Hygiene

Self-ear cleaning is widespread in Saudi Arabia, yet public knowledge about proper ear hygiene and associated risks remains variable. This study aimed to assess knowledge, attitudes, and practices regarding self-ear cleaning among adults in the Northern Border Region and to situate the findings within the context of previous studies from other Saudi regions. A cross-sectional online survey was conducted among 534 adults (ages 18–60) residing in the Northern Border Region of Saudi Arabia. Data were collected using a validated questionnaire that assessed sociodemographic characteristics, knowledge, attitudes, practices, and self-reported complications related to self-ear cleaning. Knowledge was evaluated using 8 items, with 1 point per correct response (total score 0–8), and good knowledge was defined as ≥5 correct responses. Most participants (89.1%) reported practicing self-ear cleaning, predominantly using cotton buds (73.7%). Although many recognized potential harms (81.4% believed cotton buds could push wax deeper and 78.1% were aware of the risk of eardrum perforation), 64.1% still believed regular self-ear cleaning was necessary, indicating a knowledge–practice gap. Reported complications included otitis externa (50.6%), pain (44.0%), and bleeding (18.9%). In multivariable logistic regression, higher knowledge was independently associated with postgraduate education, healthcare employment, non-smoking status, and a history of hearing problems. Comparative synthesis with previous surveys from other Saudi regions revealed broadly similar prevalence, preferred tools, and complications, suggesting that self-ear cleaning is a common and often risky behavior nationwide. In conclusion, self-ear cleaning is prevalent in the authors’ region despite substantial awareness of its risks, and a persistent knowledge–practice gap was observed. While the cross-sectional, convenience-sample design limits causal inference and generalizability, these region-specific findings may help inform targeted educational messages and future interventional studies aimed at promoting safer ear hygiene and reducing avoidable ear-related morbidity in similar settings. Full article

Transport cages used for live poultry constitute a major source of cross-contamination in slaughterhouses, particularly regarding Salmonella spp. The aim of this study was to evaluate the improvement of washing parameters—specifically temperature and detergent conductivity—in reducing Salmonella contamination as well other microbial parameters in turkey transport cages under industrial conditions. Six washing conditions were tested by combining three temperatures (40, 45, and 60 °C) and different detergent conductivities (0–4 mS/cm), using an alkaline chlorinated detergent. Microbiological analyses included Salmonella spp. and indicators such as mesophilic aerobic bacteria and Enterobacteriaceae, assessed before and after washing at three time points during the processing day. High initial contamination levels were observed in all cases. Results demonstrated a clear synergistic effect between temperature and detergent conductivity. The treatment at 60 °C and 2 mS/cm provided the most effective balance, achieving total elimination of Salmonella and significant reductions in indicator microorganisms without the need for maximum detergent concentration. Increasing conductivity beyond this level did not lead to substantial improvements. These findings support the optimization of washing parameters as a key prerequisite program within HACCP systems in poultry slaughterhouses. Full article

Quality management and internal audit are important components of patient safety, regulatory compliance, and service quality in dental practice. This narrative review examined the current status of quality management and internal audit in Romanian dental settings and explored challenges and future development opportunities in relation to European quality standards. A narrative review of the literature was conducted using PubMed, Scopus, Web of Science, and Google Scholar, complemented by an analysis of Romanian regulatory documents relevant to dental practice. The reviewed evidence suggests that quality management in Romanian dental services remains largely focused on regulatory compliance, particularly infection control and documentation requirements. Internal audit is rarely implemented as a structured tool for continuous quality improvement, while the lack of standardized audit frameworks and quality indicators limits objective performance evaluation. Additional challenges include variability in organizational resources, limited audit-related training, and uneven digital integration. Strengthening internal audit procedures and developing standardized quality-management frameworks may support continuous quality improvement and closer alignment with European quality standards. Full article

Environmental contamination represents an important risk factor for the transmission of healthcare-associated pathogens in both human and veterinary medicine. In equine hospitals, open stable environments and high patient turnover may further increase the risk of microbial spread. The aim of this study was to evaluate the hygiene status of an equine referral hospital and to assess the effect of implementing standardized cleaning and disinfection procedures combined with targeted staff training on environmental microbial burden. Surface samples were collected using agar contact plates from predefined environmental surfaces in surgical areas, examination rooms, and stable units of an equine clinic. Sampling was conducted during three investigation periods: prior to intervention, after implementation of revised cleaning protocols and staff training, and during a later follow-up assessment. Colony-forming units (CFU) were quantified and categorized into an ordinal contamination scale (0–4) to enable standardized statistical analysis. Furthermore, delta values were calculated for every sampling period, describing the reduction in the environmental microbial burden. Pre- and post-cleaning microbial burdens were compared using nonparametric statistical methods. A total of 76 locations were sampled before and after cleaning and disinfection in sampling period 1 and 2; in sampling period 3, sample collection focused on sensitive surfaces, and 21 locations were sampled. Bacterial contamination varied considerably between functional areas, with the highest baseline contamination consistently observed in stable environments. Examination and surgical areas showed heterogeneous contamination patterns, particularly on high-touch surfaces, such as keyboards, switches, and door handles. In sampling periods 1 and 2, cleaning and disinfection significantly reduced microbial burden. The delta values in sampling period 2 were significantly lower than the delta values in both sampling period 1 and sampling period 3. These findings demonstrate that environmental contamination in equine hospitals is highly variable and influenced by surface type, clinical workflow, and proximity to patients. Structured hygiene interventions, including standardized cleaning protocols and continuous staff education, can significantly improve environmental hygiene and should be integrated into infection prevention programs in veterinary clinical facilities. Full article

The occupational health implications of solar photovoltaic (PV) recycling remain critically under-investigated. This study assessed occupational exposure across the PV recycling value chain in Taiwan, evaluating primary mechanical dismantling and downstream reuse sectors (glass milling and controlled low-strength material [CLSM] batching). Area and personal samples were analyzed for total dust, respirable dust, and trace heavy metals. Results indicated that primary mechanical crushing yielded relatively low ambient dust and negligible toxic heavy metal (e.g., Pb, Cd) aerosols, attributed to the macroscopic ductility of metallic ribbons and EVA shock-absorbing properties. Conversely, a critical “hazard transfer” phenomenon was empirically identified downstream, where intensive secondary grinding and aggregate blending in the downstream reuse sector (glass milling and CLSM batching) systematically shifted the aerodynamic particle size distribution, causing the respirable dust fraction to surge to 38.9–72.6%. The pursuit of zero-waste material circularity inadvertently amplifies highly dispersive, respirable dust hazards in downstream sectors, necessitating targeted occupational exposure controls. Full article

Objectives: Inadequate access to safe water, sanitation, and hygiene (WASH) continues to drive infectious diseases, malnutrition, and educational disparities, particularly among vulnerable populations. This systematic review examined WASH intervention strategies implemented in Malaysia between 2014 and 2025, focusing on shifts in hygiene-related knowledge, attitudes and practices (KAP), health outcomes, infrastructure improvements, and implementation challenges. Methods: A comprehensive search across five databases (Science Direct, PubMed, Scopus, Web of Science, and Google Scholar) identified twelve eligible studies targeting schools, healthcare settings, and rural or Indigenous communities. Results: Education-based interventions predominated (n = 10), often employing participatory and theory-driven approaches grounded in the Health Belief Model or Information–Motivation–Behavioural Skills framework. Evidence revealed significant improvements in KAP, particularly when digital, gamified, or storytelling elements were integrated. Community-led and caregiver-inclusive models demonstrated greater behavioural adoption and retention. Thematic analysis identified several implementation challenges, which include (i) sole reliance on self-reported outcomes with limited use of objective indicators, (ii) short intervention durations (<2 months) that limit long-term impact, and (iii) lack of policy and curriculum integration. Conclusions: Findings underscore the need for culturally tailored, longitudinal, and system-embedded interventions that combine behavioural theory with infrastructure investment. Integrating WASH initiatives into Malaysia’s health and education frameworks could advance Sustainable Development Goal 6, ensuring scalable and equitable improvements in hygiene literacy, community resilience, and public health outcomes. Full article

Infection prevention and control (IPC) is imperative to ensuring patient safety; however, public hospitals in Limpopo Province suffer from poor infrastructure, lack of education, and lack of surveillance. The purpose of this research was to evaluate the performance of IPC programs within Limpopo Province and develop an evidence-based improvement strategy using the WHO Multimodal Framework. A mixed-methods research approach was used over three different phases. In Phase I, retrospective data on IPCAF were collected on all 41 public hospitals. In Phase II, semi-structured interviews were conducted with six IPC nurses. Descriptive statistics (medians and interquartile ranges) were used for quantitative analysis, while qualitative data were analyzed using thematic analysis in ATLAS.ti. An evidence-informed strategy was formulated in Phase III. Overall IPC program performance was moderate (median IPCAF score: 618.0/800), with 58.5% of hospitals having advanced status, 39.0% intermediate status, and 2.4% basic status. The most poorly performing component was workload/staffing (CC7: 60.0). Districts scored between 576.2 (Capricorn) and 636.0 (Mopani). Lack of standardized education, understaffing, and role ambiguity were the main barriers identified. The strategy uses the “Build It, Teach It, Check It, Sell It, Live It” framework. Full article

Background: Open defecation (OD) has remained a threat to the attainment of SDG 6 (sanitation and hygiene). This study measured the level of exposure to the “Clean Nigeria, Use the Toilet” campaign against open defecation, determined the level of public knowledge about open defecation-related harms and diseases, ascertained the public attitude towards open defecation, and established the prevailing defecation practices and the perceived barriers to toilet usage in Ebonyi state, the most prevalent OD state in Nigeria. Methods: The study employed a survey design, using a structured questionnaire for data collection. The multi-stage sampling technique was employed in selecting the respondents from two randomly selected Local Government Areas (LGAs) in the state. Analysis was conducted using 384 valid responses. Results: The results were presented in simple percentage frequency tables and interpreted through the descriptive method, while the Chi-Square test was used to analyse the formulated hypotheses, using the decision rule of p < 0.05. The findings show a high level of awareness of the campaign against open defecation, through the radio and community engagements by environmental activists/NGOs, even though regular access to such information was limited. The results also showed inadequate knowledge of the public health implications of open defecation, whereas good knowledge of environmental consequences was reported. The study found favourable attitudes toward OD practice and persistent open defecation, and major barriers to toilet usage include the high cost of toilet construction, lack of access to toilet facilities, poor sanitation and management of available toilets, and perceived risks of contracting infection from public toilets. However, the Chi-Square values showed that the SBCC campaign was significantly associated with knowledge, attitude, and practice (p < 0.05). Conclusions: The study concluded that localised, culturally relevant and socio-demographically targeted communication interventions, grassroot advocacy, community watch, and neighbourhood taskforce on open defecation, in addition to the provision of aids for the construction of modern toilets with water facilities, are required to combat open defecation in Ebonyi and related contexts in Nigeria. Full article

The increasing demand for safe, minimally processed, and sustainable food preservation strategies has intensified interest in light-activated antimicrobial systems derived from natural sources. This review examines the application of plant-derived photoactive compounds as functional agents that generate reactive species upon illumination, thereby facilitating effective microbial inactivation. Emphasis is placed on the diversity of phytochemicals exhibiting light-responsive properties, their mechanisms of action, and the factors influencing their efficacy, including physicochemical characteristics, environmental conditions, and formulation strategies. The review further discusses the role of delivery systems in improving the stability, solubility, and bioavailability of these photoactive compounds, as well as the influence of food matrix complexity on treatment performance. Applications across a range of food systems, including fresh produce, animal-derived products, and food packaging materials, are evaluated to demonstrate their practical relevance in food preservation. In addition, current challenges are critically highlighted, including variability in plant extract composition, limited understanding of photosensitiser behaviour within complex food matrices, restricted light penetration, and challenges associated with standardisation and scalability. This work provides an overview of emerging natural photoactive systems and their potential to advance safer and environmentally sustainable food preservation technologies. Full article

Background: Food contamination in institutional food service settings remains a significant public health concern, particularly where large numbers of consumers are exposed daily. This study aimed to assess chemical and microbiological contamination, evaluate food handlers’ knowledge, attitudes, and practices (KAP), and identify contamination patterns in university food outlets. Methods: A cross-sectional study was conducted across all 77 food outlets within a university in northern Thailand. KAP was assessed using a structured questionnaire, while chemical and microbiological contamination were evaluated using standard screening methods. Results: Food handlers demonstrated generally high KAP scores; however, microbiological contamination was still observed, including Escherichia coli on food handlers’ hands (27.3%) and food-contact utensils (14.3%), as well as Salmonella spp. in ready-to-eat food (6.5%). In contrast, chemical contamination was rarely detected in screening tests. Moreover, cluster analysis identified four distinct contamination patterns, indicating heterogeneity in contamination risk across outlets. Conclusions: These findings suggest that reported food safety practices may not fully prevent contamination and that food safety management should incorporate both behavioral and operational controls to effectively reduce contamination risks in institutional settings. Full article

Background: Healthcare-associated infections (HAIs) and antimicrobial resistance are major global public health challenges, influenced by patient clinical complexity and prescribing practices. Methods: Three-point prevalence surveys (PPSs) were conducted (P1: November 2024; P2: June 2025; P3: November 2025), involving 456 patients at the University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy. Results: The prevalence of HAIs fluctuated between 3.1% (P1) and a peak of 6.1% (P2), before decreasing to 1.9% (P3), correlating with the presence of multidrug-resistant pathogens in critical care areas. The prevalence of antibiotic use remained stable (~48%), with a decrease in carbapenem use (from 12% to 9%). A decline in ‘unknown’ McCabe scores from 24.6% to 6.8% (p < 0.001) was also observed, suggesting an improvement in completeness of prognostic data, although changes in data collection practices may also have contributed to this change. Conclusions: We showed an association between clinical severity, prolonged hospitalization, invasive device use, and infection risk in a single tertiary-care hospital, within an exploratory, cross-sectional framework. Despite high healthcare pressure, improvements were observed in antimicrobial stewardship and clinical surveillance. Future strategies should focus on optimal device management and on extending surveillance activities to medical wards with increasing patient complexity. Full article

Human norovirus is a leading cause of acute gastroenteritis, with prevention largely dependent on individual hygiene behaviors. Understanding the cognitive determinants of these behaviors is essential for designing effective prevention strategies; however, validated hygiene-specific measures grounded in behavioral theory remain limited. This study presents an initial, exploratory examination of Protection Motivation Theory constructs, some of which overlap with core principles of Social Cognitive Theory, as they relate to hygiene behaviors for human norovirus prevention. Survey data were collected from a sample of college students, and principal component analysis was used to examine the dimensionality and internal structure of theory-informed scale items. Sampling adequacy was supported by Kaiser–Meyer–Olkin indices indicating acceptable to meritorious suitability for exploratory analysis. Results revealed coherent component structures for threat and coping appraisal constructs, while a distinct response cost component did not emerge. Item retention decisions were guided by both statistical criteria and theoretical interpretability. Findings are discussed within the context of early-stage scale development, with attention to implications for theory-informed measurement refinement and future validation efforts. This preliminary work provides a foundation for advancing the assessment of hygiene behaviors relevant to human norovirus prevention. Full article

Ensuring effective cleaning and disinfection (C/D) of operating room (OR) surfaces is essential for patient safety, yet available monitoring methods vary in performance and interpretation. This study aimed to assess changes associated with a multimodal intervention on C/D quality, compare the performance of four monitoring methods, and identify predictors of post-cleaning outcomes. A quasi-experimental pre–post study was conducted during 40 surgical procedures, totaling 1400 assessments across five high-touch surfaces. Monitoring included visual inspection, adenosine triphosphate (ATP) bioluminescence, microbiological culture (reference method), and a fluorescent marker. Sensitivity, specificity, and accuracy were calculated, and multivariable models were used to evaluate predictors of post-cleaning ATP levels. The methods showed distinct performance profiles: ATP demonstrated high specificity (93.9% and 86.7%) and accuracy (92.0% and 85.0%) but low sensitivity; visual inspection showed intermediate accuracy (62.0% and 44.0%); and the fluorescent marker demonstrated high sensitivity (100% in the first collection) but low specificity. The intervention period was associated with increased cleaning time and reduced post-cleaning ATP levels. Pre-cleaning ATP was the main predictor of post-cleaning ATP (p < 0.001), while surgical duration (p = 0.038) and surface type (p = 0.035) were associated in the second phase. These findings suggest that multimethod monitoring captures complementary dimensions of environmental hygiene and may support continuous quality improvement in surgical settings. Full article

Background/Objectives: In South Asia, the prevalence of Helicobacter pylori (H. pylori) infections may be as high as 60–80%, constituting a notable public health issue, with eradication strategies critical in reducing the H. pylori-associated disease burden. The aim of our study was to assess the knowledge, attitude, and practices (KAP) regarding the screening, treatment, and follow-up of H. pylori-induced gastric ulcers among physicians in Lahore, Pakistan. Methods: A self-administered, questionnaire-based cross-sectional study—including the development and validity assessment of a 24-item questionnaire—was carried out in two tertiary-care hospitals between January and May 2024. Statistical analyses (descriptive statistics, χ²-tests, binary logistic regression, and 95% confidence interval [95% CI]) were carried out using IBM SPSS 27.0. The study adheres to the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines. Results: Among N = 385 participants, 57.9% were male, 60.0% were aged between 25 and 34 years, 59.5% worked in a public hospital, and 55.3% had <5 years of working experience. Of them, 32.9% had noted medical journals, while 27.0% reported online educational materials as their key sources of evidence-based information. Although 91.2% and 87.3% of physicians had good knowledge and attitude levels (≥50% score) pertaining to H. pylori-associated gastric ulcers, respectively. Participants aged 25–34 years (aOR: 0.217 [95% CI: 0.08–0.589]), who have <5 years of working experience (aOR: 0.328 [95% CI: 0.136–0.790]) and those working in public hospitals (aOR: 0.130 [95% CI: 0.048–0.352]) were less likely to show poor attitudes. Furthermore, 76.5% made it a routine to discuss the risk factors of H. pylori-induced ulcers with their patients, while 67.4% highlighted the importance of follow-up testing to confirm the eradication of H. pylori. Conclusions: Inconsistent and empirical treatment approaches, lack of routine screening, and inadequate follow-up practices may further compromise eradication efforts and contribute to antimicrobial resistance. Our findings emphasize the importance of targeted educational programs to address knowledge gaps, standardize practices, and enhance the appropriate management of H. pylori-induced gastric ulcers in Pakistan. Full article

Background: In Italy, Departments of Prevention (Dipartimenti di Prevenzione, DPs) are primary organizational units for disease prevention, health promotion, and environmental health. Constitutional decentralization (2001) generated significant regional variability. While national data exist, in-depth regional analyses are lacking. Objectives: To provide a systematic descriptive analysis of organizational structure, governance mechanisms, and workforce composition of DPs in the Triveneto area (Veneto, Friuli Venezia Giulia, Autonomous Provinces of Trento and Bolzano), contextualized within national and international frameworks. Methods: Cross-sectional descriptive study using 2022 Italian Prevention Observatory national survey data. A structured 87-item questionnaire assessed organizational structure, governance, staffing, and quality systems. Results: A total of 10 of 14 DPs participated (71.4% coverage; 5.2 million inhabitants, 87% of Triveneto population). All maintained three mandated core services (Public Health and Hygiene, Veterinary Public Health, and Occupational Health and Safety), employing medians of 35%, 23%, and 14% of staff, respectively. Management Committees were active in 80% of DPs (vs. 77.6% nationally). Quality certification (30%) and institutional accreditation (50%, Veneto only) showed inconsistent implementation. The workforce was predominantly non-executive (65% vs. 67% nationally), reflecting progressive task reallocation. Median staff density: 3235 inhabitants/staff member (vs. 2608 nationally). Conclusions: Participating DPs—predominantly from the Veneto Region—demonstrate comprehensive service coverage and established governance structures, yet face standardization challenges. Findings should be interpreted in light of Veneto overrepresentation (8/10 participating DPs). Alignment with territorial care reforms (Ministerial Decree 77/2022) and National Recovery Plan investments could enhance integration, digital infrastructure, and preparedness capacity. Full article

Pain is a complex experience that encompasses both physical and emotional dimensions. Stomatognathic Pain (SP) affects the anatomical and functional structures of the stomatognathic system, which is involved in essential activities such as mastication, deglutition, and phonation. Consequently, SP can significantly impair patients’ quality of life, affecting physiological, psychological, and social well-being. Precision Medicine (PM) is an emerging patient-centered approach that enables healthcare providers to tailor diagnostic and therapeutic strategies according to each patient’s biochemical, physiological, environmental, and behavioral profile. The aim of this narrative review is to highlight PM tools for the diagnosis and treatment of SP and to explore their contribution to personalized management. A literature search was conducted in the PubMed and Scopus databases using the keywords “orofacial pain”, “stomatognathic pain”, “precision medicine”, “pain management”, “pain assessment”, “pain treatment”, and “patient-centered care”. Current evidence suggests that PM can improve SP management by identifying pathogenic mechanisms, clarifying disease etiology, and integrating advanced molecular and digital technologies. Emerging approaches, including genetic profiling, biomarker analysis, artificial intelligence–based diagnostics, targeted therapies, individualized rehabilitation, and behavioral interventions, may support personalized treatment and facilitate the development of patient-centered care models, ultimately reducing the burden of SP and improving clinical outcomes and quality of life. Full article

Hand hygiene is a cornerstone of infection prevention, yet adherence often declines once public health emergencies subside. This study examines post-pandemic hand hygiene practices and knowledge among public health trainees. We conducted a cross-sectional study of graduate students (N = 93) at a U.S. School of Public Health between May and October 2025. Participants completed a self-administered questionnaire assessing knowledge, self-reported practices, and demographics, with associations analyzed using chi-square tests. Results indicated that while 65.6% of participants possessed good knowledge (mean score 6.92 ± 1.92), only 23.7% met the criteria for good hand hygiene practice. Knowledge level was not associated with practice (p = 0.631). In contrast, sex was strongly associated with behavior: 34.4% of females reported good practice compared with 3.1% of males (p = 0.0016). Furthermore, adherence in high-risk situations was low, with only 7% reporting handwashing after coughing or sneezing. In conclusion, hand hygiene knowledge did not translate into consistent preventive behavior among these trainees. The observed differences by sex suggest that post-pandemic interventions should prioritize behavioral and social determinants rather than relying on information-based strategies alone. Full article

In recent years, social media platforms have emerged as major sources of health-related information. The aim of this study was to evaluate the alignment between TikTok videos on oral hygiene and official dental protocols, and to determine the prevalence of misinformation. A quantitative, observational, cross-sectional study was conducted to analyze 246 Spanish-language TikTok videos collected between May and July 2025 using 11 hashtags. Videos were assessed using a standardized summary based on guidelines from the Fédération Dentaire Internationale, American Dental Association, Federación Odontológica Ecuatoriana, and Federación Dental Española. Content was classified as aligned if it aligned with at least one protocol. Statistical analyses included descriptive statistics, Z-tests for proportions, chi-square tests, and Mann–Whitney U tests. As results, only 1% of videos cited official references. Overall, 26.19% aligned with at least one protocol, while 73.81% contained unsupported or non-aligned information. Misrepresentation was most frequent for fluoride concentration, toothpaste quantity, dental floss characteristics, and mouthwash use. Video format, presentation style, and creator profile were significantly associated with accuracy. Engagement metrics did not consistently favor accurate content. In conclusion, most TikTok oral hygiene content does not reflect official dental protocols, highlighting the need for improved digital health literacy and responsible professional communication. Full article