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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Friday, September 26, 2014

I'll take Kill Claims for $200

From its inception, the intent of the Talk Clean to Me blog has been to educate about the choice and use of disinfectants.  The content of our blogs are based on fact drawing from a myriad of published sources and smattered with analogies or stories of direct experiences and we hope a bit of humour. If we go back to the original blogs from the Spring and Summer of 2011, we started off weaving a story of the desired traits of a disinfectant targeting key areas to consider when choosing a product.

Understanding that some may think the blog a bit self serving  as both Lee and I work for a disinfectant manufacturer, it's rewarding to read Drs Rutala and Weber's article published in ICHE this July titled "Selection of the Ideal Disinfectant" as it highlights many of the same points we have been talking about since we launched Talk Clean to Me.

Over the next several weeks, I will try to summarize the article and invite everyone to read it as it is truly a landmark piece that embodies the attributes that anyone who is choosing a disinfectant should consider.  As hinted in my title, the focus of this blog will be on the first section "Kill Claims For the Most Prevalent Healthcare Pathogens" which closely resembles the idea behind our "Strength in Not Always Found in Numbers" blog.

As Rutala and Weber highlight, the disinfectant product selected should be one that is effective against the pathogens that cause HAIs, and vegetative bacteria such as S. aureus, Enterococcus, E. coli, Klebsiella, Pseudomonas and Enterobacter have been found to cause almost 80% of all HAIs.  I hope you'll take a look at Table 3 from the article as it summarizes the most prevalent pathogens that cause HAIs very nicely. Basically, the marketing ploy by some disinfectant manufacturers focuses on who has the greatest NUMBER of claims, not who has the most APPLICABLE claims....inferring that they are the most effective product is a carefully crafted game of smoke and mirrors.

The next important area to understand is with respect to antibiotic resistance.  Without a doubt,  antibiotic resistance is a concern from a treatment perspective.  As we touched upon in our "Doors, Keys and Sledgehammers " blog and confirmed by Rutala and Weber, disinfectant testing for antibiotic-resistant organisms is not necessary, as antibiotic resistant pathogens are not more resistant to disinfectants than antibiotic sensitive pathogens.  There are however, some pathogens that are intrinsically more resistant to disinfectants than others which leads me to the third, and I think most important discussion of this section of the article - the concept of the order of susceptibility of microorganisms to disinfectants.

When considering disinfectants, we also need to consider the hierarchical scale of susceptibility.  The original hierarchy was developed by Spaulding in 1957 and is still widely cited in guidelines and policies, however, our understanding of pathogens and their susceptibility to disinfectants has dramatically improved.  Rutala and Weber have proposed a new hierarchy which I completely concur with based on my experience of conducting efficacy testing on a number of different disinfectant actives. Regardless of the hierarchical scale you choose to follow it is imperative to understand that this is only a guide and that the efficacy of disinfectants to pathogens will vary depending on the disinfectant active as well as how the product is formulated (e.g. 2 Quat-Alcohol products with different formulations can have widely varied kill claims and contact times).  As outlined in the article, a non-sporicidal disinfectant with a TB claim which traditionally was considered the most resistant vegetative bacteria does not mean that the product will have the ability to kill small, non-enveloped viruses such as Norovirus or Poliovirus.

Another area where the hierarchy should be considered is with emerging pathogens such as MERS-CoV or Enterovirus D68. Emerging pathogens generally mean that there is not an approved test methodology for a disinfectant to obtain efficacy claims by the EPA. In cases such as this where the microbiologic class has been established, than an already approved surrogate could be used.  For example, claims against Human Coronavirus would be appropriate to ensure efficacy against MERS-CoV or as in our "H1N1, H5N1, H10N8, H7N9 - What Influenza strain will we see next? " blog, proven efficacy against 1 strain of Influenza A would be sufficient to assume efficacy against emerging strains of influenza.

Lastly, for viruses where the microbiological class has not yet been determined (e.g. when SARS first hit or Ebola where there is no test method to determine efficacy) then we would look for efficacy against the heartier non-enveloped viruses.  Typically in these situations efficacy against Poliovirus, Adenovirus, Rhinovirus or Canine Parvovirus would be considered as this viruses are known to be more resistant to disinfectants than others.

As Drs. Rutala and Weber so eloquently stated "using this accumulated knowledge of microbiological susceptibility should discourage unnecessary testing, listing irrelevant organisms on labels and avoid "bug-of-the-month" testing".

Stay tuned for next week's blog which will focus on the second section "Fast Kill Times and Acceptable Wet-Contact Time To Ensure Proper Disinfection of Non-Critical Surfaces and Patient Care Equipment".


Bugging Off!

Nicole



Thursday, September 18, 2014

Like a shadow, bugs follows us wherever we go...

I'm not sure what caught my attention more, the title of the news article being "No matter how much you scrub, your home is covered in germs" or the fact that the opening sentence was "Sorry, clean freaks" which of course is the "handle" Lee and I took when starting the Talk Clean to Me blog.  Either way, the topic is one that had to be shared.

In my book review for "The Germ Code" I introduced the concept of microbiomes and the fact that the bugs that live on us tell the story of where we live or had lived.  The study at the heart of this article helps to solidify this concept.  The researchers studied seven (7) families in three (3) states and found that they could easily match up who lived where using their "microscopic roommates". Even as babies we start picking up microbes on the skin, nose and gut that will make up living communities that we coexist with throughout life.  In this day and age, the mention of "bug" generally leads us to immediately assume it is one that will cause disease, but the truth is many of these bugs play a critical role in digestion and our immune systems.  They may also directly contribute to disease and even weight gain... finally I have an excuse!

In essence the bugs we live with make up our home's immune system.   Certainly, bad bugs will show up from time to time, but perhaps instead of obsessing over killing bugs in our homes to stop the spread of infection we need to consider that many of these are "good" bugs and if we cultivate these it may lead to better health. 

The 7 households within the study comprised of 15 adults, 3 children, 3 dogs and a cat and for 6 weeks the participants collected samples by swabbing hands, feet, noses and paws of everyone in their households as well as commonly touched surfaces such as doorknobs, light switches, floors and countertops.  The findings showed that different homes harboured different populations of bugs and that these populations closely matched the microbiomes of the residents.

Most surprising was how quickly the bugs settled in.  Reminiscent of Pigpen's trailing cloud of dust in the Peanuts comic strip, wherever the family moved so too did their bugs.  In fact, it only took about a day for the microbes in a new location to closely resemble those of the old one.  This phenomenon was seen even with a family who moved from a hotel room to a house!  Having just spent 3 nights in a hotel, who's bugs did I sleep with the first night? Should I call room 442 tomorrow morning and apologize for leaving my bugs behind?
 
While the study showed our personal microbiome closely matches the bugs found in our homes, it was also found that if a family member leaves home for an extended period of time the microbiome of the home changes.  Surprisingly, when one of the study participants left for a 3-day trip, the researchers found that the cocktail of bugs that were part of the normal flora of the house changed.  In fact, they lost the contribution of bugs of the travelling person. It brings the concept of marking one's territory to a whole new level!

The key take home message  I think is that bugs live on us and all around us.  We should not despair, but learn to cohabitate and be smart in our cleaning and disinfection practices.  Certainly we cannot underestimate the importance of both hand hygiene and cleaning and disinfection when it comes to our health.  However,  when it comes to cleaning and disinfection rather than feeling the need to annihilate every bug in our homes, perhaps we need  to be more targeted in our approach and only focus on the surfaces such as bathrooms and kitchens where there is a greater likelihood of disease causing bugs living.



Bugging Off!
Nicole




Friday, September 12, 2014

Kids, Colds and Enterovirus D68



Since the inception of the Talk Clean To Me blog, we have included a blog on back to school infection prevention.  Those of us who are parents know firsthand that back to school often translates into colds, flus and other diseases such as Pink Eye, Hand Foot Mouth or Chickenpox.  Unfortunately for some parents, back to school this year has lead to the introduction of Enterovirus D68 (EV-D68).

Enteroviruses are a family of viruses that include 3 Polioviruses and 61 non-Polioviruses including Coxsackieviruses, Echoviruses and 4 other Enteroviruses (e.g. Rhinovirus).  Next to the common cold, Enteroviruses are the second most common viral infectious agents in humans causing upwards of 10 - 15 million infections each year in the United States. EV-D68 was first identified in 1962 in California, however, for the last 40-odd years it has been very rarely reported in the United States. 

Due to the fact that EV-D68 is rarely identified, it has been less studied and the ways in which it spreads are not as well defined. Like other Enteroviruses, EV-D68 causes respiratory illness and can be found in respiratory secretions such as saliva, nasal mucous or sputum.  It is very likely that the virus is transmitted via direct contact with respiratory sections and indirect contact with contaminated environmental surfaces and fomites.

The rarity of this virus, however, changed on August 15th and August 23rd when Children's Mercy Hospital in Kansas City, Missouri and the University of Chicago Medicine Comer Children's Hospital of Illinois notified the CDC of an increase in patients examined and hospitalized with severe respiratory illness. EV-D68 was identified in 19 of 22 specimens from Kansas City and 11 of 14 specimens from Chicago.  Ten (10) additional states; Alabama, Colorado, Michigan, Georgia, Ohio, Iowa, Kansas, Oklahoma, Kentucky and Utah have also reported clusters of Enterovirus illness.  Of the additional 10 states, only Colorado and Iowa have confirmed EV-D68 as the causative agent.  While Enterovirus infections as a whole are common, the number of critically ill children who have required intensive care has been unprecedented. Many of these children have a history of asthma or wheezing.

At present there are no vaccines or antiviral medications that can be used to prevent or treat EV-D68.  Infection prevention measures include hand hygiene using soap and water, paying particular attention to hand washing after changing diapers, as well as avoiding touching your eyes, nose and mouth with unwashed hands and disinfecting frequently touched surfaces such as door knobs and shared items such as toys.  When choosing a disinfectant however, it is important to understand that due to the rarity of EV-D68, most commercially available disinfectants will not have specific claims against EV-D68.  As such look for products that have claims against viruses within the same family such as Poliovirus, Coxsackieviruses or Rhinovirus.

Here's hoping that this back to school this year does not signal the start of a busy fall outbreak season!  Influenza and Norovirus season are just around the corner!

Bugging Off!

Nicole

Friday, September 5, 2014

Back to School - Education is not just for kids!

I'm guessing for many of you Tuesday was a bittersweet day.  Some of you may have been teary-eyed as you sent your child off to school for the first time (kindergarten or college / university).  For others it may be that the first day of school could not come soon enough to get your bothersome kids out of your hair and regain the opportunity to actually enjoy your morning coffee and read the paper.  The really good parents even took pictures and posted them to Facebook.  For me, Tuesday was just another day because my poor son spent most of the summer in his Montessori program and I plum forgot to take a picture, post it to Facebook and brag about how darn cute he is. Shocking, I know.

Not unlike our back to school focus, September also signals the start of Fall tradeshow and education conference season.  Kids are not the only ones who get the opportunity to learn!  The Infection Prevention Teleclass education sessions hosted by Webber Training promises to have a jam packed fall season of learning.  As noted in previous blogs, the Teleclass Education series is an international lecture series on infection prevention and control topics with the objective of bringing the best possible infection prevention and control information; to the widest possible audience; with the fewest barriers to access.  Here's the line up for September and October. 


Date
Title of Teleclass
Speaker
Sept. 4th
Antimicrobial Impregnated Surfaces in Preventing Healthcare-Acquired Infections: Differentiating the Hype from the Hope
Prof. Hillary Humphreys, Ireland
Sept. 11th
Economic Analysis of VRE: Assessing Attributable Cost and Length of Stay
Dr. Marc Romney, Canada
Sept. 16th
Key Measures for the Prevention and Control of Ebola Virus Disease (Free Teleclass)
Dr. Sergey Romualdovich Eremin, WHO
Sept. 16th
Infection Prevention and Control: The Argentina Experience (Free Teleclass)
Carolina Gluffré, Argentina
Sept. 18th
Health Economic Evaluation of An Infection Prevention and Control Program
Dr. Elizabeth Bryce, Canada
Sept. 29th
The Times They Are a Changing (Free Teleclass)
Dr. Evonne Curran, Scotland
Oct. 2nd
Infection Prevention & Control in Cystic Fibrosis
Prof. Lisa Salman, USA
Oct. 8th
Public Reporting and Disclosure of HAI Rates: Positive Impact or Confusion? (Free Teleclass)
Dr. Maryanne McGuckin, USA
Oct. 9th
Enhanced Environmental Cleaning in Controlling Clostridium difficile Infections in the Hospital Settings: Does it Matter?
Prof. Farrin A. Manian, USA
Oct. 16th
Healthcare Laundry: Epidemiology and Microbiology Issues
Dr. Lynne Sehulster, CDC
Oct. 23rd
Infection Prevention in Outpatient Oncology Settings
Dr. Alice Guh, CDC



I hope many of you will take the opportunity to join in and be educated!  


Bugging Off!

Nicole