Pools Poised for Plagues

If you’re a parent, you know that when on vacation or attending sporting tournaments a hotel or resort with a pool is a must in order to keep your kids entertained.  Travelling with a hockey team of 17 eight to nine year olds, the hotel pool was the best way to keep the boys contained and entertained. As a hockey mom, we quickly decided that the fathers should be left to deal with the splashing, yelling and squealing and we retreated to enjoy a glass of wine and conversation that did not include the words puck, stick, skates, goal or jock….

Summer of course signifies pool openings. If you have a backyard pool similar to hotel pools, you know it’s a great way to entertain kids and if you’re like me, the idea of “chlorinating them” before bed to remove the dirt, grime, germs and stink of the day!  While pools and hot tubs are great entertainment devices, if not maintained properly they can be a source, a cesspool if you will of infectious pathogens that can quickly ruin your summer fun.  If you don’t want to believe me, check out the latest Morbidity and Mortality Weekly Report where the CDC reports that nearly one-third of disease outbreaks caused by chlorinated or treated water can be linked to hotel pools and hot tubs.  I’ve never been one to use a public hot tub, but you can be assured I will not likely set foot in one again and will definitely reconsider my use of pools (at the very least, my head will be kept above water!

According to the CDC between 2000 and 2014 there were 493 outbreaks in the USA associated to recreational water that caused a total of >27,000 illnesses and 8 deaths. Of the 493 outbreaks, 158 of the outbreaks were directly linked to hotels, motels, lodges and inns. The most common illness contracted was folliculitis caused by Pseudomonas (aka hot tub rash) and the reason I avoid public hot tubs.  Legionella (causes severe pneumonia) was the second most common pathogen identified in the water followed by Cryptosporidium (a parasite that causes GI illness and diarrhea). Of interest, 22 outbreaks were associated with chemical exposure due to excess chlorine, disinfection by-products or altered pool chemistry showing even with pools the use of chemicals properly needs to be considered or you can easily amass >1000 cases of illness associated with chemicals.

With June around the corner you may also want to know that the highest number of outbreaks occurred during June to August. It shouldn’t be surprising – it ties in to the warmer months in many parts of the US and school break and summer vacations!

Stay safe this summer and perhaps consider keep you head above the water!

Bugging off!

Nicole

#FF May Mentoring Madness

In the infection prevention world, spring (usually) signifies the end of flu season and the beginning of education season. May starts of off with “Save Lives: Clean Your Hands Day” on May 5^th which kicks off the North American infection prevention conference season with IPAC Canada’s National conference at the end of May and the APIC conference in early June.  The opportunities for education are endless.


As noted in past blogs, the Teleclass Education by Webber Training is an international lecture series on topics related to infection prevention and control. The objective is to bring the best possible education to the widest possible audience with the fewest possible barriers when trying to access it.  As summer creeps up on us, be sure to check some of these teleclasses out!

Date	Title of Teleclass	Speaker
April 10th	Hopes, hypes and multivallate defences against antimicrobial resistance	Prof. Neil Woodford, England
April 12th	Understanding risk perceptions and responses of the public, healthcare professionals and the media: The case for Clostridium difficile	Dr. Emma Burnett, Scotland
April 18th	Genetic similarities between organisms isolated from the ICU	Prof. Slade Jenson, Australia
April 19th	Topical antibiotics to prevent post-operative surgical infection…is the paradigm changing?	Dr. Hilary Humphreys, Ireland
May 3rd	WHO Global hand hygiene campaign 2018: It’s in your hands – prevent sepsis in health care	Prof. Didier Pittet, Switzerland
May 10th	How the certification board of infection control (CBIC) works for you	Ivan W. Gowe and Lita Jo Henman, USA
May 28th	Trekking safety through the storm – managing complex IPAC issues	Dr. Mark Joffe, Canada
May 29th	Simulation as an education tool	Dr. Ghazwan Altabbaa and Dione Kolodka, Canada
June 13th	Involving patients in understanding hospital infection prevention and control using video-reflexive methods	Dr. Mary Wyer, Australia
June 21st	The future of infection control – bright or bleak?	Martin Kiernan, England

For more information on Webber Training, including a full list of the upcoming Infection Prevention and Control Teleclasses, please visit www.webbertraining.com

I hope many of you will take the opportunity to listen to these teleclasses and share them with your colleagues!  And don’t worry if the date you see above has passed!  All teleclasses are recorded and available to listen to at your leisure!

Bugging Off!

Nicole

Fungal coated Fomites

When I started in the infection prevention world 15 years ago, fomites (or the patient environment) was still being debated in terms of the contribution to infection transmission.  Most would agree that the potential role of fomites in the transmission of disease required further study.  No one was really ready to take a stance.

In 2002, Infection Control Today (ICT) published an article “Fomites’ Role in Disease Transmission is Still Up for Debate” concluding that the transmission of infectious diseases from fomites is still being contested in the infection control community, with no conclusive decision emerging from clinical studies. Dr. Weber and Dr. Rutala agreed that the key concept in considering the hospital environment as an infectious hazard for patients is to find definitive proof that inanimate objects played a role in transmitting in human disease. In order to support fomites as a causative agent several areas needed to be proven, including: 

- Proof that an organism can survive after inoculation on to the fomite

- Proof that a pathogen can be cultured from fomites in use

- Proof that a pathogen can proliferate on the fomite

- Proof that at least some small part of acquisition of infection cannot be accounted for by other methods of transmission

- Peer reviewed studies showing an association between exposure to the contaminated fomite and infection

In 2006, German researchers conducted a systematic review of the literature, looking at the ability of infectious organisms to survive on inanimate surfaces.  The review found that Gram-negative bacteria persist for longer periods of time than Gram-positive bacteria.  The data was mounting.

Today, I think it’s safe to say that we’ve all drank the Kool-Aid and believe (or at least agree) that pathogens can be transmitted from fomites and that fomites have been directly related to outbreaks.  Unfortunately, while we know this, our ability to ensure that fomites do not lead to transmission continues to plague us. Case in point is a recent study published by a group of researchers from the UK looking at what is being touted as being one of the largest outbreaks of Candida auris.  In investigating the outbreak, researchers found that axillary thermometers (armpit thermometers) had been used in 57 of the 66 patients (86%) of the patients infected with C. auris.  While C. auris was rarely detected in the general ward environment, researchers were able to culture samples from the medical equipment and see it on the surface of thermometers using a scanning electron microscope.  The only way the outbreak was controlled was removing the thermometers from use.

This outbreak is not the only outbreak associated with thermometers. Similar to the focus over the last several years of ensuring that the environment is being effectively cleaned and disinfected through verification programs, so too is the need to have programs and processes in place to ensure that multi-use patient care equipment is being properly and effectively cleaned and disinfected between use. Infectious pathogens are opportunistic.  If we let our guards down, they will find a way to proliferate, contaminate and infect our patients.

Bugging Off!

Nicole

May the fourth be with you!

I couldn’t help it…..I’m a geek, I’ve seen all but the last Star Wars movies - it’s purchased, just finding a night to watch it!  

May the 4^th really has nothing to do with this week’s blog….May 5^th on the other hand means everything!  Each year, May 5^th is known as “Save Lives: Wash your hands day”.  Truth be known EVERY day should be wash your hands day, but on May 5^th, the WHO and other infection prevention associations from around the world use May 5^th (and the days surrounding it) to promote, educate and REMIND people of the importance of hand hygiene.

In trying to come up with a hand hygiene topic this week I decided to instead pay homage to a number of blogs that have been shared on the Talk Clean To Me blog.  I hope you’ll enjoy the walk through history and reread at least one or two of them!

I TRIPLE DOG DARE you to wash your hands: where I referenced my favorite Christmas movie before focusing on a study that was commissioned by the Joint Commission in 2008/2009. The study found that doctors and nurses fail to wash their hands with alarming frequency, contributing to the 247 deaths caused each day by preventable hospital infections.  

A+ or F? What’s your Hand Hygiene knowledge grade?  Which challenged you to be positively deviant and take a hand hygiene quiz where the objective is to answer based on how NOT to follow hand hygiene best practices. I dare you to try it!

What is your child’s definition of good personal hygiene? I reviewed a study that investigated the knowledge and beliefs towards personal and household hygiene of college students (AJIC,2012;40:940-945).  When looking at personal hygiene (hand washing, bathing and tooth brushing), women reported higher rates of “compliance” than men.  Thankfully, almost 75% of the study participants reported washing their hands after using the toilet. I’m sharing this one as tonight I ate out with my son AFTER his hockey try out.  He’s nine. He didn’t shower, and almost didn’t wash his hands before we ate. I thought I was dealing with a teenager as he moped towards the bathroom….

Mucky Hands Wreak Havoc! Where when it comes to hand hygiene, I stated that I thought Nike’s slogan sums it up perfectly: “JUST DO IT!”

I know May 5^th is a Saturday and many of you will not be a work, but I hope that doesn’t mean you’ll stop thinking about hand hygiene and how “Just doing it” saves lives.  Perhaps on weekends when at home you’re not thinking about saving lives, but I hope you’re thinking of saving yourself from ingesting whatever bugs you’ve picked up through your travels!

Bugging Off!

Nicole

PS – this week’s picture is courtesy of Braun Medical from the IFIC conference last week and the what I think is a BRILLIANT educating campaign by developing stickers that go on your hand hygiene dispenser!

Poland, Pierogi and Proficiency

This week I’m in Krakow, Poland attending the International Federation of Infection Control (IFIC) Congress. It’s been a number of years (14 to be exact) since I last attended this conference.  I’m attending this year because I am excited to announce that next year IPAC Canada will be hosting the conference in Quebec City, Canada.  I’m also lucky enough to be sitting on the IPAC-Canada Scientific Planning Committee where, with IFIC representatives, we are jointly planning next year’s topics!  Watch for updates on the IPAC Canada and IFIC websites. 

My first introduction to IFIC was in 2003 at the conference in Malta.  Having attended as many conferences as I have over the last 15 years, I can say that IFIC is one of my favorites (and not just because it’s an opportunity to travel to different countries).  IFIC is an organization of Infection Preventionists from countries and associations from around the world.  IFIC is a group where your country or your level of infection prevention sophistication does not matter.  It’s a group where like minds come to learn, to share stories, to network and build life-long relationships. It’s been amazing getting to rekindle friendships and build new ones.

But, I’m not just here to make friends.  I’m here to learn.  I’m here so I can share my learnings with others when I speak at conferences, when I’m looking at designing a study and of course through the Talk Clean To Me blog.   So what have I learned this week?  Too much for a blog so here are my top 3 sessions so far:

1.   Prof Jacqui Reilly and Prof Kay Currie provided an afternoon workshop titled “Education & Training as a vehicle for change in IPC”.  As both a trainer and speaker, the need to understand how to effectively design and deliver content is paramount.  In the words of Woody Allen “Those who can’t do, teach.  And those who can’t teach, teach gym.” How many times have we created what we think are amazing education presentations, handouts, flyers etc only to realize that the content or concepts were not absorbed or put into practice?  It has nothing to with “you can’t train an old dog new tricks”, it has everything to do with how the material is presented.  People learn differently; some are visual who want to work from lists, written instructions and be shown how to do things, some are auditory learners who say “tell me” and will be able to perform new tasks after listening to instruction and lastly some are kinaesthetic learners meaning the prefer to experience an try things out (you can identify them because they’re generally the ones who shove you out of the way to try it).  I found out (well confirmed what I already suspected) that I have equal tendencies to all 3 ways of learning meaning the topic and / or my mood will determine which way I want to learn at any given time….  I can guarantee that I will be more mindful in how I develop content and strive to include a little bit of everything knowing that I won’t always have the luxury of knowing how my audience learns best.

2.    Dr. Nizam Damani who was presented with the Ayliffe Award gave a lecture on ritualistic, wasteful and unsafe IPC practices.  I was really a world tour reminding us that no country can claim to have perfect practices.  People generally do not mean to be wasteful.  People do not mean to work in a way that is unsafe and can harm the patients or themselves.  People are habitual.  They practice what they were taught or what they see others doing. As a disinfectant guru, the most shocking example was a facility who used Meropenem (an antibiotic given intravenously to treat bacterial infections) as a surface disinfectant – and not just any surface.  It was used to disinfect a floor!  As IPs we all have to wear our detective hats and always look for the unobvious.

3.    Martin Egerth a Human Factors Expert from Lufthansa spoke about achieving a “safety first” culture in infection prevention and control introducing what the aviation industry does and has perfected for the last 25 years.  I have so many notes and ideas from this session.  Not just in terms of the parallels to healthcare and infection prevention, but for my company and how the concept could be put into manufacturing and logistics practices.  It all comes down to having the right people with the right skills following the right processes.  We also need to understand that continual training is needed. Perfection is not one and done.  Building competencies and changing culture will not be immediate, it will take time to see the effect and it’s worth the effort to get there.

The conference is not over.  Tomorrow I have a couple of topics that I’m looking forward to attend.

As always, thanks for reading!  I know this week was a longer blog, but I think you visual learners will do just fine!  If you’re an auditory learner give me a call and I’ll read the blog to you.  If you’re a kinaesthetic learner, drop by the office, we can go for a walk and see if we can come up with novel hands-on ways for you to learn!

Bugging Off!

Nicole

City vs County: Which mice spread life-threatening human illnesses?

You never know where or when inspiration will strike. Today it happened to strike following a very large cup of regular coffee and finding the topic for this week’s blog. It’s possible that since I generally only drink decaf, that the inspiration was more of a caffeine buzz. Either way, I was excited!

As I’ve mentioned in previous blogs, I grew up on a farm. In fact, I am proud to say that both sides of my families come from farming backgrounds. My grandfather was a world renowned livestock auctioneer. I grew up playing in barns, often getting up to no good. I made pets of any farm animal we had and certainly spent my fair share of time finding ways to catch or trap “pests” aka mice, raccoons etc. As a country girl, you learn to deal with all sorts of animals, amphibians, reptiles and insects. You don’t have to like them and may try to avoid them, but I can say with complete honesty that I did not grow up with a fear of any of them.

One would think this would be true of all country kids. Nope. My mother is deathly afraid of snakes.  There are a couple of pranks we have pulled on her that without a doubt would have gone viral. I also had an uncle who hated mice. I cannot confirm if he simply HATED them or if in fact he was afraid of them. Regardless, there is one incident of him hitting a mouse with a gavel (he too was a well-known auctioneer) when a mouse popped out from under his socks in his dresser.

You may wonder why I bring up mice. It goes back to my inspiration for this week’s blog. A study that was published in mBio that looked at house mice and their ability to carry human illnesses. We know that when spring cleaning we need to be cautious about cleaning mouse droppings because of Hantavirus, but now we need to be concerned about more than just Hantavirus. The researchers collected 416 mice over a year and analyzed the droppings of the captured mice.  They we able to identify 149 distinct species of bacteria including those most commonly linked to intestinal upset; C. difficle, E. coli, Shigella and Salmonella.  The researchers also looked at the viral load of the mouse poop and found 36 separate viruses. None of the viruses found were known to infect humans, but were known to infect dogs, chickens and pigs suggesting that there may be some cross over.

I guess it’s true when we say mice are dirty.  Based on this study, researchers are recommending that if you find mouse droppings around your food that you throw it out, unless perhaps you can properly disinfect the packaging (if it’s of a non-porous substrate, like tin cans).

Of interest, the study was conducted in the city, NYC to be exact. Being a country bumpkin, I wonder if country mice would show the same results. I’m going to believe they wouldn’t. While it may not be a proven fact, country kids have better immune systems because we play in the dirt (and manure) from a pretty young age!

Bugging Off!

Nicole

Rub my feet?

I love having my feet rubbed. It’ more relaxing than my Friday night glass of wine, more satisfying than eating chocolate, candy or chips and dip. Perhaps most importantly, it’s lower in calories so I don’t hate myself in the morning and the person rubbing my feet is exerting energy and burning calories. Basically it’s an all-around win-win. I love having my feet rubbed so much that I have perfected the ability to work in “Rub my feet?” to virtually any conversation and I have found that the threat of having to rub my feet can keep a hockey team of 9 year olds under control (threatening to watch princess movies also works if you need an alternative option).

It was with a bit of personal disappointment that I came across a recently published article “Evaluation of a shoe sole UVC device to reduce pathogen colonization on floors, surfaces and patients” where researchers spiked the soles of 200 pairs of shoes, implanting 3 strains of bacteria and a non-toxigenic strain of Clostridium difficile. The shoes were then randomly assigned to be either exposed to UV-C radiation for 8 seconds or act as controls with no exposure.  According to the researchers, UV-C significantly reduced shoe sole contamination with all bacterial species they tested. Additionally, shoes that were exposed to the UV-C device also significantly reduced the contamination on all floor types and with all species of bacteria tested.

So what’s my take? The study is interesting, but the results are really not surprising. In the last several years there has been quite a bit of research on various UV-C technologies that has shown they are capable of decreasing the bacterial burden on surfaces. It’s entirely logical that these devices would be effective in disinfecting shoes. Are the soles of shoes the areas we should be concerned with disinfecting? Certainly, they could be a potential fomite that are carrying pathogens from place to place, but for now I’ll continued to be more concerned about properly disinfecting objects like stethoscopes, and other hospital equipment which we know for fact can lead to transmission of pathogens. Besides, if I think the soles of shoes (or feet) are a true concern for transmitting pathogens, how can I in good conscious ask someone to rub my feet? These socks need to be used you know!!

Bugging Off!

Nicole