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\"It has been estimated that in developed countries up to 10% of hospitalized patients develop infections every year. Not only is there a substantial cost to healthcare systems, but some healthcare associated infections (HCIAs) can be fatal. Since the majority of HCIAs are preventable, reducing HCIAs is now considered to be an integral part of patient safety and quality of care provided by all healthcare institutions worldwide. Unlike other books on infection control, the main strength of this book is to provide clear, up-to-date and practical guidance in infection control in an easy to read format which can act as a quick source of reference on all aspects of HCIA for healthcare workers who are either directly or indirectly involved in prevention and control of HCIAs. Although the book's main audience is infection control practitioners such as doctors, nurses, public health physicians, it is also a valuable reference for environmental health officers, health educators, practice managers in GP surgeries, and health service managers\"-- Provided by publisher.

Ambulances are enclosed environments that carry a high risk of airborne and surface microbial transmission, yet effective disinfection technologies remain limited. This study evaluated four photocatalytic oxidation (PCO) configurations—O₃+UVA + TiO₂, UVA + TiO₂, O₃+UVC + ZnO, and UVC + ZnO—against B. subtilis spores. The testing employed a prototype air purification system for ambulance applications, where the photocatalyst TiO 2 or ZnO was integrated into a filter medium. This system operated in combination with its corresponding UV light source (UVA or UVC) and an optional ozone generator; all housed within a laboratory-simulated ambulance cabin. (8.998 m³), where spores at 1.5 × 10⁸ CFU/mL (8 mL) were spray misted using a nebulizer and sampled using an Andersen Impactor, following the NIOSH method. Disinfection efficacy was quantified as the percentage reduction of B. subtilis spores in the air and on surfaces. Among the tested systems, efficacy ranked as UVA + TiO₂ > O₃+UVA + TiO₂ > O₃+UVC + ZnO > UVC + ZnO. UVA + TIO 2 achieved the most rapid and stable disinfection among the tested systems under controlled conditions, reducing airborne spores by > 80% within 15 min, achieving complete removal within 90 min, and reducing surface contamination by 96.77% at 120 min. In contrast, ZnO- and UVC-based systems exhibited lower or inconsistent performance. These findings identify UVA + TiO₂ photocatalysis as a safe, ozone-free, and highly effective strategy for ambulance air purification. Its rapid and durable antimicrobial action demonstrates clear advantages over approaches based on ozone or UVC, offering practical benefits for infection control in emergency medical services and providing a foundation for further optimization of photocatalytic technologies in healthcare settings.

Patients admitted to hospital can acquire multidrug-resistant organisms and Clostridium difficile from inadequately disinfected environmental surfaces. We determined the effect of three enhanced strategies for terminal room disinfection (disinfection of a room between occupying patients) on acquisition and infection due to meticillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, C difficile, and multidrug-resistant Acinetobacter. We did a pragmatic, cluster-randomised, crossover trial at nine hospitals in the southeastern USA. Rooms from which a patient with infection or colonisation with a target organism was discharged were terminally disinfected with one of four strategies: reference (quaternary ammonium disinfectant except for C difficile, for which bleach was used); UV (quaternary ammonium disinfectant and disinfecting ultraviolet [UV-C] light except for C difficile, for which bleach and UV-C were used); bleach; and bleach and UV-C. The next patient admitted to the targeted room was considered exposed. Every strategy was used at each hospital in four consecutive 7-month periods. We randomly assigned the sequence of strategies for each hospital (1:1:1:1). The primary outcomes were the incidence of infection or colonisation with all target organisms among exposed patients and the incidence of C difficile infection among exposed patients in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT01579370. 31 226 patients were exposed; 21 395 (69%) met all inclusion criteria, including 4916 in the reference group, 5178 in the UV group, 5438 in the bleach group, and 5863 in the bleach and UV group. 115 patients had the primary outcome during 22 426 exposure days in the reference group (51·3 per 10 000 exposure days). The incidence of target organisms among exposed patients was significantly lower after adding UV to standard cleaning strategies (n=76; 33·9 cases per 10 000 exposure days; relative risk [RR] 0·70, 95% CI 0·50–0·98; p=0·036). The primary outcome was not statistically lower with bleach (n=101; 41·6 cases per 10 000 exposure days; RR 0·85, 95% CI 0·69–1·04; p=0·116), or bleach and UV (n=131; 45·6 cases per 10 000 exposure days; RR 0·91, 95% CI 0·76–1·09; p=0·303) among exposed patients. Similarly, the incidence of C difficile infection among exposed patients was not changed after adding UV to cleaning with bleach (n=38 vs 36; 30·4 cases vs 31·6 cases per 10 000 exposure days; RR 1·0, 95% CI 0·57–1·75; p=0·997). A contaminated health-care environment is an important source for acquisition of pathogens; enhanced terminal room disinfection decreases this risk. US Centers for Disease Control and Prevention.

BackgroundIn a previous randomised controlled trial (RCT) in hospital healthcare workers (HCWs), cloth masks resulted in a higher risk of respiratory infections compared with medical masks. This was the only published RCT of cloth masks at the time of the COVID-19 pandemic.ObjectiveTo do a post hoc analysis of unpublished data on mask washing and mask contamination from the original RCT to further understand poor performance of the two-layered cotton cloth mask used by HCWs in that RCT.Setting14 secondary-level/tertiary-level hospitals in Hanoi, Vietnam.ParticipantsA subgroup of 607 HCWs aged ≥18 years working full time in selected high-risk wards, who used a two-layered cloth mask and were part of a randomised controlled clinical trial comparing medical masks and cloth masks.InterventionWashing method for cloth masks (self-washing or hospital laundry). A substudy of contamination of a sample of 15 cloth and medical masks was also conducted.Outcome measureInfection rate over 4 weeks of follow up and viral contamination of masks tested by multiplex PCR.ResultsViral contamination with rhinovirus was identified on both used medical and cloth masks. Most HCW (77% of daily washing) self-washed their masks by hand. The risk of infection was more than double among HCW self-washing their masks compared with the hospital laundry (HR 2.04 (95% CI 1.03 to 4.00); p=0.04). There was no significant difference in infection between HCW who wore cloth masks washed in the hospital laundry compared with medical masks (p=0.5).ConclusionsUsing self-reported method of washing, we showed double the risk of infection with seasonal respiratory viruses if masks were self-washed by hand by HCWs. The majority of HCWs in the study reported hand-washing their mask themselves. This could explain the poor performance of two layered cloth masks, if the self-washing was inadequate. Cloth masks washed in the hospital laundry were as protective as medical masks. Both cloth and medical masks were contaminated, but only cloth masks were reused in the study, reiterating the importance of daily washing of reusable cloth masks using proper method. A well-washed cloth mask can be as protective as a medical mask.Trial resgistration numberACTRN12610000887077.

'Dirt' reveals the fascinating world of filth that remains one of the very last taboos. Our major new exhibition takes a closer look at something that surrounds us but that we are often reluctant to confront. 'Dirt' travels across centuries and continents to explore our ambivalent relationship with dirt. Bringing together around 200 artefacts spanning visual art, documentary photography, cultural ephemera, scientific artefacts, film and literature, the exhibition uncovers a rich history of disgust and delight in the grimy truths and dirty secrets of our past, and points to the uncertain future of filth, which poses a significant risk to our health but is also vital to our existence. Following anthropologist Mary Douglas's observation that dirt is 'matter out of place', the exhibition introduces six very different places as a starting point for exploring attitudes towards dirt and cleanliness: a home in 17th-century Delft in Holland, a street in Victorian London, a hospital in Glasgow in the 1860s, a museum in Dresden in the early 20th century, a community in present day New Delhi and a New York landfill site in 2030. Highlights include paintings by Pieter de Hooch, the earliest sketches of bacteria, John Snow's 'ghost map' of cholera, beautifully crafted delftware, Joseph Lister's scientific paraphernalia and a wide range of contemporary art, from Igor Eskinja's dust carpet, Susan Collis's bejewelled broom and James Croak's dirt window, to video pieces by Bruce Nauman and Mierle Ukeles and a specially commissioned work by Serena Korda.

INTRODUCTION:International guidelines suggest different possibilities for drying of endoscopes during reprocessing. Clinical results of these available drying methods are not satisfactory. The aim of this study was to compare the drying cycle of a standard endoscope washer-disinfector (EWD) (standard drying method [SD]) with a shortened mandatory drying by the EWD followed by a special drying device using laminar and turbulent air flow (novel drying method [ND]).METHODS:Sixty endoscopes (duodenoscopes, colonoscocopes, and gastroscopes) from 3 different manufacturers underwent high-level disinfection and drying depending on the randomization group. Operational time of drying was measured for both groups. Residual fluid in the channels was measured using a laboratory scale. After a 14-day storage period, a sample of the endoscope channels was obtained to determine bacterial contamination.RESULTS:ND had significantly fewer residual water in endoscope channels (SD: 90% vs ND: 0%; P < 0.001) after high-level disinfection and drying and less bacterial contamination after storage for 14 days (SD: 47% vs ND: 20%; P = 0.028). Time consumed for drying in ND was also significantly shorter (SD: 16 minutes 4 seconds vs ND: 5 minutes 59 seconds; P < 0.001).DISCUSSION:Drying with a special automatic drying device was superior compared with an EWD's drying program as evidenced by no measurable residual water, reduced microbiological contamination, and a more than 2-fold decrease in operational time. Thus, drying by laminar and turbulent airflow may represent an attractive alternative to the currently used standard approach in the reprocessing process of flexible endoscopes.

The Minnesota Department of Health identified an outbreak of Legionnaires' disease in a city in northern Minnesota, USA, in April 2023 that continued until chloramine disinfection of the community water system was implemented. Before chloramine disinfection was implemented, Legionella pneumophila was detected in 1 of 16 samples from the drinking water distribution system and in 5 of 10 premise plumbing samples using both cultivation-dependent (Legiolert) and cultivation-independent (digital PCR) assays in this independent investigation. Approximately 11 weeks after disinfection was implemented, all distribution system samples tested negative; however, 1 of 6 Legiolert-tested and 3 of 6 digital PCR-tested premise plumbing samples were positive. After 24 weeks of disinfection, all samples collected from the distribution system and premise plumbing tested negative. Our results show that a community water system supplied by groundwater supported substantial growth of L. pneumophila in premise plumbing and that chloramine disinfection halted the outbreak.

Helminth and protozoan infections affect more than 1 billion children globally. Improving water quality, sanitation, handwashing, and nutrition could be more sustainable control strategies for parasite infections than mass drug administration, while providing other quality of life benefits. We enrolled geographic clusters of pregnant women in rural western Kenya into a cluster-randomized controlled trial (ClinicalTrials.gov NCT01704105) that tested 6 interventions: water treatment, improved sanitation, handwashing with soap, combined water treatment, sanitation, and handwashing (WSH), improved nutrition, and combined WSH and nutrition (WSHN). We assessed intervention effects on parasite infections by measuring Ascaris lumbricoides, Trichuris trichiura, hookworm, and Giardia duodenalis among children born to the enrolled pregnant women (index children) and their older siblings. After 2 years of intervention exposure, we collected stool specimens from 9,077 total children aged 2 to 15 years in 622 clusters, including 2,346 children in an active control group (received household visits but no interventions), 1,117 in the water treatment arm, 1,160 in the sanitation arm, 1,141 in the handwashing arm, 1,064 in the WSH arm, 1,072 in the nutrition arm, and 1,177 in the WSHN arm. In the control group, 23% of children were infected with A. lumbricoides, 1% with T. trichiura, 2% with hookworm, and 39% with G. duodenalis. The analysis included 4,928 index children (median age in years: 2) and 4,149 older siblings (median age in years: 5); study households had an average of 5 people, <10% had electricity access, and >90% had dirt floors. Compared to the control group, Ascaris infection prevalence was lower in the water treatment arm (prevalence ratio [PR]: 0.82 [95% CI 0.67, 1.00], p = 0.056), the WSH arm (PR: 0.78 [95% CI 0.63, 0.96], p = 0.021), and the WSHN arm (PR: 0.78 [95% CI 0.64, 0.96], p = 0.017). We did not observe differences in Ascaris infection prevalence between the control group and the arms with the individual interventions sanitation (PR: 0.89 [95% CI 0.73, 1.08], p = 0.228), handwashing (PR: 0.89 [95% CI 0.73, 1.09], p = 0.277), or nutrition (PR: 86 [95% CI 0.71, 1.05], p = 0.148). Integrating nutrition with WSH did not provide additional benefit. Trichuris and hookworm were rarely detected, resulting in imprecise effect estimates. No intervention reduced Giardia. Reanalysis of stool samples by quantitative polymerase chain reaction confirmed the reductions in Ascaris infections measured by microscopy in the WSH and WSHN groups. Trial limitations included imperfect uptake of targeted intervention behaviors, limited power to detect effects on rare parasite infections, and that it was not feasible to blind participants and sample collectors to treatment status. However, lab technicians and data analysts were blinded to treatment status. The trial was funded by the Bill & Melinda Gates Foundation and the United States Agency for International Development. Integration of improved water quality, sanitation, and handwashing could contribute to sustainable control strategies for Ascaris infections, particularly in similar settings with recent or ongoing deworming programs. Combining nutrition with WSH did not provide further benefits, and water treatment alone was similarly effective to integrated WSH. Our findings provide new evidence that drinking water should be given increased attention as a transmission pathway for Ascaris. ClinicalTrials.gov NCT01704105.