Sanitas
Revista arbitrada de ciencias de la salud
Vol. 3(3), 14-22, 2024
https://doi.org/10.62574/zpxt1f11
14
Analysis of health risks in hotel environments from a documentary review
Análisis de los riesgos sanitarios en entornos hoteleros desde una revisión
documental
Yamelis Lissete Morales
lissete_morales@institutodeinvestigacionperspectivasglobales.org
Instituto de Investigación Multidisciplinaria Perspectivas Globales,
Portoviejo, Manabí, Ecuador
https://orcid.org/0009-0000-2092-9798
ABSTRACT
Objective: to analyse health risks in hotel environments based on a documentary review. Methods:
A systematic review of 15 articles on clinical risk management in hotel settings was used. Results:
The identification of pathogens such as norovirus and Legionella, together with the high prevalence
of STIs, highlights the need for a comprehensive approach to the training and sanitary control of hotel
staff, whose role is critical in the spread of infectious agents. Conclusion: Outbreaks of
gastrointestinal and sexually transmitted infections, together with the identification of environmental
pathogens such as Legionella, highlight deficiencies in hygiene and control protocols, which were
insufficient to mitigate the risks of contagion. Keywords: epidemiology; hotel sanitation; health
surveillance system (Source, DeCS).
RESUMEN
Objetivo: analizar los riesgos sanitarios en entornos hoteleros desde una revisión documental.
Método: Se empleó una revisión sistemática de 15 articulos sobre la gestión de riesgos clínicos en
entornos hoteleros. Resultados: La identificación de patógenos como el norovirus y la Legionella,
junto con la alta prevalencia de ITS, destaca la necesidad de un enfoque integral en la formación y
control sanitario del personal hotelero, cuyo papel es crítico en la diseminación de agentes
infecciosos. Conclusión: Los brotes de infecciones gastrointestinales y de transmisión sexual, junto
con la identificación de patógenos ambientales como Legionella, subrayan las deficiencias en los
protocolos de higiene y control, los cuales fueron insuficientes para mitigar los riesgos de contagio.
Descriptores: epidemiología; saneamiento de hoteles; sistema de vigilancia sanitaria. (Fuente,
DeCS).
Received: 17/08/2024. Revised: 19/08/2024. Approved: 24/08/2024. Published: 01/09/2024.
Original short
Sanitas
Revista arbitrada de ciencias de la salud
Vol. 3(3), 14-22, 2024
Análisis de los riesgos sanitarios en entornos hoteleros desde una revisión documental
Analysis of health risks in hotel environments from a documentary review
Yamelis Lissete Morales
15
INTRODUCTION
Clinical risk management in hotel settings is a significant public health challenge,
given the confluence of factors that can facilitate the spread of infectious diseases.
Hotels, as places of high social interaction and reception of travellers from diverse
regions, become hotspots for the spread of both gastrointestinal and sexually
transmitted infections. Recent studies have documented numerous outbreaks in
these settings, including the rapid spread of norovirus and other gastrointestinal
diseases due to inadequate hygiene and food handling practices (1,2). The high
prevalence of sexually transmitted infections among sex workers and hotel
employees, especially in areas with sex tourism, underscores the need for more
rigorous preventive intervention and targeted educational programmes (5,7).
Furthermore, the presence of environmental pathogens such as Legionella in poorly
maintained water systems in tourist facilities is evidence of failures in surveillance
and primary prevention strategies, which can lead to outbreaks of serious diseases
such as legionellosis (9). The global health emergency caused by the COVID-19
pandemic has exacerbated these risks, revealing the inadequacy of traditional
cleaning protocols and the need for innovative and effective measures to protect
both guests and hotel staff (14,15). In this context, it is imperative to review and
strengthen public health policies in the hotel environment, considering the
accumulated scientific evidence and emerging challenges, to ensure a safe
environment and prevent the spread of diseases in an increasingly globalised world.
The aim of the research is to analyse health risks in hotel environments based on a
documentary review.
METHOD
A systematic review of 15 articles on clinical risk management in hospitality settings
was used.
Sanitas
Revista arbitrada de ciencias de la salud
Vol. 3(3), 14-22, 2024
Análisis de los riesgos sanitarios en entornos hoteleros desde una revisión documental
Analysis of health risks in hotel environments from a documentary review
Yamelis Lissete Morales
16
Articles published in peer-reviewed journals addressing the incidence of infectious
outbreaks, the prevalence of sexually transmitted infections, and the presence of
environmental pathogens in hotels were included.
The selected studies had to be in English or Spanish, published between 1980 and
2023, and provide empirical data relevant to the relationship between hotel health
practices and health outcomes.
Opinion articles, studies with significant methodological limitations, and those with
non-representative populations were excluded.
Comprehensive searches of electronic databases such as PubMed, Scopus, and
Web of Science were conducted using specific key terms: "hotel", "infectious
outbreaks", "Legionella", "sexually transmitted infections", "infection control", among
others. Reference lists of selected articles were also reviewed to identify additional
studies that might meet the inclusion criteria.
RESULTS
The results of the research are presented for consideration:
Table 1. Health risks in hotels.
N
Reference
Main theme
Key findings
Implications
Clinical risks
1
Michel et al.,
2007
Norovirus
outbreak in
hotel
Identification of
a norovirus
outbreak in a
hotel in Ireland;
the rapid
spread of the
virus is
highlighted.
Importance of
sanitary
measures in
hotels to prevent
outbreaks.
High risk of
acute
gastroenteritis
in hosts due to
norovirus
transmission.
2
Reid et al.,
1988
Viral
gastroenteritis
in a hotel
An infected
food handler
was identified
as the source
of the
outbreak.
Need for strict
controls on the
health of food
handlers.
Risk of
massive
gastroenteritis
infection
among hosts
due to
exposure to
Sanitas
Revista arbitrada de ciencias de la salud
Vol. 3(3), 14-22, 2024
Análisis de los riesgos sanitarios en entornos hoteleros desde una revisión documental
Analysis of health risks in hotel environments from a documentary review
Yamelis Lissete Morales
17
contaminated
food.
3
Yezli et al.,
2021
Food security
during Hajj
Assessment of
gastrointestinal
symptoms and
food safety
practices
among
pilgrims.
Improving food
safety education
at mass events.
Risk of
gastrointestinal
disease
outbreaks
during mass
gatherings due
to inadequate
food handling
practices.
4
Abdel-
Dayem et al.,
2014
Health of food
handlers in
hotels
Identification of
microbial and
parasitic
pathogens in
food handlers.
Reinforcement of
medical
examinations for
workers in the
hotel sector.
Risk of
transmission of
parasitic and
bacterial
infections
through food
handled by
infected
personnel.
5
Nessa et al.,
2004
Sexually
transmitted
infections
(STIs) among
sex workers
High
prevalence of
STIs among
sex workers in
hotels.
Urgent sexual
health and STI
prevention
programmes for
vulnerable
populations.
High risk of
spreading STIs
among sex
workers and
their clients.
6
Haseen et
al., 2012
Sexual
behaviour and
STIs in young
people
Sexual risk
behaviours in
young clients
of hotel sex
workers.
Need for
educational and
public health
interventions
targeting young
people.
High risk of
STIs among
young people
due to high-risk
sexual
behaviour.
7
Kapiga et al.,
2003
Herpes
simplex type 2
infection
High
prevalence of
HSV-2 among
bar and hotel
workers.
STI prevention
and sexual health
education
programmes in
high-risk areas.
Risk of HSV-2
infection and
other STIs in
hotel workers.
8
Kiwelu et al.,
2005
Identification
of HIV
variants
Screening for
HIV variants
among bar and
hotel workers.
Importance of
ongoing
surveillance and
HIV prevention
strategies in key
populations.
Risk of
infection with
HIV variants
due to high
exposure in
vulnerable
populations.
9
McDonnell et
al., 1995
Outbreaks of
infectious
Study of
outbreaks of
intestinal
Need to improve
personal hygiene
Risk of
transmission of
gastrointestinal
Sanitas
Revista arbitrada de ciencias de la salud
Vol. 3(3), 14-22, 2024
Análisis de los riesgos sanitarios en entornos hoteleros desde una revisión documental
Analysis of health risks in hotel environments from a documentary review
Yamelis Lissete Morales
18
intestinal
diseases
diseases with
person-to-
person
transmission in
hotels.
and training of
catering staff.
infectious
diseases due
to lack of
proper
hygiene.
10
Tassiopoulos
et al., 2007
Predictors of
HSV-2
prevalence
Identification of
risk factors
associated
with HSV-2
prevalence in
hotel workers.
Interventions
aimed at reducing
the incidence of
HSV-2 through
education and
prevention.
Continued risk
of HSV-2
infection in the
absence of
preventive
interventions.
11
Kapiga et al.,
2002
HIV-1
epidemic in
sex workers
Examining risk
factors in the
HIV-1 epidemic
among hotel
workers.
Creation of
specific
prevention
programmes for
women in the
hotel sector.
Elevated risk of
HIV-1
transmission in
sex workers
and their
clients.
12
Doménech-
Sánchez et
al., 2022
Legionella
surveillance in
tourist
facilities
Monitoring of
Legionella in
tourist facilities
in the Balearic
Islands.
Recommendation
for preventive
maintenance and
continuous
surveillance for
Legionella in
hotels.
Risk of
Legionellosis
outbreaks in
tourist facilities
due to lack of
adequate
surveillance.
13
Patwary et
al., 2023
Sustainable
consumption
in green
hotels
Research on
the intention of
tourists
towards green
hotels.
Strategies to
promote
sustainable
tourism through
green hotels.
No direct
clinical risks
identified,
focus on
sustainability.
14
Jiménez-
Barreto et al.,
2021
Cleaning
programmes
and COVID-
19
Effectiveness
of
communication
of cleaning
programmes in
hotels during
the pandemic.
Improved clear
and effective
communication
on health
measures to
customers.
Risk of COVID-
19 infections if
cleaning
measures are
not properly
implemented
and
communicated.
15
Sharma et
al., 2021
Innovation in
hotels during
COVID-19
Evaluation of
hotel
innovation and
performance
during the
pandemic.
Promoting
innovation in
services and
protocols to
improve the
resilience of the
hotel sector.
Risk of decline
in performance
and safety of
hotels without
innovation in
times of crisis.
Source: Own elaboration.
Sanitas
Revista arbitrada de ciencias de la salud
Vol. 3(3), 14-22, 2024
Análisis de los riesgos sanitarios en entornos hoteleros desde una revisión documental
Analysis of health risks in hotel environments from a documentary review
Yamelis Lissete Morales
19
The analysis of the results presented in table 1 shows the significant prevalence of
clinical risks associated with health management in hotel settings and their impact
on public health. Outbreaks of infectious diseases, both gastrointestinal and sexually
transmitted, underline the vulnerability of hotels as hotspots of contagion,
exacerbated by poor implementation of control and prevention measures.
The identification of pathogens such as norovirus and Legionella, together with the
high prevalence of STIs, highlights the need for a comprehensive approach to the
training and sanitary control of hotel staff, whose role is critical in the spread of
infectious agents. The interrelationship between guest behaviour and the sanitary
conditions of the establishment highlights the importance of innovation in hygiene
protocols and effective communication to mitigate risks during mass events or
emergency situations, such as the COVID-19 pandemic.
DISCUSSION
The discussion of the results obtained in the literature review highlights the
complexity and challenges facing clinical risk management in the hotel environment,
a space that, although designed for hospitality, can become a hotspot for the spread
of pathologies if rigorous preventive measures are not implemented. The research
documents multiple outbreaks of viral and bacterial infections in hotels, highlighting
how the lack of adequate controls on staff health and environmental hygiene
facilitates disease transmission. In this context, evidence of a norovirus outbreak
associated with improper food handling highlights the critical need for strict protocols
for health surveillance and ongoing staff training (4).
Beyond gastrointestinal outbreaks, the literature also points to the prevalence of
sexually transmitted infections (STIs) among hotel workers, particularly in areas with
high rates of sex tourism. Studies have shown that sex workers operating in hotels
have a high incidence of STIs, which not only underscores the vulnerability of these
populations, but also poses a significant public health risk (5). Transmission of
herpes simplex virus type 2 (HSV-2) and the identification of HIV variants in hotel
Sanitas
Revista arbitrada de ciencias de la salud
Vol. 3(3), 14-22, 2024
Análisis de los riesgos sanitarios en entornos hoteleros desde una revisión documental
Analysis of health risks in hotel environments from a documentary review
Yamelis Lissete Morales
20
workers in Tanzania illustrate the severity of the problem and the urgency of effective
preventive interventions that address both health education and access to health
services (6, 8).
On the other hand, the detection and control of environmental pathogens such as
Legionella in tourist facilities reinforces the need for continuous environmental
monitoring. The persistence of Legionella in poorly maintained water systems in
hotel facilities is evidence of failures in the implementation of primary prevention
strategies that could prevent outbreaks of Legionellosis, a disease that, although
preventable, can have fatal consequences if not properly managed (9). The
importance of these findings is amplified in situations of global health emergency,
such as the COVID-19 pandemic, where the adoption of innovative measures and
clear communication of cleaning protocols are essential to prevent disease
transmission in hotel environments, a fact that has been widely documented in
recent literature (14, 15).
CONCLUSION
The critical interrelationship between health management in hotel environments and
clinical risk prevention is evident, highlighting the need to implement advanced
preventive strategies and ongoing epidemiological surveillance. Outbreaks of
gastrointestinal and sexually transmitted infections, together with the identification of
environmental pathogens such as Legionella, highlight the deficiencies in hygiene
and control protocols, which were insufficient to mitigate the risks of contagion. It is
important that health authorities encourage closer collaboration with the hotel
industry, developing educational programmes and prevention policies that integrate
technological innovations to effectively protect public health.
FUNDING
Non-monetary
Sanitas
Revista arbitrada de ciencias de la salud
Vol. 3(3), 14-22, 2024
Análisis de los riesgos sanitarios en entornos hoteleros desde una revisión documental
Analysis of health risks in hotel environments from a documentary review
Yamelis Lissete Morales
21
CONFLICT OF INTEREST
There is no conflict of interest with persons or institutions involved in research.
ACKNOWLEDGEMENTS
To the Instituto de Investigación Multidisciplinaria Perspectivas Globales, Portoviejo,
Manabí, Ecuador.
REFERENCES
1. Michel A, Fitzgerald R, Whyte D, et al. Norovirus outbreak associated with a
hotel in the west of Ireland, 2006. Euro Surveill. 2007;12(7):E11-E12.
Published 2007 Jul 1. doi:10.2807/esm.12.07.00725-en
2. Reid JA, Caul EO, White DG, Palmer SR. Role of infected food handler in
hotel outbreak of Norwalk-like viral gastroenteritis: implications for control.
Lancet. 1988;2(8606):321-323. doi:10.1016/s0140-6736(88)92367-7
3. Yezli S, Yassin Y, Mushi A, et al. Gastrointestinal symptoms and knowledge
and practice of pilgrims regarding food and water safety during the 2019 Hajj
mass gathering. BMC Public Health. 2021;21(1):1288. Published 2021 Jul 1.
doi:10.1186/s12889-021-11381-9
4. Abdel-Dayem M, Al Zou'bi R, Hani RB, Amr ZS. Microbiological and
parasitological investigation among food handlers in hotels in the Dead Sea
area, Jordan. J Microbiol Immunol Infect. 2014;47(5):377-380.
doi:10.1016/j.jmii.2013.06.001.
5. Nessa K, Waris SA, Sultan Z, et al. Epidemiology and etiology of sexually
transmitted infection among hotel-based sex workers in Dhaka, Bangladesh.
J Clin Microbiol. 2004;42(2):618-621. doi:10.1128/JCM.42.2.618-621.2004
6. Haseen F, Chawdhury FA, Hossain ME, et al. Sexually transmitted infections
and sexual behaviour among youth clients of hotel-based female sex workers
in Dhaka, Bangladesh. Int J STD AIDS. 2012;23(8):553-559.
doi:10.1258/ijsa.2012.011373
7. Kapiga SH, Sam NE, Shao JF, et al. Herpes simplex virus type 2 infection
among bar and hotel workers in northern Tanzania: prevalence and risk
factors. Sex Transm Dis. 2003;30(3):187-192. doi:10.1097/00007435-
200303000-00001
8. Kiwelu IE, Koulinska IN, Nkya WM, Shao J, Kapiga S, Essex M. Identification
of CRF10_CD viruses among bar and hotel workers in Moshi, Northern
Tanzania. AIDS Res Hum Retroviruses. 2005;21(10):897-900.
doi:10.1089/aid.2005.21.897
9. McDonnell RJ, Wall PG, Adak GK, Evans HS, Cowden JM, Caul EO.
Outbreaks of infectious intestinal disease associated with person to person
spread in hotels and restaurants. Commun Dis Rep CDR Rev.
1995;5(10):R150-R152.
Sanitas
Revista arbitrada de ciencias de la salud
Vol. 3(3), 14-22, 2024
Análisis de los riesgos sanitarios en entornos hoteleros desde una revisión documental
Analysis of health risks in hotel environments from a documentary review
Yamelis Lissete Morales
22
10. Tassiopoulos KK, Seage G 3rd, Sam N, et al. Predictors of herpes simplex
virus type 2 prevalence and incidence among bar and hotel workers in Moshi,
Tanzania. J Infect Dis. 2007;195(4):493-501. doi:10.1086/510537
11. Kapiga SH, Sam NE, Shao JF, et al. HIV-1 epidemic among female bar and
hotel workers in northern Tanzania: risk factors and opportunities for
prevention. J Acquired Immune Deficiency Syndr. 2002;29(4):409-417.
doi:10.1097/00126334-200204010-00013
12. Doménech-Sánchez A, Laso E, Berrocal CI, Albertí S. Environmental
surveillance of Legionella in tourist facilities of the Balearic Islands, Spain,
2006 to 2010 and 2015 to 2018. Euro Surveill. 2022;27(21):2100769.
doi:10.2807/1560-7917.ES.2022.27.21.2100769
13. Patwary AK, Aziz RC, Hashim NAAN. Investigating tourists' intention toward
green hotels in Malaysia: a direction on tourist sustainable consumption.
Environ Sci Pollut Res Int. 2023;30(13):38500-38511. doi:10.1007/s11356-
022-24946-x
14. Jiménez-Barreto J, Loureiro S, Braun E, Sthapit E, Zenker S. Use numbers
not words! Communicating hotels' cleaning programs for COVID-19 from the
brand perspective. Int J Hosp Manag. 2021;94:102872.
doi:10.1016/j.ijhm.2021.102872
15. Sharma A, Shin H, Santa-Maria MJ, Nicolau JL. Hotels' COVID-19 innovation
and performance. Ann Tour Res. 2021;88:103180.
doi:10.1016/j.annals.2021.103180.
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