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Reducing public sickness risks16th of September 2011
Ann Laffeaty looks at the latest health scares and finds out how far the risks to the public can be reduced through better cleaning measures and higher standards of hygiene.
Over the past few years our society has been confronted by one health scare after another. MRSA, C.Difficile, swine flu, E.Coli – whether these conditions target closed communities such as hospital wards or affect the wider population, their effects can be deadly and we are all terrified of catching them.
Experts are constantly urging us to wash our hands thoroughly and to clean all surfaces to avoid contamination. But do such simple measures really make a difference in reducing these threats to our health?
In June the French authorities linked sprouting seeds supplied by a British company to an E.Coli outbreak that left eight people in hospital in France.
This came hot on the heels of an outbreak of a new strain of E Coli that killed at least 48 people in Germany and left 3,700 ill. Beansprouts were identified as the most likely cause here.
But seeds are not the only potential risk when it comes to E.Coli. Last year an outbreak of E.Coli at a 'petting farm' in Surrey, England, affected more than 90 people and left 17 children with kidney failure. So it seems that avoiding beansprouts alone will not necessarily keep us safe.
According to the Health Protection Agency, E. Coli is usually acquired by ingesting contaminated food or water. Some strains live harmlessly in the intestine while others cause diarrhoea and can lead to life-threatening complications.
Person-to-person transmission can occur through the oral-faecal route, which is why petting farms are particularly vulnerable. Visitors to open farms are urged to take greater care to avoid any contact with animal droppings.
George Griffin, professor of infectious diseases and medicine at St George's, University of London, led an inquiry following the outbreak of E.Coli at Surrey’s Godstone farm last year. He concluded that an overhaul of safety and hygiene was needed at open farms. “Hand washing alone is not enough - and reducing the chance of visitors touching animal faeces is the priority,” he said.
He claimed that farm operators needed to review the layout of public areas and that 'deep bedding' pens, in which animal faeces are allowed to accumulate, should be sited away from the public and should be cleaned out every few days rather than every three months as occurs in some farms.
He added that more education on the risks of E.Coli was required. The O157 strain is particularly dangerous for children and those over 76, for example: it can cause kidney failure, brain damage and even death.
According to the World Health Organisation (WHO), outbreaks linked to sprouting seeds may be a result of seeds becoming contaminated with faeces from domestic or wild animals during cultivation or handling. The organisation recommends adherence to its five basic hygiene 'Keys' to reduce the risks of infection – namely, to pay attention to personal hygiene; to separate raw and cooked foods; to thoroughly cook all foods that are meant to be served hot; to keep food at safe temperatures and to use safe water and raw materials.
Meanwhile, the Food Standards Agency advises all equipment that has come into contact with raw sprouting seeds should be thoroughly cleaned after use. Consumers should also wash their hands after handling seeds intended for planting or sprouting.
The advent of swine flu in 2009 alerted us all to the importance of washing our hands. In the panic that surrounded the first few outbreaks, the advice was unanimous: better hand hygiene could help prevent the spread of illness.
The US Center for Disease Control (CDC)was very specific in its guidelines. It recommended that hand washing should take place for a period of 15 to 20 seconds and that alcohol-based disposable hand wipes or gel sanitisers should be used when soap and water were not available.
The CDC also revealed that the swine flu virus could survive on surfaces and remain active for up to eight hours. A number of antibacterial wipes and cleaning products claiming to be active against swine flu were launched following this revelation.
The World Health Organisation, too, recommended that frequently-touched surfaces should be cleaned on a regular basis with household detergents. However WHO’s guidelines concentrated chiefly on the need for frequent hand washing with soap and water and on using a tissue to cover the nose and mouth when coughing or sneezing, then binning the tissue immediately afterwards.
WHO also recommended hand rubbing with alcohol as a supplement to hand washing where available.
MRSA – or Methicillin-resistant Staphylococcus aureus – has been a global problem in hospitals since it was first identified in the 1960s. According to the Health Protection Agency (HPA), MRSA spreads from patient to patient via the hands of carers. However, it can also survive in dust which means it is important to maintain high standards of general cleaning.
The HPA recommends thorough and regular hand washing among medical staff to prevent the spread of MRSA. It also suggests that a patient's clothes and linen should be washed in the hottest possible cycle and if possible tumble-dried or ironed.
Visitors do not need to wear protective clothing but they must wash and dry their hands thoroughly after contact.
According to Dr Stephanie Dancer, consultant microbiologist for NHS Lanarkshire, dust-associated microbes such as MRSA tend to settle on rarely-cleaned or inaccessible surfaces such as shelves, highly-placed equipment and computer keyboards.
She said a study in an Irish intensive care unit showed that cleaning a bed space using a detergent-based product followed by a one per cent hypochlorite solution was initially effective in eliminating MRSA.
“However, the site soon became re-contaminated,” she said. “It is possible that high-risk surfaces in areas such as intensive care units will require four-hourly cleaning attention in order to control recontamination by specific pathogens, such as MRSA.”
The World Health Organisation is now placing higher emphasis on alcohol-based hand rubs as an international standard in healthcare. According to its website: “At the present time, the most efficacious, well-tolerated and well-researched product which can be placed ergonomically and safely at the point of care is an alcohol-based hand rub.
“Soap and water hand washing is less efficacious, more time-consuming, and less well tolerated by skin than alcohol-based hand-rubbing.”
WHO recommends alcohol rubs?as a short-term strategy in countries where access to sinks is limited, although adds that installation of sinks should be the long-term strategy. However, WHO concedes that alcohol-based hand rubs are ineffective against Clostridium Difficile spores. It therefore recommends washing the hands with soap and water after glove removal when caring
for patients with diarrhoea during a C. Difficile outbreak.
The Health Protection Agency agrees that good hand washing practices by staff can help restrict the spread of Clostridium Difficile. The agency also advocates the routine use of alcohol gels between patients, but advises that visibly soiled hands should be washed with soap and water before thorough drying with a paper hand towel.
The Norovirus, better known as the 'winter vomiting bug'. Is chiefly transmitted through the faecal-oral route, either by consumption of faecally contaminated food or water or by direct person-to-person spread. The virus can spread very rapidly in semi-closed communities and as few as 10 viral particles may be sufficient to infect an individual.
Most foodborne outbreaks of Norovirus are likely to arise though direct contamination of food by a food handler immediately before its consumption. Outbreaks have frequently been associated with consumption of cold foods including salads, sandwiches and bakery products. Liquid items such as salad dressing or cake icing that allow the virus to mix evenly are also often implicated as a cause of outbreaks.
Food can also be contaminated at its source, and oysters from contaminated waters have been associated with widespread outbreaks. Meanwhile, waterborne outbreaks of the Norovirus in community settings have often been caused by sewage contamination of wells and recreational water.
According to Dr Stephanie Dancer, enhanced cleaning and surface disinfection with bleach-containing products can reduce the spread of Norovirus. “Such cleaning is essential for the rapid resolution of an outbreak,” she said. “Insufficient cleaning, or the mistiming of a cleaning intervention, encourages the re-emergence of cases.”
The Health Protection Agency agrees with this verdict, adding that particular attention should be paid to the toilet areas. Cleaning up any vomit rapidly will also help to reduce the risk of environmental contamination.
The HPA adds that good hygiene measures should be observed during outbreaks. The hands should be washed thoroughly with soap and water after coming into contact with someone who is ill and after using the toilet, especially for those suffering from symptoms.
General advice also includes the use of alcohol-based hand sanitisers as an adjunct method of hand hygiene.