#Risk of #transmission via #medical #employees and importance of routine #infection-prevention #policy in a #nosocomial #outbreak of #MERS: a descriptive analysis from a tertiary care hospital in South #Korea (BMC Pulm Med., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

BMC Pulm Med. 2019 Oct 30;19(1):190. doi: 10.1186/s12890-019-0940-5.

Risk of transmission via medical employees and importance of routine infection-prevention policy in a nosocomial outbreak of Middle East respiratory syndrome (MERS): a descriptive analysis from a tertiary care hospital in South Korea.

Ki HK1, Han SK2, Son JS3, Park SO4.

Author information: 1 Division of infectious diseases, Department of Internal Medicine, School of Medicine, Konkuk University, Konkuk University Medical Centre, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 05029, Republic of Korea. 2 Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung-Dong, Jongno-Gu, Seoul, 110-746, Republic of Korea. 3 Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul, Republic of Korea. 4 Department of Emergency Medicine, School of Medicine, Konkuk University, Konkuk University Medical Centre, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 05029, Republic of Korea. empso@kuh.ac.kr.




In 2015, South Korea experienced an outbreak of Middle East respiratory syndrome (MERS), and our hospital experienced a nosocomial MERS infection. We performed a comprehensive analysis to identify the MERS transmission route and the ability of our routine infection-prevention policy to control this outbreak.


This is a case-cohort study of retrospectively analysed data from medical charts, closed-circuit television, personal interviews and a national database. We analysed data of people at risk of MERS transmission including 228 in the emergency department (ED) and 218 in general wards (GW). Data of personnel location and movement, personal protection equipment and hand hygiene was recorded. Transmission risk was determined as the extent of exposure to the index patient: 1) high risk: staying within 2 m; 2) intermediate risk: staying in the same room at same time; and 3) low risk: only staying in the same department without contact.


The index patient was an old patient admitted to our hospital. 11 transmissions from the index patient were identified; 4 were infected in our hospital. Personnel in the ED exhibited higher rates of compliance with routine infection-prevention methods as observed objectively: 93% wore a surgical mask and 95.6% washed their hands. Only 1.8% of personnel were observed to wear a surgical mask in the GW. ED had a higher percentage of high-risk individuals compared with the GW (14.5% vs. 2.8%), but the attack rate was higher in the GW (16.7%; l/6) than in the ED (3%; 1/33). There were no transmissions in the intermediate- and low-risk groups in the ED. Otherwise 2 patients were infected in the GW among the low-risk group. MERS were transmitted to them indirectly by staff who cared for the index patient.


Our study provide compelling evidence that routine infection-prevention policies can greatly reduce nosocomial transmission of MERS. Conventional isolation is established mainly from contact tracing of patients during a MERS outbreak. But it should be extended to all people treated by any medical employee who has contact with MERS patients.

TRIAL REGISTRATION: NCT02605109 , date of registration: 11th November 2015.

KEYWORDS: Hand hygiene; Infection control; Isolation; Middle East respiratory syndrome coronavirus; Nosocomial infection

PMID: 31666061 DOI: 10.1186/s12890-019-0940-5

Keywords: MERS-CoV; Hand hygiene; IPCs; Nosocomial Outbreaks; S. Korea.


Effects of the #Australian National #Hand #Hygiene Initiative after 8 years on #infection control practices, #HCW #education, and clinical outcomes: a longitudinal study (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Effects of the Australian National Hand Hygiene Initiative after 8 years on infection control practices, health-care worker education, and clinical outcomes: a longitudinal study

Prof M Lindsay Grayson, FRACP, Andrew J Stewardson, FRACP, Philip L Russo, MClinEpid, Kate E Ryan, MPhysio (Cardio), Karen L Olsen, BSc, Sally M Havers, MPH, Susan Greig, RN, Marilyn Cruickshank, PhD on behalf ofHand Hygiene Australia and the National Hand Hygiene Initiative

Published: September 28, 2018 / DOI: https://doi.org/10.1016/S1473-3099(18)30491-2




The National Hand Hygiene Initiative (NHHI) is a standardised culture-change programme based on the WHO My 5 Moments for Hand Hygiene approach to improve hand hygiene compliance among Australian health-care workers and reduce the risk of health-care-associated infections. We analysed its effectiveness.


In this longitudinal study, we assessed outcomes of the NHHI for the 8 years after implementation (between Jan 1, 2009, and June 30, 2017), including hospital participation, hand hygiene compliance (measured as the proportion of observed Moments) three times per year, educational engagement, cost, and association with the incidence of health-care-associated Staphylococcus aureus bacteraemia (HA-SAB).


Between 2009 and 2017, increases were observed in national health-care facility participation (105 hospitals [103 public and two private] in 2009 vs 937 hospitals [598 public and 339 private] in 2017) and overall hand hygiene compliance (36 213 [63·6%] of 56 978 Moments [95% CI 63·2–63·9] in 2009 vs 494 673 [84·3%] of 586 559 Moments [84·2–84·4] in 2017; p<0·0001). Compliance also increased for each Moment type and for each health-care worker occupational group, including for medical staff (4377 [50·5%] of 8669 Moments [95% CI 49·4–51·5] in 2009 vs 53 620 [71·7%] of 74 788 Moments [71·4–72·0]; p<0·0001). 1 989 713 NHHI online learning credential programmes were completed. The 2016 NHHI budget was equivalent to AUD$0·06 per inpatient admission nationally. Among Australia’s major public hospitals (n=132), improved hand hygiene compliance was associated with declines in the incidence of HA-SAB (incidence rate ratio 0·85; 95% CI 0·79–0·93; p≤0·0001): for every 10% increase in hand hygiene compliance, the incidence of HA-SAB decreased by 15%.


The NHHI has been associated with significant sustained improvement in hand hygiene compliance and a decline in the incidence of HA-SAB. Key features include sustained central coordination of a standardised approach and incorporation into hospital accreditation standards. The NHHI could be emulated in other national culture-change programmes.


Australian Commission on Safety and Quality in Health Care

Keywords: Nosocomial Outbreaks; Staphylococcus Aureus; Bacteremia; Hand hygiene; Health Care Workers; Australia.


#Elizabethkingia anophelis and Association with #Tap #Water and #Handwashing, #Singapore (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 24, Number 9—September 2018 / Dispatch

Elizabethkingia anophelis and Association with Tap Water and Handwashing, Singapore

Chee-Fu Yung  , Matthias Maiwald, Liat H. Loo, Han Y. Soong, Chin B. Tan, Phaik K. Lim, Ling Li, Natalie WH Tan, Chia-Yin Chong, Nancy Tee, Koh C. Thoon, and Yoke H. Chan

Author affiliations: KK Women’s and Children’s Hospital, Singapore.



We report an Elizabethkingia anophelis case cluster associated with contaminated aerators and tap water in a children’s intensive care unit in Singapore in 2017. We demonstrate a likely transmission route for E. anophelis to patients through acquisition of the bacteria on hands of healthcare workers via handwashing.

Keywords: Elizabethkingia anophelis; Nosocomial Outbreaks; Singapore; Handwashing.


Impact of adding #handwashing and #water #disinfection promotion to oral #cholera #vaccination on diarrhoea-associated hospitalization in Dhaka, #Bangladesh: evidence from a cluster randomized control trial (Int J Infect Dis., abstract)

[Source: International Journal of Epidemiology, full page: (LINK). Abstract, edited.]

Impact of adding hand-washing and water disinfection promotion to oral cholera vaccination on diarrhoea-associated hospitalization in Dhaka, Bangladesh: evidence from a cluster randomized control trial

Nusrat Najnin, Karin Leder, Firdausi Qadri, Andrew Forbes, Leanne Unicomb, Peter J Winch, Pavani K Ram, Elli Leontsini, Fosiul A Nizame, Shaila Arman, Farzana Begum, Shwapon K Biswas, John D Clemens, Mohammad Ali, Alejandro Cravioto, Stephen P Luby

International Journal of Epidemiology, dyx187, https://doi.org/10.1093/ije/dyx187

Published: 02 September 2017 – Accepted: 15 August 2017

Citation: Nusrat Najnin, Karin Leder, Firdausi Qadri, Andrew Forbes, Leanne Unicomb, Peter J Winch, Pavani K Ram, Elli Leontsini, Fosiul A Nizame, Shaila Arman, Farzana Begum, Shwapon K Biswas, John D Clemens, Mohammad Ali, Alejandro Cravioto, Stephen P Luby; Impact of adding hand-washing and water disinfection promotion to oral cholera vaccination on diarrhoea-associated hospitalization in Dhaka, Bangladesh: evidence from a cluster randomized control trial, International Journal of Epidemiology, , dyx187, https://doi.org/10.1093/ije/dyx187

© 2017 Oxford University Press




Information on the impact of hygiene interventions on severe outcomes is limited. As a pre-specified secondary outcome of a cluster-randomized controlled trial among >400 000 low-income residents in Dhaka, Bangladesh, we examined the impact of cholera vaccination plus a behaviour change intervention on diarrhoea-associated hospitalization.


Ninety neighbourhood clusters were randomly allocated into three areas: cholera-vaccine-only; vaccine-plus-behaviour-change (promotion of hand-washing with soap plus drinking water chlorination); and control. Study follow-up continued for 2 years after intervention began. We calculated cluster-adjusted diarrhoea-associated hospitalization rates using data we collected from nearby hospitals, and 6-monthly census data of all trial households.


A total of 429 995 people contributed 500 700 person-years of data (average follow-up 1.13 years).Vaccine coverage was 58% at the start of analysis but continued to drop due to population migration. In the vaccine-plus-behaviour-change area, water plus soap was present at 45% of hand-washing stations; 4% of households had detectable chlorine in stored drinking water. Hospitalization rates were similar across the study areas [events/1000 person-years, 95% confidence interval (CI), cholera-vaccine-only: 9.4 (95% CI: 8.3–10.6); vaccine-plus-behaviour-change: 9.6 (95% CI: 8.3–11.1); control: 9.7 (95% CI: 8.3–11.6)]. Cholera cases accounted for 7% of total number of diarrhoea-associated hospitalizations.


Neither cholera vaccination alone nor cholera vaccination combined with behaviour-change intervention efforts measurably reduced diarrhoea-associated hospitalization in this highly mobile population, during a time when cholera accounted for a small fraction of diarrhoea episodes. Affordable community-level interventions that prevent infection from multiple pathogens by reliably separating faeces from the environment, food and water, with minimal behavioural demands on impoverished communities, remain an important area for research.

Vaccine, hand-washing, water treatment, diarrhoea, hospitalization

Topic: cholera – chlorine – diarrhea – bangladesh – cholera vaccines – disinfection – feces – food – soap – vaccines – pathogenic organism – washing hands – behavioral change – low income – community – potable water

Issue Section: – Original Article


Key Messages

  • Neither cholera vaccination alone nor cholera vaccination combined with hand-washing and water treatment promotion measurably reduced diarrhoea-associated hospitalization.
  • The possible reasons for lack of impact of cholera vaccine alone on all-cause diarrhoea hospitalization were: cholera incidence was too low during the study period; and high migration rate diluted cholera vaccination coverage of the intervention areas during the period of the analysis.
  • The reason for the lack of impact of the behavioural intervention on diarrhoea-associated hospitalization may have been because of the low uptake.
  • Affordable community-level interventions that prevent infection from multiple pathogens by reliably separating faeces from the environment, food and water in impoverished communities remain an important area for research.

Keywords: Cholera; Diarrhea; Vaccines; Handwashing; Bangladesh.


#Effectiveness of #personal #protective #measures in reducing #pandemic #influenza #transmission: A systematic review and meta-analysis (SD, abstract)

[Source: Science Direct, full page: (LINK). Abstract, edited.]

Epidemics / Available online 30 April 2017 / In Press, Corrected Proof / Open Access / Review

Effectiveness of personal protective measures in reducing pandemic influenza transmission: A systematic review and meta-analysis

Patrick Saunders-Hastings a, James A.G. Crispo a, b, Lindsey Sikora c, Daniel Krewski a

a University of Ottawa, McLaughlin Centre for Population Health Risk Assessment, 850 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada; b University of Pennsylvania, Department of Neurology, Philadelphia, PA, United States; c University of Ottawa, Health Sciences Library,451 Smyth Road, Ottawa, ON, Canada

Received 28 December 2016, Revised 20 March 2017, Accepted 24 April 2017, Available online 30 April 2017




  • We review the effectiveness of PPMs against pandemic influenza infection.
  • Hand hygiene provided a significant protective effect.
  • Facemask use provided a non-significant protective effect.
  • No data were found on the effectiveness of cough etiquette.



The goal of this review was to examine the effectiveness of personal protective measures in preventing pandemic influenza transmission in human populations.

We collected primary studies from Medline, Embase, PubMed, Cochrane Library, CINAHL and grey literature. Where appropriate, random effects meta-analyses were conducted using inverse variance statistical calculations.

Meta-analyses suggest that regular hand hygiene provided a significant protective effect (OR = 0.62; 95% CI 0.52–0.73; I2 = 0%), and facemask use provided a non-significant protective effect (OR = 0.53; 95% CI 0.16–1.71; I2 = 48%) against 2009 pandemic influenza infection. These interventions may therefore be effective at limiting transmission during future pandemics.

PROSPERO Registration: 42016039896.

Keywords: Pandemic influenza; Systematic review; Hand hygiene; Facemask; Cough etiquette

Keywords: Pandemic Influenza; Hand Hygiene; Facemasks.


#Handwashing and #Ebola virus disease #outbreaks: A randomized #comparison of #soap, #handsanitizer, and 0.05% #chlorine … (PLoS One, abstract)

[Source: PLoS One, full page: (LINK). Abstract, edited.]


Handwashing and Ebola virus disease outbreaks: A randomized comparison of soap, hand sanitizer, and 0.05% chlorine solutions on the inactivation and removal of model organisms Phi6 and E. coli from hands and persistence in rinse water

Marlene K. Wolfe , Karin Gallandat, Kyle Daniels, Anne Marie Desmarais, Pamela Scheinman, Daniele Lantagne

Published: February 23, 2017 / http://dx.doi.org/10.1371/journal.pone.0172734



To prevent Ebola transmission, frequent handwashing is recommended in Ebola Treatment Units and communities. However, little is known about which handwashing protocol is most efficacious. We evaluated six handwashing protocols (soap and water, alcohol-based hand sanitizer (ABHS), and 0.05% sodium dichloroisocyanurate, high-test hypochlorite, and stabilized and non-stabilized sodium hypochlorite solutions) for 1) efficacy of handwashing on the removal and inactivation of non-pathogenic model organisms and, 2) persistence of organisms in rinse water. Model organisms E. coli and bacteriophage Phi6 were used to evaluate handwashing with and without organic load added to simulate bodily fluids. Hands were inoculated with test organisms, washed, and rinsed using a glove juice method to retrieve remaining organisms. Impact was estimated by comparing the log reduction in organisms after handwashing to the log reduction without handwashing. Rinse water was collected to test for persistence of organisms. Handwashing resulted in a 1.94–3.01 log reduction in E. coli concentration without, and 2.18–3.34 with, soil load; and a 2.44–3.06 log reduction in Phi6 without, and 2.71–3.69 with, soil load. HTH performed most consistently well, with significantly greater log reductions than other handwashing protocols in three models. However, the magnitude of handwashing efficacy differences was small, suggesting protocols are similarly efficacious. Rinse water demonstrated a 0.28–4.77 log reduction in remaining E. coli without, and 0.21–4.49 with, soil load and a 1.26–2.02 log reduction in Phi6 without, and 1.30–2.20 with, soil load. Chlorine resulted in significantly less persistence of E. coli in both conditions and Phi6 without soil load in rinse water (p<0.001). Thus, chlorine-based methods may offer a benefit of reducing persistence in rinse water. We recommend responders use the most practical handwashing method to ensure hand hygiene in Ebola contexts, considering the potential benefit of chlorine-based methods in rinse water persistence.


Citation: Wolfe MK, Gallandat K, Daniels K, Desmarais AM, Scheinman P, Lantagne D (2017) Handwashing and Ebola virus disease outbreaks: A randomized comparison of soap, hand sanitizer, and 0.05% chlorine solutions on the inactivation and removal of model organisms Phi6 and E. coli from hands and persistence in rinse water. PLoS ONE 12(2): e0172734. doi:10.1371/journal.pone.0172734

Editor: D William Cameron, University of Ottawa, CANADA

Received: September 7, 2016; Accepted: February 7, 2017; Published: February 23, 2017

Copyright: © 2017 Wolfe et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are available within the paper and its Supporting Information files.

Funding: This study was funded by a grant from the United States Agency for International Development, Office of Foreign Disaster Assistance (AID-OFDA-A-15-00026). MW was supported by the National Science Foundation (grant 0966093). The funders had no role in data collection and analysis, decision to publish, or preparation of the manuscript. The funders had no input into study design after the grant was awarded. The funders were provided a final version of the manuscript before submission, and had only minor grammatical comments.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Ebola; Hand hygiene.


Delayed #norovirus #epidemic in the 2009-2010 season in #Japan: potential #relationship with intensive #hand #sanitizer use for #pandemic #influenza (Epidemiol Infect., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Epidemiol Infect. 2016 Jun 15:1-7. [Epub ahead of print]

Delayed norovirus epidemic in the 2009-2010 season in Japan: potential relationship with intensive hand sanitizer use for pandemic influenza.

Inaida S1, Shobugawa Y2, Matsuno S3, Saito R2, Suzuki H4.

Author information: 1Department of Pharmacoepidemiology,Graduate School of Medicine and Public Health,Kyoto University,Kyoto,Japan. 2Division of International Health (Public Health),Niigata University Graduate School of Medical and Dental Sciences,Niigata,Japan. 3Infectious Disease Surveillance Center,National Institute of Infectious Diseases,Tokyo,Japan. 4Niigata Seiryo University,Niigata,Japan.



Norovirus (NoV) epidemics normally peak in December in Japan; however, the peak in the 2009-2010 season was delayed until the fourth week of January 2010. We suspected intensive hand hygiene that was conducted for a previous pandemic influenza in 2009 as the cause of this delay. We analysed the NoV epidemic trend, based on national surveillance data, and its associations with monthly output data for hand hygiene products, including alcohol-based skin antiseptics and hand soap. The delayed peak in the NoV incidence in the 2009-2010 season had the lowest number of recorded cases of the five seasons studied (2006-2007 to 2010-2011). GII.4 was the most commonly occurring genotype. The monthly relative risk of NoV and monthly output of both alcohol-based skin antiseptics and hand soap were significantly and negatively correlated. Our findings suggest an association between hand hygiene using these products and prevention of NoV transmission.

KEYWORDS: Alcohol; hand hygiene; hand soap; norovirus; sentinel surveillance

PMID: 27301793 [PubMed – as supplied by publisher]

Keywords: Research; Abstracts; Norovirus; Hand Hygiene.