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, March 27, 2015

Book Review: Spillover: Animal Infections and the Next Human Pandemic

Written by David Quammen, "Spillover" is a highly engaging (at least to me) exploration of animal infections and the perils they pose for people.  Diseases such as influenza, hendra virus or HIV live in animals such as water fowl, bats or chimpanzees and as long as they do, the bug can cross to humans and have the potential to ignite a new epidemic. In fact, some 60 percent of the infections that plague humankind originated in the bodies of other animals.

The emergence of zoonotic diseases is not a new phenomenon, but they do seem to be on the rise or at the very least hitting the news with an all too frequent occurrence.  Throughout the book, Quammen explores the reasons behind this and in his last chapter touches on the impact of our exploding human population, the surge in the population of livestock and our ever increasing destruction of natural habitats. As Quammen is careful to emphasise, humans are a part of the natural world.  This is the crux of the problem as we like to think of ourselves as living distinctly separate lives from the wilds around us when we are in fact very much in the thick of things.

Spillover is a detective story with a difference as it includes a large host of murderers, all of which are factual.  The viruses, bacteria and other single-celled organisms which primarily infect animals find a way to make the jump or 'spill over' to humans.  Each chapter follows the quest to track down a new villain detailing the perils of discovery along the way and the impact (good or bad) on the researchers trying to find the answer.  But Quammen is quick to point out that pathogens can’t just rampage unconstrained.  In order to survive they need to find the balance between their disease-causing activities inside their host with their need for that same host to carry them into their next victim through coughing, having sex or contaminating the drinking water.  If the pathogen gets the balance between transmission and virulence wrong they will die out.   As Quammen states, that’s why Ebola is limited in its pandemic potential....that was at least before 2014!

If you only read Spillover for the chapter on Ebola, it will be worth it for in that chapter is a very real situation of how things can change.  Ebola in the course of a year, went from a pathogen that caused fewer than 3000 deaths since identified in 1976 to over 10,000 deaths in 2014.

If you're a germ enthusiast and are looking for a book based on facts that you hope after reading was fiction, then Spillover is definitely the book for you!

Bugging Off!


Nicole

Friday, March 20, 2015

Escaped Bacteria Infects Primates and People

Finding cures and developing vaccines is key to stopping the spread of infectious diseases.  We often learn of newly evolving diseases like SARS, MERS or Ebola through the media.  During times of conflict we often hear of the possibilities of chemical or biological warfare.  But we likely do not give much thought to the work that may be done in "secret", or perhaps more accurately described as "on the down-low" in Canada and the US to try to find vaccines etc. against organisms that could be potentially used as biological agents

These agents are defined as high-priority organisms that pose a risk to national security because they can easily be disseminated or transmitted from person to person; can result in high mortality rates and have the potential for major public health impact; might cause public panic and social disruption; and require special action for public health preparedness. Burkholderia pseudomallei is  one such agent.  
In November 2014 two macaques at the Tulane National Primate Research Center were found to be infected with Burkholderia pseudomallei.  Burkholderia pseudomallei itself is a gram negative bacteria that can be found in contaminated water and soil  and is spread to humans and animals through direct contact with the contaminated source.  Person to person transmission can occur through contact with blood and body fluids of an infected person. The bacterium causes a disease known as Melioidosis or Whitmore's disease and is predominately found in tropical climates, particularly Southeast Asia and northern Australia.
An investigation by the CDC and APHIS (Animal and Plant Health Inspection Service) has identified lapses in the appropriate use of PPE which could have led to the bacteria clinging to inner garments and being transported out of the select agent lab where research was being conducted on mice with the bacteria.  It is believed this is how the bacteria was transferred to the primate facility.  While there is no reason to believe that the bacterium has expanded beyond the research center, as a precaution all select agent research has been suspended and will remain suspended until the facility can demonstrate that procedures are in place to ensure that animals accidently exposed in the future are managed appropriately, that PPE procedures are improved, that staff appropriately trained to ensure adequate biosecurity measures.

It was believed that one of the lab employees was infected with Burkholderia, however, a second test has now indicated the person is not infected. So I guess I sensationalized the title a tiny bit.....  Regardless, this is a great lesson to us all in the importance following biosecurity procedures!

Bugging Off!


Nicole                                                                                                                          

Friday, March 13, 2015

Spring, Robins, Lyme Disease?


I admit, the topic for this blog is a bit of a departure from our typical posts, but I hope you'll indulge me.  It's almost spring, the snow is melting, we are starting to see buds on the trees and I was hoping to see my first robin - a sure sign that spring is right around the corner.  At least I was looking forward to spotting a robin until I read the article for the basis of this blog....Borreliaburgdorferi sensu lato  spirochetes in wild birds in northwestern California.

For those of you who do not know, Borrelia burgdorferi, is the bacterium that causes Lyme Disease.  In the north-eastern mid-Atlantic and north-central United States, this bacterium is spread via a bite from an infected blacklegged tick (better known as the deer tick), while on the Pacific coast it is the western blacklegged tick that spreads the disease.  These lovely little critters can attach to virtually any part of our bodies, but prefer to hide in the in hard-to-see areas such as the groin, armpits, and scalp.  If you happen to spend lots of time in woodlands and grassy areas and are diligent in wearing long sleeves and pants or checking yourself over after your jaunt in the woods, the risk of transmission from a tick bite is minimal. In most cases, the tick must be attached to you between 36 and 48 hours (or more) before the Lyme disease bacterium can in fact be transmitted.

Until reading this article, it was my (and I think most people's) belief that small mammals and rodents such as the wood rat or grey squirrel were the hosts of this disease.  That is until the researchers at UC Berkeley found that birds - PARTICULARLY robins, dark-eye juncos and golden-crowned sparrows -were also important hosts.  Hmm....I'm not a birder, but aren't these guys commonly found in suburbia and routinely congregate around backyard bird feeders?  While I do not live on the west coast, I suppose I should be thankful that I ran out of bird seed several weeks ago when I was only attracting the rift-raft... and by rift-raft I mean those loud obnoxious blue jays that torment my cat.

According to the CDC, approximately 30,000 cases of Lyme Disease are reported each year and that this number is vastly underreported.  The true number of cases is likely 10 times higher. The fact that birds are now identified as a host is most interesting, as unlike small mammals and rodents, the range of travel is far longer. As we see with Avian Influenza where infected wild birds can infect flocks of chickens or turkeys, these tick infested birds can move from region to region with relative ease bringing Borrelia burgdorferi with them!
From a disinfection perspective, infection of Lyme Disease only occurs when bitten by an infected tick. BUT, should there be some blood on the surface left after squashing an infected tick (as we're dealing with a relatively simple vegetative bacteria) rest assured that an EPA or Health Canada registered Hospital Disinfectant should have not issues managing to kill the bacteria!
Will you think twice about putting out bird feed to attract the spring robins? I know I will!


Bugging Off!


Nicole

Friday, March 6, 2015

CRE, ERCP, OMG!

It's likely that you've seen at least one news article to do with the spate of recent CRE (Carbapenem-Resistant Enterobacteriaceae) outbreaks across several states and facilities that have been linked to Endoscopic retrograde cholangiopancreatography (ERCP) procedures using duodenoscopes.  ERCP is a relatively common diagnostic procedure that examines diseases of the liver, bile ducts and pancreas.  

Duodenoscopes are long, flexible, viewing instruments that are inserted through the mouth and fed down into the top of the small intestine (duodenum). They contain a hollow channel that allows the injection of contrast dye or the insertion of other instruments to obtain tissue samples for biopsy or treat certain abnormalities. Unlike most other endoscopes, duodenoscopes also have a movable “elevator” mechanism at the tip. The elevator mechanism changes the angle of the tip of the duodenoscope, which allows the instrument to access the ducts to treat problems with fluid drainage as a result it is a complex instrument than other endoscopes and unsurprisingly can be more difficult to clean and disinfect.

Reprocessing is a detailed, multi-step process to clean and disinfect or sterilize reusable devices.  First, meticulous cleaning must occur which requires the removal of adherent visible soil, blood, protein substances, and other debris from the surfaces, crevices, serrations, joints, and lumens of instruments, devices, and equipment by a manual or mechanical process that prepares the items for safe handling and/or further decontamination using a detergent and water.  As a semi-critical device, duodenoscopes require high-level disinfection which is intended to reduce the risk of transmitting infection, but may not entirely eliminate it.  High-Level disinfection is generally completed using a germicide that inactivates all microbial pathogens, except large numbers of bacterial endospores, when used according to labeling. The FDA and Health Canada further define a high level disinfectant as a sterilant used under the same contact conditions except, for a longer contact time.

The complex design of duodenoscopes allows for improved patient outcomes for diagnosis and treatment; however, it does cause challenges for cleaning and disinfection as some parts of the scope can be extremely difficult to access.  For example, the moving parts of the elevator mechanism contain microscopic crevices that may not be reached with a brush allowing residual body fluids and organic debris to remain in these crevices after cleaning and disinfection.  This remaining soil can lead to transmission of disease causing organisms and can be transmitted to subsequent patients.

While the prevalence of such pathogens is increasing in hospitals, it is important to understand that antibiotic resistance does not translate to chemical resistance.  It is also important to remember that disinfectants have been used for well over 100 years without loss of effectiveness. While there is a hierarchy with respect to some bacteria such as spore-formers or Mycobacteria spp. being less susceptible to chemicals than their gram negative or gram positive cousins.  In fact, as shown by numerous studies, antibiotic resistant pathogens are not more resistant to disinfectants than antibiotic sensitive pathogens.

In accordance to recent communications from the FDA with respect to the best practices for cleaning and disinfection of duodenoscopes while they acknowledge that duodenoscopes are inherently difficult to reprocess, strict adherence to the manufacturer’s reprocessing instructions will minimize the risk of infection.  Facilities should have processes in place to ensure staff that are responsible for reprocessing do not deviate from the manufacturer's instructions for reprocessing as this may contribute to contamination.
The long and the short of it is....meticulous cleaning is paramount to patient safety, and similar to baking, cutting corners or skipping ingredients is bound to lead to disaster!

Bugging Off!


Nicole