Knowledge and Practices Regarding Safe Household Cleaning and Disinfection for COVID-19 Prevention - United States, May 2020

Evaluation of awareness and performance towards COVID-related disinfectant use: a comparative study between Jordan and United Arab Emirates

BACKGROUND

The World Health Organization recommended the use of chemical-based disinfectants as an effective prevention of the COVID-19 pandemic. However, calls for poisoning were reported in several medical centers. The widespread use of chemical-based disinfectants as a preventive measure during the COVID-19 pandemic has underscored potential gaps in community awareness and performance, posing health risks. This study evaluates and compares levels of awareness and performance regarding the safe use of disinfectants in Jordan and UAE.

METHODS

The study was conducted between October 2022 and June 2023 via an online questionnaire. Data of respondents from Jordan (n = 828) and UAE (n = 619) were analyzed using SPSS. ANOVA, Mann-Whitney, and Kruskal-Wallis tests evaluated significant differences in awareness and performance levels across different demographic groups in Jordan/UAE and between them. Spearman's correlation test examined the correlation between awareness and performance among respondents. Multinomial logistic regression analysis explored associations between various variables and awareness/performance levels within each population.

RESULTS

Findings reveal weak awareness (72.4% and 9.03% in UAE and Jordan, respectively) and moderate performance level (98.8% in UAE and Jordan), with a weak correlation (UAE, rho = 0.093; Jordan, rho = 0.164) observed between the two countries (P < 0.05). Multinomial logistic regression analysis indicates gender-related associations with awareness levels and education-related associations with performance levels.

CONCLUSIONS

The study emphasizes the urgent need for awareness campaigns and workshops to promote safer disinfectant practices to develop effective interventions aligning with sustainable development goals.

Attitudes and Misconceptions of Coronavirus Disease and Vaccination Among African Americans in Rural Mississippi

Despite the recommendations for COVID-19 preventive health behaviors, it continues to increase alarmingly. This study examined how media coverage, myths, political leaders, and community leaders influence the attitudes and misconceptions about COVID-19 and COVID-19 vaccination uptake in the Mississippi Delta region. This qualitative study employed focus group discussions (FDGs) with representatives from three rural counties in the Mississippi Delta. A thematic analysis approach was used for data analysis. Participants were aware of how COVID-19 is transmitted, the preventative measures that can be used to mitigate the spread of the virus, and misconceptions and beliefs that lingered in their communities. Participants were uncertain about the need for the COVID-19 vaccine in terms of perceived risks (e.g., side effects, efficacy, and safety) and its novelty. Participants also discussed a wide range of COVID-19 misinformation that resulted in distress and distrust of the vaccine and health behavior recommendations. There are varying misconceptions and beliefs about COVID-19 and COVID-19 vaccine among communities in the rural Mississippi Delta. Thus, multi-sectoral collaborations between agencies that can use risk communication frameworks to deliver accurate health information that can resolve misinformation about COVID-19 in rural communities are needed.

Knowledge and preventive practices regarding COVID-19 disease among Ukrainian refugees in Poland

Russia's invasion of Ukraine contributed one of the largest migration movements in the 21st century. Refugees may become a source of severe acute respiratory syndrome coronavirus 2 infections for the residents of host countries. The study aim was to assess knowledge and preventive practices regarding coronavirus disease 2019 (COVID-19) among Ukrainian refugees in Poland. The cross-sectional study was conducted between March and April 2022 among Ukrainian refugees registering consecutively in Zielona Góra, Poland. Knowledge and preventive practices were assessed by giving 1 point for each correct answer by anonymous, self-administered questionnaire. The response rate was 96%, 190 participated (mean age 37.8 ± 15.5 years; 57.9% females); 61.6% self-reported their socio-economic status (SES) as high, 38.9% reported high level of education. The mean COVID-19 knowledge score was 3.06 ± 1.95; 19.5% scored >50%. The knowledge level was higher among migrants with high SES (P = .003). The mean preventive practices score was 2.56 ± 1.38; 54.0% scored ≥ 60%. 40.5% declared social distancing, 62.6% followed coughing etiquette, 69.0% home isolate themselves during COVID-19. 57.9% always used masks in public space, however 74.2% wore masks with uncovered nose. Refugees with higher education, high SES and knowledge level had significantly greater preventive practices scores (P = .002; P = .02; P = .03, respectively). The knowledge and preventive practices level was insufficient. Educational campaigns oriented to raising knowledge and prevention behavior skills should be implemented, especially targeting high-risk groups to avoid spread of COVID-19.

Airway Diseases Related to the Use of Cleaning Agents in Occupational Settings

Exposure to disinfectants and cleaning products (DCPs) is now a well-established risk factor for work-related asthma (WRA). However, questions remain on the specific causal agents and pathophysiological mechanisms. Few studies have also reported an association between DCPs and rhinitis or chronic obstructive pulmonary disease. This review discusses the recent evidence pertaining to airway diseases attributable to occupational exposure to DCPs. In contrast to other agents, the incidence of WRA due to DCPs has increased over time. The use of DCPs in spray form has clearly been identified as an added risk factor. The mechanisms for WRA associated with DCPs remain poorly studied; however, both allergic and nonallergic responses have been described, with irritant mechanisms thought to play a major role. An early diagnostic workup based on clinical assessment accompanied by evaluation of lung function and immunological and airway inflammatory markers is important to guide optimal care and exposure avoidance to the implicated agent. Future research should focus on the effects of "green" products, pathophysiological mechanisms, and quantitative exposure assessment including the use of barcode-based methods to identify specific agents. There is an urgent need to strengthen preventive measures and interventions to reduce the burden of airway diseases associated with DCPs.

Hand hygiene during the spread of COVID-19: a cross-sectional study of awareness and practices among academic institutions in Lebanon

Introduction

During the pandemic, the World Health Organization has recommended hand hygiene as one of the effective preventive measures to limit the global spread of COVID-19. However, the awareness gap of hand hygiene protocols could increase the spread of COVID-19 and consequently increase the absenteeism rate among academic institutions. This study aims to assess hand hygiene awareness and practices levels among various university communities in Lebanon.

Methods

A cross-sectional study was conducted between December 2021 and June 2022 among 1,291 participants from academic settings in Lebanese universities. An online survey (score-based questionnaire) of hand hygiene was conducted to evaluate the awareness and practices among university communities (faculty, staff, and students). Mann-Whitney and Kruskal-Wallis tests were used to determine whether significant differences exist in the levels of awareness with regard to gender, age, provinces, educational level, and university status. Pearson's chi-squared test was applied to assess differences among the sample characteristics and participants' practice of hand hygiene.

Results

It was found that most of the participants showed a moderate level of awareness (76.4%) with a mean score of 7.59 out of 12 (SD = 1.68). The Mann-Whitney test indicated that females recorded higher levels of awareness than males with a significant difference of 102, 104: p < 0.05. Another notable variable was the educational level of the participants with university degrees holders recording higher scores of awareness than the ones with high school degrees as per the Kruskal-Wallis test (p < 0.05). Significant differences were also shown in awareness scores among the age groups and the university status (p < 0.05). The Pearson's chi-squared test results showed that females used alcohol-based hand rubs or soap and water more frequently than males (p < 0.05). However, males significantly preferred the frequent use of water alone compared to females (p < 0.05).

Conclusion

The study findings highlighted the necessity of awareness campaigns and health educational programs addressing the technical skills of hand hygiene among both genders (especially males) of the academic communities in Lebanon.

Exposures to Bleach, Peroxide, Disinfectants, Antimalarials, and Ivermectin Reported to the California Poison Control System Before and During the COVID-19 Pandemic, 2015-2021

OBJECTIVES

The COVID-19 pandemic led to widespread fear of infection, with many people expanding their use of cleaning products and trying unproven prevention and treatment strategies. We described shifts in reported exposures related to COVID-19 home interventions.

METHODS

This study considered suspected toxicity exposures involving household cleaning products (bleach, peroxide, disinfectants), antimalarials (hydroxychloroquine and chloroquine), and ivermectin reported to the California Poison Control System from 2015 through 2021 and assessed trends in exposures by using interrupted time-series analyses.

RESULTS

We found a significant increase in exposures reported to the California Poison Control System related to household cleaning products and ivermectin during the COVID-19 pandemic. As of January 1, 2015, the baseline level of reported exposures to household cleaning products was 707.33 per month and was declining at a rate of 1.71 (95% CI, -2.87 to -0.56) per month through February 29, 2020. In March 2020, an increase of 466.57 (95% CI, 328.08-605.07) reported exposures above baseline occurred, after which exposures to cleaning products decreased at a rate of 23.40 (95% CI, -32.48 to -14.32) per month. The number of reported exposures to antimalarials did not change significantly before or during the pandemic. The number of reported ivermectin exposures before December 2020 was initially stable at 14.50 per month and then increased by 2.05 per month through December 2021.

CONCLUSIONS

Our observations suggest that while some dangerous home prevention and treatment efforts resolve over time, further interventions may be needed to reduce the public health effects related to attempts to self-treat COVID-19 with ivermectin.

COVID-19 cleaning protocol changes, experiences, and respiratory symptom prevalence among cleaning services personnel

Introduction

Cleaning protocols were changed in response to the COVID-19 pandemic with unknown occupational health impacts. There is evidence that COVID-19 transmission risks from contaminated surfaces are low and that exposure to cleaning products can increase risks of work-related asthma. The study objective was to investigate relationships between reported COVID-19-related changes in cleaning protocols and prevalence of asthma-related respiratory symptoms for asthmatic and non-asthmatic janitors and maids. A secondary objective was to characterize experiences of respiratory symptoms associated with cleaning and barriers to personal protective equipment (PPE) use.

Methods

Employees from two Tucson-based maid service companies (approximately 30 personnel in total) and one Phoenix-based school district (>300 janitors/custodians) were invited to participate in a written survey and/or a one-on-one interview in Spanish or English. Fisher's exact tests (α = 0.05) were used to test for statistically significant associations between reported respiratory symptoms by self-reported physician-diagnosed asthma status and changes in cleaning protocols. Interviews were transcribed and then analyzed by at least two researchers in English or Spanish.

Results

Eighty-three percent reported that cleaning protocols had changed during COVID-19, with the two most reported changes including increased cleaning frequency (92%) and change of application type (e.g., fog, spray, wipe) (53%). There was a statistically significant association between multiple respiratory symptoms and self-reported physician diagnosed asthma. Reporting a type of application change (e.g., fog, spray, wipe) and being awakened during the night by attack/episode of cough were statistically significantly associated (p = 0.04). Interviews elucidated respiratory issues related to fogging devices.

Discussion

This study provides preliminary evidence that changes in cleaning and disinfection protocols during COVID-19 (namely, the use of fogging/mechanical spraying devices) may have had negative impacts on the health of workers in the cleaning industry with little benefit to reducing COVID-19 risks. Further research is needed to evaluate the generalizability of our findings across larger geographical areas and to develop guidance for employers and employees on how to protect and promote respiratory health.

Contact dermatitis caused by prevention measures during the COVID-19 pandemic: a narrative review

Introduction

During the outbreak of Coronavirus disease 2019 (COVID-19), health care workers wore personal protective equipment including masks, gloves and goggles for a long time. In order to reduce the transmission routes of the virus, public places were sprayed with disinfectant. Moreover, the body, hands and clothing were frequently disinfected and washed for hygiene purposes. Studies have shown that these practices could easily irritate the skin and damage the skin barrier. Long-term irritation or exposure to allergens may lead to the occurrence of contact dermatitis (CD).

Methods

Subject headings were searched via the National Library of Medicine (PubMed) and web of science databases: COVID-19; contact dermatitis; adverse skin reaction; PPE; dermatitis; mask; glory; hand hygiene, disinfection; face shield; goggle; protect cloth. A total of 246 and 646 articles were retrieved from the two databases, respectively. 402 articles remained after removing duplicates. Reviews, non-English articles, articles that could not be accessed to read or did not conform to our topic were excluded. Finally, a total of 32 cross-sectional studies, 9 case reports and 2 randomized controlled trials were included.

Discussion

This article reviews reports of CD caused by various prevention and hygiene measures during the COVID-19 pandemic. The amount of skin damage caused by COVID-19 prevention measures could be decreased by improved education about skin management.

Evaluation of public awareness and performance toward the safe use of household disinfectants-cleaners to prevent COVID-19 in the Emirate of Abu Dhabi

Introduction

Disinfection is one of the most effective hygienic practices that would limit the spread of the Coronavirus Disease (COVID-19) through deactivating the coronavirus on contaminated skin, supplies, and surfaces. However, the type and concentration of disinfectants should be carefully selected to avoid damaging surfaces and to limit the side effects of these chemicals on household members and users. The aim of this study is to assess the public levels of awareness and performance concerning the safe use of household cleaning products and disinfectants during the spread of COVID-19 in the Emirate of Abu Dhabi.

Methods

The cross-sectional study was conducted between October and December 2021 among 750 residents of Abu Dhabi, Al Dhafrah, and Al-Ain regions. A google survey was distributed electronically for the online recruitment of the general population. Mann-Whitney and Kruskal-Wallis tests were used to determine whether significant differences exist in the levels of awareness and performance with regard to gender, region, education level, and diagnosis with COVID-19. Spearman correlation was used to test if any correlation existed between levels of awareness and performance. Kruskal-Wallis test was also used to check if significant differences exist in the mean score of performance with respect to irritation-to-poisoning symptoms.

Results

The study population recorded a lower mean score of awareness (5.37 out of 12) than performance (11.75 out of 16). The majority of the study population claimed a minimum of one irritation-to-poisoning symptom during the handling of household cleaners and disinfectants. Significant differences exist in the awareness and performance mean scores among various educational levels (P < 0.001). The level of awareness was statistically significant with regard to infection with SARS-CoV-2 (P < 0.05). Also, the level of performance was significantly different between males and females (P < 0.001). Kruskal-Wallis test showed that the mean score of performance is statistically significant with all the studied irritation-to poisoning symptoms (P < 0.05).

Conclusions

Awareness campaigns and training programs are recommended to address the safe use of household cleaning products and disinfectants in the United Arab Emirates (UAE).

Chronic quaternary ammonium compound exposure during the COVID-19 pandemic and the impact on human health

Objective

This review examines a relevant, and underacknowledged, emerging global public health concern—the widespread exposure to quaternary ammonium compounds (QACs) during the COVID-19 pandemic. QACs are a widely used class of cationic surfactants with broad spectrum antimicrobial activity that serve as the active ingredients in antimicrobial products. While these compounds have been used for decades, the production and consumer use of QAC-containing products have steeply risen during the COVID-19 pandemic to control and prevent the spread of the SARS-Cov-2 virus. As a result, human exposure to QACs has also drastically increased.

Methods

This critical review was conducted by searching the key terms “quaternary ammonium compounds,” “disinfectants,” “COVID-19,” “SARS-Cov-2,” “human health,” and “human exposure” in the major search engines, including Google Scholar, PubMed and Science Direct.

Results

QACs are generally considered safe and effective, yet the magnitude of QAC exposure and the subsequent health effects have not been adequately investigated. Recent studies have revealed the potential for bioaccumulation of QACs in blood and tissue. Inhalation and dermal absorption of QACs are identified as the most significant exposure routes for adults, while children and infants may be significantly more vulnerable to QAC exposure and potential adverse health effects.

Conclusions

QACs are an important tool to protect individual and public health, but understanding the impact of widespread QAC exposure is vital to guide best practices for QAC use and minimize the associated health risks. These pandemic era results warrant further investigation and raise additional questions about the short-term and long-term health effects of chronic QAC exposure.

Clinical trial registration

Not applicable.

Surface Disinfection Practice in Public Hospitals in the Era of COVID-19: Assessment of Disinfectant Solution Preparation and Use in Addis Ababa, Ethiopia

Background

Surface disinfection of healthcare facilities with appropriate disinfectants is among the infection control strategies against the spread of coronavirus disease 2019 (COVID-19). As sodium hypochlorite solution (SHS) is a commonly used surface disinfectant, its preparation and proper use should be given a due attention. The current study aimed at assessing the practice of Addis Ababa public hospitals in the preparation and use of SHS.

Methods

A cross-sectional observational study was employed to assess the adequacy of disinfectant solution preparation and use. Checklists were used for data collection. Descriptive statistics were used for data analyses, and categorical variables were described by frequencies and percentages.

Results

Out of the twelve public hospitals included in the study; only three hospitals checked the potency of the working SHS. Majority of the hospitals (8 hospitals) stored the concentrated SHS products in cool, dry, and direct sunlight protected places. It was only in one hospital where appropriate personal protective equipment was used during the preparation and quality control activities. Surfaces were not cleaned in all hospitals before disinfection; and the rooms were ventilated only in 2 hospitals during the application of the disinfectant solution.

Conclusion

The study revealed that the preparations of SHS in the public hospitals did not comply with most of the requirements of good compounding practice. Moreover, standard practices were not maintained in majority hospitals during the use of SHS for surface disinfection. As a control strategy in the spread of COVID-19 and other infections, appropriate corrective actions shall be implemented in the studied hospitals to mitigate the limitations observed in the preparation and use of SHS.

Quaternary ammonium disinfectants and antiseptics: tolerance, resistance and potential impact on antibiotic resistance

BACKGROUND

Due to the substantial increase in the use of disinfectants containing quaternary ammonion compounds (QACs) in healthcare and community settings during the COVID-19 pandemic, there is increased concern that heavy use might cause bacteria to develop resistance to QACs or contribute to antibiotic resistance. The purpose of this review is to briefly discuss the mechanisms of QAC tolerance and resistance, laboratory-based evidence of tolerance and resistance, their occurrence in healthcare and other real-world settings, and the possible impact of QAC use on antibiotic resistance.

METHODS

A literature search was conducted using the PubMed database. The search was limited to English language articles dealing with tolerance or resistance to QACs present in disinfectants or antiseptics, and potential impact on antibiotic resistance. The review covered the period from 2000 to mid-Jan 2023.

RESULTS

Mechanisms of QAC tolerance or resistance include innate bacterial cell wall structure, changes in cell membrane structure and function, efflux pumps, biofilm formation, and QAC degradation. In vitro studies have helped elucidate how bacteria can develop tolerance or resistance to QACs and antibiotics. While relatively uncommon, multiple episodes of contaminated in-use disinfectants and antiseptics, which are often due to inappropriate use of products, have caused outbreaks of healthcare-associated infections. Several studies have identified a correlation between benzalkonium chloride (BAC) tolerance and clinically-defined antibiotic resistance. The occurrence of mobile genetic determinants carrying multiple genes that encode for QAC or antibiotic tolerance raises the concern that widespread QAC use might facilitate the emergence of antibiotic resistance. Despite some evidence from laboratory-based studies, there is insufficient evidence in real-world settings to conclude that frequent use of QAC disinfectants and antiseptics has promoted widespread emergence of antibiotic resistance.

CONCLUSIONS

Laboratory studies have identified multiple mechanisms by which bacteria can develop tolerance or resistance to QACs and antibiotics. De novo development of tolerance or resistance in real-world settings is uncommon. Increased attention to proper use of disinfectants is needed to prevent contamination of QAC disinfectants. Additional research is needed to answer many questions and concerns related to use of QAC disinfectants and their potential impact on antibiotic resistance.

Improving Environmental Health in Schools

School environmental conditions have immediate and long-term effects on student health and learning. Relying on disconnected, inconsistent, voluntary, or unenforced environmental standards has not resulted in sufficient protection of students from toxic insults. Furthermore, the United States public school system was not prepared to navigate a potentially deadly infectious disease like COVID-19. Although Department of Education agencies have policies to establish clean and safe learning spaces, deficiencies are evident. This article highlights common environmental challenges in schools and opportunities for improvement. Voluntary adoption of rigorous environmental policies by grassroots efforts alone is unlikely to occur in all school systems. In the absence of a legally enforced requirement, the dedication of sufficient resources to update infrastructure and build the environmental health workforce capacity is equally unlikely to occur. Environmental health standards in schools should not be voluntary. Science-based standards should be comprehensive, and part of an actionable, integrated strategy that includes preventive measures and addresses environmental health issues sustainably. Establishing an Integrated Environmental Management approach for schools will require a coordinated capacity-building effort, community-based implementation efforts, and enforcement of minimal standards. Schools will need ongoing technical support and training for staff, faculty, and teachers sufficient to enable them to assume greater oversight and responsibility for environmental management of their schools. Ideally, a holistic approach will include all environmental health components, including IAQ, IPM, green cleaning, pesticide and chemical safety, food safety, fire prevention, building legacy pollutant management, and drinking water quality. Thus, creating a comprehensive management system with continuous monitoring and maintenance. Clinicians who care for children can serve as advocates for children's health beyond their clinic walls by advising parents and guardians to be aware of school conditions and management practices. Medical professionals have always been valued and influential members of communities and school boards. In these roles they can greatly assist in identifying and providing solutions to reduce environmental hazards in schools.

Attention is not all you need: the complicated case of ethically using large language models in healthcare and medicine

Large Language Models (LLMs) are a key component of generative artificial intelligence (AI) applications for creating new content including text, imagery, audio, code, and videos in response to textual instructions. Without human oversight, guidance and responsible design and operation, such generative AI applications will remain a party trick with substantial potential for creating and spreading misinformation or harmful and inaccurate content at unprecedented scale. However, if positioned and developed responsibly as companions to humans augmenting but not replacing their role in decision making, knowledge retrieval and other cognitive processes, they could evolve into highly efficient, trustworthy, assistive tools for information management. This perspective describes how such tools could transform data management workflows in healthcare and medicine, explains how the underlying technology works, provides an assessment of risks and limitations, and proposes an ethical, technical, and cultural framework for responsible design, development, and deployment. It seeks to incentivise users, developers, providers, and regulators of generative AI that utilises LLMs to collectively prepare for the transformational role this technology could play in evidence-based sectors.

Airborne antibiotic resistome and human health risk in railway stations during COVID-19 pandemic

Antimicrobial resistance is recognized as one of the greatest public health concerns. It is becoming an increasingly threat during the COVID-19 pandemic due to increasing usage of antimicrobials, such as antibiotics and disinfectants, in healthcare facilities or public spaces. To explore the characteristics of airborne antibiotic resistome in public transport systems, we assessed distribution and health risks of airborne antibiotic resistome and microbiome in railway stations before and after the pandemic outbreak by culture-independent and culture-dependent metagenomic analysis. Results showed that the diversity of airborne antibiotic resistance genes (ARGs) decreased following the pandemic, while the relative abundance of core ARGs increased. A total of 159 horizontally acquired ARGs, predominantly confering resistance to macrolides and aminoglycosides, were identified in the airborne bacteria and dust samples. Meanwhile, the abundance of horizontally acquired ARGs hosted by pathogens increased during the pandemic. A bloom of clinically important antibiotic (tigecycline and meropenem) resistant bacteria was found following the pandemic outbreak. 251 high-quality metagenome-assembled genomes (MAGs) were recovered from 27 metagenomes, and 86 genera and 125 species were classified. Relative abundance of ARG-carrying MAGs, taxonomically assigned to genus of Bacillus, Pseudomonas, Acinetobacter, and Staphylococcus, was found increased during the pandemic. Bayesian source tracking estimated that human skin and anthropogenic activities were presumptive resistome sources for the public transit air. Moreover, risk assessment based on resistome and microbiome data revealed elevated airborne health risks during the pandemic.

Assessing the predictors of adaptive and maladaptive Covid-19 preventive behaviours: an application of protection motivation theory

Despite the high death toll of the COVID-19 pandemic, reported rates of adherence to adaptive preventive health behaviours during the early wave of the pandemic were suboptimal for reducing the risk of disease spread. Additionally, some have adopted practices with the intention of preventing infection that have harmful consequences. Protection Motivation Theory (PMT), consisting of perceived vulnerability, severity, response efficacy, and self-efficacy, has been used to predict intentions to engage in behaviours in past pandemics, and can be extended to the COVID-19 outbreak. Three hundred and thirty-three American adults completed a survey in May 2020 through Amazon's Mechanical Turk. Ten behaviours recommended by the CDC and WHO and two 'maladaptive' behaviours presented in the media were selected for investigation. Binary logistic regressions were conducted to assess the impacts of demographic variables and PMT constructs on behaviour frequency. Perceived severity and vulnerability were not significant predictors of behaviour frequency. Behaviour specific response efficacy and self-efficacy were significant predictors of 11/12 (odds ratios: 2.70-6.22) and 10/12 (odds ratios: 2.59-4.64) behaviours, respectively. Age, gender, education, political ideology, perceived severity, and perceived vulnerability were generally unimportant predictors. Beliefs about the effectiveness of the behaviour and one's ability to carry out that behaviour consistently seem to be more important in predicting how often someone engages in that behaviour than the perceived dangerousness of COVID-19 and one's believed susceptibility to infection. These results suggest that interventions trying to modulate the likelihood of engaging in preventive behaviours should focus on the effectiveness of these behaviours in reducing risk of spread and the individual's ability to engage in these behaviours frequently rather than the dangerousness of the COVID-19 pandemic and the individual's risk of becoming infected.

Susceptibility to COVID-19 Nutrition Misinformation and Eating Behavior Change during Lockdowns: An International Web-Based Survey

To understand the susceptibility to nutrition-health misinformation related to preventing, treating, or mitigating the risk of COVID-19 during the initial lockdowns around the world, the present international web-based survey study (15 April-15 May 2020) gauged participants' (n = 3707) level of nutrition-health misinformation discernment by presenting them with 25 statements (including unfounded or unproven claims circulated at the time), alongside the influence of information sources of varying quality on the frequency of changes in their eating behavior and the extent of misinformation held, depending on the source used for such changes. Results revealed widespread misinformation about food, eating, and health practices related to COVID-19, with the 25 statements put to participants receiving up to 43% misinformed answers (e.g., 'It is safe to eat fruits and vegetables that have been washed with soap or diluted bleach'). Whereas higher quality information sources (nutrition scientists, nutrition professionals) had the biggest influence on eating behavior change, we found greater misinformation susceptibility when relying on poor quality sources for changing diet. Appropriate discernment of misinformation was weakest amongst participants who more frequently changed their eating behavior because of information from poor quality sources, suggesting disparities in the health risks/safety of the changes performed.

Characterizing changes in behaviors associated with chemical exposures during the COVID-19 pandemic

The COVID-19 pandemic-and its associated restrictions-have changed many behaviors that can influence environmental exposures including chemicals found in commercial products, packaging and those resulting from pollution. The pandemic also constitutes a stressful life event, leading to symptoms of acute traumatic stress. Data indicate that the combination of environmental exposure and psychological stress jointly contribute to adverse child health outcomes. Within the Environmental influences on Child Health Outcomes (ECHO)-wide Cohort, a national consortium initiated to understand the effects of environmental exposures on child health and development, our objective was to assess whether there were pandemic-related changes in behavior that may be associated with environmental exposures. A total of 1535 participants from nine cohorts completed a survey via RedCap from December 2020 through May 2021. The questionnaire identified behavioral changes associated with the COVID-19 pandemic in expected directions, providing evidence of construct validity. Behavior changes reported by at least a quarter of the respondents include eating less fast food and using fewer ultra-processed foods, hair products, and cosmetics. At least a quarter of respondents reported eating more home cooked meals and using more antibacterial soaps, liquid soaps, hand sanitizers, antibacterial and bleach cleaners. Most frequent predictors of behavior change included Hispanic ethnicity and older age (35 years and older). Respondents experiencing greater COVID-related stress altered their behaviors more than those not reporting stress. These findings highlight that behavior change associated with the pandemic, and pandemic-related psychological stress often co-occur. Thus, prevention strategies and campaigns that limit environmental exposures, support stress reduction, and facilitate behavioral change may lead to the largest health benefits in the context of a pandemic. Analyzing biomarker data in these participants will be helpful to determine if behavior changes reported associate with measured changes in exposure.

Saudi Nurse Interns' Experiences during the COVID-19 Pandemic: A Thematic Approach

BACKGROUND

The learning process for nurses, including internships, was affected during the COVID-19 pandemic, which may have made the nurse internship program more challenging and stressful for participants. Therefore, it is significant to explore the experiences of nurse interns during COVID-19.

AIM

This study aimed to explore Saudi nurse interns' field experiences during the pandemic.

DESIGN

The study utilised descriptive phenomenological qualitative research and a thematic approach.

METHODS

A total of 19 nurse interns participated in the study, which was conducted in Saudi Arabia. Participants undertook an internship program at different government hospitals in five cities in Saudi Arabia. Unstructured individual interviews were conducted to gather data from the participants.

RESULTS

The findings revealed five themes: being passionate, lacking knowledge and skills, being concerned about their families, being cautious, and being unoriented.

CONCLUSION

The study findings document that the struggles of nurse interns in their internship programs during COVID-19 were related to their lack of knowledge, their family, and the working environment.

Alcohol-based Hand Sanitizers amid COVID-19: Chemical Formulation, Analysis, Safety

Alcohol-based hand sanitizers (ABHSs) containing ethanol (EtOH) or isopropyl alcohol (IPA) to inactivate microorganisms help prevent the spread of respiratory diseases. These products have become very popular during the COVID-19 pandemic. Apart from vaccines or other preventative antiseptic measures, the majority of consumers have relied on different types of ABHSs to disinfect their hands. As a result, there has been a global rush in the demand for these ABHSs and other antiseptic hygiene products. This has resulted in the formation of many new commercial sanitizer producers. There are around fifty companies of varying sizes that have been marketing their ABHSs in Bangladesh, most of which have only been manufacturing their products for the first time since the COVID-19 pandemic. To monitor the quality and components of these products, the Bangladesh Council of Scientific and Industrial Research (BCSIR) analyzed approximately 200 different hand sanitizer samples using GC-FID method. All samples were alcohol-based except for 3 which were alcohol-free aqueous hand sanitizers. Of the supplied formulated ABHSs, 80 samples were found to contain only IPA and 54 contained only EtOH. However, 28 samples were found to be contaminated with methanol (MeOH), 7 samples contained only MeOH and 18 samples contained both EtOH and IPA. This is the first study to explore the analysis of alcohol content in formulated ABHSs and their marketing status in Bangladesh, but the findings could be of use in other jurisdictions as similar issues have been raised in many parts of the world.

Environmental and health impacts of spraying COVID-19 disinfectants with associated challenges

Coronavirus refers to a group of widespread viruses. The name refers to the specific morphology of these viruses because their spikes look like a crown under an electron microscope. The outbreak of coronavirus disease 2019 (COVID-19) that has been reported in Wuhan, China, in December 2019, was proclaimed an international public health emergency (PHEIC) on 30 January 2020, and on 11 March 2020, it was declared as a pandemic (World Health Organization 2020). The official name of the virus was declared by the WHO as "COVID-19 virus", formerly known as "2019-nCoV", or "Wuhan Coronavirus". The International Committee on Virus Taxonomy's Coronavirus Research Group has identified that this virus is a form of coronavirus that caused a severe outbreak of acute respiratory syndrome in 2002-2003 (SARS). As a result, the latest severe acute respiratory syndrome has been classified as a corona virus 2 (SARS-CoV-2) pathogen by this committee. This disease spread quickly across the country and the world within the first 3 months of the outbreak and became a global pandemic. To stop COVID-19 from spreading, the governing agencies used various chemicals to disinfect different commercial spaces, streets and highways. However, people used it aggressively because of panic conditions, anxiety and unconsciousness, which can have a detrimental impact on human health and the environment. Our water bodies, soil and air have been polluted by disinfectants, forming secondary products that can be poisonous and mutagenic. In the prevention and spread of COVID-19, disinfection is crucial, but disinfection should be carried out with sufficient precautions to minimize exposure to harmful by-products. In addition, to prevent inhalation, adequate personal protective equipment should be worn and chemical usage, concentrations, ventilation in the room and application techniques should be carefully considered. In the USA, 60% of respondents said they cleaned or disinfected their homes more often than they had in the previous months. In addition to the robust use of disinfection approaches to combat COVID-19, we will explore safe preventative solutions here.

Household disinfection practices by women living in Egypt during the 2020 COVID-19 lockdown and the association of information sources and suspected bleach toxicity

INTRODUCTION

The spread of contradictory health information was a hallmark of the early COVID-19 pandemic. Because of a limited understanding of the disease, its mode of transmission, and its pathogenicity, the public turned to easily accessible and familiar sources of information. Some of these sources included wrong or incomplete information that could increase health risks and incidents of toxicity due to improper information about the usage of disinfectants. The objective of this study was to assess the relationship between sources of information about the COVID-19 pandemic, the related household cleaning and disinfection practices among adult women living in Egypt, and the associated adverse effects of bleach toxicity during a national lockdown.

METHODS

Through a self-administered online survey, 452 adult women (18 years and older) living in Egypt were recruited from 13 cities between 4 June 2022 and 4 July 2022 to answer the questionnaire. The questionnaire included (41) questions in Arabic and collected data about respondents' household cleaning and disinfection practices to prevent the spread of the SARS-CoV-2 virus and protect their families during the lockdown that started in Egypt in March 2020.

RESULTS

The study found that 88.1% (n = 398) of participants reported increased use of disinfectants during the lockdown. Women who chose social media as their primary source of information to learn about disinfection practices reported an increased frequency of respiratory symptoms associated with bleach toxicity (correlation coefficient = 0.10, p-value = 0.03), followed by women who depended on relatives and friends as the primary source of information (correlation coefficient = 0.10, p-value = 0.02).

CONCLUSION

This study showed that social media is an easily accessible, efficient and fast communication tool that can act as a primary source for individuals seeking medical information compared to other media platforms (e.g., websites, T.V., satellite channels). However, better regulations and monitoring of its content may help limit the harms caused by the misinformation and disinformation spread by these popular platforms, particularly in times of uncertainty and upheaval.

[Experiences and Resilience of Hygiene Team Members During the SARS-CoV-2 Pandemic]

BACKGROUND

In compliance with German data protections regulations, we conducted an anonymous survey among participants of the annual infectious disease and control meeting in Freiburg, Germany in October 2021.

MATERIAL AND METHODS

We report the results of nurse and physician members of infection control teams on their perceptions and emotions during the pandemic. Descriptive statistics and Chi Square Test with P<0.05 (SPSS Statistics Standard Version) were used when applicable.

RESULTS

Of the 391 of 750 distributed surveys, 391 were returned; 48% were infection control practitioners (IP), 12% Link Nurses (LN), 12% Board Certified Hospital Epidemiologists (HE), 17% infection control-trained physicians (ITP), 1% Occupational Health or Public Health specialists and 10% others. 72% were female, 25.3% male, 0.2% divers and 2.5% gave no answers. The 349 members of infection control teams (IP, LN, HE, ITP) reported a high level of competency, importance and appreciation and a low rate of anxiety or hopelessness. A quarter reported anger and frustration which nevertheless did not result in reduced motivation. Information provided by the German national health agency Robert Koch-Institute (RKI) was utilized most by participants. Social media, on the other hand, were criticized frequently. Cooperation within the institution and local public health authorities was good. Free text answers regarding lessons learned showed wide potential for improvement.

CONCLUSION

Our survey results indicate a high level of resilience among members of infection control teams in German medical institutions despite obvious shortcomings in supplies during the first wave of the pandemic. The high level of self-perceived competency and appreciation possibly helped deal with the situation and prevented the feeling of loss of control implied in the question items "feeling overwhelmed" and "hopeless". However, the lessons learned from the pandemic need to be implemented to maintain this high level of resilience not only for infection control teams but the medical system in general.

Chlorine poisoning caused by improper mixing of household disinfectants during the COVID-19 pandemic: Case series

BACKGROUND

Misuse of disinfectants during the coronavirus disease 2019 pandemic has led to several poisoning incidents. However, there are few clinical case reports on poisoning caused by improper mixing of household disinfectants.

AIM

To summarize the clinical characteristics and treatment effects of chlorine poisoning caused by improper mixing of hypochlorite bleach with acidic cleaning agents.

METHODS

We retrospectively analyzed baseline and clinical data, clinical symptoms, and treatment methods of seven patients with chlorine poisoning who were admitted to the National Army Poisoning Treatment Center.

RESULTS

Among the seven patients, the average poisoning time (exposure to admission) was 57 h (4-240 h). All patients were involved in cleaning bathrooms. Chest computed tomography scans revealed bilateral lung effusions or inflammatory changes in five patients. The partial pressure of oxygen decreased in six patients, and respiratory failure occurred in one. Five patients had different degrees of increase in white blood cell count. Humidified oxygen therapy, non-invasive mechanical ventilation, anti-inflammatory corticosteroids, antioxidants, and antibiotics were administered for treatment. The average length of hospital stay was 7 d (4-9 d). All seven patients recovered and were discharged.

CONCLUSION

Improper mixing of household disinfectants may cause damage to the respiratory system due to chlorine poisoning. Corticosteroids may improve lung exudation in severe cases, and symptomatic supportive treatment should be performed early.

Characteristics Associated With US Adults' Self-Reported COVID-19 Protective Behaviors When Getting Food From Restaurants, Winter 2021

Objectives:

Visiting restaurants and bars, particularly when doing so indoors, can increase transmission risk of SARS-CoV-2, the virus that causes COVID-19, among people who are not fully vaccinated. We aimed to understand US adults’ self-reported protective behaviors when getting food from restaurants during the COVID-19 pandemic when vaccines were not widely available.

Methods:

We used online nationwide survey data from January 2021 to assess self-reported restaurant-related behaviors of respondents (n = 502). We also used multiple logistic regression models to examine associations between respondents’ characteristics and these restaurant-related behaviors.

Results:

Half (49.7%) of respondents reported eating indoors at a restaurant at least once in the month before the survey. Respondents most likely to report eating inside restaurants were in the youngest age category (18-34 y), had personal COVID-19 experience, or indicated they felt safe eating inside a restaurant. Among respondents who had gotten food from a restaurant, more than 65% considered each of the following factors as important in their restaurant dining decision: whether the restaurant staff were wearing face masks, the restaurant requires face masks, other customers are wearing face masks, seating was spaced at least 6 feet apart, someone in their household was at risk for severe COVID-19 illness, and the restaurant was crowded. The most common protective behavior when eating at a restaurant was wearing a face mask; 44.9% of respondents who had eaten at a restaurant wore a face mask except when actively eating or drinking.

Conclusion:

The need for practicing prevention strategies, especially for those not up to date with COVID-19 vaccines, will be ongoing. Our findings can inform COVID-19 prevention messaging for public health officials, restaurant operators, and the public.

Conceptual Design of the "Private Car" Self-Isolation Ecosystem for the 2019-nCoV Infection

Since the beginning of the COVID-19 outbreak, confirmed and suspected cases of the disease have been increasing rapidly. The isolation of cases is one of the most effective methods for the control and containment of COVID-19 and has been rapidly popularized. Problems with isolation have gradually emerged, such as the inadequate allocation of isolation resources and the failure to properly resettle many of the suspected cases of the 2019-nCoV infection. In this paper, a self-isolation ecosystem of a rapid-deploying negative-pressurized "private car" is proposed for housing patients with 2019-nCoV infection, which could be lightweight, moderately sized and transparent to enable group supervision and communication. This "private car" isolation method aims to achieve self-isolation of patients and essentially solves the problem of where and how to isolate suspected cases while saving isolation resources and preventing the large-scale transmission of COVID-19.

Strengthening the Case for Universal Health Literacy: The Dispersion of Health Literacy Experiences Across a Southern U.S. State

Background:

How individuals perceive their health literacy may differ based on demographic and individual characteristics.

Objective:

The purpose of this study was to understand the dispersion of health literacy across demographics in the state of Georgia in 2021 and to determine which factors influence health literacy.

Methods:

Study participants were age 18 years and older and completed an on-line Health Literacy Questionnaire (N = 520). The participant pool was stratified to mirror state-wide demographics of geography and race. Results were further collapsed into composite scales reflecting basic, communicative, and critical health literacy. Descriptive statistics, bivariate Pearson's correlations, and multiple regression analyses were used. A two-step cluster analysis was performed with the nine health literacy scales.

Key Results:

Rural county and no health insurance were negatively related to all three composite scales (rs = .093-.254, ps < .05). Demographic predictors accounted for 6.7% of the variance in basic (F[6, 439] = 5.287, p < .001), 10% in communicative (F[6, 438] = 8.154, p < .001), and 6% for critical (F[6, 439] = 4.675, p < .0010. In all scales, health insurance status was the strongest primary unique predictor (βs = .236, .295, .181, ps <.05, respectively). In a two-step cluster analysis only health insurance status differentiated the health literacy level clusters (X²(3) = 9.43, 34.51, ps = 024, <.001 respectively).

Conclusion:

Lacking health insurance is the most consistent and largest contributor to low health literacy across the state of Georgia; population demographics are not. Health literacy policies and practices should be developed for universal application and not focus on specific populations. [HLRP: Health Literacy Research and Practice. 2022;6(3):e182–e190.]

Plain Language Summary:

In this study, demographics that are usually associated with low health literacy like age, sex, race, educational attainment, and type of county (rural or urban) were not associated with; the only significant factor was lack of health insurance. This relationship strengthens the case for universal health literacy precautions that go beyond population demographics.

SARS-CoV-2 remains infectious for at least a month on artificially-contaminated frozen berries

The potential transmission of SARS-CoV-2 via food has been controversial since the beginning of the COVID-19 pandemic. To investigate these concerns, reliable detection methods and data on virus die-off rates in various foods are needed. Here, an FDA-standard method for the detection of enteric viruses’ RNA from soft fruits was modified for the recovery of infectious SARS-CoV-2. Then, the survival of SARS-CoV-2 on berries was investigated as well as the effectiveness of washing virus-contaminated berries with water. The modified method did not significantly reduced log infectivity titers of recovered viruses, but berries did. The detection limit of the method for infectious SARS-CoV-2 was ∼2.97 log TCID50/g of berries. On SARS-CoV-2-inoculated berries that were stored at 4 °C for 7 days, significant reductions in SARS-CoV-2 infectivity were observed over time. In contrast, on frozen berries, infectious SARS-CoV-2 was recovered for 28 days without significant reductions. Washing SARS-CoV-2-inoculated berries with water removed >90% of infectious viruses within 10 min; however, infectious viruses were detected in wash water. Therefore, on fresh berries infectious viruses are markedly inactivated over time and can be largely removed by washing with water. However, the prolonged survival of SARS-CoV-2 on frozen berries suggests that the virus can potentially spread through frozen fruits.

The practicality and prospects for disinfection control by photocatalysis during and post-pandemic: A critical review

The prevalence of global health implications from the COVID-19 pandemic necessitates the innovation and large-scale application of disinfection technologies for contaminated surfaces, air, and wastewater as the significant transmission media of disease. To date, primarily recommended disinfection practices are energy exhausting, chemical driven, and cause severe impact on the environment. The research on advanced oxidation processes has been recognized as promising strategies for disinfection purposes. In particular, semiconductor-based photocatalysis is an effective renewable solar-driven technology that relies on the reactive oxidative species, mainly hydroxyl (•OH) and superoxide (•O₂^-) radicals, for rupturing the capsid shell of the virus and loss of pathogenicity. However, the limited understanding of critical aspects such as viral photo-inactivation mechanism, rapid virus mutagenicity, and virus viability for a prolonged time restricts the large-scale application of photocatalytic disinfection technology. In this work, fundamentals of photocatalysis disinfection phenomena are addressed with a reviewed remark on the reported literature of semiconductor photocatalysts efficacies against SARS-CoV-2. Furthermore, to validate the photocatalysis process on an industrial scale, we provide updated data on available commercial modalities for an effective virus photo-inactivation process. An elaborative discussion on the long-term challenges and sustainable solutions is suggested to fill in the existing knowledge gaps. We anticipate this review will ignite interest among researchers to pave the way to the photocatalysis process for disinfecting virus-contaminated environments and surfaces for current and future pandemics.

The Efficacy of Common Household Cleaning Agents for SARS-CoV-2 Infection Control

The COVID-19 pandemic caused by SARS-CoV-2 is having devastating effects on a global scale. Since common household disinfectants are often used to minimise the risk of infection in the home and work environment, we investigated the ability of some of these products to inactivate the virus. We tested generic brands of vinegar, bleach, and dishwashing detergent, as well as laboratory-grade acetic acid, sodium hypochlorite, and ethanol. Assays were conducted at room temperature (18–20 °C, 40% relative humidity), and two time points were used to reflect a quick wipe (30 s) and a brief soak (5 min). Vinegar, and its active ingredient, acetic acid, were completely ineffective at virus inactivation even when exposed to the virus at 90% v/v (a final concentration equivalent to 3.6% v/v acetic acid). In contrast, ethanol was capable of inactivating the virus at dilutions as low as 40% v/v. Dishwashing detergent effectively rendered SARS-CoV-2 inactive when diluted 100-fold (1% v/v). Bleach was found to be fully effective against SARS-CoV-2 at 0.21 g/L sodium hypochlorite after a 30 s exposure (1/200 dilution of commercial product). Given reports of infectious virus recovered from the surface of frozen packaging, we tested the persistence of infectiousness after multiple freeze-thaw cycles and found no change in infectious SARS-CoV-2 titre after seven freeze-thaw cycles. These results should help inform readers of how to effectively disinfect surfaces and objects that have potentially been contaminated with SARS-CoV-2 using common household chemicals.

Self-care, Household Cleaning and Disinfection During COVID-19 Pandemic: A Study from Metropolitan Cities of India

Hygiene has been noticed as one of the most effective procedures against COVID-19 cross-transmission, especially hand hygiene and covering the face with the mask. Therefore, this study tried to peek into the people movements and seeks to understand how people are handling their daily use items like fruits and vegetables, how people are managing unavoidable grooming services, how people are disinfecting themselves after coming from outside, and what all hygienic practices they are following during this pandemic. Furthermore, this study attempts to explore ways through which people are disinfecting their houses. At last, the study seeks to explore the knowledge/information people have about Coronavirus. The study collected primary data through a self-administered questionnaire. A quota sampling technique was used to collect the data. Bivariate analysis was carried out to reach the study findings. Based on the findings, it is the need of the hour to disseminate the information on the use of unhealthy disinfectants as they lack the knowledge about the safe use of various types of cleaners and disinfectants. It is also reiterated that there is an urgency to promote further information on risk factors of Coronavirus among people and compulsion to promote healthy hand hygiene and sanitation practices. There is a need to promote information through mass media and other modes of awareness, such as artwork and announcements.

Significant variations of dangerous exposures during COVID-19 pandemic in Italy: a possible association with the containment measures implemented to reduce the virus transmission

BACKGROUND

In response to the COVID-19 health emergency, mass media widely spread guidelines to stop the virus transmission, leading to an excessive and unaware use of detergents and disinfectants. In Italy and in other countries this tendency caused a significant increase of exposures to these products in 2020. Evaluating data collected by the Italian Pavia Poison Centre (PPC), this study intends to examine the relationship between the COVID-19 lockdown and the variations of exposures to specific product categories possibly associated to the containment measures implemented. Simultaneously, this work shows the effectiveness of the European Product Categorisation System (EuPCS) in surveillance activities of dangerous chemicals.

METHODS

Exposure cases managed by the PPC during March-May 2020 (lockdown) and during the same months of 2017-2018-2019 were compared. Differences in categorical variables were tested with the Chi-square test. The level of significance was set at Alpha = .05. The study included all EuPCS groups but specifically focused on cleaners, detergents, biocides and cosmetics.

RESULTS

During the lockdown, calls from private citizens showed a highly significant increase (+ 11.5%, p < .001) and occupational exposures decreased (- 11.7%, p = .011). Among Cleaners, exposures to Bleaches slightly increased while Drain cleaning products went through a significant reduction (- 13.9%, p = .035). A highly significant increase of exposures to Disinfectants was observed (+ 7.7%, p = .007), particularly to those for surfaces (+ 6.8%, p = .039). Regarding Cosmetics, both handwashing soaps and gel products significantly increased (respectively: + 25.0, p = .016 and + 9.7%, p = .028). Among children 1-5 years, the statistical significance is reached with exposures to Dishwashing detergents (+ 13.1%, p = .032), handwashing soaps (+ 28.6%, p = .014) and handwashing gel products (+ 16.8%, p = .010). Contrarily, Liquid Laundry Detergent Capsules decreased in a highly significant manner (- 25%; p = .001). The general severity of exposures showed a highly significant decrease (Moderate: - 10.1%, p = .0002).

CONCLUSIONS

This study investigated the relationship between the COVID-19 lockdown and the variations of exposures to some product categories related to the containment measures. The results obtained support any action to be taken by Competent Authorities to implement measures for a safer use of cleaners/disinfectants. This paper shows the benefit in applying the EuPCS to categorize products according to their intended use, though an extension of this system to products not covered by CLP Regulation may be a further advantage.

Exposures and suspected intoxications during SARS-CoV-2 pandemic: preliminary results from an Italian poison control centre

Data on cleaner and disinfectant exposure and misuse-related acute intoxications in Italy during SARS-CoV-2 pandemic are still lacking. The aim of the present study was to analyse and describe cleaner and disinfectant-related intoxications during SARS-CoV-2 pandemic in an Italian poison control centre. Data were obtained from the toxicological consultations requested to the Toxicology Unit and Poison Centre, Careggi University Hospital, Florence (Italy). We compared data from January 1st to April 30th of 2019 and 2020. Data concerning probable or acute intoxication from any causative agent in the general population (all age groups), from private individuals or from Regional and National health structures, were included in the analysis. A toxicological evaluation was also performed to calculate the Poisoning Severity Score.In 2019, 451 phone counselling sessions were performed and compared to a total of 410 calls received during the same period of 2020. In both periods, the majority of events occurred in paediatric (0-17 years) and adult (18-65 years) patients, who were mainly exposed to one toxic agent, and intoxications took place principally at home due to domestic accidents. The oral route of intoxication was the most frequently observed one, followed by inhalation of toxic agents, which increased by 4.7% in 2020. In 2020, sanitizers and cleaners were reported in 21.6% of cases compared to 12.5% in 2019. This is the first study describing cleaner and disinfectant-related intoxications in Italy. Our results suggested a possible misuse of these products during the SARS-CoV-2 pandemic, underling the effects of home isolation on mental health and unintentional toxic exposures.

Food Handling Concerns and Practices at Home during the COVID-19 Pandemic by Food Security Status

ABSTRACT

There is limited examination about coronavirus disease 19 (COVID-19)-related food handling concerns and practices that cause chemical or microbial contamination and illness, particularly among those with food insecurity. We investigated consumer food handling concerns and practices during the COVID-19 pandemic and whether they differed by food insecurity status. An online survey was distributed among Chicago, IL, residents between 15 July and 21 August 2020 (n = 437). Independent t tests and Fisher's exact tests were used to identify differences in food handling concerns and practices between those with and without food insecurity (alpha = 0.05). Survey items included questions about food handling practices that were considered safe or neutral (i.e., washing hands and produce with water, sanitizing food packaging) and unsafe (i.e., using cleaning agents to wash foods, leaving perishable foods outside) by using 5-point Likert-style scales or categorical responses (i.e., yes, no). Participant responses fell between "slightly" and "somewhat" concerned about contracting COVID-19 from food and food packaging (mean ± standard error [SE]: 2.7 ± 0.1). Although participants reported washing their hands before eating and before preparing foods at least "most of the time" (mean ± SE: 4.4 ± 0.0 and 4.5 ± 0.0, respectively), only one-third engaged in unsafe practices. The majority of participants (68%) indicated that they altered food handling practices due to the COVID-19 pandemic and received information about food safety from social media (61%). When investigating differences in concerns and practices by food insecurity status, food insecure participants were more concerned about COVID-19 foodborne transmission for all food items (all P < 0.001) and more frequently performed unsafe food handling practices than those with food security (all P < 0.001). Results from this study suggest more investigation is needed to understand barriers to safe food handling knowledge and practices, particularly among those with food insecurity.

HIGHLIGHTS

Exploring the impact of daily food habit and modification of lifestyle for boosting immunity against COVID-19

The lockdown crisis due to novel coronavirus (COVID-19) mainly affected people who live under economic despair. Since boosting the immune system against the virus depends on a variety of food intake and lifestyle approaches; hence, it is crucial to know how daily food habits and lifestyle modification protect from pathogenic viral infections. This study focused on the benefit of plant-based foods, functional foods and the modified lifestyle which enhance the immunity of all aged groups against COVID-19 in Bangladesh. An online close-ended randomly selected structured multiple-choice questionnaire survey was conducted for people of different parts of Bangladesh (n = 161; male 51.55%, female 48.45%). The total percentage was counted for all variables. We found that plant-based foods, functional foods, and physical exercise played a vital role in enhancing people's immunity to control COVID-19. Plant-based micronutrients, nutraceuticals and antioxidants mainly took part to boost the immune system against the virus. Furthermore, physical activity had a vital role in improving people's immunity to manage COVID-19. Literature suggested that food habits, body immunity, awareness, stress and weight variation were affected by the COVID-19 pandemic. The vaccine or proper medication of COVID-19 still remains in an enigma. In this situation, boosting immunity to combat Coronavirus is the only way to survive.

Is Peracetic Acid Fumigation Effective in Public Transportation?

The COVID-19 pandemic made more people aware of the danger of viruses and bacteria, which is why disinfection began to be used more and more often. Epidemiological safety must be ensured not only in gathering places, but also in home and work environments. It is especially challenging in public transportation, which is a perfect environment for the spread of infectious disease. Therefore, the aim of the study was the identification of bacteria in crowded places and the evaluation of the effect of fumigation with peracetic acid (PAA) in public transportation. Inactivation of microorganisms in buses and long-distance coaches was carried out using an automatic commercial fogging device filled with a solution of peracetic acid stabilized with acetic acid (AA) and hydrogen peroxide (H₂O₂). Before and after disinfection, samples were taken for microbiological tests. The most prevalent bacteria were Micrococcus luteus and Bacillus licheniformis.Staphylococcus epidermidis was only present in buses, whereas Staphylococcus hominis and Exiguobacterium acetylicum were only present in coaches. Statistical analysis showed a significant reduction in the number of microorganisms in samples taken from different surfaces after disinfection in vehicles. The overall effectiveness of disinfection was 81.7% in buses and 66.5% in coaches. Dry fog fumigation with peracetic acid is an effective method of disinfecting public transport vehicles.

Prevention is political: political party affiliation predicts perceived risk and prevention behaviors for COVID-19

Background

Many US politicians have provided mixed messages about the risks posed by SARS-CoV-2/COVID-19 and whether and to what extent prevention practices should be put in place to prevent transmission. This politicization of the virus and pandemic may affect individuals’ risk perceptions and willingness to take precautions. We examined how political party affiliation relates to risk perception for one’s own and other people’s likelihood of SARS-CoV-2 infection/COVID-19 illness.

Methods

We surveyed members of a nationally-representative, probability-sampling based survey panel (N = 410) to examine their risk perceptions, precautionary behaviors, and political party affiliation.

Results

The more strongly one identified as a Republican, the less risk one perceived to oneself from SARS-CoV-2/COVID-19 and the less risk one perceived other people faced. Moreover, those identifying as more strongly Republican engaged in fewer preventive behaviors.

Conclusions

This differential response may affect virus transmission patterns and poses a considerable challenge for health communications efforts.

Decisions to attend holiday gatherings during COVID-19 and engagement in key prevention strategies - United States, January 2021

Gatherings where people are eating and drinking can increase the risk of getting and spreading SARS-CoV-2 among people who are not fully vaccinated; prevention strategies like wearing masks and physical distancing continue to be important for some groups. We conducted an online survey to characterise fall/winter 2020–2021 holiday gatherings, decisions to attend and prevention strategies employed during and before gatherings. We determined associations between practicing prevention strategies, demographics and COVID-19 experience. Among 502 respondents, one-third attended in person holiday gatherings; 73% wore masks and 84% practiced physical distancing, but less did so always (29% and 23%, respectively). Younger adults were 44% more likely to attend gatherings than adults ≥35 years. Younger adults (adjusted prevalence ratio (aPR) 1.53, 95% CI 1.19–1.97), persons who did not experience COVID-19 themselves or have relatives/close friends experience severe COVID-19 (aPR 1.56, 95% CI 1.18–2.07), and non-Hispanic White persons (aPR 1.57, 95% CI 1.13–2.18) were more likely to not always wear masks in public during the 2 weeks before gatherings. Public health messaging emphasizing consistent application of COVID-19 prevention strategies is important to slow the spread of COVID-19.

Exposure to hand sanitisers and other cleaning products in Victoria, Australia during the COVID-19 pandemic

BACKGROUND

In response to the COVID-19 pandemic, there was increased promotion and use of topical antiseptics (especially hand sanitisers) and cleaning products to reduce transmission of the SARS-CoV-2 virus. This study describes unintentional exposures (oral or ocular) to these substances by children during the first year (2020) of the COVID-19 pandemic compared to the previous year (2019).

METHODS

This was a retrospective observational study of unintentional exposures reported to the Victorian Poisons Information Centre for the period 1 January 2019 to 31 December 2020. Substances included topical antiseptics (including hand sanitisers), bleach, multipurpose cleaners, disinfectants and high-percentage ethanol products. We analysed data for two age groups; under 5 years and 5 to 14 years.

RESULTS

Oral exposures (ingestion or buccal) to topical antiseptics increased from 435 in 2019 to 882 in 2020 in the under 5 age group, with peak call numbers in 2020 coinciding with peaks in active COVID-19 daily case numbers. Oral exposures in older children (5-14 years) were lower (23 and 77 in 2019 and 2020, respectively). No children had moderate or severe symptoms at the time of the call to the Poisons Centre. Ocular exposures to topical antiseptics more than doubled from 2019 to 2020 (from 20 to 53 among children under 5 years, and 8 to 18 in older children). The majority of children with ocular exposure presented with mild symptoms; one had moderate symptoms. Changes in exposures to disinfectants, bleach and cleaners were smaller and not consistent with peaks in active COVID-19 cases.

CONCLUSIONS

Unintentional oral exposures to topical disinfectants (mainly hand sanitiser) by young children increased during the COVID-19 pandemic and were more prevalent during periods of increased COVID-19 cases. While there were no cases of severe harm identified, the high number of exposures suggests that appropriate use and storage of hand sanitisers should be promoted.

Epidemiological profile and temporal trend of exogenous intoxications in children and adolescents

Objective:

To describe the epidemiological profile and to analyze the trend in the incidence rate of exogenous poisoning concerning children and adolescents (0–19 years old) in the city of Arapiraca, Alagoas, Brazil, in the period from 2007 to 2015.

Methods:

Observational study with data extracted from the Notifiable Diseases Information System. The variables sex, age group, toxic agent, and circumstance were analyzed using descriptive statistics. For temporal analysis, cut-off rates of incidence/10,000 inhabitants were calculated and the inflection point regression model was used for analysis.

Results:

There were 5,539 cases of exogenous intoxication in individuals aged 0–19 years in the city, of which 53.1% (n=2,944) occurred in girls and 61.5% (n=3,405) in children aged 0–9 years. Medicines consisted in the main agent responsible for intoxications (28.5%; n=1,580), mainly by accidental use (18.2%; n=1,010). There was a significant increase in the events during the study period (Average Annual Percent Change: 12.7; 95%CI 1.1–25.6; p<0.001), with rates increasing from 56.52/10,000 inhabitants in 2007 to 56.64/10,000 inhabitants in 2015. The incidence of cases in girls increased from 57.34/10,000 inhabitants in 2007 to 62.27/10,000 inhabitants in 2015. In boys, the incidence of cases was stationary: 55.69/10,000 inhabitants to 50.9 /10,000 inhabitants in the same period.

Conclusions:

The study showed a higher frequency of cases in girls aged 0 to 4 years and an increasing trend in the incidence rate during the study period. Implementation of actions and strategies, with emphasis on health education, is needed in order to prevent cases of exogenous intoxication.

Perfil epidemiológico e tendência temporal de intoxicações exógenas em crianças e adolescentes

Resumo Objetivo: Descrever o perfil epidemiológico e analisar a tendência da taxa de incidência por intoxicações exógenas ocorridas em crianças e adolescentes (0–19 anos) em Arapiraca, Alagoas, Brasil, no período de 2007 a 2015. Métodos: Realizou-se um estudo observacional com dados extraídos do Sistema de Informações de Agravos de Notificação. No componente descritivo, foram analisadas as variáveis sexo, faixa etária, agente tóxico e circunstância mediante estatística descritiva (frequência). Para a análise temporal, foram calculadas as taxas de incidência/10 mil habitantes e foi utilizado o modelo de regressão por pontos de inflexão para a análise. Resultados: Ocorreram 5.539 casos de intoxicações exógenas em indivíduos de 0 a 19 anos em Arapiraca (AL), dos quais 53,1% (n=2.944) eram do sexo feminino e 61,5% (n=3.405) eram crianças de 0 a 9 anos. Os principais agentes responsáveis pelas intoxicações foram medicamentos (28,5%; n=1.580) e a circunstância frequente foi uso acidental (18,2%; n=1.010). Houve variação do coeficiente de incidência geral, o qual apresentou comportamento temporal crescente (average annual percent change: 12,7; intervalo de confiança — IC95% 1,1–25,6; p<0,001) e cuja taxa passou de 56,52/10.000 habitantes para 56,64/10.000 habitantes. A incidência de casos, no sexo feminino, passou de 57,34/10.000 habitantes para 62,27/10.000 habitantes e apresentou tendência crescente. Já no sexo masculino, a incidência de casos passou de 55,69/10.000 habitantes para 50,99/10.000 habitantes e apresentou comportamento temporal estacionário. Conclusões: O estudo demonstrou maior frequência de casos no sexo feminino, na faixa de 0 a 4 anos, e tendência crescente da taxa de incidência. Recomenda-se a implementação de ações e estratégias, com destaque para a educação em saúde, a fim de prevenir casos de intoxicação exógena.

In vitro virucidal efficacy of a dry steam disinfection system against Human Coronavirus, Human Influenza Virus, and Echovirus

This in vitro study was aimed to assess the efficacy of dry steam in inactivating Human Coronavirus OC43 (HCoV-OC43) as surrogate of SARS-CoV-2, Human Influenza Virus A/H1N1/WSN/33 and Echovirus 7 on stainless steel, polypropylene, and cotton. The virus models were chosen on the basis of their transmission route and environmental resistance. Tests were carried out under a laminar flow cabinet, where two panels of each material were contaminated with a viral suspension. The inocula were left to dry and then the virus on untreated panel (control) was collected by swabbing in order to determine the initial titer. The other panel was treated using a professional vacuum cleaner equipped with a dry steam generator. Dry steam is generated in a boiler where tap water is heated up to 155 °C at 5.5 bar pressure and then during the passage along the flexible hose the temperature decreases to a value between 100 °C and 110 °C at the output. The dry steam was applied for four sec with a window wiper on metal and plastic panels or a brush covered by a microfiber cap on cotton, simulating the steam application during routine cleaning. After the treatment, infectious virus possibly remained on the surface was collected following the same swabbing procedure applied for controls. HCoV-OC43 and Echovirus 7 were titrated by end-point method on HCT-8 line cells and Vero cells, respectively, while Human Influenza Virus was quantified by plaque reduction assay on MDCK cells. Dry steam resulted effective against the three viruses on all tested materials, achieving a mean Log₁₀ reduction factor ≥4 in viral titer of treated samples compared with controls according to UNI EN 14476:2019. Thus, dry steam may be proposed as an ease to use, effective, fast, and nontoxic alternative to chemicals for surface disinfection without damaging materials. Therefore, this device could be employed not only in healthcare facilities but also in occupational, domestic, and community settings, with advantages for environment and human health.

Applications of Healthcare Robots in Combating the COVID-19 Pandemic

Due to the increasing number of COVID-19 cases, there is a remarkable demand for robots, especially in the clinical sector. SARS-CoV-2 mainly propagates due to close human interactions and contaminated surfaces, and hence, maintaining social distancing has become a mandatory preventive measure. This generates the need to treat patients with minimal doctor-patient interaction. Introducing robots in the healthcare sector protects the frontline healthcare workers from getting exposed to the coronavirus as well as decreases the need for medical personnel as robots can partially take over some medical roles. The aim of this paper is to highlight the emerging role of robotic applications in the healthcare sector and allied areas. To this end, a systematic review was conducted regarding the various robots that have been implemented worldwide during the COVID-19 pandemic to attenuate and contain the virus. The results obtained from this study reveal that the implementation of robotics into the healthcare field has a substantial effect in controlling the spread of SARS-CoV-2, as it blocks coronavirus propagation between patients and healthcare workers, along with other advantages such as disinfection or cleaning.

Revisiting COVID-19 policies: 10 evidence-based recommendations for where to go from here

BACKGROUND

Strategies to control coronavirus 2019 disease (COVID-19) have often been based on preliminary and limited data and have tended to be slow to evolve as new evidence emerges. Yet knowledge about COVID-19 has grown exponentially, and the expanding rollout of vaccines presents further opportunity to reassess the response to the pandemic more broadly.

MAIN TEXT

We review the latest evidence concerning 10 key COVID-19 policy and strategic areas, specifically addressing: 1) the expansion of equitable vaccine distribution, 2) the need to ease restrictions as hospitalization and mortality rates eventually fall, 3) the advantages of emphasizing educational and harm reduction approaches over coercive and punitive measures, 4) the need to encourage outdoor activities, 5) the imperative to reopen schools, 6) the far-reaching and long-term economic and psychosocial consequences of sustained lockdowns, 7) the excessive focus on surface disinfection and other ineffective measures, 8) the importance of reassessing testing policies and practices, 9) the need for increasing access to outpatient therapies and prophylactics, and 10) the necessity to better prepare for future pandemics.

CONCLUSIONS

While remarkably effective vaccines have engendered great hope, some widely held assumptions underlying current policy approaches call for an evidence-based reassessment. COVID-19 will require ongoing mitigation for the foreseeable future as it transforms from a pandemic into an endemic infection, but maintaining a constant state of emergency is not viable. A more realistic public health approach is to adjust current mitigation goals to be more data-driven and to minimize unintended harms associated with unfocused or ineffective control efforts. Based on the latest evidence, we therefore present recommendations for refining 10 key policy areas, and for applying lessons learned from COVID-19 to prevent and prepare for future pandemics.

Alcohol-based hand sanitizer - composition, proper use and precautions

During the COVID-19 pandemic, the use of alcohol-based hand sanitizers (ABHS) increased worldwide among the public as well as the health care workers in pursuit to prevent the spread of SARS-CoV-2, the causative virus of COVID-19. Hand hygiene is one of the primary preventive measures to prevent the spread of harmful germs. Although ABHS are effective hand hygiene products and help reduce the transmission of pathogenic microorganisms, appropriate use of such products is necessary to ensure the maximum killing of pathogens and to prevent hazards associated with ABHS. The effectiveness of ABHS against different microorganisms, including SARS-CoV-2 is also documented, but proper knowledge on hand hygiene techniques, selection of appropriate hand sanitizer product, and safe handling of ABHS are required to avoid their adverse effects such as allergies, skin irritation, lung injury, fire hazards, and toxicities. The effectiveness of ABHS is dependent on several factors including its appropriate usage, manufacturing methods, the choice of active agents, and the appropriateness of the agent on the target pathogen. This article highlights the importance of proper usage, handling, and appropriate ABHS selection for maximum efficacy against intended pathogens and safe use of ABHS. User awareness can help promote the appropriate usage of ABHS and prevent its hazards, which ultimately can help in preventing the transmission of pathogenic microorganisms.

"You Are Not Alone"-Opportunities and Challenges for University Students' Collaborative Engagement When Dealing With Online Information About COVID-19

In view of the COVID-19 pandemic, students had to cope with the challenging situation of handling a vast amount of potentially conflicting online information while staying informed. Reading conflicting scientific information has been shown to require cognitive effort for one to integrate it successfully, but reading such information during a crisis–such as the COVID-19 pandemic–may cause additional emotional stress, as students also had to cope with critical aspects of the pandemic (e.g., physical distancing and uncertainty). Different studies have indicated that in crises, stress can be relieved by seeking online social support (as a coping strategy). Similarly, working together (as collaborative learning) can also help people more critically discuss information on a cognitive level. Based on the approaches of online collaborative learning and online social support seeking, we were interested in whether an individual vs. collaborative communication setting would lead to any differences in students’ cognitive as well as emotional engagement with conflicting information about COVID-19. In a 2 × 2 mixed design, N = 109 education science students were exposed to two conflicting texts regarding COVID-19 testing that contained current scientific information. The online experiment was conducted in Germany in April 2020, which was the beginning of lockdown in that country. After reading the two texts, participants were asked to reflect on their engagement with the conflicting information either individually (individual group, n = 49) or via chat collaboratively (collaboration group, n = 60 in 30 dyads). With respect to participants’ written reflections (content-analyzed regarding cognitive as well as emotional engagement), participants in the collaborative group, compared to those in the individual group, more often discussed the pandemic in general and less often engaged emotionally when discussing the evidence from texts. All participants reported higher perceived information overload, lower self-efficacy in sourcing information about COVID-19, and higher active coping strategies after the reflection task compared to before reading the information, with no significant differences between the collaborative and individual groups. We discuss these findings regarding any opportunities and challenges that arise in online collaboration between students for cognitive and emotional engagement when handling conflicting information about COVID-19.

Event-Based Surveillance of Poisonings and Potentially Hazardous Exposures over 12 Months of the COVID-19 Pandemic

The COVID-19 pandemic has seen people and governments utilise an array of chemical and pharmaceutical substances in an attempt to prevent and treat COVID-19 infections. The Centre for Radiation, Chemicals and Environmental Hazards (CRCE) at Public Health England (PHE) routinely undertakes Event-Based Surveillance (EBS) to monitor public health threats and incidents related to chemicals and poisons. From April 2020, EBS functions were expanded to screen international media for potentially hazardous exposures associated with the COVID-19 pandemic. Media sources reported that poisons centres were experiencing increased enquiries associated with the use and misuse of household cleaners and alcohol-based hand sanitiser (HS). There were also media reports of people self-medicating with over-the-counter supplements and traditional or herbal remedies. Public figures who directly or indirectly facilitated misinformation were sometimes reported to be associated with changes in poisoning trends. Border closures were also believed to have been associated with increasingly toxic illicit drug supplies in Canada, and record numbers of opioid-related deaths were reported. In other countries, where the sale of alcohol was banned or limited, home-brewing and methanol-based supplies resulted in a number of fatalities. At least two chemical incidents also occurred at industrial sites in India, after sites were left unattended or were closed and reopened due to lockdown measures. Reports of poisoning identified in the international media were provided to the UK National Poisons Information Service (NPIS) and contributed to the UK COVID-19 public health response.

The use of cleaning products and its relationship with the increasing health risks during the COVID-19 pandemic

OBJECTIVE

The present study aimed to determine the factors affecting the use of cleaning products at the home environment and the frequency of problems during the coronavirus disease-19 (COVID-19) pandemic.

MATERIALS AND METHODS

This cross-sectional research was performed online between 30 August 2020 and 15 September 2020. The population of the study consisted of adults aged between 18 and 80 years, affected by the COVID-19 pandemic. Data collection forms (introductory information and risk perception form and cleaning products usage characteristics form) were shared through Web2 tools. The questionnaire study was completed with 674 participants between the ages of 18 and 80 years in Turkey. Descriptive statistics and classification tree were used in the analysis of the data. Statistical significance was accepted as P ≤ .01 in all analyses.

RESULTS

During the pandemic period compared with the pre-pandemic period, it was observed that the frequency of cleaning (69.3%) and the amount of cleaning product usage (74.2%) increased significantly and the frequency of problems related to the use of cleaning products was found as 46.9%. The most commonly reported problems were skin disturbances (68%) and shortness of breath (23%). It was determined that the history of contact with the COVID-19 patient, the perceived risk of COVID-19 infection and risky cleaning behaviour were predictive in determining the risk of experiencing problems related to cleaning products. The amount of bleach consumed per month among who did experience problems was higher than those who did not experience problems and was associated with the perceived risk of COVID-19 infection.

CONCLUSION

In the COVID-19 pandemic, human beings have been found to increase the frequency of cleaning and using cleaning products. In order to reduce the negative effects of chemicals used for cleaning on human and environmental health, the trainings to be given by the teams providing primary healthcare services can be effective as well as general education activities for community groups.