Happy International Infection Prevention Week!

I’m sorry to say that this year at Virox we did not celebrate IIPW.    I remember thinking to myself “I have plenty of time to plan”.  I then remember thinking “you’d better get on this” and then this past Friday it was “crap, where did the time go?”  I have no excuse, and I’m glad to see that those working at healthcare facilities have been busy celebrating and educating!  If you’re on Twitter check out #IIPW2018 to see what has been going on around the world!

As my tribute to IIPW I want to share a few of my favorite Talk Clean To Me blogs from over the last 7 years:

1.       The Top 10 Offences looked at the most common mistakes or ways to misuse disinfectants.  I’m sorry to say, almost 7 years after writing this blog I still see the same issues!

2.       ATP – a microbiologist’s square peg discussed the use of ATP as a tool for validating cleanliness. I agree that we need to have a way to validate cleaning, but in looking at using tools we need to ensure that we understand their limitations!

3.       Cotton – it absorbs more than just water discussed the ugly truth of Quat binding and its impact on our infection prevention programs.

4.       PEDv Pooping Pigs Pose Pharaonic Problems discussed a new Coronavirus impacting pigs.  I’m really sharing this because I think it is my best alliteration EVER!

5.       Mommy, this water tastes funny shared stories of what can happen if disinfectant bottles are not clearly marked.

6.       Cross Contamination Conundrum reviewed a study showing how some disinfectants wipes can redeposit pathogens back on to a surface.

7.       The joys of birth and the nightmares of SSIs was one of the 5 blogs I wrote last year for IIPW sharing stories of lives impacted by SSI’s.

8.       Bacterial laden wristbands was a fun experiment conducted after having to wear a silky ribbon 24 hrs per day for 4 days while at a tradeshow.  #GROSS

What I enjoy most about writing blogs is that you’re never short on topics when it comes to infection prevention.  In a perfect world we would never have to worry about SSI’s.  In a perfect world we would have disinfectants that kill everything on contact without impacting the surfaces or medical equipment that we need to disinfect.  In a perfect world we would never hear of stories where disinfectants caused harm because they were not properly identified.  In a perfect world we would not be concerned about the next emerging pathogen.  While we do not live in a perfect world, we do have people who are passionate about infection prevention.  Thankfully, these passionate people are concerned for the health and welfare of every patient that walks through the door.  For that I salute you and thank you for the work you do!

Happy IIPW!

Bugging Off!

Nicole

Copper Coatings for Consumers?

I don’t believe I’ve ever tried to pull the wool over the eyes of my readers.  I’ve been upfront in stating I work for a disinfectant manufacturer, and I’ve been diligent in trying to ensure the topics and content I include in my blogs are educational and not promoting of my company’s products.  My belief, is that in developing the best cleaning and disinfection protocols - regardless of whether it’s for our homes, our offices, our schools, hospitals or even barns - that education, discussion, debate and even the occasional agree to disagree stalemate helps us look at the information laid out in front of us, evaluate it and draw the conclusions that are right for us and that we are comfortable and confident in implementing.

There are always two sides to every story.  In science, the data can and in many cases is often presented in a way to draw conclusions that we want the reader to see.  As a reader, it’s up to us to read between the lines; to ensure that both sides of the story are being presented equally and draw our conclusions after looking at all of the facts.  For that life lesson, I’ll be forever grateful for my Wildlife Ecology teacher from university.

Why do I bring this up?  Well, there was an article published in the Toronto Sun indicating there is a way to beat the bugs found in our public transit systems.  I’m not going to deny, there have been a number of articles published talking about studies looking at the level of bacteria or viruses found on public surfaces.  Heck, I’ve blogged about some of them: toilets, airplanes, security bins.  The reason for my sharing is that we need to be aware of our surroundings.  We need to know that yes, our world includes bugs, many of which can cause harm via infections.  We need to be reminded that we need to wash our hands, and we need to be reminded that cleaning surfaces to remove dirt, grime and pathogens that have been deposited during the day is an important part of life.

The article in question is an opinion article.  Everyone is entitled to their opinion.  Someone who works for a company that develops and sells copper coatings for environmental surfaces is going to provide their opinion on how their product can be used to improve the lives of TTC riders.  According to the author of the article, “Copper immediately begins killing bacteria and stops it spreading.  The antimicrobial power of copper never stops, so a copper coated surface that is new or 100 years old, will be equally antimicrobial.”  The author further suggests that “Premier Ford, who has vowed to upload the TTC to the province might consider investing in this made-in-Canada technology to protect Torontonians.”

Copper and other coatings have been investigated for some time as potential aids in reducing the bioburden of bacteria in hospitals, where the concern of picking up a deadly infection is very concerning and very real.  In fact, in 2013 I did a “Disinfectant Chemistry Report Card on Copper and Silver Antimicrobial Coatings”.   Governmental agencies and microbiology experts have been discussing and debating for years over what testing should be conducted in order to determine efficacy of antimicrobial coatings.  In fact in 2008, the US EPA proposed a protocol assessing the bactericidal activity of 21 different copper and copper alloy surfaces. Those surfaces can be registered with the claim to “kill 99.9% of bacteria within two hours”.  For reference, many disinfectants kill to the same level in 10 – 30 seconds.  

 

I’m not saying that antimicrobial surfaces do not have a place.  What I am hoping to get across is that they are not the silver bullet.  Yes, they have the ability to kill and reduce bacteria, but what about viruses?  The outbreaks that impact our cities with greater frequency and with greater impact to our life are viral based (SARS, Influenza, Norovirus etc). 

To highlight some of the “holes” in the use of copper coatings, I wanted to share a recently published journal article that showed a meta-analysis of the published literature on the use of copper and its alloys.  The authors reviewed 257 studies and concluded that there is no clear evidence of the clinical benefit of copper surfaces. While copper surfaces have demonstrated antimicrobial activity, the implications of this activity in healthcare settings are still unclear, and no published study has been able to show a clear effect on healthcare associated infections.

Another tidbit that we should find interesting is that, while copper does have a continued ability to reduce bacterial levels, there are factors that can inhibit the killing action of copper such as antioxidants, organic soil, or the repeated use of cleaning products.  I think we can agree, that with the numbers of TTC riders each and every day, soil and dirt will be deposited on the copper surfaces and this soil will need to be removed with cleaning products.

So what’s my opinion?  I’m not going to count my copper pennies yet.  I think there is some interesting data to show that there could be some benefit to using antimicrobial surfaces like copper.  However, their use and impact in reducing the spread of infections is not clear, and regardless of their use, we will dirty the areas we inhabit.  This means we’ll always need to clean, which as some data is supporting, can impact or reduce the effectiveness of copper. 

Bugging Off!

Nicole

Eye touchers beware!

I have no qualms about touching my eyeballs.  I particularly like doing it in front of people who can’t and get all squeamish and grossed out.  It’s really a good party trick, particularly around a pack of young boys.  However, our eyes are more than the window to our souls.  As a mucous membrane they are one of the areas of our body that can be incredibly susceptible to infections.  Pink eye is a great example, that nasty infection that results in itchy oozing eyes.

As a former contact wearer, the importance of infection control was not lost on me.  Simple things like washing your hands before putting your “eyes” in or taking them out and keeping the contact lens container clean were incredibly important.  Even though I knew this, and thought I practiced good hygiene I ended up with an ulcer in my eye.  My eye doctor suspected my lens solution as the cause and whether it was an allergic reaction or an infection. I was lucky, had the ulcer been in a different location it could have impaired by vision.

Why would you care about my eyes?  Well, I hope you care about yours especially if you happen to live in the UK where Acanthamoeba keratitis infections have been spiking among contact lens users.  The recent outbreak has UK Health experts urging contact lens users to be more careful.  According to the study that was published in the British Journal of Ophthalmology, the rate of Acanthamoeba keratitis infection has gone up by 3 times since 2011.  This type of infection is usually considered rare with only 2.5 people / 100,000 every year.  The study found that reusable contact lens users who had eye infections were more likely to have ineffective contact lens solution, contaminated lenses and overall poor contact lens hygiene.  Aside from poor hygiene, wearing contact lenses while swimming, using hot tubs or showering can also increase the risk as the amoeba can be found in bodies of water, soil and even air.

Moving to disposable lenses eliminates the need for contact lens cases or contact lens solutions.  However, while they reduce some risk factors the use of disposable lenses does not remove the need for proper hand hygiene.  The long and the short is if you use contacts or if like me you frequently touch your eyes make sure your hands are clean before handing the contact lenses or touching your eyeball!

Bugging Off!

Nicole

#FF Fall for Fun!

I have a love hate relationship with fall.  As much as I love watching the leaves change colour, and don’t mind the cooler nights for sleeping, I know that cool is going to lead to cold….   It also means hockey season starts in full force so when it’s warm and sunny outside, I can be found often wrapped in a blanket at the rink catching up on reading or listening to podcasts and teleclasses while pretending to feign interest in the practice.

As noted in past blogs, the Teleclass Education by Webber Training is an international lecture series on topics related to infection prevention and control. The objective is to bring the best possible education to the widest possible audience with the fewest possible barriers when trying to access it.  Here's the list of teleclasses for the fourth quarter of 2018.

For more information on Webber Training, including a full list of the upcoming Infection Prevention and Control Teleclasses, please visit www.webbertraining.com.  If you’re a Twitter follower you can also be part of the conversation during the sessions by following #WebberTraining.

I hope many of you will take the opportunity to listen to these teleclasses and share them with your colleagues!  

Bugging Off!

Nicole

Disinfectants cause obesity?

I’m female.  Of course I have been on a diet.  I don’t exactly come from “skinny” stock, but after years of trying (successfully or not) to maintain a healthy weight I’ve come to the realization that any weight issues I have are not my fault.  They are my mothers due to her overuse of disinfectants when I was a child.

Or at least that is how I could interpret my battle with the bulge after reading a study recently published in the Canadian Medical Association Journal.  According to the study, the use of household disinfectants could increase the risk of children becoming overweight by altering the makeup of their gut bacteria (their microbiome) during the first few months of life.  As our understanding of infection prevention improves, so to does our use of hand sanitizers and disinfectants.  

In a blog from 2014, I talked about a study showing that different homes harboured different populations of bugs and that these populations closely matched the microbiomes of the residents.  As disinfectants and hand sanitizers are agents that are designed to kill microbes (good or bad), in theory the concept that the use of disinfectants could impact our microbiome is plausible. 

The study looked at over 750 infants and while I will not get into the specifics of what gut microbiota increased or decreased, suffice it to say, the researchers concluded that exposure to household disinfectants was associated with higher BMI at age 3 and that children were less prone to being overweight in households that cleaned with eco-friendly products.

With cold and flu season virtually upon us, it’s important not to jump to conclusions.  The researchers did note that there were a number of limitations in their study.   For example, the status of infant exposure to cleaning agents was assumed from parent report meaning recall bias is a very likely possibility.  The study did not differentiate cleaning products by brand name or the presence of specific ingredients meaning the results lumping every active ingredient together and not accounting for the known health and safety issues with some active ingredients.  Further, the eco-friendly products did not list ingredients on their labels.  Lastly, the gut microbiota was from a single point in time nor did they account for any interventions in the child’s life (e.g. exposure to antibiotics) that may have occurred during this time.

What does this all mean?  Well, we know that chemicals found in common cleaners and disinfectants can have negative impacts on our health such as asthma or cancer.  We know that the purpose of disinfectants is to kill indescriminantly meaning that there can be the opportunity for “bad” bacteria to overpower “good” bacteria.   We also know the same is true with the use of antibiotics.

My conclusion is that the study is interesting, but further studies are required to better understand the mechanisms through which disinfectants or cleaning products may alter our micrbiome and what that change may have on our health.

Bugging Off!

Nicole

Do you need to declare hitchhikers after using airport security bins?

Travelling can be fun, particularly if you’re heading off on vacation.  Perhaps a little stressful when travelling with a family, but once you get through the hurdles of security and customs it’s generally smooth sailing.  For most, security and customs is the most stressful part of the trip.  You’re stuck in lines.  You never know when you’re going to pull the dreaded “SSSS” card and get to have a complete search; body, shoes and luggage.  You’re inches behind the person in front of you and only have inches between you and the person who happens to be breathing down your back.  If you’re really lucky, the people in front of you are leaving on their honeymoon and can’t keep their hands or mouths off of each other.  While I prescribe that PDA’s are not needed at any time of the day, I particularly have no interest in observing prior to 9am in the morning...

I’ve written previous Talk Clean To Me blogs about the perils of travel and the fact that bugs can be found on everyone and anywhere.  If you want or need a refresher of how gross travelling on planes can be, you can check out I’m leaving on a jet plane and I fly, you fly we all share bugs together.   We all know that the plane itself can be a hotspot for picking up bugs, and due to the lack of hand hygiene, bathrooms, elevator buttons, hand rails etc. can be contaminated. However, have you thought about the level of contamination on one of the first items we touch at airports?  After we get our tickets, where do we line up?  Security.  What happens there?  We stand in line with 100’s of other people.  What do people have in common?  We carry or may be carrying germs.

A new study published by researchers from Finland and Britain found that half of the grey plastic airport security bins may be carrying infectious viruses.  The researchers took environmental swabs and tested them for influenza A and B viruses, respiratory syncytial virus (RSV), adenovirus, rhinovirus and coronaviruses (e.g. SARS and MERS).  Of the 90 environmental samples taken in total, 8 were from the grey bins.  While a very small sample size, 4 of the 8 were found to have respiratory viruses while none of the 42 samples taken around toilets showed any sign of the viruses. 

Similar to any commonly touched surface, this really shouldn’t be surprising.  At Toronto Pearson Airport about 1,100 flights take off per day.  If you consider that the smallest plane only carries around 14 people and the largest carries 525 people, there are a WHOLE LOT of people going through security and using the grey bins.   Where people congregate, germs are sure to be found.   It’s unrealistic to think that the bins are going to be cleaned and disinfected between uses.  An airport is not a hospital.  We can hope that they are cleaned daily, but the likelihood is that they’re only cleaned when visibly dirty.  It’s up to us to protect ourselves.  Wash your hands or use the hand sanitizer that is very likely hanging on your briefcase, your purse or laying at the bottom of your bag.

Bugging Off!

Nicole

Are hand sanitizers losing their battle with bugs?

With the start of school most of us are preprogrammed to believe that summer is over.  Summer is a time of indulgence, a time to let your hair down and enjoy.  Unfortunately for some of us that means come fall our clothes may fit a bit differently than the last time we wore them!  We’ve lost the battle to the bulge.

What other battles are we loosing as we go about our daily routines?  I think we can all agree that hand sanitizers have become a staple in our lives.  They’re in our children’s lunch bags, in our purses, attached to our briefcases and probably stashed in places we’ve forgotten about.  It’s because of this rampant use of hand sanitizers that a recently published study I came across is so interesting.  Conducted by a group of researchers in Australia, “Increasing tolerance of hospital Enterococcus faecium to hand-wash alcohols” is something you may want to read.

Antibiotic resistance is a well-known phenomenon.  It occurred as a result of widespread and overuse of antibiotics prescribed to patients.  With hand sanitizers moving to mainstream use within the community and not just in healthcare facilities have we potentially repeated history and will start to see resistance of pathogens of concern to hand sanitizers?  According to this study that very well may be the case.  The study investigated 139 samples of Enterococcus faecium.  The samples were subjected to different strengths of alcohol ranging from 23% to 70%. The samples had been taken over a 19 year period (1997 – 2015) and they found that samples from 2010 on were 10 times more resistant to alcohol.  Could this be in part an explanation to the increased numbers of HAIs associated with Enterococci?  The development of resistance to hand sanitizers would certainly complicate our infection control practices.  Additional measures or procedures would need to be put into place to reduce the risk of further resistance development.

Before we cry wolf, this is the first study to show such an occurrence.  While both interesting and concerning we can’t jump to conclusions.  That said, I hope that we have learned from our past mistakes and take a more serious look to determine if this truly is happening and if it’s happening on a global basis we seriously contemplate what we need to do to slow the resistant development down.  Enterococci are as we know widely resistant to multiple antibiotics.  Hand hygiene and surface disinfection is our first line of defense when it comes to infection prevention.  Alcohol is used in lower concentrations in many of the surface disinfectants we use.   We cannot afford to have our hand hygiene or surface disinfection products develop resistance or we’ll really be up the creek without a paddle!

Bugging Off!

Nicole