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.

Tuesday, December 24, 2013

TCTM’s 2013 Top 10 Blogs


It's unfathomable that 2013 is almost at a close.  In writing this, our last and 52nd blog of the year Lee and I wanted to review the year and share what we and others think the Top 10 Talk Clean To Me blogs were.  In writing the blog, I'm undecided if you should keep David Letterman's Top 10 in mind (Lee's pick) or because I'm singing along to Christmas Carols if perhaps the 12 Days of Christmas or The Sound of Music's "These are a few of my favorite things" should be the theme song to hum while you read (obviously I vote for humming!).  I'll leave the decision to you and hope you agree with our Top 10 picks.

10. Burnt Bums Call for Ban on Disinfectants: Disinfectant residue determined to be the cause for chemical burns on a child's bottom.  Perhaps rather than calling for a ban on the use of  disinfectants and sanitizing agents in schools perhaps the better alternative is to lobby for the use of disinfectants and sanitizing agents that do not leave harmful residues behind.  For example, hydrogen peroxide breaks down into water an oxygen - that sounds pretty safe to me!

9.  It’s getting harder and harder to breathe!:Custodians and cleaners have the highest incidence of work related asthma.  What steps do you have in place to reduce the potential exposure to harmful and potentially asthma causing chemicals?  Does your product selection committee consider safer cleaning and disinfectant options or employ practices and protocols that will reduce a user’s chance of triggering occupational asthma?

8. ATTENTION LADIES! There is scientific proof of why men should put the toilet seat down!:  Lidless conventional toilets may increase the risk of C. difficile environmental contamination.   Should public toilets have lids?  Certainly, they may help reduce potential spread of "stuff" being flushed, but will very likely become contaminated themselves upon flushing.  Do you want to lift the lid knowing someone's "stuff" is on it?

7. Safe, Safer, Safely, Safest – Who knew they were “Bathroom” words!:  Safe, Safely, Safer, Safest, Green, Non-Toxic, Harmless... are wonderfully simple yet descriptive words that clearly impart in plain English a meaning that the general population can understand, however, when it comes to adjectives used to describe EPA registered disinfectants they are banned, they are taboo, they are to be avoided at all costs and if used....there can be hefty repercussions. 

6. ATTENTION PLEASE!! ATP CANNOT be used to compare different disinfectant chemistries!:  If you're looking to change cleaning and disinfecting products and are looking at the use of ATP to determine which product works better I hope you'll think twice!  ATP CANNOT AND SHOULD NOT  be used to compare cleaning or disinfection effectiveness between difference chemistries. 

5. ESKAPE Stops Here!:  When it comes to disinfection, antibiotic resistant bacteria should be no more of a challenge to kill with hospital grade disinfectant than the non-resistant strains. Ultimately, ESKAPE pathogens can have a major impact on the treatment options available to healthcare professionals, but in the world of cleaning and disinfection - it’s just another day at the office.

4. Viruses  - They cause more infections than you think!:  Did you know that some of the most commonly transmitted viruses are not killed by the disinfectant you may be using on a day to day basis?  Is your infection control program prevention or intervention based?  Infection PREVENTION measures such as changing of disinfectant solutions or increased cleaning and disinfection during winter months can certainly be implemented with relative ease and will contribute to fewer infections.  The alternative of course is having to implement INTERVENTION measures to help combat a viral outbreak! 

3. iPads, iPhones and Blackberries….oh My!:   Electronic devices such as smart phones, tablets and portable computers have become increasingly important tools for the delivery of healthcare services   and certainly pose a very serious risk of becoming contaminated and acting as a source for the transmission of microorganisms.  How then do we develop and infection prevention program for  devices that were not developed with healthcare use in mind?

2. The Ugly Truth – 24/7, 365 = the optimal time for bacterial growth:  The ugly truth is despite our best efforts hospital associated infections (HAIs) continue to occur. A research team showed that within 6.5 hrs after cleaning/disinfecting, the bacterial burden found on bedrails had rebounded back by 30% – 40%!    Housekeeping budgets are largely comprised of man hours, cutting back on housekeeping are perhaps not the best way to save a facility money.  Is anyone brave enough to go ask for more money in order to hire more cleaning staff and increase the frequency of cleaning?

1. Cotton – it absorbs more than just water: Did you know Quats and cotton do not mix?  Perhaps your current VRE or MRSA outbreak is not due to poor cleaning, but due to the fact that while the name of the product may contain the word "Disinfectant" the cleaning process you are using may counteract and inhibit the ability for disinfection to actually occur. 

We hope you agree with our Top 10 picks (and if you haven't read them, we hope you'll take the time to read them now!)   Thank you from both Lee and I for your continued support of the Talk Clean To Me blog!  We hope 2014 is full of health and happiness for all!

Bugging Off!

Nicole

 

 

 

 

 

 

 

 

 

 

Wednesday, December 18, 2013

Holiday Madness & Celebrating Microbes!


For many, this week may signify the last week of work (or school) for 2014.  Many people are winding down and preparing for the Christmas holidays (in my case, I'm winding up as I still have shopping, baking and a TON of wrapping to do!).  Assuming like me, your brain needs a break too I thought this week I would lightened it up and share someone's rendition of a Christmas classic!

 

The Night After Christmas*
Anonymous
 
‘Twas the night after Christmas and all through the kitchen
Little creatures were stirring up potions bewitching
Salmonella were working in gravy and soup,
In the hopes they could turn it to poisonous goop!
 
 
Clostridium were nestled all snug in the ham,
While Hepatitis A viruses danced in the yam.
Little John with his Gobots and Mary in her cap,
Had just settled down for a long overdue nap.
When down in their guts there arose such a clatter
They sprang from their beds to see what was the matter.
They ran to the bathroom, threw open the door
Too late! Now their mother is cleaning the floor.
 
Wash your hands before cooking! Put your food away quick!
Or that jolly old food germ we know as Saint Sick
With his eight tiny microbes will ruin the feast
As they make their toxins. He calls out to each beast:
"Now Hepatitis! Now Staph and Perfringens;
We'll punish those humans for holiday binges!
 
On Botulinum! E. coli! Shigella!
Go get 'em Amoeba! Work fast, Salmonella!
        If those humans can't learn to handle food right,
A Merry Christmas they'll have, then a long,
sleepless night!"
 

*Source: foodmicrobe.com

Next week will be the last Talk Clean To Me blog of the year - a review of my and some of the loyal Talk Clean To Me readers favorite blog of 2013.



Bugging Off!

Nicole

Wednesday, December 11, 2013

Environmental Contamination - is the cloth more concerning than the patient?

Until now, I have never really given much thought to what may or may not transpire when doing laundry.  Certainly, I KNOW if you want to keep your whites white, you DO NOT want that errant piece of red clothing to be part of the white load.  Just as my mother had taught me, I separate laundry to have a linens load, a whites load, a colours load etc.  She DID NOT, however, teach me to have a separate underwear load.  If you keep reading you'll see where I'm going.....

Last week's blog Cotton - it absorbs more than just water focused on how cotton cloths absorb Quats and therefore impact disinfection.  It gets worse, SO MUCH worse. Gerba et al recently published a study in AJIC titled "Microbial contamination of hospital reusable cleaning towels".  The focus was not on what was found on the cloth AFTER using, but what was found on the cloth AFTER laundering and therefore assumed CLEAN!!!  Ten (10) hospitals participated in the study - 8 of which used cotton cloths, 2 of which used microfiber cloths.  Of the 10 facilities, 9 used a Quat as their daily disinfectant.   After last week's blog we know that's a potential infection prevention and control nightmare.  After sampling the "CLEAN" cloths Gerba and his team found that 93% of the cleaning cloths contained viable microorganisms EVEN AFTER LAUNDERING!

The microorganisms that were found on the offending cloths included bacteria that play a significant role in HAIs such as Klebsiella spp, Pseudomonas spp and Serratia spp.  The gross factor (at least to me) was the fact they found coliform bacteria on the cloths...for those who do not know, coliform bacteria are universally present in large numbers in the feces of warm-blooded animals (and humans). Basically there was POOP on the cloths!

The researchers did find that there was a significant difference in the contamination level found after laundering the cotton and microfiber cloths with microfibers showing the highest level of bacterial adhesion.  Previously published data has supported the fact that bacteria adhere more strongly to microfiber cloths which can have the impact of spreading pathogens to different surfaces as the microfiber cloths are continually used.  In the end, Gerba and his colleagues found that typical laundering practices are not sufficient to remove viable pathogens from cleaning cloths.  What they could not determine was if the contamination was due to a breakdown in the laundering process or if the cloths get contaminated from storage and handling (I am going to hope it's the latter). The end result is that the Infection Preventionists and Environmental Services staff need to consider that cleaning cloths could be a potential reservoir for nosocomial pathogens.

I will admit, I have always questioned the laundering process at hotels and so I NEVER let the bed covers touch my face.  I think perhaps now, with the knowledge that coliforms can be found on cleaning cloths after laundering I am going to have to rethink how I sort my laundry.  Effective immediately, underwear are GOING TO BE LAUNDERED ON THEIR OWN....need I say more?

 
Bugging Off!

Nicole

 

Friday, December 6, 2013

Cotton - it absorbs more than just water!

Bath towels, dish cloths, T-shirts and socks made of cotton have one thing in common - absorbency.  Whether it is wicking the water off after we shower, the sweat during and after a workout or wiping up the spills of water or milk we so frequently seem to have at my dinner table, many of us turn to cotton in some form. 


While microfiber is making in-roads, cotton terry cloth towels are still very prevalent as the cloth of choice for cleaning and disinfection within healthcare facilities.  Infection Prevention and the Product Selection Committee spend hours reviewing disinfecting products weeding through the attributes of the various chemistries, ensuring that they have the list of efficacy claims (the kill list) to meet the facilities' needs etc.   However, in focusing on what a product kills is there any consideration as to what impact the materials housekeeping uses to clean with will have on the efficacy of the product?  I think not.


In the October 2013 edition of AJIC, Koenig et al published an article titled "Decreased activity of commercially available disinfectants containing quaternary ammonium compounds when exposed to cotton towels".  As noted in the study poorly cleaned surfaces have been identified as being a potential reservoir for pathogens and may be the cause of many healthcare associated infections.  Numerous studies have shown that effective cleaning (and disinfection) is necessary to reduce the risk of HAIs.  Disinfectants are an important aspect in reduction of pathogens so reduction in performance of a disinfectant could play a significant role in allowing transmission to occur.

The truth is that is the negative impact on efficacy of Quats by either dilution with hard water and/or exposure to cotton cloths has been known for some time.  Koenig et al investigated the reduction of Quat concentration resulted from the use of cotton and microfiber cleaning towels and the impact this reduction would have on disinfectant performance.  The results were indeed scary. 



First the good news, it would appear in this study that exposure to microfiber cloths did not have an impact on the Quat concentration and that the products tested retained their full germicidal efficacy.  Cotton on the other hand did not fare so well.  Exposure of the Quat products tested resulted in a reduction of Quat concentration by 88.9% within 30 seconds of being exposed to cotton!    Excuse ME!?  That would leave only 11.1% of the actual concentration of Quat needed, tested and approved by the EPA to achieve disinfection.  In fact, when the researchers tested the efficacy of the Quat solution after exposure to cotton towels they all failed!  They were unable to meet the level of kill needed to be registered by the EPA as a hospital grade disinfectant. 


I'm not saying that Quats are bad.  BUT, this study certainly highlights the fact that we need to take more into consideration than just what a product kills, what the cost of a product is and what the material compatibility of a product is.  The impact and cost to a facility due to HAIs is very real.  I think Koenig et al have done an excellent job in highlighting the fact that when choosing a disinfectant the process by which a disinfectant will be used must also be taken into consideration and further research into potential interactions between the disinfectant and cloth choose to apply the product also needs to be considered.  Particularly if concerned about reducing HAIs and providing the safest environment for our patients as possible.


If you use Quats at your facility, I hope you'll run down to Environmental Services to see what type of cloth is being used.  Perhaps your current VRE or MRSA outbreak etc is not due to poor cleaning, but due to the fact that while the name of the product may contain the word "Disinfectant" the cleaning process you are using may counteract and inhibit the ability for disinfection to actually occur.

Bugging Off!

Nicole



Friday, November 29, 2013

RSV - Is it more common that the cold?


Unexplained rashes, sniffles, snot and all the other lovely body fluids that children can produce are an unfortunate consequence of being a parent.  For some parents, September signifies the return to school and getting life back in order for at least the next 10 months.  For those of us in the know, it really just signifies the start of cold and flu season (and by cold and flu I mean ALL of the viruses out there that cause respiratory or gastrointestinal infections).

Respiratory Syncytial Virus (RSV) is a virus that infects the lungs and airways and is considered the most common cause of lower respiratory tract infections in young children worldwide, with almost all children having their first RSV infection by two years of age. Similar to the Flu and Norovirus, RSV follows a seasonal pattern where annual outbreaks occur during fall, winter, and early spring among urban centres.  In the Northern hemisphere, epidemics generally peak in February and March. Within USA, 100,000 hospitalizations and 4,500 deaths annually are attributed to RSV infections. RSV is also a major cause of nosocomial infections.

RSV is usually a mild disease that goes away on its own. In very young children RSV can sometimes lead to serious infections like pneumonia or bronchiolitis (a swelling of the bronchioles — the smallest air passages of the lungs).   In most children, RSV usually causes symptoms similar to the common cold: stuffy or runny nose, cough, ear infections (sometimes), low-grade fever and sore throat.  RSV is most likely transmitted through direct contact with infectious secretions (via fomites) and/or large-particle aerosols; however, close contact with infected individuals, or significant exposure of nasal or conjunctival mucosa with contaminated hands is required for transmission.

A 2004 study published in Pharmacoeconomics reviewed data from 2000 and found that nearly 98% of RSV infection-related hospitalisations occurred in children <5 years old. There were approximately 86,000 hospitalisations, 1.7 million office visits, 402 000 emergency room visits and 236,000 hospital outpatient visits with associated annual direct medical $US394 million!

A more recent study published in the Spring of this year by Jacobs et al, in the Canadian Journal of Infectious Diseases and Medical Microbiology developed a model to determine costs of community (CRSV) and nosocomial RSV infections (NRSV).  Similar to stats in the US, 10% of hospitalized patients will acquire a nosocomial infection of which 71% are due to respiratory viruses!  Annual costs of NRSV in Canada for patients <1yr of age was determined to be about $7.9 Million.  The study determined that NRSV added $993 to each CRSV case and also found if improved infection control procedures were in place a reduction of transmitted treatment costs of $469/patient could be attained.  What a novel idea - Infection Prevention programs can help save money!

It's very hard to keep from catching RSV, just like it's hard to keep from catching a cold.  You can lower the chances by practicing good health habits such as washing your hands often, and teach your child to do the same.   If you're in the Northern Hemisphere and your child has to be admitted to hospital I hope you'll remember that respiratory viruses this time of year are just as rampant in hospitals as in the community.  Ask the nurse and doctor to wash their hands and don't be scared to find a disinfectant wipe to clean the area you're in!
 
 

Bugging Off!

Nicole

Friday, November 22, 2013

#FF - Micro Blog's Viral Misfortunes

There are times when the best laid plans go to awry. In keeping on my viral theme for the month I had planned to talk about a Norovirus outbreak in a pediatric unit that was caused by healthcare workers.  I know I read the study, but my recall abilities seem to have gone into early hibernation.  Was it late spring, summer or early fall?  I know I was on a plane.....  Regardless, it was a great example of "inconvenience and irritation" from last week's blog "The Burden of You and the Flu". 

It was also the first time that Google let me down...at least in finding the study I was looking for.  My Google search however, did pop up the Micro Blog which is written by Jon Otter (@jonotter) and Saber Yezli from the UK.  If you're a Infection Prevention nut like me, follow it.  Touted as "Your window to the world of healthcare microbiology and epidemiology" -  Otter and Yezli post some great blogs. 

It was the "Domestic Outbreak of Gastroenteritis" that had me chuckling, not at Otter's misfortunes mind you, but because almost a year ago last night, I lived through the same thing.  Here's the summary of Otter's outbreak:

"Last Wednesday (let’s call it outbreak day 1), our 18-month old toddler “sprayed” projective vomit around our porch. My wife cleaned up the mess. On outbreak day 3, 36 hours later, my wife presented (grumpily) with acute gastroenteritis. We made every effort to limit domestic horizontal transmission (including regular bleach disinfection of contact surfaces in the bathroom and cohorting of personal effects) but to no avail; a little over 24 hours later on outbreak day 4, I endured acute gastroenteritis."

In the 2012 Kenny Outbreak, our then 3.5yr old projectile vomited over his bed, the carpet in his room and ME in the wee hours of a Friday.  By Sunday, both my husband and I were inflicted with the same thing (thankfully we have 3 bathrooms).  Our cohorting consisted of taking turns in parental duty by lying on the couch in the family room to ensure Sawyer was somewhat safe or sprawling on our bed.  I have never been so happy for the invention of TV, DVDs and pre-packaged food!

The truth is, Norovirus happens.  It is irritating.  It is an impediment and it is certainly an inconvenience!  It happens everywhere and especially when you least expect it!   As Otter detailed in an earlier blog about a Norovirus outbreak that was associated with a Car Dealership where the generous mother left the mess for the staff to clean up using nothing more than dry paper towels, you just never know when or how you may pick up your next gastro bug!  I need to get my car in for servicing...I can assure you I will never use a car dealership's washroom again!

Bugging Off!                                                        

Nicole

PS - after using a "Life Line" and emailing a friend I now have the  title of the study I was looking for in the first place, An Outbreak of Norovirus Infection in a Bone Transplant Unit.  Better late than never I suppose - I hope you take the time to read it!

 

Monday, November 18, 2013

The Burden of You and the Flu


Depending on your situation in life we look at illness in many different ways.  As an irritant - your spouse or significant other or your children ALWAYS get sick when you have the least time to deal with their whining shenanigans.  As an impediment -  you do not have the time nor the patience to feel under the weather due to work or family commitments. As an inconvenience - your colleagues insist upon coming to work or your friends or family insist on coming for a visit without the forethought that they may spread their illness to you or your family.

In my blog from two weeks ago "Cleaning, Hand Hygiene & Vaccination a few of my Interventions for Flu Season" I have already captured the key tips (Interventions) for limiting the spread of the flu, but after reading an article recently published in AJIC by Mitchell et al titled "Understanding the burden of influenza infection among adults in Canadian hospitals: A comparison of the 2009-2010 pandemic season with the prepandemic and postpandemic seasons", I realized that the impact to me, my family, my colleagues or the burden of influenza on our healthcare system was not touched upon and is something of great importance and worthy of consideration.

The truth of the matter is that Influenza infections are costly. They cause substantial morbidity and mortality and are strain on every country's healthcare resources.  However, the impact or burden to our healthcare system varies greatly year to year depending on the Influenza strains in circulation.  The study reviewed lab-confirmed inpatient characteristics, treatment and outcomes of the pandemic season (2009-2010) with the prepandemic (2006-2007 & 2008-2009) and postpandemic (2010-2011) seasons. Of the 2868 cases identified, 629 cases were from the prepandemic season, 1132 cases from the pandemic season and 1107 cases from the postpandemic season. Of interest was the fact that the healthcare-associated influenza cases was lower during the pandemic than the pre and post pandemic seasons.  Also of interest was the fact that the Healthcare-associated Influenza cases was higher in acute care facilities than long term care facilities during the pandemic season as compared with pre and post pandemic seasons.

With respect to patient characteristics, during the pandemic season the median age of those inflicted during the pandemic season was significantly lower than the pre and post pandemic season (hence the lower infection rates seen in LTC's!).  Similarly, during the pandemic season inpatients were more apt to have pulmonary disease whereas in the postpandemic season they were more likely to have chronic heart and kidney disease.  Possibly as expected, more severe outcomes were reported during the pandemic season as vaccination rates were lower.

Of particular interest was the impact of infection prevention and control practices during the pandemic season.  With knowledge that vaccines were not readily available, ensuring effective interventions were in place (hand hygiene, cleaning and disinfection, isolation etc) likely helps limit healthcare-associated transmission.  If this is true, then the ugly truth is that the increase of healthcare-associated infections in the postpandemic season could be directly related to a lapse and complacency around in infection prevention practices.

We cannot underestimate the flu and its significant impact on the resources needed to effectively limit its spread.  Being prepared to combat Influenza should not be relegated as a response to an outbreak or a pandemic.  The threat of infection and the threat of transmission is an ongoing annual concern and should be an automatic response on a daily basis during Flu Season.  Influenza is an enveloped, easy to kill virus.  Ensuring that environmental surfaces and patient care equipment are cleaned and disinfected daily (and of course after each patient use!) will go a long way to minimizing transmission from environmental surfaces.   Of course, getting vaccinated and washing your hands helps too!




Bugging Off!

Nicole

 

Wednesday, November 6, 2013

Viruses - they cause more infections than you think!


I'm not one for themes - well unless it comes to planning birthday parties: CARS, Angry Birds or surprise parties for "big" milestones.  In writing our weekly blogs, Lee and I have tried to weave a story about the use of disinfectants for infection prevention.  However unintentional, this month, as I plan out topics for the blog, I'm seeing a theme develop - viruses. 

In part the reason for developing theme is an article I read that was published in the October edition of AJIC by Tzialla et al titled "Viral Outbreaks in neonatal intensive care units: What we do not know".   Not unexpectedly, infants admitted to NICUs are at risk for contracting HAIs and certainly over the past decade, the HAIs rates have steadily increased.  However, the vast majority of outbreaks published in scientific studies focus on bacterial or fungal infections and certainly they do account for a significant portion of the outbreaks, the impact of viruses as nosocomial agents are not well documented.

Tzialla et al queried an outbreak database and found a total of 75 neonatal outbreaks of which 64 were directly related to neonatal patients and 44 (>68%) associated with NICUs.  The top 5 causative agents were: Rotavirus (>23%), RSV (>17%), Enterovirus (>15%), Hepatitis A (>10%) and Adenovirus (>9%) with gastrointestinal system infections accounting for >54% of outbreaks and respiratory tract infections accounting for >34%  of the infections.

From an infection prevention perspective, is there a common theme? 

• From a microbiological perspective, Rotavirus, Hepatitis A, Enteroviruses and Adenoviruses are non-enveloped viruses.  They tend to be hardier viruses that are more resistant to traditional disinfectant chemistries such as quaternary ammonium compounds.

• From a transmission perspective, Rotavirus, Enterovirus, Hepatitis A and Adenovirus can be transmitted via fecal-oral route - meaning the poor little neonate is eating poop!

• From a transmission perspective RSV, Adenovirus and Enterovirus are transmitted by contact with respiratory droplets.

• Transmission from contact with environmental surfaces and/or fomites has been documented.

• Many of these viruses increase circulation during the fall, winter and early spring.

We are well into Fall and what we typically call Flu Season, in fact there are only 46 more days until the first day of winter!  While we often plan well in advance for Halloween, the Canadian and US Thanksgiving and Christmas holidays (there are only 49 more days to shop!), do we consider planning for "Virus Season"?  Are there preventative measures we can and should consider putting into place?  When was the last time you reviewed the efficacy claims of the daily disinfectant your facility uses?  Does your product carry claims against Influenza, Norovirus, Rotavirus, RSV, Enterovirus, and Adenovirus?  Do you have an infection prevention plan that considers making a change to a more efficacious product to help in the prevention of viral outbreaks?  Do you increase the frequency with which high-touch hand contact surfaces are cleaned and disinfected in order to reduce the risk of transmission from contact with these surfaces?  Do you have a readily accessible Fact Sheets that can be reviewed with staff to help them identify when they may be ill to help minimize the risk that staff are the source of the outbreak?

A fulsome program that considers (and hopefully implements) infection PREVENTION measures such as changing of disinfectant solutions or increased cleaning and disinfection can certainly be implemented with relative ease and likely contribute to fewer infections.  The alternative of course is having to implement INTERVENTION measures to help combat a viral outbreak! 



Bugging Off!

Nicole

Thursday, October 31, 2013

CLEANING, HAND HYGIENE & VACCINATION a few of my favorite INTERVENTIONS for Flu Season!

The ugly truth is that Summer is over, Fall is upon us and with that is the start of Flu and Norovirus season.  While the Flu season does not typically peak until January-February, we have entered into what we consider the "FLU SEASON" (read with the Twilight Zone theme song in mind) and truly never know when we may start to see cases or outbreaks of Influenza within hospitals, long term care facilities or schools pop up.

The fact that my son has come down with his first "viral" infection of the Fall and I just finished reading an article by Wong et al published in Pediatrics titled "Influenza-Associated Pediatric Deaths in the United States, 2004−2012" seemed a good enough reason to tackle infection prevention practices for the flu.  But first, let me highlight some of the facts uncovered in the study:

1. Between 2004 & 2013 the CDC logged 830 flu deaths in children younger than 18.

2. 43% of the children who died, did not have underlying conditions that put them at risk for flu complications.

3. A disproportionate number of flu deaths were seen in kids with underlying conditions such as asthma (there are currently 7.1 Million children in the US who have asthma).

4. Previously healthy youngsters appeared to die more quickly than those who had underlying conditions—one-third died within 3 days of symptom onset.  Pneumonia was the most frequent complication.

5. Few of the children who died were vaccinated against flu.

First off, the flu is NOT a gastro or intestinal bug.  Influenza is a highly contagious respiratory disease caused by an Influenza virus.  Unlike the common cold, the flu usually comes on suddenly and most people will often feel some or all of these symptoms:

• Fever or feeling feverish/chills (but not EVERYONE will have a fever)

• Cough

• Sore throat

• Runny or stuffy nose

• Muscle or body aches

• Headaches

• Fatigue (tiredness)

• Some people may have vomiting and diarrhea, though this is more common in children than adults.

People with flu can spread it by coughing, sneezing or TALKING to others up to about 6 feet away!  The droplets "excreted" by someone carrying the flu can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.  People can also get flu by touching a surface or object that has flu virus on it and then touching their own mouth or nose.

This is where my favorite INTERVENTION strategies come in to play:

1. Cleaning:  Environmental surfaces should be cleaned and disinfected frequently with an EPA or Health Canada approved disinfectant.  Access to Pre-moistened wipes that can be easily used without need for PPE is a great way to include not just nursing and environmental services staff as the primary parties for cleaning and disinfection.  Visitors, patients and students (for schools) can also do their part in helping to keep the environment clean and flu free!

2. Hand Hygiene: Wash hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.

3. Vaccination:  The annual Flu shot can help reduce your chance of getting seasonal flu by 80%.  The flu kills, why chance yours or a loved one's life!

According to the WHO, Influenza A H3N2 is the predominant strain in circulation this year.  Check out the WHO Influenza website for the latest flu trends and Influenza activity from around the world.

Stay safe this FLU SEASON!
 

Bugging Off!

Nicole

 

Tuesday, October 22, 2013

Infection Control Week - 7 days of focused prevention!

This week is International Infection Prevention Week (IIPW) around the world. As many of you will know from reading past blogs, Infection Prevention and Control programs have been widely recognized as a corner stone to preventing and controlling the spread of infections both within the community and within healthcare facilities.  IIPW is a week to not only promote infection prevention practices but celebrate with healthcare workers for the work and efforts put forth the other 51 weeks of the year to stop the spread of infection.

There are a number of educational webinars and other educational materials available:




While IIPW is often focused towards healthcare settings, there is nothing to stop those of us who work in non-healthcare areas to celebrate IIPW.  There are numerous fun and educational games or activities that can be tailored to any facility.  A hand washing competition using Glo-Germ (UV reflective goo), regardless of where you work is always entertaining!   Or with the increased usage of ATP meters, activities such as “who has the dirtiest cell phone or keyboard” can also open one’s eyes as to the need for cleaning and disinfection of the surfaces we touch and use frequently throughout the day.

Test your Infection Prevention knowledge with the following questions.
 
If you post your answers on the blog and we'll let you know how well you did!

True or False:   

1. To disinfect for pathogens such as bacteria or viruses, spray or wipe the disinfectant on to the surface to be disinfected and let air dry.
 
2. Cleaning with a disinfecting agent will remove pathogens no matter how you use it.

3. The most common route of bacteria transmission is contaminated surfaces.

Word Scramble:

4. Your best defense against infection is:  AHDN EGNYEHI

5. The name of the virus that causes respiratory infections typically between the months of November and April:  UZILANNFE

Perhaps next year we can have an Infection Prevention joke off?   Do you think I'd win with this?

How do you get a tissue (Kleenex) to dance?  You put a BOOGIE in it!!!



Bugging Off!

Nicole

 

Sunday, October 20, 2013

Disinfectant Chemistry Report Card #17 - Silver and Copper as Antimicrobial Surface Agents

Copper is the oldest metal known to human civilization, and dates back to about 10,000 years. Silver mining also started about 5,000 years ago, where silver was used as a value resource and coinage. Antimicrobial effects of both metals have been utilized long before the concept of microbes became reality. Containers with an external layer of silver or copper were used to keep water fresh and food from spoiling. Silver coins were also dropped into milk containers to prevent milk from spoiling quickly. Direct use of copper and silver as antimicrobials started only in the recent decades. Disinfectant solutions containing colloidal copper or silver ions are used to treat hard surfaces. An external layer of copper is used on certain high-touch surfaces in healthcare settings to aid in prevention of microbial cross-contamination. Certain soft surfaces, such as fabrics, are also impregnated with silver nanoparticles to control and minimize the growth of odor causing bacteria. 

Based on the chemical properties of silver or copper ions in solution, such disinfectants by themselves would have no cleaning power, unless additional surfactants and soaps are added to the formulation. In general, both metal ions are cytotoxic to pathogenic bacteria. Free silver ions disrupt the functional properties of active proteins such as enzymes. This change would cause alteration of the 3D structure of proteins and therefore result in loss of function. Silver is also hypothesized to damage DNA structures. Copper is known to interact with active proteins in microbial cells and therefore interrupt their functions, resulting in microbial death. Copper ions are also thought to interact with membrane lipids which results in rupturing of the microbial cells.

These metal ions can in additionally affect viruses, as viruses also have protein and lipid structures on their external shell. Resistant strains of pathogens have been known to combat against the metal ions by either preventing their entry into the cell, or through mutations that result in change of their protein surfaces.

Silver oxidation does occur slowly. Disinfectant solutions containing colloidal silver care exposed to gradual oxidation, which would eventually cause them to crash out of the solution and precipitate. Once out of solution, they no longer are available to interact with microbial cells. Antimicrobial surfaces covered with copper coatings also undergo oxidation. Such antimicrobial hard surfaces are in fact affected by oxidation and deposition of organic soils on the most surface layer of copper. Organic soils and oxidized ions can act as a barrier layer and prevent the surface microbes from touching and interacting with the silver or copper layers. Therefore, the surfaces have to be cleaned and kept residue free in order to be effective against pathogens. Copper and silver coated surfaces also impose compatibility problems when they are to be disinfected with various cleaner disinfectant agents. Such incompatibilities may arise in forms of corrosion, or immediate formation of an oxidized film layer that either degrades the surface or decreases the efficacy of those against pathogens.

Continuous exposure of humans to solutions with colloidal silver can result in deposition of silver particles inside the skin cells. Over a very long exposure time and over-accumulation, it can cause a condition called Argyria, which is discolouration of skin into a blue-gray colour.

Both copper and silver, especially silver, are extremely harmful to the environment. Silver is known to have high aquatic toxicity as it can bioaccumulate in marine organisms’ tissues. Therefore, proper disposal of disinfectants containing colloidal silver or copper are often problematic, as the intent is to prevent its flow to open waters and oceans.

Here’s how we would score Silver and Copper on the key decision making criteria for antimicrobial surface agents:

Speed of Disinfection – N/A

o Use of Silver and Copper provides continuous reduction and inhibits growth of pathogens on surfaces (e.g. over extended periods of time from 2 - 24hrs)

Spectrum of Kill – C

o Efficacy against bacteria and viruses has been shown but is dependent upon the metal ions being able to directly contact the pathogen

Safety Profile – B - C

o Prolonged to silver can lead to bio-accumulation on skin and lead to health concerns

Environmental Profile – D

o Both copper and silver and known to be extremely harmful to the environment

o Silver in particular has high aquatic toxicity and can bioaccumulate in tissues

Cost Effectiveness – D

o Such products are still in their infancy, facilities need to weigh the cost of use versus benefit to infection reduction

 

**For more in-depth scientific information about Silver, Copper and other Antimicrobial Surface Agents, stay tuned to www.infectionpreventionresource.com.
 
 
Bugging Off!
 
Nicole

 

 

 

Friday, October 11, 2013

A little Salmonella with your Chicken?


I'm almost getting too paranoid to travel. In August I blogged about the Cyclospora outbreak that was affecting 16 states and linked back to lettuce used by several restaurant chains including one that I had eaten at while on a trip to Michigan and Massachusetts. I just got back from San Fran on Sunday and wouldn't you know it, by Monday I was reading about a Salmonella outbreak that is currently circulating around 17 states across the US with California being the hardest hit.   I was under the weather for a few days while on this trip. I did eat some chicken while there, but can't say that food was the true cause.

As of October 7, 2013, a total of 278 persons infected with seven outbreak strains of Salmonella Heidelberg have been reported from 17 states. Of these cases, 42% of ill persons have been hospitalized, but no deaths have been reported. Illness onset dates range from March 1 to September 24, 2013 with a range in age from <1 year to 93 years.  The median is age of 20 years and 51% percent of ill persons are male (can we say beer, chicken wings and Monday Night Football?).

The on-going outbreak investigations conducted by local, state, and federal officials indicate that consumption of Foster Farms brand chicken is the likely source of this outbreak of Salmonella Heidelberg infections. The outbreak strains associated with the outbreak are resistant to several commonly prescribed antibiotics which may be associated with an increased numbers of hospitalizations seen thus far.  While it is not unusual for raw poultry from any producer to have Salmonella bacteria, it is uncommon to have multidrug-resistant Salmonella bacteria.

Salmonella  is a rod-shaped, gram-negative, non-spore-forming bacteria.   In the US, there approximately 42,000 cases of salmonellosis reported each year, but because many milder cases are not diagnosed or reported, the actual number of infections may be twenty-nine or more times greater.  Most persons infected with Salmonella bacteria develop diarrhea, fever, and abdominal cramps 12 to 72 hours after infection. The illness usually lasts 4 to 7 days, and most persons recover without treatment. Salmonella bacteria can survive for weeks outside a living body, and they are not destroyed by freezing.

Salmonella can be transmitted both by direct and indirect contact through a number of ways as listed below, but basically, you're eating poop:

• Infected or contaminated food;

• Poor kitchen hygiene, especially problematic in institutional kitchens and restaurants because this can lead to a significant outbreak;

• Excretions from either sick or infected but apparently clinically healthy people and animals;

• Polluted surface water and standing water (such as in shower hoses or unused water dispensers);

• Unhygienically thawed fowl;

• An association with reptiles (pet tortoises, snakes, iguanas, aquatic turtles, and also amphibians (frogs)

In healthcare facilities, high touch surfaces are often contaminated with nosocomial pathogens, and may serve as vectors for cross-transmission.  While Salmonella is typically associated with eating of contaminated food a study that investigated the degree of pathogen transfer from contaminated surfaces to hands showed that transmission to hands occurred 100% of the time with Salmonella spp., Escherichia coli, and Staphylococcus aureus.  As hand hygiene compliance rates for healthcare workers is around 50 % at best, the risk of transmission from contaminated surfaces cannot be overlooked.

The best way to avoid any type of direct contact with Salmonella is to immediately wash your hands and all contaminated surfaces after every use. Surfaces that are reused in the kitchen such as countertops and food prep areas should be cleaned and sanitized in order to kill off bacteria.  Surfaces within a patient's room infected with Salmonella should be cleaned and disinfected daily and healthcare workers and visitors should be vigilant with hand hygiene.

Let's hope that thawing a turkey in a cooler is considered hygienic!   I'd hate to be the cause of a Salmonella outbreak at the Canadian Thanksgiving Dinner I'm hosting on Saturday....


Bugging Off!

Nicole