Pigs have outbreaks too!

This week I was in Des Moines, Iowa attending the Iowa Pork Congress.  As you’ve likely guessed, the congress draws people interested in the swine industry from producers and contract feeders to consultants and students.  I am now certified in Transport Quality Assurance meaning I am now among many in the industry that understand the best practices for handling, moving and transporting pigs and the impacts that can occur on pig well-being, the quality of meat and what biosecurity considerations need to contemplated to avoid outbreaks.

As mentioned in the last several weeks, we have a potential for a global outbreak in the works with the 2019-nCoV outbreak in China and cases now found in the US.  At this point, all imported cases can be traced back to Wuhan, China.   While the world may be focused on this outbreak and becoming increasingly concerned for what it may mean to our health you may not be aware that for the swine industry and outbreak of African Swine Fever Virus (ASF).  In 2007 an outbreak occurred in Georgia and the virus has been spreading through the Caucasus region, the Russian Federation and Eastern Europe with cases being confirmed the wild boar population in Belgium.   In 2018, ASF hit China and has rapidly spread across the country which has the global community on high alert as containing the virus has been serious challenge in a country that owns almost half of the world’s domestic pigs.

From a Canadian perspective, because of China’s endemic status of Foot and Mouth Disease live pigs and even pork products are not allowed to be imported into Canada.  When in comes to ASF, on a global basis, the highest risk factor from China is the importation of feed, travellers coming into contact with the virus and bringing it back on their clothes and footwear, and people smuggling in infected pork and pork products.

The virus itself is an enveloped virus belonging to the Asfivirus family and includes at least 22 strains which has helped in tracing outbreaks to their source. It is extremely resistant to putrefaction and sunlight and can persist in refrigerated meat and carcasses for up to 6 months and for much longer when frozen.  This highlights the reason why smuggling pork into countries that do not yet have the virus is such a concern.  The virus is spread from pig to pig by aerosol from infected discharges and faeces by the bites of soft ticks, the bites of lice and flies and by direct inoculation from contaminated syringes. Infection can also be spread on contaminated implements and during transport.

The world is small.   You never know when a pathogen is going to board a passenger or cargo flight or arrive by sea on a ship in hold of feed destined for not just us, but the animals we eventually eat.

Bugging Off!

Nicole

One World, One Health

Last week, I referred to an outbreak of a new coronavirus in China.  Being an epi geek, I love following and reading about disease causation, transmission and outbreak investigation.  As I mentioned to some of my colleagues, this is the stuff that I get excited about and love sharing.   I also know not everyone shares my love of a good outbreak, so I gave my colleagues an “opt out” option for my “Outbreak Geek Alert” emails.  So far no one has opted out so maybe I’ve converted them to be as geeky as me!

The appearance of novel pathogens with epidemic potential and potentially high mortality rates have threatened global health security for centuries. The unfortunate truth is that over the past few decades, new zoonotic infectious diseases of humans caused by pathogens arising from animal reservoirs such as Ebola virus, Nipah virus, Lassa Fever virus, Hantavirus,  severe acute respiratory syndrome coronavirus, highly pathogenic avian influenza viruses, Middle East Respiratory Syndrome Coronavirus, and Zika virus. 

The latest outbreak is yet another example.  The rapid identification and containment of the 2019-nCoV is reassuring, however, there are many unanswered questions, such as what animals or other reservoirs the virus originated from, what is the route of transmission, incubation period,  or risk factors for infection, and survival rates.   When it comes to coronaviruses in particular, SARS-CoV has seemingly disappeared, while MERS-CoV continues with sporadic cases and continued questions, such as the source, how it’s transmitted, and what the epidemic potential is.  This latest coronavirus outbreak is a stark reminder of the continuing threat of zoonotic diseases to global health security and the need to support a collaborative global "one-health" approach in the battle against zoonotic diseases. 

One Health is a growing movement with the intention to create interdisciplinary collaborations, research and education in all aspects of health care for humans, animals and the environment recognizing that the health of humans is CONNECTED to the health of animals and the environment and vice versa.  I think we can all agree that human populations are growing and expanding into areas that were previously inhabited by animals.  The result being that as we increase the number of people that live in close contact with wild and even domestic animals, this closeness provides more opportunities for disease to pass between animals and people.  Further, our growth and development has caused changes to climate and land use (e.g. deforestation to build homes and intensive farming practices). The result? Disruptions in environmental conditions and habitats provide new opportunities for diseases to pass to animals.  Lastly, the world has become a very small place with our ability to travel internationally in very short periods of time means diseases can spread quickly across the globe.  

The next time you see a coyote on a walk in a park or skunk or possum in your back yard remember that where you are living may have been forest and their home before you took over the area.  One Health is important, so much so that January has been designated as One Health Awareness Month.  If you’re interested in learning more, follow along via social media using #onehealth.

Bugging Off!

Nicole

New Year, New Virus!

Happy New Year!  I hope many of you were able to take some time off during the holidays.  Rest, relaxation and spending time with family and friends are some of the best ways to recharge your batteries.  While many of us may be trying to ease back into the work routine, one thing we can certainly say is “Bugs Don’t Rest!” It would see that 2020 is starting off with a bang when it comes to “bugs”.

In the Hubei province of China, a mysterious pneumonia outbreak has struck almost 60 people.  The virus causing the outbreak does not seem to transmit effectively from person to person, but as researchers have been able to identify it as a new Coronavirus the infection control community is on edge as the timing is similar to 17 years ago when the deadly severe acute respiratory syndrome (SARS) Coronavirus appeared.  It was in fact during the first wave of SARS hitting Canada that I started in the infection control industry and any time a new Coronavirus is identified the infection control community becomes concerned, and for good reason.  In 2002-2003, SARS infected more than 8,000 people, killed and spread to 37 countries.  In 2012, Middle East respiratory syndrome (MERS) was first identified in Saudi Arabia and has since killed 851 people.

If a new Coronavirus is not bad enough, Influenza is playing havoc this flu season.  According to the CDC, 27 children have died of the flu so far this season.  That's the highest number of child flu deaths at this point in the season since the CDC started keeping records 17 years ago.

While I’m not exactly sure what 2020 is going to bring, you can be sure that I’ll touch on all facets of human and animal health and will try to cover as many topics and share as many educational resources as possible.  As the year starts out it seems that the #17 may be significant; 17 years in this exciting and always unpredictable arena of infection control, 17 years since SARS first hit, 17 years of keeping records of pediatric flu deaths and 17….okay 9, years of bringing the Talk Clean To Me blog to your inbox.  It will be interesting to see if the #17 pops up in any other ways!

Wishing everyone a wonderful January, a lovely February, a peaceful March, a stress-free April, a fun-filled May, joy that lasts from June to November, and finally a happy December...I just hope this year doesn't fly by as fast as 2019 because I certainly am not getting any younger!  

Bugging Off!

Nicole

And That’s a Wrap!

Wow.  I find it hard to fathom that yet another year has flown by, and as I write this blog, Christmas is only 5 sleeps away.  While saying goodbye to one year may be hard, I love looking back over the blogs that have been shared.  They paint a story of what has transpired throughout the year, from emerging pathogens and new trends to areas we had not considered that are now becoming an infection prevention concern.  They also highlight the breadth of interest you, the readers, have in the topics I’m sharing.  Over 2019, Talk Clean to Me averaged over 3000 page views per month and for that I am grateful to you and your support and interest in reading and sharing the blogs each week.

As you can see from the top 10 Talk Clean to Me blogs for 2019, the topics are pretty varied!  In David Letterman style, let’s count down to the most widely-read blog:

1. False Sense of Security – looked at a study published in ICHE, which concluded that improper removal of PPE contaminated Healthcare Workers (HCWs) leads to self-contamination.
2. Colleagues Contribution to Contagion – reviewed a report by the CDC that investigated infectious diseases in workplaces.
3. Warm Weather Weight Loss – warned readers that at least a dozen US residents returning from Tijuana, Mexico, were diagnosed with infections caused by an antibiotic-resistant form of Pseudomonas aeruginosa bacteria.
4. Smartphone or Toilet Seat, which would you Kiss? – talked to a study that found that 1 in every 6 phones have poop on them and asked you how many phones you have touched or used.
5. Best Before, Not Bad After – talked about expiry dates and the use of disinfectants.
6. It’s So Fluffy! - warned owners not to kiss and snuggle your pet hedgehog as a result of a Salmonella outbreak affecting eight states.
7. Worms and Germs – warned residents on the west side of Lake Ontario that a tapeworm, Echinococcus multilocularis, wasn't thought to be present in Ontario until five sick dogs has been found in their area.
8. Sick Spring Puppies – discussed a report of brucellosis associated with dogs adopted from a rescue in southwestern Ontario. 
9. The Horror of Hand Dryers – read the blog, but just stay away from them!
10. How Dirty is Your Money – is perfect for this time of year if you use cash to pay for Christmas gifts!

To quote from Dr. Seuss “And the Grinch, with his Grinch-feet ice cold in the snow, stood puzzling and puzzling, how could it be so? It came without ribbons. It came without tags. It came without packages, boxes or bags. And he puzzled and puzzled ’till his puzzler was sore. Then the Grinch thought of something he hadn’t before. What if Christmas, he thought, doesn’t come from a store?  What if Christmas, perhaps, means a little bit more.” 

To put into the context of infection prevention, what if saving lives and reducing HAIs was not all about the quest for the silver bullet, focusing on what a product kills or who is or who is not doing their job? What if 2016 brings us wisdom, strength and courage?  What if 2020 brings us the wisdom to realize that we cannot continue on with the status quo?  What if 2020 gives us the strength to fight for what we know is right and courage to not back down in the face of adversity and put our patients and their lives first?

Wishing everyone a Happy Holidays! 

Bugging Off for 2019!

Nicole

Self-Serve and Germ Pick Up

Where has 2019 gone?  Today marks the last business trip of the year and my 2^nd to last blog for 2019.  Travelling can be equal parts of enjoyment and irritation.  Enjoyment in terms of the people you meet, places you get to see and the occasional really good dinner.  Irritation due to waiting in lines, delays in travel, last minute cancelled meetings and poorly cleaned hotel rooms (as evidenced by the picture of my hotel room faucet).

With Christmas season upon us, travel will be increasing.  Kids are coming home from school, families travelling to see their loved ones and if your parents are like mine – many people will be travelling to escape the cold.   I’ve previously blogged on the level of contamination found on those horrid grey bins we place our belongings in when we go through security and of course the most frequently contaminated surfaces on a plane, but have you thought about the self-check-in kiosks at the airports?  How frequently are they cleaned and more importantly how many hands touch them throughout the course of a day?!

Hartsfield-Jackson International Airport is the busiest airport in North American and perhaps the world.  With 192 gates, the airport manages 2,500 flights and 275,000 people every day. Having been one on many occasions I can say, they do a pretty good job of moving people along and have a pretty decent selection of restaurants to eat or drink away your time between flights.

A study completed by Insurance Quotes found that the average self-check-in screen contained 253,857 Colony Forming Units (CFUs) of germs which is 13 times more than the average airport water fountain button.  To put it into comparison, when we think toilets are gross they on average only have 172 CFUs on the seats.

There are always pros and cons when it comes to improving efficiency.  In the world of self-check-in kiosks at airports or self-check-out kiosks at grocery stores, restaurants and as I came across last night while getting my bad of Doritos for dinner at the Houston Airport – even quick serve food self-check-outs, germs are everywhere!  It’s not that improving with the times is a bad thing.  It’s about not forgetting the tried and true methods for keeping ourselves healthy.  If you grab something on the go, wash your hands before you eat, particularly if you are eating on a plane.

If you’re an owner of the one of these self-serve kiosks consider looking at how frequently they are cleaned or better yet have some disinfectant wipes handy that can be used by customers to wipe down before they the check-out machine!

Bugging Off!

Nicole

Kids, Coughs and Viruses on Healthcare Workers

This week we received an email from my son’s teacher confirming what I already knew – respiratory viruses are in abundance and wreaking havoc in schools, offices and anywhere people congregate. We have a nasty virus floating around my office that keeps taking people down one by one.  The only way to manage cold and flu season is to keep as healthy as you can in order to fight off the germs that plague us, keep our environment clean and wash our hands frequently.

Due to the number of kids sick and differing types of infections – phlegmy coughs to bronchitis and pneumonia, I sent a canister of wipes to school with my son, gave his teacher a few tips on what surfaces she may want to wipe down with more frequency and suggest she engage the kids in helping to “wipe out” the germs.  She did just that and my son said it was fun helping to wipe down his area.

With the number of respiratory viruses floating around it was interesting to come across a recently published study in ICHE that investigate the level of virus contamination on PPE, skin, and clothing of healthcare workers.  The researchers that 31% of glove samples, 21% of gown samples and 12% of face mask samples, 21% of bare hand samples, 11% of scrub samples and 7% of face samples were positive for viruses.  This level of contamination can contribute to transmission of pathogens via contact and increase not only the risk for infection in health care workers but increase the risk of contaminating the environment.

The study highlights the ease and frequency of viral contamination on PPE, clothes, and skin of HCWs which emphasizes the significance of appropriate PPE use, and hand hygiene in preventing transmission via both direct and indirect contact.  Of further interest, there was an association between the number of self-contacts by HCWs with their gloves, gowns, or masks and the concentration of virus their PPE meaning the more self-contacts, the more virus was found.  The strongest correlation identified was between self-contact with the gown (torso) and virus concentrations on a personal stethoscope, which as we know is often draped around the neck.

A study published in BMC Infectious Diseases earlier this year looked at contamination of masks by respiratory viruses and found similar results. In this study, 10% of the masks tested were found positive for respiratory pathogens and the risk is higher with longer duration of mask use (> 6 h).  The researchers concluded that finding respiratory pathogens on the outer surface of the used medical masks may result in self-contamination.

Unfortunately, respiratory viruses cannot be avoided.  Whether you’re a teacher, student, parent, coach or healthcare worker you’re likely to come into contact with someone who is infectious and spreading their virus with each cough, sneeze or touch of their dirty unwashed hands on surfaces you then touch.  What’s as important is that the PPE we wear to protect ourselves can also become contaminated and we can unwittingly contaminate ourselves.  In the end, the best prevention is cleaning and disinfecting high touch surfaces and wash our hands with increased frequency!

Bugging Off!

Nicole

Mold Found in Air Causes Death

You never know where and how a pathogen may enter a healthcare facility and wreak havoc.  For the last several years, we have been focusing on environmental surfaces and shared patient care equipment and their contribution to infections - whether it be direct contact by a patient, or indirect by healthcare workers’ hands that have been contaminated from touching surfaces.  Infections resulting from improperly reprocessed medical devices have also resulted in quite a bit of scrutiny about processes that need to be followed, ease of reprocessing in designing medical devices and the type of training needed by healthcare workers tasked with reprocessing.

There are some pathogens that are easier to determine the route of transmission and pinpoint how they may have managed to be passed to a patient.  MRSA and C. difficile are recognized as two of the more significant pathogens transmitted via environmental surfaces.  As such, a focus on these and other antibiotic-resistant pathogens has been given to ensure cleaning and disinfection methods are up to par, that disinfectant products have the capability of killing the pathogens of concern, and that facilities have a method to validate and monitor cleaning and disinfection practices.

Unfortunately, that does not stop other pathogens from arriving on the door step, or in the ORs of your facility.  Case in point, Seattle Children’s Hospital has had to close most of its ORs after finding Aspergillus following air testing.  This is the second time this year, ORs at the facility have had to close and the facility has attributed at least 6 deaths as a result.  The facility has acknowledged that Aspergillus has been in the air of the ORs since at least 2001.  Aspergillus is not an uncommon pathogen.  In truth, it can before everywhere — indoors and outdoors.  More than 180 different types of Aspergillus have been identified and while most are harmless, some types can cause a variety of diseases ranging from simple allergic reactions to life-threatening invasive disease.  Illness from Aspergillus is referred to as Aspergillosis and rarely develops in healthy individuals - in fact, most people breathe in these spores every day without any issues.  The risk of infection increases in individuals who have an underlying condition such as asthma, cystic fibrosis, etc. and/or in people who have taken corticosteroid drugs for a long period of time or who have weakened immune systems.

In Seattle, the presence of the mold is being blamed on deficiencies in the ventilation and purification systems.  To correct the situation, the ORs will remain closed until the end of January so that in-room HEPA filters can be installed in every operating room.  HEPA filtration is capable of removing more than 99.9% of particles from air that passes through the filters.  It’s unfortunate that this situation has occurred and my heart goes out to the families impacted.  I hope, however, that other facilities will take this as a wakeup call and check out their air, their infrastructure and ensure that something like this does not happen in another facility.

Bugging Off!

Nicole