Hygiene

The term “vaccine” has been broadly and inconsistently applied to a range of products with widely divergent immunological outcomes, leading to the erosion of public trust and confusion among both medical professionals and the public. Historically, and by broad public understanding, a vaccine is expected to prevent infection, transmission, and disease through the induction of sterilizing, or true neutralizing immunity, specifically, the prevention of pathogen entry and replication in vivo. This ideal extends beyond the mere elicitation of neutralizing antibodies demonstrable in vitro. This paper proposes a three-tier classification system designed to differentiate products currently designated as “vaccines,” specifically to address the distinction between those that meet the traditional, highest-expectation definition (Tier 1), therapeutic vaccines that primarily prevent disease (Tier 2), and immunomodulatory therapeutics that primarily reduce disease severity (Tier 3). By detailing the mechanism of action of each product and emphasizing the urgent need for this refined classification, our aim is to restore public confidence in vaccination programs, improve understanding of vaccine-induced immunity among healthcare professionals, and empower informed decision-making by the public. We argue that a clearer understanding of vaccine capabilities will ultimately lead to increased vaccine uptake for those vaccines that do prevent infection, transmission, and disease. Full article

Biofilms, structured communities of microorganisms encased in an extracellular matrix, are a major cause of persistent infections, particularly when formed on medical devices. This study investigated the kinetics of biofilm formation by Escherichia coli and Pseudomonas aeruginosa, two clinically significant pathogens, on two medical-grade polymers: polyether ether ketone (PEEK) and polyamide 12 (PA12). Using a modified crystal violet staining method and spectrophotometric quantification, we evaluated biofilm development over time on polymer granules and catheter segments composed of these materials. Results revealed that PEEK surfaces supported significantly more biofilm formation than PA12, with peak accumulation observed at 24 h for both pathogens. Conversely, PA12 demonstrated reduced bacterial adhesion and lower biofilm biomass, suggesting surface characteristics less conducive to microbial colonization. Additionally, the study validated a reproducible protocol for assessing biofilm formation, providing a foundation for evaluating anti-biofilm strategies. While the assays were performed under static in vitro conditions, the findings highlight the importance of material selection and early prevention strategies in the design of infection-resistant medical devices. This work contributes to the understanding of how surface properties affect microbial adhesion and underscores the critical need for innovative surface modifications or coatings to mitigate biofilm-related healthcare risks. Full article

Parental attention and care is essential for children and adolescents who are unable to take care of their own oral health. There have been studies on the characteristics of mothers and the oral conditions of children in Korea, but there are very few previous studies that report on the oral health status of children according to the employment status of mothers. The aim of this study was to investigate the relationship between maternal employment and educational status and children’s oral health. Using data from the 10th Panel Study on Korean Children (PSKC), we analyzed the association between maternal employment and education status and the occurrence of dental caries among 1175 nine-year-old Korean children. The relationship was examined through cross-tabulation and logistic regression analysis. After adjusting for the mother’s age, parental style, parental relationship, family talk time, family meal time, leisure time, area of residence, and household income, the study found that children with working and studying mothers were 1.159 times more likely to have dental caries than children with non-working and non-studying mothers. The relationship between maternal employment and educational status and children’s oral health was confirmed. Based on the results of this study, it is expected that systematic follow-up studies will be needed to better understand the association and causal relationship between dental caries and oral disease in children according to whether mothers are employed or educated. Full article

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

Malocclusion can arise due to various causes and may impact not only temporomandibular joint (TMJ) disorders but also overall systemic health. This study aimed to evaluate the association of individual occlusal characteristics with sleep quality and stress levels in female college students. Occlusal analysis was conducted using T-Scan III on 84 participants (age: 21.7 ± 2.09), while sleep quality and stress levels were assessed using the Korean version of the Pittsburgh Sleep Quality Index and self-reported stress questionnaires, respectively. Sleep quality was categorized as “good sleeper” (≤5 points) or “poor sleeper” (>5 points). Stress levels were classified as Normal (≤13), Initial stress (14–16), Moderate stress (17–18), or Severe stress (≥19). The results indicated no significant differences in sleep quality based on occlusal characteristics. However, participants with Type A occlusion (posterior contact without anterior contact) exhibited higher stress scores than those with Type B occlusion. Correlation analysis showed a weak negative association between stress scores and occlusion type, but no significant relationship was found between occlusal characteristics, sleep quality, and stress levels. In conclusion, individual occlusal characteristics have limited explanatory power regarding their effects on sleep quality and stress. Full article

Background: Infection control is fundamental in dental practice, especially following the COVID-19 pandemic, which highlighted the variability in students’ adherence to disinfection protocols. This study aimed to evaluate the knowledge, attitudes, and practices of the fifth-year dental students at the National and Kapodistrian University of Athens regarding antisepsis and infection control, and to assess the effectiveness of an educational intervention. Methods: A pre-post interventional study was conducted involving two in-person seminars, supplementary e-learning material, and a structured questionnaire administered before and after the intervention. The survey assessed the knowledge, clinical practices, and attitudes toward infection control, including vaccination history and prior exposure incidents. Results: The intervention led to statistically significant improvements in infection control knowledge, especially in risk-based sterilization strategies, disinfectant classification, and PPE use. Students with prior hepatitis B vaccinations and antibody testing demonstrated higher baseline scores and more significant knowledge gains. However, some misconceptions, particularly regarding surface disinfection and prosthetic care, persisted after the intervention. Conclusions: The findings support the effectiveness of structured educational interventions in improving infection control awareness among dental students. Practical, simulation-based training and earlier curriculum integration are recommended to enhance compliance and ensure safe clinical practice. Full article

Fluoride mouthwashes are often recommended by dental professionals due to their proven benefits for oral hygiene. However, it is vital to acknowledge that these products may have undesirable effects on orthodontic treatment outcomes, particularly by altering the biomechanical properties of orthodontic devices and their components. To gain a comprehensive understanding of this potential issue, an extensive and systematic search was conducted across seven distinct databases. PRISMA extension for scoping reviews (PRISMA ScR) guidelines were followed. Following a detailed evaluation and careful scrutiny of the available evidence, a total of seven relevant studies met the inclusion criteria and were incorporated into the current scoping review. Findings indicated that regular intraoral use of fluoride-containing mouthwashes could lead to heightened corrosion and greater release of metal ions from stainless-steel brackets and nickel–titanium (NiTi) archwires. Additionally, the mechanical properties and structural integrity of titanium–molybdenum alloy (TMA) wires were negatively influenced by exposure to fluoride mouthwashes. Although existing evidence highlights these potential drawbacks, there remains a clear necessity for additional comprehensive research. Given the possibility that fluoride mouthwashes could adversely influence orthodontic treatment effectiveness, orthodontists and dental clinicians must exercise cautious judgment and deliberate consideration when prescribing fluoride-based mouthwashes for patients undergoing orthodontic therapy. Full article

Restrooms are associated with the transmission of bacterial and viral illnesses. Disinfecting contaminated surfaces is associated with reducing transmission risk. The goal of this study was to determine how cleaning/disinfecting frequency affects restroom pathogen contamination. The Phase 1 intervention included cleaning toilet surfaces (the toilet bowl, water, and rim) using 9.5% w/w hydrochloric acid. The Phase 2 intervention used fomite-specific products to clean/disinfect additional restroom surfaces, including the vanity countertop, sink faucet handle, toilet seat, flush handle, floor, and doorknob. A designated household member was responsible for cleaning/disinfecting surfaces at the beginning of each interval. Fomite sample collection was randomized, and samples were tested for heterotrophic, coliform, and Escherichia coli bacteria after specified intervals: 1, 2, 3, or 7 days. The greatest numbers of bacteria and largest reductions occurred on fomites after three days. A statistically significant difference was found for heterotrophic bacteria (p = 0.009), coliforms (p = 0.10), and E. coli (p = 0.13) with cleaning/disinfecting every three days. A quantitative microbial risk assessment (QMRA) estimated a >98% reduction in risk of infection by norovirus with an every-3-day cleaning/disinfection routine on the most heavily contaminated sites. Results indicate an optimal cleaning frequency of twice weekly for minimizing exposure to pathogens. Full article

Background: This study examines the role of the built environment in mitigating risk in healthcare facilities, with a particular focus on how the design of hospital infrastructures can influence and improve the safety of patients, staff, and visitors. Methods: A two-phase mixed-methods approach was adopted. First, a scoping literature review was conducted to identify design-based strategies targeting five categories of risk: healthcare-associated infections (HAIs), indoor air quality (IAQ), safety, falls, and emergency resilience. Based on this review, a structured questionnaire was developed and administered to a sample of hospital facilities in Northern Italy to assess the implementation of the strategies emerged. Results: The literature review identifies recurring specific design solutions and strategies that have proven effective in mitigating risks in healthcare infrastructures in the following dimensions: infection mitigation, indoor air quality, falls reduction, safety, emergency preparedness. At the same time, survey data from (n = 9) hospitals indicate a significant implementation gap. Key shortcomings included a lack of spatial flexibility, limited environmental monitoring (especially for IAQ and acoustic conditions), and underutilization of antibacterial surfaces. Antibacterial flooring and wall finishes were absent in (n = 4/9) and (n = 6/9) of the facilities, respectively. IAQ monitoring was mostly confined to surgical areas, with (n = 0/9) facility reporting comprehensive building-wide monitoring. Only two (n = 2) facilities reported adaptable spaces suitable for emergency conversion and accessible green areas. Conclusions: This study provides a comprehensive overview of risk mitigation strategies in hospital design. The results reveal critical gaps in implementation, particularly in spatial flexibility, environmental monitoring, and antimicrobial surfaces. Future research should focus on developing adaptable design models that are context-sensitive, scalable, and capable of enhancing healthcare resilience in response to emerging global health threats. Full article

Patients represent the primary stakeholders in health systems, making it crucial to enhance their level of satisfaction. The relationship between physician and patient is crucial during treatment, especially for patients dealing with long-term issues. Generally, every illness has the potential to cause high levels of stress, leading to varying reactions from individuals, influenced by factors such as age, personality, relationships with caregivers, treatment environment, and specific disease characteristics. As the healthcare provider acquires a more profound insight into how the disease affects the patient’s quality of life, the relationship between the patient and the physician evolves. In this study, we analyzed information from hospital clinics that took part in the survey for the same timeframe, from July 2019 to December 2020. Correlated data were derived from two separate surveys. The initial survey, created by Spector, focused on gathering feedback from health professionals in hospitals, with 3278 responses collected. A second survey was designed to gather feedback from patients in hospitals, with 2851 responses collected. The survey revealed a total of 97 common observations among physicians and patients in the hospital clinics. According to the findings from the two-stage least squares (2SLS) regression analysis, an essential method for researchers addressing endogeneity challenges in structural equation modeling, an increase of 1 point in the job satisfaction of physicians is associated with a corresponding positive increase of 1.12 points in patient satisfaction. At the heart of effective healthcare is the relationship between physicians and patients. Positive attitudes from patients during medical appointments help improve health outcomes, especially for those with long-term illnesses. In order to encourage patients to take an active role, physicians need to focus on enhancing the physician-patient bond, humaneness, creating trust and stable communication, encouraging the sharing of information, and empowering patients to participate in decision-making. Full article

Breast milk is vital for infant survival, protecting against infections and strengthening the immune system. In addition to nutrients, breast milk contains beneficial microorganisms, antimicrobial peptides and proteins (APPs), including lactoferrin and lysozyme, and peptides such as defensins and cathelicidins that destroy harmful bacteria and regulate the neonatal immune response. Breast milk also promotes the growth of beneficial gut bacteria (Bacteroidaceae and Bifidobacteriaceae) while reducing harmful pathogens, fostering a healthy gut microbiome, and supporting long-term infant health. Traditionally, research on antimicrobial proteins and milk microbiota has been conducted in isolation. However, at the molecular level, these components do not function independently; they interact synergistically, influencing immunomodulation, inflammation, and the composition of the gut microbiome. Therefore, this review aims to provide an overview of the discovery and identification of APPs in breast milk, the dynamic relationship between the breast milk microbiota, and the potentiation of artificial feeding with supplemented formulas when breastfeeding is impossible, benefits on newborn immune systems, and even the benefits to breast tissue. Full article

In recent decades, the world has observed the emergence and re-emergence of a multitude of previously non-existent or re-emerging infectious diseases, for which there is a paucity of timely and effective preventative measures. The WHO has published a catalogue of priority pathogens that are likely to trigger future epidemics, with the objective of designing effective prophylactic and therapeutic interventions. The rationale behind these interventions is rooted in a comprehensive understanding of the aetiology, epidemiology, and pathogenesis of the target diseases. While it is imperative to acknowledge the pivotal role that evolutionary changes in pathogens play, it is equally important to recognise the influence of a multifaceted interplay of factors on the emergence and re-emergence of infectious diseases. These include changes in human populations, the vectors and reservoirs of exposure, and environmental changes. This review summarises the aetiology, epidemiology, and pathogenesis of the ten WHO priority diseases, as well as those with high epidemic potential that are already the focus of specific control programme initiatives, such as HIV/AIDS, tuberculosis, and malaria diseases. Furthermore, this review concentrated on the means of addressing these infections through public health surveillance and response systems. Such systems must be designed to rapidly detect unusual and unexpected disease patterns, track and share information in real time, and rapidly mobilise global responses, which are the most important ways to effectively contain transmission. Full article

The spread of diarrheal disease is a major public health problem, and a lack of proper sanitation is an important contributor to this. In 2014, the Swachh Bharat Mission (SBM) was initiated by the Government of Bharat (India) to improve sanitation across the entirety of the country. SBM has received worldwide praise for its success, and it is now being expanded further. For the purposes of guiding the ongoing implementation of SBM and determining where it has or has not been successful, the objective of this scoping review was to determine the perceptions, knowledge, and attitudes of individuals regarding SBM. After screening 5454 research articles across seven databases, nine total articles were eligible for inclusion in this review. In spite of the reduced number of selected studies, numerous key themes emerged: Many chose to greatly praise SBM for its past successes; individuals felt that mass media should continue to be used to raise awareness; mindsets and a lack of awareness continue to serve as barriers to change; addressing inadequate waste disposal and waste segregation should be a very high priority to ensure cleanliness in Bharat. The findings of this review can guide policymakers, government workers, non-governmental organizations, and researchers in ensuring the continual development of SBM in its second phase and beyond the successful achievement of its aims, though the inherently limited generalizability of the qualitative studies included in this scoping review should also be recognized. Further research that is both qualitative and quantitative in nature is needed to develop a deeper understanding of the perceptions regarding SBM and the ways in which the ongoing program can be improved. Full article

Legionella bacterium has the aquatic environment as its natural reservoir. In humans, it can cause a form of interstitial pneumonia called legionellosis which can be transmitted by inhalation of contaminated water aerosols. Legionella infection occurs more frequently in certain more susceptible population groups, including smokers, alcoholics, men, the elderly, as well as people with acquired immunodeficiency syndrome, hematological cancers, and diabetes mellitus. This study aimed to evaluate the effectiveness of the new Italian National Guidelines for the prevention of Legionella colonization in water systems application by analyzing the environmental monitoring data of Legionella carried out in healthcare facilities in the Campania region from 2019 to 2022. The secondary objectives were to estimate the most observed serogroups of L. pneumophila and to analyze the possible link between water temperature and the presence of Legionella, respectively. From our data, it emerged that in 2019, 41.1% of the examined facilities were contaminated by the Legionella genus; in 2020, the contamination percentage was 42.9%; in 2021, it was 54.5%; in 2022, it was 45.5%. Instead, the Legionella positivity rate decreased from 2019 (54.3%) to 2022 (52.4%), suggesting a possible positive influence of more restrictive prevention and control measures. The prevalent species was Legionella pneumophila, particularly serogroup 1; water temperature was the risk factor implicated in Legionella contamination. Full article

Background: Respiratory viruses spread through airborne droplets and aerosols, causing highly contagious acute respiratory syndromes in humans. This study evaluated the antiviral potential of vapours of catmint-oil-based formulations against respiratory viruses. Methods: The antiviral activity of formulations with or without catmint oil (CO) in solution or in aerosolised form was determined against influenza virus H1N1 ATCC VR-1469 and mouse hepatitis virus (MHV-1) ATCC/VR261. In solution, both viruses were exposed to CO formulations for 2–3 h. In aerosolised form, H1N1 was exposed to formulations for 2 min in a closed cylinder and MHV-1 for 10 min in a booth. The antiviral effect of the formulations was evaluated by growing H1N1 in a Madin–Darby canine kidney (MDCK; ATCC-CRL-2936) and MHV-1 in A9 ATCC/CCL 1.4 cells using TCID50 and a plaque assay, respectively. Transmission electron microscopy (TEM) was conducted to investigate the mode of action of the formulations. Results: In solution, the formulation containing hydrogenated CO (HCO), bromelain, N-acetylcysteine and Tween 20 (Formulation (1)) reduced the viability of H1N1 by 2.6 ± 0.07 log₁₀ (p = 0.025) and MHV-1 by 4.5 ± 0.14 log₁₀ (p = 0.014) within 2–3 h. In vapourised form, Formulation (1) produced similar antiviral effects against H1N1, reducing it by 3.00 ± 0.07 log₁₀ (p = 0.002) within 2 min, and Formulation (1) produced a 3.00 ± 0.07 log₁₀ reduction of MHV-1 (p < 0.001) within 10 min (the minimum time needed to detect infective viral particles in the experimental set-ups). Formulation (3) (without bromelain) reduced H1N1 by 1.57 ± 0.14 log₁₀ (p = 0.008) after 2 min and MHV-1 by 1.3 ± 0.04 log₁₀ (p = 0.057) after 10 min. In the absence of catmint oil (Formulation (4)) or in the absence of catmint oil and bromelain (Formulation (5)), there were only slight reductions in the viability of aerosolised H1N1 (1.00 ± 0.14 log₁₀, p = 0.046; <1 log₁₀, p = 0.966, respectively) and MHV-1 (1.07 ± 0.02 log₁₀, p = 0.013; 0.16 ± 0.03 log₁₀, p = 0.910, respectively). The TEM analysis showed that the formulation disrupted the H1N1 envelopes and caused a reduction in size of the viral particles. Conclusions: The catmint-oil-based formulations reduced the H1N1 and MHV-1 by disrupting the vial envelopes. Full article