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<p class="study03-1Cap">Dr. Shigeharu Oie<br />
Sanyo-Onoda City University, Professor, Faculty of Pharmacy, Tokyo Healthcare University, Guest Professor, Postgraduate School. FY2012 Chairman Annual Meeting of the Japan Society for Environmental Infectious Diseases. Specializes in investigating the causes of nosocomial infection and hygiene management in hospitals. He is endeavoring to producing guidelines, etc., for administrative organizations such as the Ministry of Health and Welfare and has authored "Guidelines for disinfection and sterilization", "Book on Disinfection and Sterilization that can be used in Hospital Wards" and "How to choose and use disinfectants".</p>
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<p class="lead">When the season changes from autumn to winter, what stands out are the reports of outbreaks of "Norovirus". It is generally known that eating raw oysters is a primary source of infection; however, the cause of epidemics is school lunches, catered meals and other secondary infections during the preparation of meals. There are also repeated reports of infections between family members in bathrooms at home. We spoke with Dr. Shigeharu Oie, one of Japan's leading authorities in the prevention, disinfection, and sterilization of infectious diseases, regarding preventive measures.</p>
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<p class="question clearfix"><span class="q_no">Q1.</span><span class="q_text">What are the kinds of "intestinal infections" that many Japanese people suffer from? Please inform us about the major intestinal infections.</span></p>
<p class="answer"><span>It is always a problem when living in groups and the norovirus is extremely common. Outbreaks can easily occur and it is especially prominent among intestinal infections.<br />
Every year in Japan, over 14,000 patients are reported, however, the symptoms are not serious and so there are some who do not seek medical treatment. Therefore the actual situation can be thought to be more than 10 times or even 100 times this number. Because there is no immunization, some people are infected multiple times.
</span><img src="../images/asking_expert/01/ill05.gif" width="269" height="200" alt=""/></p>
<p class="answer clear">The most common cause of infection in Japan is the habit of eating raw oysters. The reason for this being common between November and February is probably because of eating raw oysters during winter.</p>
<p class="answer">Academically, the norovirus is not limited to oysters and can be found concentrated in bivalves. Of course, cooking it will render them safe to eat and there are also oysters that can be eaten raw in the summer such as the summer oysters from the Sea of Japan. All causes of infection are not because of oysters.</p>
<img src="../images/asking_expert/01/ill01.gif" width="672" height="490" alt="ノロウイルスの感染サイクル" class="large" />
<p class="answer">Becoming infected orally with norovirus will cause severe diarrhea, vomiting and much suffering; however, it will rarely be serious enough to cause death. It is basically similar to influenza and people will recover from it in 3 to 4 days.<br />
However, there have been cases where elderly persons have died after being infected. In most cases, the cause of death is not the infection itself but rather choking on matter from vomiting or from dehydration because of diarrhea. <br />
Additionally, in recent years in Japan, what has increased is intestinal infections caused by Campylobacter. Infection is caused by eating half-cooked chicken, etc. When imported frozen chicken was examined, Campylobacter was detected in almost 70%. Therefore, you should make sure the chicken is appropriately cooked.
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<p class="question clearfix"><span class="q_no">Q2.</span><span class="q_text">Norovirus is prone to massive outbreaks. What is the mechanism that causes it to spread?</span></p>
<p class="answer"><span>A characteristic of norovirus is that it is very easily spread through oral infection. It is a highly contagious virus and the frequency of infection is also high. The infectivity of intestinal tract infections can be expressed as "infective dose(about how many will it take for an infection if taken orally)", for example, 1 million organisms for Salmonella Entertidis or 1 million viral particles for hepatitis A virus. On the other hand, norovirus infection will occur when 10 to 100 viral particles enter from the mouth. Incidentally, infection with the least amount of germs can occur with O-157 (enterohemorrhagic E. coli) and Shigella with as few as around 10 organisms.</span><img src="../images/asking_expert/01/ill02.gif" width="269" height="200" alt=""/></p>
<p class="answer clear">The norovirus is found in the small intestine of infected people and is detected in the stool and regurgitation (vomit). There are 10 million viral particles in the stool. The concentration is not as high in regurgitation (vomit) as in stool and is about 1 million viral particles. There are 100,000 viral particles even in 0.1 gram so it means that infection will occur even from trace amounts that cannot be seen.<br />
The cause of infection spreading is often when food handlers (such as cooks) touch food with hands contaminated with stool or vomit and the norovirus enters the mouth from the food. In 2017, it was reported that a widespread infection of norovirus occurred from sliced laver in the school lunch. Genetic analysis revealed that after the laver manufacturer vomited, the sliced laver was manufactured without sufficiently washing hands and children who ate the laver about 3 months later, became infected. In this manner, it was confirmed that the norovirus can survive for very long periods of time even in a dry environment.<br />
Additionally, there was also a case where norovirus infection occurred even without touching the vomit at all. This is a pattern where the regurgitated matter (virus) when vomiting is scattered as a mist and attaches to the pharynx and infection occurs when the virus is swallowed along with the saliva. There is also a pattern where dried vomit (virus) becomes airborne and attaches to the pharynx and is swallowed along with the saliva. In that respect, norovirus can also be transmitted by droplet infection or airborne infection.</p>
<img src="../images/asking_expert/01/ill03.gif" width="672" height="450" alt="病原微生物の感染菌量（経口）" class="large" />
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<p class="question clearfix"><span class="q_no">Q3.</span><span class="q_text">In order to prevent the spread of infection, it is necessary to be self-aware. After using the restroom, what precautions are necessary?</span></p>
<p class="answer">It is very important to not get any fecal matter (stool) on your hands in the first place. If it does not get on your hands, the cause of infection will not spread by adhering to door knobs, food or cookware.<br />
In my laboratory in 2017, there was a comparative experiment for the contamination of hands after defecating. First, the condition after defecating was simulated with model buttocks and artificial stool containing germs then a wiping test was conducted to see how much germs adhered to hands was investigated.</p>
<img src="../images/asking_expert/01/ph01.jpg" width="672" height="190" alt="人工尻模型と菌含有の人工便を使って排便後の状態を模擬して拭き取り試験" class="large"/>
<p class="mb20">Source：Shigeharu Oie, Hiromi Aoshika, Emiko Arita, Akira Kamiya. The Use of Electric Toilet Seats with Water Spray Is Efficacious in Maintaining Hand Hygiene in Experimental Model. Japanese Journal of Infectious Disease 2018 Volume 71 Issue 4 306-308</p>
<p class="answer"><span>Four layered sheets of toilet paper were used for wiping. This was based on the result of a survey conducted by the Japan Sanitary Equipment Industry Association that the largest number of people replied that they used "4 layers of sheets to wipe". The results were that germs were attached to the hands after wiping with four layered sheets of toilet paper. Toilet paper is full of infinite holes when viewed under a microscope. Because the size of the holes were about 100 times larger than the size of the germs, it was easy for the germs to pass through even when 4 sheets were layered.</span><img src="../images/asking_expert/01/ill07.jpg" width="264" height="263" alt=""/></p>
<p class="answer clear">At the same time, tests were conducted by wiping with 4 layered sheets of toilet paper after washing for 30 seconds using a spray seat to cleanse buttocks. The results were that after using a spray seat for 30 seconds, the number of germs attached to the hand was less than 10,000 times lower than when not used.</p>
<p class="answer">Next, a test at the actual time of excretion was conducted. The results were that the number of germs attached to the hand was about 10 times less than people who did not use the spray seat. When a spray seat is used, the risk of infection will be reduced to about 90%. Although there are individual differences such as usage, the use of a spray seat can reduce the number of germs attaching on hands and can be said to be extremely effective in preventing intestinal infections.</p>
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<p class="question clearfix"><span class="q_no">Q4.</span><span class="q_text">What should you do if a family member or person living in your surroundings is infected with norovirus?</span></p>
<p class="answer"><span>It would be better to have everyone in the family be aware that infection is easily spread among family members. Careful hygiene of hands should be taken especially when preparing food. <br />
It is thought that the possibility of norovirus is 60% to 70% when vomiting occurs during winter and so disinfection should be done carefully. Wear disposable gloves when cleaning regurgitated matter (vomit) and also wearing surgical masks is ideal.</span><img src="../images/asking_expert/01/ill06.gif" width="269" height="200" alt=""/></p>
<p class="answer clear">Additionally, it is dangerous to leave regurgitated matter (vomit) for prolonged periods. There has also been cases reported that people were infected from dust after vacuuming dried regurgitated matter. When dried, it is easier for it to become airborne and become attached to the pharynx causing infection.<br />
It is also imported to clean the toilet after defecation or vomiting. There are few disinfectants that can be used in homes, however, sodium hypochlorite 0.1% (1,000 ppm) solution or ethanol (sold at pharmacies as a non-prescription drug) for disinfecting carpets and solid wood etc., can be used. It is fundamental to use these two disinfectants properly according to the location.<br />
In addition, it should be noted that the disinfection ability of sodium hypochlorite is easy rendered less effective when exposed to direct sunlight and with the passage of time. When purchasing products, choose products with a specified concentration and expiration date. To be specific, it is recommended that disinfectant solutions for infants, such as Milton<sup>®</sup>, Purifan<sup>®</sup> P and Milkpon<sup>®</sup>, be diluted and used.<br />
Even if you don't have any symptoms, it is also important to wash your hands after defecation. You should know that many cases of the norovirus are also "subclinical infections". For example, eating oysters infected with norovirus does not mean that everyone will show the symptoms and some people do not. In other words, some people will carry the norovirus without developing the disease and outbreaks that occur in hotels, hospitals, etc. may spread as a result of such “subclinical infections”.<br />
Children and the elderly are especially prone to norovirus infection; however, this is related to the gastric liquids showing germicidal effects. In children, this is because the gastric liquids are still insufficient while in the elderly, one reason is that it is difficult for them to produce it sufficiently. Accordingly, special consideration is required for households with children and elderly persons. Additionally, even in adults, if they are taking medication for symptoms of stomach ulcers to suppress stomach acid (H2 blocker gastrointestinal medication, etc.), they will be more susceptible to infection.
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<p class="question clearfix"><span class="q_no">Q5.</span><span class="q_text">What are some precautions in avoiding infection from O-157, etc.?</span></p>
<p class="answer"><span>Maintaining normal intestinal flora is one important preventive measure in avoiding infection from O-157, etc. In healthy intestines, a wide variety of microorganisms make up the microbiota and these act to control the growth of specific germs and function to prevent infections. For example, even if O-157 should enter the intestines, if large numbers of microorganisms are there, the O-157 will not be able to multiply and the occurrence of infection will be less likely.<br />
</span><img src="../images/asking_expert/01/ill04.gif" width="264" height="190" alt=""/></p>
<p class="answer clear">In hospitals, serious intestinal infections such as pseudomembranous colitis caused by Clostridioides difficile (formerly called Clostridium) germs are a major problem, however, these only affect people who are administered antibiotics and anticancer drugs. Because some antibiotics and anti-cancer drugs are germicidal, they will "harm intestinal flora".<br />
When we eat, we also provide some nutrients to the intestinal microorganisms and in turn, the internal microorganisms play a role in protecting us from infections. We also know that we acquire vitamin B and vitamin K that the microorganisms produce. We coexist with the various intestinal microorganisms. It is very important to maintain normal intestinal flora to prevent the abnormal increase of problem causing microorganisms.</p>
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<p class="lasttitle">＜Summary＞<br />Basic knowledge in preventing norovirus infection</p>
<ul class="summary">
<li>Washing hands after defecation is essential. People who prepare meals should especially be careful about washing their hands.</li>
<li>If you use a spray seat, the amount of bacteria that are transferred on hands will be about 1/10.</li>
<li>Clean the toilet bowl when having diarrhea because the virus is scattered around in the toilet bowl. In this case, it is better to use a product labeled “disinfectant” instead of an antibacterial or a sanitizing agent.<br />Use either sodium hypochlorite 0.1% (1,000 ppm) or ethanol for disinfection.</li>
<li>Use disposable gloves and surgical masks when treating vomit.</li>
<li>Clean vomit quickly as it is more dangerous when dry and can become airborne.</li>
<li>Wash laundry stained with diarrhea and vomit separately from other laundry.<br />Washing will reduce the amount of norovirus. Washing with hot water with a temperature of 70°C or higher is even more effective.</li>
<li>It is also important to cook food at a sufficient heat. Norovirus will be killed when heated at 80°C for 1 minute or more.</li>
<li>Be wary of people who have subclinical infections. "No symptom does not mean the person is not a carrier (no norovirus)".</li>
</ul>
<div class="att">
<p>The site that introduces Dr. Oie research is from here</p>
<p><span class="link_type_a"><a href="/global/health_research/study05.html" onclick="ga('send', 'event', 'linkclick', 'click', 'pdf_study05')" target="_blank">The Use of Electric Toilet Seats with Water Spray Is Efficacious in Maintaining Hand Hygiene in Experimental Model</a></span></p>
<p><span class="link_type_a"><a href="/global/health_research/study06.html" onclick="ga('send', 'event', 'linkclick', 'click', 'pdf_study05')" target="_blank">Microbial contamination of hands with or without the use of bidet toilets (electric toilet seats with water spray) after defecation</a></span></p>
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<p class="study03-1Cap">Dr. Shigeharu Oie<br />
Sanyo-Onoda City University, Professor, Faculty of Pharmacy, Tokyo Healthcare University, Guest Professor, Postgraduate School. FY2012 Chairman Annual Meeting of the Japan Society for Environmental Infectious Diseases. Specializes in investigating the causes of nosocomial infection and hygiene management in hospitals. He is endeavoring to producing guidelines, etc., for administrative organizations such as the Ministry of Health and Welfare and has authored "Guidelines for disinfection and sterilization", "Book on Disinfection and Sterilization that can be used in Hospital Wards" and "How to choose and use disinfectants".</p>
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<img src="../images/asking_expert/01/doctor_photo01s.jpg" width="151" height="222" alt="尾家重治先生" / class="right_img">
<p class="lead">When the season changes from autumn to winter, what stands out are the reports of outbreaks of "Norovirus". It is generally known that eating raw oysters is a primary source of infection; however, the cause of epidemics is school lunches, catered meals and other secondary infections during the preparation of meals. There are also repeated reports of infections between family members in bathrooms at home. We spoke with Dr. Shigeharu Oie, one of Japan's leading authorities in the prevention, disinfection, and sterilization of infectious diseases, regarding preventive measures.</p>
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<p class="question clearfix"><span class="q_no">Q1.</span><span class="q_text">What are the kinds of "intestinal infections" that many Japanese people suffer from? Please inform us about the major intestinal infections.</span></p>
<p class="answer"><span>It is always a problem when living in groups and the norovirus is extremely common. Outbreaks can easily occur and it is especially prominent among intestinal infections.<br />
Every year in Japan, over 14,000 patients are reported, however, the symptoms are not serious and so there are some who do not seek medical treatment. Therefore the actual situation can be thought to be more than 10 times or even 100 times this number. Because there is no immunization, some people are infected multiple times.
</span><img src="../images/asking_expert/01/ill05.gif" width="269" height="200" alt="" /></p>
<p class="answer clear">The most common cause of infection in Japan is the habit of eating raw oysters. The reason for this being common between November and February is probably because of eating raw oysters during winter.</p>
<p class="answer">Academically, the norovirus is not limited to oysters and can be found concentrated in bivalves. Of course, cooking it will render them safe to eat and there are also oysters that can be eaten raw in the summer such as the summer oysters from the Sea of Japan. All causes of infection are not because of oysters.</p>
<img src="../images/asking_expert/01/ill01.gif" width="672" height="490" alt="ノロウイルスの感染サイクル" class="large" />
<p class="answer">Becoming infected orally with norovirus will cause severe diarrhea, vomiting and much suffering; however, it will rarely be serious enough to cause death. It is basically similar to influenza and people will recover from it in 3 to 4 days.<br />
However, there have been cases where elderly persons have died after being infected. In most cases, the cause of death is not the infection itself but rather choking on matter from vomiting or from dehydration because of diarrhea. <br />
Additionally, in recent years in Japan, what has increased is intestinal infections caused by Campylobacter. Infection is caused by eating half-cooked chicken, etc. When imported frozen chicken was examined, Campylobacter was detected in almost 70%. Therefore, you should make sure the chicken is appropriately cooked.
</p>
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<p class="question clearfix"><span class="q_no">Q2.</span><span class="q_text">Norovirus is prone to massive outbreaks. What is the mechanism that causes it to spread?</span></p>
<p class="answer"><span>A characteristic of norovirus is that it is very easily spread through oral infection. It is a highly contagious virus and the frequency of infection is also high. The infectivity of intestinal tract infections can be expressed as "infective dose(about how many will it take for an infection if taken orally)", for example, 1 million organisms for Salmonella Entertidis or 1 million viral particles for hepatitis A virus. On the other hand, norovirus infection will occur when 10 to 100 viral particles enter from the mouth. Incidentally, infection with the least amount of germs can occur with O-157 (enterohemorrhagic E. coli) and Shigella with as few as around 10 organisms.</span><img src="../images/asking_expert/01/ill02.gif" width="269" height="200" alt="" /></p>
<p class="answer clear">The norovirus is found in the small intestine of infected people and is detected in the stool and regurgitation (vomit). There are 10 million viral particles in the stool. The concentration is not as high in regurgitation (vomit) as in stool and is about 1 million viral particles. There are 100,000 viral particles even in 0.1 gram so it means that infection will occur even from trace amounts that cannot be seen.<br />
The cause of infection spreading is often when food handlers (such as cooks) touch food with hands contaminated with stool or vomit and the norovirus enters the mouth from the food. In 2017, it was reported that a widespread infection of norovirus occurred from sliced laver in the school lunch. Genetic analysis revealed that after the laver manufacturer vomited, the sliced laver was manufactured without sufficiently washing hands and children who ate the laver about 3 months later, became infected. In this manner, it was confirmed that the norovirus can survive for very long periods of time even in a dry environment.<br />
Additionally, there was also a case where norovirus infection occurred even without touching the vomit at all. This is a pattern where the regurgitated matter (virus) when vomiting is scattered as a mist and attaches to the pharynx and infection occurs when the virus is swallowed along with the saliva. There is also a pattern where dried vomit (virus) becomes airborne and attaches to the pharynx and is swallowed along with the saliva. In that respect, norovirus can also be transmitted by droplet infection or airborne infection.</p>
<img src="../images/asking_expert/01/ill03.gif" width="672" height="450" alt="病原微生物の感染菌量（経口）" class="large" />
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<p class="question clearfix"><span class="q_no">Q3.</span><span class="q_text">In order to prevent the spread of infection, it is necessary to be self-aware. After using the restroom, what precautions are necessary?</span></p>
<p class="answer">It is very important to not get any fecal matter (stool) on your hands in the first place. If it does not get on your hands, the cause of infection will not spread by adhering to door knobs, food or cookware.<br />
In my laboratory in 2017, there was a comparative experiment for the contamination of hands after defecating. First, the condition after defecating was simulated with model buttocks and artificial stool containing germs then a wiping test was conducted to see how much germs adhered to hands was investigated.</p>
<img src="../images/health_research/ph01_waifu2x_photo_noise1_scale.png" width="660" height="auto" alt="" class="large" />
<p class="mt20 mb20">Source：Shigeharu Oie, Hiromi Aoshika, Emiko Arita, Akira Kamiya. The Use of Electric Toilet Seats with Water Spray Is Efficacious in Maintaining Hand Hygiene in Experimental Model. Japanese Journal of Infectious Disease 2018 Volume 71 Issue 4 306-308</p>
<p class="answer"><span>Four layered sheets of toilet paper were used for wiping. This was based on the result of a survey conducted by the Japan Sanitary Equipment Industry Association that the largest number of people replied that they used "4 layers of sheets to wipe". The results were that germs were attached to the hands after wiping with four layered sheets of toilet paper. Toilet paper is full of infinite holes when viewed under a microscope. Because the size of the holes were about 100 times larger than the size of the germs, it was easy for the germs to pass through even when 4 sheets were layered.</span><img src="../images/asking_expert/01/ill07.jpg" width="264" height="263" alt="" /></p>
<p class="answer clear">At the same time, tests were conducted by wiping with 4 layered sheets of toilet paper after washing for 30 seconds using a spray seat to cleanse buttocks. The results were that after using a spray seat for 30 seconds, the number of germs attached to the hand was less than 10,000 times lower than when not used.</p>
<p class="txt_c"><img src="../images/health_research/seratia_comparison.png" width="500" height="auto" alt="Reference photo: Experiment situation" class="large mb20"></p>
<p class="answer">Next, a test at the actual time of excretion was conducted. The results were that the number of germs attached to the hand was about 10 times less than people who did not use the spray seat. When a spray seat is used, the risk of infection will be reduced to about 90%. Although there are individual differences such as usage, the use of a spray seat can reduce the number of germs attaching on hands and can be said to be extremely effective in preventing intestinal infections.</p>
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<p class="question clearfix"><span class="q_no">Q4.</span><span class="q_text">What should you do if a family member or person living in your surroundings is infected with norovirus?</span></p>
<p class="answer"><span>It would be better to have everyone in the family be aware that infection is easily spread among family members. Careful hygiene of hands should be taken especially when preparing food. <br />
It is thought that the possibility of norovirus is 60% to 70% when vomiting occurs during winter and so disinfection should be done carefully. Wear disposable gloves when cleaning regurgitated matter (vomit) and also wearing surgical masks is ideal.</span><img src="../images/asking_expert/01/ill06.gif" width="269" height="200" alt="" /></p>
<p class="answer clear">Additionally, it is dangerous to leave regurgitated matter (vomit) for prolonged periods. There has also been cases reported that people were infected from dust after vacuuming dried regurgitated matter. When dried, it is easier for it to become airborne and become attached to the pharynx causing infection.<br />
It is also imported to clean the toilet after defecation or vomiting. There are few disinfectants that can be used in homes, however, sodium hypochlorite 0.1% (1,000 ppm) solution or ethanol (sold at pharmacies as a non-prescription drug) for disinfecting carpets and solid wood etc., can be used. It is fundamental to use these two disinfectants properly according to the location.<br />
In addition, it should be noted that the disinfection ability of sodium hypochlorite is easy rendered less effective when exposed to direct sunlight and with the passage of time. When purchasing products, choose products with a specified concentration and expiration date. To be specific, it is recommended that disinfectant solutions for infants, such as Milton<sup>®</sup>, Purifan<sup>®</sup> P and Milkpon<sup>®</sup>, be diluted and used.<br />
Even if you don't have any symptoms, it is also important to wash your hands after defecation. You should know that many cases of the norovirus are also "subclinical infections". For example, eating oysters infected with norovirus does not mean that everyone will show the symptoms and some people do not. In other words, some people will carry the norovirus without developing the disease and outbreaks that occur in hotels, hospitals, etc. may spread as a result of such “subclinical infections”.<br />
Children and the elderly are especially prone to norovirus infection; however, this is related to the gastric liquids showing germicidal effects. In children, this is because the gastric liquids are still insufficient while in the elderly, one reason is that it is difficult for them to produce it sufficiently. Accordingly, special consideration is required for households with children and elderly persons. Additionally, even in adults, if they are taking medication for symptoms of stomach ulcers to suppress stomach acid (H2 blocker gastrointestinal medication, etc.), they will be more susceptible to infection.
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<p class="question clearfix"><span class="q_no">Q5.</span><span class="q_text">What are some precautions in avoiding infection from O-157, etc.?</span></p>
<p class="answer"><span>Maintaining normal intestinal flora is one important preventive measure in avoiding infection from O-157, etc. In healthy intestines, a wide variety of microorganisms make up the microbiota and these act to control the growth of specific germs and function to prevent infections. For example, even if O-157 should enter the intestines, if large numbers of microorganisms are there, the O-157 will not be able to multiply and the occurrence of infection will be less likely.<br />
</span><img src="../images/asking_expert/01/ill04.gif" width="264" height="190" alt="" /></p>
<p class="answer clear">In hospitals, serious intestinal infections such as pseudomembranous colitis caused by Clostridioides difficile (formerly called Clostridium) germs are a major problem, however, these only affect people who are administered antibiotics and anticancer drugs. Because some antibiotics and anti-cancer drugs are germicidal, they will "harm intestinal flora".<br />
When we eat, we also provide some nutrients to the intestinal microorganisms and in turn, the internal microorganisms play a role in protecting us from infections. We also know that we acquire vitamin B and vitamin K that the microorganisms produce. We coexist with the various intestinal microorganisms. It is very important to maintain normal intestinal flora to prevent the abnormal increase of problem causing microorganisms.</p>
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<p class="lasttitle">＜Summary＞<br />Basic knowledge in preventing norovirus infection</p>
<ul class="summary">
<li>Washing hands after defecation is essential. People who prepare meals should especially be careful about washing their hands.</li>
<li>If you use a spray seat, the amount of bacteria that are transferred on hands will be about 1/10.</li>
<li>Clean the toilet bowl when having diarrhea because the virus is scattered around in the toilet bowl. In this case, it is better to use a product labeled “disinfectant” instead of an antibacterial or a sanitizing agent.<br />Use either sodium hypochlorite 0.1% (1,000 ppm) or ethanol for disinfection.</li>
<li>Use disposable gloves and surgical masks when treating vomit.</li>
<li>Clean vomit quickly as it is more dangerous when dry and can become airborne.</li>
<li>Wash laundry stained with diarrhea and vomit separately from other laundry.<br />Washing will reduce the amount of norovirus. Washing with hot water with a temperature of 70°C or higher is even more effective.</li>
<li>It is also important to cook food at a sufficient heat. Norovirus will be killed when heated at 80°C for 1 minute or more.</li>
<li>Be wary of people who have subclinical infections. "No symptom does not mean the person is not a carrier (no norovirus)".</li>
</ul>
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<p>The site that introduces Dr. Oie research is from here</p>
<p><span class="link_type_a"><a href="/global/health_research/study05.html" onclick="ga('send', 'event', 'linkclick', 'click', 'pdf_study05')" target="_blank">The Use of Electric Toilet Seats with Water Spray Is Efficacious in Maintaining Hand Hygiene in Experimental Model</a></span></p>
<p><span class="link_type_a"><a href="/global/health_research/study06.html" onclick="ga('send', 'event', 'linkclick', 'click', 'pdf_study05')" target="_blank">Microbial contamination of hands with or without the use of bidet toilets (electric toilet seats with water spray) after defecation</a></span></p>
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<li class="page_g"><a href="/global/asking_expert/">Asking an Expert in the Prevention</a></li>
<li>Explanation of Research Results by Researchers Specializing in the Prevention, Disinfection, and Sterilization of Infectious </li>
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<span class="blue"><br><br>Japan Restroom Industry Association commissioned researchers <br>who are active on the front lines specializing in the prevention, <br>disinfection, and sterilization of infectious diseases to conduct<br> research on the use of bidet toilets and hand hygiene.<br>
The results of the research have been posted as a summary, <br>but we have written an article that explains the contents <br>in a more easy-to-understand manner.
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<h4><img src="/global/images/asking_expert/02/interview_title02.png" alt="" width="500" height="120"></h4>
<p class="study03-1Cap">Dr. Shigeharu Oie<br />
Sanyo-Onoda City University, Professor, Faculty of Pharmacy, Tokyo Healthcare University, Guest Professor, Postgraduate School. FY2012 Chairman Annual Meeting of the Japan Society for Environmental Infectious Diseases. Specializes in investigating the causes of nosocomial infection and hygiene management in hospitals. He is endeavoring to producing guidelines, etc., for administrative organizations such as the Ministry of Health and Welfare and has authored "Guidelines for disinfection and sterilization", "Book on Disinfection and Sterilization that can be used in Hospital Wards" and "How to choose and use disinfectants".</p>
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<p class="question clearfix"><span class="q_no">1.</span><span class="q_textleft">
When microorganisms from feces adhere to your hands and fingers...</span></p>
<p class="answer">
It is known that microorganisms attached to the hands and fingers during defecation can cause intestinal infections if they enter the mouths of other humans via food or environment. Various intestinal infections such as norovirus gastroenteritis, enterohemorrhagic E. coli infection, dysentery, cholera, and hepatitis A may occur.<br>
For example, a food handler with subclinical norovirus infection (infected but asymptomatic) attached the norovirus when inspecting bread and as many as 1,271 students who ate the school lunch bread developed norovirus gastroenteritis (Illustration 1.).
</p>
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<p>Illustration 1.Insufficient Hand Washing after Defecation Caused 1,271 Cases of <br>Norovirus Gastroenteritis.</p>
<img src="/trend/images/data11/ill_02.png" alt="" width="500" height="auto">
<p class="left_ttl ft13">In regards to the number of sheets of toilet paper, it is understood that most people wipe with four layers of toilet paper after defecation (Graph 1. Illustration 2.).</p>
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<p class="close"><b>Click ＋ for Graph 1.</b></p>
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<p>Graph 1. Number of layers of toilet paper used to wipe buttocks <br>(Japan Sanitary Equipment Industry Association)<br><br>
[Total of men and women, total users and non-users of bidet toilets,<br> single and double total, n=1,748]</p>
<img src="/global/images/asking_expert/02/graph_03.gif" alt="" width="690" height="auto">
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<p>Illustration 2. 4 Layers of toilet paper</p>
<img src="/global/images/asking_expert/02/ex_photo02_1.jpg" alt="" class="mb20">
<p class="left_ttl ft13">However, microorganisms in feces can easily pass through four layers. This is because even with four layers, there are many holes that are about 100 times the size of bacteria (Figure 1).</p>
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<p>Figure 1. Microscope photo of 4 layers of toilet paper (35x)<br>
There are many holes about the size of 0.1mm in diameter (about 100 times the size of bacteria).
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<p class="question clearfix"><span class="q_no">2.</span><span class="q_textleft">Bacteria attached to your hands and fingers after defecation are significantly reduced <br>by using the toilet's cleaning function!</span>
</p>
<p class="answer">
It was discovered that using the toilet's buttocks cleaning function significantly reduced the bacteria contaminating the hands and fingers after defecation compared to not using the function (Oie et al. Japanese Journal of Infectious Disease 2018, Oie et al. Journal of Water Health 2022).
First, a wiping test using a model of buttocks and artificial feces mixed with Serratia bacteria to simulate the condition after defecation to determine how much bacteria would adhere to hands was conducted. The results showed that when the buttocks cleaning function was used, the number of germs on hands was less than 1/10,000 times lower than when not used (Figure 2).
</p>
<p class="txt_c">
<b>Figure 2. Culture Comparison Example - Color red indicates Serratia bacteria</b>
<img src="/global/images/asking_expert/02/seratia_comparison.png" width="500" height="auto" class="mg_center mb20"></p>
<p class="answer">Next, with the cooperation of 32 nursing students, the number of bacteria on hands and hands and fingers after defecation was investigated depending on whether or not the buttocks cleaning function was used.<br> The results showed that the average value was 39,499 bacteria/hands and fingers when unused, and 4,146 bacteria/hands and fingers when used (Table 1). <br>Using the buttocks cleaning function reduced the number of bacteria contaminating hands to approximately 1/10. The duration and water pressure (high, medium, or low) for washing the buttocks were left up to each individual in this study.
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<p class="close"><b>Click ＋ for Table 1 of results</b></p>
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<p class="answer clear"></p>
<p>Table 1. Microbial contamination of hands and fingers with and without the use of buttocks cleaning function<sup class="base_line">*1</sup></p>
<table id="table02" class="inner_table_2">
<tbody>
<tr>
<th rowspan="2" class="wt52">Participant number</th>
<th colspan="2" class="">Number of bacteria/hands and fingers</th>
<th rowspan="2" class="wt30">Gender</th>
<th rowspan="2" class="wt88">Water force of buttocks cleaning function</th>
<th rowspan="2" class="wt100">Usage time of the buttocks cleaning function (seconds)</th>
</tr>
<tr>
<th class="wt136">Buttocks cleaning function unused（cfu<sup>*3</sup>/gloves）</th>
<th class="wt136">Buttocks cleaning function used（cfu<sup>*3</sup>/gloves）</th>
</tr>
<tr>
<td>1</td>
<td>4.1×10<sup>5</sup></td>
<td>5.4×10<sup>4</sup></td>
<td>Male</td>
<td>High</td>
<td>30</td>
</tr>
<tr>
<td>2</td>
<td>1.7×10<sup>5</sup></td>
<td>664</td>
<td>Male</td>
<td>Low</td>
<td>30</td>
</tr>
<tr>
<td>3</td>
<td>1.0×10<sup>5</sup></td>
<td>3.4×10<sup>4</sup></td>
<td>Male</td>
<td>Low</td>
<td>80</td>
</tr>
<tr>
<td>4</td>
<td>8.5×10<sup>4</sup></td>
<td>2.4×10<sup>4</sup></td>
<td>Male</td>
<td>Medium</td>
<td>30</td>
</tr>
<tr>
<td>5</td>
<td>7.8×10<sup>4</sup></td>
<td>131</td>
<td>Male</td>
<td>High</td>
<td>20</td>
</tr>
<tr>
<td>6</td>
<td>7.2×10<sup>4</sup></td>
<td>115</td>
<td>Female</td>
<td>Medium</td>
<td>5</td>
</tr>
<tr>
<td>7</td>
<td>7.1×10<sup>4</sup></td>
<td>328</td>
<td>Female</td>
<td>Low</td>
<td>30</td>
</tr>
<tr>
<td>8</td>
<td>5.6×10<sup>4</sup></td>
<td>38</td>
<td>Female</td>
<td>Medium</td>
<td>15</td>
</tr>
<tr>
<td>9</td>
<td>2.4×10<sup>4</sup></td>
<td>310</td>
<td>Male</td>
<td>High</td>
<td>30</td>
</tr>
<tr>
<td>10</td>
<td>2.4×10<sup>4</sup></td>
<td>720</td>
<td>Male</td>
<td>Medium</td>
<td>30</td>
</tr>
<tr>
<td>11</td>
<td>2.2×10<sup>4</sup></td>
<td>5</td>
<td>Male</td>
<td>Medium</td>
<td>10</td>
</tr>
<tr>
<td>12</td>
<td>2.1×10<sup>4</sup></td>
<td>7.2×10<sup>3</sup></td>
<td>Male</td>
<td>Medium</td>
<td>25</td>
</tr>
<tr>
<td>13</td>
<td>1.8×10<sup>4</sup></td>
<td>352</td>
<td>Female</td>
<td>Medium</td>
<td>10</td>
</tr>
<tr>
<td>14</td>
<td>1.7×10<sup>4</sup></td>
<td>816</td>
<td>Female</td>
<td>Medium</td>
<td>30</td>
</tr>
<tr>
<td>15</td>
<td>1.7×10<sup>4</sup></td>
<td>4.8×10<sup>3</sup></td>
<td>Male</td>
<td>Medium</td>
<td>15</td>
</tr>
<tr>
<td>16</td>
<td>1.5×10<sup>4</sup></td>
<td>1.0×10<sup>3</sup></td>
<td>Male</td>
<td>High</td>
<td>30</td>
</tr>
<tr>
<td>17</td>
<td>1.4×10<sup>4</sup></td>
<td>420</td>
<td>Male</td>
<td>Medium</td>
<td>30</td>
</tr>
<tr>
<td>18</td>
<td>1.1×10<sup>4</sup></td>
<td>66</td>
<td>Male</td>
<td>High</td>
<td>45</td>
</tr>
<tr>
<td>19</td>
<td>1.0×10<sup>4</sup></td>
<td>134</td>
<td>Male</td>
<td>Medium</td>
<td>60</td>
</tr>
<tr>
<td>20</td>
<td>7.0×10<sup>3</sup></td>
<td>1.5×10<sup>3</sup></td>
<td>Female</td>
<td>Low</td>
<td>40</td>
</tr>
<tr>
<td>21</td>
<td>5.0×10<sup>3</sup></td>
<td>848</td>
<td>Female</td>
<td>High</td>
<td>30</td>
</tr>
<tr>
<td>22</td>
<td>4.0×10<sup>3</sup></td>
<td>172</td>
<td>Female</td>
<td>Low</td>
<td>30</td>
</tr>
<tr>
<td>23</td>
<td>4.0×10<sup>3</sup></td>
<td>360</td>
<td>Male</td>
<td>Medium</td>
<td>10</td>
</tr>
<tr>
<td>24</td>
<td>2.0×10<sup>3</sup></td>
<td>38</td>
<td>Male</td>
<td>High</td>
<td>20</td>
</tr>
<tr>
<td>25</td>
<td>2.0×10<sup>3</sup></td>
<td>15</td>
<td>Female</td>
<td>Medium</td>
<td>20</td>
</tr>
<tr>
<td>26</td>
<td>2.0×10<sup>3</sup></td>
<td>63</td>
<td>Male</td>
<td>Medium</td>
<td>30</td>
</tr>
<tr>
<td>27</td>
<td>1.0×10<sup>3</sup></td>
<td>29</td>
<td>Female</td>
<td>Low</td>
<td>30</td>
</tr>
<tr>
<td>28</td>
<td>1.0×10<sup>3</sup></td>
<td>265</td>
<td>Female</td>
<td>Medium</td>
<td>50</td>
</tr>
<tr>
<td>29</td>
<td>320</td>
<td>97</td>
<td>Female</td>
<td>Medium</td>
<td>24</td>
</tr>
<tr>
<td>30</td>
<td>244</td>
<td>18</td>
<td>Female</td>
<td>Low</td>
<td>60</td>
</tr>
<tr>
<td>31</td>
<td>228</td>
<td>124</td>
<td>Female</td>
<td>Medium</td>
<td>30</td>
</tr>
<tr>
<td>32</td>
<td>184</td>
<td>75</td>
<td>Female</td>
<td>Medium</td>
<td>20</td>
</tr>
<tr>
<td>Average ± standard deviation <sup>*2</sup></td>
<td>39,499.3 ±<br>77,768.3</td>
<td>4,146.9 ±<br>11,427.7</td>
<td></td>
<td></td>
<td></td>
</tr>
</tbody>
</table>
<p>
<span>*1 Four layers of toilet paper were used after defecation. Additionally, the outer gloves of the double-layer gloves were checked for contamination.</span><br>
<span>*2 Significant difference found [p &lt; 0.00001 (Wilcoxon signed-rank test)]</span><br>
<span>*3 Colony Forming Unit abbreviation, Number of colonies (populations) formed by culturing bacteria in a medium.</span>
</p>
</div>
<div class="att">
<p>Click here for the research results overview page</p>
<p><span class="link_type_a"><a href="/global/health_research/study06.html" target="_blank">Microbial contamination of hands with or without the use of bidet toilets (electric toilet seats with water spray) after defecation –(Accepted form December 2021)</a></span></p>
</div>
<p class="pagetop clear"><a href="#container" class="pageLink">PAGE TOP</a></p>
</div>
</div>
<div class="section clearfix">
<div class="content">
<p class="question clearfix"><span class="q_no">3.</span><span class="q_textleft">Buttocks cleaning function contributes to improving public health</span></p>
<p class="answer">
In principle, hands should be thoroughly washed after defecation however, there are many instances where hands are not washed sufficiently or properly. Therefore, the buttocks cleaning function, which can greatly reduce adhesion of fecal-derived microorganisms to hands, can be said to aid hygiene of the hands and fingers (Illustration 3). If in the future the buttocks cleaning function proliferates throughout the world, it could greatly contribute to improving public health.
</p>
</div>
<div class="img_box">
<p>Illustration 3. When the buttocks cleaning function is used, the number of bacteria on the hands and fingers is significantly reduced.</p>
<img src="/trend/images/data11/ill_06.png" alt="" width="640" height="auto">
</div>
<p>References<br>
<span>1) Yuji Tsuchiya, Atsushi Sahara, Tatsuya Jimbo, others. Case study of norovirus mass food poisoning caused by bread. Journal of the Japanese Society of Food Microbiology. 32: 153-158, 2015.</span><br>
<span>2) Oie S, Aoshika H, Arita E, Kamiya A. The use of electric toilet seats with water spray is efficacious in maintaining hand hygiene in experimental model. Jpn J Infect Dis. 71: 306-308, 2018.</span><br>
<span>3) Oie S, Kawai S. Microbial contamination of hands with or without the use of bidet toilets (electric toilet seats with water spray) after defecation. J Water Health. 20: 21-71-275, 2022</span>
</p>
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global/health_research/index.html
......@@ -121,8 +121,11 @@
<h3 class="blueText01 pngfix">Research on hand hygiene from using spray seat</h3>
<p>* In this study, the &quot;Spray Seat&quot; is referred to as &quot;Electric Toilet Seats with Water Spray&quot;.</p>
<p><span class="link_type_b"><a href="/global/health_research/study06.html">Microbial contamination of hands with or without the use of bidet toilets (electric toilet seats with water spray) after defecation –(Accepted form December 2021)</a></span></p>
<p><span class="link_type_b"><a href="/global/health_research/study05.html">The Use of Electric Toilet Seats with Water Spray Is Efficacious in Maintaining Hand Hygiene<br />
<p><span class="link_type_b"><a href="/global/health_research/study05.html">The Use of Electric Toilet Seats with Water Spray Is Efficacious in Maintaining Hand Hygiene
<br>
in Experimental Model -(Accepted form March 2018)</a></span></p>
<p class="mt10">The explanation by the researcher who studied on the benefits of spray seats use and hand hygiene is shown here.</p>
<p><span class="link_type_b"><a href="/global/asking_expert/02.html">Explanation of Research Results by Researchers Specializing in the Prevention, Disinfection, and Sterilization of Infectious Diseases</a></span></p>
</div>
</div>
......
global/health_research/study05.html
......@@ -99,9 +99,17 @@ includeHeadEn();
</tr>
<tr>
<th scope="row">Publication:</th>
<td>Japanese Journal of Infectious Diseases (2018 Volume 71 Issue 4 306-308) articles, see here for publication details.（<a href="https://www.jstage.jst.go.jp/article/yoken/71/4/71_JJID.2017.515/_article/-char/en" target="_blank">external site</a>）</td>
<td>Japanese Journal of Infectious Diseases (2018 Volume 71 Issue 4 306-308) articles, see here for publication details.（<a href="https://www.jstage.jst.go.jp/article/yoken/71/4/71_JJID.2017.515/_article/-char/en" target="_blank">external site</a>）</td>
</tr>
</table>
<img src="../images/health_research/ph01_waifu2x_photo_noise2_scale.png" width="672" height="auto" alt="Reference photo: Experiment situation" class="large mt10">
<p class="mb20 mt10">Source：Shigeharu Oie, Hiromi Aoshika, Emiko Arita, Akira Kamiya. The Use of Electric Toilet Seats with Water Spray Is Efficacious in Maintaining Hand Hygiene in Experimental Model. Japanese Journal of Infectious Disease 2018 Volume 71 Issue 4 306-308</p>
<div class="txt_c">
<img src="../images/health_research/seratia_comparison.png" width="500" height="auto" alt="Reference photo: Experiment situation" class="large mt10">
</div>
</div>
......
trend/expert/study07-1.html
......@@ -183,7 +183,7 @@
<p class="close"><b>結果の表１は&thinsp;＋&thinsp;をクリック</b></p>
</div>
<div class="accor">
<p class="answer clear"><span>表1．おしり洗浄機能の使用の有無による手指の微生物汚染<sup class="base_line">＊1</sup></span></p>
<p class="answer clear"><p>表1．おしり洗浄機能の使用の有無による手指の微生物汚染<sup class="base_line">＊1</sup></p>
<table id="table02" class="inner_table_2">
<tbody>
<tr>
......
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