#FF - Christmas is Almost Here!

I truly cannot fathom how we have flown through the year and that Canadian Thanksgiving is this weekend!  Fall used to be one of my favorite times of the year.  The weather is cool and crisp, the fall colours are breathtaking, and of course - Halloween. 


As we turn into fall and enter the last quarter of the year, I thought I’d share some upcoming education opportunities! 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 2019:

For more information on Webber Training, including a full list of the upcoming Infection Prevention and Control Teleclasses, please visit www.webbertraining.com.

I hope many of you will take the opportunity to listen to these teleclasses and share them with your colleagues! After all, we’re entering into colder weather so it’s the perfect time to listen to a teleclass while snuggled under a blanket in front of a fire!

Bugging Off!

Nicole

How Dirty is Your Money?

As you know from past blogs, I travel for work.  Travel is a double-edged sword. On the positive you get to see new cities or countries, meet new people, catch up with old friends and if you’re lucky, make new ones!  The downside is that you’re often stuck in cramped places (aka planes), using taxis or Ubers that have not been cleaned after the last people left, often eating from buffet and handling money as you pay for everything.

This week I was in Seattle at a non-infection prevention conference with 4000 people.  I was able to catch up over coffee with an old friend and eat some wonderful local food, but without a doubt observed some questionable infection control practices (e.g. poor and/or non-existent hand hygiene practices made more difficult by the minimal soap that was dispensed….) so I avoided the using any ice and was careful with my choices in food in the buffet line at breakfast and lunch.  Of course, after reading a new study on the trip to Seattle by Andreas Voss from the Netherlands I also chose not to use any cash and stuck to the use of my MasterCard or Apple Pay.

Did you know that by time your money is taken out of circulation it will have touched hundreds and most likely even thousands of people’s hands?   Think about your use of money: we readily withdraw it from the bank, hand it over when purchasing and readily take back the change from strangers.  Just think about how many dirty hands the bill could have touched over the course of its life!  In Voss’ study, they looked at currency from the US, Europe, Canada, India, Romania, Morocco and Croatia and found that our currency can in fact harbor and spread some nasty bugs.  The upside is that currency used by the USA and EU that is made with a mixture of fibers like cotton and stabilizers like gelatin seem to minimize the ability to allow bacteria to proliferate and/or allow those bugs to transfer to the hands of the next users.  The downside is that currency that is more plastic-based seems to have more of an affinity for growing and sharing anything that may be on it.  The study concluded that the Romanian leu, is quite literally the dirtiest money known to humankind!

Voss’ team used MRSA, VRE and ESBL E. coli as their “bugs du jour”.  The bills were sterilized with UV light, squirted with bacteria, and then allowed to dry before being tested at 3, 6, and 24 hours post inoculation.  They also conducted trials with less-dangerous bacteria where test subjects rubbed the bills between their hands for 30 seconds, to see if anything rubbed off.  The good news is that while many bills retained their bacteria after 3 hours, by 24 hours most showed no more bacteria. The big exception was the leu, a polymer-based bill continued to exhibit growth of all bacteria after six hours, and some remaining MRSA even after a day.  When it came to the transfer test, the Euro did not transfer any of the bacteria tested and the US bill transferred single colonies of Staph.  The Leu on the other hand transferred multiple segments of Staph and E. coli.

All in all, the findings - while interesting and a bit gross - are not really a threat to public health.  However, after handling money you definitely want to wash your hands, so be sure to have a tube of hand sanitizer handy! 

Bugging Off!

Nicole

Quills, Hooks and Fungi

Have you ever gone for hike and gotten burrs stuck on your clothes?  Depending on the type of clothing you have on, the hooks or teeth on the burr can bury themselves in and make them virtually impossible to get out.  The same goes for long haired black cats that get up to no good on their nightly walk around.

What do burrs and porcupine quills have in common – aside from the fact that both burrs and quills can attach themselves into your skin and become difficult to remove?  The only reason that I’m talking about them together is that I was reading an article about porcupines when my no-good, very bad long-haired black cat came in covered head-to-toe in burrs.  He was so heavily covered with them he managed to get my son’s Teenage Mutant Ninja Turtle stuck to him as well.

The article I had been reading was discussing a fungal infection that had been found in several porcupines from three states (Maine, Massachusetts and New Hampshire).  The porcupines had been taken to different wildlife rehabilitators and although first thought to have mange, they were actually infected with Trichophyton mentagrophytes, a fungal organism that is commonly found in domesticated cats and dogs, livestock and even humans. 

In humans, Trichophyton is known to cause athlete’s foot.  It is also one of the causative organisms for ringworm.  While Trichophyton generally causes only minor skin infections in humans and most animals, in porcupines the lesions spread to infect the entire body and can become debilitating, and if not treated can be fatal.   While a common fungal organism, this is the first time that Trichophyton has been found in porcupines, and the fact that it has been found in porcupines in three states brings about the question of how the fungal infection is being spread.  While humans and porcupines do not chum around together, this does increase the concern of zoonotic transmission.

Trichophyton can be transmitted by direct contact, by contact with infected particles (of dead skin, nails, hair) shed by the host, and by contact with the fungi's spores.  Porcupines tend to stick close to trees, but can also be found alongside river undergrowth and maybe in the trees by a rocky ledge. They live in dens found in rock piles, caves, fallen logs and trees and like to stay close to home except when they forage for food.  Finding where and how they came across the fungi will be hard to find, but certainly as we expand our reach and take over natural habit of these interesting creatures, the unfortunate truth is that we or our pets could be the source of their woes.

Bugging Off!

Nicole

Are you seeing blue?

Painting ceilings have to be one of the worst jobs there is when it comes to painting.  I would much rather scooch around on my bum painting baseboard then craning my neck staring at a ceiling and hope I do not miss a spot.  There’s nothing worse than ending up with a sore neck, finding the spot you missed and having to go back to fix it.   In my opinion, one of the best inventions was the tinted ceiling paint that went on with a purplish or pinkish tint and dried white.  You could see where you applied and didn’t end up with irritating unpainted areas.

When it comes to cleaning and disinfection two key points of success include ensuring that the product is actually applied to the surface and achieving the contact time.  In recent years a number of studies have looked at ways to improve cleaning and disinfection as there is a direct correlation between the transmission of pathogens and the cleanliness of the environment.  Implementation of training programs that include validation or verification processes using ATP or UV reflective gel to ensure surfaces are being cleaned and disinfected have successfully shown an improvement in cleaning and disinfection.  Additional visual cues to help the environmental services team or nursing staff see where a disinfectant has or has not been applied could further improve outcomes and be a handy training tool for new staff.

In the June ICHE, a study was published looking at the effectiveness of a novel colorant additive to bleach wipes.  Similar to the concept of tinted ceiling plant, the blue dye is applied to the disinfectant wipe via a battery-driven device attached to the top of the wipes canister.  While the concept seems sound and would intuitively be thought to improve outcomes the findings of this study proved differently.  The addition of the dye did improve the cleaning of inner bathroom door knobs, however overall the non-dye impregnated wipes provided better overall results.  The researchers verified that the application of the dye was not impacting or neutralizing the efficacy of the disinfectant and looked to obtain feedback from the environmental services staff.  While they liked how the dye reduced the odor of the bleach product making it easier to work with and the fact that they liked being able to see what areas had been cleaned or not, there was a concern over the fact that residual dye was left on the surface after drying which made for additional work and effort in wiping to remove it.  The researchers then wondered if the discrepancy in the results was due to the fact that larger surfaces were not being wiped down due to concerns with staining.

While it could be easy to assume that the study was not a success, however, we need to remember that innovation takes time and needs tweaks and refinements along the way.  The overall feedback and ability to have a visual cue was positive.  Being able to see what has or has not been cleaned without a doubt can have a very real and direct impact on patient outcomes.  The best part is as this was a prototype, following the study, the company did make modifications to improve the precision in the addition of the dye.  It will be interesting to follow this innovation along and see if it can be improved to remove any concerns regarding staining with its use!

Bugging Off!

Nicole

Do You Really Want that Ultrasound Probe Used on You?

For many, we’re closing in on the 2^nd week of school.   My son has so far avoided catching his first cold of the school season but I’m sure one will hit soon enough - and of course, flu season is only a few short weeks away.  I just hope nothing too serious hits, so that we can avoid doctor’s visits or trips to the ER, especially after reading a recent article about cleaning mobile patient care equipment!

Like our personal devices, mobile patient equipment (MPE) like thermometers, blood pressure cuffs or bladder scanners can often be overlooked in terms of the frequency or thoroughness of cleaning.  While the practice can be relatively simple and effective in removing potential pathogens, it can be more difficult to effectively implement and monitor MPE cleaning and disinfection programs.  This is in part because MPEs tend to move from place to place, so unless you have a ‘tag and bag’-type process to clearly identify dirty from clean devices, it is harder to verify what ones have or have not been cleaned.  This then leads to the issue of potential transmission of pathogens when healthcare workers either fail to clean or use MPEs that have not been cleaned immediately after use on a patient.

A study published in ICHE by Reese et al discussed the implementation of cleaning and evaluation of MPE cleaning.  The study used ATP as their method for validating cleanliness.  ATP can have its challenges, and as the disinfectant or disinfectants used in the study were not disclosed, it is hard to determine if the results presented could have been skewed by quenching or enhancing of the ATP readings as a result from interactions by the disinfectant.    Regardless, the researchers started with a one-month baseline period to gain an understanding of the level of cleanliness of the MPEs.  Following the baseline period, there was a six-month implementation period with weekly ATP testing.  The results were shared with nurse educators and management, and subsequently shared with nursing staff with the provision of ongoing education.  They then entered a maintenance period for an additional six months where ATP results were collected bi-weekly.

Over all, the ATP results and therefore, the cleanliness of the MPEs did improve and was maintained with a 75% improvement in the levels of cleanliness.  The study also highlighted the areas where no significant improvement was seen.  The ultrasound probes tested in the ED consistently had higher than acceptable ATP readings, and this is consistent with similar studies looking at cleaning in the ED due to the large number of patients and high turnover of patients.

So what can we learn from this study?  It highlights that with focus on MPEs in most areas of a healthcare facility, sustained improvements in the level of cleanliness can be achieved which in turn should minimize the risk of transmission of infectious pathogens and improve overall patient outcomes.  It also highlights that the ED is an area of consistent issues in cleaning MPEs. Perhaps due to the nature of the ED with rapid patient turnover, high patient throughput and the fact that many patients can be critical and take more time, additional staff should be responsible for cleaning of MPEs (and perhaps even implementing a bag and tag program) to ensure that ED staff can immediately identify which MPEs are clean and safe to use and which MPEs are dirty and should not be touched.

If you happen to find yourself in an ED, feel free to do your own audit of cleaning.  Unless you’re in critical condition you’re likely going to have time to waste!  The only issue is that conducting your own audit may then make you wish you had just stayed home!

Bugging Off!

Nicole

Practicing Protection or Causing Contamination?

I think it would be safe to say that we have been told that Personal Protective Equipment (PPE) is intended to protect you from infections pathogens.   Gloves are the most commonly used PPE item.  We see healthcare providers (doctors, nurses, phlebotomists, dentists etc.) wearing gloves.  From a healthcare perspective the gloves work in two ways: they are intended to protect us as patients and of course protect the healthcare worker from picking up the bugs we carry.  If you travel, you likely see the TSA officers wearing gloves, and if you’re astute enough you may also see the fact that their hands are sweating in the gloves, meaning they’ve had them on for most of their shift.  In their case, they put them on with the belief they are protecting themselves from the germs we bring into the airport. In reality they really are just becoming a source for moving and most likely transmitting pathogens like colds and flus from all the surfaces they touch during the course of the time they are wearing gloves.  Then there are the food service workers who put on the disposable gloves on before they make our sub.  They change between customers, but do they wash their hands before putting on the next set?  Did they take them off to ring in your order and take your money?  Think on that.

A study published in the March 2019 Special Edition of The Journal of Hospital Infection looked at what role removing and disposing gloves has on contaminating the environment.  In the study, the researchers observed three disposal methods: an underhanded throw or overhand throw into or towards the garbage bin and my personal favorite: pulling on the gloves to stretch and launch into or towards the garbage bin. When surveyed, none of the participating healthcare workers indicated they disposed their gloves by “flinging” and most indicated they “placed” them into the garbage bin.  In practice, no one placed the gloves into the garbage bin.  Most “tossed” them and missed getting their second glove into the garbage bin 50% of the time.  The next favorite disposal method is the “fling” and that method led to a 40% success rate in getting the second glove into the bin.

When researchers sampled the area around the garbage bin, the vast majority of the sampled areas were contaminated by the gloves seeded with bacteriophage. In addition, the fluorescent dye used was found to extend outside of the sampled area and was widely found within a 0.61m circumference of the participant, as well as on their wrists, fingers and forearms.   As expected, the “flight path” of the glove did show contamination, with the highest contamination directly around the garbage bin.

It has been well established that mixed policies from facilities or government, policy ambiguity and lack of in-depth training leads to workplace non-compliance with PPE protocols. In this study it was assumed that all healthcare workers that participated were aware of the CDC doffing protocol and were not using a personally devised protocol.

The long and the short is during the doffing of gloves, the environment and the healthcare worker can be contaminated.  The question then becomes, if a healthcare worker (who undoubtedly at some point has had training on donning and doffing procedures for PPE and would certainly understand the potential impact on their health) can contaminate themselves and the environment so widely, what do you think is happening in industries outside of healthcare, where the training for donning and doffing likely does not take place?

It certainly makes me think of gloves in a different light and you can be sure I will be watching the doffing procedures for gloves.  If “flinging” is involved I just may choose the exit as quickly as I can, and will certainly try to avoid touching surfaces and wash my hands at the first chance I get!

Bugging Off!

Nicole

First Day, First Cold

For many, next Tuesday (September 3^rd) is the first day back to school.   For my son, the emails of who his teacher will be next year arrived and with it, a flurry of texts to all my mom friends to find out who else was going to be in his class.  He got lucky; several of his buddies are with him.  A few of his friends, however, did not get so lucky.  I expect there will be a lot of grumbling around the dinner table on Tuesday as we try to pry out how the first day of school went.

The first day of school signifies a number of things; the end of summer, back to school shopping, nerves over meeting your new teacher and entering a new grade where you know the work is going to get harder.  For parents it also signifies cold and flu days. 

According to the CDC, 40% of children aged 5 – 17 missed 3 or more school days last year because of illness or injury.  If you count up all the students, that means nearly 22 million school days are lost due to colds and 38 million school days are lost due to the flu each year.  Although 3 days may not seem like a lot to our children, I’m sure that for many of you, 3 days of staying home with a sick kid seems like an eternity and invariably we, as the caretakers, end up getting sick.  Thankfully, it’s not that hard to keep germs at bay.

Teach Cough and Snot etiquette because 10,000 is the number of bacteria in a sneeze:

• To avoid spreading germs, teach your child to cough into their elbow and not their hand.  This helps minimizing a germ-laden hand from touching all of the high touch surfaces.  
• Pack tissue in your child’s bag or send a box of tissue they can keep at their desk so that they can blow their nose and dispose of the contents, rather than wipe their nose with the back of their hand and increase the chance for their secretions to be left on another surface for someone to touch.

Teach hand hygiene, because cold and flu germs can survive on surfaces for 72 hours:

• Teach your children early the importance of washing their hands, especially before they eat and always after they have blown their nose or coughed into their hand.
• Help your child’s teacher keep the classroom healthy by donating alcohol-based hand sanitizer.

Help keep the classroom clean, because on average, your kid touches 300 surfaces in 30 minutes:

• This is not just the job of the teacher or custodian.  Send wet wipes with your child’s lunch and have them get into the practice of wiping down their desk top before they eat.  The more frequently the desk top is wiped the less chance germs have to stay on the surface and make your child sick.
•  Provide sanitizing wipes to your child’s teacher for their use in the classroom.  The more readily available they are, the easier it is to wipe down high touch surfaces that everyone in the class touches, which will help stop the spread of germs.

Vaccinate:

• Vaccination is one of the most effective ways to stop the spread of disease.  Before heading off to school, make sure your child’s vaccinations are up-to-date and that they get the annual flu shot.

You can be sure that on Tuesday, aside from taking the obligatory first day of school picture, I’ll be “reminding” my son to wash his hands and help keep the classroom clean! 

Bugging Off!

Nicole