The UK is currently facing an outbreak of Shiga toxin-producing Escherichia coli (E. coli) O145, with 113 confirmed cases as of 4 June 2024 (GOV.UK, 2024). This outbreak has been primarily linked to a nationally distributed food item, affecting individuals from the ages of two to 79, with the majority of cases found in young adults (GOV.UK, 2024). As a senior lecturer in public health and postdoctoral researcher in hand hygiene practices, I want to emphasise the importance of proper hygiene practices to help prevent the spread of such infections.

Understanding E. coli O145

Escherichia coli is a Gram-negative, rod-shaped bacterium that is part of the Enterobacteriaceae family. E. coli, or Escherichia coli, is a type of bacteria commonly found in the intestines of humans and animals (Suwito et al., 2023). While most strains are harmless (Manzanas et al., 2023), some, like the Shiga toxin-producing E. coli (STEC) O145 involved in this outbreak, can cause severe illness. This strain is part of a group of pathogenic E. coli serogroups that includes O26, O45, O103, O104, O111, and O157, which are associated with causing foodborne illnesses globally (Koti et al., 2024). STEC O145 is one of several serogroups of E. coli that can produce Shiga toxins, leading to symptoms such as bloody diarrhoea, stomach cramps, vomiting, and fever (Pas et al., 2023). 

Hand Washing with Soap and Water

Hands play a crucial role in the transmission of enteric pathogens (Alzyood et al., 2019), including E. coli, as they can become contaminated with faecal bacteria and pathogens, facilitating their spread through various mediums like fomites, food, water, and soil (Cantrell et al., 2023). One of the most effective ways to prevent the transmission of E. coli and other gastrointestinal infections is thorough hand washing with soap and warm water. This simple yet crucial practice can eliminate many pathogens that cause illness, which alcohol-based hand gels may not completely remove. It is particularly important to wash your hands:

• Before preparing or eating food
• After blowing your nose, coughing, or sneezing
• Before and after treating a cut or wound
• Before and after caring for someone who is ill
• After using the toilet
• After handling raw meat
• After touching animals or their environments
• After being in a public place and touching items like door handles, shopping carts, or elevator buttons

Washing Vegetables and Pre-Packed Salads

Fresh produce, such as lettuce and other pre-packed salads, can sometimes be contaminated with harmful bacteria. It is essential to wash these items carefully before consumption. Rinsing vegetables under running water can help remove any potential contaminants like E. coli, which have been found in fresh vegetables sold in local markets (Chotinantakul, Woottisin and Okada, 2022).

Embedding Hand Hygiene in Daily Routines

Dr Alzyood argues that promoting good hand hygiene behaviours from a young age is critical. In countries like Japan, children are taught the importance of hand washing as part of their daily routine, both at home and in school. This practice helps embed good hygiene habits that can last a lifetime and reduce the spread of infections.Primary and secondary school students should be encouraged to wash their hands regularly, especially before eating and after using the restroom. Additionally, universities and colleges play a crucial role in reinforcing these behaviours. Collaborative efforts from these institutions and hand hygiene experts can provide the necessary facilities and integrate hygiene education into their curricula, ensuring that young adults carry these practices into their future professional and personal lives.

Ongoing Vigilance Against Bacteria and Viruses

Dr Alzyood reminds us that outbreaks of bacteria and viruses will be recurrent if we do not remain vigilant. While for many, the threat of COVID-19 may seem to have passed, it, along with other risks, still surrounds us. Good hygiene practices, particularly hand washing with soap and water, are essential to preventing the spread of not just E. coli but a wide range of infectious diseases, including COVID-19.Embedding these practices in our daily lives, especially from a young age, can significantly reduce the risk of outbreaks and promote overall public health. As a reminder of the importance of hand hygiene, Dr Alzyood states that hand hygiene is the single most important means of preventing the spread of infection. This timeless advice underscores the power of simple hygiene practices in safeguarding our health against microorganisms.

For more detailed guidance and updates on the E. coli outbreak, refer to the UK Government’s advice. If you need any medical support, always check the dedicated NHS page for the latest information and assistance.

References

Alzyood, M., Jackson, D., Aveyard, H., & Brooke, J. (2020). covid‐19 reinforces the importance of handwashing. Journal of Clinical Nursing, 29(15-16), 2760-2761. https://doi.org/10.1111/jocn.15313

Cantrell, M. E., Sylvestre, É., Wharton, H. C., Scheidegger, R., Curchod, L., Gute, D. M., … & Pickering, A. J. (2023). Hands are frequently contaminated with fecal bacteria and enteric pathogens globally: a systematic review and meta-analysis. ACS Environmental Au, 3(3), 123-134. https://doi.org/10.1021/acsenvironau.2c00039 

Chotinantakul, K., Woottisin, S., & Okada, S. (2022). The emergence of ctx-m-55 in extended-sectrum β-lactamase-producing <i>escherichia coli</i> from vegetables sold in local markets of northern thailand. Japanese Journal of Infectious Diseases, 75(3), 296-301. https://doi.org/10.7883/yoken.jjid.2021.139

GOV.UK (2024) E. coli advice issued amid rise in cases, GOV.UK. Available at: https://www.gov.uk/government/news/e-coli-advice-issued-amid-rise-in-cases#:~:text=The%20public%20health%20agencies%20are,18%20in%20Wales (Accessed: 9 June 2024).

Koti, K., Rodas-Gonzalez, A., Nadon, C., McAllister, T., Yang, X., & Narváez-Bravo, C. (2024). Evaluating disinfectant efficacy on mixed biofilms comprising shiga toxigenic escherichia coli, lactic acid bacteria, and spoilage microorganisms. Frontiers in Microbiology, 15. https://doi.org/10.3389/fmicb.2024.1360645 

Manzanas, C., Morrison, E., Kim, Y. S., Alipanah, M., Adedokun, G., Jin, S., … & Fan, Z. H. (2023). Molecular testing devices for on-site detection of e. coli in water samples. Scientific Reports, 13(1). https://doi.org/10.1038/s41598-023-31208-4 

Pas, C., Latka, A., Fieseler, L., & Briers, Y. (2023). Phage tailspike modularity and horizontal gene transfer reveals specificity towards e. coli o-antigen serogroups. Virology Journal, 20(1). https://doi.org/10.1186/s12985-023-02138-4 

Suwito, W., Andriani, Martini, T., & Nugroho, W. (2023). Characterization e. coli isolated clinical and subclinical mastitis at ettawa-crossbreed goat (pe) in yogyakarta, indonesia. IOP Conference Series: Earth and Environmental Science, 1246(1), 012059. https://doi.org/10.1088/1755-1315/1246/1/012059