Cross-contamination and infection in the domestic environment and the role of chemical disinfectants

Cross-contamination in the kitchen: A model for quantitative microbiological risk assessment

A quantitative microbiological risk assessment model for the cross-contamination transmission route in the kitchen (KCC) is presented. Bacteria are transmitted from contaminated (chicken) meat to hands, kitchen utensils, and other surfaces, subsequently contaminating a salad. The model aims to estimate the fraction of bacteria on the meat that is ingested due to cross-contamination, determine the importance of the different transmission routes, and assess the effect of scenarios (interventions) on the fraction ingested. The cross-contamination routes defined, bacterial source-to-recipient transfer fractions as available and derived from literature, and important characteristics (e.g., washing in cold water vs. hot water with soap) shaped the KCC model. With this model, 32 scenarios of an eight-step preparation of a "meat and salad" meal in a domestic kitchen were stochastically simulated. The "cutting board-salad" route proved dominant and the salad plays a major role in the final exposure. A realistic scenario (washing hands, cutting board, and knife with cold water after cutting the meat) estimates that a mean fraction of 3.2E - 3 of the bacteria on the meat is ingested. In the case of "hand washing with hot water and soap" and "cutting board and knife replacement," the mean fraction ingested is 3.6E - 6. For a subsequent meal, where the contaminated sources were kitchen fomites, the estimated mean fraction is 4.3E - 4. In case of hamburger, part of the bacteria is unavailable for cross-contamination, resulting in a mean fraction ingested of about 5.4E - 5. The role of the dishcloth in cross-contamination transmission proved to be minor.

International ring trial to validate a new method for testing the antimicrobial efficacy of domestic laundry products

Due to greater environmental awareness, domestic laundry habits are changing, and antimicrobial control by chemical methods has become an essential factor to compensate for the use of lower temperatures during washing machine cycles. Disinfectants added to laundry detergents are a preventive strategy to reduce the transmission of bacteria, fungi, and viruses in the home, correct aesthetic damage (e.g., spotting, discolouration, and staining), and control the microbial contamination that leads to malodour. In Europe, disinfectants are regulated by the EU Biocidal Products Regulation (No. 528/2012), which stipulates that antimicrobial efficacy must be evaluated according to standardized methods. Current European standards for laundry sanitization only apply to clinical settings (EN 16616: 2015) and are restricted to the main wash cycle. Therefore, there is a gap in the EU standards regarding the testing of product efficacy in household laundering. With the aim of addressing this gap, an international ring trial was organized to evaluate the robustness of a new method (prEN 17658) designed to test the efficacy of antimicrobial laundry products in a domestic setting. The seven participating laboratories were equipped with 5 different laboratory-scale devices to simulate the washing process, and they evaluated 7 microbial parameters for 2 experimental conditions and 3 levels of active substance. The analysis of data according to ISO 5725–2 and ISO 13528 demonstrated that the method was robust. All reproducibility standard deviation values were between 0.00 and 1.40 and the relative standard deviation indicates satisfactory reproducibility. Values of logarithmic reduction ranged from less than 2 log₁₀ for tests with water to more than 5 log₁₀ when disinfectants were added. The evidence generated by the ring trial was presented in a proposal for a standardized method under CEN/TC 216, in which the SOP used in the ring trial is referred to as the prEN 17658 phase 2 step 2 test method covering chemothermal textile disinfection in domestic settings.

VasH Contributes to Virulence of Aeromonas hydrophila and Is Necessary to the T6SS-mediated Bactericidal Effect

Aeromonas hydrophila is a Gram-negative bacterium that is commonly distributed in aquatic surroundings and has been considered as a pathogen of fish, amphibians, reptiles, and mammals. In this study, a virulent strain A. hydrophila GD18, isolated from grass carp (Ctenopharyngodon idella), was characterized to belong to a new sequence type ST656. Whole-genome sequencing and phylogenetic analysis showed that GD18 was closer to environmental isolates, however distantly away from the epidemic ST251 clonal group. The type VI secretion system (T6SS) was known to target both eukaryotic and prokaryotic cells by delivering various effector proteins in diverse niches by Gram-negative bacteria. Genome-wide searching and hemolysin co-regulated protein (Hcp) expression test showed that GD18 possessed a functional T6SS and is conditionally regulated. Further analysis revealed that VasH, a σ54-transcriptional activator, was strictly required for the functionality of T6SS in A. hydrophila GD18. Mutation of vasH gene by homologous recombination significantly abolished the bactericidal property. Then the virulence contribution of VasH was characterized in both in vitro and in vivo models. The results supported that VasH not only contributed to the bacterial cytotoxicity and resistance against host immune cleaning, but also was required for virulence and systemic dissemination of A. hydrophila GD18. Taken together, these findings provide a perspective for understanding the VasH-mediated regulation mechanism and T6SS-mediated virulence and bactericidal effect of A. hydrophila.

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.

Determining the Potential Food Safety Risks Associated with Dropped Produce on Floor Surfaces in Grocery Stores

ABSTRACT

Grocery stores handle fresh produce in large quantities daily. According to the Food and Drug Administration Food Code, food is to be stored at least 15 cm above the floor, and all foods shall be protected from any source of contamination or otherwise discarded. It is reported in the literature that dropped produce could be a potential source of microbial contamination. Both consumers and employees often drop produce on the floor and then place it back into a display case or bin, which could potentially serve as a source of contamination. This study aims to determine the bacterial transfer rate on different produce types when dropped for various contact times onto floor surfaces contaminated with Listeria monocytogenes. Apples, peaches, and romaine lettuce were dropped separately onto carpet and tile surfaces from a distance of 1 m and held for 5 s, 1 min, 10 min, 1 h, and 4 h. Results showed that transfer from all produce types occurred from both the carpet (10.56%) and tile (3.65%) surfaces. Still, percent transfer was not statistically significant among different times used in this study (P > 0.05). Dropped romaine lettuce had the most transfer (28.97%) from both the surfaces combined, followed by apples (8.80%) and peaches (7.32%) with minimal transfer. Even with a low transfer level, grocery stores should include signage to alert consumers not to pick up dropped produce and should train their employees accordingly.

HIGHLIGHTS

The Household Resistome: Frequency of β-Lactamases, Class 1 Integrons, and Antibiotic-Resistant Bacteria in the Domestic Environment and Their Reduction during Automated Dishwashing and Laundering

Households provide a habitat for bacteria originating from humans, animals, foods, contaminated clothes, or other sources. Thus, bacteria carrying antibiotic resistance genes (ARGs) may be introduced via household members, animals, or the water supply from external habitats into private households and vice versa. Since data on antibiotic resistance (ABR) in the domestic environment are limited, this study aimed to determine the abundance of β-lactamase, mobile colistin resistance, and class 1 integron genes and the correlation of their presence and to characterize phenotypically resistant strains in 54 private households in Germany. Additionally, the persistence of antibiotic-resistant bacteria during automated dishwashing compared to that during laundering was assessed. Shower drains, washing machines, and dishwashers were sampled and analyzed using quantitative real-time PCR. Resistant strains were isolated, followed by identification and antibiotic susceptibility testing using a Vitek 2 system. The results showed a significantly higher relative ARG abundance of 0.2367 ARG copies/16S rRNA gene copies in shower drains than in dishwashers (0.1329 ARG copies/16S rRNA gene copies) and washing machines (0.0006 ARG copies/16S rRNA gene copies). bla _CMY-2, bla _ACT/MIR, and bla _OXA-48 were the most prevalent ARG, and intI1 occurred in 96.3% of the households, while no mcr genes were detected. Several β-lactamase genes co-occurred, and the resistance of bacterial isolates correlated positively with genotypic resistance, with carbapenemase genes dominating across isolates. Antibiotic-resistant bacteria were significantly reduced during automated dishwashing as well as laundering tests and did not differ from susceptible strains. Overall, the domestic environment may represent a potential reservoir of β-lactamase genes and β-lactam-resistant bacteria, with shower drains being the dominant source of ABR.IMPORTANCE The abundance of antibiotic-resistant bacteria and ARGs is steadily increasing and has been comprehensively analyzed in natural environments, animals, foods, and wastewater treatment plants. In this respect, β-lactams and colistin are of particular interest due to the emergence of multidrug-resistant Gram-negative bacteria. Despite the connection of private households to these environments, only a few studies have focused on the domestic environment so far. Therefore, the present study further investigated the occurrence of ARGs and antibiotic-resistant bacteria in shower drains, washing machines, and dishwashers. The analysis of the domestic environment as a potential reservoir of resistant bacteria is crucial to determine whether households contribute to the spread of ABR or may be a habitat where resistant bacteria from the natural environment, humans, food, or water are selected due to the use of detergents, antimicrobial products, and antibiotics. Furthermore, ABR could limit the options for the treatment of infections arising in the domestic environment.

Modelling and magnitude estimation of cross-contamination in the kitchen for quantitative microbiological risk assessment (QMRA)

In the kitchen of the consumer, two main transmission routes are relevant for quantitative microbiological risk assessment (QMRA): the cross-contamination route, where a pathogen on a food product may evade heating by transmission via hands, kitchen utensils and other surfaces, e.g. to non-contaminated products to be consumed raw; and the heating route, where pathogens remain on the food product and are for the most part inactivated through heating. This project was undertaken to model and estimate the magnitude of cross-contamination in the domestic environment. Scientific information from the relevant literature was collected and analyzed, to define the cross-contamination routes, to describe the variability sources and to extract and harmonise the transfer fractions to be included as model parameters. The model was used to estimate the relative impact of the cross-contamination routes for different scenarios. In addition, the effectiveness of several interventions in reducing the risk of food-borne diseases due to cross-contamination was investigated. The outputs of the model showed that the cutting board route presents a higher impact compared to other routes and replacement of the kitchen utensils is more effective than other interventions investigated; the transfer to other surfaces and objects, which can house bacteria in the environment, is also described. Laboratory cross-contamination trials have been performed to estimate bacterial transfer via cutting, from the external surface of the meat to the cutting surfaces and to the knife. The results, obtained from the laboratory trials, show magnitudes of and differences in the bacterial transfer fraction to the knife and the cutting surface in relation to which side of the meat is contaminated. Despite the complexity of factors which influence bacterial transfer, the combination of laboratory work with mathematical modelling enhanced scientific understanding and appreciation of the uncertainty of the estimates. QMRA methodology results in magnitude estimation of cross-contamination in the kitchen and evaluation of intervention strategies.

Survival and transfer efficacy of mixed strain Salmonella enterica ser. Typhimurium from beef burgers to abiotic surfaces and determination of individual strain contribution

The aim of the study was to evaluate the survival and transfer efficacy of 3 Salmonella Typhimurium strains from beef burgers to abiotic surfaces and determine the individual strain distribution. S. Typhimurium population on beef burgers during incubation remained constant at initial levels of contamination approximately 3 and 5 log CFU/g. Additionally, the survival of pathogens on soiled HDPE surfaces was significant during incubation at both initial inocula, while ca 1.5 log CFU/cm² reduction was observed at 168h. The log transformed transfer rate (log₁₀Tr) was -1.86±0.23 and -1.75±0.40 for high and low inoculum. The level of initial contamination did not have any statistical important impact on bacterial transfer (P>0.05). In addition, the results regarding the strain contribution revealed rather random individual proportion of each strain, recovered from HDPE, SS surfaces and beef burgers. However, the dominance of each strain was strongly dependent on surface at low inoculum and time in case of high inoculum. This observed strain variability during survival and transfer of S. Typhimurium might be of great importance in order to understand and consequently limit the possibility of cross contamination during food processing in a common household.

Delta Hemolysin and Phenol-Soluble Modulins, but Not Alpha Hemolysin or Panton-Valentine Leukocidin, Induce Mast Cell Activation

Mast cells are located at host interfaces, such as the skin, and contribute to the first-line defense against pathogens by releasing soluble mediators, including those that induce itching and scratching behavior. Here, we show that delta-hemolysin (Hld) and phenol soluble modulins (PSMs) PSMα1 and PSMα3, but not alpha-hemolysin (Hla) or Panton-Valentine leukocidin (PVL), induce dose-dependent tryptase, and lactate dehydrogenase (LDH) release by the HMC-1 human mast cell line. Using supernatants from isogenic strains, we verified that tryptase and LDH release was Hld- and PSMα-dependent. PSMα1 and Hld production was detected in 65 and 17% of human Staphylococcus aureus-infected skin abscess specimens, respectively, but they were produced in vitro by all clinical isolates. The results suggest that Hld and PSM-α1 produced in vivo during S. aureus skin infections induce the release of mast cell mediators responsible for itching and scratching behavior, which may enhance skin to skin transmission of S. aureus via the hands. As Hld and PSMs are upregulated by accessory gene regulator (agr), their association may contribute to the elective transmission of S. aureus strains with a functional agr system.

Effectiveness of UV-C light irradiation on disinfection of an eSOS(®) smart toilet evaluated in a temporary settlement in the Philippines

Ultraviolet germicidal (short wavelength UV-C) light was studied as surface disinfectant in an Emergency Sanitation Operation System(®) smart toilet to aid to the work of manual cleaning. The UV-C light was installed and regulated as a self-cleaning feature of the toilet, which automatically irradiate after each toilet use. Two experimental phases were conducted i.e. preparatory phase consists of tests under laboratory conditions and field testing phase. The laboratory UV test indicated that irradiation for 10 min with medium-low intensity of 0.15-0.4 W/m(2) could achieve 6.5 log removal of Escherichia coli. Field testing of the toilet under real usage found that UV-C irradiation was capable to inactivate total coliform at toilet surfaces within 167-cm distance from the UV-C lamp (UV-C dose between 1.88 and 2.74 mW). UV-C irradiation is most effective with the support of effective manual cleaning. Application of UV-C for surface disinfection in emergency toilets could potentially reduce public health risks.

Preventing infection in the home

F undamental to controlling infection transmission in the home is the need to recognise it as an environment where all human activities occur, including food hygiene, hand hygiene and hygiene related to care of vulnerable groups. In recent years the concept of a risk assessment/risk reduction approach to hygiene has successfully controlled microbial risks in food and other manufacturing environments.

To deliver hygiene policy with real health benefits it is now accepted that a risk-based approach must also be developed for the home. The first step, hazard characterisation, involves identifying sites and surfaces where pathogens most frequently occur, and whether they are likely to be present in numbers that represent an infectious dose. A risk assessment is then made by considering this information together with an assessment of the probability of human exposure to the hazard. Risk reduction is achieved by application of a suitable hygiene procedure at the appropriate time.

Relationships among hygiene indicators in take-away foodservice establishments and the impact of climatic conditions

AIMS

This paper examined the relationships among hygiene indicators in take-away foodservice establishments and the impact of climatic conditions.

METHODS AND RESULTS

A total of 7545 samples were collected encompassing 2050 from food handlers' (HF) hands, 3991 from stainless steel food contact surfaces (FCS) and 1504 samples from plastic FCS. The study covered a period of 43 months. Hygiene-indicator bacteria (total plate count, Enterobacteriaceae Staphylococcus) were determined from the samples collected from 559 different take-away establishments. Climatic conditions were evaluated in respect to the outside temperature, pressure, humidity and precipitation. Logistic regression confirmed that the presence of precipitation was associated with an increased likelihood of exhibiting both Enterobacteriaceae and Staphylococcus on HF' hands as well as exhibiting Enterobacteriaceae on both types of FCS. Numerable Enterobacteriaceae and Staphylococcus levels on HF' hands were detected when higher outside temperatures and higher precipitations occurred. Higher outside temperatures were observed when Enterobacteriaceae were detected on both plastics (P < 0·05) and stainless steel (P > 0·05). Higher precipitation was observed when Enterobacteriaceae was detected on stainless steel while in contrast, this indicator was detected on plastics in periods with lower precipitation.

CONCLUSIONS

This research confirms relationships between hygiene indicators in take-aways and climatic conditions, mostly temperature and precipitation.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study provides another perspective into the possible nature of cross-contamination and foodborne outbreaks originating in foodservice establishments and brings to attention the necessity of analysing various climatic conditions.

Transfer and Decontamination of S. aureus in Transmission Routes Regarding Hands and Contact Surfaces

Hand hygiene, cleaning and disinfection are pre-requirements for hygiene management in hospital settings and the food industry. In order to facilitate risk management, different contamination scenarios and interventions need to be evaluated. In the present study data on transfer rates and reductions of Staphylococcus aureus were provided in an experimental set-up using artificial skin. Using this methodology, test persons were not exposed with pathogenic bacteria. An exposure assessment model was developed and applied to evaluate different contamination routes and hygiene interventions. The transfer rates of S. aureus from inoculated VITRO-SKIN^® to fomites were calculated from blotting series. The VITRO-SKIN^® was more prone to spread bacteria than fomites. When different surfaces were cleaned, the reduction of S. aureus varied between <1 and 7 log CFU. It could not be concluded that a certain coupon material, cleaning agent, cleaning wipe, soiling or humidity consistently resulted in a high or low reduction of S. aureus. The reduction of S. aureus and E. coli during hand washing was evaluated on artificial skin, VITRO-SKIN^®. The reduction of E. coli on VITRO-SKIN^® was similar to the log reduction obtained when washing human hands. The S. aureus count on a human hand was both calculated in different scenarios describing different contamination routes starting from a contaminated hand using the exposure assessment model, and measured on an experimental setup using VITRO-SKIN^® for validation. A linear relationship was obtained between the analysed level of S. aureus and the calculated level. However, the calculated levels of S. aureus on the VITRO-SKIN^® in the scenarios were 1–1.5 log lower than the analysed level. One of the scenarios was used to study the effect of interventions like hand washing and cleaning of surfaces.

Qualitative and Quantitative Analysis of Microbial Communities in Household Dishwashers in Germany

The proper cleaning of used dishes provides an essential means to maintain a sufficient hygiene level on food contact surfaces. However, little is known on the microbiological quality of domestic dishwashers themselves, especially in relation to consumer habits. This study investigated dishwashers in German households to analyse the number and composition of microbial colonisers and their putative impact on dishwashing hygiene. Although the microbiological status of dishwashers appeared to depend on multiple factors, data suggest that a trend towards lower temperatures might effect in a decreased hygiene.

An observational study of frequency of provider hand contacts in child care facilities in North Carolina and South Carolina

BACKGROUND

Children enrolled in child care are 2.3-3.5 times more likely to experience acute gastrointestinal illness than children cared for in their own homes. The purpose of this study was to determine the frequency surfaces were touched by child care providers to identify surfaces that should be cleaned and sanitized.

METHODS

Observation data from a convenience sample of 37 child care facilities in North Carolina and South Carolina were analyzed. Trained data collectors used iPods (Apple, Cupertino, CA) to record hand touch events of 1 child care provider for 45 minutes in up to 2 classrooms in each facility.

RESULTS

Across the 37 facilities, 10,134 hand contacts were observed in 51 classrooms. Most (4,536) were contacts with porous surfaces, with an average of 88.9 events per classroom observation. The most frequently touched porous surface was children's clothing. The most frequently touched nonporous surface was food contact surfaces (18.6 contacts/observation). Surfaces commonly identified as high-touch surfaces (ie, light switches, handrails, doorknobs) were touched the least.

CONCLUSION

General cleaning and sanitizing guidelines should include detailed procedures for cleaning and sanitizing high-touch surfaces (ie, clothes, furniture, soft toys). Guidelines are available for nonporous surfaces but not for porous surfaces (eg, clothing, carpeting). Additional research is needed to inform the development of evidence-based practices to effectively treat porous surfaces.

Evaluation of two recommended disinfection methods for cleaning cloths used in food services of southern Brazil

In the State of Rio Grande do Sul (RS), Southern Brazil, a good manufacturing practices regulation was published recommending two disinfection methods for cleaning cloths used in food services. The aim of the present study was to evaluate the efficacy of those methods. Cleaning cloths were sampled without prior notice at food services, on common working days. For the analyses, the cloths were divided in two sub-samples, being one of them microbiologically analyzed. The second sub-sample was further divided in two pieces and submitted to hand washing for two minutes. After that, one piece was boiled in water for 15 min and the other one was soaked in a 200 ppm sodium hypochlorite solution for 15 min. Both pieces of cloth were submitted to microbiological analyses. Cleaning cloths presented total aerobic mean counts of 6.9 ± 6.7 log/cm(2). All cleaning cloths presented coliform contamination, and 40% demonstrated mean counts of 6.2 ± 5.6 log/cm(2). Presumptive S. aureus mean counts of 5.5 ± 4.9 log/cm(2) were found. No statistic correlation was observed among the number of meals served daily in the food services and the microbiological contamination levels. After washing and disinfection, microbiological counts were significantly (p < 0.05) reduced by both methods, achieving an approximately 5 log reduction. The reductions achieved by the sodium hypochlorite soaking method and the boiling method were not significantly different. Thus, it was possible to conclude that both recommended methods were suitable to disinfect cleaning cloths used in food services.

Using lytic bacteriophages to eliminate or significantly reduce contamination of food by foodborne bacterial pathogens

Bacteriophages (also called 'phages') are viruses that kill bacteria. They are arguably the oldest (3 billion years old, by some estimates) and most ubiquitous (total number estimated to be 10(30) -10(32) ) known organisms on Earth. Phages play a key role in maintaining microbial balance in every ecosystem where bacteria exist, and they are part of the normal microflora of all fresh, unprocessed foods. Interest in various practical applications of bacteriophages has been gaining momentum recently, with perhaps the most attention focused on using them to improve food safety. That approach, called 'phage biocontrol', typically includes three main types of applications: (i) using phages to treat domesticated livestock in order to reduce their intestinal colonization with, and shedding of, specific bacterial pathogens; (ii) treatments for decontaminating inanimate surfaces in food-processing facilities and other food establishments, so that foods processed on those surfaces are not cross-contaminated with the targeted pathogens; and (iii) post-harvest treatments involving direct applications of phages onto the harvested foods. This mini-review primarily focuses on the last type of intervention, which has been gaining the most momentum recently. Indeed, the results of recent studies dealing with improving food safety, and several recent regulatory approvals of various commercial phage preparations developed for post-harvest food safety applications, strongly support the idea that lytic phages may provide a safe, environmentally-friendly, and effective approach for significantly reducing contamination of various foods with foodborne bacterial pathogens. However, some important technical and nontechnical problems may need to be addressed before phage biocontrol protocols can become an integral part of routine food safety intervention strategies implemented by food industries in the USA.

Fecal indicator bacteria contamination of fomites and household demand for surface disinfection products: a case study from Peru

Surface-mediated disease transmission is understudied in developing countries, particularly in light of the evidence that surface concentrations of fecal bacteria typically exceed concentrations in developed countries by 10- to 100-fold. In this study, we examined fecal indicator bacterial contamination of dinner plates at 21 households in four peri-urban communities in the Peruvian Amazon. We also used surveys to estimate household use of and demand for surface disinfectants at 280 households. Despite detecting total coliform, enterococci, and Escherichia coli on 86%, 43%, and 24% of plates sampled, respectively, less than one-third of households were regularly using bleach to disinfect surfaces. Among non-users of bleach, only 3.2% of respondents reported a new demand for bleach, defined as a high likelihood of using bleach within the next year. This study highlights the potential for marketing approaches to increase use of and demand for surface disinfectants to improve domestic hygiene.

Lifting the lid on toilet plume aerosol: a literature review with suggestions for future research

Background

The potential risks associated with “toilet plume” aerosols produced by flush toilets is a subject of continuing study. This review examines the evidence regarding toilet plume bioaerosol generation and infectious disease transmission.

Methods

The peer-reviewed scientific literature was searched to identify articles related to aerosol production during toilet flushing, as well as epidemiologic studies examining the potential role of toilets in infectious disease outbreaks.

Results

The studies demonstrate that potentially infectious aerosols may be produced in substantial quantities during flushing. Aerosolization can continue through multiple flushes to expose subsequent toilet users. Some of the aerosols desiccate to become droplet nuclei and remain adrift in the air currents. However, no studies have yet clearly demonstrated or refuted toilet plume-related disease transmission, and the significance of the risk remains largely uncharacterized.

Conclusion

Research suggests that toilet plume could play a contributory role in the transmission of infectious diseases. Additional research in multiple areas is warranted to assess the risks posed by toilet plume, especially within health care facilities.

Sanitizing alternatives for Escherichia coli and Salmonella typhimurium on bell peppers at household kitchens

Fresh fruits and vegetables are known to play an important role as carriers of disease-causing organisms in household kitchens. The aims of this study were to assess and compare the effectiveness of sodium hypochlorite, organic acid-based and silver-based products to reduce Escherichia coli and Salmonella typhimurium inoculated on individual bell pepper pieces. Inoculated bell pepper pieces (n = 5) were submerged in sodium hypochlorite, organic acid-based and silver-based product solutions, at the concentration specified in the product label for sanitization of fruits and vegetables. Sodium hypochlorite reduced E. coli and Salmonella typhimurium by 3.13 Log10/25 cm(2) and 2.73 Log10/25 cm(2), respectively. Organic-based and silver-based products reduced E. coli and S. typhimurium by 2.23 Log10/25 cm(2), 1.74 Log10/25 cm(2) and 2.10 Log10/25 cm(2), 1.92 Log10/25 cm(2), respectively. The results showed that greater attention is needed in selecting sanitizing products to kill or remove human pathogens from fresh produce to minimize risk of foodborne infections.

Sonochemical coating of cotton and polyester fabrics with "antibacterial" BSA and casein spheres

A novel antibacterial coating for cotton and polyester fabrics has been developed by using drug-loaded proteinaceous microspheres made of bovine serum albumin and casein proteins. The microbubbles were created and anchored onto the fabrics (see figure) in a one-step reaction that lasts 3 min. The sonochemically produced "antibacterial fabrics" have been characterized. The efficiency of the sonochemical process in converting the native proteins into microspheres, encapsulating the drug, and coating the fabric has also been studied.

Microwave oven heating for inactivation of Listeria monocytogenes on frankfurters before consumption

Microwave oven heating was evaluated for inactivation of Listeria monocytogenes on inoculated and stored frankfurters. Frankfurters formulated without/with 1.5% potassium lactate and 0.1% sodium diacetate were inoculated with L. monocytogenes (1.9 +/- 0.2 log CFU/cm(2)), vacuum-packaged, and stored (4 degrees C) to simulate conditions prior to purchase by consumers. At storage days 18, 36, and 54, packages were opened and placed at 7 degrees C, simulating aerobic storage in a household refrigerator. At 0, 3, and 7 d of aerobic storage, 2 frankfurters were placed in a bowl with water (250 mL) and treated in a household microwave oven at high (1100 W) power for 30, 45, 60, or 75 s, or medium (550 W) power for 60 or 75 s. Frankfurters and the heating water were analyzed for total microbial counts and L. monocytogenes populations. Exposure to high power for 75 s reduced pathogen levels (0.7 +/- 0.0 to 1.0 +/- 0.1 log CFU/cm(2)) to below the detection limit (<-0.4 log CFU/cm(2)) on frankfurters with lactate/diacetate, even after 54 d of vacuum-packaged storage followed by 7 d of aerobic storage. For frankfurters without lactate/diacetate, high power for 75 s caused reductions between > 1.5 and 5.9 log CFU/cm(2) from control levels of 1.5 +/- 0.1 to 7.2 +/- 0.5 log CFU/cm(2). Depending on treatment and storage time, the water used to reheat the frankfurters had viable L. monocytogenes counts of <-2.4 to 5.5 +/- 0.5 log CFU/mL. The results indicated that frankfurters should be reheated in a microwave oven at high power for 75 s to inactivate up to 3.7 log CFU/cm(2) of L. monocytogenes contamination.

Evaluation of the hygiene of ready-to-eat food preparation areas and practices in mobile food vendors in the UK

This study was undertaken to assess the cleanliness of food preparation areas, cleaning methods used, and the microbiological quality of water used by 1258 mobile food vendors in the UK. Samples collected included potable water (1102), cleaning cloths (801) and environmental swabs from food preparation surfaces (2704). Cleaning cloths were more heavily contaminated with Aerobic Colony Counts, Enterobacteriaceae, Escherichia coli, and Staphylococcus aureus compared to surfaces sampled. Surfaces that were visually dirty, wet, and chopping boards that were plastic or damaged also had high levels of these bacteria. Fifty-four percent of potable water samples were of poor microbiological quality; i.e. contained coliforms, E. coli and/or enterococci. A documented food safety management system was only evident in 40.1% of vendors and cleaning schedules were only used by 43.6%. Deficiencies in the correct use of cleaning materials, such as dilution factors and the minimum contact time for disinfectants, were identified.

Inactivation of Listeria monocytogenes, Escherichia coli O157:H7, and Salmonella typhimurium with compounds available in households

Solutions of selected household products were tested for their effectiveness against Listeria monocytogenes, Escherichia coli O157:H7, and Salmonella Typhimurium. Hydrogen peroxide (1.5 and 3%), vinegar (2.5 and 5% acetic acid), baking soda (11, 33, and 50% sodium bicarbonate), household bleach (0.0314, 0.0933, and 0.670% sodium hypochlorite), 5% acetic acid (prepared from glacial acetic acid), and 5% citric acid solutions were tested against the three pathogens individually (five-strain composites of each, 10(8) CFU/ml) by using a modified AOAC International suspension test at initial temperatures of 25 and 55degrees C for 1 and 10 min. All bleach solutions (pH 8.36 to 10.14) produced a >5-log reduction of all pathogens tested after 1 min at 25 degrees C, whereas all baking soda solutions (pH 7.32 to 7.55) were ineffective (<1-log reduction) even after 10 min at an initial temperature of 55 degrees C. After 1 min at 25 degrees C, 3% hydrogen peroxide (pH 2.75) achieved a >5-log reduction of both Salmonella Typhimurium and E. coli O157:H7, whereas undiluted vinegar (pH 2.58) had a similar effect only against Salmonella Typhimurium. Compared with 1 min at 25 degrees C, greater reductions of L. monocytogenes (P < 0.05) were obtained with all organic acid and hydrogen peroxide treatments after 10 min at an initial temperature of 55 degrees C. The efficacies of household compounds against all tested pathogens decreased in the following order: 0.0314% sodium hypochlorite > 3% hydrogen peroxide > undiluted vinegar and 5% acetic acid > 5% citric acid > baking soda (50% sodium bicarbonate). The sensitivity of the tested pathogens to all tested household compounds followed the sequence of Salmonella Typhimurium > E. coli O157: H7 > L. monocytogenes.

Survival of Salmonella on refrigerated chicken carcasses and subsequent transfer to cutting board

OBJECTIVE

To determine the effect of refrigeration time and temperature on Salmonella cell numbers on inoculated chicken carcasses and their transfer to a plastic cutting board.

METHODS AND RESULTS

The survival of Salmonella on chicken skin and the transfer to a plastic cutting board when exposed to different refrigeration temperatures (2, 6 or 8 degrees C) for 9 days were the two main issues on which this work focused. Two scenarios were carried out to ascertain these effects: carcasses treated with a decontaminating acetic acid solution and untreated carcasses. All of the contaminated carcasses remained contaminated after 9 days of refrigeration. However, on untreated samples, while Salmonella numbers increased almost 1.5 log at 8 degrees C, the pathogen numbers decreased about 1 log at 2 and 6 degrees C. On acid-treated samples, cell numbers slightly decreased at all of the temperatures studied. Temperature did not affect salmonellae transfer to the cutting board, but time did. Acid decontamination increased cell numbers transferred to the cutting board compared with untreated samples.

CONCLUSION

Proper refrigeration at low temperatures did not allow Salmonella numbers to rise, regardless of which carcasses had been, or had not been, acid treated. Despite the fact that the rate of transfer was not affected by temperature, the acid treatment detached Salmonella cells from the chicken skin and, therefore, the probability of greater cross-contamination should be studied further.

SIGNIFICANCE AND IMPACT OF THE STUDY

The results of this study may provide better information about the refrigeration conditions for fresh chicken storage and also determine if these, along with acetic acid decontamination of broiler chicken, would affect the pathogen transfer to a cutting board.

Recovery and transfer of Salmonella typhimurium from four different domestic food contact surfaces

Domestic food contact surfaces can play an important role in the transmission of foodborne disease, yet debate continues as to which surface materials pose the greatest risk to consumer health in terms of cross-contamination during food preparation. Salmonella Typhimurium was inoculated onto stainless steel, Formica, polypropylene, or wooden surfaces (25 cm2) in the presence or absence of protein (tryptic soy broth supplemented with 5% horse serum) and held at room temperature. The pathogen was recovered from the test surfaces immediately after inoculation (T=0) and every hour for up to 6 h, by a conventional microbiological sampling technique and by direct transfer onto a model ready-to-eat food (cucumber slices). On all surfaces, pathogen numbers declined during the 6-h holding period, with the most rapid reductions occurring within the first hour. The presence of protein significantly increased (P < 0.05) the number of bacteria recovered from all surface types. However, regardless of application medium or holding time, the number of bacteria recovered from Formica (in all cases) and stainless steel (in most cases) was significantly higher than were the numbers on polypropylene or wood. Similarly, regardless of application medium or holding time, significantly higher bacterial numbers were transferred to the model food from Formica or stainless steel than from polypropylene or wooden surfaces. These differences were greater when the bacteria were applied in a protein-rich medium and the test surfaces held for 1 h or more. The results of this study emphasize that differences, both in recoverability and in the number of bacteria transferred to the model food rather than simply reflecting differences in pathogen survival, may also reflect differences in the ability of the test bacteria to remobilize from the different surface types. However, the results also demonstrate a fundamental problem when choosing food contact surfaces, i.e., that those characteristics that make a surface "easy to clean" may also render it more likely to release contaminating pathogens during common food preparation practices.

The effectiveness of existing and modified cleaning regimens in a Welsh hospital

Hospital cleaning currently has a high media profile. The effectiveness of an existing ward-cleaning regimen was assessed at selected sites over a 14 day period and shown to be highly variable. The cleaning regimen was subsequently modified in two stages, both changes involving a rinse stage and substituting cloths with disposable paper towels. One modification continued using the existing detergent; the other replaced detergent with a quaternary ammonium sanitiser. Both modifications yielded significantly lower and more consistent bacterial counts. Assessment of residual organic soil using adenosine triphosphate (ATP) detection demonstrated that failure rates (measurements exceeding benchmark clean value of 500 relative light units (RLU)) fell from 86-100% after existing cleaning methods, to 0-14% after modified cleaning. Maximum ATP readings fell from 163,870 to 2289 RLU. Incorporating a quaternary ammonium sanitiser into the cleaning regimen produced a further slight, but not significant, improvement in cleaning efficacy. These findings suggest that simple improvements can be made to existing cleaning regimens to increase their efficacy.

Effectiveness of domestic antibacterial products in decontaminating food contact surfaces

Four commercially available antibacterial products (two wipes and two sprays) were tested under laboratory conditions on a range of food contact surfaces (wood, glass, plastic, Microban incorporated plastic). The products' effectiveness at preventing cross-contamination of Escherichia coli and Staphylococcus aureus and the influence of surface type and drying time were assessed. Survival of the bacterial culture (approximately 400 colonies per 8 cm(2)) on the above preparation surfaces was determined using an in situ nitroblue tetrazolium (NBT) method. In the absence of any antibacterial products, both bacteria survived up to 120 min on all test surfaces with glass and plastic showing no reduction in bacterial number. The order of survival is: glass>plastic>>Microban incorporated plastic>wood (<8%). The length of drying time did not affect the survival of either bacterium on glass and plastic surfaces. On wood and Microban incorporated plastic, E. coli appeared to be more sensitive to drying time than S. aureus. Only plastic appeared to affect the effectiveness of the antibacterial products, where the reduction in bacterial number was significantly lower than the other test surfaces (p<0.05). The overall results suggest the antibacterial products are effective in disinfecting food preparing surfaces, provided products instructions are carefully followed.

Comparison of the adhesion ability of different Salmonella enteritidis serotypes to materials used in kitchens

Contamination of kitchen surfaces due to bacteria present in foodstuffs is one of the main causes of foodborne outbreaks. Salmonella infections are an important cause of foodborne disease, and Salmonella Enteritidis is the most common isolate in the past few years. In this study, the adhesion ability of four Salmonella Enteritidis isolates to different materials (polyethylene, polypropylene, and granite) used in kitchens was compared. The results indicated that the two plastic materials were generally less prone to colonization than was the granite. As surface properties of both bacteria and materials are a determinant in the adhesion process, surface hydrophobicity was determined through contact angle measurement, and the roughness of the materials was evaluated through the R(a) and R(z) values by a noncontact laser stylus tracing. The four Salmonella strains showed similar degrees of hydrophilicity, while the materials were hydrophobic, with granite having a very low degree of hydrophobicity (deltaG(lwl) = -4.7 mJ/m2). However, the different extents of adhesion could not be explained in terms of surface hydrophobicity and roughness of the materials tested. The main conclusion to be drawn is that Salmonella adhesion is strongly strain dependent, despite the similar degree of hydrophobicity displayed by all the strains assayed, and this can constitute a factor of virulence among the different serotypes.