritising access to clean water and sanitation when countries are planning infrastructure for primary care would make a big difference. “WASH has to be something that is properly financed from the beginning”, she said. Solutions for waste management need not be costly. “Using simple principles, you can do a lot with very little”, explains Didier Pittet (University of Geneva Hospitals and Faculty of Medicine, Switzerland). “It is mostly about education; you train people on the basics, where to discard what, and you spend a bit of money on colour-coded bins.”

Pittet stresses the importance of alcohol-based hand rubs. “If health-care facilities really want to make a significant change in the risk of infection transmission, they must switch to alcohol-based hand rub”, he said. “Hand-washing facilities do not improve compliance to hand hygiene, because health-care workers do not always have the time to wash their hands with soap and water.” He points out that if water supplies are contaminated, then hand-washing can even be counterproductive, especially if users rinse off the soap and leave their hands wet. Alcohol-based hand rubs can provide an effective transitional solution for institutions that cannot afford to install basic water services throughout, although they cannot act as a substitute for soap and water after using the toilet. “It is a direct way to change the process, it has been proven in developed and developing countries, and you can introduce it to places where there is difficulty in putting in hand-washing facilities”, concluded Pittet.

Neira notes that without improving WASH services, it is hard to envisage progress in key areas of health care. “You might have fantastic plans for preventing maternal and neonatal mortality, or on antimicrobial resistance, but you will still have major difficulties unless water safety and sanitation are a strong part of your programmes.”

Article by Talha Burki

Article shared from: https://www.thelancet.com/infection Vol 19 June 2019

For the WASH report see https://apps.who.int/iris/bitstream/handle/10665/311620/9789241515504-eng.Pdf


Mind the Staph: London Is Crawling with Antibiotic-Resistant Microbes

The bacteria are not a major threat, but they could transfer their resistance to more dangerous pathogens

London is teeming with bacteria—some of which have developed resistance to antibiotics. These microbes are mostly harmless, but if they do cause an infection, it can be hard to treat. And there is a chance that they could transfer their resistance to more dangerous strains, experts warn.

In a new study, researchers in England and their colleagues found that frequently touched surfaces—such as elevator buttons, ATMs and bathroom-door handles—can be reservoirs of drug-resistant staphylococcus, or staph, bacteria.

The researchers collected 600 samples from locations throughout East and West London such as hospitals, public washrooms and ticket machines, finding 11 species of staphylococci. Nearly half of the samples—including 57 percent in East London and about 41 percent in less crowded West London—contained bacteria resistant to two or more frontline antibiotics. Just under half of the staph found in hospital public areas was drug resistant, compared with 41 percent in community settings, the team reported Thursday in Scientific Reports.

“Resistance genes and elements present in these bacteria can spread to human pathogens and result in the emergence of new [antimicrobial-resistant] clones,” says Hermine Mkrtchyan, a senior lecturer at the University of East London, who headed the team that conducted the research. “Although these bacteria are nonpathogenic, the increased levels of antibiotic resistance that we found in general public settings in the community and in hospitals pose a potential risk to public health.”

Should people be worried?

“So long as you wash your hands after going out into public areas, it should be fine,” says Richard Stabler, co-director of the Antimicrobial Resistance Center at the London School of Hygiene & Tropical Medicine, who was not involved in the work. “I certainly recommend washing your hands after being out in London.”

Despite the high ick factor of the idea of touching potentially dangerous bacteria in familiar settings, Stabler concedes that these species are commonly found on skin, so it is no surprise that they would be found in public places where people are constantly shedding skin and microbes.

These bacteria do not pose a real danger right now, Stabler says, because although some of them were resistant to two common antibiotics, they cannot evade the entire medical arsenal. “This is potentially a problem out there, but at the moment, it’s still quite containable,” he says.

Antimicrobial resistance is a major public health threat across the globe, Mkrtchyan notes. Every year, more than 700,000 people die because of it, and the toll is predicted to rise to 10 million by 2050. Resistance means patients will stay sick for longer, which increases the cost of health care, Mkrtchyan says. “Our research highlights that general public areas (part of our everyday life) can be reservoirs for multidrug-resistant bacteria and alerts us that concrete global efforts are required to tackle the problem.”

Mkrtchyan and her colleagues previously found similar drug-resistant bacteria in a study of London hotel rooms. They are now comparing the genes of the 11 species found in both studies to better understand how they evade drugs and the physical environments that support their development and transmission.

Knowing about the presence of antibiotic-resistant bugs is useful, Stabler adds, because public officials can utilize the information to prepare and guide treatment. “It’s okay that they’re out there,” he says. “We have to live with them rather than trying to exterminate them—because that doesn’t work.”

Antimicrobial resistance is a major public health threat across the globe, Mkrtchyan notes. Every year, more than 700,000 people die because of it, and the toll is predicted to rise to 10 million by 2050. Resistance means patients will stay sick for longer, which increases the cost of health care, Mkrtchyan says. “Our research highlights that general public areas (part of our everyday life) can be reservoirs for multidrug-resistant bacteria and alerts us that concrete global efforts are required to tackle the problem.”

Mkrtchyan and her colleagues previously found similar drug-resistant bacteria in a study of London hotel rooms. They are now comparing the genes of the 11 species found in both studies to better understand how they evade drugs and the physical environments that support their development and transmission.

Knowing about the presence of antibiotic-resistant bugs is useful, Stabler adds, because public officials can utilize the information to prepare and guide treatment. “It’s okay that they’re out there,” he says. “We have to live with them rather than trying to exterminate them—because that doesn’t work.”

Lipkin notes that some antibiotic resistance exists naturally. Researchers have found resistant microbes in isolated caves, he says, suggesting that some bacteria have evolved to tolerate natural antibiotics. But humans have dramatically increased the prevalence of these microbes by using antibiotics inappropriately.

The findings are concerning but not a reason to panic, Lipkin says. Similar drug resistance has been found in other places for years. “It’s just another call to be more sensible about how we use antibiotics,” he explains. Still, “the fact that they’re there at all means that they’re capable of moving into people.”

 

Article shared from: https://www.scientificamerican.com
By Karen Weintraub

Karen Weintraub is a freelance health and science journalist who writes regularly for the New York Times, STAT and USA Today, among others.


Hand hygiene helps reduce HCAIs (healthcare-associated infection)

Chris Wakefield, Vice President at GOJO Industries-Europe Ltd, highlights how hand hygiene systems reduce the spread of healthcare-associated infection (HCAI)

It is estimated that 300,000 patients a year in England acquire a healthcare associated infection (HCAI) as a result of care within the NHS. Such infections draw large attention from patients, regulatory bodies and the media. Not only because of the magnitude of the problem – after all, they are associated with morbidity, mortality and the financial cost of treatment – but, also, because most are preventable.

Despite being avoidable, HCAIs continue to present a major threat to our public health. They are particularly difficult to eliminate due to the speed and ease that they can be transmitted – and because of their long-life span. Did you know, for example, that MRSA can live up to nine weeks, whilst C.Diff spores can live up to five months? Or that they can be spread through both direct and indirect contact?

Studies have shown that contaminated hands can sequentially transfer some viruses to up to seven surfaces, and that fourteen people can be contaminated by touching the same object one after the other. Perhaps itʼs not surprising then, that research indicates that you have a 50/50 chance of picking up a dangerous pathogen anytime you touch anything or anyone in a hospital.

Such outbreaks can have serious repercussions; including the increased risk to the lives of vulnerable patients, disruption of services and reduced clinical activity, such as the enforced closure of hospital wards, cancelled admissions and delayed discharges. There is also the cost of treatment to factor.
Indeed, a report by the National Audit Office estimated that a reduction in the rates of MRSA bloodstream infections saved the NHS in England between £45 million-£59 million in treatment costs between 2003/4 and 2008/9. It also identified that by reducing the rate of C. difficile infections, between £97 million-£204 million was saved in treatment costs between 2006/7 and 2007/8.

Going back to basics

A great deal of scientific research has shown that, if properly implemented, hand hygiene is the single most important, easiest and cost-effective means of reducing the prevalence of HCAIs and the spread of antimicrobial resistance. In fact, research shows it can cut the number of HCAI cases by up to 50%. Several other studies have also demonstrated that handwashing virtually eradicates the carriage of MRSA which invariably occurs on the hands of healthcare professionals working in intensive care units. An increase in handwashing adherence has also been found to be accompanied by a fall in MRSA rates.
In order to reduce the spread of illness, everyone has to engage with hand hygiene practices – not only healthcare workers, who already make this a part of their daily lives, but visitors and patients too. As a founder member of the World Health Organization (WHO) Private Organizations for Patient Safety group, GOJO is a strong advocate of the ‘total solutionʼ approach to making hand hygiene second nature to everyone in a healthcare setting. We believe that, to successfully change behaviour, a triple-pronged approach is required.

Firstly, handwashing facilities must be accessible and dispensers easy to use. The WHO recommends that an adequate number of appropriately positioned hand hygiene facilities should be readily available at the point of care.

Secondly, the high frequency with which healthcare workers clean their hands means that the formulations must be gentle yet effective against germs, complying with key hospital norms EN 1500, EN 14476 and EN 12791. Studies have also shown that using an alcohol-based handsanitising rub can improve hand hygiene practice, since it is quicker, is microbiologically more effective and is less irritating to skin than traditional hand washing with soap and water.
Finally, eye-catching signage is very effective as a prompt, especially at key germ hot-spots such as washrooms and waiting areas. Hand hygiene facilities must remain well-stocked and maintained at all times too.

Getting smart

Although evidence supports a ‘back to basicsʼ approach, digital innovation also has a role to play. GOJO has spent many years developing advanced formulations and high-tech dispensers, and has recently harnessed revolutionary smart technology to create its SMARTLINK™ Electronic Monitoring Solutions. These two mobile apps are a smarter way to help reduce the maintenance time spent on dispensers, and measure hand hygiene performance – ultimately helping to prevent the spread of germs.
Combining the latest technology with the simple act of hand hygiene, and working together to put effective systems in place, we can reduce the spread of HCAIs. GOJO, the leading global producer of skin health and hygiene solutions for away-from-home settings, is your specialist partner in healthcare hygiene.

For a tailored, effective, total solution for your setting, or for more information, please call +44 (0)1908 588444,
email infouk@GOJO.com or visit www.GOJO.com

 

By Kerrie Doughty
Trade Marketing & Communications Manager GOJO Industries-Europe
Tel: +44 (0)1908588457
infouk@gojo.com
www.GOJO.com
www.twitter.com/GOJO_Hcare
www.twitter.com/GOJO_Europe

 

 

References
1. https://www.nice.org.uk/guidance/qs61/chapter/introduction
2. Hata B et al. Clin Infect Dis 2004; 39k1182 | Kramer A et al. BMC Infect Dis 2006; 6k130 | Havill NL. et al. Infect Control Hosp Epidemiol 2014; 35k445 | Weber DJ et al. Infect Control Hosp Epidermiol 2015.
3. Barker J, Vipond IB, Bloomfield SF. J Hosp Infect 2004,58k42-494 Stiefel U et al. Infect Control Hosp Edipdemiol 2011; 32k185.
4. 2008 SDA Clean Hands Report Card® sponsored by the Soap and Detergent Association.
5. 24 &25 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249958/#ref1
6. 26 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249958/#ref1
7. 2,3 & 35
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249958/#ref1


Ebola is back – can it be contained?

The current outbreak of the deadly virus in the DRC has been called the most complex public health emergency in history. Peter Beaumont describes his recent visit to the DRC and Sarah Boseley discusses how the 2014 outbreak was eventually contained. Plus: Helen Pidd on what has been achieved with the ‘northern powerhouse’

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The latest outbreak of Ebola, with more than 2,200 cases and more than 1,500 confirmed deaths in just over a year, is the second largest in history, despite the recent availability of an effective experimental vaccine. Political, security and cultural complications – not least a refusal to believe that Ebola exists – have thwarted efforts to overcome the Democratic Republic of the Congo’s deadly outbreak.

Senior global development reporter Peter Beaumont tells Anushka Asthana about his recent trip to North Kivu, which is at the heart of the recent outbreak. He discusses why some health officials are calling it the most complicated public health emergency in history. Guardian health editor Sarah Boseley, who reported on the 2014 outbreak, looks at how that was contained – and why the situation is potentially far more frightening this time round.

And: the Guardian’s northern editor, Helen Pidd, looks at whether the “northern powerhouse” has been a success five years after its creation.

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Publihed by the Guardian,

Presented by Anushka Asthana with Sarah Boseley, Peter Beaumont and Helen Pidd, produced by Nicola Kelly, Elizabeth Cassin, Iain Chambers and Axel Kacoutié; executive producers Nicole Jackson and Phil Maynard


The European Commission has awarded its Seal of Excellence to Resani’s Horizon 2020 Phase 2 proposal - describing Resani’s disruptive hand sanitizing and compliance technology.

The Seal of Excellence is a quality label awarded to a few project proposals submitted to Horizon 2020, the EU’s research and innovation funding programme.

Following evaluation by an international panel of independent experts, Resani’s proposal was scored as A HIGH-QUALITY PROJECT PROPOSAL IN A HIGHLY COMPETITIVE EVALUATION PROCESS *)

* ) This means passing all stringent Horizon 2020 assessment thresholds for the 3 award criteria (excellence, impact, quality and efficiency of implementation) required to receive funding from the EU budget Horizon 2020.


Hands are vehicles for transmission of Streptococcus pneumoniae

Hands can be vehicles for transmission of pneumococcus and lead to acquisition of nasopharyngeal colonization, according to research published in the European Respiratory Journal.

Streptococcus pneumoniae (pneumococcus) is a major cause of acute otitis media, sinusitis, pneumonia, and meningitis worldwide, with more than 1.2 million attributed deaths annually. Colonization of the nasopharynx with these bacteria is a prerequisite for infection and it is the primary reservoir for transmission. It is theorized that transmission of pneumococcus occurs primarily through indirect contact through inhalation of airborne droplets and is associated with living in higher-density populations. For upper respiratory tract infections in general, direct contact is implicated in disease transmission, which can be interrupted by hand washing. However, the relative contribution of direct and indirect transmission modes to pneumococcal colonization and disease are unknown. Therefore, this study sought to assess the potential for pneumococcal hand-to-nose transmission to cause nasopharyngeal colonization.

A total of 63 healthy adult participants were enrolled into a controlled Experimental Pneumococcal Challenge model that was modified to assess
“hand-to-nose” (ISRCTN identifier: 12909224). Participants were divided into 4 transmission groups and dministered pneumococcus (3.2X106 mid-log phase colony-forming units of S pneumoniae serotype 6B) onto their hand and asked to either sniff or make direct contact with the nasal mucosal surface with the bacterial residue either immediately after exposure (wet) or when visibly dry (1-2 minutes after exposure). The 4 groups were: (1) sniffing wet bacterial suspension (wet sniff), (2) sniffing bacterial suspension after air-drying (dry sniff), (3) pick/poke nose with finger exposed to wet bacterial suspension (wet poke), and (4) pick/poke nose with finger exposed to bacterial suspension after air-drying (dry poke). After 9 days of exposure, nasopharyngeal colonization was assessed through nasal washes and all samples were tested by quantitative polymerase chain reaction (qPCR) with primers for lytA and for S pneumoniae serotype 6A/b.

Of the 40 participants, 20% were found by culture at follow up to be experimentally colonized with pneumococcus (6B), with the highest rates in the wet poke (40%) and wet sniff (30%) groups. In the dry sniff and dry poke groups, 10% and 0% of participants, respectively, were found to be experimentally colonized. When wet and dry groups were compared, colonization rates in the wet groups were significantly higher than in the dry groups (P =.04, Fisher exact test). Molecular detection via lytA qPCR identified higher colonization rates compared with culture (P <.0001). This was most apparent in the dry poke group, which had a colonization rate of 0% by culture and 70% using qPCR. Samples that were only positive with qPCR, such as the dry poke group, tended to have lower densities of carriage compared with samples that were positive with both methods, such as both of the wet groups.

Overall, the results provide a better understanding of the duration of survival of pneumococci in nasal secretions on the hands and the entire transmission process. The study authors concluded that, “This modification of the Experimental Pneumococcal Challenge model has several potential uses, including testing of current or new hand cleaning interventions to ensure reduction in transmission of this important bacterial pathogen.”

Reference
Connor V, German E, Pojar S, et al. Hands are vehicles for transmission of Streptococcus pneumoniae in novel controlled human infection study. Eur espir J. 2018;52(4):1800599.

Published by infectiousdiseaseadvisor.com , April 3rd 2019

https://www.infectiousdiseaseadvisor.com/home/topics/prevention/hands-are-vehicles-for-transmission-of-streptococcus-pneumoniae/


Healthy and happy staff make businesses thrive

‘Nobody cares how much you know until they know how much you care.”

This quote, often attributed to Theodore Roosevelt, is one that more company bosses should consider, because those who look after their staff will reap the productivity benefits of a happier and more engaged workforce.

It also breeds loyalty, as the tale of one ex-Warburtons chairman tells. The story goes that he personally drove a delivery driver to the physio each week after the workerʼs legs were badly injured in an accident. He was treated until fit again and repaid the act by working for the family bakery until he retired as a senior director.

Another leader who believed that cared-for staff make for better and more successful organisations was John Spedan Lewis, founder of the John Lewis Partnership. He implemented pastoral care and employed a chief medical officer, GPs, physiotherapists and chiropodists to support department store colleagues. This was before and after the formation of the NHS.

I saw the benefits of this approach in the 2000s, when I was retail director of Waitrose. We had just taken over a number of competitor shops and I recall one poorly performing store having roughly one out of every 11 employees off sick at any one time.

By focusing on well-being and happiness, sick absence fell to below 3pc in less than six months. Staff turnover also decreased by two thirds. It not only brought immediate savings, but because experience was retained and improved, service standards and productivity increased. The shop went from being a loss-maker to generating a healthy profit.

In 2017, an estimated 131m working days were lost in the UK due to sickness. Absence will cost the economy £26bn by 2030. Something must be done to improve the situation. When I built my engaging.works website, which measures the workplace happiness of thousands of individuals, I wanted to find out how employees felt about their well-being at work.

Four questions of the overall 13 provide an answer. These are: do you rarely feel depressed or anxious at work; do you feel that the organisation cares for your well-being; do you feel that you have a good relationship with your line manager; and do you enjoy your job? Respondents answer on a scale of one (strongly disagree) to 10 (strongly agree).

The first two make up a “health hygiene” score, while the other two form a “job satisfaction” score. Plotted on an axis and ignoring those with no strong opinion either way, you can see several types of employee.

People who score low on health hygiene but high on satisfaction are what I call “stoics” (they endure personal problems due to their job being good enough). Oppositely, those who report high on health hygiene and low in encouragement are “discouraged”.

“Thriving” employees score more than seven out of 10 on both, while those who score low on both are “neglected”. Finally, there are
“prospering” workers, who donʼt score as highly as thriving colleagues, but still well.

Whatʼs striking is that almost one in four employees (24pc) scored themselves badly in terms of health hygiene, with one in 11 (9pc) falling into the “neglected” quadrant. That may sound like a decent score, but if 90 employees in a 1,000-strong organisation are suffering and have no job satisfaction, thatʼs a huge chunk of disengaged and unproductive staff.

Women make up the greatest numbers in the “neglected” camp, with 8pc of female managers in this group versus 5pc of male managers. For non-managers, itʼs 11pc versus 8pc, respectively – and for women and men over the age of 35, itʼs 10pc versus 7pc.

Women are also lacking when it comes to the “thriving” camp, with 31pc of male managers in this category compared to 28pc of their female counterparts. But there is one glimmer of hope at the non-management level; “thriving” women outscore men 29pc to 26pc.

What else? If youʼre in a non-management role, your health hygiene score is likely to be significantly worse than your manager (managers outperform non-managers in the “thriving” and “prospering” categories). Millennials are also more likely to be thriving than their older colleagues.

The results are clear that businesses must focus on improving the well-being of their female employees – managers in particular. Older colleagues and those on the front-line also need attention.

They could start by following Lewisʼs example and provide healthcare and mental health support. But importantly, employers should focus on the things that improve workplace happiness: fair reward, recognition, adequate and appropriate information to do a job well, trust, empowerment, career development and supportive line management.

Mark Price is a businessman, writer and was previously minister of state for trade and managing director of Waitrose. For a free copy of this report, email mark.price@engaging.works

 

By Mark Price

Published by Telegraph February 1st 2019

https://www.telegraph.co.uk/business/2019/02/01/healthy-happy-staff-make-businesses-thrive/