Don’t smooch with your pooch!

Are you a dog lover? Do you cuddle, sleep, kiss or let your pooch lick you?  I like dogs, but growing up on farm my definition of having a dog is opening the door to let him or her run out to do their business, roam around the farm for a bit and then open the door to let them back in when they barked. Living in a city with a busy schedule and a fair bit of travel means I’ve chosen cats over dogs. I can love them. I can feed them and I can leave them. Growing up on farm with dogs and a mom who was a nurse also meant that our dogs (and my brother and I) were taught not to lick. Dog kisses were not something that occurred in our house. Truth be told, Kahlua, the black lab we had for 16 years like to find carcasses of dead animals to roll in and chomp on and of course liked to play in the barn with the cows. You never knew what had been in her mouth before coming to say “Hi” and if you got close enough to her mouth you often found yourself gagging from what she had just gotten into…

But why the dog talk? Because I came across a study published in the journal of mBio that found that some dogs in China are carrying a potpourri of influenza viruses including swine, avian and canine flu viruses. Since we like to have “close” relationships with our canine babies, there is a potential that someday these viruses may jump to humans.

The researchers swabbed 800 ill dogs between 2013 and 2015 and found that 15% of the dogs had the flu. Shockingly, after the viruses were sequenced they found that 16 different strains of the flu were being carried by these dogs and some of them were in fact Swine influenza strains that had been detected in people in Europe and Asia. While there is no indication (at least at this point) that the flu can jump from your pooch to you, it doesn’t mean it’s out of the question. In fact, our close contact may have allowed for us to build immunity against dog flu, but that is yet to be seen.

What does this mean to us? Well, as I’ve mentioned in several past Talk Clean To Me blogs, don’t get your knickers in a knot over the particular strain of influenza. I’m not insinuating we need to down play influenza and the risk of transmission by any means. What I am saying is let’s be smart about influenza.  This study shows dogs can carry pig flu, swine flu or bird flu. There are additional studies to show that some of the earlier canine flu outbreaks may have originated from Equine or horse flu. Influenza has been identified in all sorts of animals and of course people. 

The good news is that regardless of the number of influenza A strains we come up against, based on available scientific information, and the fact there are over 500 EPA registered disinfectants with claims against various strains of Influenza A on the market if a new strain pops up we will be covered! The EPA’s emerging pathogens protocol proves that!

Bugging Off!

Nicole

Does the “Ick” factor reduce infection transmission?

I’m pretty sure at some point we’ve all cringed, wrinkled our noses or had the involuntary “EWE!” slip out at some point in our lives when we’ve seen something gross.  Of course depending on what it is depends on your next reaction which may range from complete revulsion to fascination.  When it comes to blood, guts and gore (or pus) I tend to weigh in on the fascination side.  I’ve always been the person to look closer at what is grossing others out, even if we’re dealing with a dead animal on the side of the road.  Bugs, insects and most rodents are another story. 

A recently published study in Philosophical Transactions (The Royal Society) by Val Curtis and Mícheál de Barra sought to determine if in fact disgust evolved to protect us from disease and if we can still rely on our instinctual reaction of disgust to help us from getting sick. Curtis and de Bara recruited 2,500 participants of which two-thirds were women with an average age of 28. The study participants read brief descriptions of 75 potentially revolting scenarios they might encounter in a day rating them from “No Disgust” to “Extreme Disgust”.  Curtis and de Barra were then able to develop and sort the responses into six common categories of disgust "cues" such as poor hygiene; animals/insects that bring disease; promiscuous sex; body deformities or behavioral irregularity (e.g. coughing or homelessness); lesions, blisters, boils or pus; and spoiled food.

While the results of the study may not have correlated to disease per say, they did seem to reflect the types of things and people that should be avoiding in order to not catch something infectious.  The participants knew to avoid objects, skin lesions, spoilt food, individuals with poor hygiene and promiscuous sexual practices.  While a feeling of disgust does not allow us to “see” pathogens, the study does provide further evidence that when we feel disgust it in does indeed correlate with staying away from something potentially infectious.

Which leads me to my fascination with lesions, blisters, boils, pus, blood, guts and gore…..  Inwardly I may say “ewe”, but man do I like a good close up and investigation of what everyone else may think as being gross!  

What way do you lean?

Bugging Off!

Nicole

Infection Control for Basic Beauty

The joy of my job is that with the exception of booked travel, I never know what market I may be supporting in terms of cleaning and disinfection. This week I attended the Premier Orlando International Beauty event. It was 2 days of jaw dropping beauty, personal style and in some cases questionable infection control. If you were looking for a new hair style or colour, nail art, skin care tips there was no way you could not come home with ideas! The key is whether you’re brave enough to follow through on some of the ideas you came home with!

In the Professional Beauty market what amazes me the most is the difference between states in terms of the level of cleaning and disinfection required for tools and implements.  In the healthcare world (hospitals, dental, etc.), the guidelines are standard across the nation and everyone is generally doing the same thing. The same cannot be said in spas, salons or nail shops. If you’re an infection control nut like me you may want to take some time to investigate what the State Cosmetology Boards require for cleaning and disinfection requirements are before your next mani-pedi.  As I’ve come to learn, for most states the use of an EPA registered disinfectant is sufficient for tools. My question is what type of EPA registered disinfectant?  A low level disinfectant that can kill bacteria, may or may not be able to kill hardier non-enveloped viruses and may or may not kill relevant bacterial pathogens?  Should an intermediate level disinfectant be used that can kill TB? Are the facilities allowed to use the solution as a soak for 1 day, multiple days or do they have to change after each disinfection cycle?  How do they test to ensure that the product is at the appropriate concentration?

My personal preference is the use of a High Level Disinfectant. These are FDA registered disinfectants that undergo stringent testing and validation to be able to disinfect medical devices via soaking applications. The testing requires a soil challenge, proven ability to kill a higher number of organisms and the products are generally designed and tested in such a way to allow for a re-use claim (meaning once put into a soaking try you can use for multiple days in a row) and must have a method to test and verify that they remain within the appropriate concentrations to ensure disinfection has occurred.

But that’s not really the reason for this week’s blog. My reason was what I saw in terms of lack of infection prevention measures. This show provided a means to see all of the new products for sale and often provided the ability to watch demonstrations or try the products. I saw emery boards that are supposed to be single use being used on multiple people. I saw dremel type sanding bits being used on multiple people with perhaps a wipe of a tissue sprayed with alcohol.  I saw microblading and permanent make-up tattooing being demonstrated – sure they had gowns on, but I’m not certain how the multiple use devices were being disinfected. I saw people trialing teeth whitening systems. It was all fascinating, but by golly I kept my hands to myself and tried NOTHING!

Similar to my Pools Poised for Plagues blog that highlighted the number of outbreaks associated with public swimming pools and the highest rates being in the summer, I suppose it’s time to remind ourselves that summer too is a time when many of us want our feet, toes and nails to look pretty.  After this week it’s a reminder to myself to ask how mani-pedi tools and implements are disinfected if trying a new place.  ruth be told, I think if I can’t get into my preferred facility and aesthetician then I may just settle for doing it myself and hope that I can paint within the lines!

Bugging Off!

Nicole

Beautiful Banff Brings Education, Enlightenment and Elation!

It’s been a long week, but long in a good way!  The IPAC Canada National Conference was this week in Banff, Alberta. The theme of the conference was “Climbing Mountains: Pathways to Discovery”. I must say the speakers did an amazing job pulling in our theme and weaving stories that were inspirational, educational and left everyone with pearls of wisdom to both take back to work and leverage in our personal lives.

I hosted a full day pre-conference symposium on Cleaning and Disinfection.  I must say, I think this was my favorite of the 5 such symposiums I have hosted.  The day was interspersed with both lectures and interactive activities that made people think beyond the obvious. We were stretched to think of the unobvious issues that can result in our facilities whenever cleaning and disinfecting products are used. The topics for the day weaved and intertwined with speakers building on and validating each other’s presentations. The day taught us to how to read and truly gather information from a product label, learn how to investigate and determine compatibility of a disinfectant with surfaces and devices found in our facilities and how to uncover where errors or issues in cleaning and disinfection have occurred. We also covered Room Decontamination Devices and their use in infection control programs, where and what types of biofilms may be lurking and closed off with a discussion on chemical resistance and what concerns there may be with our ever increasing use and reliance on cleaning and disinfecting chemicals.

Sharron Wood, the first North American female to summit Everest by the west ridge and north face gave the opening key note talk. While one would not think of mountain climbing and infection prevention as having anything in common, I can say we are wrong. One cannot just decide to climb Mount Everest and head out the next day. Planning is actually the largest part of ensuring success.  Execution, the actual climbing can be successful if the planning has been done correctly.  During the climb you need mental strength to keep putting one foot in front of the other and to make the right decisions. To have a successful infection prevention program, we too require a focus on planning and when we’re in the throes of an outbreak where things are ever changing so to do we need the mental fortitude to keep putting one foot in front of the other and the ability to make the right decisions.

The conference closed with Patch Adams – yes, the REAL Patch Adams! I’m sure many of us have seen the movie starring Robin Williams. What an experience to be in a room with him. Patch Adams held us in complete rapture expounding his beliefs that laughter, joy and creativity are an integral part of the healing process. He showed that laughter really can be the best medicine with examples and videos of the work he does around the world clowning.  Some of my “ah-ha” moments were the fact that WE can choose to have a happy day and that our choosing to be happy has an incredible effect on those around us. As leaders, colleagues, friends and family, WE can make an environment where a person can see the best in themselves and that can be very powerful in helping to deal with whatever struggles they may be having or empowering them to think differently when faced with a challenge. Lastly, Patch Adams pointed out that in every job, there is something that is boring. Rather than lament in the dullness of the task, ask yourself what you can do to make it fun?

Those that know me know, that I like to have fun. In my current role there are times I feel that perhaps I’m too gregarious. Certainly, there are times where laughter, joking and clowning around are not appropriate, but I’m going to take to heart that I can choose to be happy and always look for the positive. I can choose to make others laugh and help them to be happy and in doing so I may be able to make the world a better place.

Bugging Off!

Nicole

Pools Poised for Plagues

If you’re a parent, you know that when on vacation or attending sporting tournaments a hotel or resort with a pool is a must in order to keep your kids entertained.  Travelling with a hockey team of 17 eight to nine year olds, the hotel pool was the best way to keep the boys contained and entertained. As a hockey mom, we quickly decided that the fathers should be left to deal with the splashing, yelling and squealing and we retreated to enjoy a glass of wine and conversation that did not include the words puck, stick, skates, goal or jock….

Summer of course signifies pool openings. If you have a backyard pool similar to hotel pools, you know it’s a great way to entertain kids and if you’re like me, the idea of “chlorinating them” before bed to remove the dirt, grime, germs and stink of the day!  While pools and hot tubs are great entertainment devices, if not maintained properly they can be a source, a cesspool if you will of infectious pathogens that can quickly ruin your summer fun.  If you don’t want to believe me, check out the latest Morbidity and Mortality Weekly Report where the CDC reports that nearly one-third of disease outbreaks caused by chlorinated or treated water can be linked to hotel pools and hot tubs.  I’ve never been one to use a public hot tub, but you can be assured I will not likely set foot in one again and will definitely reconsider my use of pools (at the very least, my head will be kept above water!

According to the CDC between 2000 and 2014 there were 493 outbreaks in the USA associated to recreational water that caused a total of >27,000 illnesses and 8 deaths. Of the 493 outbreaks, 158 of the outbreaks were directly linked to hotels, motels, lodges and inns. The most common illness contracted was folliculitis caused by Pseudomonas (aka hot tub rash) and the reason I avoid public hot tubs.  Legionella (causes severe pneumonia) was the second most common pathogen identified in the water followed by Cryptosporidium (a parasite that causes GI illness and diarrhea). Of interest, 22 outbreaks were associated with chemical exposure due to excess chlorine, disinfection by-products or altered pool chemistry showing even with pools the use of chemicals properly needs to be considered or you can easily amass >1000 cases of illness associated with chemicals.

With June around the corner you may also want to know that the highest number of outbreaks occurred during June to August. It shouldn’t be surprising – it ties in to the warmer months in many parts of the US and school break and summer vacations!

Stay safe this summer and perhaps consider keep you head above the water!

Bugging off!

Nicole

#FF May Mentoring Madness

In the infection prevention world, spring (usually) signifies the end of flu season and the beginning of education season. May starts of off with “Save Lives: Clean Your Hands Day” on May 5^th which kicks off the North American infection prevention conference season with IPAC Canada’s National conference at the end of May and the APIC conference in early June.  The opportunities for education are endless.


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.  As summer creeps up on us, be sure to check some of these teleclasses out!

Date	Title of Teleclass	Speaker
April 10th	Hopes, hypes and multivallate defences against antimicrobial resistance	Prof. Neil Woodford, England
April 12th	Understanding risk perceptions and responses of the public, healthcare professionals and the media: The case for Clostridium difficile	Dr. Emma Burnett, Scotland
April 18th	Genetic similarities between organisms isolated from the ICU	Prof. Slade Jenson, Australia
April 19th	Topical antibiotics to prevent post-operative surgical infection…is the paradigm changing?	Dr. Hilary Humphreys, Ireland
May 3rd	WHO Global hand hygiene campaign 2018: It’s in your hands – prevent sepsis in health care	Prof. Didier Pittet, Switzerland
May 10th	How the certification board of infection control (CBIC) works for you	Ivan W. Gowe and Lita Jo Henman, USA
May 28th	Trekking safety through the storm – managing complex IPAC issues	Dr. Mark Joffe, Canada
May 29th	Simulation as an education tool	Dr. Ghazwan Altabbaa and Dione Kolodka, Canada
June 13th	Involving patients in understanding hospital infection prevention and control using video-reflexive methods	Dr. Mary Wyer, Australia
June 21st	The future of infection control – bright or bleak?	Martin Kiernan, England

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!  And don’t worry if the date you see above has passed!  All teleclasses are recorded and available to listen to at your leisure!

Bugging Off!

Nicole

Fungal coated Fomites

When I started in the infection prevention world 15 years ago, fomites (or the patient environment) was still being debated in terms of the contribution to infection transmission.  Most would agree that the potential role of fomites in the transmission of disease required further study.  No one was really ready to take a stance.

In 2002, Infection Control Today (ICT) published an article “Fomites’ Role in Disease Transmission is Still Up for Debate” concluding that the transmission of infectious diseases from fomites is still being contested in the infection control community, with no conclusive decision emerging from clinical studies. Dr. Weber and Dr. Rutala agreed that the key concept in considering the hospital environment as an infectious hazard for patients is to find definitive proof that inanimate objects played a role in transmitting in human disease. In order to support fomites as a causative agent several areas needed to be proven, including: 

- Proof that an organism can survive after inoculation on to the fomite

- Proof that a pathogen can be cultured from fomites in use

- Proof that a pathogen can proliferate on the fomite

- Proof that at least some small part of acquisition of infection cannot be accounted for by other methods of transmission

- Peer reviewed studies showing an association between exposure to the contaminated fomite and infection

In 2006, German researchers conducted a systematic review of the literature, looking at the ability of infectious organisms to survive on inanimate surfaces.  The review found that Gram-negative bacteria persist for longer periods of time than Gram-positive bacteria.  The data was mounting.

Today, I think it’s safe to say that we’ve all drank the Kool-Aid and believe (or at least agree) that pathogens can be transmitted from fomites and that fomites have been directly related to outbreaks.  Unfortunately, while we know this, our ability to ensure that fomites do not lead to transmission continues to plague us. Case in point is a recent study published by a group of researchers from the UK looking at what is being touted as being one of the largest outbreaks of Candida auris.  In investigating the outbreak, researchers found that axillary thermometers (armpit thermometers) had been used in 57 of the 66 patients (86%) of the patients infected with C. auris.  While C. auris was rarely detected in the general ward environment, researchers were able to culture samples from the medical equipment and see it on the surface of thermometers using a scanning electron microscope.  The only way the outbreak was controlled was removing the thermometers from use.

This outbreak is not the only outbreak associated with thermometers. Similar to the focus over the last several years of ensuring that the environment is being effectively cleaned and disinfected through verification programs, so too is the need to have programs and processes in place to ensure that multi-use patient care equipment is being properly and effectively cleaned and disinfected between use. Infectious pathogens are opportunistic.  If we let our guards down, they will find a way to proliferate, contaminate and infect our patients.

Bugging Off!

Nicole