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Friday, January 13, 2017

In like a Lion, out like a Lamb

I suspect many of you automatically thought “March” when you read the title of this week’s blog.  You may think I’m lamenting over winter and wishing that spring was right around the corner.  You’d be partly correct - there are approximately 129 days and 12 hours until we put our boat back in the water.  The truth is weather sayings are as colorful as our imagination. Many sayings are based on careful observations and do turn out to be true while others are merely rhymes or beliefs passed down from generation to generation. 

The real reason behind my reflection on this phrase is because we have similar rhymes or beliefs in the infection prevention world.  In Canada, the sounds of hacking, sneezing and sniffling have been filling the halls of healthcare facilities, workplaces and schools.  In fact, in the last 2 weeks of December, >3100 people tested positive for Influenza.  That’s a 10-fold increase over the same time last year, and is particularly frightening when you think that only a fraction of people who have the flu actually seek medical treatment and are tested for confirmation.  I’ve been tested for the flu once and frankly have absolutely NO intention of ever having another nasal swab in my life.  I would far prefer the sinus burn from too much wasabi on my sushi than the pain from a swab being stuck so far up my nose it comes dangerously close to impaling my brain.

The flu strain that seems to be circulating primarily is H3N2.  It’s a nasty strain that hits the elderly and other frail people particularly hard. While this year’s flu shot is a good match to the strains circulating, H3N2 has the ability to mutate quickly so while the flu shot may be helping now, it may not be as helpful much later in the flu season.  If H3N2 is not bad enough, RSV is also out and about with a vengeance.  The symptoms for RSV are very similar to the flu, however this virus’ prime target is children with breathing problems and premature babies.

If you’re looking for how to combat the cold and flu virus, go no further than our educational campaigns such as last month’s Ba-Hum Bug campaign or the numerous Talk Clean To Me blogs that have been written on how to keep colds, the flu and RSV at bay.  I’ll also throw in a link to a blog on Norovirus because….it is the “winter vomiting disease”!

While I have not come across any rhymes that support a belief that if a year closes out with high flu numbers, the peak will either wane in the New Year or continue to pile up like the winter snow,  I can say that as I write this blog, I have that irritating scratchy feeling in the back of my throat.  My ears are a bit achy.   My sinuses are filling up and I had a bit of a cough today.   Except for the cough I could not hide, I’ve kept my other symptoms to myself.  Why?  Well, if this is “just” a cold it means I was probably starting to be contagious yesterday and will continue to be contagious for the next 5 to 7 days.  If this is the flu (fingers crossed, no fever yet!) the period I’m contagious is the same as if this is a cold.  The good news is that I’ve been holed up in my office mostly to myself the last 2 days.  Tomorrow, however, is a different story! 

Bugging Off!


PS - I’ll let you know next week if I’m in the group who have the flu but did not seek medical attention!

Friday, January 6, 2017

Welcome to 2017!

As I mentioned in my final blog of 2016, “life really does go faster as we get older”.  Case in point was the fact that Christmas break flew by!  I was fortunate enough to have 9 days off, and so one would think you’d come back refreshed. However, with 4 family functions, 1 birthday party and a multi-day hockey tournament, I cannot say I had much time to sit and relax!

As I now sit watching the Canada vs USA World Junior Hockey Gold Medal game, I wonder what 2017 will hold?  As a Canadian, I know there will be many different celebrations as we move towards July 1st and the celebration of our 150th year.  Will 2017 follow in the footsteps of 2016 with so many celebrity deaths?  Perhaps 2017 will be the year of the “bad guy deaths”?  I hear that Charles Manson is quite ill…

If I were to make predictions for 2017, I would say the One Health Initiative will continue to grow as the focus of managing and preventing antibiotic resistant organisms in both the human and animal health markets expands.  I would also say that the environment’s role in transmitting infections and the need to effectively clean and disinfect environmental surfaces and shared medical equipment will continue to be a focus.  I can at least guarantee that I will continue to blog - 2017 marks the 6th year for Talk Clean To Me.  In 2017, I will try to cover as many topics and share as many educational resources as possible, and without a doubt I guarantee that I will continue to be quirky and cheeky!

While I’m not exactly sure what 2017 is going to bring in terms of topics, you can be sure that I’ll touch on all facets of human and animal health. Will a new zoonotic disease pop up?  Will 2017 be a bad year for Influenza (Human, Avian, Swine or Canine)? Will we find the silver bullet for ensuring surfaces are clean and do not contribute in the spread of disease?  Will we unlock the secret of how to get people to wash their hands?  Your guess is as good as mine, but I know I look forward to finding interesting and fun topics to blog about and hope you’ll continue reading!

To continue with my tradition of signing off my first blog of the year, I wish everyone a wonderful January, a lovely February, a peaceful March, a stress-free April, a fun-filled May, joy that lasts from June to November, and finally a happy December. While I know it’s highly unlikely to happen, I hope this year doesn't fly by as fast as 2016! 

Bugging Off!


Thursday, December 22, 2016

These are a few of your favorite things!

I recall being in about grade 9, mocking my parents for staying in on a Friday night to watch “Dallas” when my mother retorted that I too will want to stay in on a Friday night when “I got older”.  I tuned out for some of the “conversation” as teenage girls are apt to do, but then also recall something along the lines of her saying “the older you get the faster life goes” and Friday nights are a night to slow the pace down.   A few decades later and as much as I HATE to admit it…..my mom was right.  Life really does go by faster and faster with each year that passes.

It seems like only yesterday that I was writing my 2015 year in review blog and yet almost 52 weeks have gone by!  In trying to come up a theme for the end of the year blog, I couldn’t help but think of a song that has been in my head the last several days “These are a few of my favorite things” from the Sound of Music.  I find there are two camps: you’re either a Julie Andrew’s lover who loves the Sound of Music or you have no taste…   I happened to grow up with the Sound of Music soundtrack blasting in the background on most Saturdays as my mom cleaned the house.  I can still sing most songs word for word and I thought I’d take a play on the song, but instead of sharing my favorite things, I want to share the blogs that you, my loyal readers, enjoyed the most!

  1. Has the sky fallen with mcr-1?
  2. Dwell Time Disease
  3. Let Down of Olympic Proportions
  4. Boot Camp Baby!
  5. Nothing says love like boys, beards and bugs
  6. OMG I hate HPV!
  7. How big are your hands?
  8. Is your pet making you sick?
  9. The art of topping up
  10. Sunshine or Rainclouds – What is our future?
  11. Safety Indifference Syndrome
  12. Label Deficit Disorder

I’m not exactly sure what 2017 is going to bring, but I look forward to finding interesting and fun topics to blog about and hope you’ll continue reading!

Wishing everyone a Merry Christmas, Happy Hanukkah, and Happy Holidays! 

Bugging off!


Friday, December 16, 2016

Pathogens Now Boarding!

It’s hard to be believe we are only 9 days to Christmas and 15 days to the end of the year.  I’m not sure where the year has gone, except to say a good portion of it was spent on 45 flights around North America.  At least according to my most recent update from Air Canada, that’s where they say I’ve been!  In fact, my last two flights of the year were on Monday – a quick day trip from Toronto to Pittsburgh. 

Travelling is a double-edged sword.  Most of the time it’s gruelling, but there are times when it can be fun.  You have to be prepared to entertain yourself during long layovers or flight delays.  I generally catch up on reading and keeping current with newly published science (I know….yawn…), but admit I spend my fair share of time people watching.  Not to sound snobbish, but I can spot a “traveller” from a “non-traveller” a mile away.  I will also have you know there is a distinct difference between a “business traveller” and a “vacation traveller”. Business travellers are far more organized and efficient!

To while away the hours on Monday, I was catching up on some of my reading and came across a new study published in the journal of Clinical Microbiology and Infection that looked at the ease of which antibiotic resistant bacteria like MRSA could be transmitted from frequently touched surfaces in airports.  In essence, they were trying to determine how easy it was for these bacteria to hitch a ride with travellers.  The researchers focused on the inside of the toilet stall doors making the assumption that as these are frequently used by multiple people and touched after “potentially unhygienic activities” they would be expected to be filthy and most likely contaminated with bacteria commonly found on our skin and gut (aka fecal contamination).

The study looked at 400 bathroom door handles at 136 airports in 59 countries.  Of interest is that 60% of the samples were from the men’s room….which is rather interesting as we know from previous blogs on hand hygiene, that men wash their hands less frequently them women.  While gross to think of, a variety of bacteria commonly associated with fecal contamination was found on the handles.  Staphylococcus aureus was the most commonly found bacteria.  Stenotrophomonas maltophilia was the next most commonly found bacteria followed by Acinetobacter baumannii.  The strain of MRSA found in one airport in Paris matched a community-acquired MRSA found in India.   The conclusion of the study being that antimicrobial resistance is no longer a national problem, but a global challenge as these resistant bacteria do not respect boarders, have no qualms on hitching rides and when entering a new country, do not feel the need to declare themselves!   Basically, germs are making trips we never thought possible.   Thankfully, I have a few weeks off from travelling over the Christmas holidays.  Mid-January will be my first flight of 2017 and after reading this study, I’m not sure I am ever going to be able to look at or use a public toilet again! 

If you’re not so lucky I hope you check out our new Bah-Hum-Bug education campaign for tips on how to keep you healthy over the holidays!

Bugging Off!


Friday, December 9, 2016

Pig Health – A Balancing Act

Pigs are among the most intelligent animals.  Pigs are (or can be) cute. But did you know that pigs can also be an integral part of our health?  They provide nourishment (if you’re like me, you think pigs are delicious) and have the potential to save our lives, but they also have the potential of harming us.  From the “saving our lives” perspective, researchers have been trying for decades to make animal-to-human transplants work, a process known as xenotransplantation.  There are thousands of people on organ transplant waiting lists as there are not nearly enough donors, and having such a breakthrough would save lives.  In an article I came across, a research team has used CRISPR (a new gene editing technology) to create pig embryos designed to keep human immune systems from rejecting them with the hopes to move forward with animal trials in the near future.  Such a breakthrough would be enormous.

Conversely, a second article I read this week on pigs that was published in the journal of Antimicrobial Agents and Chemotherapy uncovered the fact that Carbapenem resistance has been found on at least one swine production facility in the US.  The researchers collected 1500 fecal samples and tested the pig’s environment four times over a 5-month period.  The gene that allows for Carbapenem resistance was found in several of the samples taken.  According to the researchers, none of the pigs on the farm were sick, but there could be a potential for human handlers to be colonized which could lead to person to person transmission.

2017 will mark the beginning of more stringent use of antibiotics in the farmed animal market. We are all responsible for the judicious use of antibiotics so that these lifesaving tools remain effective for treating people and animals.  As part of this antimicrobial stewardship initiative, changes are coming to how antibiotics are allowed to be used in the farmed animal market.  From a human perspective, CRE (Carbapenem resistant Enterobacteriaceae) are considered nightmare bacteria.  Half of the patients infected with CRE in their bloodstream have died as a result of it. One reason why CRE bacteria are so scary is that they can transfer their resistance to other bacteria within the same family. While currently almost all CRE infections occur in people receiving significant medical care in hospitals, long-term acute care facilities, and nursing homes, the fact that we have found CRE on at least one farm poses a concern for possible transmission and/or colonization outside of our healthcare facilities. This could leave us in a dire situation if even the strongest antibiotics we have in our treatment arsenal do not work in treating infections which could leave patients with potentially untreatable infections.

Before we start to panic, consider the positive. We are aware.  We can now make positive changes.  We know that CRE is spread from person to person through contact with an infected or colonised person.  This generally occurs directly from the hands of another person or indirectly from environmental surfaces or medical equipment that have become contaminated.  We know CRE is not spread through the air or by coughing or sneezing.  CRE is a vegetative bacteria.  While it carries antibiotic resistance, this does not make it more resistant to disinfectants.  As the environment is a key area of concern with respect to transmission, being vigilant and increasing or improving our cleaning and disinfection practices be it at a farm, in animal transport trailers, slaughter houses, food packaging facilities, hospitals, long term care facilities or our homes will help control this “nightmare bacteria”.  
This is a perfect example of the One Health initiative - Animals, People and the Environment.  We are all connected.  Pointing fingers or laying blame will not help.  We need to all work together towards the common goal of a world where people, animals and the environment can be happy and healthy.
Bugging Off!

Friday, December 2, 2016

Geeking out with a new Bug!

I love working in the science field.  I love to learn, ask questions and try and understand the mysteries of living organisms – human or animal.  I love the thrill of discovery, innovation and feeling like a pioneer in fields that interest me (infection prevention and biosecurity).  Science has taught me how little I know and how truly fascinating the world is.  I get paid to think hard and irritate the non-scientists I work with by insistently asking questions and starting many sentences with “Ya-but….”  It’s an awesome gig.  I’ve embraced my geekiness, but admit there are times when my geekiness can get embarrassing.

Why do I love infection prevention and biosecurity so much?  I get to play in both the human and animal health markets.  There are always new “bugs” popping up.  I am always tasked with figuring out the best way to clean and disinfect so that a facility can stop the transmission and save the lives of their patients. Every time I learn about a new bug, I get to learn and work to figure out how cleaning and disinfection can help.   As you can imagine, reading an article about a new strain of Streptococcus totally grabbed my attention!  According to the articles I’ve read, between February and November of this year, there have been 28 confirmed cases, 4 of which died.  Ten of the people were found in the Fairbanks area and 18 in Anchorage. The most recent cased in Anchorage have occurred in homeless men with a history of alcohol abuse.

There are 220 different strains of Group A Strep (also known as GAS) which can cause a wide range of infections including strep throat and wound infections, to toxic shock syndrome and necrotizing fasciitis.  People who are generally more susceptible include the elderly, the very young and those with underlying health conditions.  There is also data that suggests that some racial demographic groups are also at higher risks.  While Alaska averages 60 to 90 GAS infections each year, this outbreak is associated with a newly identified strain.  One that has never been seen before.  The strain was identified in July and of interest the cases have been mostly middle-aged Alaska Native men, many of who have stayed in homeless shelters.

Residents of homeless shelters may represent a population at increased risk of GAS carriage and infection due to the fact that they may have various health conditions, such as lung disease and alcohol abuse which make them more prone to infections.  Group A Strep can easily spread to other people.  It lives in the nose and throat of individuals and is spread by direct contact with nose and throat discharges of an infected individual or with infected skin lesions. The risk of spread is greatest when an individual is ill, such as when people have strep throat or an infected wound. When someone who is infected coughs or sneezes, the bacteria travels in small respiratory droplets.  You can then get sick if these respiratory droplets are breathed in or a surface that has the droplets on it is touched followed by touching your mouth or nose.  You can also become ill if you drink from the same glass or eat from the same plate as a sick person.  Crowded conditions within a busy homeless shelter can therefore be the perfect environment for spreading disease.

Do you see why science is so awesome?  I certainly would never want to minimize the deaths that have occurred from this outbreak, but finding a new strain – Streptococcus anchorage – you have to admit is pretty cool.

Bugging Off!


Friday, November 25, 2016

Lazy? Naïve? Complacent?

Do you ever sit back and wonder how the human race has managed to survive and evolve?  I’ll admit, there are days that I do.  When we first launched the Talk Clean to Me blog back in 2011, I wrote a blog titled “To Clean or Not to Clean…” that opened with examples of self-cleaning products.  I’m embarrassed to say I now own a self-cleaning kitty litter, but happy to say after 5 years, my self-cleaning pool vacuum (aka my husband James) is still working fine!  The focus of the self-cleaning blog was the fact that cleaning is important.  Cleaning is necessary as it removes dirt that can harbour pathogens.  It can save lives and while we can develop self-cleaning devices, we cannot get away from having to physically remove the dirt ourselves.

In October I wrote a blog “The quest for the silver bullet” which again talked about our obsession with developing surfaces that will kill pathogens.  As I concluded in that blog, it’s not that I’m against innovation, but what I am against is the use of Silver Bullets like doorknobs, handrails, or what have you made out of antimicrobial agents when we have not addressed the fact that hand hygiene rates continue to be dismal or we continue to understaff housekeeping departments.

Hence the title of this week’s blog.  I’m not sure if we’ve just become a society built on entitlement and laziness that think we’re too good to clean up after ourselves, or if we are simply naïve because of the constant bombardment of new technologies,  or if we are just unaware of the potential dangers that come with  blindly believing in  the success of these self-cleaning surfaces.   

A recent letter to the editor in ICHE talks to just this.  Titled “Antimicrobial Curtains: Are They as Clean as You Think?, this letter discusses an investigation to determine the degree of contamination of antimicrobial curtains that had been implemented at their facility.  The long and the short is that 95% of the curtains they sampled showed bacterial growth and included both Gram-negative and Gram-positive organisms!  While there are published studies that support the fact that there is a reduction of pathogens on pre-treated textiles, there are studies that show that these surfaces can and do become contaminated with pathogenic organisms.  If we blindly believe that they only need to be changed when visibly soiled, we are forgetting the fact that we cannot see pathogens with our naked eye and could be ignoring a very real fomite that could be the reservoir for contaminating the hands of healthcare workers.   Can they help to reduce the load?  Yes.  Should we wait until they look dirty to us to change?  Probably not.  If we’re truly looking to protect our patients we probably should change the curtains upon terminal cleaning regardless of how clean they look!

Bugging Off!