Hygiene, Volume 2, Issue 1 (March 2022) – 5 articles

Orthopedic implants, such as screws, are provided in a non-sterile state and must be reprocessed before each use, therefore they may be subjected to multiple reprocessing cycles until they are implanted in the patient. The effect of these various reprocessing cycles on the quality and safety of these implants has been a subject of concern and discussion around the world. In this narrative review, we discuss the four main challenges associated with supplying these non-sterile implants to the same standard, with respect to their quality and safety, as implants that are provided sterile: microbiological contamination (focusing on biofilm), non-microbiological contamination, surface damage, and their acquisition in surgical trays from loaner companies. Full article

Primary health care (PHC), a holistic approach to health, was proposed at Alma-Ata in 1978 and has been the guiding principle for the health system rebuilding of Liberia, a post-conflict, low-income country. However, since its adoption, health care delivery and outcomes remain less than optimal. A comprehensive literature review of all current health policy documents in Liberia, with a focus on the PHC approach, was identified and analyzed using the Walt and Gilson policy framework. Three major policy-related gaps were identified. 1. The lack of explicit inclusion of the community as an actor in the formulation of several of the policy documents. 2. The lack of timely revision of some policy documents. 3. The lack of an explicit PHC strategic approach in the implementation plans of multiple policy documents. The poor health outcomes in Liberia, therefore, are indicative of problems with PHC that go beyond implementation to the policy level. Full article

Background: During the COVID-19 pandemic, hygiene behaviors such as keeping distance, avoiding masses, wearing face masks, and complying with hand hygiene recommendations became imperative. The current study aims to determine factors interrelating with hygiene behaviors. Methods: A total of 4049 individuals (1305 male, 2709 female, aged 18–80 years) were recruited from rehabilitation clinics or freely on the internet. They were surveyed via online questionnaires between May 2020 and August 2021. Sociodemographics, hygiene behaviors, and fear of COVID-19 infection were assessed. Results: Overall prevalence for hygiene behaviors was: keeping a distance—88.1%; avoiding mass gatherings—88.0%; wearing face masks—96.9%; and hand hygiene—81.6%, with 70% of the study participants complying with all four researched behaviors. Hygiene behaviors were significantly related to fear in a linear and quadratic fashion. Conclusion: Patients are more compliant according to their self-reported responses than the general population. To improve hygiene behavior, hand hygiene in particular provides options for improvements. A medium level of fear seems to be more functional than too-elevated fear. Behavioral interventions and targeted communication aiming at improving different behaviors in orchestration can help individuals to protect their health and to remain healthy. Accordingly, communication is required to ensure high hygiene standards and patient safety, and to prevent adverse effects. Full article

Pneumonic plague outbreaks are relatively infrequent in modern times, but in the early part of the 20th century, they were commonplace including several well-documented epidemics responsible for the deaths of thousands. The transmissibility of this disease seems to be discontinuous since in some outbreaks few transmissions occur, while in others, the progression of the epidemic is explosive. Modern epidemiological studies explain that transmissibility within populations is heterogenous with relatively few subjects likely to be responsible for most transmissions and that ‘super spreading events’, particularly at the start of an outbreak, can lead to a rapid expansion of cases. These findings concur with outbreaks observed in real-world situations. It is often reported that pneumonic plague is rare and not easily transmitted but this view could lead to unnecessary complacency since future risks such as the spontaneous incidence of anti-microbial strains, climate change leading to a disruption of natural cycles within plague foci and use of plague as a bioweapon cannot be discounted. Carers and first responders are vulnerable, particularly in poorer countries where access to medicines and protection equipment may be limited, outbreaks occur in inaccessible areas or where there is a lack of surveillance due to a paucity of funds. Full article

Contamination of water use points in health establishments is a frequent and concerning problem. Maintenance and disinfection of water systems can be inefficient. Sterilizing filters are commonly used at selected taps. We report diagnostic and corrective approaches that have succeeded in making a contaminated health facility sustainably compatible with its activity without restriction in taps use. The zones contaminated with pseudomonas as well as those, along the water networks, at risk of biofilm development were identified. Corrective measures on the network and various types of decontamination were carried out. At the end of this work, the bacterial load in the water significantly decreased and 219 out of 223 controls were negative for P. aeruginosa over 3 years of follow-up. Four positive results were linked to three taps not used for care which were satisfactorily treated locally. Errors at the design and setup phases of health facilities may result in resistant bacterial contamination. P. aeruginosa contamination of newly built healthcare facilities is an underreported problem. Guidelines on design, disinfection, and monitoring procedures of water networks of healthcare facilities should be adapted consequently and would certainly improve the offered care limiting patients’ risk and avoid many unwanted financial situations for the providers. Full article