Custodial Chemist - Mixing Acids and Bleach

I hate news that talks about death.  I especially hate it when it could be avoided.  Case in point was the death of a restaurant worker last week in Burlington, MA.  A 32-year-old man lost his life and 14 others were affected by the incident.  The cause of the accident was mixing of cleaning chemicals.

According to reports, an employee was cleaning the floor of the restaurant and used two different products.  One was a bleach-based product, the second an acid cleaner.  Unfortunately, when you mix these two chemicals together it causes a serious chemical reaction. When bleach is mixed with any acid, it releases highly toxic chlorine gas.  The acrid fumes of chlorine gas are capable of can destroying lung tissue and can cause the lungs to fill with fluid.  The end result in essence is death caused by drowning. 

Long story short, NO acid must ever be mixed with chlorine bleach. This includes acidic drain cleaners, rust removers and even vinegar (acetic acid).  

Back in 2011, I coined the term “Custodial Chemists”.   The Custodial Chemist is a group of people that believe that their collective years as professional cleaners make them far more knowledgeable then formulating chemists who have years of higher education and develop the products the Custodial Chemists use. The Custodial Chemist is someone who mixes products together in the belief they are making a better product (or simplifying their job). Why use a degreaser or glass cleaner followed by a disinfectant when you can mix them together and create a degreaser-disinfectant or the best disinfectant glass cleaner on the market.

The situation that lead to this happening was likely due to the fact that the employee (a Custodial Chemist) did not know or understand that bleach and acids should never be mixed and what the resulting consequences could be. 

Employers are required by law to provide training on the use of cleaning and other chemicals PRIOR to their use because chemicals pose such a wide range of health and safety hazards.  OSHA’s Hazard Communication standard (29 CFR 1910.1200) is designed to ensure that information about these hazards and associated protective measures is communicated to workers. Under OSHA’s standard, the required training should include:

1. Health and physical hazards of the cleaning chemicals
2. Proper handling, use and storage of all cleaning chemicals being used, including dilution procedures when a cleaning product must be diluted before use
3. Proper procedures to follow when a spill occurs
4. Personal protective equipment required for using the cleaning product, such as gloves, safety goggles and respirators
5. How to obtain and use hazard information, including an explanation of product labels and SDSs

This is an unfortunate accident that left a 3-month old baby boy without his dad.  As employers, it is our duty to ensure our employees are kept safe and have the appropriate training to do their jobs safely.  As employees, it is our duty to ask questions, assume we do not know everything and work in a manner that is going to keep us safe.

Bugging Off!

Nicole

Common Sense or Panic & Paranoia?

Rightly or wrongly, a good outbreak can be exciting.  Don’t get me wrong, it’s not the impact of illness that interests me – I’m not that heartless.  What fascinates me is what we learn when a new “bug” pops up or what we “relearn” when we get hit by “bug” we know how to handle.  When it comes to infection prevention, we cannot relax and become comfortable because everything is ticking along smoothly and most importantly, just because nothing has happened in a while we cannot afford to lower our defences.

That said, keeping ourselves and others healthy is about finding the balance between being too cavalier and too paranoid.  Take a recent article I read about the cleanliness level of highchairs in restaurants in the UK.  The BBC revealed that restaurant highchairs are dirtier than tables at several different restaurants.  Surprisingly to some, the highchairs tested at McDonald’s were cleaner than the tables.  While the level of bacteria found on the highchairs was significantly higher than expected, it was still not at a level that would cause health concerns.  Of concern was the fact that coliform bacteria were found, as this type of bacteria is associated with waste from humans and animals.  In fact, coliform bacteria are often referred to as "indicator organisms" because they indicate the potential presence of disease-causing bacteria, particularly in water.   Thankfully, the bacteria found on the highchairs can easily be removed and/or killed with diligent cleaning, sanitizing or disinfection. 

The question is if as a society we need to start to panic that highchairs in restaurants could be the harbingers of doom for our babies.  Let’s mull this over and use a little common sense.

1. Unlike viruses, bacteria have the ability to reproduce.  When conditions are favourable such as if the right temperature and nutrients are available, some bacteria like Escherichia coli can divide every 20 minutes. This means that in just 7 hours one bacterium can generate 2,097,152 bacteria.
2. A large percentage of infections and outbreaks are spread by contaminated hands. Appropriate hand washing practices can reduce the risk of foodborne illness and other infections.  According to the WHO, adherence to HH by HCWs ranges from 5% to 89% with the overall average being 38%!  If healthcare workers have poor hand hygiene practices, you can be sure the public is much worse.
3. Highchairs in many restaurants are often stored in readily accessible areas, meaning they could be considered a high touch surface.
4. Depending on the restaurant, highchairs may sit for some time between usages. 
5. Cloths used to clean surfaces where food is prepared need to be changed regularly or thoroughly disinfected to prevent the growth of bacteria.  Bacteria on uncleaned cloths can transfer to the hands of staff then on to work surfaces, equipment and utensils.

What does this mean?  Well, pathogens are easily spread from hands to surfaces and surfaces to hands.  Restaurants tend to use the reuse cloths for cleaning tables.  As the cloth picks up food and germs it has the ability to redeposit the soil and/or pathogens to another surface helping them spread and proliferate.  Bacteria can quickly reproduce, so if you have a highchair that has not been cleaned for a while, was poorly cleaned after its last use or in an area where you have umpteen people and kids touching it (most likely with dirty hands), you can be assured that germs will be present and they are likely multiplying at an alarming rate.

What is my take-home message?  If I’m concerned with protecting my loved ones - and young ones in particular who have undeveloped immune systems and are more susceptible to picking things up – then I’m not going to panic or become paranoid about how well a restaurant has cleaned the highchair.  I am going to assume that it has been touched by others after it has been cleaned.  I am going to assume that it has been sitting around for a while between usage and I’m going to assume that it’s dirty.  I am going to clean the highchair before I put my young one it in.

Thankfully, my young one is well past the highchair stage.  He has not yet gotten past the stage of me having to nag him to wash his hands before he eats!

Bugging Off!

Nicole

Turtles and Halloween Horrors

It’s a rainy Halloween Eve in my neck of the woods.  Thankfully, I have a cold so I pleaded the fact that I need to stay in and not get wet and chilled.  Instead, I sit here stuffing my mouth with chocolate, sipping on an adult beverage and while I wait patiently for the next trick-or-treater to arrive. 

The “turtle” part of the blog is because there is currently an outbreak of Salmonella across 13 states that has been linked back to pet turtles.  According to the CDC as of Wednesday, twenty-one people have been infected with Salmonella oranienburg with seven of those cases requiring hospitalization.  Thankfully there have not been any deaths.

California had the most reported cases at six, while Illinois, New York and Washington have also reported multiple cases. This is not the first outbreak associated with pet turtles.  People that own or come in contact with pet turtles should always wash their hands thoroughly with soap and water after handling.  While turtles may look cuddly, you should also avoid kissing or snuggling them or let turtles roam freely where food is prepared or stored (e.g. your kitchen).  Another thing to avoid is cleaning a turtle's tank, toys or supplies in the kitchen.  If can clean it outside the house, that would be the safest!

So how does an outbreak associated with turtles go with Halloween horrors?  Why Salmonella of course!  I mean who would not Google “Salmonella outbreaks associated with chocolate”!?  While I was hoping for none, that did not happen.  I’d forgotten the outbreak earlier this year associated with chocolate-covered cream puffs.  Back in 2006, Cadbury had to recall more than 1 million of its chocolate bars and ended up pleading guilty to nine charges relating to breaches of food safety regulations.  In 2018, the company that makes Duncan Hines desserts recalled four types of cake mix after Salmonella was found in their “Classic White” mix.

Symptoms of a Salmonella infection include diarrhea, fever, and stomach cramps about 12 to 72 hours after being exposed to the bacteria. The illness usually lasts four to 7 days, and most people recover without needing treatment.  So, if any of the candy you or your kids eat has been contaminated with Salmonella you can expect to be sick as early as tomorrow.  Since candy can be a bit like Russian roulette, assuming it takes you a week to finish anytime between tomorrow and up to the 10^th of November puts you in the 12-72 hr window!

Bugging Off!

Nicole

Top 10 Health Hazards for 2020

You never know what can impact our health.  Certainly the media does a great job sensationalizing outbreaks.  If that’s not bad enough we can have disagreements among “experts” as to what is safe or what can pose a long term risk (aka the vaccine debacle of a falsified study linking vaccines to autism).  We know that hand hygiene and disinfection - or lack thereof - can directly impact our health through the spread of hospital associated infections. 

The ECRI Institute recently published their “Top 10 Health Technology Hazards for 2020”.  The intent of the report is to inform healthcare facilities of potential risks associated with the use of medical devices or systems.  The list is compiled from insights gained through investigating incidents, testing medical devices in the ECRI lab, observing operations and assessing hospital practices, reviewing literature and speaking with healthcare providers.  The 2020 list includes:

1. Misuse of surgical staples
2. Adoption of point-of-care ultrasound is outpacing safeguards
3. Infection risks from sterile processing errors in medical and dental offices
4. Hemodialysis risks with central venous line catheters (will home dialysis increase dangers?)
5. Unproven surgical robotic procedures may put patients at risks
6. Alarm, alert and notification overload
7. Cybersecurity risks in the connected home healthcare environment
8. Missing implant data can delay or add danger to MRI scans
9. Medication errors from dose timing discrepancies in EHRs
10. Loose nuts and bolts can lead to catastrophic device failures and severe injury

When it comes to cleaning and disinfection, sterile processing errors are unfortunately not a new thing.  In fact, in the 2018 ECRI report, a similar issue was identified.  As we know, failure to follow proper cleaning, disinfecting, and sterilization protocols can result in a compromised device—and devastating effects for patients. As our healthcare expands beyond hospitals to outpatient or ambulatory care clinics, medical offices or home care services we run the risk that these settings do not have infection control practices, certified medical device reprocessing technicians or practices in place to audit, monitor and validate that reprocessing practices are being completed appropriately.

What’s concerning is that while we know incorrectly reprocessed devices can be a source for infection transmission we have not yet found a way to stop this from happening.  Certainly, factors such as not cleaning and disinfectant or sterilizing correctly are obvious issues which leads us to question what training is needed and/or how frequently re-training is required.  But aside from human factors what else is at play?  Is the equipment becoming too complex?  In our need to increase throughput and provide services to as many patients as possible are we not giving enough time to correctly reprocess the devices we are using?  Due to the cost of the devices, do we run with too lean of an inventory?  We need to be contemplating more than just the physical reprocessing of devices as the risk; we need to stand back and look at things from every angle.

Bugging Off!

Nicole

Wrapping Up Infection Control Week

I admit, I love Infection Control Week.  In the past I have been fortunate enough to be involved with events at facilities, education days for infection prevention chapters and more recently, we have developed our own infection control week at our company to remind people of how we can keep healthy during cold and flu season.   It’s amazing how our entire company gets into it…..of course the gift certificates may help!

This week we played 'find the plushie bug'.   It took almost the entire day to find one of them so we’ve become great at hiding.  Of course, the message is that you never know what you might find so looking at how you can keep you environment clean via cleaning and disinfection and practicing good hand hygiene are important pillars for keeping healthy.

We’ve had drawing competitions, riddles, cross word puzzles, word searches and word scrambles to complete.  It was interesting how 3 of the winners work in the same area.  We’re pretty sure that they combined efforts in order to win the prizes…..but I guess that could be a discussion for collaboration and how it takes all of us working together to keep ourselves healthy.

Today was one of my favorites – guess how many bugs are in a jar (aka candy).  Unfortunately, since I bought the candy I was not allowed to guess.  What’s worse, I have a cold, so as much as I would like to steal some from who ever won the jars, in good conscience I can’t.  I want to.  It’s a proven fact that if you pass your cold on to one person you will start to feel better.  Which leads me to the next topic: we can learn to help keep ourselves healthy.  Understand the difference between a cold and a flu.

 

Both colds and the flu are contagious and are caused by viruses. The typical incubation period for influenza (aka the flu) is about one to four days, but some adults can be contagious from about one day before onset of symptoms for up to two weeks after symptoms start. For colds, most individuals become contagious about a day before cold symptoms develop and remain contagious for about five to seven days.  I’m on day 2 of symptoms, with luck I’ve passed it on to someone.  Otherwise, but Monday I should less infectious and starting to feel better!

We’re ending our infection control week with a Kahoot quiz.  We have some competitive people at my company, and its pretty fun watching the competition of everyone trying to win the top spot!  I hope everyone has had as much fun with infection control week as we have.  While it’s fun, the reason behind infection control week is not funny.  HAIs kill, and we all have our part to play in ensuring we keep our patients, our friends, our family and I suppose our colleagues healthy!

Bugging Off!

Nicole

#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