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Thursday, January 30, 2014

PEDv Pooping Pigs Pose Pharaonic Problems!

Those of you who have followed the Talk Clean To Me blog know I am a sucker for alliteration so you can imagine how giddy I am over what I think is the brilliance of the title for this week's blog!  Admittedly, until today I had never heard of the word Pharaonic - basically a fancy word for big, huge, enormous in size, but the excitement I had in finding a "P" word was beyond words!

The intent of the Talk Clean To Me blog is to chat about the use of disinfectants for infection prevention and while they tend to focus on healthcare, I spend a significant amount of my time working in the Animal Health world (vet offices, shelters, aquaculture, farms, etc) which also has significant and very real concerns with infections and outbreaks.  Being a lover of BBQ (pork shoulder, ribs etc) and of course bacon, that magical, delectable meat, the news that the first case in Canada of PEDv (Porcine Epidemic Diarrhea virus) had hit a farm very close to where I grew up was most concerning indeed.

PEDv is an enveloped virus from a disinfection perspective that is a member of the Coronaviridae family.  While PEDv is from the same family of viruses that was the cause of SARS in 2003 and more recently MERS, it is only infectious to pigs and is not in any way a food safety concern.  Within the swine industry, Coronaviruses are known to cause to a number of infectious diseases.  The significance of PEDv  however is the mortality rate with an average of up to 100% in suckling piglets (under the age of 7 days).  PEDv is transmitted by direct (pig-to-pig) or indirect (contaminated fomites, transport truck/trailers, footwear, clothing, farm supplies, etc) exposed to the virus. The incubation period of PEDv is thought to be as short as 22 - 36 hrs and is characterized by acute outbreaks of severe diarrhea and vomiting that can affect up to 100% of the herd if previously unexposed.  The fact that this is the first time PEDv has been found in Canada means our herds do not have any immunity to this virus.  The economic impact of PEDv will be substantial. 

In the US since the first case was identified in May 2013, more than 2000 farms in 22 states have been grappling with the virus that has caused the death of at least 1 million baby pigs.  The two farms that PEDv has been confirmed have seen almost a 100% mortality of 2 - 5 day old pigs and 15 - 20% mortality with older pigs.   If the virus was to spread beyond Ontario, PEDv could cost the Canadian pork industry an estimated $45 Million in losses. 

From a management and decontamination perspective, the expectation is that most of the commonly used disinfectants used by the swine industry for their cleaning and disinfection needs will be effective at inactivating the PEDv virus. There was a recently published study by Iowa State University that found that a commonly used powder-based disinfectant was not effective against PEDv.  The moral to this study is thorough washing, disinfecting and drying of hog trailers using traditional cleaning methods and liquid disinfectants is the way to go.   For now, the primary concern with respect to preventing further transmission to other farms is the frigid temperatures we are experiencing in Ontario - a decrease in temperature impacts the contact time for disinfectants.  They will still kill, but they will need more time to do so.  Just like in healthcare, cleaning and not cutting corners saves lives.  In this case we're talking about the lives of really cute piglets!

Bugging Off!

Nicole

 

Friday, January 24, 2014

Norovirus - It's a game of Cat and Mouse


The truth of efficacy testing for disinfectants is that it's not as easy as just "growing" the bug you want to test and seeing if a product can kill it.  Certainly there is a plethora of scientific literature to show how long bugs can survive on surfaces and this often leads us to incorrectly conclude, that if a bug is hardy enough to live on a surface for a significant period of time then it must be hardy enough to be grown in a lab.

Unfortunately, the organisms of interest cannot always be reliably cultured ("grown")  and as a result surrogate organisms are used.

What the heck are surrogates?  Well they are bugs that show genetic and stability similarities to the bug we're interested in.  Perhaps not the best analogy, but one that I certainly know very well from experience is cooking and baking your favorite recipes when your husband is allergic to dairy.  Milk or cream gets substituted with Soya Milk, Almond Milk or Goat's Milk.  Butter is substituted for margarine - but beware, depending on the recipe you also need to consider whether you should use soft or hard margarine and for the record....don't bother trying to make short bread cookies.  With margarine they are NEVER EVER going to taste as good as your Grandma's.

Getting back to surrogates and Norovirus, at present there is no recognized cell culture infectivity model for testing efficacy against Human Norovirus. Efficacy testing relies on the use of viral surrogate models for which a number of factors are considered in selecting a surrogate microorganism such as (a) safety for lab workers, (b) ease of culture and quantitation in the lab, (c) relative resistance to physical and chemical agents, (d) stability in the ambient environment and (e) a reasonable fast turn‐around of test results.

Feline Calicivirus (FCV) is currently accepted around the world as the representative surrogate. FCV is primarily a respiratory pathogen in cats and is found mainly in respiratory secretions. It is also found in cat feces, which can play a role in FCV spread. FCV is also known to infect dogs where it can cause
acute diarrhea, thereby making FCV a very suitable surrogate for Human Norovirus for use in efficacy testing of disinfectants.  FCV is the surrogate recognized and approved by the EPA for making claims against Norovirus on EPA registered disinfectants.

In recent years, we have seen Murine (Mouse) Norovirus (MNV) suggested as a suitable surrogate as it shows greater genetic similarities, pathological and environmental stability to Human Norovirus. MNV can be cultured in the lab. While there are greater genetic similarities between Murine Norovirus and Human Norovirus, Murine Norovirus appears to be less stable and less resistant to microbicides than FCV.  The CDC has made recommendations in their Norovirus Prevention Guideline to perhaps consider products that have been tested against both FCV and MNV.  That certainly can be done, but the long and the short is the EPA ONLY recognizes FCV and when it comes to disinfectant claims in the US - the EPA is the king of the castle!

Certainly, there are a number of researchers who have presented data showing efficacy of different disinfectants to Human Norovirus. However, after conducting a quick literature review, I was unable to find any studies on human Norovirus with an animal end point.  There are a number of studies with Human Norovirus that are based on non-kill parameters (e.g. DNA, RNA, protein analysis).  These types of studies are not accepted by EPA to date as they do not confirm that the virus has been inactivated.  The EPA only accepts efficacy studies that shows that all cells, eggs, or living animals survive after the virus has been treated with a disinfectant. 

In the end, the debate on which virus is a better surrogate for the Human Noroviruses is likely to continue for some time to come. The reality, however, is that the moment you grow a virus in the lab you alter its surroundings and characteristics, including its susceptibility and its resistance to physical and chemical agents. I expect science will find a way some day to effectively grow Human Norovirus so that it can be used to determine disinfectant efficacy, but  for now it's a cat and mouse game where FCV reigns supreme (at least in the eyes ofthe EPA).

 

Bugging Off!

Nicole

 

Friday, January 17, 2014

ACMNPV - the new, but not so catchy HAI acronym!


Unlike the brilliant ESKAPE acronym, I cannot (at least in the 20 minutes I gave myself) come up with a catchy acronym for Acinetobacter, Clostridium difficile, MRSA, Norovirus, Pseudomonas and VRE.  ACMNPV is simply the first letter of each.  Perhaps PNAVCM of  VACNMP would be better? 

Regardless, according to the December 2013 Primer on Hospital Pathogens published by ICT, these are the pathogens most prevalent in the hospital environment.  These are the pathogens that should be of significant concern to Infection Preventionists (IPs).  But why? 

Acinetobacter baumannii is a lovely  gram negative bacterium that can inflict a wide range of diseases - bacteraemia, wound infections or pneumonia to name a few.  While it poses very little risk to healthy individuals, those with suppressed immune systems (e.g. patients in ICUs, Burn Units) or chronic underlying diseases (e.g. diabetes or COPD etc) present the perfect target for this opportunistic little bugger.  From an environmental impact perspective, Acinetobacter is transmitted via contact (e.g. person to person or indirect via contact with fomites) and is believed to survive in the environment for several days and perhaps up to months.

Clostridium difficile is a spore forming gram positive bacterium.  It's the spore forming or suit of armor creating characteristic that has caused many a grey hair for IPs around the world.  In fact, C. diff accounts for 15 - 25% of all cases of antibiotic-associated diarrhea.  The suit of armor helps increase the length of survival in the environment making the need for diligent cleaning and disinfection all the more important and by diligent, I in no way mean that you try to nuke all surfaces with a sporicidal agent, I mean that we need to do a thorough job in cleaning and physically removing soils and spores from environmental surfaces and patient care equipment.  But don't just blame the environment or the housekeeper, antibiotics are the primary cause for development of C.diff Diarrhea - be sure to look at and question antibiotic prescription practices by doctors.

Methicillin Resistant Staphylococcus aureus or MRSA to those in the know, is a gram positive bacterium that is resistant to many different antibiotics.  At any given time, between 20 and 30 per cent of the general population carry Staph bacteria and /or MRSA on their hands or in their noses, but are not ill.  This is particularly concerning as researchers have shown that MRSA can survive on environmental surfaces for up to 56 days!  Similar to Acinetobacter, MRSA can be transmitted via both direct and indirect contact so environmental hygiene (e.g. cleaning and disinfection) cannot be underestimated in its importance for keeping MRSA off the surfaces to stop transmission.  The good news is that according to U.S. health officials, MRSA infections have fallen by nearly 30 percent in the last decade. 

Norovirus - a wonderful winter weight loss program - is a non-enveloped virus that is quite resistant to many of our commonly used day-to-day disinfectants.  It does not take much of hardy little terrorist to cause infection and can live in virtually any environment (including at freezing temperatures to 60C/140F).  Transmission is primarily caused by eating poop (the less technical way of stating fecal-oral) and can survive on surfaces for up to 14 days.  While we often panic over the antibiotic resistant bacteria, we cannot underestimate the economic burden of Norovirus as it is estimated to cause up to 21 MILLION cases of gastroenteritis (aka puking and pooping) per year in the US.  Best of all you just have to "ride" it out - viruses are not susceptible to treatment with antibiotics.  Focusing on cleaning and disinfection with a disinfectant that is effective against Norovirus and judicious hand hygiene are the best means to deal with this bad guy.

Pseudomonas aeruginosa (most commonly referred to as Pseudo) is a gram negative bacterium that is widely found in the environment and particularly found on water and moist conditions and accounts for about 10% of all HAIs.  Like MRSA and Acinetobacter it can be transmitted by both direct and indirect contact and is more concerning to patient with weakened immune systems.  While, Pseudo loves moist environments, it has been found to survive on dry surfaces for up to 16 months and can cause all sorts of infections (bacteraemia, pneumonia, UTIs etc) depending on its portal of entry (e.g. how it got into you).  As you've likely guessed, cleaning and disinfection and hand hygiene will help stop the spread.

Lastly, VRE or Vancomycin Resistant Enterococci  are a group of gram positive bacteria that are naturally present in our intestines, in the female genital tract and the environment.  As the name would imply, they are resistant to some classes of antibiotics and as expected is more concerning with people who have weakened immune systems.   VRE is a hardy little pest that can survive for extended periods of time in the environment and can be transmitted by both direct and indirect transmission.  Because of its ability to survive in the environment, if cleaning and disinfection is not completed with utmost care researchers have shown there is a VERY strong chance of the next person admitted into a room or bed previously occupied by someone with VRE. 

I would expect the organisms we just reviewed are already on your hit list for infection prevention programs and intervention strategies.  The key (or theme) I hope you picked up is the association with transmission from contaminated surfaces.  Cleaning saves lives, but cleaning is not something that can be rushed because short cuts will cost lives.

 

Bugging Off!

Nicole

 

Friday, January 10, 2014

2014 - the Year of the Horse and Theme-Based Blogs


Happy New Year and welcome back to the Talk Clean To Me blog!  While we had a few "themes" during 2013, our primary focus for topics was covering the newly published science as it related to the use of chemical disinfectants for infection prevention.  For 2014, Lee and I have decided to have quarterly themes, certainly we will still intersperse hot topics as studies that we think are important and worth blogging about hit the press and we also intend to bring back the Guest Bloggers to bring you fresh and in some cases hopefully controversial topics and opinions.

The first Quarter will be a focus on relevant pathogens that cause us grief from an infection prevention standpoint such as Norovirus, C. difficile, AROs and emerging pathogens we may want to start keeping an eye on.  By no means do I mean we will start creating dull FAQ type blogs on these pathogens.  Just the thought of that makes me yawn.  Besides we can find much of that information on the CDC, Health Canada or WHO websites.  Our focus will be much more exciting such as how to choose a disinfectant when specific pathogen claims do not exist or why surrogates are used for some claims rather than the actual pathogen.  OK, perhaps that doesn't seem much better, but I promise you'll we'll make the blogs fun to read and perhaps even get a snort out of one or two of you!

The second Quarter (or Q2 as most business people would shorten it to) will look at the costs and return on investment in designing and implementing an environmental infection prevention and control program.   If Lee and I do our jobs correctly, we'll arm you with a laundry list of what we call "So What's" that should counter virtually any road block thrown in your path to improving your environmental infection prevention and control program.

Q3 (yep, that's the third quarter) will focus on Occupational Health and Safety, covering topics such as OSHA's Hazard Communication standards, the new Global Harmonized Systems, changes to Safety Data Sheets (formerly known as MSDS) and how as people tasked with choosing disinfectants consideration to more than just the cost of a product and what it kills needs to be considered....we want to kills germs, not our staff, even if some of them "bug" us!

To finish off the year, we'll spend some time looking at how we can "green" our environmental cleaning programs not just in terms of choosing chemicals, but looking at processes and how small changes to how we clean and disinfect can improve our bottom lines.

We enjoy your comments and would love to hear from you as to topics that would be of interest!

 

Bugging Off!

Nicole