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PubMed1984

Water supply and health in developing countries: selective primary health care revisited.

The inclusion of water supply and sanitation programs as a component of primary health care (PHC) has been questioned on the basis of calculations of the costs of these programs per infant death averted. In this paper the procedures used in these cost-effectiveness calculations are examined and found to be wanting. The calculations are misleading since gross rather than net costs have been used, and the health impact of these programs underestimated. It is also shown that the methodology used is biased against water supply and sanitation and other programs with multiple outputs. The time constraints facing mothers in implementing PHC programs, as well as the contribution of improved water supplies in alleviating these constraints are outlined. Data are presented to show that, if poor women in developing countries were to choose the mix of activities to be included in PHC programs, improved water supplies would frequently constitute part of that mix.

Cost-Benefit Analysis↗
PubMed2006

Low risk for helminth infection in wastewater-fed rice cultivation in Vietnam.

This study was done to assess the risk of helminth infection in association with wastewater-fed rice cultivation in an agricultural setting of Nam Dinh city, Vietnam. In a cross sectional survey data were collected for 202 households in a commune where wastewater was used for irrigation and for 201 households in a commune that used river water. Parasitological examination was conducted on single stool samples obtained from 1,088 individuals aged -15 years from the households. The irrigation water used in both communes was enumerated for helminth eggs and thermotolerant coliforms. The prevalence of infection with Ascaris spp., Trichuris spp., and hookworm was 42.2%, 19.9% and 10.5% respectively, with an overall prevalence of infection with any helminth of 53.4%. Surprisingly, the prevalence of infection with Ascaris and Trichuris was lower among people exposed to wastewater (containing 40-200 helminth eggs/l and 10(4) thermotolerant coliforms/100 ml) compared to people exposed to river water that contained lower worm egg and bacterial numbers. Poor sanitation and hygiene practices and not using protective measures were important independent risk factors for helminth infection. For hookworm infection, no significant difference was observed between the wastewater exposed and unexposed groups. Children living in the wastewater use area had a significantly better nutritional status than those in the area using river water. This suggests a generally higher welfare level of the wastewater use area. In conclusion, this study showed no evidence that rice cultivation with wastewater poses a risk for helminth infection. More detailed studies are needed on the reduction of fecal indicators and helminth eggs in peri-urban wastewater-irrigated rice culture systems and on the relative importance of wastewater irrigation compared to other risk factors for human helminth infection such as poor sanitation and poverty.

Animals↗
PubMed2006

Enhanced primary treatment of concentrated black water and kitchen residues within DESAR concept using two types of anaerobic digesters.

Anaerobic digestion of concentrated domestic wastewater streams--black or brown water, and solid fraction of kitchen waste is considered as a core technology in a source separation based sanitation concept (DESAR--decentralised sanitation and reuse). A simple anaerobic digester can be implemented for an enhanced primary treatment or, in some situations, as a main treatment. Two reactor configurations were extensively studied; accumulation system (AC) and UASB septic tank at 15, 20 and 25 degrees C. Due to long retention times in an AC reactor, far stabilisation of treated medium can be accomplished with methanisation up to 60%. The AC systems are the most suitable to apply when the volume of waste to be treated is minimal and when a direct reuse of a treated medium in agriculture is possible. Digested effluent contains both liquid and solids. In a UASB septic tank, efficient separation of solids and liquid is accomplished. The total COD removal was above 80% at 25 degrees C. The effluent contains COD and nutrients, mainly in a soluble form. The frequency of excess sludge removal is low and sludge is well stabilised due to a long accumulation time.

Anaerobiosis↗
PubMed2006

Technology in the high entropy world.

Modern growing society is mainly driven by oils and may be designated "petroleum civilisation". However, the basic energy used to drive the global ecosystem is solar radiation. The amount of fossil energy consumption is minimal in the whole global energy balance. Economic growth is mainly controlled by the fossil (commercial) energy consumption rate in urban areas. Water and sanitation systems are bridging economical activities and global ecosystems. Therefore, vast amounts of high entropy solar energy should always be taken into account in the water industry. Only in urban/industrial areas where most of the GDP is earned, are commercial energy driven systems inevitably introduced with maximum effort for energy saving. A water district concept to ensure appropriate quality use with the least deterioration of the environment is proposed. In other areas, decentralised water and sanitation systems driven on soft energy paths would be recommended. A process and system designed on a high entropy energy system would be the foundation for a future urban metabolic system revolution for when oil-based energy become scarce.

Animals↗
PubMed1989

Premilking udder hygiene.

Incidence of intramammary infection is highly correlated to the number of mastitis pathogens on the teat end at milking. The objective of premilking teat sanitation is to reduce the microbial population in order to minimize the probability of mastitis. Milking time hygiene is extremely important due to the potential interaction between milking machine functions and microflora of teat skin. Current recommended procedures for premilking udder preparation range from water hose wash, manual drying, wet paper towel wash plus paper towel dry, to predipping alone plus paper towel dry. Regardless of udder cleaning procedure, manual drying of teats is a significant factor in reduction of total bacteria counts. Predipping with iodine-based sanitizers, .1 to .25% iodine concentration, reduced intramammary infection with environmental pathogens 51% compared with good udder preparation in a field trial on four commercial dairy farms. Infections by coagulase-negative staphylococci were not reduced by predipping. Effective premilking udder hygiene is essential for the production of high quality milk. Bacteria, preincubation and pasteurized milk counts are reduced. Sediment is minimized. Incidence of mastitis is reduced. Proper udder hygiene procedures should be practiced at every milking.

Animals↗
PubMed1992

Managerial determinants of intramammary coliform and environmental streptococci infections in Ohio dairy herds.

Forty-eight dairy herds in Ohio were selected as a stratified random sample for participation in a disease monitoring study to relate the prevalence of IMI with coliform and environmental streptococci to herd management and environmental conditions. Management and environmental conditions were assessed by farm inspection and by an interview with the dairy producers. A separate analysis for each independent variable identified many potential disease determinants. A multivariable analysis of a covariance model to predict the prevalence of coliforms had 6 model df (R2 = .47). Increased prevalence of coliform infection was associated with an increased amount of milk remaining in the udder after milking, use of free stalls, regular use of a running water wash, increased person hours per cow spent milking, and poor sanitation. The multivariable model for environmental streptococci used 5 model df (R2 = .51). Increased prevalence of environmental streptococci was associated with poor sanitation, increased number of days dry, use of tie stalls, no use of a shared wash cloth, and no use of an individual dry cloth.

Analysis of Variance↗
PubMed1993

Efficacy evaluations on five chlorhexidine teat dip formulations.

Three developmental postmilking teat dip formulations containing chlorhexidine digluconate were evaluated against Staphylococcus aureus and Streptococcus agalactiae in sequential experimental exposure trials. Two additional commercial chlorhexidine digluconate teat dip products were evaluated in natural exposure trials. Under conditions of experimental challenge, the developmental formulations were efficacious against Staph. aureus but did not significantly reduce incidence of new IMI by Strep. agalactiae. None of the three formulations of a conventional germicide used as teat sanitizers effectively reduced incidence of new Strep. agalactiae IMI under experimental challenge conditions. In the natural exposure trials with negative controls, a .35% chlorhexidine teat sanitizer had efficacy of 88.7% against Staph. aureus and 51.4% against Strep. agalactiae. The .5% chlorhexidine product reduced Staph. aureus and Strep. agalactiae IMI by 86 and 56%, respectively.

Administration, Cutaneous↗
PubMed1993

A comparison of ozonation and chlorination for the disinfection of stainless steel surfaces.

Ozonated water and chlorinated sanitizer were compared for effectiveness against biofilms of milk spoilage bacteria. Stainless steel plates were incubated in UHT-pasteurized milk inoculated with pure cultures of either Pseudomonas fluorescens (ATCC 949) or Alcaligenes faecalis (ATCC 337). After incubation, the plates were removed and rinsed in sterile PBS. A control rinsed stainless steel plate was swabbed and plated on standard plate count agar. A second rinsed stainless steel plate was covered and treated for 2 min with a commercial chlorinated sanitizer (dichloro-s-triazinetrione), prepared according to the manufacturer's recommendations; after treatment, the plate was rinsed twice in sterile PBS, swabbed, and plated on standard plate count agar. A third rinsed stainless steel plate from the culture was placed in ozonated deionized H2O (.5 ppm of ozone) for 10 min, rinsed twice as described, swabbed, and plated. Both ozonation and chlorination reduced bacteria populations by > 99% at initial cell densities in the range of approximately 1.24 x 10(5) to 8.56 x 10(5) cfu/cm2 for P. fluorescens and 1.53 x 10(4) to 8.56 x 10(5) cfu/cm2 for A. faecalis in milk films on stainless steel surfaces.

Alcaligenes↗
PubMed2005

Norovirus transmission on cruise ship.

An outbreak of norovirus gastroenteritis affected passengers on two consecutive cruises of ship X and continued on 4 subsequent cruises despite a 1-week sanitization. We documented transmission by food and person-to-person contact; persistence of virus despite sanitization onboard, including introductions of new strains; and seeding of an outbreak on land.

Caliciviridae Infections↗
PubMed2006

A successful experience of soil-transmitted helminth control in the Republic of Korea.

Soil-transmitted helminths (STH), namely Ascaris, Trichuris and hookworms (Ancylostoma and Necator), present a global health problem to about a half of the earthos population. In the Republic of Korea, STH were highly prevalent and were considered a high priority target for national control. To promote the control, a non-governmental organization named Korea Association for Parasite Eradication (currently Korea Association of Health Promotion) was founded in 1964, and mass fecal examination followed by selective mass chemotherapy with anthelmintics was performed twice a year from 1969 to 1995 targeting whole nationwide schoolchildren. Meanwhile, decreasing patterns of national STH infections have been monitored by 7 timeso quinquennial national surveys targeting general population. In 1971, the overall intestinal helminth egg positive rate was 84.3% (Ascaris 58.2%, Trichuris 65.4%, and hookworms 10.7%), which became 63.2% in 1976, 41.1% in 1981, 12.9% in 1986, 3.8% in 1992, 2.4% in 1997, and 4.3% (Ascaris 0.03%, Trichuris 0.02%, and hookworms 0%) in 2004. During the control period, national economy rapidly developed, and living standards including environment, sanitation, and agricultural technology greatly improved, which undoubtedly boosted the STH control effects. Our experience indicates that social driving force to establish an eligible national control system to conduct repeated mass chemotherapy, together with improvement of environment and sanitation, is important for initiating and achieving STH control in a developing community.

Ancylostomatoidea↗
PubMed1993

Location of Salmonella typhimurium during incubation and hatching of inoculated eggs.

Location of Salmonella during hatching of broiler chicks was studied in three experiments. Unincubated, fertile hatching eggs heated to 42 C were inoculated by immersion for 15 min in a 16 C physiological saline solution containing approximately 1 x 10(5) cfu/mL of a nalidixic acid-resistant strain of Salmonella typhimurium. All eggs were sanitized externally by wiping with a paper towel wet with 70% ethanol. When incubating eggs were transferred to a hatcher, each was placed in a closed paper bag to minimize cross-contamination. Unhatched eggs were sampled by cutting away the shell over the air cell, sanitizing the inner air cell membrane with 70% ethanol, and removing the contents through the membrane. Shells and membranes were crushed and mixed in 10 mL buffered peptone (BP). Yolks were dissected out, dipped in 70% ethanol, and mixed with 10 mL BP. Embryos or chicks and all surrounding fluid were rinsed in 100 mL BP. A total of 172 eggs was sampled. Shells and membranes were 100% Salmonella-positive 30 min after inoculation, but only 38% were positive after 17 to 21 days of incubation. No chick rinses were positive before pipping, but 15% were positive after pipping. Yolk samples were 2% positive before pipping versus 8% after pipping. A majority of chicks hatching from positive shells and membranes were Salmonella-negative.

Animals↗
PubMed2004

Impact of waste disposal on health of a poor urban community in Zimbambwe.

OBJECTIVE: To assess excreta and waste disposal facilities available and their impact on sanitation related diseases in Epworth, an informal settlement on the outskirts of Harare. DESIGN: Descriptive cross-sectional survey. SETTING: This was a community based study of Epworth informal settlement. SUBJECTS: A total of 308 households were interviewed. Participating households were randomly selected from the three communities of Epworth. Secondary medical archival data on diarrhoeal disease prevalence was collected from local clinics and district health offices in the study areas. RESULTS: Only 7% of households were connected to the sewer system. The study revealed that in Zinyengere extension 13% had no toilet facilities, 48% had simple pits and 37% had Blair VIP latrines. In Overspill 2% had no toilet facilities, 28% had simple latrines and 36% had Blair VIP latrines while in New Gada 20% had no toilet facilities, 24% had simple pits and 23% had Blair VIP latrines. Although a significant percentage had latrines (83.2%), over 50% of the population were not satisfied with the toilet facilities they were using. All the respondents expressed dissatisfaction with their domestic waste disposal practices with 46.6% admitting to have indiscriminately dumped waste. According to the community, diarrhoeal diseases were the most prevalent diseases (50%) related to poor sanitation. Health statistics also indicated that diarrhoea was a major problem in this community. CONCLUSION: It is recommended that households and the local authorities concentrate on improving the provision of toilets, water and waste disposal facilities as a way of improving the health state of the community.

Attitude to Health↗
PubMed1996

Monolaurin and acetic acid inactivation of Listeria monocytogenes attached to stainless steel.

Individual and combined antimicrobial effects of monolaurin and acetic acid on Listeria monocytogenes planktonic cells or stainless-steel-adherent cells were determined in order to evaluate cell viability during a 25-min exposure period at 25 degrees C. A 10(7)-colony-forming units (CFU)/ml population of planktonic cells was completely inactivated by the synergistic combination of 1% acetic acid with 50 or 100 microg/ml of monolaurin within 25 or 20 min, respectively. Either compound alone caused partial but incomplete inactivation within the same time periods. A population of 10(5) CFU/cm2 of 1-day adherent cells on stainless steel was completely inactivated within 25 min, but with the highest concentrations of the combined chemicals, i.e., 1% acetic acid and 100 microg/ml of monolaurin. The combined chemical treatment again synergistically produced greater inhibition. A 10(6)-CFU/cm2 population of 7-day adherent cells was not completely inactivated within 25 min of exposure, although counts did decline. The results demonstrate increased resistance of attached L. monocytogenes to acetic acid and monolaurin and show that resistance increased with culture age. Combinations of organic acids and monolaurin might be considered as sanitizers of food contact surfaces, but activities of such combinations are likely to be less than other commonly used sanitizers.

Acetic Acid↗
PubMed1999

Identification and control of processing variables that affect the quality and safety of fluid milk.

The objective of this study was to increase quality and safety of fluid milk by eliminating postpasteurization contamination as measured by extended shelf life. Milk shelf life was defined as the number of days for standard plate count to reach 20,000 CFU/ml in milk stored at 7 degrees C. Sequential analysis of the fluid milk processing system indicated filling machine and pasteurizer were significant sources of postpasteurization contamination. Aseptically sampled milk from the pasteurizer outlet indicated a maximum shelf life of more than 30 days could be achieved. The pasteurizer can be a source of contamination when inadequately cleaned or maintained. The filling machine was a significant source of contamination. Shelf life of milk in 236-ml containers was reduced 20 days compared with milk sampled before the filling machine. Carton-forming mandrels, filling heads, and airborne microorganisms were sources of contamination within the filling machine. Eliminating sources of postpasteurization contamination and proper cleaning followed by sanitizing with chlorine significantly increased milk shelf life in paperboard containers to 20.4 days from an initial shelf life of 9 days. Changing the sanitizing agent to peroxyacetic acid significantly increased milk shelf life to 33.9 days. Enclosing the filling chamber and adding sterile laminar flowing air significantly improved microbiological quality of air inside the chamber and reduced variance among milk shelf life samples.

Animals↗
PubMed2002

Differentiation of viable and dead Escherichia coli O157:H7 cells on and in apple structures and tissues following chlorine treatment.

Confocal scanning laser microscopy (CSLM) was used to differentiate viable and nonviable cells of Escherichia coli O157:H7 on and in raw apple tissues following treatment with water and 200 or 2,000 ppm active chlorine solution. Whole unwaxed Red Delicious cultivar apples at 25 degrees C were inoculated by dipping in a suspension of E. coli O157:H7 (8.48 log10 CFU/ml) at 4 degrees C, followed by treatment in water or chlorine solution at 21 degrees C for 2 min. The dead cells on and in apples were distinguished from live cells by treating tissue samples with SYTOX green nucleic acid stain. Viable and dead cells were then labeled with an antibody conjugated with a fluorescent dye (Alexa Fluor 594). The percentage of viable cells on the apple surface, as well as at various depths in surface and internal structures, was determined. The mean percentages of viable cells located at the sites after treatment with water or chlorinated water were in the following order, which also reflects the order of protection against inactivation: floral tube wall (20.5%) > lenticels (15.0%) > damaged cuticle surrounding puncture wounds (13.0%) > intact cuticle (8.1%). The location of viable cells within tissues was dependent on the structure. Except for lenticels, the percentage of viable cells increased as depth into the CSLM stacks increased, indicating that cells attached to subsurface structures were better protected against inactivation with chlorine than were cells located on exposed surfaces. Further research is warranted to investigate the efficacy of other chemical sanitizers. as well as that of surfactants and solvents in combination with sanitizers, in removing or killing E. coli O157:H7 lodgedin protective structures on the surface and within tissues of apples.

Bacterial Adhesion↗
PubMed2003

A comparison of hand washing techniques to remove Escherichia coli and caliciviruses under natural or artificial fingernails.

Compared with other parts of the hand, the area beneath fingernails harbors the most microorganisms and is most difficult to clean. Artificial fingernails, which are usually long and polished, reportedly harbor higher microbial populations than natural nails. Hence, the efficacy of different hand washing methods for removing microbes from natural and artificial fingernails was evaluated. Strains of nonpathogenic Escherichia coli JM109 and feline calicivirus (FCV) strain F9 were used as bacterial and viral indicators, respectively. Volunteers with artificial or natural nails were artificially contaminated with ground beef containing E. coli JM109 or artificial feces containing FCV. Volunteers washed their hands with tap water, regular liquid soap, antibacterial liquid soap, alcohol-based hand sanitizer gel, regular liquid soap followed by alcohol gel, or regular liquid soap plus a nailbrush. The greatest reduction of inoculated microbial populations was obtained by washing with liquid soap plus a nailbrush, and the least reduction was obtained by rubbing hands with alcohol gel. Lower but not significantly different (P > 0.05) reductions of E. coli and FCV counts were obtained from beneath artificial than from natural fingernails. However, significantly (P < or = 0.05) higher E. coli and FCV counts were recovered from hands with artificial nails than from natural nails before and after hand washing. In addition, microbial cell numbers were correlated with fingernail length, with greater numbers beneath fingernails with longer nails. These results indicate that best practices for fingernail sanitation of food handlers are to maintain short fingernails and scrub fingernails with soap and a nailbrush when washing hands.

Alcohols↗
PubMed2003

Reduction of Escherichia coli O157:H7 and Salmonella on laboratory-inoculated alfalfa seed with commercial citrus-related products.

Alfalfa sprouts contaminated with the bacterial pathogens Escherichia coli O157:H7 and Salmonella have been the source of numerous outbreaks of foodborne illness in the United States and in other countries. The seed used for sprouting appears to be the primary source of these pathogens. The aim of this study was to determine whether the efficacy of commercial citrus-related products for sanitizing sprouting seed is similar to that of high levels of chlorine. Five products (Citrex, Pangermex, Citricidal, Citrobio, and Environné) were tested at concentrations of up to 20,000 ppm in sterile tap water and compared with buffered chlorine (at 16,000 ppm). Alfalfa seeds were inoculated with four-strain cocktails of Salmonella and E. coli O157:H7 to give final initial concentrations of ca. 9.0 and 7.0 CFU/g, respectively. Treatments (10 min) with Citrex, Pangermex, and Citricidal at 20,000 ppm and chlorine at 16,000 ppm produced similar log reductions for alfalfa seed inoculated with four-strain cocktails of E. coli O157:H7 and Salmonella (3.42 to 3.46 log CFU/g and 3.56 to 3.74 log CFU/g, respectively), and all four treatments were significantly (P<0.05) more effective than the control treatment (a buffer wash). Citrobio at 20,000 ppm was as effective as the other three products and chlorine against Salmonella but not against E. coli O157:H7. Environné was not more effective (producing reductions of 2.2 to 2.9 log CFU/g) than the control treatment (which produced reductions of 2.1 to 2.3 log CFU/g) against either pathogen. None of the treatments reduced seed germination. In vitro assays, as well as transmission electron microscopy, confirmed the antibacterial nature of the products that were effective against the two pathogens and indicated that they were bactericidal. When used at 20,000 ppm, the effective citrus-related products may be viable alternatives to chlorine for the sanitization of sprouting seed pending regulatory approval.

Anti-Bacterial Agents↗
PubMed2004

Internalization of bacterial pathogens in tomatoes and their control by selected chemicals.

The effect of different washing or sanitizing agents was compared for preventing or reducing surface and internal contamination of tomatoes by Salmonella Typhimurium and Escherichia coli O157:H7. The tomatoes were inoculated by dipping them in a bacterial suspension containing approximately 6.0 log CFU/ml of each pathogen and then rinsing them with tap water, hypochlorite solution (250 mg/liter), or lactic acid solution (2%, wt/vol). All treatments were applied by dipping or spraying, and solutions were applied at 5, 25, 35, and 55 degrees C. With the exception of the lactic acid dip at 5 degrees C, all treatments reduced both pathogens on the surfaces of the tomatoes by at least 2.9 cycles. No significantly different results were obtained (P > 0.05) with the dipping and spraying techniques. For internalized pathogens, the mean counts for tomatoes treated with water alone or with chlorine ranged from 0.8 to 2.1 log CFU/g. In contrast, after lactic acid spray treatment, all core samples of tomatoes tested negative for Salmonella Typhimurium and, except for one sample with a low but detectable count, all samples tested negative for E. coli O157:H7 with a plate count method. When the absence of pathogens was verified by an enrichment method, Salmonella was not recovered from any samples, whereas two of four samples tested positive for E. coli O157:H7 even though the counts were negative. Few cells of internalized pathogens were able to survive in the center of the tomato during storage at room temperature (25 to 28 degrees C). The average superficial pH of tomatoes treated with tap water, chlorine, or lactic acid was 4.9 to 5.2, 4.1 to 4.3, and 2.5, respectively (P < 0.05), whereas no differences were observed in the internal pH (3.6 to 3.7) of the tomatoes treated with different sanitizers. The general practice in the tomato industry is to wash the tomatoes in chlorinated water. However, chlorine is rapidly degraded by organic matter usually present in produce. Therefore, lactic acid sprays may be a more effective alternative for decontaminating tomato surfaces. The use of warm (55 degrees C) sprays could reduce pathogen internalization during washing.

Colony Count, Microbial↗