Welcome to Professional and Technical Services (PTS) – experts in chemical disinfection for infection prevention. Our goal is to educate and provide you the latest resources related to cleaning and disinfection of environmental surfaces, medical devices and hands. As specialists in disinfectant chemistries, microbiology, environmental cleaning and disinfection, facility assessments and policy and procedure creation we are dedicated to helping any person or facility who uses chemical disinfectants.

Our expertise is utilized by Infection Preventionists, Public Health Experts, First Responders, Dentists, Physicians, Nurses, Veterinarians, Aestheticians, Environmental Services professionals and janitorial product distributors to develop more sustainable cleaning and disinfection practices in North America.

Our commitment to providing chemical disinfectant education is more than business, it is a passion.

Friday, March 24, 2017

Post vacation woes…

I’m not going to gloat.  I’m tanned.  I’m refreshed.  I devoured three books – only 1 of which is worth remembering and/or recommending (The Bite of Mango).  The weather is above freezing, even if it is raining today.  All in all, it was a great week’s vacation. 
   
When I wasn’t reading I will admit, I was people watching and minding my infection prevention practices!  It truly is amazing the number of people who have no understanding of how easy it can be to pick up “bugs” while travelling.  The following are a few of my favorite pictures depicting a few infection control risks I found!
  1. Shared towels….  Okay, fine they are laundered and yes I used them BUT if you recall a Gerba study found that 93% of the “clean” cloths contained viable microorganisms EVEN AFTER LAUNDERING! 
      
  2. Cream on tables….  Here’s one I learned the hard ways years ago on a trip.  Do NOT use cream or milk that has been sitting on a table unless you are looking for a quick weight loss program!  If you do not believe me check out “Real Raw Milk Facts” as an example of outbreaks associated with raw/unpasteurized versus pasteurized milk and milk products.  In tropical climates, bacteria can grow quickly!  Skip the milk and keep the calories for consumption of other beverages or snacks! 
       
  3. Bare feet….  I could not believe the number of people walking around without shoes – even in the “He – She” (aka restrooms).  Athlete’s footplantar warts you name it!  I kept my shoes on to avoid bringing home anything that would ruin my beautifully pedicured feet! 
       
  4. Water…  You always need to be sure when you can or cannot drink the water.  For us, tap water was a no-go and we kept to bottled water except when at the resort restaurants.  However, after watching the video of us getting “slimed” and watching the resort staff squeegee the green water away I have to admit I wondered if they were recycling the green water.  I never asked.  I do not want to know.  I do not seem to have any long term ill effects from the experience!

Is anyone as geeky as me when on vacation? If you have any pictures or stories I would love to see and/or hear them!


Bugging Off!


Nicole

Friday, March 17, 2017

What’s your E. coli transmission rate?

I write this blog on the eve of my vacation.  Tomorrow, regardless of the fact that I have to get up at an unreasonable hour, I will be sitting in a warm tropical climate by mid-afternoon.  This is particularly inviting, since this week has been cold, windy and snowy (-8 to -12 0C / 10 to 17 0F - not including wind chill - and about 10 inches of snow the last couple of days).  I am DONE with winter.

In preparation for my trip, I have taken my Dukoral to protect myself against heat-labile producing enterotoxigenic E. coli (I will say, had I realized that sodium hydrogen carbonate powder was part of the vaccine, I may have passed).  I have also packed enough hand sanitizer and disinfecting wipes to ensure I am completely covered and have no fear of touching the TV remote in my hotel room!  So as I finish the last of my packing and was scrolling through my e-newsletter, I came across a study by researchers at the University of Geneva titled “Assessing the Likelihood of Hand-to-Hand Cross-Transmission of Bacteria: An Experimental Study” that looked at how much E. coli needed to be present on a person’s hands in order to be potentially transmitted to another person, I knew I had to read it.

According to the researchers, only 1 Log10 of viable E. coli cells need to present for transmission.  The study used healthcare worker pairs (e.g. a “transmitter” and a host) and increased the amount of E. coli present on the “transmitters” hands.  The “transmitter” then held the hand of the “host” for 1 minute.  In the end, the study found that hand-to-hand transmission of E. coli was 8.22 times more likely when the viable bacterial count on the “transmitter” hand was >1 Log10.  If the viable cell concentration increased to 4 Log10, the Odds Ratio increased to 212.6 times!  GROSS!

In doing a bit of “Googling”, the Minnesota State Department of Health has a poster that states there are 1500 bacteria on each square centimeter of your hand. Knowing that 1 Log10 is just a fancy way of saying “approx. 10 bacteria”, then in theory, at any given time it is possible for a person to have enough E. coli on their hands to lead to transmission.   Further, according to a 2013 study by Michigan State University, researchers found men were much more likely to just rinse their hands than women after using the restroom.   Other research on hand hygiene suggests just 37% of men and 61% of women wash their hands (with soap) after using the restroom.

What does this mean to me?  Well, it means that while I “should” be protected from enterotoxigenic E. coli after drinking that nasty Dukoral concoction, there could still be enough pathogenic bacteria on the hands of the housekeeping, wait staff and/or cooks to sink a small ship (aka my vacation).  I can’t control everyone, but you can bet I am going to try in earnest to only use female waitresses while on vacation – not because women rule, but at least I have a higher chance that she will have washed her hands after using the restroom, and so “should” have fewer “poop-related” bugs on her hands!


Bugging Off!


Nicole

Friday, March 10, 2017

#FF March Madness

If you’re “lucky” like me, today is a PD (Professional Development) Day at school and next week is March break.  While we are thankfully going on vacation, we are not leaving until next Thursday - meaning I have 4 days to figure out what to do with my son (aka I’ve been scrambling).  I have to admit, this scrambling has caused some chaos in my life leading to the inability to choose a blog topic this week.  It’s not that I don’t have a topic, the problem is that I have a number of topics and just can’t decide on which one I want to blog on!  Rather than pick a single topic I thought I’d embrace my March Madness and share the articles and topics that have tickled my fancy this week!

1.      High Pathogenic Avian Influenza found in Tennessee Farm – if you recall the outbreak of Avian Influenza in 2015, you may know that it caused the destruction of 49.5 million chickens and turkeys.  Some believe it was the largest animal health emergency in the US, so when a farm in Tennessee was found to have a positive test you can imagine how quickly people jumped to action.  The CDC has stated the H7N9 strain found on the farm poses a low risk for humans.  The farm is under quarantine as are 6 other farms in a 30-mile radius.  From various articles I have read so far this week the other farms are clear, but this certainly highlights the fact that influenza can hit at anytime and anywhere.  Whether we’re a producer of chickens, turkeys or ducks or a healthcare worker, we need to be vigilant during “flu” season.

2.      The Medical Minute: Is it a bad cold or RSV? – if you’re a parent, you may have experienced that moment of panic when you’re trying to determine if the “cold” your child has is turning or has turned into something worse.  Respiratory syncytial virus (RSV) is a nasty virus that can turn a runny nose and cough into a child who is having trouble breathing.  According to the article I was reading from PennState Health, an infected person can be contagious for up to 20 days after infection, meaning we can easily pass it on to our young children who are far more susceptible to this virus than we are. We can also easily pass it onto the elderly for which RSV causes >14,000 deaths per year.  Oh, and by the way, we are also still in prime RSV season!

3.      Flu can cause worse symptoms in people with asthma – being an asthmatic, this is a topic near and dear to me, particularly since I know firsthand what happens when the flu turns to pneumonia…..   A study published by researchers at the University of Southampton assessed lung samples from asthmatics and healthy volunteers. The researchers investigated whether immune system differences could explain why asthmatics are more likely to end up in hospital if they get flu.  According to the results, samples from healthy people showed a strong immune system-triggering reaction to the flu virus versus samples from asthma patients where the reaction was much weaker. Further studies need to be conducted to determine whether the difference in immune response is due to the asthma itself, or the medications used by participating asthmatics to control their condition, but I hope you agree this is a pretty cool study!

While on the surface (pun intended) you may be wondering why I found these articles or studies so interesting as they do not directly talk to the need for cleaning and disinfection which in essence is the basis for the Talk Clean To Me blog.  The reason is because both RSV and Influenza, regardless of whether it’s a strain that infects humans or animal, are transmitted via surfaces and fomites.  When it comes to Avian Influenza, the need for strict infection control and biosecurity measures is paramount to limit the spread of disease and minimize the number of birds that need to be culled if even a single confirmed infection shows up on a farm.
 
Similarly, as these articles highlight, the fact that transmission of these viruses can occur with relative ease from healthy individuals (a.k.a. someone who will “get over” an infection with relative ease) to more susceptible individuals (the young, the old, or the asthmatics).  The importance of hand hygiene and disinfection of the environment needs to be top of mind.  Spring may just be around the corner and yes, the clocks turn back this weekend, robins have been showing up and in my back yard I have buds on the trees, but we’re not out of the woods yet when it comes to RSV or Influenza infections.  We need to be vigilant, and these articles keep us grounded and highlight why we need to be vigilant.


Bugging Off!

Nicole


Friday, March 3, 2017

Top 12 Super Villain Watch List

Having an 8 year old, I can honestly say that when I think of a super villain I think of Rhino, The Goblin, Mystique, Magneto, Cat Woman, The Joker, Loki – you know the villains that super heroes like Spiderman, Batman, the Avengers or The X-Men fight against.  If you’re a bug fighter, you might think differently, especially after the WHO released their list of the 12 most dangerous superbugs.

Similar to the list of Top Emerging Pathogens that were released by WHO prior to Christmas, the WHO has released a list of superbugs we need to be on the lookout for.  The 12 bacteria listed were chosen based on their level of drug resistance, the number of deaths they cause, the frequency they infect people outside of healthcare facilities and the burden they place on healthcare facilities.  The top 3 offenders, while not as common as other antibiotic resistant organisms (AROs), are incredibly costly to manage and have very high mortality rates. The top 3 offenders include Carbapenem-resistant Acinetobacter baumannii, Carbapenem-resistant Pseudomonas aeruginosa and Carbapenem-resistant and ESBL-producing Enterobacteriaceae.  These bacteria are most commonly associated with medical devices such as ventilators, catheters and endoscopes.

In the “we need new antibiotics to treat” group the WHO identified Vancomycin-resistant Enterococcus faecium (VRE), Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-intermediate Staphylococcus aureus, Vancomycin-resistance Staphylococcus aureus, Clarithromycin-resistant Helicobacter pylori, Fluoroquinolone-resistant Campylobacter spp., Fluoroquinolone-resistant Salmonellae, Cephalosporin-resistant Neisseria gonorrhoeae and Fluoroquinolone-resistant Neisseria gonorrhoeae.  This group of bacteria are ones that cause infections in healthy people.  According to the CDC, Gonorrhoeae is the 2nd most commonly reported infectious disease with approx. 820,000 new infections reported each year and the majority of those are between 15 and 29 years old with 20 – 24 year olds being the age group with the highest numbers.

The last group include Penicillin-non-susceptible Streptococcus pneumoniae, ampicillin-resistant Haemophilus influenzae and Fluoroquinolone-resistant Shigella spp.  The concern here is that this group is becoming increasingly resistant to available drugs. If we do not start to become more vigilant, the group will creep up higher on the list of priority, particularly if new treatments are not developed.

While our treatment options are limited and certainly concerning if drug companies do not start working on the development of new options, the upside is that science continues to show that antibiotic resistant pathogens are not more resistant to disinfectants than antibiotic sensitive pathogens.  While we may not have treatment options, ensuring that we have a strong infection prevention program that includes a focus on hand hygiene, effective cleaning, and disinfection of environmental surfaces and medical devices, we can minimize the transmission.  The concern of course still exists from a perspective of transmission outside of healthcare facilities, where cleaning and disinfection and/or hand hygiene practices are not as strict.


Bugging Off!

Nicole


Friday, February 24, 2017

Do disinfectants pose health risks?

Whether we’re talking politics, religious beliefs, vaccination, science or the use of disinfectants as part of an infection prevention program, there will always be differing opinions and there will always be that polarizing personality that you either love or hate.  As a wise woman (or man) once said “there are two sides to every story and the truth lies somewhere in the middle”.

A great example of this is the use of disinfectants and their role in occupational or worked-related asthma.  According to sources I have read, more than 300 workplace substances have been identified as possible causes of occupational asthma.  These substances can be broken down into the following categories: animal substances, chemicals, enzymes, metals, plant substances and respiratory irritants.  If you’re luckier than me, I hope you’ve never experienced an asthma attack.  If you’re not familiar with asthma, symptoms start when your lungs become irritated which leads to inflammation.   This inflammation causes a restriction of the airways which makes breathing difficult.  With occupational asthma, lung inflammation may be triggered by either an allergic response to a substance or irritation of the lungs caused by an inhalation of a substance, such as chlorine.

Enter the differing opinions.  A study published in May 2016 in AJIC titled “Occupational healthrisks associated with the use of germicides in health care” concluded that the data reviewed in the study demonstrate that occupational asthma as a result of chemical exposures, including low-level disinfectants, are exceedingly rare.  However, unprotected exposures to high-level disinfectants may cause respiratory symptoms. 

On the other side of the story, a study by Rosenman et alreported that a cleaning product was at least 1 of the 3 suspected agents identified in 12% of confirmed work related asthma cases that they reviewed.  The fact that bleach was the most frequently identified product should not be all that surprising considering that bleach was recently designated an asthma-causing agent by the Association of Occupational and Environmental Clinics (Sastre 2011).   Furthermore, Quaternary ammonium compounds (Quats or QACs) also tend to be frequently identified as potential asthma causing agents due to their prevalence in numerous cleaning and disinfectant products.  Michigan’s SENSOR program published a detailed report on the link between asthma and Quats in their 2008-2009 newsletter.  The newsletter includes several case reports and a review of several peer reviewed studies completed on the subject. 

This leads me to try to figure out what the “truth” is.  I think there is enough evidence to support the fact that the use of some chemicals (including some disinfectants) can lead to occupational asthma particularly with our increased reliance on disinfectants as part of our infection prevention program.  However, I also believe that we cannot with broad strokes state that all disinfectants will cause occupational asthma.  I think there are products available on the market that meet the criteria of non-asthma inducing agents that can be used safety and effectively.

As a person with asthma, I know I can state categorically that some disinfectant actives irritate my airways more than others.  I can also state without a doubt that the method of application can also dramatically increase or decrease the level of irritation.  Perhaps the next investigation should be to look at the method of application – spray and wipe versus wiping with a cloth or pre-moistened wipe to see which method reduces the likelihood of inducing respiratory irritation.  Not to say I already know the answer, but I do know which method bugs me the least!  Wiping!  I also happen to believe that wiping is the best method of application for disinfectants to ensure even distribution of the disinfectant solution and physical friction to help lift and remove soils and bugs from the surface you are wiping.  But, I’ll let you decide for yourself!


Bugging Off!


Nicole

Friday, February 17, 2017

Do engineering and cleaning have anything in common?

Regardless of the fact that we are into the second month of 2017, for some the concept of cleaning has not progressed much past Florence Nightingale’s introduction to the concept of hygienic needs during the Crimean war in 1854.  For others however, we are looking past the mop and bucket, the cotton versus microfiber cloths, or the difference between disinfectant chemistries. Instead, we are considering change management and implementation science as ways to improve our cleaning and disinfecting practices.

Being someone who actively seeks to learn and develop processes or behaviors to improve our cleaning practices and perhaps more importantly ways that we can elevate the importance of the environmental services department from the CEO downward, I was most excited to read an article from Health Facilities Management about a new three year study that has just begun.  I am dismayed of course that I will have to wait three years to learn of the outcomes, but the fact that the study is using human factors engineering as a way to improve and optimize cleaning and disinfection practices is extremely exciting to me!

The study is aimed at using a human factors engineering approach to measure and improve patient room cleaning and disinfection processes. The study will explore work systems, tools and technologies that environmental services staff use as they go about their day.  However, the study will go beyond just the methods and process of how the work is done, it will also look at training, education and how environmental staff are valued within the hospitals organization.

After auditing 7 environmental staff clean a total of 70 rooms, the researchers noted that many surfaces were only cleaned about half of the time (or less).  They were quick to point out that missing these surfaces was not an issue of the staff being inattentive or careless, but in many cases the missed items were in use during the time they were cleaning the room and/or staff would be asked to vacate the room before they had completed their work.

While it is still in the early days of the study, it’s exciting to see that unlike the focus of many studies where the assumption is that housekeeping staff are simply not doing their jobs, this study is looking at why the job is not getting done and realizing that that there are extenuating circumstances that makes achieving 100% compliance virtually impossible…..at least by today’s methods and by today’s organization standards.  The focus on the need to have multidisciplinary collaboration at a unit level is also exciting.  If we think of the adage “it takes a village to raise a child” perhaps at the end of the three years we will realize that “it takes everyone on a unit working together” to keep the area clean.

It reminds me of my favorite definition of insanity – doing the same thing over and over and expecting different results.  Perhaps through this out-of-the-box approach to investigating the processes, tools or materials used, the training and the collaboration between disciplines working on a unit will finally get us to nirvana…..or at least a place where cleaning and disinfection can happen 100% of the time.


Bugging Off!


Nicole

Friday, February 10, 2017

Short Staff, Short Cuts

According to the National and State Healthcare-Associated Infections Progress Report released in May 2016, on any given day, about 1 in 25 hospital patients have at least one healthcare-associated infection. While the number of HAIs has decreased overall, we certainly have a long way to go.  The stats currently spewed in so many studies or reports estimate that there are 722,000 HAIs in US hospitals each year, with 75,000 patients dying during their hospitalization as a result of an HAI.  The attributed cost for these HAIs according to a 2013 study is an estimated $96-147 billion annually.


I think we can all agree there has been a significant focus on trying to reduce HAIs.  I’m sure we can all agree that there is not one single magic bullet.  Reducing HAIs is a bundled approach where we need to ensure environmental surfaces and medical devices are cleaned and disinfected, everyone cleans their hands, and antibiotic stewardship programs are put into place.   Unfortunately, we also know that hospitals need to balance their budgets.   HAIs and outbreaks are expensive.  There are times when a hospital is forced to rob Peter to pay Paul.  The ugly truth is that Environmental Services staff are often on the chopping block when it comes to having to make cut backs.

I realized it may seem logical when you are just looking at numbers on a piece of paper, but let’s think about the unintended consequences of such an action.  Does the size of the facility change?  No.  Can you cut back on cleaning and disinfection?  No, there is a plethora of data linking the fact that effective cleaning and disinfection can reduce HAIs.  What then is the reality of cutting back on the number of staff when the workload has not been reduced?  Corners get cut.  Short cuts are taken.  The result is a potential increase in HAIs.

According to a survey conducted in 2016, understaffing in environmental services is getting worse, with reports of layoffs and cuts occurring regularly.  Concerns are growing among environmental service workers that hospitals do not have the capacity and enough cleaning staff to keep key surfaces like bedrails, mattresses, taps, door handles and chairs clean.  The survey revealed a disturbing pattern of having to speed through the cleaning, being short staffed due to vacations or sick days, employees admitting to having high levels of stress and injuries occurring at work.  In fact, a large majority reported that more duties have been added to their already heavy workloads. Over half of the respondents believe the situation is unsafe.

A study from 2014 noted that cleanliness in hospitals can be characterized as less than optimal. Nearly 40% of respondents did not judge their hospital to be sufficiently clean for infection prevention and control purposes.  If we admit the truth, we know there is reams of data to support the fact that infection rates would decline and fewer people would die if we just cleaned.  The problem is determining how to apply the science and the data generated into mathematical models that can calculate the return on investment (ROI) and define what the value proposition is for supporting a fully staffed Environmental Services department.

We know that cleaning works.  We know that cleaning is time and labour intensive.  We know that having adequate staff will impact the budget.  Are we willing to risk the lives of patients when we know the harm that can be prevented by improving our cleaning and disinfection programs?  I’m hoping the answer is no.


Bugging Off!


Nicole