Is Nipah Virus our New Nemesis?

I admit that I’m a bit of an outbreak addict. I’m fascinated, particularly when we’re dealing with an emerging pathogen that we still have much to learn about. In March 2015, I wrote a book review for “Spillover: Animal Infections and the Next Human Pandemic” which was right up my alley focus on emerging zoonotic disease. I’ll be truthful, I’m not exactly sure if there are more diseases popping up or if we are better at finding them and with society being what it is and sharing via social media we hear about them with increasing frequency.

Last week, India announced that a 23 year old college student has been confirmed to have Nipah Virus (NiV). Now there are at least 300 people under observation, but no additional cases have been identified. Nipah virus infection is an emerging zoonotic disease that has the potential to cause severe disease in both animals and humans with outbreaks having occurred in Malaysia, Singapore, Bangladesh, and eastern India. Outbreaks have been associated with close contact with pigs (intermediate host), eating fruit contaminated with saliva or poop from infected fruit bats (the natural host) and direct person-to-person contact. 

Symptoms of NiV are varied including fever, headaches, myalgia (muscle pain), vomiting and sore throat. As the infection progresses, dizziness, drowsiness, altered consciousness, and neurological signs that indicate acute encephalitis may occur and some people can also experience atypical pneumonia and severe respiratory problems, including acute respiratory distress. The incubation period is believed to range from 4 to 14 days and based on data from reported outbreaks the mortality rates are 40% to 70%.

With many countries importing fruits, there is a risk of international transmission via fruits or fruit products such as raw date palm juice that has been contaminated with urine or saliva from infected fruit bats. Luckily transmission can be prevented by washing the fruit thoroughly or peeling them before eating. If you’ve purchased fruit that looks to have bites taken out of it, the WHO recommends that it is discarded and not consumed.

Does this mean we panic? No. But it does remind us that in the world of viruses, nothing stays still and that we must continue to be vigilant and remind ourselves that with globalization, things are closer than we think and can be whisked around the world in under 15 hours (the time it takes to fly direct from Toronto to Shanghai). We’ll never know when an infected person, or contaminated food or object may be on its way to spread disease to unsuspecting populations!   

Bugging Off!

Nicole

Philly Cheese Steaks – Food for the Brain

Next week I’m off to the annual APIC conference in Philly. The 3-day conference (at least the 3 days I’m there), is touting itself as the must-attend event for unparalleled infection prevention and control learning and networking. I’m lucky, one of the perks of my job is that I get the opportunity to attend conferences and soak up as much as I can. 

To say that APIC can be overwhelming is an understatement. If you so choose, there are sessions from 6am, and evening symposiums that run until 8 or 9pm (the non-educational functions run later, if you know what I mean…). The exhibition area is huge, with booths ranging from mediocre to SPECTACULAR, hocking all sorts of infection prevention and control related items… and some not so infection prevention and control related items. The 9 hours of exhibit time over three days requires some serious strategizing to ensure you see everything you wanted to!

From an education perspective, the conference agenda is 41 pages long with topics hitting on virtually any topic related to infection prevention and control. As a lover of all things cleaning and disinfection, if you want to meet up, the following are some of the sessions I intend on hitting: 

 

    1. Hospital Mattresses as a Source of HAIs: Current Recommendations for Disinfection

    2. Interpreting the Results of Microbial Cultures and Biochemical Tests for Residual Contamination on Flexible Endoscopes 

    3. Breaches in Dental Infection Prevention-Could This Be Your Practice?  

    4. The Journey Towards Compliance with Point of Care Pre-cleaning: Developing a Standard Work Document

    5. Disentangling Disinfectants: Considerations for Selecting or Changing Disinfecting Wipes

    6. Bringing Best Practice to Point of Care: Pre-cleaning of Instruments Outside of the OR

    7. I’m Sorry, Did You Say...Prions?

    8. Biofilms: Development, Transmission, Removal, and Disinfection 

    9. Reprocessing Best Practices Can Be Operationalized in Outpatient Clinics-Here’s How!

    10. Sterilization and Disinfection Troubleshooting for the IP

For those of you attending APIC, be sure to find me. I'd love to catch up or meet you for the first time! I'll be tweeting so follow me @nicolecronkenny. If you're not attending, be sure to follow #APIC2019 to keep up with what is being said! The conference as I said promises to cover a wide variety of topics!

Bugging Off!

Nicole

The Horror of Hand Dryers

I just returned from the 2019 IPAC-Canada National conference. Since Friday I have been using public washrooms in hockey rinks, hotels, restaurants, conference centers and airports. It’s no secret that I’m not a fan of public bathrooms. They can be dirty. They can lack amenities (aka TP and soap) and whats even more disgusting, is that they may have only the option to use hand dryers. My dislike for hand dryers stems too much reading, but also observing what the area around hand dryers looks like. You can see the buildup of water splatter (aka biofilm) on the walls, if the bathroom has the air jet type you can see the pooling of water at the bottom, and if you’re really lucky the telltale reddish-pinkish hue of Serratia.

In 2012, guest blogger Prof. Todd wrote about hand washing and drying to reduce microbial contamination highlighting the fact that the friction generated during hand drying is even more important than that generated during washing. Why? Because the soaping stage loosens the microorganisms from the skin, while the physical friction from drying removes them. Since then, this concept has stuck with me, and ensured my preference was to dry my hands using some form of hand towel.

In 2017, I summarized a study (Ban the Bad Blowers!) looking at microbial contamination in washrooms that utilized paper towels and hand dryers. The researchers found lower microbial levels in the washrooms using paper towels while washrooms that employed the hand dryer had much higher microbial contamination. These washrooms also had a greater range of bacteria, and in general the floor, the hand dryer and the dust samples were more heavily contaminated. This study really solidified my dislike of hand dryers, and my reduction in their usage when using washrooms.

This week a friend send me a link to a study published in 2018 that I had not come across - Deposition of Bacteria and Bacterial Spores by Bathroom Hot-Air Hand Dryers. The researchers compared the bacterial contamination in the air of a bathroom, and found something that now makes me feel that I need to hold my breath in bathrooms with hand dryers. The study showed that petri dishes exposed to bathroom air for two minutes with the hand dryers off only grew one colony of bacteria (or none at all). Conversely, the petri dishes exposed to hot air from a bathroom hand dryer for 30 seconds grew up to 254 colonies of bacteria (most had 18 to 60 colonies).  

If this is not bad enough, the researchers further studied how the bacteria came to be in the hand dryer. After placing a HEPA filter over the air intake and testing the hand dryers again, they found that the amount of bacteria grown in the petri dishes had fallen by 75%. The bacteria is not coming from the hand dryer itself but the air pulled through it and used to dry our hands. In another 2018 study, researchers found that every time a lidless toilet is flushed, it aerosolizes a fine mist of microbes and that this “fecal cloud” may disperse over an area as large as six square meters (65 square feet).

Does this mean that you’re better off not to dry your hands when a hand dryer is the only option? No. Drying actually helps minimize the chances of bacteria left on your hands after you’ve washed to survive. Truthfully, the chances of picking up a pathogenic bacteria is higher via direct contact with someone than a bathroom, but the findings are still gross and I still will try to avoid hand dryers whenever I can!

Bugging Off!

Nicole