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An infected family member may act as the primary source of infection in the
home. Infected people may show no symptoms and may spread infection
unknowingly. People can continue to harbour and shed stomach bugs after
symptoms have ceased.
Through infected food purchased from retail premises. The most common
sources are meat and poultry, raw eggs, unpasteurised milk, filter feeding
shellfish (e.g. oysters, mussels and clams) which are harvested from sewagecontaminated waters, or vegetables grown or washed in polluted water.
Through contaminated water.
Domestic animals can carry some types of stomach bugs e.g. Salmonella and
Campylobacter, and may shed them in their faeces.
Animals can transfer pathogens (e.g. via their paws) to environmental surfaces.
The pathogens can then be transferred via hands to the mouth or to ready-to-eat
foods. Ready-to-eat foods can become contaminated if placed on a surface (such
as a kitchen work surface) that family pets are free to walk across.
This follows on from an earlier (199) study by Mead et al. The results opf this study
are shown in Table 2.
Table 2 Estimated annual infectious gastrointestinal illnesses in the USA (From
Mead et al 1999
Norovirus
Rotavirus
Campylobacter
Salmonella
Shigella
Hepatitis A
E. coli O157
Total infectious
GI illnesses
23,000, 000
3,900,000
2,453,926
1,412,498
448,240
83,391
73,480
In a Netherlands study carried out between 1996 and 1999, it was estimated that
about 1 in 3.5 people experience a bout of infectious GI disease each year.
Campylobacter was detected most frequently (10% of cases), followed by Giardia
lamblia (5%), rotavirus (5%), norovirus (5%) and Salmonella (4%). Relative to the
population of The Netherlands (16 million), 650,000 norovirus gastroenteritis cases
occur annually.5
A 2007 report in Germany by Krause et al evaluated data from 30,578 outbreak
reports captured 20012005. Of particular note is the fact that the most common
settings among the 10,008 entries for 9,946 outbreaks in 2004 and 2005 were
households (53%).6
In Australia, OzFoodNet sites reported 1,640 outbreaks of gastrointestinal illness
affecting 30,193 people and resulting in 722 people being hospitalised. There were
89 deaths associated with these outbreaks. The majority of outbreaks (81%,
1,330/1,640) were due to person-to-person spread, 9% (154/1,640) were suspected
or confirmed to have been transmitted by contaminated food, 9% (155/1,640) had an
unknown mode of transmission and 1 outbreak was due to transmission from animal
to person.
In New Zealand, during 2011, there were 581 reported outbreaks of
gastrointestinal disease, involving 7796 cases. A total of 204 cases required
hospitalisation and four cases died.7 Campylobacter spp accounted for 29 (5%)
of outbreaks. The most commonly identified enteric pathogen was norovirus in
31.2% of outbreaks, followed by Giardia spp. in 12.4%, Campylobacter spp. and
Cryptosporidium spp. both 5.0% of outbreaks. The most common settings for
exposure or transmission were the private home environment (24.8%). Person-toperson transmission was reported for 78.0% of outbreaks in 2011. Foodborne and
environmental transmission were reported for 21.0% and 17.7% of outbreaks,
respectively. Multiple modes of transmission were implicated in 33.0% of outbreaks.
Contamination of food was the most common factor contributing to foodborne
outbreaks (40.2%), followed by time/temperature abuse (38.5%,). For New Zealand,
over the last 10 years, there have been substantial changes in the reporting of
modes of outbreak transmission. Over this period, person-to-person transmission
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developed symptoms. The following hygiene measures also apply to preventing the
spread of infection in the workplace and schools.
Since the risk of introducing stomach bugs into the home, either via people or foods
is constant and may not be recognised until an outbreak of infection occurs within the
family, this means that good day-to-day hygiene including good food hygiene makes
sense.
General Hygiene
To prevent transmission of infection from an infected family member (or a family
member who may have been exposed to infection outside the home) to other family
members or to food:
Good handwashing practice is the single most important infection control
measure. Hands should be thoroughly washed with soap and running water*. If
access to soap and running water is a problem, use an alcohol hand rub or hand
sanitiser. Where there is an outbreak in the home, it is suggested that
handwashing followed by use of an alcohol rub/sanitiser should be encouraged.
Hygienically clean surfaces in the bathroom and toilet, with particular attention to
washbasins, baths, toilet seats, toilet handles and showers. This can be achieved
by cleaning with a detergent cleaner followed by thorough rinsing under running
water, or where this is not possible, e.g. for toilet seats, toilet flush handles etc.,
using an effective disinfectant cleaner**. If someone has diarrhoea, toilets should
be disinfected after each time they use it.
Keep the infected persons immediate environment hygienically clean. The most
important surfaces are those which come into contact with the hands, e.g. door
handles, telephones, bedside tables, bed frames, computer keyboards, TV
remote controls. To make these surfaces hygienically clean use an effective
disinfectant cleaner or disinfectant product**, although, for items such as
computer keyboards which might be damaged, it is better to make sure the family
always wash their hands before using shared family computers. In a busy
household it is not always possible to keep hand contact surfaces hygienically
clean at all times. This is why it is so important to wash hands as frequently as
possible to break the chain of infection.
Cleaning cloths can easily spread stomach bugs around the home. They should
be hygienically cleaned after each use, particularly after use in the immediate
area of the infected person or the bathroom and toilet used by that person. This
can be done in any of the following ways:
- wash in a washing machine at 60C (hot wash).
- clean with detergent and warm water, rinse and then immerse in disinfectant
solution for at least 20 minutes or as prescribed.
- clean with detergent and water then immerse in boiling water for 20 minutes.
Alternatively use disposable cloths.
Where floors or other surfaces become contaminated with faeces or vomit, they
should be hygienically cleaned at once:
- Remove as much as possible of the excreta, from the surface using paper or
a disposable cloth, then
- Apply disinfectant cleaner** to the surface using a fresh cloth or paper towel
to remove residual dirt then
- Apply disinfectant cleaner** to the surface a second time using a fresh cloth
or paper towel to destroy any residual contamination.
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Disposable gloves should be worn if in contact with faeces, and hands should be
washed after removing gloves.
After someone has vomited, if possible, vacate the room and ventilate the room
by opening windows for a short time to disperse aerosol particles
Clothing, sheets and pillows and linens from the infected person (or carrier)
should be kept separate from the rest of the family laundry and should be
laundered in a manner which kills any stomach bugs. Either:
- for preference, wash at 60C or above, using a powder or tablet detergent
containing active oxygen bleach (see ingredients on back of pack).
- alternatively wash at 40C with a powder or tablet detergent containing
active oxygen bleach (see ingredients on back of pack)
Note: washing at 40C without the presence of bleach will not destroy stomach bugs
Do not share towels, facecloths, toothbrushes and other personal hygiene items
with the infected or carrier person.
Where young children are ill, or at particular risk:
- their handwashing, personal and toilet hygiene may need supervision
- nappies should be disposed of safely, or cleaned, disinfected and washed.
Contrary to popular perception, the faeces of babies can be highly infectious.
Where possible, infected people should stay in their own room and use their own
facilities, cutlery, crockery etc. Infected people should particularly avoid contact
with those who may be more vulnerable to infection, and their personal items.
Food and Kitchen hygiene
Rigorous food hygiene is important in preventing the spread of stomach bugs in the
home. Where there is an infected person in the home, food hygiene practices should
focus on preventing contamination of food, particularly ready-to-eat foods such as
sandwiches and salads. Where there is a suspected food source of the outbreak in
the home, food hygiene practice should focus on containing and destroying the
source, and preventing transfer to other foods.
Infected people should try to stay away from the kitchen and should not prepare
food for others.
Wash hands after handling food which may be contaminated and disinfect using
an alcohol handrub or sanitiser.
Wash hands before handling ready-to-eat foods and disinfect using an alcohol
handrub or sanitiser.
Hygienically clean all food contact surfaces, utensils and cloths after handling and
preparation of raw foods using a disinfectant cleaner**. Hygienically clean all
contact surfaces, utensils and cloths before handling and/or preparing ready-toeat foods.
Cook foods thoroughly.
Wash any foods such as fruit and vegetables to be eaten raw thoroughly under
clean running water.
Store foods carefully in a refrigerator or freezer. Ensure that cooked foods are
kept separate from uncooked foods.
Handwashing technique is very important. Rubbing with soap and water lifts the
germs off the hands, but rinsing under running water is also vital, because it is this
process which actually removes the germs from the hands. The accepted procedure
for handwashing is:
ensure a supply of liquid soap, warm running water, clean hand towel/disposable
paper towels and a foot-operated pedal bin
always wash hands under warm running water
apply soap
rub hands together for 1530 seconds, paying particular attention to fingertips,
thumbs and between the fingers
rinse well and dry thoroughly.
In situations where soap and running water is not available an alcohol- based hand
rub or hand sanitiser should be used to achieve hand hygiene:
apply product to the palm of one hand
rub hands together
rub the product over all surfaces of hands and fingers until your hands are dry.
Note: the volume needed to reduce the number of germs on hands varies by product.
In high risk situations where there is an outbreak in the home, handwashing followed
use of an alcohol rub/sanitiser should be encouraged.
One very simple thing which people can do which can significantly reduce the risk of
disease is to avoid putting their fingers to their mouth.
**Disinfectants and disinfectant cleaners:
Make sure you use a disinfectant or disinfectant/cleaner such as a bleach-based
product, which is active against the type of stomach bug which is causing the
outbreak. In many situations it is likely that the causative organisms will not be
known. In this case it is important to use a disinfectant or disinfectant cleaner which
is active against all types of organisms (bacteria and viruses). For more details on
choosing the appropriate disinfectant, consult the IFH information sheet Cleaning
and disinfection: Chemical Disinfectants Explained. Also consult the manufacturers
instructions for information on the spectrum of action, and method of use (dilution,
contact time etc). For bleach (hypochlorite) products, use a solution of bleach, diluted
to 0.5% w/v or 5000ppm available chlorine. Household bleach (both thick and thin
bleach) for domestic use typically contains 4.5 to 5.0% w/v (45,000-50,000 ppm)
available chlorine. In situations where concentrated bleach is recommended a
solution containing not less than 4.5% w/v available chlorine should be used.
Bleach/cleaner formulations (e.g. sprays) are formulated to be used neat (i.e.
without dilution). It is always advisable however to check the label as concentrations
and directions for use can vary from one formulation to another.
Good Food hygiene practice in the home is described in more detail in:
1. Home Hygiene - prevention of infection at home: a training resource for carers
and their trainers. International Scientific Forum on Home Hygiene. Available
from: http://www.ifh-homehygiene.org/2003/2public/2pub06.asp.
2. Home Hygiene in Developing Countries: Prevention of Infection in the Home and
Peridomestic Setting. A training resource for teachers and community health
professionals in developing countries. International Scientific Forum on Home
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http://www.ifh-homehygiene.org/2003/2PUBLIC/ifh_
Page 9/12
http://www.ifh-homehygiene.org/review/global-burden-hygiene-related-diseasesrelation-home-and-community
The Community Summary Report on Trends and Sources of Zoonoses, Zoonotic
Agents, Antimicrobial resistance and Foodborne outbreaks in the European Union.
http://www.efsa.europa.eu/en/zoonosesscdocs/zoonosescomsumrep.htm
Centre for Diseases Control and Prevention. Preliminary FoodNet data on the
incidence of infection with pathogens transmitted commonly through food in 10
states, 2006-2013. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6315a3.htm
WHO, Five keys to safer food. 2006. Food Safety Department. World health
Organisation.www.who.int/foodsafety/publications/consumer/manual_keys.pdf
References
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WHO. Water and Health in Europe: A Joint Report from the European Environment Agency and
the WHO Regional Office for Europe. 2002. Eds: Bartram J, Thyssen N, Gowers A, Pond K, Lack T.
The Longitudinal study of infectious intestinal disease in the UK (IID2 study): incidence in the
community and presenting to general practice Tam CC, Rodrigues LC, Viviani L, et al. Gut (2011).
doi:10.1136/gut.2011.238386.
Food Standards Agency. A report of the study of infectious intestinal disease in England (TSO,
2000).
Hall AJ, Wikswo ME, Manikonda K, Roberts VA, Yoder JS, Gould LH. Acute gastroenteritis
surveillance through the National Outbreak Reporting System, United States. Emerg Infect Dis.
2013. http://dx.doi.org/10.3201/eid1908.130482 .
de Wit MA, Koopmans MP, Kortbeek LM, van Leeuwen NJ, Bartelds AI, van Duynhoven YT.
Gastroenteritis in sentinel general practices in The Netherlands. Emerging Infectious Diseases
2001;7:82-91.
Krause G, Altmann D, Faensen D, et al. SurvNet electronic surveillance system for infectious
disease outbreaks, Germany. Emerging Infectious Diseases 2007; 13:1548-55.
Summary of Outbreaks in New Zealand 2011. Institute of Environmental Science and
Research Limited. July 2012.
https://surv.esr.cri.nz/PDF_surveillance/AnnualRpt/AnnualOutbreak/2011/2011OutbreakRpt.pdf