Home and everyday life hygiene

Home and everyday life hygiene

Home hygiene pertains to the hygiene practices that prevent or minimize disease and the spreading of disease in home (domestic) and in everyday life settings such as social settings, public transport, the work place, public places etc.

Hygiene in home and everyday life settings plays an important part in preventing spread of infectious disease. It includes procedures used in a variety of domestic situations such as hand hygiene, respiratory hygiene, food and water hygiene, general home hygiene (hygiene of environmental sites and surfaces), care of domestic animals, and healthcare (the care of those who are at greater risk of infection).

At present, these components of hygiene tend to be regarded as separate issues, although all are based on the same underlying microbiological principles. Preventing the spread of infectious diseases means breaking the chain of infection transmission. The simple principle is that, if the chain of infection is broken, infection cannot spread. In response to the need for effective codes of hygiene in home and everyday life setting the International Scientific Forum on Home Hygiene has developed a risk-based approach (based on Hazard Analysis Critical Control Point  (HACCP), which has come to be known as ‘targeted hygiene’. Targeted hygiene is based on identifying the routes of spread of pathogens in the home, and applying hygiene procedures at critical points at appropriate times to break the chain of infection.

The main sources of infection in the home are people (who are carriers or are infected), foods (particularly raw foods) and water, and domestic animals (in western countries more than 50% of homes have one or more pets). Additionally, sites that accumulate stagnant water—such as sinks, toilets, waste pipes, cleaning tools, face cloths—readily support microbial growth, and can become secondary reservoirs of infection, though species are mostly those that threaten “at risk” groups. Germs (potentially infectious bacteria, viruses etc.) are constantly shed from these sources via mucous, faeces, vomit, skin scales, etc. Thus, when circumstances combine, people become exposed, either directly or via food or water, and can develop an infection. The main “highways” for spread of germs in the home are the hands, hand and food contact surfaces, and cleaning cloths and utensils. Germs can also spread via clothing and household linens such as towels. Utilities such as toilets and wash basins, for example, were invented for dealing safely with human waste, but still have risks associated with them, which may become critical at certain times, e.g., when someone has sickness or diarrhea. Safe disposal of human waste is a fundamental need; poor sanitation is a primary cause of diarrheal disease in low income communities. Respiratory viruses and fungal spores are also spread via the air.

Good home hygiene means targeting hygiene procedures at critical points, at appropriate times, to break the chain of infection i.e. to eliminate germs before they can spread further. Because the “infectious dose” for some pathogens can be very small (10-100 viable units, or even less for some viruses), and infection can result from direct transfer from surfaces via hands or food to the mouth, nasal mucosa or the eye, 'hygienic cleaning' procedures should be sufficient to eliminate pathogens from critical surfaces. Hygienic cleaning can be done by:

• Mechanical removal (i.e. cleaning) using a soap or detergent. To be effective as a hygiene measure, this process must be followed by thorough rinsing under running water to remove germs from the surface.
• Using a process or product that inactivates the pathogens in situ. Germ kill is achieved using a “micro-biocidal” product i.e. a disinfectant or antibacterial product or waterless hand sanitizer, or by application of heat.
• In some cases combined germ removal with kill is used, e.g. laundering of clothing and household linens such as towels and bedlinen.

FOOD SAFETY

Ten point plan for safer cooked meat production
Preparation
1. Clean and disinfect the raw meat preparation area before you start. This area must be separate from any area in which cooked meat is handled.
A detergent solution should be used to clean surfaces before they are disinfected. It is important to use the correct disinfectant for surfaces and equipment which will not adversely affect the food, and to use it at the appropriate concentration for the minimum specified time. For guidance on the use of disinfectants see point 9.
Wash your hands before and after handling the raw meat.
Cooking
2. To cook meat safely so that E.coli 0157, Salmonella and Listeria are killed, the centre of the meat must reach a core temperature of at least 70°c for 2 minutes or the equivalent temperature/time combination see 10). It is important that the juices run clear.
3. Make sure your cooking equipment can achieve this consistently.
4. The cooking process must be monitored. You should record the core temperature of at least one item for every cook using a probe thermometer. Wash and disinfect the probe thermometer after each use. Remember to check the accuracy of the thermometer regularly.
Cooling
5. The cooked product should be cooled as quickly as possible in order to prevent the growth of food poisoning bacteria and then kept under refrigeration. Remember the smaller the joint the quicker it cools.
Handling after cooking
6. Clean and disinfect the cooked product handling area, which must be separate from any area in which raw products are handled.
7. Always wash your hands before handling cooked products.
All equipment must be thoroughly cleaned and disinfected before and after use on cooked foods.
8. NEVER allow raw foods or any other product, used utensil or tool, or surface likely to cause contamination to come into contact with cooked foods.
REMEMBER THAT FOOD POINSONING FROM COOKED FOODS OFTEN OCCURS AS A RESULT OF CROSS-CONTAMINATION FROM RAW FOODS (DIRECTLY OR INDIRECTLY).
Help available
9. Your Trade Associations or Environmental Health Officer will be only too pleased to help you if you need any advice on the safe handling of foods, and on disinfectants. For safe and effective use of disinfectants always follow the manufacturers instructions very carefully.
10. EQUIVALENT CORE COOKING TIME/TEMPERATURE
Temperature Time
60°c 45 minutes
65°c 10 minutes
70°c 2 minutes
75°c 30 seconds
80°c 6 seconds

GENERAL PATHOLOGY

GENERAL PATHOLOGY

General pathology is the study of the functional and structural changes that occur in cells and tissues as a result of direct damage by, or reactions to, a wide range of unfavourable circumstances. At any given time our knowledge of these circumscribed by the techniques available to study these processes. Despite this reservation, it is probably true to say that the number of responses of the mammalian cell is finite. These responses represent, on the whole, either an increase or a reduction or loss in some of the components of a large, but not infinite, number of normal cell processes.

            This general principle holds good only so long as so change has taken place in the genome of the target cell or in the transcription of its genetic information. If such changes have occurred, them a new range of phenotypic characteristics and new responses, not characteristics of this cell (at least in its adult or fully differentiated form), may be acquired. The words “adult or fully differentiated” should be stressed because the acquisition of apparently new functions (such as the secretion of fetal antigens by the cells of the tumours) may be the expression of functions that were normal and appropriate at an earlier stage of the organism’s embryological development.

Morphological Change Can Occur Without Significant Functional Disturbance

Morphological Change Can Occur Without Significant Functional Disturbance

In other situations a considerable degree of morphological alteration may be present as, for instance, in some large benigh neoplasms, but functional disturbance may be slight or absent. 

Severe Functional Disturbances Need Not be Accompanied by Significant Structural Changes

Severe Functional Disturbances Need Not be Accompanied by Significant Structural Changes

A direct relationship between disordered function and disordered structure is not always present and there may be very severe functional disturbances without any significant structural changes being present. A striking example of this has been of the worst scourges of humankind, yet it is caused by an organism, Vibrio cholera, that cannot either destroy the lining cells of the gut wall or even penetrate between them. There is no microscopic evidence that the organism damages any tissue. However, if untreated, more than half of the infected people will die from the dehydration and electrolyte disturbances that are V.Cholerae causes. This diarrhea occurs because the epithelial lining cells of the intestine respond to a toxin, secreted by the organism, which behaves in the same way as a normal hormonal regulatory signal. When food is delivered to the small intestine, a peptide binds to a receptor site on the luminal membrane of the small intestinal epithelial cell and stimulates the adenylate cyclase system, with the result that about 2 litres of alkaline fluid are pumped into the small intestine.

THE CONCEPT OF DISEASE

THE CONCEPT OF DISEASE

What is disease? Some have defined it as the condition in which the normal function of some part or organ of the body is disturbed. Others have maintained that disease does not exist except as a reaction to injury. These definitions are both valid and in no way mutually exclusive. Any individual disease can usefully be regarded, in terms of simple set theory, as the common set of a number of sets, most notably type of injury, type of reaction and the location of injury. One can expand this simple concept to cover situations in which cells, tissue or organs are acted upon unfavourably either by injurious agents or by inborn errors acting alone or in conjunction of events that follows may be dominated by the direct effects of the injurious agent on the cell (as in certain chemical injuries), or may be a combination of these direct effects, and the local and general cell and tissue reactions that may be elicited.

            The functional disturbances produced by injury to cells are often mirrored by structural changes (a lesion), just as, in turn, structural damage may be followed by loss or alteration of some normal function. The sum of these effects finds its expression in the symptoms experienced by the patient and the signs observed by the physician.

OBESITY AND HEALTH

OBESITY AND HEALTH

The relationship between obesity cardiovascular risk factors and cardiovascular disease (CVD) has been documented by numerous studies. The following are the major issued that remain unresolved:

1.    Whether there is a threshold level of obesity and increase in prevalence of cardiovascular risk factors.

2.    Whether the increase in risk factors primarily is a function of weight gain over time or the extent of overweight / obesity at a specific age, and

3.    Whether weight gain between different ages has similar effects on cardiovascular risk factors?

Weight gain is associated with increased cardiovascular risk factors. Are the changes in risk factors with weight gain a function of increased caloric intake, decreased energy expenditure, or changes in specific types of calories and nutrients, namely fat, saturated fat, salt intake, or dietary cholesterol? Is the relationship between measures of obesity and risk of CVD linear, or is there a threshold effect? Is there a relationship between the distribution of body fat and risk of CVD, independent of the level of obesity? Is the association of measures of obesity and distribution of body fatness and subsequent risk of CVD age dependent? What are the possible pathophysiological processes that relate obesity and distribution of body fat to the risk of CVD?

            There is solid evidence that weight loss is associated with a decrease in cardiovascular risk factors [such as blood pressure, low density lipoprotein cholesterol (LDLC), and blood glucose levels]. Evidence that weight reduction is associated with a decrease in morbidity and mortality caused by CVD is weaker, and the magnitude of the effect is still unknown.

WOMEN WITH LOW RISK PREGNANCIES SHOULD BE ABLE TO CHOOSE WHERE THEY GIVE BIRTH

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WOMEN WITH LOW RISK PREGNANCIES SHOULD BE ABLE TO CHOOSE WHERE THEY GIVE BIRTH
Research: Perinatal and maternal outcomes by planned place of birth for women with low risk pregnancies: The Birthplace in England national prospective cohort study.

Women with low risk pregnancies should be able to choose where they give birth, concludes a study published on bmj.com today.Although it shows that first-time mums who opt for a home birth are at a higher risk of adverse outcomes, the overall risk is low in all birth settings.The researchers say their results "support a policy of offering women with low risk pregnancies a choice of birth setting" and will enable women and their partners to have informed discussions with health professionals about planned place of birth. Perinatal refers to the period just before, during or shortly after birth. So a team led by Professor Peter Brocklehurst from the University of Oxford for the Birthplace in England Collaborative Group set out to compare perinatal outcomes and interventions in labour by planned place of birth across all NHS trust in England. Planned place of birth included home, freestanding midwifery units, midwife-led units on a hospital site with obstetric service, and obstetric units. Serious adverse outcomes included stillbirth after start of care in labour, early neonatal death, brain injury (encephalophaty), faeces in the lungs (meconium aspiration syndrome), and injuries to the upper arm or shoulder during birth. A total of 64,538 single, full term infants born to women with low risk pregnancies were involced in the study. Factors, such as maternal age, ethnic group, body mass index and deprivation score were taken into account. Overall, the rate of adverse outcomes was low in all birth settings (4.3 per 1,000 births) and there were no significant differences in the odds of an adverse outcome for any of the non-obstetric unit settings compared with obstetric units.For women giving birth for the first time (nulliparous women), the risk of an adverse outcome was higher (9.3 per 1,000 births) for planned home births compared with obstetric units, but not for either midwifery unit settings. In contrast, for women who had given birth before (multiparous women), there were no significant differences in the rate of adverse outcomes between birth settings. the results also show that interventions during labour, such as epidural, forceps delivery or caesarean section, were substantially lower in all non-obstetric unit settings. Transfer from non-obstetric unit settings were also much higher (up to 45%) for nulliparous women than for multiparous women (up to 13%). "These results will enable women and their partners to have informed discussions with health professionals in relation to clinical outcomes and planned place of birth," say the authors. "For policy makers, the results are important to inform decisions about service provision and commissioning." They add that a cost effectiveness analysis of the different birth settings is currently being carried out, and they suggest that further research on this issue is needed, particularly into the effect of staffing and service configuration on outcomes, and more detailed analysis of transfer from non-obstetric settings.

ALTERNATIVE CANCER TREATMENTS

Alternative cancer treatments

Alternative cancer treatments describes alternative and complementary treatments for cancer that have not been approved by the government agencies responsible for the regulation of therapeutic goods. They include diet and exercise, chemicals, herbs, devices, and manual procedures. The treatments may be untested or unsupported by evidence, either because no proper testing has been conducted, or because testing did not demonstrate statistically significant efficacy. Concerns have been raised about the safety of some of them.

Alternative cancer treatments are typically contrasted with experimental cancer treatments, which are treatments for which experimental testing is currently underway. All currently approved chemotherapeutic cancer treatments were considered experimental cancer treatments before their safety and efficacy testing was completed.

Such therapies can be categorized broadly into three groups: alternative treatments offered as a substitute to standard medical treatment; alternative treatments as an addition to standard treatment; and treatments proposed in the past that have been found in clinical trials to be useless and/or unsafe. Some of these obsolete or disproven treatments continue to be promoted, sold, and used.

Since the 1940s, medical science has developed chemotherapy, radiation therapy, adjuvant therapy and the newer targeted therapies, as well as refining surgical techniques for removing cancer. Before the development of these modern, evidence-based treatments, 90% of cancer patients died with five years. With modern mainstream treatments, only 34% of cancer patients die within five years. However, while generally prolonging life or permanently curing cancer, most effective, mainstream forms of cancer treatment have side effect ranging from unpleasant to fatal, and permanent cures are not guaranteed. These side effects and the uncertainty of success create appeal for alternative treatments for cancer, which purport to cause fewer side effects or to increase survival rates.

Alternative cancer treatments have typically not undergone properly conducted, well-designed clinical trials, or the results have not been published due to publication bias (a refusal to publish results showing a treatment does not work).  Among those that have been published, the methodology is often poor. A 2006 systematic review of 214 articles covering 198 clinical trials of alternative cancer treatments concluded that almost none conducted dose-ranging studies, which are necessary to ensure that the patients are being given a useful amount of the treatment. These kinds of treatments appear and vanish frequently, and have throughout history.

THE HISTORY OF THE PAP TEST

THE HISTORY OF THE PAP TEST

The pap test is considered by many to be the most cost effective cancer reduction program ever devised. Credit for its conception and development goes to George N. Papanicolaou, an anatomist and Greek immigrant to the Unites States. In 1928 he reported that malignant cells from the cervix can be identified in vaginal smears. Later, in collaboration with the gynaecologist Herbert Traut, who provided him with a large number of clinical samples, Papanicolaou published detailed descriptions of preinvasive cervical lesions. Pathologist and physicians initially greeted this technique with skepticism, but by the late 1940s Papanicolaou’s observations had been confirmed by others. The Canadian gynaecologist J. Ernest Ayre suggested taking samples directly from the cervix with wooden spatula rather than from the vagina with a pipette as originally described by Papanicolaou.” Eventually, cytologic smears were embraces as  an ideal screening test for preinvasive lesions, which, if treated, would be prevented from developing into invasive cancer.

                The first cervical cancer screening clinics were established in the 1940s,” The Pap test was never evaluated in a controlled, prospective study, but several pieces of evidence link it to the prevention of cervical cancer. First, the mortality rate from cervical cancer fell dramatically after screening was introduced, by 72% in British Columbia and 70% in Kentucky. Second, there was a direct correlation between the intensity of screening and the decrease in mortality. Among Scandinavian countries, the death rate fell by 80% in Iceland, where screening was greatest; in Norway, where screening was lowest, the death rate fell by only 10%. A similar correlation was observed in high and low screening regions of Scotland and Canada. In the United States, the decrease in deaths from cervical cancer was proportional to the screening rates in various states. Finally, women who do not develop invasive cancer are more likely to have had a Pap test than women with cancer. In Canadian study, the relative risk for women who had not had a Pap test for 5 years was 2.7, and screening history was a highly significant risk factor independent of other factors such as age, income, education, sexual history, and smoking. In Denmark, a woman’s risk of developing cervical cancer decreased in proportion to the number of negative smears she had had, by 48% with just one negative smear, 69% with two to four negative smears, and 100% with five or more smears.

                Screening guidelines differ around the world. Even in the United States, the recommendations of different organizations vary in some of their details. The American Cancer Society (ACS) recommends the following:

-          Cervical cancer screening should begin approximately 3 years after a woman begins having vaginal intercourse, but no later than 21 years of age.

-          Until age 30, cervical screening should be carried out every year with conventional Pap tests or every 2 years using liquid-based Pap tests.

-          At or after age 30, a woman who has had three normal test result in a row may be screened every 2 to 3 years with a Pap test (smear or liquid-based) or every 3 years with a Pap plus human papilloma virus (HPV) test.

-          A women 70 years of age and older has had three or more normal Pap test results and no abnormal results in the previous 10 years may choose to stop cervical cancer screening.

-          A women who has had a total hysterectomy  may choose to stop cervical cancer screening. [Exceptions are women with a history of CIN2,3, cervical cancer, or in utero diethylstilbestrol [DES] exposure.)

Women with a history of cervical cancer, in utero DES exposure, and who are immunocompromised (organ transplantation, chemotherapy, chronic corticosteroid treatment, or positive for human immunodeficiency virus (HIV) may benefit from more frequent screening. Adherence to these guidelines is critical for cervical cancer prevention. In the United States, more than 50% of women who develop cervical cancer have not had a Pap test in the 3 years before their cancer diagnosis.

The recent development of two prophylactic HPV vaccines provides a new opportunity for cervical cancer prevention. Both vaccines consist of empty protein shells called virus-like particles that are made up of the major HPV capsidprotein L1.They contain DNA AND ARE NOT INFECTIOUS. One of the vaccines, Gardasil (Merck & Co., Inc.), is a quadrivalent vaccine against HPV types 6, 11, 16, and 18. The other is the bivalent vaccine Cervarix (GlaxoSmithKline) that protects against HPV 16 and 18.They have shown extraordinary efficacy in preventing type-specific histologic CIN 2, 3 lesions, with no different in serious adverse effects compared to placebo. The vaccines are administered in three doses to females ages 9 to 26 years before the intiation of sexual activity. Continued Pap screening will remain important for many decades, however, because these vaccines do not protect against 30% of cervical cancers(i.e., those not related to HPV 16 or 18); the duration in treating prevalent HPV infections; and the cost of the vaccines light limit their use in some populations.

As seen in the aforementioned ACS recommendations, thecombination of a Pap test plus HPV test is included as an option for screening women 30 years of age or older. The rationale is to combine the superior sensitivity of HPV testing with the superior specificity of the Pap test. This recommendation is controversial because regarding the ideal management of women with discrepant results (e.g.,HPV test positive and Pap negative). The search for the best screening algorithm will undoubtedly continue, particularly as molecular diagnostic methods become more readily available.