Infection prevention and control: knowledge, practices and associated factors among cleaners at a National Referral Hospital in Uganda.

Background: While most infection prevention and control (IPC) studies focus on healthcare professionals, IPC is everyone's responsibility in any healthcare facility. There is little known about the IPC knowledge among the cleaners who are responsible for housekeeping, environmental cleaning, and waste management within hospitals. This study sought to evaluate the knowledge and practice of IPC among cleaners at Mulago National Referral Hospital (MNRH) to establish a foundation for empowering a strategic workforce that will improve IPC practices within the hospital. Methods: A cross-sectional study was conducted among the cleaners in a national referral hospital in Uganda. The participants were purposively sampled, and data was collected using a web-based, interviewer-administered, questionnaire about IPC knowledge and practices. Results: Of the 120 cleaners recruited, 52.5% were female. Good IPC knowledge was demonstrated in 58.3%, and 30.8% reported good IPC practices. Participants with at least 5 years' work experience had higher knowledge levels (aOR: 10.3, P=0.006, 95% CI: 2-54). Those closely supervised had lower IPC knowledge compared with those with less supervision. Participants with fixed work schedules (aOR: 0.2, P=0.028, 95%CI: 0-0.8), were less likely to exhibit good IPC practices. In addition, 63.1% were knowledgeable about waste segregation, recognising bin colours and the correct disposal of sharps and needles. Despite good compliance with personal protective equipment, poor hand-washing practices were reported. A positive correlation between knowledge and practice scores was established. Conclusion: Hospital cleaners in a national referral hospital in Uganda IPC reported poor infection prevention practices despite good knowledge. For IPC knowledge and practice to correlate positively, ongoing practical training is vital to maintain knowledge and good practice to establish a successful IPC program.

Use of Portable Air Cleaners in Washington State Schools: A Qualitative Analysis Based on the Technology Acceptance Model.

BACKGROUND: The US government allocated over $2.5 billion in "Elementary and Secondary School Emergency Relief (ESSER)" funds to Washington State for COVID-19 response and ventilation improvements. Despite available funding, gaps persist in supporting schools to successfully use portable air cleaners (PACs). We evaluated PAC needs within King County, Washington and characterized factors influencing schools' purchase and use of PACs. METHODS: Public Health-Seattle & King County (PHSKC) assessed school's ventilation systems and IAQ improvements through a survey (N = 17). Separately, semi-structured interviews (N = 13) based on the technology acceptance model (TAM) were conducted with school personnel. A thematic analysis using inductive and deductive coding was conducted and logistic regression models assessed the predictive capability of the TAM. RESULTS: The PHSKC survey findings informed our recommendations. Positive attitudes, knowledge, and beliefs in ease of use and effectiveness of PACs were facilitators to PAC use. While barriers included a lack of training, education, and concerns about PAC maintenance and sustainability. TAM constructs of perceived usefulness (PU) and perceived ease of use (PEU) were predictive of having the intention to use PACs in schools. CONCLUSIONS: There is a critical need for solutions to circumvent challenges to implementing PACs in schools. This characterization provides insight for promoting PAC use in IAQ-impacted schools.

Effects of Overnight Denture Cleaners on Surface and Optical Properties of Conventional, CAD/CAM Milled, and 3D Printed Dentures.

OBJECTIVE: Evaluate the roughness and color stability of different types of resins used to immerse denture bases in various denture cleansers overnight. METODOLOGY: A total of 150 resin samples were made, which were divided into 3 groups of denture resin (conventional thermally activated, milled and 3D printed) (n= 50) and subdivided into 5 denture cleaners (Distilled water, Corega Tabs, Efferdent, NaOCl 1.0%, Listerine Cool Hint) (n= 10). The roughness properties (Ra) and chromatic difference (ΔE00) were evaluated during 90 days and 180 days of overnight cleaning. Data were evaluated by two-way ANOVA and Tukey's test for multiple comparisons (P<.05). RESULTS: Listerine had significantly higher Ra and ΔE values (P<.001) compared to other solutions, being significant in conventional resin at 180 days (P<.001). CONCLUSIONS: The use of Listerine as an overnight cleaner presents greater damage to the optical and surface properties of denture base resins, mainly with conventional resin, with 1% NaOCl being a valid option in relation to cost-benefit.

Quantification of Byproduct Formation from Portable Air Cleaners Using a Proposed Standard Test Method.

In response to the COVID-19 pandemic, air cleaning technologies were promoted as useful tools for disinfecting public spaces and combating airborne pathogen transmission. However, no standard method exists to assess the potentially harmful byproduct formation from air cleaners. Through a consensus standard development process, a draft standard test method to assess portable air cleaner performance was developed, and a suite of air cleaners employing seven different technologies was tested. The test method quantifies not only the removal efficiency of a challenge chemical suite and ultrafine particulate matter but also byproduct formation. Clean air delivery rates (CADRs) are used to quantify the chemical and particle removal efficiencies, and an emission rate framework is used to quantify the formation of formaldehyde, ozone, and other volatile organic compounds. We find that the tested photocatalytic oxidation and germicidal ultraviolet light (GUV) technologies produced the highest levels of aldehyde byproducts having emission rates of 202 and 243 µg h-1, respectively. Additionally, GUV using two different wavelengths, 222 and 254 nm, both produced ultrafine particulate matter.

Precarious employment and mental health in the Belgian service voucher system: the role of working conditions and perceived financial strain.

INTRODUCTION: Jobs in domestic cleaning are often conceived as 'precarious employment' (PE)-i.e. a multidimensional concept referring to accumulated adverse characteristics of employment due to workers' weak bargaining position. Against this background, the Belgian service voucher system (SVS) was implemented aimed at creating formal and stable, subsidized domestic services jobs. PURPOSE: The current study assesses the relationship between PE and mental health (WHO5) in the Belgian SVS, accounting for the potential mediating role of working conditions and perceived financial strain at the household level. METHODS: We analysed a cross-sectional sample of 1,115 Belgian SVS domestic cleaners, collected in 2019 through an online survey. A mediation model was estimated. RESULTS: The crude effect of PE on adverse mental health was strong (ß 0.545-S.E. 0.063). However, 50% of the association between PE and mental well-being was mediated by work task characteristics (quantitative demands, physical demands, task variation and autonomy) and 25% by household-level perceived financial strain. The remaining direct effect of PE on adverse mental well-being is ß 0.066 (S.E. 0.032-25% of the total effect). CONCLUSION: These findings are the first based on the Belgian Employment Precariousness Scale (EPRES-BE) and are consistent with earlier-made-but seldom simultaneously tested-assumptions on the mechanisms relating PE to adverse mental health-i.e. involving direct associations and indirect associations via adverse working conditions and material deprivation. Based on the results, we recommend more democratic and higher-quality management practices in the SVS, in addition to higher wages and working time reduction.

Self-reported health impacts of do-it-yourself air cleaner use in a smoke-impacted community.

Background: Smoke exposure from wildfires or residential wood burning for heat is a public health problem for many communities. Do-It-Yourself (DIY) portable air cleaners (PACs) are promoted as affordable alternatives to commercial PACs, but evidence of their effect on health outcomes is limited. Objective: Pilot test an evaluation of the effect of DIY PAC usage on self-reported symptoms, and investigate barriers and facilitators of PAC use, among members of a tribal community that routinely experiences elevated concentrations of fine particulate matter (PM2.5) from smoke. Methods: We conducted studies in Fall 2021 ("wildfire study"; N = 10) and Winter 2022 ("wood stove study"; N = 17). Each study included four sequential one-to-two-week phases: 1) initial, 2) DIY PAC usage ≥8 h/day, 3) commercial PAC usage ≥8 h/day, and 4) air sensor with visual display and optional PAC use. We continuously monitored PAC usage and indoor/outdoor PM2.5 concentrations in homes. Concluding each phase, we conducted phone surveys about participants' symptoms, perceptions, and behaviors. We analyzed symptoms associated with PAC usage and conducted an analysis of indoor PM2.5 concentrations as a mediating pathway using mixed effects multivariate linear regression. We categorized perceptions related to PACs into barriers and facilitators of use. Results: No association was observed between PAC usage and symptoms, and the mediation analysis did not indicate that small observed trends were attributable to changes in indoor PM2.5 concentrations. Small sample sizes hindered the ability to draw conclusions regarding the presence or absence of causal associations. DIY PAC usage was low; loud operating noise was a barrier to use. Discussion: This research is novel in studying health effects of DIY PACs during wildfire and wood smoke exposures. Such research is needed to inform public health guidance. Recommendations for future studies on PAC use during smoke exposure include building flexibility of intervention timing into the study design.

Randomized Trial to Test a Chemo-Mechanical Antiplaque Regimen as Adjunct to Periodontal Therapy.

BACKGROUND: The control of dental biofilm regrowth after nonsurgical periodontal therapy is associated with better clinical outcomes. However, many patients have difficulty achieving optimal plaque control. Subjects with diabetes, in which immune and wound-healing responses are typically impaired, may benefit from intensive antiplaque control regimens after scaling and root planing (SRP). OBJECTIVES: This study aimed to evaluate the effects of an intensive, at-home, chemical, and mechanical antiplaque regimen as an adjunct to SRP for the treatment of moderate to severe periodontitis. A secondary objective was to compare responses in subjects with type 2 diabetes and nondiabetics. METHODS: This was a 6-mo, single-center, parallel-group, randomized trial. The test group received SRP and oral hygiene instructions, and subjects were instructed to use a 0.12% chlorhexidine gluconate mouthrinse twice a day for 3 mo and utilize rubber interproximal bristle cleaners twice a day for 6 mo. The control group received SRP and oral hygiene instructions. The main outcome was change in mean probing depth (PD) from baseline to 6 mo. Secondary outcomes included change in sites with deep PDs, mean clinical attachment level, bleeding on probing, plaque index, hemoglobin A1C, fasting blood glucose, C-reactive protein, and taste assessment. This study was registered at ClinicalTrials.gov as NCT04830969. RESULTS: In total, 114 subjects were randomized to either treatment. Eighty-six subjects completed the trial with no missing visits. Neither an intention-to-treat nor a per-protocol analysis showed statistically significant differences between treatment groups in mean PD at 6 mo. In a subgroup analysis, subjects with diabetes in the test group showed a statistically significant greater reduction in mean PD at 6 mo when compared to subjects with diabetes receiving the control treatment (Δ = 0.15, P = 0.04), while there were no differences within nondiabetics (Δ = 0.02, P = 0.75). CONCLUSION: Outcomes in subjects with diabetes may be improved by chemo-mechanical antiplaque measures after nonsurgical periodontal therapy. KNOWLEDGE TRANSFER STATEMENT: This study suggests diabetic subjects may benefit from an intensive, at-home, chemical, and mechanical antiplaque regimen to improve nonsurgical periodontal therapy outcomes.

Effectiveness of experimental dentifrices based on essential oils on biofilm on complete dentures: an in vitro study

Abstract Specific products containing natural resources can contribute to the innovation of complete denture hygiene. Objective: To conduct an in vitro evaluation of experimental dentifrices containing essential oils of Bowdichia virgilioides Kunth (BvK), Copaifera officinalis (Co), Eucalyptus citriodora (Ec), Melaleuca alternifolia (Ma) and Pinus strobus (Ps) at 1%. Methodology: The variables evaluated were organoleptic and physicochemical characteristics, abrasiveness (mechanical brushing machine) simulating 2.5 years, and microbial load (Colony Forming Units - CFU/mL), metabolic activity (XTT assay) and cell viability (Live/Dead® BacLight™ kit) of the multispecies biofilm (Streptococcus mutans: Sm, Staphylococcus aureus: Sa, Candida albicans: Ca and Candida glabrata: Cg). Specimens of heat-polymerized acrylic resins (n=256) (n=96 specimens for abrasiveness, n=72 for microbial load count, n=72 for biofilm metabolic activity, n=16 for cell viability and total biofilm quantification) with formed biofilm were divided into eight groups for manual brushing (20 seconds) with a dental brush and distilled water (NC: negative control), Trihydral (PC: positive control), placebo (Pl), BvK, Co, Ec, Ma or Ps. After brushing, the specimens were washed with PBS and immersed in Letheen Broth medium, and the suspension was sown in solid specific medium. The organoleptic characteristics were presented by descriptive analysis. The values of density, pH, consistency and viscosity were presented in a table. The data were analyzed with the Wald test in a generalized linear model, followed by the Kruskal-Wallis test, Dunn's test (mass change) and the Bonferroni test (UFC and XTT). The Wald test in Generalized Estimating Equations and the Bonferroni test were used to analyze cell viability. Results: All dentifrices showed stable organoleptic characteristics and adequate physicochemical properties. CN, Ec, Ps, Pl and PC showed low abrasiveness. There was a significant difference between the groups (p<0.001) for microbial load, metabolic activity and biofilm viability. Conclusions: It was concluded that the BvK, Ec and Ps dentifrices are useful for cleaning complete dentures, as they have antimicrobial activity against biofilm. The dentifrices containing Bowdichia virgilioides Kunth showed medium abrasiveness and should be used with caution.

Effectiveness of methods for removing the Candida albicans biofilm from the dental acrylic surface.

BACKGROUND: Approximately half of the adult population in Europe have used some form of dental prosthesis. Much effort has been put into developing denture cleaning methods and the most recommended are brushing the prosthesis after meals and cleaning it with special liquids (sometimes prepared just before the procedure). However, these simple techniques are often omitted or insufficient due to, i.e., age-related mental or motor disabilities. OBJECTIVES: The aim of the study was to compare a range of techniques that can be performed at home and do not require patient dexterity in order to find the most efficient method of reducing the viability of the C. albicans biofilm and removing it from acrylic surfaces. MATERIAL AND METHODS: The 20 mm × 25 mm × 1 mm unpolished acrylic plates were inoculated with C. albicans and incubated for 72 h. Plates with formed biofilms were divided into 6 equal groups: a control group and 5 groups for different cleaning procedures: a dental cleaner with liquid, a dental cleaner with phosphate-buffered saline (PBS), air drying, antiseptic liquid, and an ultrasonic cleaner. Biofilm viability was assessed by plating serial dilutions and counting the colonies of C. albicans on the Sabouraud dextrose agar (SDA) medium. RESULTS: The study found that both MultiClean fluid and Sonic-3 ultrasonic cleaner were effective against Candida cells. MultiClean fluid showed the strongest biocidal properties, both when used with the Sonic Denture Cleaner and independently. CONCLUSIONS: Cleaning acrylic surfaces with a dental cleaner followed by antiseptic liquid is more effective than using these methods separately.

PREVALENCE AND RISK FACTORS OF NEEDLE STICK INJURIES AMONG CLEANERS IN A TERTIARY HEALTH FACILITY IN GOMBE, NORTHEAST, NIGERIA.

Introduction: The cleaning staff working in a health facility are at risk of needle stick injuries (NSI) because of the nature of their work which involves the disposal of used needles and sharps. This study aimed to determine the prevalence and risk factors of NSI among cleaning staff at Federal Teaching Hospital Gombe. Methodology: A cross-sectional study was carried out among 150 cleaning staff, selected using simple random sampling technique. An interviewer-administered questionnaire was used to collect data on the research variables. Data was analyzed using SPSS Version 23. Bivariate analysis was conducted to examine the relationships between sociodemographic factors and the prevalence of injury, while logistic regression was used to determine the predictors of needle stick injuries. Statistical significance was determined at a p-value of ≤0.05. Result: Majority of the respondents were males (64%) and uneducated (63.3%) with a mean age of 39.9±9 years. The prevalence of NSI among the cleaners was 35.3% with 23.3% having experienced injury at least once. Uneducated individuals were found to have experienced NSI more than those who were educated. Risk factors found to be predictors of NSI were sex, educational level, job duration of > 10 years, and number of hours spent during cleaning activity. Conclusion: Most of the staff were uneducated with no formal training before the commencement of work. Prevalence of NSI was high and therefore, there is a need for health education on the risks of the job and formal training of staff before commencement of work.

The association between number of steps and the ambulatory blood pressure during leisure vs. work hours among cleaners.

PURPOSE: The physical activity paradox states occupational physical activity (OPA) to be hazardous and leisure time physical activity (LTPA) to be beneficial for health. Yet, the acute effects of OPA and LTPA on cardiovascular risk factors are sparsely investigated. The aim of this study was to investigate the acute effects on ambulatory blood pressure (ABP) from steps/hour during work and leisure time among cleaners. METHODS: Data were obtained from a cluster randomized worksite intervention among 91 cleaners in Denmark and included a questionnaire, objective physical measurements, ABP (measured across 24 h), and steps/hour (measured during work and leisure time). A preliminary linear regression analysis was conducted as a mixed model including random intercept and slope, allowing for both within- and between-participant variability. We adjusted for sex, age, job seniority, medication use, smoking, self-reported fitness and BMI. Changes in ABP (mmHg) were estimated per 100 steps/hour. RESULTS: The number of steps taken was not associated with ABP during either work or leisure. Moreover, the ABP did not seem to differ between exposure to steps taken during work (systolic - 0.42 mmHg, 95% Confidence Interval (CI): - 1.10-0.25, diastolic - 0.03 mmHg, 95% CI, - 0.45-0.39) and leisure time (systolic -0.47 mmHg, 95% CI, - 1.66-0.72, diastolic 0.25 mmHg, 95% CI, - 0.46-0.97). CONCLUSION: Our findings show no significant association between steps/hour and ABP and no contrasting effects between work and leisure time. These mechanisms fostering the divergent results need to be further investigated to improve the understanding of the physical activity paradox.

An updated systematic review and meta-analysis on portable air cleaners and blood pressure: Recommendations for users and manufacturers.

Fine particulate matter (PM2.5) air pollution is a leading contributor to the global burden of cardiovascular disease (CVD). One important underlying mechanism is an increase in blood pressure (BP). A growing number of studies have reported a beneficial effect of portable air cleaners (PACs) on systolic and diastolic BP; SBP and DBP. We conducted an updated systematic review and meta-analysis of studies using true versus sham mode filtration reporting the effects on BP. Of 214 articles identified up to February 5, 2023, seventeen (from China, USA, Canada, South Korea and Denmark) enrolling approximately 880 participants (484 female) met the inclusion criteria for meta-analyses. Aside from studies conducted in China, research on PACs and BP has been conducted in relatively low pollution settings. Mean indoor PM2.5 concentrations during the active and sham mode purification were 15.9 and 41.2 µg/m3, respectively. The mean efficiency of PACs against indoor PM2.5 was 59.8 % (ranging from 23 % to 82 %). True mode filtration was associated with a pooled mean difference of - 2.35 mmHg (95 % confidence interval [CI]: - 4.5, - 0.2) and - 0.81 mmHg (95 % CI: - 1.86, 0.24) in SBP and DBP, respectively. After removing the studies with high risk of bias, the magnitude of the pooled benefits on SBP and DBP increased to - 3.62 mmHg (95 % CI: - 6.69, - 0.56) and - 1.35 mmHg (95 % CI: - 2.29, - 0.41), respectively. However, there are several barriers to the use of PACs, specifically in low- and middle-income countries (LMICs), such as the initial purchase cost and filter replacements. There may be several avenues to help overcome these economic burdens and improve cost effectiveness, such as implementing government or other subsidized programs to distribute PACs targeting vulnerable and higher-risk individuals. We propose that environmental health researchers and healthcare providers should be better trained to educate the public regarding the use of PACs to reduce the impacts of PM2.5 on cardiometabolic diseases globally.

Infection Prevention and Control Practices and Associated Factors Among Healthcare Cleaners in Gondar City: An Analysis of a Cross-Sectional Survey in Ethiopia.

Background: Healthcare-associated infections are a global health problem and are more prevalent in developing countries such as Ethiopia, but there is a paucity of research on the infection prevention practices of cleaning staff. Therefore, this study aimed to assess infection prevention and control practices and associated factors among cleaners working in healthcare facilities in Gondar City, Ethiopia. Methodology: A cross-sectional survey was conducted among healthcare cleaning staff from May to June 2022. A total of 428 cleaners took part in the survey. Data were collected using a semi-structured interviewer-administered questionnaire. The data were entered into EpiData version 4.6 and analyzed using Stata version 14 software. A multivariable binary logistic regression analysis was used to ascertain the significance of associations at <0.05 p-value and the adjusted odds ratio (AOR) with a 95% confidence interval (CI). Results: Among the 390 study participants included, 294 (75.1%) were female. Of the surveyed participants, 186 (47.7%) had good knowledge of infection prevention and control practices. This study revealed that out of the 390 healthcare cleaners, 204 (52.3%) had good infection prevention and control practices with 52.3% [95% CI (47.2, 56.4)]. Good knowledge of infection prevention and control [AOR: 1.56, 95% CI (1.03, 2.37)] and the availability of infection prevention and control guidelines in the workplace [AOR: 1.54, 95% CI (1.01, 2.33)] were significant factors associated with infection prevention and control practice. Conclusion: The present study found that almost half of the healthcare cleaners had poor IPC practices. The finding underlines the importance of good IPC knowledge and the accessibility of IPC guidelines to improve IPC practices among healthcare cleaning staff. The findings of this study also highlight that behavioral change interventions and paying attention, particularly to nonclinical staff such as cleaners in health care settings, are critical to reducing infection in health care settings.

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).

Multi-objective optimization of mechanical ventilation with the aid of purifiers in two scenarios: Regular operation and mitigating the spread of respiratory infectious diseases.

COVID-19 and its impact on society have raised concerns about scaling up mechanical ventilation (MV) systems and the energy consequences. This paper attempted to combine MV and portable air cleaners (PACs) to achieve acceptable indoor air quality (IAQ) and energy reduction in two scenarios: regular operation and mitigating the spread of respiratory infectious diseases (RIDs). We proposed a multi-objective optimization method that combined the NSGA-II and TOPSIS techniques to determine the total equivalent ventilation rate of the MV-PAC system in both scenarios. The concentrations of PM2.5 and CO2 were primary indicators for IAQ. The modified Wells-Riley equation was adopted to predict RID transmissions. An open office with an MV-PAC system was used to demonstrate the method's applicability. Meanwhile, a field study was conducted to validate the method and evaluate occupants' perceptions of the MV-PAC system. Results showed that optimal solutions of the combined system can be obtained based on various IAQ requirements, seasons, outdoor conditions, etc. For regular operation, PACs were generally prioritized to maintain IAQ while reducing energy consumption even when outdoor PM2.5 concentration was high. MV can remain constant or be reduced at low occupancies. In RID scenarios, it is possible to mitigate transmissions when the quanta were < 48 h-1. No significant difference was found in the subjective perception of the MV and PACs. Moreover, the effects of infiltration on the optimal solution can be substantial. Nonetheless, our results suggested that an MV-PAC system can replace the MV system for offices for daily use and RID mitigation. Electronic Supplementary Material ESM: The Appendix is available in the online version of this article at 10.1007/s12273-023-0999-z.

Anti-fungal efficacy of Miswak Extract (Salvadora Persica) and commercial cleaner against Candida albicans on heat cured polymethylmethacrylate denture base.

AIM: The aim of the study was to compare the antifungal efficacy between commercial cleaner (Corega) and Miswak extract (Salvadora persica) against Candida albicans on heat cured Polymethyl methacrylate (PMMA) acrylic denture base resin. MATERIALS AND METHODS: Forty-eight samples of heat cured PMMA acrylic denture base resin were fabircated in the study. The sterile acrylic resin specimens were immersed in standardized cell suspension of Candida albicans and incubated for 60 min at 370°C for cell adhesion and 2 h at 370°C for biofilm formation. After 24 h biofilm was evaluated by cell viability (CFUs) on SDA and cell counting of Candida albicans under light microscope at 400× magnification. The fungicidal effect of commercial cleaner and Miswak extract on Candida albicans biofilm was then evaluated by colony-forming units on SDA and cell counting under light microscope at 400× magnification. RESULTS: Screening test agar disk-diffusion assay showed mean inhibitory zone of 3 mm for commercial cleaner as compared to Miswak extract, which showed mean inhibitory zone of 2 and 1 mm for different concentrations. Broth microdilution method showed 31 mg/ml MIC and 62.5 mg/ml Minimal Fungicidal Concentration (MFC) values for commercial cleaner as compared to Miswak extract that showed 125 mg/ml MIC and 250 mg/ml MFC values against Candida albicans. A significant difference (p < 0.05) was observed between pre and post treatment of both commercial cleaner and Miswak extract, for CFUs and cell count for Candida albicans. CONCLUSION: Commercial denture cleaner (Corega) showed better antifungal (C albicans) activity than Miswak extract (Salvadora persica) on heat cured PMMA acrylic denture base resin.

Principal stratification analysis to determine health benefit of indoor air pollution reduction in a randomized environmental intervention in COPD: Results from the CLEAN AIR study.

BACKGROUND: Indoor air quality represents a modifiable exposure to Chronic Obstructive Pulmonary Disease (COPD) health. In a randomized controlled trial (CLEAN AIR study), air cleaner assignment had causal effect in improving COPD outcomes. It is unclear, however, what is the treatment effect among those for whom intervention reduced air pollution and whether it was reduction in fine particulate matter (PM2.5) or nitrogen dioxide (NO2) that contributed to such improvement. Because pollution is a posttreatment variable, treatment effect cannot be assessed while controlling for pollution using intention-to-treat (ITT) analysis. OBJECTIVE: Using principal stratification method, we assess indoor pollutants as the intermediate variable, and determine the causal effect of reducing indoor air pollution on COPD health. METHOD: In randomized controlled trial, former smokers with COPD received either active or placebo HEPA air cleaners and were followed for 6 months. Saint George's Respiratory Questionnaire (SGRQ) was the primary outcome and secondary measures included SGRQ subscales, COPD assessment test (CAT), dyspnea (mMRC), and breathlessness, cough, and sputum scale (BCSS). Indoor PM2.5 and NO2 were measured. Principal stratification analysis was performed to assess the treatment effect while controlling for pollution reduction. RESULTS: Among those showing at least 40 % PM2.5 reduction through air cleaners, the intervention showed improvement in respiratory symptoms for the active (vs. placebo), and the size of treatment effect shown for this subgroup was larger than that for the overall sample. In this subgroup, those with active air cleaners (vs. placebo) showed 7.7 points better SGRQ (95%CI: -14.3, -1.1), better CAT (ß = -5.5; 95%CI: -9.8, -1.2), mMRC (ß = -0.6; 95%CI: -1.1, -0.1), and BCSS (ß = -1.8; 95%CI: -3.0, -0.5). Among those showing at least 40 % NO2 reduction through air cleaners, there was no intervention difference in outcomes. CONCLUSION: Air cleaners caused clinically significant improvement in respiratory health for individuals with COPD through reduction in indoor PM2.5. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02236858.

Job and exposure intensity among hospital cleaning staff adversely affects respiratory health.

BACKGROUND: Occupational exposure to various types of cleaning agents may increase the risk of adverse respiratory health among cleaners. This study investigated the relationship between exposure to cleaning and disinfecting agents, using a job-task and exposure intensity metric, and respiratory outcomes among cleaners. METHODS: A sample of 174 cleaners was selected from three public hospitals in Durban. A questionnaire was used to collect demographic and occupational information, and spirometry, including post-bronchodilator measures, was conducted according to the American Thoracic Society guidelines and skin prick testing were performed. Exposure metrics for job tasks and chemical exposures were created using frequency and employment-lifetime duration of exposure. Multivariate analysis regression models used job task and exposure intensity metrics. RESULTS: Doctor-diagnosed asthma prevalence was 9.8%. Breathlessness with wheeze (22.4%) was the prevalent respiratory symptom. Positive responses to skin prick testing were seen in 74 (43.2%). There was a statistically significant increased risk for shortness of breath with exposure to quaternary ammonium compounds (odds ratio [OR]: 3.44; 95% confidence interval [CI]: 1.13-10.5) and breathlessness with exposure to multipurpose cleaner (OR: 0.34; CI: 0.12-0.92). The losses in percent-predicted forced expiratory volume in 1 s (FEV1) ranged from 0.3%-6.7%. Results among the bronchodilator-positive (8.6%) showed lung function losses twofold greater when compared to the total study population with percentage predicted FEV1 (-22.6 %; p < 0.000). CONCLUSION: Exposure to certain cleaning and disinfectant agents adversely affects respiratory health, particularly lung function. This effect, while seen generally among cleaning workers, is more pronounced among those with pre-existing reversible obstructive lung disease.

Can air purification improve sleep quality? A 2-week randomised-controlled crossover pilot study in healthy adults.

Insufficient quantity and quality of sleep is a public health concern that can be addressed by interventions for improving sleep outcomes. Environmental factors such as poor air quality are a potential target for intervention, particularly in light of associations between air pollution and worse sleep. The aim of this pilot study was to investigate the effects of using an air purifier on sleep outcomes and mood in 30 healthy adults. There were two conditions: (i) air purifier with a high-efficiency particulate air filter; (ii) air purifier with a placebo filter. Participants undertook both conditions, each over 2 weeks with a 2-week washout, following a counterbalanced, double-blind design. Daily sleep outcomes were measured with actigraphy watches and sleep diaries, whilst daily mood was assessed with the Positive and Negative Affect Schedule. The Insomnia Severity Index, the Pittsburgh Sleep Quality Index, and symptoms of anxiety and depression were measured pre- and post-. The purifier filter was associated with increased total sleep time for an average of 12 min per night, and increased total time in bed for an average of 19 min per night relative to the placebo. There were several sleep and mood outcomes for which no changes were observed, and time awake after sleep onset was higher for the purifier filter. Air quality was better during the high-efficiency particulate air filter condition. These findings offer positive indications that environmental interventions that improve air quality can have benefits for sleep outcomes in healthy populations who are not exhibiting clinical sleep disturbances.

The implementation of portable air-cleaning technologies in healthcare settings - a scoping review.

The COVID-19 pandemic revealed opportunities to improve prevention practices in healthcare settings, mainly related to the spread of airborne microbes (also known as bioaerosols). This scoping review aimed to map methodologies used to assess the implementation of portable air cleaners in healthcare settings, identify gaps, and propose recommendations for future research. The protocol was registered in the Open Science Framework and reported following the checklist provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis - an extension for Scoping Reviews (PRISMA-ScR) statement. The search strategy was performed in five databases and one grey literature source. At the last selection phase, 24 articles that fulfilled our inclusion criteria were summarized and disseminated. Of these, 17 studies were conducted between 2020 and 2022; one of them was a protocol of a multicentre randomized controlled trial. The outcomes measured among the studies include airborne microbe counts, airborne particle concentrations, and rate of infections/interventions. The leading healthcare settings assessed were dental clinics (28%), patient's wards (16%), operating rooms (16%), and intensive care units (12%). Most of the devices demonstrated a significant potential to mitigate the impact of bioaerosols. Although some indoor air quality parameters can influence the mechanics of aerosols, only a few studies controlled these parameters in their analyses. Future clinical research should assess the rate of infections through randomized controlled trials with long-term follow-up and large sample sizes to determine the clinical importance of the findings.