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Concept: Cleanliness

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There has been extensive outsourcing of hospital cleaning services in the NHS in England, in part because of the potential to reduce costs. Yet some argue that this leads to lower hygiene standards and more infections, such as MRSA and, perhaps because of this, the Scottish, Welsh, and Northern Irish health services have rejected outsourcing. This study evaluates whether contracting out cleaning services in English acute hospital Trusts (legal authorities that run one or more hospitals) is associated with risks of hospital-borne MRSA infection and lower economic costs. By linking data on MRSA incidence per 100,000 hospital bed-days with surveys of cleanliness among patient and staff in 126 English acute hospital Trusts during 2010-2014, we find that outsourcing cleaning services was associated with greater incidence of MRSA, fewer cleaning staff per hospital bed, worse patient perceptions of cleanliness and staff perceptions of availability of handwashing facilities. However, outsourcing was also associated with lower economic costs (without accounting for additional costs associated with treatment of hospital acquired infections).

Concepts: Staphylococcus aureus, Hospital, England, Scotland, Hygiene, Cleanliness, Irish language, Irish people

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BackgroundBreath odor is a nuisance problem for many people around the world. Bad breath affects social interactions of people in daily life by causing personal discomfort and emotional stress. There are chemical and mechanical methods for controlling oral malodor. Many studies of various mouth rinse applications and tongue cleaning procedures have been conducted. However, few studies have compared the effect of simultaneous chemical and mechanical procedures on the reduction of volatile sulfur compounds (VSCs) in subjects with oral malodor. The purpose of this study was to assess the effects of different oral hygiene procedures on reduction of VSCs in subjects with oral malodor.MethodsThirty male volunteers who matched with study criteria were divided randomly into two groups. Both groups performed tooth brushing, mouth washing with chlorine dioxide, tongue cleaning and combination of those in different sequence for five weeks. Total VSCs of subjects were measured with a Breathtron®, and oral health status was also examined. Quantitative analyses were performed using the Statistical Package for Social Science (SPSS 16.0).ResultsThere were no significant differences in oral health status between the two groups at the baseline. No significant decrease in oral malodor was detected after one week of tooth brushing. Significant reductions in VSCs were shown by adding mouthwash or tongue cleaning to tooth brushing from the second week to fourth week (P <0.01). The greatest reduction in VSCs was found at the fifth week after the practice of all three oral hygiene regimens.ConclusionsTooth brushing alone does not significantly reduce oral malodor. Mouth washing and tongue cleaning significantly reduce oral malodor, but combining tooth brushing, mouth washing and tongue cleaning regimens is most effective for oral malodor reduction. The results of this study could contribute to the formulation of appropriate preventive strategies against oral malodor not only for the general public but also for dental professionals serving as oral malodor-related service providers.Trial registrationRegistration number - ClinicalTrials.gov NCT02113137. Registration date ¿ April 7th, 2014.

Concepts: Clinical trial, Effectiveness, Hygiene, Oral hygiene, Mouthwash, Halitosis, Cleanliness, Tongue cleaner

14

It is commonly assumed that cats actively avoid eliminated materials (especially in multi-cat homes), suggesting regular litter box cleaning as the best defense against out-of-box elimination. The relationship between previous use and litter box appeal to familiar subsequent users is currently unknown. The purpose of this study was to investigate the relationship between previous litter box use and the identity of the previous user, type of elimination, odor, and presence of physical/visual obstructions in a multi-cat household scenario. Cats preferred a clean litter box to a dirty one, but the identity of the previous user had no impact on preferences. While the presence of odor from urine and/or feces did not impact litter box preferences, the presence of odorless faux-urine and/or feces did - with the presence of faux-feces being preferred over faux-urine. Results suggest neither malodor nor chemical communication play a role in litter box preferences, and instead emphasize the importance of regular removal of physical/visual obstructions as the key factor in promoting proper litter box use.

Concepts: The Key, Household, Cat, Preference, Income quintiles, Home, Cleanliness

9

Trachoma is the world’s leading cause of infectious blindness. The World Health Organization (WHO) has endorsed the SAFE strategy in order to eliminate blindness due to trachoma by 2020 through “surgery,” “antibiotics,” “facial cleanliness,” and “environmental improvement.” While the S and A components have been widely implemented, evidence and specific targets are lacking for the F and E components, of which water, sanitation, and hygiene (WASH) are critical elements. Data on the impact of WASH on trachoma are needed to support policy and program recommendations. Our objective was to systematically review the literature and conduct meta-analyses where possible to report the effects of WASH conditions on trachoma and identify research gaps.

Concepts: Medicine, Evidence-based medicine, Systematic review, Effect size, Meta-analysis, World Health Organization, Hygiene, Cleanliness

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BACKGROUND: Although the wearing of face masks in public has not been recommended for preventing influenza, these devices are often worn in many Asian countries during the influenza season. In Japan, it is thought that such behavior may be an indicator of other positive hygiene practices. The aim of this study, therefore, was to determine if wearing a face mask in public is associated with other positive hygiene practices and health behaviors among Japanese adults. METHODS: We initially recruited around 3,000 Japanese individuals ranging from 20 to 69 years of age who were registered with a web survey company. Participants were asked to recall their personal hygiene practices during the influenza season of the previous year. Logistic regression analysis was then used to examine the associations between wearing a face mask in public and personal hygiene practices and health behaviors. RESULTS: A total of 3,129 persons responded to the survey, among whom 38% reported that they had worn a face mask in public during the previous influenza season. Wearing a face mask in public was associated with various self-reported hygiene practices including: frequent hand washing (adjusted Odds Ratio [OR]: 1.67; 95% Confidence Interval [95%CI]: 1.34-1.96), occasional hand washing (OR: 1.43; 95%CI: 1.10-1.75), frequently avoiding crowds (OR: 1.85; 95%CI: 1.70-1.98), occasionally avoiding crowds (OR: 1.65; 95%CI: 1.53-1.76), frequent gargling (OR: 1.68; 95%CI: 1.51-1.84), occasional gargling (OR: 1.46; 95%CI: 1.29-1.62), regularly avoiding close contact with an infected person (OR: 1.50; 95%CI: 1.33-1.67), occasionally avoiding close contact with an infected person (OR: 1.31; 95%CI: 1.16-1.46), and being vaccinated of influenza in the last season (OR: 1.31; 95%CI: 1.17-1.45). CONCLUSIONS: Overall, this study suggests that wearing a face mask in public may be associated with other personal hygiene practices and health behaviors among Japanese adults. Rather than preventing influenza itself, face mask use might instead be a marker of additional, positive hygiene practices and other favorable health behaviors in the same individuals.

Concepts: Regression analysis, Logistic regression, Health, Person, Hygiene, Hand washing, Cleanliness, Masks

5

This paper describes a novel method for removal of particulate contamination - loosely referred to as dust - from solid surfaces using polymeric micropillars. In this paper, we illustrate for the first time that polymeric microfibrils of controlled interfacial and geometrical properties can effectively remove micrometric and sub-micrometric contaminant particles from a solid surface without damaging the underlying substrate. Once these microfibrils are brought into contact with a contaminated surface, due to their soft and flexible structure, they develop intimate contact with both the surface contaminants and the substrate. While these intrinsically non-sticky micropillars have minimal interfacial interactions with the substrate, we show that they produce strong interfacial interactions with the contaminant particles, granting the detachment of the particles from the surface upon retraction of the cleaning material. The origin and strength of the interfacial interactions at the interfaces between a contaminant particle and both the substrate and the cleaning materials are thoroughly discussed. Unlike flat substrates of the same material, using micro-fibrillar structures of controlled interfacial and geometrical properties also allows the elimination of the adsorbed particles from the contact interface. Here we demonstrate that by moving the adsorbed particles from the tip to the side of the fibrils and consequently removing them from the contact interface, polymeric microfibrils can clean all contaminant particles from the surface. The effects of the geometrical and interfacial properties of polymeric micropillars on removing the adsorbed particles from the tips of the pillars are fully discussed. This research is not only important in terms of introducing a novel method which can offer a new paradigm for thorough yet nondestructive cleaning of dust particles from solid surfaces, but also it is of fundamental significance for researchers with interests in exploiting the benefits offered by micro-structured surfaces in development of interfacially-active materials and devices.

Concepts: Materials science, Surface, Particle, Object-oriented programming, Differential geometry, Analytic geometry, Dust, Cleanliness

5

This document is an executive summary of APSIC Guidelines for Environmental Cleaning and Decontamination. It describes best practices in routine cleaning and decontamination in healthcare facilities as well as in specific settings e.g. management of patients with isolation precautions, food preparation areas, construction and renovation, and following a flood. It recommends the implementation of environmental hygiene program to keep the environment safe for patients, staff and visitors visiting a healthcare facility. Objective assessment of cleanliness and quality is an essential component of this program as a method for identifying quality improvement opportunities. Recommendations for safe handling of linen and bedding; as well as occupational health and safety issues are included in the guidelines. A training program is vital to ensure consistent adherence to best practices.

Concepts: Environment, Natural environment, Management, Quality assurance, Hygiene, Environmentalism, Occupational safety and health, Cleanliness

4

Improving dementia care is a policy priority nationally and internationally; there is a ‘diagnosis gap’ with less than half of the cases of dementia ever diagnosed. The English Health Department’s Quality and Outcomes Framework (QOF) encourages primary care recognition and recording of dementia. The codes for dementia are complex with the possibility of underidentification through miscoding. We developed guidance on coding of dementia; we report the impact of applying this to ‘clean up’ dementia coding and records at a practice level.

Concepts: Health care, Diagnosis, Evaluation, Code, Hygiene, English people, Cleanliness, Gramophone record

3

Carrying food to water and either dunking or manipulating it before consumption has been observed in various taxa including birds, racoons and primates. Some animals seem to be simply moistening their food. However, true washing aims to remove unpleasant surface substrates such as grit and sand and requires a distinction between items that do and do not need cleaning as well as deliberate transportation of food to a water source. We provide the first evidence for food washing in suids, based on an incidental observation with follow-up experiments on European wild boar (Sus scrofa) kept at Basel Zoo, Switzerland. Here, all adult pigs and some juveniles of a newly formed group carried apple halves soiled with sand to the edge of a creek running through their enclosure where they put the fruits in the water and pushed them to and fro with their snouts before eating. Clean apple halves were never washed. This indicates that pigs can discriminate between soiled and unsoiled foods and that they are able to delay gratification for long enough to transport and wash the items. However, we were unable to ascertain to which degree individual and/or social learning brought this behaviour about.

Concepts: Pig, Wild boar, Domestic pig, Suidae, Pork, Omnivore, Cleanliness

2

The early hygiene hypothesis explained the development of allergies by a lack of infections; nowadays, the aspect of excessive cleanliness in affluent populations seems to have replaced this concept. Yet, no investigation has shown that home or personal cleanliness relate to allergic diseases.

Concepts: Immune system, Asthma, Allergy, Atopy, Eczema, Cleanliness, Hygiene hypothesis