Sally F. Bloomfield

A study of cross-contamination of food-borne pathogens in the domestic kitchen in the Republic of Ireland

To date, there have been no published information and empirical data available on the role played by the food preparer in the domestic kitchen in the Republic of Ireland. In this study, we have looked at the incidence of potential food pathogens and their cross-infection in the domestic kitchen during the preparation of a Sunday roast chicken lunch. Key contact sites in the domestic kitchen were sampled, including the chicken carcass before and after the preparation of a roast chicken meal. Twelve contact sites in twenty-five domestic kitchens were analysed and tested for aerobic plate count, Salmonella, Campylobacter, Escherichia coli and Staphylococcus aureus. Our findings identified the ability of food-borne disease microorganisms to become disseminated from infected foods, such as fresh chickens, to hand and food contact surfaces in the domestic kitchen, reiterating the need for consumer awareness and knowledge of effective hygiene procedures in the domestic kitchen.

An investigation of microbial contamination in the home

An investigation of the bacterial flora in over 200 homes is reported. The occurrence of potential pathogens and the levels of contamination at individual sites, particularly in the kitchen, toilet and bathroom is described and the implications for hygiene practices in the home discussed.

The effectiveness of hand hygiene procedures in reducing the risks of infections in home and community settings including handwashing and alcohol-based hand sanitizers

Infectious diseases (ID) circulating in the home and community remain a significant concern. Several demographic, environmental, and health care trends, as reviewed in this report, are combining to make it likely that the threat of ID will increase in coming years. Two factors are largely responsible for this trend: first, the constantly changing nature and range of pathogens to which we are exposed and, secondly, the demographic changes occurring in the community, which affect our resistance to infection. This report reviews the evidence base related to the impact of hand hygiene in reducing transmission of ID in the home and community. The report focuses on developed countries, most particularly North America and Europe. It also evaluates the use of alcohol-based hygiene procedures as an alternative to, or in conjunction with, handwashing. The report compiles data from intervention studies and considers it alongside risk modeling approaches (both qualitative and quantitative) based on microbiologic data. The main conclusions are as follows: (1) Hand hygiene is a key component of good hygiene practice in the home and community and can produce significant benefits in terms of reducing the incidence of infection, most particularly gastrointestinal infections but also respiratory tract and skin infections. (2) Decontamination of hands can be carried out either by handwashing with soap or by use of waterless hand sanitizers, which reduce contamination on hands by removal or by killing the organisms in situ. The health impact of hand hygiene within a given community can be increased by using products and procedures, either alone or in sequence, that maximize the log reduction of both bacteria and viruses on hands. (3) The impact of hand hygiene in reducing ID risks could be increased by convincing people to apply hand hygiene procedures correctly (eg, wash their hands correctly) and at the correct time. (4) To optimize health benefits, promotion of hand hygiene should be accompanied by hygiene education and should also involve promotion of other aspects of hygiene.

The effects of cleaning and disinfection in reducing Salmonella contamination in a laboratory model kitchen

Aims:  To establish a laboratory model to compare the effectiveness of detergent‐based disinfection procedures for reducing cross‐contamination risks during handling of contaminated chicken.

Time to abandon the hygiene hypothesis: new perspectives on allergic disease, the human microbiome, infectious disease prevention and the role of targeted hygiene

Aims: To review the burden of allergic and infectious diseases and the evidence for a link to microbial exposure, the human microbiome and immune system, and to assess whether we could develop lifestyles which reconnect us with exposures which could reduce the risk of allergic disease while also protecting against infectious disease. Methods: Using methodology based on the Delphi technique, six experts in infectious and allergic disease were surveyed to allow for elicitation of group judgement and consensus view on issues pertinent to the aim. Results: Key themes emerged where evidence shows that interaction with microbes that inhabit the natural environment and human microbiome plays an essential role in immune regulation. Changes in lifestyle and environmental exposure, rapid urbanisation, altered diet and antibiotic use have had profound effects on the human microbiome, leading to failure of immunotolerance and increased risk of allergic disease. Although evidence supports the concept of immune regulation driven by microbe–host interactions, the term ‘hygiene hypothesis’ is a misleading misnomer. There is no good evidence that hygiene, as the public understands, is responsible for the clinically relevant changes to microbial exposures. Conclusion: Evidence suggests a combination of strategies, including natural childbirth, breast feeding, increased social exposure through sport, other outdoor activities, less time spent indoors, diet and appropriate antibiotic use, may help restore the microbiome and perhaps reduce risks of allergic disease. Preventive efforts must focus on early life. The term ‘hygiene hypothesis’ must be abandoned. Promotion of a risk assessment approach (targeted hygiene) provides a framework for maximising protection against pathogen exposure while allowing spread of essential microbes between family members. To build on these findings, we must change public, public health and professional perceptions about the microbiome and about hygiene. We need to restore public understanding of hygiene as a means to prevent infectious disease.

Does microbicide use in consumer products promote antimicrobial resistance? A critical review and recommendations for a cohesive approach to risk assessment

The increasing use of microbicides in consumer products is raising concerns related to enhanced microbicide resistance in bacteria and potential cross resistance to antibiotics. The recently published documents on this topic from the European Commission have spawned much interest to better understand the true extent of the putative links for the benefit of the manufacturers, regulators, and consumers alike. This white paper is based on a 2-day workshop (SEAC-Unilever, Bedford, United Kingdom; June 2012) in the fields of microbicide usage and resistance. It identifies gaps in our knowledge and also makes specific recommendations for harmonization of key terms and refinement/standardization of methods for testing microbicide resistance to better assess the impact and possible links with cross resistance to antibiotics. It also calls for a better cohesion in research in this field. Such information is crucial to developing any risk assessment framework on microbicide use notably in consumer products. The article also identifies key research questions where there are inadequate data, which, if addressed, could promote improved knowledge and understanding to assess any related risks for consumer and environmental safety.

Methicillin-resistant Staphylococcus aureus, Clostridium difficile, and extended-spectrum β-lactamase–producing Escherichia coli in the community: Assessing the problem and controlling the spread

Although health care-associated methicillin resistant staphylococcus aureus and clostridium difficile strains are primarily a risk to hospital patients, people are increasingly concerned about their potential to circulate in the community and the home. They are thus looking for support in order to understand the extent of the risk, and guidance on how to deal with situations where preventing infection from these species becomes their responsibility. A further concern are the community-acquired MRSA and C. difficile strains, and other antibiotic resistant strains circulating in the community such as the Extended-spectrum β-lactamase (ESBL) Escherichia coli. In response to concerns about such organisms in the community, the International Scientific Forum on Home Hygiene has produced a report evaluating MRSA, C. difficile, and ESBL-producing E. coli from a community viewpoint. The report summarizes what is known about their prevalence in the community, their mode of transmission in the home, and the extent to which they represent a risk. It also includes “advice sheets” giving practical guidance on what to do when there is a risk of infection transmission in the home.

The effects of different hygiene procedures in reducing bacterial contamination in a model domestic kitchen

Few studies have compared the effectiveness of hygienic cleaning under simulated use conditions. This study compares commonly used and novel cleaning methods for food contact and hand contact surfaces in kitchens.

A risk assessment approach to use of antimicrobials in the home to prevent spread of infection

Home and everyday life hygiene is a key part of the public health strategy to reduce infectious disease, but an effective code of practice is required. This short review summarizes the basic scientific principles of a risk-based approach to home hygiene where hygiene procedures are applied at critical points at appropriate times. It suggests that, although detergent-based cleaning can be used to break the chain of infection, in some cases an antimicrobial agent is required.

[Prevention of infection through hygiene in the home and community. The need for a family-centred approach].

Over the past 20 years, infectious disease has moved back up the health agenda, prompting new emphasis on developing strategies for prevention and control, including reduction of spread of infection within the family at home and in their social and work lives outside the home. This paper reviews the various issues that have contributed to this trend. In response to the need for a science-based approach to home hygiene, the International Scientific Forum on Home Hygiene has developed an approach based on risk management which involves identifying the critical control points for preventing the spread of infectious diseases in the home. If we are to be successful in achieving behaviour change in the community, we need to develop a family-centred approach which ensures an understanding of infectious disease agents and their mechanism of spread.ZusammenfassungIn den letzten 20 Jahren ist das Thema der Infektionskrankheiten wieder in die Gesundheitsagenda zurückgekehrt und hat zur Entwicklung neuer Präventions- und Kontrollstrategien geführt, die im zunehmenden Maße darauf ausgerichtet sind, Infektionen innerhalb der Familie im häuslichen Umfeld sowie in ihrem sozialen und Arbeitsumfeld zu reduzieren. So wurde z. B. vom International Scientific Forum on Home Hygiene eine Vorgehensweise entwickelt, die die „kritischen Kontrollpunkte“ identifiziert und die hygienischen Maßnahmen festgelegt, die für die Prävention der Übertragung von Infektionskrankheiten im häuslichen Umfeld notwendig sind. Zur Verhaltensänderung im öffentlichen Umfeld muss eine familienzentrierte Strategie entwickelt werden, die das Wissen über Infektionserreger und deren Weiterverbreitung verbessert sowie ein risikobasiertes Hygienemanagement einbezieht.AbstractOver the past 20 years, infectious disease has moved back up the health agenda, prompting new emphasis on developing strategies for prevention and control, including reduction of spread of infection within the family at home and in their social and work lives outside the home. This paper reviews the various issues that have contributed to this trend. In response to the need for a science-based approach to home hygiene, the International Scientific Forum on Home Hygiene has developed an approach based on risk management which involves identifying the critical control points for preventing the spread of infectious diseases in the home. If we are to be successful in achieving behaviour change in the community, we need to develop a family-centred approach which ensures an understanding of infectious disease agents and their mechanism of spread.