Perceived challenges in implementing halal standards by halal certifying bodies in the United States.

Islamic dietary laws inform halal standards, defining which foods are halal (lawful and permissible). Many halal foods are produced in non-Muslim majority countries increasing the likelihood they might be haram (prohibited). Halal certification is one way to operationalize halal standards, hence protecting Muslim consumers. At present there is no unified halal standard guiding halal certification. The aim of this study was to determine the perceived challenges in implementing halal standards in the United States. Semi-structured in-depth interviews were done with a representative from 6 of the 11 halal certifying bodies (HCBs) in the United States. All reported their role was to verify food safety records for compliance with government regulations but not to monitor food safety practices. Two main issues-forged halal certificates and expired halal logos were identified as significant issues. Three HCBs stated there is no problem with having multiple halal standards, but all believed it is necessary to have one universal halal standard with minimum standards followed by everyone. The findings of this study can be beneficial to the U.S. halal industry as it highlights the challenges and issues they face.

Evaluating the Alignment and Quality of Microgreens Training Materials Available on the Internet: A Content Analysis.

Interest in microgreens, young, edible seedlings of a variety of vegetables, spices, and herbs, is growing worldwide. A recent national survey of the U.S. microgreen industry reported 48% of 176 growers learned to grow microgreens by viewing websites and videos on the internet. However, it is unknown if the content related to growing microgreens is aligned with regulations and clearly presented. The aim of this research was to conduct a content analysis to determine alignment with the Food Safety and Modernization Act Produce Safety Rule (PSR)and the presentation quality of existing microgreen training materials available on the internet. Microgreen training materials were collected using two search engines - Google and YouTube. A deductive approach was used to inform the development of three coding manuals to evaluate the training materials meeting the eligibility criteria. One was used to determine the alignment of the content and was based on the PSR. The other two manuals were used to determine the presentation quality of Google and YouTube training materials according to CDC's Quality E-learning Checklist. A total of 223 training materials (86 Google and 137 YouTube), which fulfilled the inclusion criteria, were selected for the analysis. The results of the alignment with the PSR revealed that both sources minimally covered food safety principles with several areas minimally or not addressing specific information (e.g., water testing, worker training, environmental monitoring, and record keeping). In addition, some food safety information was unclear or presented conflicting information (e.g., requirement of washing microgreens, cleaning and sanitization methods, seed treatment methods, and waste management). The Google and YouTube quality scoring systems resulted in a mean quality score of 15.81 and 22 of a maximum score of 28, respectively. These findings indicate the quality and alignment with the PSR of microgreen training materials need to be improved.

Factors driving norovirus transmission in long-term care facilities: A case-level analysis of 107 outbreaks.

Norovirus is the most common cause of gastroenteritis outbreaks in long-term care facilities (LTCFs) in the United States, causing a high burden of disease in both residents and staff. Understanding how case symptoms and characteristics contribute to norovirus transmission can lead to more informed outbreak control measures in LTCFs. We examined line lists for 107 norovirus outbreaks that took place in LTCFs in five U.S. states from 2015 to 2019. We estimated the individual effective reproduction number, Ri, to quantify individual case infectiousness and examined the contribution of vomiting, diarrhea, and being a resident (vs. staff) to case infectiousness. The associations between case characteristics and Ri were estimated using a multivariable, log-linear mixed model with inverse variance weighting. We found that cases with vomiting infected 1.28 (95 % CI: 1.11, 1.48) times the number of secondary cases compared to cases without vomiting, and LTCF residents infected 1.31 (95 % CI: 1.15, 1.50) times the number of secondary cases compared to staff. There was no difference in infectiousness between cases with and without diarrhea (1.07; 95 % CI: 0.90, 1.29). This suggests that vomiting, particularly by LTCF residents, was a primary driver of norovirus transmission. These results support control measures that limit exposure to vomitus during norovirus outbreaks in LTCFs.

Molecular Detection of Salmonella spp. and E. coli non-O157:H7 in Two Halal Beef Slaughterhouses in the United States.

The aim of this study was to estimate the prevalence of pathogenic bacteria on halal beef carcasses and environmental surfaces in two halal beef slaughterhouses in the United States. To evaluate halal beef slaughter operations, 144 beef carcass samples (pre- and post-evisceration), and 24 environmental site samples (slaughter hall floor, brisket saw, and offal's table) were collected in two halal beef slaughterhouses during June to September 2017. All carcass and environmental samples were analyzed for the presence of Salmonella spp., Escherichia coli O157:H7, and shiga toxin-producing E. coli (non-O157 STEC). Results revealed that Salmonella spp. was isolated and confirmed for the presence of invA gene in 5/36 samples (13.8%) and 5/36 samples (13.8%) at pre-evisceration in plants A and B, respectively. Salmonella spp. was isolated in 2/9 samples (5.6%) of plants A and was not detected in any sample at post-evisceration process. E. coli O157:H7 was not detected in any sample collected from plant A and B. E. coli non-O157 was isolated and confirmed for the presence of virulence genes in 4/36 samples (11.1%) and 2/36 samples (5.5%) at post-evisceration in plants A and B, respectively. Salmonella spp. was detected based on the presence of the Salmonella invA gene in the slaughter hall floor (4/4) and the offal's table (2/4) samples using multiplex polymerase chain reaction (mPCR). In plant B, Salmonella spp. was also confirmed in the slaughter hall floor (2/4) and brisket saw (2/4) samples. On the other hand, one isolate of E. coli O157:H7 and one non-O157 STEC were obtained from the slaughter hall floor of plant A. The E. coli O157:H7 isolate was positive for stx1, stx2, eaeA, and EHEC-hly genes. Two isolates of non-O157 STEC (2/4) were detected in the environmental site samples, one from the slaughter hall floor, and one from an offal's table sample of plant B. These data can be used to inform food safety interventions targeting halal meat operations in the southeastern United States.

Relationship between ATP Bioluminescence Measurements and Microbial Assessments in Studies Conducted in Food Establishments: A Systematic Literature Review and Meta-Analysis.

ABSTRACT: Adherence to proper environmental cleaning practices is critical in food establishments. To validate cleanliness, cleaning practices should be routinely monitored, preferably by a rapid, reliable, and cost-effective method. The aim of this study was to determine whether a correlation exists between ATP bioluminescence measurements and selected microbial assessments in studies conducted in food establishments. A systematic literature review and meta-analysis was conducted using the principles of preferred reporting items for systematic reviews and meta-analyses. Twelve online databases and search engines were selected for the review. Peer-reviewed articles published in English between January 2000 and July 2020 were included in the search. From a total of 19 eligible studies, 3 that included Pearson correlation coefficients (r) between ATP bioluminescence measurements and microbial assessments were used for the meta-analysis calculations. Only the fixed-effect model produced a strong correlation because one value dominated the estimates: r = 0.9339 (0.9278, 0.9399). In contrast, both the random effects model, 0.2978 (0.24, 0.3471), and the mixed effects model, r = 0.3162 (-0.0387, 0.6711), indicated a weak relationship between ATP bioluminescence and microbial assessments, with no evidence of a strong correlation. The meta-analysis results indicated no sufficient evidence of a strong correlation between ATP bioluminescence measurements and microbial assessments when applied within food establishments. This lack of evidence for a strong correlation between the results of these two monitoring tools suggests that food establishments cannot depend on only one method. Yet, with immediate feedback and quantification of organic soiling, ATP bioluminescence could be an effective monitoring tool to use in food establishments.

Efficacy of EPA-registered disinfectants against two human norovirus surrogates and Clostridioides difficile endospores.

AIMS: To determine the efficacy of a panel of nine EPA-registered disinfectants against two human norovirus (HuNoV) surrogates (feline calicivirus [FCV] and Tulane virus [TuV]) and Clostridioides difficile endospores. METHODS AND RESULTS: Nine EPA-registered products, five of which contained H2 O2 as active ingredient, were tested against infectious FCV, TuV and C. difficile endospores using two ASTM methods, a suspension and carrier test. Efficacy claims against FCV were confirmed for 8 of 9 products. The most efficacious product containing H2 O2 as ingredient achieved a >5.1 log reduction of FCV and >3.1 log reduction of TuV after 5 min, and >6.0 log reduction of C. difficile endospores after 10 min. Of the five products containing H2 O2 , no strong correlation (R2  = 0.25, p = 0.03) was observed between disinfection efficacy and H2 O2 concentration. Addition of 0.025% ferrous sulphate to 1% H2 O2 solution improved efficacy against FCV, TuV and C. difficile. CONCLUSION: Disinfectants containing H2 O2 are the most efficacious disinfection products against FCV, TuV and C. difficile endospores. Product formulation, rather than the concentration of H2 O2 in a product, impacts the efficacy of a disinfection product. SIGNIFICANCE AND IMPACT OF STUDY: H2 O2 -based disinfectants are efficacious against surrogate viruses for HuNoV and C. difficile endospores.

Hygienic monitoring in long-term care facilities using ATP, crAssphage, and human noroviruses to direct environmental surface cleaning.

BACKGROUND: Norovirus and C. difficile are associated with diarrheal illnesses and deaths in long-term care (LTC) facilities and can be transmitted by contaminated environmental surfaces. Hygienic monitoring tools such as adenosine triphosphate (ATP) bioluminescence and indicators of fecal contamination can help to identify LTC facility surfaces with cleaning deficiencies. METHODS: High-touch surfaces in 11 LTC facilities were swabbed and tested for contamination by norovirus, a fecal indicator virus, crAssphage, and ATP which detects organic debris. High levels of contamination were defined as log ATP relative light unit values or crAssphage log genomic copy values in the 75th percentile of values obtained from each facility. RESULTS: Over 90% of surfaces tested positive for crAssphage or gave failing ATP scores. Norovirus contamination was not detected. Handrails, equipment controls, and patient beds were 4 times more likely than other surfaces or locations to have high levels of crAssphage. Patient bed handrails and tables and chairs in patient lounges had high levels of both ATP and crAssphage. CONCLUSIONS: Surfaces with high levels of ATP and crAssphage were identified. Quantifying levels of contamination longitudinally and before and after cleaning might enhance infection prevention and control procedures for reducing diarrheal illnesses in LTC facilities.

A study to introduce National Early Warning Scores (NEWS) in care homes: Influence on decision-making and referral processes.

AIM: Early warning scores are commonly used in hospital settings, but little is known about their use in care homes. This study aimed to evaluate the impacts of National Early Warning Scores alongside other measures in this setting. DESIGN: Convergent parallel design. METHODS: Quantitative data from 276 care home residents from four care homes were used to analyse the relationship between National Early Warning Scores score, resident outcome and functional daily living (Barthel ADL (Barthel Index for Activities of Daily Living)) and Rockwood (frailty). Interviews with care home staff (N = 13) and care practitioners (N = 4) were used to provide qualitative data. RESULTS: A statistically significant link between National Early Warning Scores (p = .000) and Barthel ADL (p = .013) score and hospital admissions was found, while links with Rockwood were insignificant (p = .551). Care home staff reported many benefits of National Early Warning Scores, including improved communication, improved decision-making and role empowerment. Although useful, due to the complexity of the resident population's existing health conditions, National Early Warning Scores alone could not act as a diagnostic tool.

New Approach to Food Safety Training: A Review of a Six-Step Knowledge-Sharing Model.

Significant resources, including both human and financial capital, have been dedicated to developing and delivering food handler training programs to meet government and organizational mandates. Even with the plethora of food safety-oriented training programs, there is scant empirical evidence documenting effectiveness, suggesting the need to rethink the design and delivery of food safety training for food handlers. One underlying assumption of most training programs is that food handlers engage in unsafe practices because of lack of knowledge. As a result, many training curricula are designed to improve knowledge, assuming behavior will change as knowledge increases. However, food handlers often return to the work environment and try to implement the new knowledge with minimal success. One explanation for this is that the training context and the implementation context often differ, making it difficult for the food handler to transfer what they learned into practice. Understanding the connection between knowledge, the organization, and its environment is critical to knowledge implementation. The focus of this review is to describe a six-step knowledge-sharing model. Here, knowledge sharing is broadly defined as the process of creating and then using knowledge to change a practice or behavior. Our proposed knowledge-sharing model includes six steps: generation, adaptation, dissemination, reception, adoption, and implementation. We have organized this model into two dyads: (i) transfer between researcher (i.e., knowledge generators) and educator and (ii) transfer between educator and food handler (i.e., knowledge implementers). To put into practice this proposed model for developing and delivering effective food safety training for food handlers, we have provided suggested actions that can be performed within each step of the knowledge-sharing process.

Factors associated with environmental service worker cleaning practices in health care settings: A systematic review of the literature.

INTRODUCTION: Health care-associated infections can be reduced through better environmental disinfection practices. Central to effective disinfection is the environmental service worker (ESW). The aim of this systematic literature review was to identify factors associated with the disinfection practices of ESWs in health care settings. METHODS: A systematic literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses principles. Ten online databases and search engines were selected for the review of English-language studies published between 2000 and 2019. RESULTS: Thirty-one (31) eligible studies were identified. Environmental disinfection was associated with many factors (eg, knowledge, perceptions) as well as ESW exposure to education/training sessions. When education/training was combined with performance evaluation/feedback, significant improvement in ESW disinfection practices was reported. CONCLUSIONS: To sustain improvements in disinfection practices, education/training sessions need to be continuous. The long-term commitment of an organization is also essential for continuous improvement in disinfection outcomes. While knowledge transfer is critical for behavior change, education/training also needs to focus on the skills and perceptions of ESWs. Future studies need to use a randomized controlled design with larger sample sizes to determine a true effect.

Development and Validation of a Multidimensional Instrument: Assessing Barriers to Dietary Practices.

BACKGROUND AND PURPOSE: Poor dietary practices are linked to many chronic diseases. The purpose of this validation study was to develop a psychometrically sound instrument that can be administered by health practitioners to measure dietary barriers. METHODS: The Dietary Health Status (DHS) instrument, designed to measure dietary barriers is comprised of items in the National Health and Nutrition Examination Survey-What We Eat in America datasets. Content validity was established for DHS using an expert review process. Principal component analysis (PCA) was then used to assess validity and reliability as determined by Cronbach's alpha values. RESULTS: The PCA supported a 10-component solution, explaining 61% of the total variance. Cronbach's alpha was .67 for the entire instrument, ranging from .55 to .87 for the 10 subscales. CONCLUSION: Results suggest the instrument had sufficient construct and internal validity. This exploratory study is an important first step in validating the DHS instrument.

Establishing content validity for a conceptualized instrument to measure barriers to eating a healthful diet in adults: a consensus approach.

BACKGROUND: A poor quality diet is a well-known risk factor for many chronic diseases. However, eating a healthful diet is not always simple as many underlying factors can impede adherence. Individuals with fewer barriers are more likely to eat a healthful diet than those who have more barriers. Accurately measuring barriers to eating a healthful diet could inform personalized interventions, particularly those aiming to prevent chronic diseases. The aim of this study was to establish content validity for selected items obtained from the National Health and Nutrition Examination Survey (NHANES) database to be considered for inclusion as items on the conceptualized Dietary Health Status (DHS) instrument, which is designed to measure barriers to eating a healthful diet in adults. METHODS: The Behavioral Change Wheel hub COM-B and the Theoretical Domains Framework (TDF) were the two theoretical frameworks underpinning the development of the DHS instrument. Seven steps were conducted to create the instrument: 1) development of operational definitions for each TDF domain; 2) identification of items from the NHANES database 2011-2012; 3) screening of items to ensure inclusion of all relevant items; 4) assigning items to a theory-based domain; 5) evaluation of the items against inclusion/exclusion criteria; 6) solicitation of feedback from expert reviewers to reach consensus on inclusion into a domain; and 7) validation of items. RESULTS: A total of 170 items representing twelve domains were identified as potential barriers to eating a healthful diet-- knowledge, optimism, beliefs about consequences, beliefs about capabilities, reinforcement, memory, attention and decision processes, environmental context and resources, social influences, emotion, behavioral regulation, health identity, and functional status. CONCLUSION: Expert review consultation and a consensus approach established content validity for 12 theory-based domains comprised of 170 items identified as potential barriers to eating a healthful diet. The use of these explanatory domains may: assist researchers to better understand barriers to adult dietary practices; inform the development of a screening tool that could be used in a community setting to measure barriers to eating a healthful diet; and inform individualized interventions.

Comparative Recovery of Two Human Norovirus Surrogates, Feline Calicivirus and Murine Norovirus, with a Wet Vacuum System, Macrofoam-Tipped Swab, and Bottle Extraction Method from Carpets.

Human noroviruses (HuNoV) are the leading cause of known foodborne illness in the United States, but direct detection during outbreak investigations is challenging. On the other hand, sampling both hard and soft environmental surfaces can be used to improve outbreak investigations. Currently, we lack virus recovery methods for soft surfaces, such as carpet, despite evidence suggesting that carpets contribute to HuNoV outbreaks. Our aim was to compare two recovery methods, wet vacuum and swabbing, for routine carpet sampling of HuNoV against a laboratory reference method known as bottle extraction (BE). Specifically, we compared the microbial vacuum (MVAC), macrofoam-tipped swab (MS), and BE by using HuNoV surrogates, feline calicivirus (FCV) and murine norovirus (MNV), inoculated on wool and nylon carpet carriers. The highest recovery of infectious FCV from wool was 5.51, 3.76, and 5.16 log PFU, whereas on nylon, recovery was 5.03, 3.62, and 4.75 log PFU by using BE, MS, and MVAC, respectively. On the other hand, the highest recovery of infectious MNV from wool was 6.10, 4.50, and 5.99 log PFU, while recovery on nylon was 6.07, 4.58, and 6.13 log PFU by using BE, MS, and MVAC, respectively. Significantly more PFU and genomic copies were recovered by using BE and MVAC compared with MS, while buffer type played a significant role in recovery of infectious FCV.

Efficacy of Silver Dihydrogen Citrate and Steam Vapor against a Human Norovirus Surrogate, Feline Calicivirus, in Suspension, on Glass, and on Carpet.

Carpets and other soft surfaces have been associated with prolonged and reoccurring human norovirus (HuNoV) outbreaks. Environmental hygiene programs are important to prevent and control HuNoV outbreaks. Despite our knowledge of HuNoV transmission via soft surfaces, no commercially available disinfectants have been evaluated on carpets. Our aim was to adapt a current standardized method for virucidal testing by assessing two disinfection technologies, silver dihydrogen citrate (SDC) and steam vapor, against one HuNoV surrogate, feline calicivirus (FCV), on wool and nylon carpets. First, we evaluated the effect of both technologies on the appearance of carpet. Next, we evaluated the efficacy of SDC in suspension and the efficacy of SDC and steam vapor against FCV on a glass surface, each with and without serum. Lastly, we tested both technologies on two types of carpet, wool and nylon. Both carpets exhibited no obvious color changes; however, SDC treatments left a residue while steam vapor left minor abrasions to fibers. SDC in suspension and on glass reduced FCV by 4.65 log10 and >4.66 log10 PFU, respectively, but demonstrated reduced efficacy in the presence of serum. However, SDC was only efficacious against FCV on nylon (3.62-log10 PFU reduction) and not wool (1.82-log10 PFU reduction). Steam vapor reduced FCV by >4.93 log10 PFU on glass in 10 s and >3.68 log10 PFU on wool and nylon carpet carriers in 90 s. There was a limited reduction of FCV RNA under both treatments compared to that of infectivity assays, but RNA reductions were higher in samples that contained serum.IMPORTANCE Human noroviruses (HuNoV) account for ca. 20% of all diarrheal cases worldwide. Disease symptoms may include diarrhea and vomit, with both known to contribute to transmission. The prevention and control of HuNoV are difficult because they are environmentally resilient and resistant to many disinfectants. Several field studies have linked both hard and soft surfaces to HuNoV outbreaks. However, many disinfectants efficacious against HuNoV surrogates are recommended for hard surfaces, but no commercially available products have demonstrated efficacy against these surrogates on soft surfaces. Our research objectives were to evaluate liquid and steam-based technologies in suspension and on hard surface carriers in addition to adapting and testing a protocol for assessing the virucidal effects of disinfection technologies on carpet carriers. These results will inform both the government and industry regarding a standard method for evaluating the virucidal effects of disinfectants on carpet while demonstrating their efficacy relative to suspension and hard-surface tests.

Prevalence of Human Noroviruses in Commercial Food Establishment Bathrooms.

Although transmission of human norovirus in food establishments is commonly attributed to consumption of contaminated food, transmission via contaminated environmental surfaces, such as those in bathrooms, may also play a role. Our aim was to determine the prevalence of human norovirus on bathroom surfaces in commercial food establishments in New Jersey, Ohio, and South Carolina under nonoutbreak conditions and to determine characteristics associated with the presence of human norovirus. Food establishments (751) were randomly selected from nine counties in each state. Four surfaces (underside of toilet seat, flush handle of toilet, inner door handle of stall or outer door, and sink faucet handle) were swabbed in male and female bathrooms using premoistened macrofoam swabs. A checklist was used to collect information about the characteristics, materials, and mechanisms of objects in bathrooms. In total, 61 (1.5%) of 4,163 swabs tested were presumptively positive for human norovirus, 9 of which were confirmed by sequencing. Some factors associated with the presence of human norovirus included being from South Carolina (odd ratio [OR], 2.4; 95% confidence interval [CI], 1.2 to 4.9; P < 0.05) or New Jersey (OR, 1.7; 95% CI, 0.9 to 3.3; 0.05 < P < 0.10), being a chain establishment (OR, 1.9; 95% CI, 1.1 to 3.3; P < 0.05), being a unisex bathroom (versus male: OR, 2.0; 95% CI, 0.9 to 4.1; 0.05 < P < 0.10; versus female: OR, 2.6; 95% CI, 1.2 to 5.7; P < 0.05), having a touchless outer door handle (OR, 3.3; 95% CI, 0.79 to 13.63; 0.05 < P < 0.10), and having an automatic flush toilet (OR, 2.5, 95% CI, 1.1 to 5.3; 0.05 < P < 0.10). Our findings confirm that the presence of human norovirus on bathroom surfaces in commercial food establishments under nonoutbreak conditions is a rare event. Therefore, routine environmental monitoring for human norovirus contamination during nonoutbreak periods is not an efficient method of monitoring norovirus infection risk.

Recovery Optimization and Survival of the Human Norovirus Surrogates Feline Calicivirus and Murine Norovirus on Carpet.

Carpets have been implicated in prolonged and reoccurring outbreaks of human noroviruses (HuNoV), the leading cause of acute gastroenteritis worldwide. Viral recovery from environmental surfaces, such as carpet, remains undeveloped. Our aim was to determine survival of HuNoV surrogates on an understudied environmental surface, carpet. First, we measured the zeta potential and absorption capacity of wool and nylon carpet fibers, we then developed a minispin column elution (MSC) method, and lastly we characterized the survival of HuNoV surrogates, feline calicivirus (FCV) and murine norovirus (MNV), over 60 days under 30 and 70% relative humidity (RH) on two types of carpet and one glass surface. Carpet surface charge was negative between relevant pH values (i.e., pH 7 to 9). In addition, wool could absorb approximately two times more liquid than nylon. The percent recovery efficiency obtained by the MSC method ranged from 4.34 to 20.89% and from 30.71 to 54.14% for FCV and MNV on carpet fibers, respectively, after desiccation. Overall, elution buffer type did not significantly affect recovery. Infectious FCV or MNV survived between <1 and 15 or between 3 and 15 days, respectively. However, MNV survived longer under some conditions and at significantly (P < 0.05) higher titers compared to FCV. Albeit, surrogates followed similar survival trends, i.e., both survived longest on wool then nylon and glass, while 30% RH provided a more hospitable environment compared to 70% RH. Reverse transcription-quantitative PCR signals for both surrogates were detectable for the entire study, but FCV genomic copies experienced significantly higher reductions (<3.80 log10 copies) on all surfaces compared to MNV (<1.10 log10 copies).IMPORTANCE Human noroviruses (HuNoV) are the leading cause of acute gastroenteritis worldwide. Classical symptoms of illness include vomiting and diarrhea which could lead to severe dehydration and death. HuNoV are transmitted by the fecal-oral or vomitus-oral route via person-to-person contact, food, water, and/or environmental surfaces. Published laboratory-controlled studies have documented the environmental stability of HuNoV on hard surfaces, but there is limited laboratory-based evidence available about survival on soft surfaces, e.g., carpet and upholstered furniture. Several epidemiological reports have suggested soft surfaces may be HuNoV fomites illustrating the importance of conducting a survival study. The three objectives of our research were to demonstrate techniques to characterize soft surfaces, develop a viral elution method for carpet, and characterize the survival of HuNoV surrogates on carpet. These results can be used to improve microbial risk assessments, the development of much-needed soft surface disinfectant, and standardizing protocols for future soft surface studies.

The effect of hand-hygiene interventions on infectious disease-associated absenteeism in elementary schools: A systematic literature review.

BACKGROUND: Hand-hygiene interventions are widely used in schools but their effect on reducing absenteeism is not well known. METHODS: The aim of our literature review was to determine whether implementation of a hand-hygiene intervention reduced infectious disease-associated absenteeism in elementary schools. The eligible studies (N = 19), published between 1996 and 2014, were summarized and the methodologic quality of each was assessed. RESULTS: Our review indicated evidence is available to show hand-hygiene interventions had an effect on reducing acute gastrointestinal illness-associated absenteeism but inadequate evidence is available to show an effect on respiratory illness-associated absenteeism. CONCLUSIONS: The methodologic quality assessment of eligible studies revealed common design flaws, such as lack of randomization, blinding, and attrition, which must be addressed in future studies to strengthen the evidence base on the effect of hand-hygiene interventions on school absenteeism.

A Review of State Licensing Regulations to Determine Alignment with Best Practices to Prevent Human Norovirus Infections in Child-Care Centers.

OBJECTIVES: Close, frequent contact between children and care providers in child-care centers presents many opportunities to spread human noroviruses. We compared state licensing regulations for child-care centers with national guidelines written to prevent human noroviruses. METHODS: We reviewed child-care licensing regulations for all 50 U.S. states and the District of Columbia in effect in June 2015 to determine if these regulations fully, partially, or did not address 14 prevention practices in four topic areas: (1) hand hygiene, (2) exclusion of ill people, (3) environmental sanitation, and (4) diapering. RESULTS: Approximately two-thirds (8.9) of the 14 practices across all state regulations were partially or fully addressed, with few (2.6) fully addressed. Practices related to exclusion of ill people and diapering were fully addressed most often, while practices related to hand hygiene and environmental sanitation were fully addressed least often. CONCLUSION: Regulations based on guidelines for best practices are one way to prevent the spread of human noroviruses in child-care facilities, if the regulations are enforced. Our findings show that, in mid-2015, many state child-care regulations did not fully address these guidelines, suggesting the need to review these regulations to be sure they are based on best practices.

The survival and inactivation of enteric viruses on soft surfaces: A systematic review of the literature.

BACKGROUND: Worldwide, enteric viruses are the main cause of acute gastroenteritis. In humans, these viruses spread via person-to-person contact, food, water, and/or the environment. Their survival and inactivation on hard surfaces have been extensively studied; however, nonlaunderable soft surfaces, such as upholstery and carpet, have received little attention. The aim of this systematic review was to determine factors that influence the survival and inactivation of enteric viruses on nonlaunderable soft surfaces. METHODS: EBSCO and Web of Science were searched for experimental studies published between 1965 and 2015 using Preferred Reporting Items for Systematic Reviews and Meta-Analyses methods. Titles and abstracts were screened using 3 eligibility criteria. The quality of all study methods was also assessed. RESULTS: Our search yielded 12 articles. Viruses survived between 0 hours and 140 days depending on surface and environment conditions. Virus survival was influenced by temperature, relative humidity, organic content, and deposition method. A variety of chemistries were tested across studies and were shown to have a varied effect on enteric viruses. Chlorine, glutaraldehyde, vaporous ozone, and hydrogen peroxide were the most efficacious against enteric viruses (> 3-log reduction). CONCLUSIONS: Environmental factors, such as temperature and relative humidity, can influence survival of enteric viruses on nonlaunderable soft surfaces. The efficacy of liquid and vaporous chemistries are associated with surface and virus type.