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.

Friday, April 24, 2015

CRE - Deadly, but not the strongest survivor

Clinical microbiologists, Infection Preventionists and Infectious Disease experts all agree that multidrug-resistant gram-negative bacteria pose the greatest risk to public health. The reasoning is 2-fold. First, resistance development occurs faster in  gram-negative bacteria than gram-positive bacteria, but perhaps most importantly there are fewer new antibiotics coming to market that are active against gram-negative bacteria.  If we combine this with the fact that over the past decade we have been able to prove that the environment plays a large role in the spread of most of the key hospital-associated infections, this means that we need to better understand the ability of these key pathogens to survive on surfaces and infect our patients.

CRE in particular is a concern due to the fact that CRE infections are difficult to treat with mortality rates of 40% - 50%!   Due to CRE's impact as a public health threat, Weber et al conducted a study that investigated the frequency and location of environmental contamination of CRE and the ability of CRE to survive on surfaces.

For the first part of the study, the researchers sampled surfaces such as bed rails, overbed tables, chair arms, sinks, toilets, bathroom floor, supply/medicine carts and the tops of the linen hampers in 15 rooms of patients colonized or infected with CRE.  The cultures found 6 different strains of Enterobacter spp. and a strain of Klebsiella pneumoniae and found that only 8.4% of the surfaces were contaminated, with bed rails, sinks and toilets being associated with the most frequently contaminated.

The second part of the study looked at the survival ability of CRE strains of K. pneumoniae, E.coli and Enterobacter sp. when inoculated on overbed tables, vinyl surfaces, stainless steel, Formica and cloth.  With the exception of Klebsiella on Formica, all 3 pathogens showed <15% survival rate at the 24 hr mark, <5% at the 48 hr mark and 0% at 72hrs.  Further E. coli did not survive as well as K. pneumoniae or Enterobacter spp.

Overall, the study showed that CRE is infrequently isolated from environmental surfaces in rooms of infected patients, and if isolated, is only found in small numbers.  These results suggests that CRE does not survive well in the environment in comparison with other key hospital-associated pathogens such as MRSA, VRE, C.diff, MDR Acinetobacter spp and MDR Pseudomonas.

Without a doubt, CRE is a growing concern and significant public health threat, however we may be able to breathe a little easier knowing that it appears the environment may play a less important role in the transmission of CRE.  It's certainly not conclusive.....but it could be a glimmer of a light at the end of a long and dark tunnel in understanding how to manage CRE.

Bugging Off!


Nicole

Friday, April 17, 2015

Warm Weather, White Legs and Tanning Beds

It's amazing how warm, sunny weather brings out the best in people.  Winter is over, and for most of us the snow has receded to a deep dark corner of our memory and we are languishing in the joy that is spring; robins (Lyme Disease), budding trees and flowers (allergies) and lunches on patios (sunburns).  For those of us of the female persuasion we are also looking forward to doing away with tights, leggings and pantyhose in favour of sandals, pretty toes and bare legs....

That is, unless you're afflicted with winter white skin like me and have been blamed for burning the retinas of your colleagues' eyes the first day you sport your bare legs on a warm spring day.  In that case, you're probably scouring flyers and scrolling through Groupons looking for the best deal on a spray tan or tanning bed deal.  However, this year you may think twice about using tanning beds after reading an article that highlights the fact that Tanning Beds Can Spread Herpes and Other Pathogens

According to Dr. David Goldberg, a dermatologist in the New York area, "you may get more than just a nice glow the next time you get into a tanning bed." The fact is that the UV light used to tan our skin is not capable of killing the bacteria or viruses that may have been left on the surface by the person who used the tanning bed before you.  In fact, it is highly probable that the technician who is showing you to your room has not even cleaned or disinfected the bed after it was previously used.  Let's be honest, there is a lot of skin to skin contact on tanning beds and most of that skin to skin contact leads to perspiration and sweat as you heat up under the lamps.  Heat and moisture are perfect breeding grounds for bacteria, particularly bacteria like Staphylococcus, Klebsiella, Enterococcus and Enterobacter which are pathogens known to cause serious skin infections.

Researchers in a letter to the editor in The Journal of the American Academy of Dermatology outlined a study they had conducted at 10 Tanning Salons voted to be the "Best of New York".  Let's just say, they did not observe any cleaning efforts.  All tanning beds cultured in the salons were found positive with disease-causing organisms, which certainly highlights a very real concern for disease transmission.  While the study focused on culturing of bacteria, tanning beds could also be a fomite that allows for indirect transmission of human papillomavirus (genital warts).

My take on the above is that if you want to use tanning beds to shed your skin of its winter whiteness, take your own disinfecting wipes and clean before you lay down.  As for me, perhaps this year I'll hand out sunglasses the first time I go without pantyhose.....unless anyone can recommend a good spray tan place!

Bugging Off!
                                                                                                                                             
Nicole

Friday, April 10, 2015

Disinfectant Chemistry Report Card #19 - Ultraviolet (UV) Room Decontamination

Generally, decontamination of hospital rooms has been done manually, using traditional applied disinfectant technologies as we have discussed in previous Disinfectant Chemistry Report Cards.  Concerns associated with conventional cleaning and disinfection methods include: lack of proper cleaning and disinfection protocols, incompatibility between the disinfectant chemistry and cleaning  substrate (e.g. the cloth...), operator error (e.g. was the product diluted correctly?), concerns with unrealistic contact time and if surfaces were actually contacted.  In looking for an adjunct to improve the level of cleanliness in a patient room, a new technology has been developed which uses ultraviolet light in an automated system to disinfect rooms.

Ultraviolet room disinfection systems use either a continuous or a pulsed UV lamp. A continuous lamp, which requires a warm-up period, is powered by low-pressure mercury vapour, and emits light at 253.7 nm, while a pulsed system (no warm-up required) uses either xenon or krypton gas with a pulsed emission that ranges from 200 nm to the visible light range.  These systems use the same general method; inactivation of microbes by DNA and/or protein damage. UV light induces formation of either thymine dimers or thymine-cytosine photoproducts, preventing microbes from replicating; it is very effective for viruses and bacteria, and less effective at inactivating fungi and spores.

Compared to H2O2 room disinfection systems, UV systems do not require room sealing or HVAC shut-off and do not have consumable products required, though both are residue free and there are no post-cleaning health concerns. Decontamination times can be significantly reduced with the use of UV-reflective wall coating. There are some disadvantages that come with a UV disinfection system. Coverage is a primary concern, as indirect coverage does not have the same disinfection efficacy that direct exposure does. Equipment and furniture must be moved away from walls to ensure complete room coverage. These systems may perform poorly against organisms with inherent resistance, or ones that can repair themselves; there is evidence that bacteria can evolve UV resistance when exposed to repeated cycles of low doses. Like other room disinfection systems, the rooms must be empty and there is a significant capital investment required. Lastly, UV systems share the same problem that other disinfection systems have; reduced efficacy with soiled surfaces.

In terms of safety, direct exposure to UV-C radiation is not fatal, but it can lead to skin and eye irritation.

Continuous lamps contain a very small amount of mercury, about the same amount as a 4-foot fluorescent bulb, while pulsed UV lamps contain non-toxic xenon or krypton gas. These systems may be destructive to metals and plastics/vinyl and cause fading in coloured paints and fabrics. UV light is known to degrade acetal, acrylonitrile butadiene styrene (ABS), polyamide (PA) and polycarbonate (PC)-type plastics.  A side effect of low dose rates from indirect exposure is bacterial resistance. Bacteria found at high altitudes have exhibited resistance to UV light, and bacteria exposed to low doses of UV light can gain resistance.

Ultraviolet disinfection systems are best for terminal use and in the ICU or other high-risk infection areas, due to the high capital cost and the evacuation requirement. They do not eliminate the need for other infection control and cleaning practices, and are not feasible for hallways, etc.

Here’s how we would score Ultra Violet Room Decontamination on the key decision making criteria for room disinfection:

• Speed of Disinfection – B-C

o Cycle time can range from 15 minutes to 45 minutes depending on room size and system used
o Room preparation is required - furniture must be pulled away from walls

• Spectrum of Kill – A

o Proven efficacy against all organisms: bacteria, viruses, fungi, mycobacteria and bacterial endospores
o Requires direct exposure to ensure disinfection will occur

• Cleaning Effectiveness – D

o Ultraviolet Room Decontamination systems do not eliminate the need for the physical removal of soils to ensure effectiveness and provide an aesthetically  pleasing environment

• Safety Profile – B

o Used correctly, the safety concerns can be minimized

• Environmental Profile – A

o No chemicals are used

• Cost Effectiveness – C

o Costs of capital expenditure, labour, and consumables need to be considered


**For more in-depth scientific information about Ultraviolet Room Decontamination Devices, stay tuned to www.infectionpreventionresource.com.


Bugging Off!


Nicole

Thursday, April 2, 2015

L, M,(N), O, P...Leave Norovirus Mops Off Please!

It's not that I jump at the chance to languish in other people's misfortunes...BUT when there is a lesson to learn and the "misfortune" provides a great example of what not to do, or why we shouldn't do something, you’d  want to bet I'm going to exploit it. 

Case in point... All non-emergency operations have been cancelled at a Cumbrian hospital following an outbreak of Norovirus and the North Cumbria University Hospitals NHS Trust have barred children from visiting until further notice.

Why you ask?  NOROVIRUS!  Some of us may have been fooled that because spring has sprung the pesky winter vomiting disease has "left the building", but in reality Norovirus can pop up at any time and in closed spaces where we have elderly and/or sick people it can run rampant.   The truth is for some hospital associated outbreaks, the initial cause was a family member who just "had" to visit their great-aunt Ethel, Granny, Grampy or sibling, cousin or friend who just had a baby.  People, if you're feeling under the weather or are sick....STAY HOME!

In this situation, cases of Norovirus began cropping up in January, and after a review of the more than 200 confirmed cases  at the two Cumbria, UK, hospitals, the infection prevention control team stated  there were “significant concerns” over the standard of cleanliness and determined that, “Cleaning staff are reusing mops contaminated with norovirus.”

Things that make you go hmmm......or GROSS!

This is a great and not uncommon example of the breakdown in cleaning protocols.  This breakdown may occur as a result of the fact that training just hasn't been provided (e.g. the housekeeper has had no formal training in the differences of cleaning for health in healthcare facilities vs. what they're mom taught them...).  There are some organisms (Norovirus being a great example) that can survive on surfaces for extremely long periods of time and can EASILY be moved from one surface to another via contaminated hands or as it appears in this case, from a surface (fomite....e.g. cleaning cloth or mop) to another surface which subsequently lead to transmission...

There are a number of studies that talk to the importance of cleaning and disinfection to combat / stop outbreaks.  There are also numerous studies that focus on the importance of cleaning compliance (e.g. if you don't clean it, you don't kill it).  In February of this year a new study was published in the American Journal of Infection Control that concluded the use of an effective disinfectant in conjunction with a clear protocol for how to clean and disinfect the environment (e.g. lots of training had occurred) and a compliance program where surfaces were being monitored for cleanliness reduced HAIs (VRE, MRSA and C.diff) by 20%.

In the case of Cumbria, ensuring that housekeeping staff had adequate training, had clear protocols in terms of how to clean and understood the risk of Norovirus transmission would (at least in my opinion), have minimized the size of the outbreak.  Don't get me wrong, Norovirus can spread easily - just look at what happens aboard cruise ships.  BUT, when you have processes in place to ensure you are effectively marrying products with protocols the end results will be inhalation of the bug you’re combating or in the case of the study noted above....not allowing it to rear its head in the first place!

Bugging Off!


Nicole