Significance of biocide usage and antimicrobial resistance in domiciliary environments

Recent events have raised awareness of the need for effective hygiene in the home. Not least is the requirement to reduce antibiotic resistance by reducing the need for antibiotic prescribing. Current evidence suggests that improved hygiene in the domestic setting could have a significant impact. Recently, it has been suggested that widespread biocide usage, particularly in consumer products, may be a contributory factor in antibiotic resistance. In developing home hygiene policies, however, it is important that biocide use as an integral part of good hygiene practice is not discouraged in situations where there is real benefit. Although laboratory data indicate possible links, it is necessary to assess whether and to what extent biocide exposure could contribute to antibiotic resistance in clinical practice. The extent to which reduced susceptibility to biocides resulting from biocide exposure could compromise their 'in-use' effectiveness must also be considered. Equally, it is important that changes in susceptibility induced by biocide exposure are assessed relative to those induced by antibiotic exposure or the phenotypic changes induced by 'normal' environmental 'stresses'. It is proposed that to be effective, home hygiene policy should be based on the concept of risk assessment and risk prevention. Using this approach, critical risk situations are identified and appropriate hygiene procedures applied to reduce risks. This may involve either soap and water cleaning, or cleaning combined with a disinfection process. A 'targeted' hygiene approach not only provides the most effective means of preventing infectious disease, it also offers a means of addressing concerns about 'too much hygiene' and 'too many antibacterials' amongst a public who have lost confidence regarding appropriate hygiene for their home environment.     

Quantitative microbiological risk assessment: principles applied to determining the comparative risk of salmonellosis from chicken products

Since causal links have been established between food-borne illness and particular microorganisms, it has been possible to assess the public health risks of their presence in foods and propose measures to ensure the safety of customers. Effective control measures for food safety have been based on knowledge of the resistance of pathogenic microorganisms to the treatments used for preservation (e.g. acidification or reduced water activity) or decontamination (e.g. pasteurisation or sterilisation). Using this principle, food safety has been managed informally and successfully within the food industry for many years. Recently, formal risk assessment schemes, for example from Codex Alimentarius, have developed and placed the elements of decision-making on suitable control measures into a formal framework with clearly identifiable stages. The output of the four stages of a formal risk assessment (hazard identification, hazard characterisation, exposure assessment and risk characterisation) provides the basis for decisions on actions needed to control the identified hazard. There are many difficulties in ensuring that risk assessments are realistic and accessible to potential users, in many cases their value is limited by the data available. The study reported here on control of Salmonella in poultry products illustrates that it is possible to produce a comparative risk assessment based on published data. This study is not a full quantitative risk assessment, but provide useful pointers for a risk manager. Differences are discussed between the exposure assessment data needed to propose controls for infectious or toxigenic pathogens. For infectious pathogens, the presence of viable and infectious microorganisms is itself the hazard, but for toxigenic microorganisms, absence or destruction of viable cells at ingestion does not in itself ensure the absence of toxin. For toxin hazards, exposure assessment needs to consider previous conditions that may have led to toxin formation and persistence, rather than just the level of microbes at ingestion.     

Distribution of biofilm on internal and external surfaces of upper complete dentures: the effect of hygiene instruction

Objectives: The purpose of this study was to evaluate biofilm distribution over internal and external surfaces of upper complete dentures. It was also aimed at assessing the effect of oral hygiene instructions before and after home use of a disclosing solution. Materials and methods: The sample consisted of 29 complete denture wearers whose upper prostheses were evaluated. Surface biofilm was disclosed by means of a 1% neutral red solution and quantified with regard to internal and external surfaces. Oral hygiene information was provided on an individual basis. During the second stage, an amount of disclosing solution was given for domestic use. Results: Internal and external surfaces presented a similar amount of biofilm, which was concentrated over the area of the posterior teeth area, palatal rugae and the internal vestibular incline of the distobuccal flange. This pattern was maintained during the study. However, overall amounts were reduced following denture hygiene information. The use of disclosing solution by subjects at home resulted in a further reduction. Conclusions: It was concluded that biofilm deposits were similar over assessed surfaces, regardless of the type of procedure but irregular areas presented greater amounts. Oral health instruction was effective in reducing the biofilm, in particular when associated with home use of a disclosing agent.     

Comparison of electric hand dryers and paper towels for hand hygiene: a critical review of the literature

Numerous studies are published on the benefits of electric hand dryers vs paper towels (PT) for drying hands after washing. Data are conflicting and lacking key variables needed to assess infection risks. We provide a rapid scoping review on hand-drying methods relative to hygiene and health risks. Controlled vocabulary terms and keywords were used to search PubMed (1946–2018) and Embase (1947–2018). Multiple researchers independently screened abstracts for relevance using predetermined criteria and created a quality assessment scoring system for relative study comparisons. Of 293 papers, 23 were included in the final analysis. Five studies did not compare multiple methods; however, 2 generally favoured electric dryers (ED); 7 preferred PT; and 9 had mixed or statistically insignificant results (among these, 3 contained scenarios favourable to ED, 4 had results supporting PT, and the remaining studies had broadly conflicting results). Results were mixed among and within studies and many lacked consistent design or statistical analysis. The breadth of data does not favour one method as being more hygienic. However, some authors extended generalizable recommendations without sufficient scientific evidence. The use of tools in quantitative microbial risk assessment is suggested to evaluate health exposure potentials and risks relative to hand-drying methods. We found no data to support any human health claims associated with hand-drying methods. Inconclusive and conflicting results represent data gaps preventing the advancement of hand-drying policy or practice recommendations.     

Hygienic tendencies correlate with low geohelminth infection in free-ranging macaques

Parasites are ubiquitous in nature and can be costly to animal fitness, so hosts have evolved behavioural counter-strategies to mitigate infection risk. We investigated feeding-related infection-avoidance strategies in Japanese macaques via field-experimentation and observation. We first examined risk sensitivity during foraging tasks involving faecally contaminated or debris-covered food items, and then investigated individual tendencies to manipulate food items during natural foraging bouts. We concurrently monitored geohelminth infection in all subjects. We ran a principal component analysis on the observational/experimental data to generate a hygienic index across individuals and found that hygienic tendencies towards faeces avoidance and food manipulation correlated negatively with geohelminth infection. Females scored higher in hygienic tendencies than males, which might contribute to the common vertebrate pattern of male-biased infection. The behavioural tendencies observed may reflect a general form of hygiene, providing a mechanism of behavioural immunity against parasites with implications for the evolution and diversification of health maintenance strategies in humans.     

Kitchen hygiene in daily life

More and more data are available indicating that numerous (infectious) diseases are related to the home environment. Airborne microorganisms (bacteria, fungi), mites (in sheets or carpets), and (parts of) insects and beetles may be the cause of respiratory diseases such as asthma. In Europe and North America, more than half of the registered food infections appear to be contracted in the home. Then there is the development of new pathogens or the adaptation of microorganisms to extreme conditions. In many cases, the occurrence of adapted or resistant microorganisms is a reaction to the changing environment. Examples of this are the growth of Listeria monocytogenes in refrigerated food products and the presence of Legionella pneumophila in systems containing stagnant water.The main sources of infection in the domestic environment are people, pests, pets, and contaminated food and water. Germs are transmitted by direct contact with people or animals, by contaminated food, water, surfaces and air.Under circumstances favourable to microorganisms, the cells are able to survive or multiply into large numbers. Especially in places which stay moist for a long time considerable amounts of microorganisms are found, among with pathogenic types.The phrase ‘home hygiene’ does not merely refer to cleaning the house (daily). In practice, cleaning is not the only important issue; knowing how to prevent contamination is just as crucial. Domestic hygiene is the total sum of the measures used to prevent (insofar as possible) contamination with pathogens, and thus decreasing the number of infectious diseases. The hygiene measures required can be divided into three groups:

• Hygiene during food preparation.

• Personal and sanitary hygiene.

• Domestic environment.

This contribution will focus on food storage, food preparation and the effect of 'hygienic cleaners’ in the domestic kitchen.     

Dental disease and risk of coronary heart disease and mortality.

OBJECTIVE--To investigate a reported association between dental disease and risk of coronary heart disease. SETTING--National sample of American adults who participated in a health examination survey in the early 1970s. DESIGN--Prospective cohort study in which participants underwent a standard dental examination at baseline and were followed up to 1987. Proportional hazards analysis was used to estimate relative risks adjusted for several covariates. MAIN OUTCOME MEASURES--Incidence of mortality or admission to hospital because of coronary heart disease; total mortality. RESULTS--Among all 9760 subjects included in the analysis those with periodontitis had a 25% increased risk of coronary heart disease relative to those with minimal periodontal disease. Poor oral hygiene, determined by the extent of dental debris and calculus, was also associated with an increased incidence of coronary heart disease. In men younger than 50 years at baseline periodontal disease was a stronger risk factor for coronary heart disease; men with periodontitis had a relative risk of 1.72. Both periodontal disease and poor oral hygiene showed stronger associations with total mortality than with coronary heart disease. CONCLUSION--Dental disease is associated with an increased risk of coronary heart disease, particularly in young men. Whether this is a causal association is unclear. Dental health may be a more general indicator of personal hygiene and possibly health care practices.     

Effect of oral hygiene education and motivation on removable partial denture wearers: longitudinal study

Objectives: The purpose of this study was to determine the effect of two different preventive oral hygiene education and motivation programmes on the plaque and gingival index, as well as denture hygiene of patients provided with removable partial denture (RPD) during a 12‐month follow‐up. Material and methods: A total of 53 partially edentulous patients were recruited for this study. The presence or absence of plaque and gingival bleeding by gentle probing was scored on all tooth surfaces at the preliminary visit. The plaque and gingival indexes were measured using the Löe index. Following treatment, the patients were randomly divided into three groups. In Control Group I, subjects were instructed to continue their personal oral hygiene routine. In Group II, participants were given verbal instructions and a self‐educational manual on oral hygiene without illustrations. In Group III, oral hygiene guidance was delivered using a combination of verbal instructions and a self‐teaching manual. To evaluate the effect of the different modes of instruction, the presence or absence of plaque and gingival bleeding was scored on all tooth surfaces (day zero examination) and re‐examined 7, 15 and 30 days, 3, 6 and 12 months following RPD placement. The state of denture hygiene was evaluated 7, 15 and 30 days and 3, 6 and 12 months following rehabilitation. Parametric statistics was applied to dental plaque and gingival indexes. For accumulation of plaque and calculus on the RPD, non‐parametric statistic was applied. Results: The frequency of plaque found during the preliminary visit was higher than that found in the other periods. With regard to gingival index, significant difference was found between the preliminary visit examination and other periods. There was a significant difference in the plaque accumulation on the denture surface between groups I and III. Conclusion: The different methods of oral hygiene instruction used in this study indicate that the type of education was not of significant importance.     

Anticipation of Risks and Benefits of Emerging Technologies: A Prospective Analysis Method

Methods for the identification, evaluation, and control of hazards are well recognized, whereas a method for the anticipation of hazards has eluded the field of industrial hygiene. The Emerging Technologies Team at the National Institute for Occupational Safety and Health has developed a method for anticipating not only occupational hazards but also potential benefits of emerging technologies for occupational safety and health. This method incorporates forecasting tools with a prospective assessment step into the risk assessment model, stresses research results as an iterative driver in the assessment, and depends on inherently safer design to eliminate or reduce hazards. An iterative process that involves the occupational safety and health professional as a team member in the development of emerging technologies is recommended.     

Acute appendicitis and bathrooms in three samples of British children

The occurrence of appendicectomy in three national samples of British children was analysed in relation to household amenities, crowding in the home, and social class. The risk of having the operation depended on the amenities present in the home, in particular whether or not there was a bathroom. This risk was independent of social class.The findings support a relation between acute appendicitis and Western hygiene, which would explain the geographical distribution of the disease and its changing incidence over time. In the developing world, where children grow up in conditions of poor hygiene, there may be outbreaks of appendicitis when housing improves.     

The needs of denture-brushing in geriatrics: clinical aspects and perspectives

doi: 10.1111/j.1741‐2358.2011.00557.x
The needs of denture‐brushing in geriatrics: clinical aspects and perspectives Introduction: Oral and denture hygiene are often defective in particular with dependent persons such as geriatric subjects. The reasons are the lack of hygiene education of the subjects or those caring for them. Consequently, oral hygiene is often neglected, resulting in poor oral health and an increase in the presence of local or general infections. Objective: This paper is a report of brushing effectiveness on microbial biofilm deposits on dentures of subjects participating in a specific oral hygiene programme. Materials and methods: Thirty‐nine dentures of 30 subjects were assessed for 2 weeks following an educational brushing programme. Microbial biofilm was recovered using fluoresceine and then scanned and quantified by ‘Mesurim’ software three times: before study, after 1 and 2 weeks. Results: The repeated measurement procedures showed a decrease in the percentage of biofilm present (F = 15, p < 0.001) whatever the type of denture (partial or complete) and for all biomaterials. Conclusion: Regular denture‐brushing can improve local hygiene. Consequently, decreasing the biofilm surface can reduce the prevalence of oral pathogens, thereby contributing to the general prevention of the risks of infections such as pneumotisis.     

Are the barriers to good oral hygiene in nursing homes within the nurses or the patients?

doi: 10.1111/j.1741‐2358.2011.00554.x
Are the barriers to good oral hygiene in nursing homes within the nurses or the patients? Objective: To explore nursing home patients’ oral hygiene and their nurses’ assessments of barriers to improvement. Background: In nursing homes, nurses are responsible for patients’ oral hygiene. Materials and methods: This study assessed the oral hygiene of 358 patients in 11 Norwegian nursing homes. 494 nurses in the same nursing homes participated in a questionnaire study. Results: More than 40% of patients had unacceptable oral hygiene. ‘More than 10 teeth’ gave OR = 2, 1 (p = 0.013) and ‘resist being helped’ OR = 2.5 (p = 0.018) for unacceptable oral hygiene. Eighty percent of the nurses believed knowledge of oral health was important, and 9.1% often considered taking care of patients’ teeth unpleasant. Half of the nurses reported lack of time to give regular oral care, and 97% experienced resistant behaviour in patients. Resistant behaviour often left oral care undone. Twenty‐one percent of the nurses had considered making legal decisions about use of force or restraints to overcome resistance to teeth cleaning. Conclusion: Oral hygiene in the nursing homes needed to be improved. Resistant behaviour is a major barrier. To overcome this barrier nurses’ education, organisational strategies to provide more time for oral care, and coping with resistant behaviour in patients are important factors.     

Control of enteric pathogens in ready-to-eat vegetable crops in organic and 'low input' production systems: a HACCP-based approach

Risks from pathogens such as Salmonella, Yersinia, Campylobacter and Escherichia coli O157 have been identified as a particular concern for organic and 'low input' food production systems that rely on livestock manure as a nutrient source. Current data do not allow any solid conclusions to be drawn about the level of this risk, relative to conventional production systems. This review describes six Risk Reduction Points (RRPs) where risks from enteric pathogens can be reduced in ready-to-eat vegetables. Changes can be made to animal husbandry practices (RRP1) to reduce inoculum levels in manure. Outdoor livestock management (RRP2) can be optimized to eliminate the risk of faecal material entering irrigation water. Manure storage and processing (RRP3), soil management practices (RRP4) and timing of manure application (RRP5), can be adjusted to reduce the survival of pathogens originating from manure. During irrigation (RRP6), pathogen risks can be reduced by choosing a clean water source and minimizing the chances of faecal material splashing on to the crop. Although preventive measures at these RRPs can minimize enteric pathogen risk, zero risk can never be obtained for raw ready-to-eat vegetables. Good food hygiene practices at home are essential to reduce the incidence of food-borne illnesses.     

Managing electromagnetic fields from residential electrode grounding systems: A predecision analysis

Several epidemiological studies have linked exposure to electromagnetic fields (EMFs) with health effects, including leukemia and brain cancer, but the research is still inconclusive. In particular, no clear causal mechanism has been identified by which EMFs may promote cancers. Nevertheless, the concerns raised by the positive epidemiological studies have led to increasing efforts to reduce EMFs from a number of sources. One source of EMFs are home grounding systems that are connected through water pipes in homes to water mains. This paper analyzes whether home owners who are concerned about electromagnetic fields exposure from home grounding systems should take any action to reduce fields. Assuming that the grounding system produces elevated magnetic fields (e.g., 2–3 mG or higher), this study investigates several readily available alternatives and evaluates them with respect to five criteria: risk reduction, cost, fire risk increase, worker risk, and electrical shock risk. Because of the lack of conclusive evidence about an EMF-cancer relationship, this study uses a parameterized approach that makes conditional estimates of health risk depending on future research outcomes and on the nature of the EMF/health effects relationship. This type of analysis, which is called predecision analysis because of its preliminary nature, is therefore highly dependent on a set of assumptions. Nevertheless, this predecision analysis had some fairly clear results. First, waiting for more research or taking a fairly inexpensive corrective action (insulating the water pipe to reduce ground current flow) seem to be the main contenders for the best decision for many different assumptions and parameters. Second, the choice between these two actions is very sensitive to variations in assumptions and parameters. Homeowners who accept the base-case assumptions and parameters of this study should prefer to wait. If any of the base-case parameters are changed to more pessimistic estimates or if psychological concerns (like worry and regret) are considered, then the best action is to insulate the pipe to reduce the current flow through the water pipes. © 1996 Wiley-Liss, Inc.     

Cross-contamination in the kitchen: effect of hygiene measures

Aims:  To determine the effect of hygiene measures on cross-contamination of Campylobacter jejuni at home and to select a safe tracer organism for C. jejuni.
Methods and Results:  Comparative tests were conducted with nonpathogenic Escherichia coli and Lactobacillus casei and L. casei was chosen as the safe tracer organism. Salads containing chicken breast fillet contaminated with a known number of C. jejuni and L. casei were prepared according to different cross-contamination scenarios and contamination levels of salads were determined. Cross-contamination could be strongly reduced when cleaning cutting board and cutlery with hot water (68°C), but generally was not prevented using consumer-style cleaning methods for hands and cutting board.
Conclusions:  Dish-washing does not sufficiently prevent cross-contamination, thus different cutting boards for raw meat and other ingredients should be used and meat–hand contact should be avoided or hands should be thoroughly cleaned with soap. Lactobacillus casei can be used as a safe tracer organism for C. jejuni in consumer observational studies.
Significance and Impact of the Study:  Cross-contamination plays an important role in the transmission of food-borne illness, especially for C. jejuni . This study delivers suitable data to quantitatively assess the risk of campylobacteriosis caused by cross-contamination and it shows the effect of different preventive hygiene measures.     

An oral hygiene protocol improves oral health for patients in inpatient stroke rehabilitation

The objective

To determine whether a simple oral hygiene protocol improves the oral health of inpatients in stroke rehabilitation.

The background data discussing the present status of the field

Poor oral health can lead to serious complications, such as pneumonia. The comorbidities associated with stroke, such as dysphagia, hemiparesis and cognitive impairment, can further impede independent oral care. International stroke guidelines recommend routine oral care but stop short of detailing specific regimes.

Materials and methods

The oral health assessment tool (OHAT) was conducted by speech‐language pathologists with 100 patients with and without dysphagia in three metropolitan inpatient stroke rehabilitation facilities. A simple nurse‐led oral hygiene regime was then implemented with all participants, which included twice daily tooth brushing and mouth rinsing after lunch, and oral health was measured again one week later.

Results

Initially, dysphagia was negatively associated with OHAT scores, and independence for oral hygiene was positively associated with oral health. After one week of a simple oral hygiene regime, the OHAT scores available for 89 participants indicated an improvement on average for all participants. In particular, 59% of participants with dysphagia had an improvement of 1 or more points. None of the participants developed pneumonia.

Conclusion

A simple, inexpensive oral hygiene regime resulted in positive outcomes for patients with and without dysphagia in inpatient stroke rehabilitation settings. Oral health assessments and oral hygiene regimes that are simple to implement by the interdisciplinary team can be incorporated into standard stroke care with positive effect.     

A new fluid switching flow sorter

Conventional cell sorters produce potentially hazardous microdroplets containing dyes and radiolabeled compounds commonly used to identify and trace subpopulations of cells. Many of these substances are potential toxins, mutagens, or carcinogens constituting a risk to personal associated with the sorting device. The separation of living cells for continued study of cell growth from an "in air" sample stream includes the risk of contamination with microorganisms altering the following cultures. To avoid those risks, we have constructed a new capsular flow cytometer sorter which consists of a small chamber completely encasing the sorting mechanism. Data acquisition, analysis, and processing are accomplished by using a microcomputer-based pulse height analyser.     

A Comparison of Disease Risk Analysis Tools for Conservation Translocations

Conservation translocations are increasingly used to manage threatened species and restore ecosystems. Translocations increase the risk of disease outbreaks in the translocated and recipient populations. Qualitative disease risk analyses have been used as a means of assessing the magnitude of any effect of disease and the probability of the disease occurring associated with a translocation. Currently multiple alternative qualitative disease risk analysis packages are available to practitioners. Here we compare the ease of use, expertise required, transparency, and results from, three different qualitative disease risk analyses using a translocation of the endangered New Zealand passerine, the hihi (Notiomystis cincta), as a model. We show that the three methods use fundamentally different approaches to define hazards. Different methods are used to produce estimations of the risk from disease, and the estimations are different for the same hazards. Transparency of the process varies between methods from no referencing, or explanations of evidence to justify decisions, through to full documentation of resources, decisions and assumptions made. Evidence to support decisions on estimation of risk from disease is important, to enable knowledge acquired in the future, for example, from translocation outcome, to be used to improve the risk estimation for future translocations. Information documenting each disease risk analysis differs along with variation in emphasis of the questions asked within each package. The expertise required to commence a disease risk analysis varies and an action flow chart tailored for the non-wildlife health specialist are included in one method but completion of the disease risk analysis requires wildlife health specialists with epidemiological and pathological knowledge in all three methods. We show that disease risk analysis package choice may play a greater role in the overall risk estimation of the effect of disease on animal populations involved in a translocation than might previously have been realised.

     

Risk factors for infection with soil-transmitted helminths during an integrated community level water,sanitation, and hygiene and deworming intervention in Timor-Leste

Water, sanitation and hygiene interventions have been advocated as important complements to deworming programs to improve soil-transmitted helminth control. Evidence for the impact of water, sanitation and hygiene on soil-transmitted helminth infections is mixed, and based mainly on cross-sectional studies. In this study, we assessed associations between individual- and household-level water, sanitation and hygiene variables and soil-transmitted helminth infections, using data collected during the 2?year follow-up study period of the WASH for WORMS randomised controlled trial in Timor-Leste. Data were collected across four surveys, conducted at 6 monthly intervals in 23 communities. We analysed water, sanitation and hygiene and sociodemographic variables as risk factors for infection with Necator americanus, Ascaris spp., and undifferentiated soil-transmitted helminth infection, using generalised linear mixed models to account for clustering at community, household and participant levels. Water, sanitation and hygiene risk factors were examined both concurrently and with a 6?month lag period that coincided with the most recent deworming. The analysis included 2333 participants. Factors associated with N. americanus infection included age group, male sex (adjusted odds ratio (aOR) 3.1, 95% confidence interval (CI) 2.4–4.2), working as a farmer (aOR 1.7, 95% CI 1.2–2.4), and completing secondary school or higher (aOR 0.29, 95% CI 0.16–0.53). Risk factors for Ascaris spp. infection included age group, living in a dwelling with more than six people (aOR 1.6, 95% CI 1.1–2.3), having a tube well or borehole as the household water source (aOR 3.7, 95% CI 1.3–10.8), and using a latrine shared between households 6?months previously (aOR 2.3, 95% CI 1.2–4.3). Handwashing before eating was protective against infection with any soil-transmitted helminth (aOR 0.79, 95% CI 0.65–0.95). In the context of regular deworming, few water, sanitation and hygiene-related factors were associated with soil-transmitted helminth infections. Future research examining the role of water, sanitation and hygiene in soil-transmitted helminth transmission is required, particularly in low transmission settings after cessation of deworming. Identifying improved indicators for measuring water, sanitation and hygiene behaviours is also a key priority.     

A Comparison of Disease Risk Analysis Tools for Conservation Translocations

Conservation translocations are increasingly used to manage threatened species and restore ecosystems. Translocations increase the risk of disease outbreaks in the translocated and recipient populations. Qualitative disease risk analyses have been used as a means of assessing the magnitude of any effect of disease and the probability of the disease occurring associated with a translocation. Currently multiple alternative qualitative disease risk analysis packages are available to practitioners. Here we compare the ease of use, expertise required, transparency, and results from, three different qualitative disease risk analyses using a translocation of the endangered New Zealand passerine, the hihi (Notiomystis cincta), as a model. We show that the three methods use fundamentally different approaches to define hazards. Different methods are used to produce estimations of the risk from disease, and the estimations are different for the same hazards. Transparency of the process varies between methods from no referencing, or explanations of evidence to justify decisions, through to full documentation of resources, decisions and assumptions made. Evidence to support decisions on estimation of risk from disease is important, to enable knowledge acquired in the future, for example, from translocation outcome, to be used to improve the risk estimation for future translocations. Information documenting each disease risk analysis differs along with variation in emphasis of the questions asked within each package. The expertise required to commence a disease risk analysis varies and an action flow chart tailored for the non-wildlife health specialist are included in one method but completion of the disease risk analysis requires wildlife health specialists with epidemiological and pathological knowledge in all three methods. We show that disease risk analysis package choice may play a greater role in the overall risk estimation of the effect of disease on animal populations involved in a translocation than might previously have been realised.