Hygiene, Volume 5, Issue 3 (September 2025) – 5 articles

Background: In September 2023, Storm Daniel triggered catastrophic flooding across Thessaly, in central Greece, leading to the deaths of approximately 483,476 animals and heightening concerns about zoonotic diseases, particularly Q fever caused by Coxiella burnetii. Sofades, a municipality in the Karditsa region that is severely impacted by the floods, emerged as a critical area for evaluating the risk of zoonotic disease transmission. This study aimed to determine the seroprevalence status of Coxiella burnetii Phase 1 IgA antibodies among residents in the rural area of Sofades after the Daniel floods. Methods: Serum samples were obtained from a convenient sample of residents with livestock exposure between 1 March and 31 March 2024. Enzyme-linked immunosorbent assay (ELISA) was used to detect Coxiella burnetii Phase 1 IgA antibodies. Descriptive analyses summarized demographic data, and logistic regression was employed to examine the association between gender, age, and positive ELISA results. Results: The overall seroprevalence was 16.66%. Males had a significantly higher positivity rate (28.57%) than females (6.25%). Seropositivity was more frequent among individuals aged 41–80 years, with peak prevalence observed in the 61–80 age group. Conclusions: This cross-sectional study offers a snapshot of Coxiella burnetii exposure in a high-risk rural population post-flood. The slightly higher seroprevalence in Sofades (16.66%) compared to Karditsa (16.1%) suggests limited influence of environmental factors on transmission. Despite limitations in causal inference, the findings highlight the need for enhanced surveillance and targeted public health measures. Longitudinal studies are needed to assess the long-term impact of environmental disasters on Q fever dynamics. Full article

Healthcare-associated infections (HAIs), also referred to as nosocomial or hospital-acquired infections, are a significant cause of death worldwide, with hand hygiene being the most powerful means to tackle them. The present study had a twofold aim: first, to assess the level of knowledge and the degree of compliance with hand hygiene practices based on healthcare workers’ self-reports; second, to evaluate whether behavioral economics techniques, specifically a poster combining an image and an informational message, designed according to the published literature, can increase the level of healthcare workers’ compliance with hand hygiene. Factors that potentially affect compliance were also examined. This study involved distributing a questionnaire to healthcare workers in Greek public hospitals, from which 314 completed responses were collected during the last quarter of 2023. Participants were randomly and evenly assigned to an intervention group that received a nudging poster or to a control group, which did not. Self-reported compliance with hand hygiene practices was high, based on two latent variables derived through exploratory factor analysis, although knowledge of germ transmission was moderate, as reflected in the relevant knowledge question scores. However, nudging had no statistically significant effect on hand hygiene behavior. Compliance was associated with several factors, including gender, age, work experience, profession, perceived adequacy of available hygiene-related resources, and perceived consequences of nosocomial infections on patient outcomes. Full article

In 2020, Directive (EU) 2020/2184 was published and subsequently transposed into Italian legislation via Legislative Decree 18/23 (Lgs.D. 18/23). The Directive aims to protect public health through a proactive approach based on a site-specific risk analysis along the entire water supply chain (Water Safety Plan, WSP). Between February and November 2024, a survey was conducted in Italy to assess both hospitals’ knowledge of Lgs.D. 18/23 and the application of the WSP in these facilities. A total of 300 hospitals were asked to complete an anonymous questionnaire containing 60 questions about the characteristics of the facility and the management of the water network, including the chemical–physical and microbiological monitoring of Legionella and other microbiological parameters. A total of 102 questionnaires were sent out (response rate: 34%), but only 72 were properly completed and analyzed. The results of the chemical–physical monitoring are not presented in this manuscript. Overall, 52.8% of the hospitals were built before 2000, and most are aware of Directive (EU) 2020/2184, Lgs.D.18/23 (80.6%), in particular, Article 9 on the risk assessment and management of internal water systems and the guidelines for its implementation (77.8%). All hospitals perform annual microbiological water testing, including Legionella analysis, with a detection rate of <50%. National guidelines for the implementation of WSPs are known in 75% of the hospitals, but only 38.9% have started planning to implement them, and 13.9% organize staff training on the subject. The questionnaire responses highlight the need to train hospital staff in water system risk management and WSP planning, which will be mandatory by 2029. Full article

The transmission of infectious diseases via the use of public restrooms has been previously documented. The goal of this study was to compare bacterial contamination in public vs. household restrooms and, using quantitative microbial risk assessment (QMRA), to assess the probability of infection from fomite contact with selected high-touch sites within the restrooms. Fomite surfaces in four public and four household restrooms were sampled over a period of two months. The public restrooms were in an office building occupied by 80 individuals and were considered moderate usage. The toilet seat, toilet flush handle, countertops, and floor were sampled for heterotrophic, coliform, and Escherichia coli bacteria. The highest numbers of heterotrophic bacteria and coliforms were detected on the countertops, followed by the floor. The greatest numbers of E. coli were recovered from the countertops in the household restroom, but the greatest numbers in the public restroom were recovered from the toilet flush handle. Numbers of heterotrophic bacteria and coliforms were 10 to 100 times greater in household restrooms than in public restrooms. The QMRA suggested that the greatest risk of acquiring a norovirus infection involved the touching of the countertops in household restrooms and the toilet flush handles in public restrooms. Full article

Night shift work (NSW), has been associated with adverse health outcomes in women, including increased risks of metabolic disorders, cardiovascular diseases, and reproductive dysfunctions. However, the specific effects of NSW during the climacteric period remain underexplored. This narrative review aimed to examine original studies evaluating the health impacts of NSW on women in their climacteric, with a focus on menopausal timing, hormonal balance, and related symptoms. Relevant studies published in PubMed, Embase, and Scopus were reviewed in January 2025. Of 664 articles screened, 15 met the inclusion criteria. Results indicate that NSW may lead to circadian rhythm disruption, which in turn affects hormonal regulation, the timing of menopause, and the intensity of climacteric symptoms. Prolonged exposure to night shift work appears to increase the risk of metabolic and cardiovascular conditions, and certain cancers. These findings underscore the need to consider NSW as a potential modifiable risk factor for adverse health outcomes during midlife in women. They also highlight the importance of developing targeted occupational health policies and workplace interventions to mitigate these risks and promote healthier aging and quality of life. Full article