Handwashing and Ebola virus disease outbreaks: A randomized comparison of soap, hand sanitizer, and 0.05% chlorine solutions on the inactivation and removal of model organisms Phi6 and E. coli from hands and persistence in rinse water.

To prevent Ebola transmission, frequent handwashing is recommended in Ebola Treatment Units and communities. However, little is known about which handwashing protocol is most efficacious. We evaluated six handwashing protocols (soap and water, alcohol-based hand sanitizer (ABHS), and 0.05% sodium dichloroisocyanurate, high-test hypochlorite, and stabilized and non-stabilized sodium hypochlorite solutions) for 1) efficacy of handwashing on the removal and inactivation of non-pathogenic model organisms and, 2) persistence of organisms in rinse water. Model organisms E. coli and bacteriophage Phi6 were used to evaluate handwashing with and without organic load added to simulate bodily fluids. Hands were inoculated with test organisms, washed, and rinsed using a glove juice method to retrieve remaining organisms. Impact was estimated by comparing the log reduction in organisms after handwashing to the log reduction without handwashing. Rinse water was collected to test for persistence of organisms. Handwashing resulted in a 1.94-3.01 log reduction in E. coli concentration without, and 2.18-3.34 with, soil load; and a 2.44-3.06 log reduction in Phi6 without, and 2.71-3.69 with, soil load. HTH performed most consistently well, with significantly greater log reductions than other handwashing protocols in three models. However, the magnitude of handwashing efficacy differences was small, suggesting protocols are similarly efficacious. Rinse water demonstrated a 0.28-4.77 log reduction in remaining E. coli without, and 0.21-4.49 with, soil load and a 1.26-2.02 log reduction in Phi6 without, and 1.30-2.20 with, soil load. Chlorine resulted in significantly less persistence of E. coli in both conditions and Phi6 without soil load in rinse water (p<0.001). Thus, chlorine-based methods may offer a benefit of reducing persistence in rinse water. We recommend responders use the most practical handwashing method to ensure hand hygiene in Ebola contexts, considering the potential benefit of chlorine-based methods in rinse water persistence

Suellen Glashausser: Books as Revelation

Suellen Glahausser insisted she was a professional artist because she wasn’t suited for anything else. Just as she assigned herself a weekly day to see art in New York, packing a sandwich and apple so as not to waste precious time, Glashausser pushed her own work into new territory with each annual exhibit at Amos Eno Gallery, the cooperative she joined in 1976. Her titles were terse and descriptive: Mounds (1977), Stacks (1978), Fences (1979), Trestles (1980), Paper Shadows (1982), Columns/Wedges (1984), Gardens (1985), etc. They reflected her interest in structure, repetition and infinite variation. These concerns also appear in her books, which rather than being laboratories of ideas, became distillations of larger pieces. Despite its changeability, Glashausser’s work always was immediately identifiable. The person and work appeared one. Trained as a painter at Manhattanville College, in Purchase, New York, Glashausser earned an M.F.A. at the University of California, Berkeley, under Ed Rossbach—a pioneer in the contemporary reinterpretation of textile structures. Two other Berkeley mentors--Joanne Segal Brandford, who taught textile history, and Lillian Elliot on off-loom techniques—based their innovative nets and baskets on ethnographic research. In 1976 Glashausser published a book on plaiting with Carol Westfall, head of the fibers program at Montclair State, where we three were colleagues. Before taking over the papermaking area, she offered a range of textile classes, along with occasional stints in drawing, and two-dimensional design. Plaiting, rather than Minimalism probably accounts for the primacy of the grid in her books. As writers on feminism in the 1970s and 80s noted, many women artists, wrestling with fragmented time and limited space, used the grid as an organizing principle. For example, grids and serial imagery figure prominently in the process-driven sculpture of Jackie Winsor and Eva Hesse, as well as in plaited paper pieces by Neda al-Hilali. Glashausser also admired the subtle, all-white paintings of Robert Reiman, which deal with surface texture and mark-making. Her pages—layered, pricked and sewn—reward touch. However, the books show equal affinity to Pattern & Decoration. Painters like Kim Mac Connell and Miriam Shapiro recycled anonymous domestic linens, revaluing bright color and kitsch sensibility. Undeniably, a love of folk art, especially what the French call bricolage, was added to this mix

Artists' Riffs on Suellen Glashausser

Artists' Riffs draws on presentations made at the opening of Suellen Glashausser and Her Circles. Judith Krall-Russo, a Highland Park neighbor and co-participant in a local women artists' group, discusses her artistic debt to Suellen Glashausser and the sometimes-exacting nature of their friendship. Like Krall-Russo, Debra Rapoport, a New York based artist, attends to her relationship with Glashausser as mediated by their interest in food, in gleaning pieces of "everyday life" and art: "assembling, building, and collecting." Lore Lindenfeld, pays homage to It Is Our Pleasure to Serve You. Another of Glashausser's more canonical works, Topaz Man, forms the main topic in an essay by Debra Weier, a painter and book artist. Karen Guancione reflects on moments of surprised recognition that have occurred for her after Glashausser's death. Pamela Scheinman, artist, writer, scholar, and instructor at Montclair State University, traces echoes in theme, material, and technique between Glashausser's artists' books and her paintings, sculptures, and installations

Seeking Clearer Recommendations for Hand Hygiene in Communities Facing Ebola: A Randomized Trial Investigating the Impact of Six Handwashing Methods on Skin Irritation and Dermatitis

<div><p>To prevent disease transmission, 0.05% chlorine solution is commonly recommended for handwashing in Ebola Treatment Units. In the 2014 West Africa outbreak this recommendation was widely extended to community settings, although many organizations recommend soap and hand sanitizer over chlorine. To evaluate skin irritation caused by frequent handwashing that may increase transmission risk in Ebola-affected communities, we conducted a randomized trial with 91 subjects who washed their hands 10 times a day for 28 days. Subjects used soap and water, sanitizer, or one of four chlorine solutions used by Ebola responders (calcium hypochlorite (HTH), sodium dichloroisocyanurate (NaDCC), and generated or pH-stabilized sodium hypochlorite (NaOCl)). Outcomes were self-reported hand feel, irritation as measured by the Hand Eczema Score Index (HECSI) (range 0–360), signs of transmission risk (e.g., cracking), and dermatitis diagnosis. All groups experienced statistically significant increases in HECSI score. Subjects using sanitizer had the smallest increases, followed by higher pH chlorine solutions (HTH and stabilized NaOCl), and soap and water. The greatest increases were among neutral pH chlorine solutions (NaDCC and generated NaOCl). Signs of irritation related to higher transmission risk were observed most frequently in subjects using soap and least frequently by those using sanitizer or HTH. Despite these irritation increases, all methods represented minor changes in HECSI score. Average HECSI score was only 9.10 at endline (range 1–33) and 4% (4/91) of subjects were diagnosed with dermatitis, one each in four groups. Each handwashing method has benefits and drawbacks: soap is widely available and inexpensive, but requires water and does not inactivate the virus; sanitizer is easy-to use and effective but expensive and unacceptable to many communities, and chlorine is easy-to-use but difficult to produce properly and distribute. Overall, we recommend Ebola responders and communities use whichever handwashing method(s) are most acceptable, available, and sustainable for community handwashing.</p><p><b>Trial Registration:</b> International Standard Randomized Controlled Trial Registry <a href="https://clinicaltrials.gov/ct2/show/ISRCTN89815514" target="_blank">ISRCTN89815514</a></p></div

Average Concentration and pH of Chlorine Solutions.

<p>Average Concentration and pH of Chlorine Solutions.</p

Experimental design.

<p>Experimental design.</p

Percentage of subjects displaying each aspect of the HECSI score over time.

<p>Percentage of subjects displaying each aspect of the HECSI score over time.</p

<i>E</i>. <i>coli</i> handwashing results.

<p>Error bars represent standard error of log reduction.</p