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.

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Thursday, January 31, 2013

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.   Thanks to improved efficacy testing methods, Chemical manufacturers have certainly done their part in developing disinfectants that can kill virtually any pathogen known to man.  Environmental Services has worked diligently to implement these products, train their staff and ensure through the use of cleaning validation tools that we are in fact cleaning the surfaces.   As we know that contaminated hands are still likely the largest contributor to transmission, Infection Prevention and Control has put a strong focus on Hand Hygiene in order to improve compliance rates.

Why then are we still seeing transmission?

Aside from the fact that Hand Hygiene rates are still dismal, I think the unfortunate truth is we still are not cleaning (aka killing bugs) effectively.  By this, I am not meaning that our Environmental Services team is doing a poor job of cleaning.  Regardless of country or region, what do we all have in common?  I think we can agree that would be limited or dwindling budgets.  We are all asked to do more with less.  BUT, when it comes to effective cleaning and disinfection we need both the appropriate amount of time and the right number of people to do it.  Cutting back on time and people forces staff to cut corners and cutting corners in the healthcare world leads to adverse patient events (e.g. HAIs). 

Now go and read the article published in AJIC by Schmidt et al (AJIC 2012;40:907-912).  This research team investigated the bacterial burden associated with bed rails and how disinfection helps to minimize the bacterial burden thereby reducing the chance for transmission.  Makes perfect sense doesn’t it?  We know that cleaning and disinfection reduces pathogens on environmental surfaces which has a direct impact on hand contamination... etc, etc... As expected, the results showed that after cleaning and disinfection the microbial burden found on the bed rails was reduced by at least 95%.  That’s pretty darn good!

However, they also looked at what happens to the bacterial burden after disinfection took place.  Within 6.5 hrs after cleaning, the bacterial burden had rebounded back by 30 – 40%. In fact, when using a standard of 250 CFU/100 cm as the level of contamination considered “safe”, within 2hrs after cleaning the contamination on the bed rails exceeded that arbitrary number.  The overall contamination rate was still lower than before the bed rails were cleaned but over the course of 6.5hrs there was a whole whack of reproducing going on!  

Another interesting tidbit is that the researchers compared the results of a standard Quat with a 10-minute contact time to a Quat-Alcohol with a 3-min contact time.  And yes, it is true, the faster the contact time the better the kill will be, but in the end bacteria reign supreme!

Let me ask you this.  What is the definition of INSANITY?  According to Albert Einstein it is doing the same thing over and over again and expecting different results. If our cleaning schedule allows only for Environmental Services to clean patient rooms once per day and while we know this will reduce the environmental bioburden but we also know by the time we get back to clean that same room the next day we are basically back to square one are we insane? Perhaps the answer to solving HAIs is in fact increasing the frequency of cleaning.  The more we clean, the more we remove the environmental bioburden which will have a direct impact on hand contamination and HAI transmission. If we follow the data presented in the study, the optimal frequency between cleaning would be every 3 hrs. That may be a bit hard to get buy in for, but, I do know of one facility that has increased their EVS budget to allow for their cleaning staff to clean ALL high touch surfaces twice, yes TWICE, per day. I’ll be sure to let you know what impact they are seeing to their HAI rates.

In the meantime, who’s brave enough to go ask for more money in order to hire more cleaning staff and increase the frequency of cleaning? 

Bugging Off!
Nicole



Friday, January 25, 2013

#FF - Follow Friday!



For those of you also in the Twitter-Sphere you will have undoubtedly come across the concept of #FF (‘Follow Friday’).'Follow Friday' is basically about promoting an interesting Twitter user and helping them attract and increase their followers.  Since launching the blog we have included Guest Bloggers as a unique way to promote people who you may not know or get a chance to hear their more personal opinions. Admittedly, one blogger did have to have their blog read and approved by their communication and legal team – a process I am happy I don’t have to go through!

Social Media whether through blogging or tweeting or any other forum is about having a conversation on a topic that is of interest to you!  In the Talk Clean To Me Blog we focus on topics related to the use of Chemical Disinfectants and Infection Prevention – this is the stuff we know and know well.  This week I’m taking the concept of #FF to the Blog-Sphere and want to introduce to a couple of blogs that I think are worth following!

The Germ Guy: Confessions of Mercurial Microbiologist by Jason Tetro is a blog providing a personal and unique look at germs, hygiene and staying healthy. Through The Germ Guy Blog, Jason is able to take an idea, find something new about it and then tell a story that’s different, entertaining and thought-provoking. If you like what you read you can also follow Jason on Twitter – his handle is @JATetro.

Wired Science blogs is a repository for a number of, as you have likely guessed – blogs on topics related to science. You can really turn your inner geek on at this blog site and read about everything from how Dung Beetles use the sun and stars to navigate to how our brain knows what we smell like. The main blog I follow on this site is SUPERBUG written by Maryn McKenna.  Maryn is a journalist for national magazines and is also the author of BEATING BACK THE DEVIL. Like me, she finds emerging diseases strangely exciting.

ScienceBlogs is another repository for science based blogs with topics grouped similar to a newspaper – you can find blogs on Life Sciences, Medicine, The Environment and Politics (snore...but that’s just me!) etc. Did you know that the feather pattern on the chests of some birds may be an outward sign of how healthy the bird is?  Really?  While I have no plans on reading anything further about that there is a great post with a video by Abbie Smith, a Virologist titled “How I learned to stop worrying and love viruses”. It's worth watching – especially since we are well into Flu and cold season!

That’s it for this #FF! I hope you turn on your inner geek and check out some of these blogs!



Bugging Off!
Nicole


Friday, January 18, 2013

What is your child’s definition of good personal hygiene?

 
I think it’s a safe assumption that if hand hygiene compliance by nurses, doctors and on other healthcare workers is lacking then those of us not in a healthcare related field (especially our children) must be dismal.   Depending on where you look the rates for hand hygiene within healthcare facilities varies.  One study I found looked at hand hygiene in ICU versus non-ICU settings.  Prior to initiating the 12-month study, compliance rates were 26% for ICU settings and 36% for non-ICU settings.  After the 12-month study, which included education and feedback the rates improved slightly to 37% and 51% respectively.  PATHETIC – especially when we know that hand hygiene is the single most important factor in the prevention of health care associated infections.

This is in part why I found the study published in the American Journal of Infection Control so interesting.  Miko, BA, et al investigated the knowledge and beliefs towards personal and household hygiene of college students (AJIC,2012;40:940-945).  The results were quite interesting.  When looking at personal hygiene (hand washing, bathing and tooth brushing), women reported higher rates of “compliance” than did men.   Thankfully, almost 75% of the study participants reported washing their hands after using the toilet (I shudder to think what the remaining 25% are doing  or touching after they have used the toilet……).  Greater than 65% reported daily showering and twice daily tooth brushing – I’d hazard a guess, this group likely has a significant other!  What was interesting is that Freshmen had better hygiene rates than seniors and science majors had better hygiene rates than humanity majors.   I am SO thankful I am a woman who was a science major!  I plead the fifth as to whether my personal hygiene decreased over my 4 years at school….  I ALWAYS washed my hands after my biology labs where we were touching or dissecting things!

When it came to looking at household hygiene, the frequency of cleaning was remarkably varied.  Greater than 50% reported cleaning their rooms weekly (I’m not sure I did that during my two years living in residence, my roommates and I did clean weekly once we moved into a house) and there was no difference in cleaning frequency when the student was ill, but many would increase cleaning if their roommate was ill.

We know that deficiencies in hand hygiene practices have been associated with outbreaks of viral gastroenteritis and upper respiratory tract infections and we have the science to prove that hand hygiene will decrease your chance of getting these infections by 31% and 21% respectively.  We’re certainly doing a better job starting in Pre-School to reinforce the need and importance of washing your hands and covering your mouth.  I’m not sure if I’m proud or embarrassed, but my son is the class tattle tale if he sees his pre-school classmates coming out of the bathroom without washing their hands….

Perhaps when we’re sending our college age kids off to school, we need to reinforce the importance of cleaning their rooms as well.  And dads…you may want to tell your sons they will have a better chance finding a girl if they shower daily and brush their teeth!

This week I participated in a webinar titled “A Clean Approach to Flu Prevention” where we touched on the science behind why we need to clean, hand hygiene and how to clean.  It ties in nicely with this blog and maybe if your kid won’t sit and listen to you expound on the virtue of good personal hygiene, perhaps they’ll watch a video!




Bugging Off!
Nicole

Thursday, January 10, 2013

I think my dear Watson the culprit was the Privacy Curtain.....

What I find so interesting about the field of infection control and the prevention of infections is the fact that on almost a daily basis you can have an "AH-HA" moment that has the potential to change our current ways of practice. 

Ferreting out the "culprit or culprits" that could be a reservoir for potentially pathogenic organisms is very much like playing Sherlock. Nothing is elementary; everything has the potential to be the prime suspect. Our investigations need to move beyond the obvious, we need to start looking outside of the box and consider that perhaps we have not identified ALL of the high touch surfaces that have the potential to contaminate hands.

I think it would be safe to say that most of us do not give much thought to hospital privacy curtains except to perhaps think "boy that is an ugly pattern or colour". I would even hedge a bet that if you were to review your facility's infection prevention and control policies you would find only a small statement (if anything at all) that mentions that they should be changed when visibly soiled and/or after completing a terminal clean of an Isolation Room.

I mean they're curtains for Pete’s sake!  Why would we give them another thought? To answer that question perhaps we should conduct a study that investigates how many times privacy curtains are touched on a daily basis by healthcare workers (HCWs), patients and visitors. Like studies that look at the number of cars that pass through a particular intersection to determine traffic flow etc, I think we would be blown away by the frequency this seemingly innocuous surface is touched.  

In a study recently published in AJIC, Ohl et al investigated the persistence of bacterial contamination on privacy curtains over a 3 week period.  Of the 43 curtains tested in the study, 95.5% showed contamination on at least 1 occasion and the 13 curtains that were changed during this time period showed that within a week 92.3% of the new curtains were found to be contaminated with pathogens associated with HAIs. 

AH-HA moment #1 - CURTAINS ARE CONTAMINATED!!!

Now that we know the curtains are contaminated, what impact do they play with hand hygiene and how do we clean/disinfect them? Realistically, HCWs are quite likely to touch the curtains after they have performed HH and donned gloves but before performing patient care activities. Yes, HH was completed, but have we now just unwittingly contaminated our hands by touching the curtain? 

AH-HA moment #2 - CURTAINS CAN LIKELY CONTAMINATE HANDS! 

Now, how on earth can we clean/disinfect them or put procedures into place that can eliminate or reduce contamination? This is where we need more science; however, there was a poster presented by Price et al at the 2012 APIC conference that used H2O2 to clean the leading edge of the curtain where contact was most likely and showed that yes, one can conceivably implement a cleaning strategy that can help to reduce contamination. Using a 3% H202 solution did significantly reduce the bio-burden load on the curtain within 5 minutes and continued to show a decrease up to 2 hrs post application. Another alternative could be the use of barriers. Similar to a dental operatory where barrier covers are routinely used, we could consider applying a barrier cover on the leading edge of the curtain that can be changed perhaps on a daily basis to help reduce contamination.

AH-HA moment #3 - WE NEED TO IMPLEMENT A PROCESS TO REDUCE CURTAIN CONTAMINATION

We still have a lot of sleuthing left to do my dear Watson, but knowing that HCWs, patients and visitors frequently touch curtains and knowing that touching contaminated surfaces can contaminate hands suggests the potential for transmission of pathogenic organisms from curtains to hands to patients.  Perhaps we need to consider that privacy curtains are a high touch surface that can be a significant source of pathogenic contamination.


Bugging Off!

Nicole

Friday, January 4, 2013

Happy New Year!


If, like me you were able to take some time off over the holidays you are likely trying to slowly edge yourself back into the work routine.I suppose it’s the one upside of having a young child, they don’t understand that you are supposed to sleep in during vacation so unlike some of you at least I am not trying to get back into the grove of getting up before 7 am!  

I hope that 2013 proves to be as interesting as 2012 in terms of the advancement of science surrounding the importance of cleaning and the use of disinfectants in preventing infections. As was illustrated in the SOS – Spores on Surfaces blog – CLEANING WORKS! I look forward to being able to highlight such studies throughout 2013.

If you are a nut about the role of the environment as I am you may also want to check out the Spring SHEA conference that will be held in Atlanta, GA May 1 – 4th.  There is a day and a half dedicated to The Role of the Environment covering topics such as; Does Improving Environmental Disinfection Reduce HAIs?, The Role of Inanimate Surfaces and Fomites in Transmission of HAIs, How Hospital Cleanliness Should be Measured and “Thorny” Issues in Environmental Cleaning. I certainly plan on being there!

While many of us may be trying to ease back into the work routine, one thing we can certainly say is “Bugs Don’t Rest!” I’m afraid to say that this winter may be a nasty one and I’m not talking about the fact that many areas around North America just got hammered with snow!  Norovirus seems to be a leading character in many headlines with outbreaks hitting around the globe. We did a lengthy blog on Norovirus last year and quickly highlighted it again in our Happy Healthy Holiday blog so we'll leave it to you to read these if you want to learn more or refresh your memory.  Suffice it to say, if you’re looking to lose the weight you gained over the holidays, Norovirus may be your answer!

If you want to read a few of the headlines, here’s a link to the top 5,650 headline results!

Next week’s blog will be a discussion on privacy curtains and their role in infection transmission….unless I find something “ickier” to write about!


Bugging Off!

Nicole