Personal Care Products as a Contributing Factor to Antimicrobial Resistance: Current State and Novel Approach to Investigation.

Antimicrobial resistance (AMR) is one of the world's industrialized nations' biggest issues. It has a significant influence on the ecosystem and negatively affects human health. The overuse of antibiotics in the healthcare and agri-food industries has historically been defined as a leading factor, although the use of antimicrobial-containing personal care products plays a significant role in the spread of AMR. Lotions, creams, shampoos, soaps, shower gels, toothpaste, fragrances, and other items are used for everyday grooming and hygiene. However, in addition to the primary ingredients, additives are included to help preserve the product by lowering its microbial load and provide disinfection properties. These same substances are released into the environment, escaping traditional wastewater treatment methods and remaining in ecosystems where they contact microbial communities and promote the spread of resistance. The study of antimicrobial compounds, which are often solely researched from a toxicological point of view, must be resumed considering the recent discoveries, to highlight their contribution to AMR. Parabens, triclocarban, and triclosan are among the most worrying chemicals. To investigate this issue, more effective models must be chosen. Among them, zebrafish is a crucial study system because it allows for the assessment of both the risks associated with exposure to these substances as well as environmental monitoring. Furthermore, artificial intelligence-based computer systems are useful in simplifying the handling of antibiotic resistance data and speeding up drug discovery processes.

Impact of COVID-19-adapted guidelines using different airway management strategies on resuscitation quality in out-of-hospital-cardiac-arrest - a randomised manikin study.

BACKGROUND: Although airway management for paramedics has moved away from endotracheal intubation towards extraglottic airway devices in recent years, in the context of COVID-19, endotracheal intubation has seen a revival. Endotracheal intubation has been recommended again under the assumption that it provides better protection against aerosol liberation and infection risk for care providers than extraglottic airway devices accepting an increase in no-flow time and possibly worsen patient outcomes. METHODS: In this manikin study paramedics performed advanced cardiac life support with non-shockable (Non-VF) and shockable rhythms (VF) in four settings: ERC guidelines 2021 (control), COVID-19-guidelines using videolaryngoscopic intubation (COVID-19-intubation), laryngeal mask (COVID-19-Laryngeal-Mask) or a modified laryngeal mask modified with a shower cap (COVID-19-showercap) to reduce aerosol liberation simulated by a fog machine. Primary endpoint was no-flow-time, secondary endpoints included data on airway management as well as the participants' subjective assessment of aerosol release using a Likert-scale (0 = no release-10 = maximum release) were collected and statistically compared. Continuous Data was presented as mean ± standard deviation. Interval-scaled Data were presented as median and Q1 and Q3. RESULTS: A total of 120 resuscitation scenarios were completed. Compared to control (Non-VF:11 ± 3 s, VF:12 ± 3 s) application of COVID-19-adapted guidelines lead to prolonged no-flow times in all groups (COVID-19-Intubation: Non-VF:17 ± 11 s, VF:19 ± 5 s;p ≤ 0.001; COVID-19-laryngeal-mask: VF:15 ± 5 s,p ≤ 0.01; COVID-19-showercap: VF:15 ± 3 s,p ≤ 0.01). Compared to COVID-19-Intubation, the use of the laryngeal mask and its modification with a showercap both led to a reduction of no-flow-time(COVID-19-laryngeal-mask: Non-VF:p = 0.002;VF:p ≤ 0.001; COVID-19-Showercap: Non-VF:p ≤ 0.001;VF:p = 0.002) due to a reduced duration of intubation (COVID-19-Intubation: Non-VF:40 ± 19 s;VF:33 ± 17 s; both p ≤ 0.01 vs. control, COVID-19-Laryngeal-Mask (Non-VF:15 ± 7 s;VF:13 ± 5 s;p > 0.05) and COVID-19-Shower-cap (Non-VF:15 ± 5 s;VF:17 ± 5 s;p > 0.05). The participants rated aerosol liberation lowest in COVID-19-intubation (median:0;Q1:0,Q3:2;p < 0.001vs.COVID-19-laryngeal-mask and COVID-19-showercap) compared to COVID-19-shower-cap (median:3;Q1:1,Q3:3 p < 0.001vs.COVID-19-laryngeal-mask) or COVID-19-laryngeal-mask (median:9;Q1:6,Q3:8). CONCLUSIONS: COVID-19-adapted guidelines using videolaryngoscopic intubation lead to a prolongation of no-flow time. The use of a modified laryngeal mask with a shower cap seems to be a suitable compromise combining minimal impact on no-flowtime and reduced aerosol exposure for the involved providers.

Toilet hygiene-review and research needs.

The goal of good toilet hygiene is minimizing the potential for pathogen transmission. Control of odours is also socially important and believed to be a societal measure of cleanliness. Understanding the need for good cleaning and disinfecting is even more important today considering the potential spread of emerging pathogens such as SARS-CoV-2 virus. While the flush toilet was a major advancement in achieving these objectives, exposure to pathogens can occur from failure to clean and disinfect areas within a restroom, as well as poor hand hygiene. The build-up of biofilm within a toilet bowl/urinal including sink can result in the persistence of pathogens and odours. During flushing, pathogens can be ejected from the toilet bowl/urinal/sink and be transmitted by inhalation and contaminated fomites. Use of automatic toilet bowl cleaners can reduce the number of microorganisms ejected during a flush. Salmonella bacteria can colonize the underside of the rim of toilets and persist up to 50 days. Pathogenic enteric bacteria appear in greater numbers in the biofilm found in toilets than in the water. Source tracking of bacteria in homes has demonstrated that during cleaning enteric bacteria are transferred from the toilet to the bathroom sinks and that these same bacteria colonize cleaning tools used in the restroom. Quantitative microbial risk assessment has shown that significant risks exist from both aerosols and fomites in restrooms. Cleaning with soaps and detergents without the use of disinfectants in public restrooms may spread bacteria and viruses throughout the restroom. Odours in restrooms are largely controlled by ventilation and flushing volume in toilet/urinals. However, this results in increased energy and water usage. Contamination of both the air and surfaces in restrooms is well documented. Better quantification of the risks of infection are needed as this will help determine what interventions will minimize these risks.

Nurses' Perceptions Regarding Exposure to COVID-19 Risks, and Impact of COVID-19 Outbreak on their Work and Psychosocial Health: A Cross-sectional Study

Introduction: Coronavirus (COVID) is a large family of RNA viruses that cause illnesses ranging from the common cold to more severe symptoms. Objectives: Determine nurses' perceptions in Saudi Arabia regarding their risks, measures and coping mechanisms to prevent COVID-19 infection and transmission and the significant associated factors for their anxiety. Methods: This is a correlational cross-sectional study. A convenience sampling method was used to recruit a total of 345 nurses. A valid and reliable questionnaire was adapted from a previous study and the generalized anxiety disorder-2 items (GAD-2) scale was used to collect the data. Results: The majority of the participants (75.7%) perceived that they were most likely at risk of getting COVID-19. In terms of preventative actions,84.3% said they were avoiding crowded places, 77.4% were adhering to protocols and recommended measures, about 73.0% of participants were taking nutritional supplements and vitamins, practicing exercises, and changing out of work clothes, 54.8% were taking a shower before going home, and 53.9% were temporarily staying away from home in alternative housing to prevent having COVID-19 or transmitting the virus to their relatives. Furthermore, significant association was found between the participants' anxiety and the male gender (r=0.1, p=0.04), less nursing experience (r=0.41, p=0.02), number of children (r=0.35, p=0.03). Additionally, participants exposed to COVID-19 patients, who did not implement the measures and coping mechanisms to prevent COVID-19 were significantly associated with a high level of GAD-2. Conclusion: The majority of nurses perceived that they were at high risk of getting COVID-19 and were concerned that they could easily transmit COVID-19 to their relatives. As a result, many implemented preventive measures to protect themselves and prevent transmission of COVID-19 to their families and relatives. The continued attendance of health education programs about COVID-19 as well as the implementation of basic standard precautions, is essential to protect health workers and their families. © 2022 Elneblawi et al.

Humans peeing: Justice-involved women's access to toilets in public spaces.

Justice-involved women face myriad challenges as they negotiate the terms of community supervision and manage the long-term implications and stigma of living with a criminal record. Major tasks that women juggle include securing safe, affordable housing, finding and retaining employment, accessing physical and mental health care (including substance use treatment), and handling relationships with family, friends, children, and intimate partners. In addition to these responsibilities, women must meet their basic physiological needs to eat, sleep, and use the toilet. Women's ability to safely meet their personal care needs may impact their capacity to manage their criminal-legal challenges. This study uses qualitative methods to understand justice-involved women's lived experiences related to urination. Specifically, the study reports on a thematic analysis of 8 focus groups conducted with justice-involved women (n = 58) and the results of a toilet audit conducted in the downtown areas of the small city in the United States where the focus group participants were living. Findings suggest that women had limited access to restrooms and reported urinating outside. Lack of restroom access impacted their engagement with social services support and employment and their ability to travel through public spaces. Women perceived their public toilet options as unsafe, increasing their sense of vulnerability and reinforcing the idea that they did not have full access to citizenship in the community because of their criminal-legal involvement. The exclusion and denial of women's humanity that is perpetuated by a lack of public toilet access impacts women's psychosocial outcomes. City governments, social service agencies, and employers are encouraged to consider how lack of toilet access may impact their public safety and criminal-legal objectives and expand opportunities for people to access safe restroom facilities.

[Educating to properly close the toilet knob taps or to replace them]. / Educare a chiudere in modo corretto i rubinetti a manopola del bagno o a sostituirli.

Systematic reviews have shown a prevalence close to 20% of gastrointestinal symptoms in COVID-19 positive patients, with nearly 40% of patients shedding viral RNA in their faeces, even if it may not be infectious, possibly because of inactivation by colonic fluid.According to current evidence, this virus is primarily transmitted by respiratory droplets and contact routes, including contaminated surfaces. The virus is quite stable on stainless steel, being detected up to 48-72 hours after application. Therefore, some individuals can be infected touching common contaminated surfaces, such as bathroom taps. Taps can be underestimated critical points in the transmission chain of the infection. Indeed, just by turning the knob, people leave germs on it, especially after coughing over their hands, sneezing, and/or blowing their nose. After handwashing with soap, user take back their germs when turning the knob. Paradoxically, the following user collects the germs back on his/her fingers by implementing a preventive measure, maybe before putting food into the mouth or wearing contact lenses.The Italian National Institute of Health recommends to clean and disinfect high-touched surfaces, but it is unrealistic and inefficient to do so after each tap use. As an alternative, new toilets should install long elbow-levers - or at least short levers - provided that people are educated to close them with the forearm or the side of the hand. This is already a standard measure in hospitals, but it is particularly important also in high-risk communities, such as retirement homes and prisons. It would be important also in schools, in workplaces, and even in families, contributing to the prevention both of orofaecal and respiratory infections.In the meantime, people should be educated to close existing knobs with disposable paper towel wipes or with toilet paper sheets.

Relationship of the Significance of Freshwater Use to Health Protocols During the Covid-19 Pandemic in Bantul Village, Yogyakarta

The Covid-19 pandemic has an impact on the use of freshwater. Freshwater has an essential role in preventing the spread of Covid-19 related to the implementation of health protocols also Clean and Healthy Living Behavior. The important factors that influence water use are socioeconomic conditions, including income level, type of work, and education level. The spread of Covid-19 significantly occurs in urban areas. Bantul village is the center of government, economy and one of the planned areas of urban settlements in Bantul Regency. Bantul village is also a hinterland of the Yogyakarta agglomeration area. This study was conducted to determine the influence of socio-economic conditions on the significance of changes in water use during the Covid-19 pandemic to implement health protocols in Bantul village. The data was obtained through interviews with 99 respondents based on random sampling techniques. This research was conducted with quantitative methods and descriptive analysis techniques. The result shows an increase in freshwater use during the pandemic, particularly washing hands and taking a shower. The highest increase in freshwater use is in Kurahan Hamlet. While in Grujugan Hamlet, there has been no increase. The increase in freshwater use indicates the suitable implementation of health protocols. © The Authors, published by EDP Sciences.

Evaluation of Workplace Exposures to Volatile Chemicals During COVID-19 Building Disinfection Activities with Proton Transfer Reaction Mass Spectrometry.

We conducted an experimental case study to demonstrate the application of proton transfer reaction time-of-flight mass spectrometry (PTR-TOF-MS) for mobile breathing zone (BZ) monitoring of volatile chemical exposures in workplace environments during COVID-19 disinfection activities. The experiments were conducted in an architectural engineering laboratory-the Purdue zero Energy Design Guidance for Engineers (zEDGE) Tiny House, which served as a simulated workplace environment. Controlled disinfection activities were carried out on impermeable high-touch indoor surfaces, including the entry door, kitchen countertop, toilet bowl, bathroom sink, and shower. Worker inhalation exposure to volatile organic compounds (VOCs) was evaluated by attaching the PTR-TOF-MS sampling line to the researcher's BZ while the disinfection activity was carried out throughout the entire building. The results demonstrate that significant spatiotemporal variations in VOC concentrations can occur in the worker's BZ during multi-surface disinfection events. Application of high-resolution monitoring techniques, such as PTR-TOF-MS, are needed to advance characterization of worker exposures towards the development of appropriate mitigation strategies for volatile disinfectant chemicals.

Effectiveness of Consumer Promotions in Brick-and-Mortar Retail Stores

The purpose of this study is to identify the factors that aid in the measurement of the effectiveness of consumer promotions in brick-and-mortar retail. The already highly competitive landscape of retail is set to undergo a huge transformation post the COVID-19 outbreak, which will inadvertently lead to manufacturing cutting down costs wherever possible to maintain their margins and stay afloat. Advertising spends are bound to go down, and there is a need for a statistical model to measure the effectiveness of the capital spends by a firm towards consumer promotions. For the study, national level sales data of 4 sub-brands of a particular toilet soap brand (shower soap bars) was analyzed for a leading retail chain in India from January 2018 to February 2020. Regression analysis was used to do the data analysis. The study focused on price-off consumer promotions only for the designated period for four variants of a popular Indian soap brand. The discount percentage (including both promotion spend by the manufacturer as well as a retailer), the quantity of the particular unit sold on which the promotion was run during the period when the promotion was run, the effective price to consumer per gram, and profitability for the manufacturer in terms of the net contribution percentage were the factors which were found to show a strong correlation and formed the input variables for the regression equation. The regression analysis showed that all the factors, namely: overall discount percentage, quantity sold, the effective price per gram, and the net contribution (profitability), were statistically significant in determining the uplift in sales quantity due to the discount (the effectiveness of the price promotion). The equation provides retailers and manufacturers a model to measure the effectiveness of promotion spending for price promotions that are run every month at a national and state level by giving state-level values as inputs. It also helps arrive at a baseline sales quantity for a particular SKU if no price-off promotion is run.

Outreach and educational activities within the EEE cosmic ray network

The Extreme Energy Events (EEE) network consists in a sparse array of telescopes based on Multigap Resistive Plate Chambers, installed in high school buildings all over the Italian territory and at CERN. Besides the many research activities concerned with extensive air shower detection, long distance correlation studies and additional physics results obtained during the last decade, the EEE project is extensively employed for educational and outreach activities, constituting a unique opportunity to promote a fruitful and close collaboration between students, high-school teachers and researchers. The involvement is at all levels, from the construction of the chambers during short stages at CERN over the past 15 years, with the participation of several hundred high-school students and teachers, to the installation, monitoring and data taking with the telescopes by high-school teams, to masterclasses, physics lectures, data analysis sessions and joint discussions on the results and their interpretation. Recent developments of the EEE network led to the installation and use of additional detectors in the Arctic region and on board of sailing ships, to measure the cosmic ray flux over large latitude intervals. Periodical remote and in presence (pre-Covid era) meetings allowed in these years a large participation (several thousand people) from the high-school community to the EEE activities. National and local outreach initiatives in cosmic ray physics are also carried out around Italy by the EEE network, as a contribution to the dissemination of science among young people. © Copyright owned by the author(s) under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0)

Environmental contamination with highly resistant microorganisms after relocating to a new hospital building with 100% single-occupancy rooms: A prospective observational before-and-after study with a three-year follow-up.

INTRODUCTION: Inanimate surfaces within hospitals can be a source of transmission for highly resistant microorganisms (HRMO). While many hospitals are transitioning to single-occupancy rooms, the effect of single-occupancy rooms on environmental contamination is still unknown. We aimed to determine differences in environmental contamination with HRMO between an old hospital building with mainly multiple-occupancy rooms and a new hospital building with 100% single-occupancy rooms, and the environmental contamination in the new hospital building during three years after relocating. METHODS: Environmental samples were taken twice in the old hospital, and fifteen times over a three-year period in the new hospital. Replicate Organism Direct Agar Contact-plates (RODACs) were used to determine colony forming units (CFU). Cotton swabs premoistened with PBS were used to determine presence of methicillin-resistant Staphylococcus aureus, carbapenemase-producing Pseudomonas aeruginosa, highly resistant Enterobacterales, carbapenem-resistant Acinetobacter baumannii, and vancomycin-resistant Enterococcus faecium. All identified isolates were subjected to whole genome sequencing (WGS) using Illumina technology. RESULTS: In total, 4993 hospital sites were sampled, 724 in the old and 4269 in the new hospital. CFU counts fluctuated during the follow-up period in the new hospital building, with lower CFU counts observed two- and three years after relocating, which was during the COVID-19 pandemic. The CFU counts in the new building were equal to or surpassed the CFU counts in the old hospital building. In the old hospital building, 24 (3.3%) sample sites were positive for 49 HRMO isolates, compared to five (0.1%) sample sites for seven HRMO isolates in the new building (P < 0.001). In the old hospital, 89.8% of HRMO were identified from the sink plug. In the new hospital, 71.4% of HRMO were identified from the shower drain, and no HRMO were found in sinks. DISCUSSION: Our results indicate that relocating to a new hospital building with 100% single-occupancy rooms significantly decreases HRMO in the environment. Given that environmental contamination is an important source for healthcare associated infections, this finding should be taken into account when considering hospital designs for renovations or the construction of hospitals.

Things We Carry

My wife won’t let me carry anything into the home after work. She has me stand by the doorway, remove my clothing, and march straight to the bathroom for decontamination. She calls ours a “no-COVID” home. Whenever I bring up the fact that I had already caught COVID-19, fought it, and recovered from it, she pauses but does not oblige: ours is a “no-more-COVID” home. Once I’m in the shower, she picks up my things from the floor and carries them into the washer to be cleaned.

Impact of recommissioning flushing on Legionella pneumophila in a large building during the COVID-19 pandemic

COVID-19 shutdowns drastically increased the frequency and duration of water stagnation events in building plumbing systems, urging local authorities to issue guidance for the safe reopening of buildings mostly by recommissioning flushing. The objectives of this study were to document the dynamic changes of bacterial indicators [adenosine triphosphate (ATP), total and intact cell counts (TCC, ICC)] and the prevalence of Legionella pneumophila (Lp) in 20–21 showerheads in a large building before (16-week building closure) and then shortly (24 h) and monthly (4-week of distal water stagnation) after targeted recommissioning flushing. Following the 16-week shutdown, the highest mean of ATP (10 pg ATP/mL), TCC (1.7 × 106 count/mL) and ICC (5.2 × 105 count/mL) were measured in first draw samples. This bacterial amplification was mostly attributable to detachment from biofilm present in the distal devices and immediate connecting piping. Culture-based (mean of 4 487 MPN/L) and quantitative polymerase chain reaction (qPCR;mean of 63 822 gu/L) concentrations of Lp were respectively measured in 81 and 90% of first draw samples. Individual flushing of showerheads for 5 min resulted in 1.2–278-fold decreases in ATP, whereas TCC and ICC were lowered by 1.1- and 0.7-log on average. A one-log reduction in culture-based and qPCR Lp was only achieved in 63 and 29% of paired water samples, resulting in less than one-log reduction in mean risk values per exposure, thus demonstrating the limited effects of fixture-flushing for risk reduction. Clear short-term (24 h) benefits of device recommissioning flushing included lowered values of all bacterial indicators and Lp levels systematically under the common alert threshold of 1 000 MPN/L in first draws. However, after a period of 1 month without water use, these benefits were mostly lost with considerable rebounds of concentrations to similar levels than those measured following the 16-week building closure. Results highlight the temporary benefits of device recommissioning flushing for the control of Lp in shower systems, especially in buildings colonized by Legionella. Copyright © 2022 Grimard-Conea, Deshommes, Doré and Prévost.

Decolonization to Reduce After-Surgery Events of Surgical Site Infection

Health and nutrition emergency response among internally displaced persons at Ranch collective site, Chagni, Ethiopia: The role of emergency operation center, lessons from the field, and way forwards

Background In October 2020, about 79,041 ethnically Amhara/Agew people had been internally displaced (IDPs) from Metekel zone of Benishangul-Gumuz region and lived in Ranch collective site, Chagni town, Ethiopia. Onsite PHEOC met the health and nutrition needs of the IDPs as per international humanitarian response standards. Methods On January 11/2021, the Amhara Public Health Institute (APHI) established an onsite Public Health Emergency Operation Center (PHEOC) at Ranch collective site. Health workers and vehicles were deployed. A temporary clinic having nine outlets was built. Drugs and medical supplies were mobilized from different sources. The overall response period lasted about 8 months, from December 2020 up to June 2021. Results A total of 33,410 IDPs had received free essential health services. Mental health and psychosocial support services had been given for 1,803 cases. Specialized medical services such as trachomatous trichiasis (30), cataract surgery (8) and sputum samples for mycobacterium tuberculosis (120) have been done. Moreover, 454 women received antenatal care services and 137 women gave birth at health facilities. About 837 children have got measles supplementary dose and 1,280 adults took a COVID-19 vaccination. A total of 1,448 children under five, 454 pregnant and 402 lactating women had been screened on monthly basis. Of which, severe and moderate malnutrition rate was 46 (3.2%) and 75 (5.2%), respectively. A total of 194 trench latrine seats, 74 shower rooms and 50 hand washing facilities had been constructed. There were no human feces present nor solid wastes accumulated around the shelters or settlements. Both active and passive surveillance activities were carried out throughout the camp life. We also conducted regularly Risk Communication and Community Engagement activities on priority health issues. Conclusion We adequately met the health and nutrition needs of the IDPs as stated in the Sphere humanitarian handbook. We sought to have a strong Incident Management System and coordination platforms like PHEOC, a resilient health system, a training curriculum called Leading in Emergencies, and a multipurpose collective center with infrastructures, humanitarian response guidelines, training materials, and risk/vulnerability-based preparedness plan.

Gender-Neutral Toilets: A Qualitative Exploration of Inclusive School Environments for Sexuality and Gender Diverse Youth in Western Australia.

School toilets have been identified by sexuality and gender diverse (SGD) students as the least safe spaces in educational institutions. They are sites of verbal, physical and sexual victimisation. Providing gender-neutral toilets in primary and secondary schools may reduce the bullying and victimisation of SGD students, particularly those who are transgender or gender-diverse. This study explored factors influencing the inclusion of gender-neutral toilets in primary and secondary schools in Western Australia. Thirty-four interviews were conducted from May to December 2020 with policy makers or practitioners (n = 22) and school staff (n = 12) in Perth, Western Australia. Interviews were conducted online and face-to-face using semi-structured interview guides. A thematic analysis of the cross-sectional qualitative data was undertaken. School staff, policy makers, and practitioners identified school toilets as sites of bullying and victimisation of SGD youth and expressed support for gender-neutral toilets as an anti-bullying strategy. Perceived barriers to introducing gender-neutral toilets in schools included financial and spatial costs, building code compliance constraints, resistance from parents and students, privacy and confidentiality concerns, and cultural appropriateness. Including gender-neutral toilets in schools may reduce school-based bullying and victimisation, and improve the mental and physical health of SGD youth.

Improving Toilet Usability and Cleanliness in Public Schools in the Philippines Using a Packaged Operation and Maintenance Intervention.

This study evaluated the impact of packaged interventions for operation and maintenance (O&M) on the usability and cleanliness of toilets in public schools in the Philippines. In this cluster-randomized controlled trial, the divisions of Roxas City and Passi City were randomly assigned to the intervention or control group. Schools in Roxas City (n = 14) implemented the packaged O&M interventions; schools in Passi City (n = 16) formed the control group. Outcome variables were toilet usability-defined as accessible, functional and private-and toilet cleanliness, measured using the Sanitation Assessment Tool (SAT) and the Cleaner Toilets, Brighter Future (CTBF) instruments at baseline and at four months follow-up through direct observation of school toilets. SAT results showed that intervention schools had a 32.0% (4.6%; 59.3%) higher percentage of usable toilets than control schools at follow-up after full adjustment (p = 0.024). CTBF results found a similar result, although this was not statistically significant (p = 0.119). The percentage of toilets that were fully clean was 27.1% (3.7%; 50.6%) higher in intervention schools than in control schools after adjustment (p = 0.025). SAT results also showed an improvement in cleanliness of toilets in intervention schools compared to those in controls, but this did not remain significant after adjustment. The findings indicate that the additional implementation of O&M interventions can further stimulate progress towards reaching Water, Sanitation and Hygiene service levels aligned with the Sustainable Development Goals.

WASH to control COVID-19: A rapid review.

Background: Preventive public health has been suggested as methods for reducing the transmission of COVID-19. Safety and efficacy of one such public health measure: WASH intervention for COVID-19 has not been systematically reviewed. We undertook a rapid review to assess the effect of WASH intervention in reducing the incidence of COVID-19. Methods: We conducted searches in PubMed, MEDLINE, and EMBASE. We undertook screening of studies in two stages and extracted data and assessed the quality of evidence for the primary outcome using GRADE recommendations. Main results: We included a total of 13 studies with three studies on COVID-19 and 10 on SARS. The study found that hand washing, sterilization of hands, gargling, cleaning/shower after attending patients of COVID-19, or SARS was protective. Evidence also found that frequent washes can prevent SARS transmission among HCWs. However; one study reported that due to enhanced infection-prevention measures, front-line HCWs are more prone to hand-skin damage. The certainty of the evidence for our primary outcome as per GRADE was very low. We did not find any studies that assessed the effect of WASH on hospitalizations, and mortality due to COVID-19. Also; we did not find any study that compared WASH interventions with any other public health measures. Conclusions: Current evidence of WASH interventions for COVID-19 is limited as it is largely based on indirect evidence from SARS. Findings from the included studies consistently show that WASH is important in reducing the number of cases during a pandemic. Timely implementation of WASH along with other public health interventions can be vital to ensure the desired success. Further good-quality studies providing direct evidence of the efficacy of WASH on COVID-19 are needed.

Are patients forgetting the basics?

According to a study published in the European Journal of Social Psychology, it takes 18 to 254 days for a person to form a new habit.1 The study concluded that, on average, it takes 66 days for a new behaviour to become automatic. This got me thinking. At the beginning of March 2020, my alarm clock would go off around 7am, cats would sit on me while I had a cup of tea catching up with news I'd missed overnight, teeth, shower, dressed and out of the door I went. It was a routine, and it was one that worked for me.