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Friday, May 26, 2017

Conference Conversions and Controversies

Can you believe that next week we’ll be heading into June?  I truly have no clue where the first 5 months of this year have gone.  For those of us in the North American Infection Prevention community, June signifies the highlight of our year – it’s conference time!  I’m fortunate enough to get the opportunity to attend both the APIC and IPAC-Canada conferences.  I will say though, that I’m not looking forward to my red eye back to Toronto from Portland and only being at home for less than 28 hrs before I head off to Charlottetown for the IPAC-Canada conference.  Regardless of how tired I will be, the line-up of speakers and topics looks amazing - and I’m not just saying that because I was lucky enough to be chosen to present at the APIC conference!

Education and networking is vitally important to our ability to keep up with the ever changing world of infection prevention.  Whether we’re concerned with learning more about the newest pathogens of concern such as Candida auris, looking for a faster and safer way to disinfect the surfaces in our environments, finding an automated way to monitor hand hygiene or figure out how to reprocess that new medical device that just showed up in your OR, there is always something to learn and always that pearl of wisdom or nugget of knowledge that you can take back to your team.  A good conference should also have some controversies.  I’m not talking about fisticuffs or hair pulling, but a good old fashion debate and difference of opinions.  Some of my favorite sessions I have attended over the years are ‘debates’ where the session pits two people against each other taking opposing sides of the argument.  The first such session I saw was at the IFIC conference in Malta back in 2003.  I’m not going to name the speakers but there was “Pro-Disinfection” and an “Anti-Disinfection” speaker, and WOW being only 6 months into my career in the world of infection prevention I was both star struck and mind boggled with the polar differences in opinion.

 I’m not sure now almost 14 years later, that the same debate could be had, as a lot has transpired with respect to our understanding of the importance and impact that environmental hygiene has on our infection prevention programs.  One thing that I can still say exists even after all of these years is the seemingly endless myths and misconceptions about disinfectants.  Looking back through my files, I found an article I wrote back in 2008 – Myths and Facts about Infection Prevention that I would like to say we’ve been able to bust the beliefs of many about who are responsible for infection prevention and how we can all benefit from understanding how pathogens are transmitted.  I’m sad to say that some of the myths about disinfectants still hold true.  In fact my “protégé” wrote a blog – The Infection Prevention Army Dispels Disinfection Myths - this week on myths we still routinely hear about and try to educate against.

If you check out the Insights Blog you might also be wondering who this Microbe Militia is!  You’ll have to stay tuned for the next 3 weeks as we slowly unveil our newest education campaign and if you’re at APIC or IPAC-Canada, you’ll get to see it firsthand!


Bugging Off!


Nicole

Friday, May 19, 2017

Will dinosaurs save our future?

I’m not sure why, but pretty much every kid in the world goes through a “dinosaur phase”.  The timing seems to be kid dependent in terms of age, but without fail, there is a time where they eat, sleep and breathe dinosaurs and it’s funny as heck when they start pronouncing some of the names – tyrannosaurus, triceratops, and parasaurolophus. You name it, they try to say it or worse, make you try to say it!   My son went through the phase and at 8, still waffles in his love of reading about, learning about and playing with dinosaurs.   He also likes to correct me when I say the name wrong….not to worry, as a good parent and lover of microbes, I shoot back trying to get him to say Trichophyton mentagrophytes or Acinetobacter baumannii.  Yep, I’m mature.

I may have geeked out a little when my worlds collided last week. I thought “Wow, dinosaurs and bacteria, how cool is that?”.  A new study published in Cell, looked at the evolutionary history of Enterococci.  These particularly pesky pathogens (a.k.a. VRE) have become the bane of our existence in hospitals, with their ability to become antibiotic resistant and survive in the environment for “eons”.   The researchers analyzed the genomes and behaviours of today’s enterococci and then “rewound” the clock by tracking through history back to the earliest existence of this group of bacteria.  As we now know, bacteria have been around virtually ‘forever’.  As animals started to emerge from sea to land, so too did bacteria.  As we know, there are bacteria humans need in order to lead healthy lives and there are also bacteria that can cause us significant distress.

The study allows us to better understand what type of environment bacteria can live in, what they need to survive and what mechanisms they can develop to ensure survival.   Having a clearer understanding of these requirements, could help us predict how bacteria will adapt to the use of antibiotics and antimicrobial agents, such as disinfectants or hand hygiene products. 

It’s interesting, we often talk about learning from our mistakes.  We’re quick to discount history or listen to our “elders”.  A quote from a recent article I read on millennials in Harvard Business Review states “We are a generation that is ruthlessly comparing ourselves with those around us and our role models at the same time. And if we are not doing something exceptional or don’t feel important and fulfilled for what we are doing, we have a hard time.”   Is this so different from all of us? We want to learn on our own, we want to prove our worth to others.  Perhaps we all need to stop trying to prove how good we are and spend more time looking back through history.  It’s not that we’ll be learning from our mistakes, it’s that we now have the ability to learn, to understand, to truly investigate and uncover what happened in the past.  Perhaps this is the way we will continue to survive in the future and win the battle over the bugs!  I joked last week in my “Wives’ Tale” blog that cow manure can treat athlete’s foot.  Perhaps studying history will teach us that we’re trying too hard to come up with new ways of fighting pathogens.  Maybe the answer is something far simpler….


Bugging Off!


Nicole 

Friday, May 12, 2017

A tribute to our mothers

This Sunday is Mother’s Day.  I’m sure many of you have plans of lavish family dinners.  I’m looking forward to a quiet weekend at our cottage watching the river flow.  I thought in tribute to our moms, I would have some fun reviewing “old wives’ tales” associated with infection prevention….well infection treatment to be exact.  If you’ve watched the movies or read the Hunger Games trilogy, you’ll recall that each year a female and male “tribute” were chosen or forced to participate in the annual games that were played until only 1 tribute remained standing. I chose to title the blog a “tribute” because as you’ll read below, if many of these were practiced on us, we’d likely not be here…..  

Wives’ Tale #1: If you go outside with wet hair, you'll catch a cold.
Cold weather, wet hair, and chills don't cause colds or the flu; viruses like rhinovirus, influenza etc. do. These viruses are spread more easily indoors, where there may be more contact with dry air and people with colds, which as we know is why we consider late fall and winter prime cold and flu season.  Dry air — indoors or out — can lower resistance to infection.  Having wet hair, while it may freeze and get crunchy, will not cause you to catch a cold.

Wives’ Tale #2: Cover your mouth with your hand when you cough to prevent spreading colds.
It is true we should cover our mouth and nose when we cough or sneeze, thereby trapping the viruses and preventing their spread.  However, if you use your hand, your virus laden hand becomes the perfect weapon for passing your cold on to someone else. You’ll also leave viruses on doorknobs, phones, countertops, elevator buttons and anything else you touch!  To prevent such icky transmissions, be sure to wash your hands frequently, and use a tissue or, if one isn't handy, cough and sneeze into your elbow. 

While the next three tales may be considered more “folk magic” then wives’ tales, in investigating preventions and cures, I came across an interesting site that definitely had me thanking my lucky stars I was born when I was!

Wives’ Tale #3: Sticking your hand in a bag will cure warts.
The theory was that if you had warts on your hand, you should stick the infected hand in a bag and tie it.  The first person to untie the bag will get your warts!   It’s no wonder that early healers were called witches and persecuted.  What kind of cure is one that infects someone else!  Although I suppose if the person who untied the bag was, say, an ex-girlfriend/boyfriend, irritating older or younger sibling and/or the person you despise the most, then if it worked you’d get to have the last chuckle!

Wives’ Tale #4: Cow dung cures all.
Okay, it doesn’t cure all, but according to the wives’ tale list I found on a self-care and home remedies site, stepping in warm cow dung cures athlete’s foot.  Growing up on a farm I can say I’ve stepped in my fair share of cow paddies – and yes one or two times I may have been bare foot, but I can say with all honesty it was not to try and cure an itchy foot!  While gross, there could be some merit as cow dung does have a pretty high ammonia content and ammonia is known to have antiseptic properties.  If I ever get athlete’s foot maybe I’ll give it a try!

Wives’ Tale #5: Cure a sore throat with a dirty sock.
According to this this tale, you need to take a sock that you've worn until it stinks and then tie it around your neck and keep it there until your throat heals.  This one is laughable, but if anyone would like to try, I would be happy to send one of my 8-year old son’s socks after he’s worn them for a day and played some hockey!  My guess on this one is that you’re so focused on trying not to wretch or vomit from the smell that you forget about the sore throat….

This last one is one that I can get behind.  It was one that my mom used on us and I still use to this day!

Wives’ Tale #6: Honey will sooth and treat a cough.
If you’ve never tried it, then the thought of using honey to treat a cough may sound like a hare-brained idea that came about one late night when you ran out of cough syrup and all the drug stores were closed.   Why not?  Honey has the same consistency as cough syrup, and hopefully the placebo effect will be strong enough to let everyone get back to sleep!  Whoever started this old wives’ tale was on to something, as studies have been conducted proving that honey is better than the drugs used in cough syrup at relieving cold and cough symptoms. Researchers think that the stickiness and viscosity of honey is what helps it alleviate coughs, while the natural antioxidants can help in the healing process.

Next week I promise to get back to topic more relevant to cleaning and disinfection but sometimes you need to depart from your scheduled program. Besides, perhaps you’ll feel inclined to create a Mother’s Day gift basket using some of the wives’ tales cures!  Wishing all of the mothers out there a very Happy Mother’s Day!

 
Bugging Off!

Nicole

PS – I would love to hear some of the wives’ tales you were told growing up!

Friday, May 5, 2017

Not ready to back down

I knew the topic for this week’s Talk Clean To Me blog would be about Hand Hygiene, after all May 5th is World Hand Hygiene Day.  I had planned to share links to the hand hygiene videos that I found most entertaining – you know all those videos that facilities have been creating as an entertaining way to get people to realize just how important washing your hand is?  The intent behind these are of course to create a clear, compelling and hopefully memorable message that resonates with the viewer so that they will take action and become part of the Clean Hands Coalition.

It would be fun.  It would be cute. 

This morning I came in as I do each morning, a little earlier than most to have some quiet time and set myself up for the day.  As is my morning ritual, I scan the various news feeds and chat groups I follow, read a few articles, and check out what’s going on in the world.  This morning, an article popped up from a colleague.  It was a heartfelt article about how he almost lost his mom to a Vancomycin-resistant Enterococci (VRE) infection.  It made me realize that fun and cute was not working.  Fun and cute, while well intended, was not getting a clear, compelling and memorable message across about the importance of hand hygiene.  It made me wonder if we’ve become numb to the stats that are spewed almost daily about HAIs.  It made me wonder if we have become too laissez-faire when it comes to hand hygiene and its impact on the health and welfare of those around us.  Those that our jobs directly impact and those that our actions can directly harm.

The definition of laissez-faire is the practice or doctrine of non-interference in the affairs of others, especially with reference to individual conduct or freedom of action.  How frequently do you tip toe around your colleagues?  How frequently have you seen firsthand someone not wash their hands before an aseptic technique?  How frequently have your witnessed someone wash their hands only to contaminate them by touching a surface before providing patient care?  I know I have.  I know that I have kept quiet because I was in the room observing how it was being cleaned but saw firsthand a nurse perform an aseptic technique after her gloves were on and after she had touched numerous surfaces.

I’m Canadian.  We’re known to be nice.  We’re known to be polite.  Perhaps it’s time to change.  Perhaps it’s time to drop our laissez-faire attitude and get right up in the face of those you see do something wrong. 

Thanks Rick for the heartfelt article.  Thanks for being the inspiration to look at things differently.  This may not be the most “clear, compelling and memorable” blog I’ve written, but you can be darn sure the next time I see someone not wash their hands and put a patient in risk, I’m going to call you out on it and if I offend you, then so be it!  To quote the lyrics of the Dixie Chicks “I’m not ready to be nice, I’m not ready to back down.


Bugging Off!


Nicole

Friday, April 28, 2017

Is snot our newest Superhero?

I’m hoping there are a few of you who like to shock, awe, or gross out your family, friends and colleagues.  Juvenile perhaps, but is there anything better than watching people squirm when regaling a tale?  I take great pleasure in grossing people out by talking about something I find fascinating, knowing others likely don’t feel the same.  By noon today I had was able to hit on 3 different stories – screwworms in Key Deer, the topic for today’s blog and my Sunfish story (message me if you want to hear that one!).

I will admit talking about boogers, snot, mucous, and phlegm is gross.  Truthfully, it grosses me out, but yesterday I came to realize that snot may be our newest superhero friend in the fight against antibiotic resistance!  According to researchers at the Massachusetts Institute of Technology we may have found a new way of combating problematic pathogens.  If we think of this logically, mucous is everywhere in our body (mouth, eyes, lungs, nose, digestive tract, etc.) and microbes are also widely found within (e.g. digestive tract) and on our bodies (e.g. skin flora).  By understanding the functions of the slimy substance we refer to as snot or mucous, the researchers were out to determine how it works to protect us.  It’s not our next silver bullet for killing, but it seems to be excellent at taming pesky pathogens.

As the study describes, when looking at two different bacteria known to compete for dominance in human mouths, synthetic mucous impacted bacterial populations. They found that when the samples were grown outside of the synthetic mucous the bacteria known to cause cavities prevailed. However, when the samples were grown in the presence of the synthetic mucous the bacteria associated with good oral health prevailed.  From this, it would appear that mucous could be key to maintaining a healthy microbial diversity in other areas of our body.  Furthermore, work is being conducted around the world looking at how and if the synthetic mucous can in fact help control problematic pathogens both inside and outside of the body.

Perhaps the next time you see someone picking their nose and wiping it on a surface or hacking up phlegm and spitting it out, while still gross and generally unacceptable from a social perspective, you’ll wonder how quickly it tames whatever pathogenic bacteria are present.  The possibilities could be endless!  Will synthetic snot be our next antimicrobial surface coating? We’ve gotten over the ick factor of fecal transplantation for C. diff management…perhaps we’ll be popping phlegm pills in the future!

Either way, I think this is a fascinating topic and look forward to keeping up with where the research goes!


Bugging Off!

Nicole

Friday, April 21, 2017

Do you have a Preventative Maintenance Plan?

If you have a car and live in an area where snow is a winter fact, you likely have winter tires; and with spring arriving, you’ve likely been to your mechanic to have your winter tires swapped out for your summer tires.  You may also have timed the tire change with a LOF (Lube-Oil-Filter) and maybe changed out your windshield wipers.  We understand that when we drive a car we need to do more than just fill it up with gas.  Many of us are also probably pretty good at our own preventative maintenance plan for our health and well-being with annual physicals, eye checkups, working out, eating and sleeping right and if you are like me, your preventative maintenance plan also includes hair appointments, manicures and pedicures!

I would hazard a guess that most of us recognize that virtually any piece of equipment we use, in order to be effective at our jobs, also needs preventative maintenance.  We know that with patient care equipment or other medical equipment this is an important aspect of protecting the lives of our patients.  How many of you consider the dilution systems we use to dilute concentrated surface disinfectants or the associated test strips used to validate the dilution (assuming your facility uses test strips)?  The unfortunate truth is that while we now acknowledge that compliance in cleaning and achieving the contact time as indicated on the label in order to ensure disinfection occurs are important, we do not stop to think of other factors that may impact the effectiveness of our chosen disinfectant.

The one area that we often overlook is the preventative maintenance required to ensure the dilution systems that we rely on to properly dilute the disinfectants are working properly.  Over the course of my career in Healthcare, it never ceases to amaze me that many facilities still fail to consider this.  While I will not name facilities I can say that I have been in more than my fair share of facilities helping brainstorm why a disinfectant seems to be failing to support the infection control program.  When I ask when the last time the dilution system was serviced and / or validation had been done to ensure it was diluting properly I often get blank stares….  

The importance of preventative maintenance on dilution systems is not just to ensure that the product dilutes at the correct concentration to kill the pathogens we’re concerned with, but to also ensure that it is diluting correctly so that the product is safe to handle.  Case in point is a call recently received from a facility who realized the product they were using seemed foamier than normal and a few concerns with skin irritation had been noted.  When looking at the dilution system they found there was no tip on the syphoning tube meaning more product than needed was being used.  When asked about the use of test strips the answer was that the strips were not changing colour.  When asked about the expiry date on the test strips it was determined they have long since expired…

The long and short is that disinfectants must be used in the dilution specified on the product label as indicated by the manufacturer.  The importance of this is not just for optimal decontamination, but also for optimal occupational health and safety of the workers using the disinfectants and the patients who may come in contact with the disinfectant.  I hope you’ll go check to find out what your preventative maintenance plan for your dilution systems is – and while you’re at it be sure to check and confirm the test strips have not expired!


Bugging Off!


Nicole

Thursday, April 13, 2017

Volcanic Soil vs Hantavirus

Do you ever get really excited about something, only to have the rug pulled out from under you?  That happened to me this week.  In scanning through my e-newsletters and outbreak summaries I came across an article “Ugandan outbreak of elephantiasis linked to walking barefoot in volcanic soil”.  As geeky as I know I’m going to sound, without reading the article I was giddy and I had already come up with how I would start the blog by tying in the fact that I HATE sand.  I know it’s rather ironic having just gone on vacation to a beach resort, but I really do HATE sand and assume the same would be said of volcanic soil.  It gets everywhere and I particularly HATE walking in sand – the feel on the bottom of my feet, the feel when it gets between my toes….  Ask my husband, me walking on sand is akin to a cat outdoors walking in snow.  You know that pick foot up and shake before you put it down again?  That’s me. 

Then I read the article and learned that the elephantiasis was not being caused by an infectious organism.  It was actually caused from walking on the volcanic soil itself which has sharp mineral crystals that penetrate the soles of feet and cause inflammation and pain…  There was no tie in with disinfection of hands, surfaces or devices which is the intent of Talk Clean To Me….  The rug had been pulled out from under me.

And then this morning, I came across an article stating that the first person for 2017 in New Mexico has died from Hantavirus.  While no death from an infectious agent is funny, I had to chuckle a bit as several years ago I involuntarily acquired a “bestie” who called concerned about finding a mouse nest in his boat when he went to launch it in the spring.  The conversation was memorable because it did not just end with one call, but over a couple of years each spring I would get a call to confirm how to deal with the newest mouse nest he found to ensure he did not get hantavirus….

Hantaviruses are a group of viruses, carried by rodents, particularly wild rodents such as deer mice, white-footed mice and several species of rats.  Hantaviruses found in North, South and Central America, can cause severe respiratory (lung) disease in humans.  They are transmitted to rodents and humans alike, via both direct contact through bites and via aerosolization of dust contaminated with rodent droppings, urine or saliva.  While human infection concerns exist in environments where rodents may be, pets and livestock do not have any concerns with becoming infected with hantavirus.  That said, if you happen to have a pet mouse or rat, you do want to keep them away from wild rodents to avoid transmission.

If you’re doing any form of spring cleaning – particularly in a cottage or boat that may have been closed up for the winter, a few key tips to avoid infection include: wearing rubber gloves when cleaning areas where rodents may have been, allow the area to air out before entering, wet surfaces with a disinfectant and avoid sweeping or other activities that raise a lot of dust.  If you’re concerned with raising dust, then wear a face mask to protect yourself.

Happy spring cleaning!


Bugging Off!

Nicole