Alcohol – good for drinking, not soaking

I’ve been known to imbibe now and again.  I like to have fun.  Those that know me well may have been involved in one or two of my escapades and a few of you may have heard some stories.  I am happy to say I have never been arrested and never been hospitalized.  Being grounded while a teenager…..well that’s another story!

Why the discussion of alcohol?  Alcohol is one of those “magical” chemicals – you can drink it, you can cook with it, you can wash your hands with it, you can clean with it, you can kill with it and you can use it for fuel (it’s also lights nicely with a match!).  In the chemical world, there are a number of different types of alcohols that can be used as a solvent (helps to dissolve things) mixed in with other chemistries (e.g. Quats) that can be used as a disinfectant.  On its own (aka 70% IPA), we use it as a disinfectant for skin prep and in microbiology, use it as a fixative agent.  Here in lies the catch.

Alcohol is a fixative.  It’s well known to be one, but generally speaking most do not realize what that means or how its ability to adhere organic matter to a surface can impede cleaning and disinfection.  In fact, a study published in AJIC recently looked at just that.  The researchers found that treating contaminated surgical instruments with alcohol and allowing them to dry, increased difficulty in cleaning and could lead to sterilization inefficiency.  The rationale of using alcohol in this way is of course for its killing properties to reduce pathogen load prior to cleaning and disinfection or sterilization.  The researchers found that yes, the bacterial load was reduced when instruments were wiped or sprayed, but this practice significantly increased the attachment of soil to the instruments which made cleaning these same instruments significantly harder. The long and the short was that the benefit associated with the decreased microbial load was overshadowed by the increased difficulty in cleaning and should be discouraged.

While the study looked at surgical instruments, we need to contemplate that alcohol used for surface disinfection will do the same thing.  In surface products, alcohol (IPA, ethanol etc) is often added to boost the efficacy of quats and other disinfectant actives to either enhance efficacy (such as achieve a TB claim) or help to reduce the contact time.  Similar to the effect of sticking soils to instruments, the same will happen when using alcohols on surfaces, highlighting the importance of removing soils prior to wiping with an alcohol containing surface disinfectant.

In the end, it’s about finding the balance of what you are looking for in your facility and knowing the advantages and disadvantages of the disinfectant you are looking at.  If you know what you’re dealing with, you can implement practices to try and minimize the negative side effects of the product.  When it comes to surgical equipment, as cleaning is so vital to ensuring that disinfection or sterilization can occur, I hope you’ll stop the practice of using alcohol to wipe down the instruments prior to cleaning.  When it comes to surface products,  I hope you also do your research, particularly if you work in a high soil environment!

Bugging Off!

Nicole

Poopy Love from Puppies

As I’ve mentioned before, I grew up on a farm.  We raised beef cows, capons (neutered male chickens) and grew cash crops (wheat, corn, soya beans, etc).  As any good animal loving country girl can probably attest, you can make a pet out of virtually any animal.  Some of my favorites were Joy our Jersey who, while a cow, we rode like a horse; there was also Cookie the Capon, Miss Piggy, Herman and Hersey (also cows), Rainbow my thoroughbred horse, Pursey my albino rabbit, Mr. Boots my Dutch belted rabbit, Sparky a very vocal guinea pig and of course we always had a dog or two and lots and lots of cats.  I played in our barns, I’ve mucked my fair share of stalls and yes, I’ve been known to get into manure fights while mucking stalls. I’m pretty sure at some point in my life I’ve eaten poop – unknowingly of course, but I’m sure it’s had to have happened.

While acknowledging in a public forum that I’ve eaten poop, what I can say is that when coming in from the barn I always washed my hands. I washed my hands after playing with our pets, before eating, and I NEVER let any of our animals lick my face or kiss them in any close vicinity to their tongues.  How many of you can say the same?  Not to shame you if you have, but GROSS!!!!  Do you know where those mouths and those tongues have been?

We often talk about Swine or Avian Influenza and Salmonella as common zoonotic diseases.  Certainly, we need only go back a few weeks to my “Fall Fair Fun” blog to read about transmission of pathogens from animals to humans.  Only a few weeks ago there was yet another Salmonella outbreak associated with pet turtles (I talked about that in my “Pet Turtles Pose Health Problems” blog back in 2015).   I think we’ve come to understand that farm animals (and pet turtles) can spread disease but what about adorable, cute, cuddly and wet tongued puppies? 

Well….those darn adorable puppies can also be the cause of outbreaks. In fact, the CDC is currently investigating a multi-state Campylobacter outbreak in people that have been linked to puppies purchased from a chain of pet stores.  At least 39 people across 7 states have been identified and the cause has been linked to puppies sold by a chain of pet stores based in Ohio.  Of the 39 people, 12 are employees while the remaining 27 have been directly linked to either purchasing a puppy from the store or visited the store.  The CDC does not yet know the exact cause of the outbreak and it may be difficult to ever pinpoint the exact cause.

Campylobacter itself is a bacterium that can infect dogs, cats and humans.  There are a number of different strains of Campylobacter that can be found in many of our food production animals so it is most frequently linked to eating raw or undercooked meat. Typical symptoms include diarrhea, abdominal pains and fever that can last for about a week.  Person to person transmission is rare, but transmission from exposure to dog feces is possible.  Washing your hands after handling poop and after touching your dog is recommended – I would hazard a guess that’s not realistic for many dog lovers!  While the CDC does not call it out, letting your dog lick you or kissing on the mouth should also be avoided….dogs do clean themselves down there you know!

Bugging Off!

Nicole

P.S.  Next week it will be a toss-up between a study about how alcohol fixes soil to medical devices or a study on bleach causing COPD.  If you have a preference tweet and let me know!

I’m leaving on a jet plane…

Tell the truth…you all started humming John Denver’s famous song “Leaving on a Jet Plane”.  In case didn’t know, the reason he wrote the song was that he loved to travel, but he hated leaving people (friends, family, loved ones) behind while out on the road.  I too hate leaving my loved ones behind when out on the road.  For most, September signifies back to school and back to routine after an enjoyable summer.  For some of us, it also means back to the travel grind of attending tradeshows and events.  While my fall does not look as bad as my winter and spring travel, I can say that I’m still on track to keep my travel status and in fact will come in at fewer flights than last year.  As I write this blog I have already looked at the weather in Vegas where I am off to on Monday for the ISSA Interclean Tradeshow and started to “virtually” pack my bag.

As many of you are probably well aware, while travelling can be fun and in this case educational, it can also come with myriad of problems such as delayed flights, lost luggage and the very real threat of picking up something infectious.  If you’re lucky, it may be just the common cold; and while it’s irritating, you’ll generally recover without much to show for it (unless it’s a man cold of course).  If your luck is not so good you may pick up norovirus and take a bit longer to feel back to normal, but happy that you’ve lost any weight you gained over the summer.  If you’re really unlucky, well you might pick up the next superbug or emerging viral pathogen. It’s the give and take we have to partake in when it comes to travel.  We have the luxury of globetrotting to far away destinations, but so do bugs!

I think we can all agree there have been several studies and articles about how “germy” planes are and what the “germiest” surface is…. The obvious solution is to ensure the plane arrives with enough time to properly turn it around which includes cleaning and disinfecting all of the surfaces the people on the last flight touched.  The reality of course is that to avoid delaying the next flight, corners get cut to get the next set of passengers on board.  I was extremely interested to see a study out of Arizona State University that looked at ways of decreasing the chance of contamination or spread of germs.  They found that if you split up how the plane was boarded you could decrease the risk!

The researchers realized that if you could reduce the clustering and crowding of people in the isles during the boarding process you could significantly reduce the risk of infecting travelers.  Using a model looking at transmission of Ebola, they found that under the current boarding process there was a 67% chance of reaching 20 or more cases of air travel-related cases of Ebola per month.  However, if they modified how people boarded to reduce crowding, they found the risk of infecting 20 people per month dropped to 40%.  They also found that smaller planes (e.g. 150 seats or less) also reduced the risk of transmission.  I wouldn’t call that rocket science.  With fewer people on a plane there would be less crowding and therefore, the risk of spreading disease would (should) be lower.

Basically, next week I’m doomed.  A hot spot like Vegas means a large plane and lots of people.  The upside is that my status allows me to be one of the first to board the plane and one of the first to get off the plane.  As long as everyone keeps their hands to themselves I should be good!  Of course, it doesn’t hurt that I always have a supply of disinfectant wipes!


Bugging Off!

Nicole

Texas Keep Strong!

Like me, I am sure many of you are following the situation in Texas.  It’s heartbreaking. I cannot fathom the devastation and the toll on the lives of those who live in the area – human or animal. Hurricane Harvey can only be described as catastrophic not just due to the vehemence with how it hit land, but because of the continued rainfall after the fact.  The flooding that has occurred is truly an example of how we are no match for Mother Nature.

In light of the recent events in Charlottesville, it’s refreshing to see the country pulling together to help those in need.  From news clips of “The Cajun Navy” pulling boats heading to Houston to help with rescue efforts, to a boat filled with 21 dogs that a group of good Samaritans helped rescue, to donations made by celebrities and us “regular” folk, I think it’s fair to say that those affected by Hurricane Harvey know people everywhere are doing what they can to help out.

While people rush to help, it’s important to realize that flood water is not just dangerous in terms of drowning its victims.  Flood water can also be dangerous because of what it contains.  It can be full of a myriad of contaminants from pesticides and other chemicals to animal or human waste.  The bacterial count in flood water is extremely high and can cause health issues from ingestion such as vomiting and diarrhea to skin infections and even chemical poisoning.  Even after the flood waters subside, the worry is not over.  The silt and mud left behind from the water will likely be contaminated, so care in handling during clean-up efforts will be needed. Then of course we move from moving water to potential standing water and the probable infestation of mosquitoes carrying arboviruses such as Zika and West Nile Virus.

If that’s not enough, biosecurity measures need to be put in place to manage potential transmission of diseases between animals that may not normally come in contact with each other.  For example, there is a cattle fever tick eradication program in South Texas with the quarantine area extending more than 500 miles from Del Rio to the Gulf of Mexico.  While anticipated rain and flooding have not yet occurred in the quarantine area, government officials are working to issue permits to allow for the relocation of livestock to safer grounds should it be necessary in the days ahead. 

Needless to say, Texas needs our help.  If you’re interested in lending a hand or donating items or money, the following are some organizations that are looking for help:

• Texas Board of Veterinary Medical Examiners – Temporary Emergency License Application
• Red Cross – Hurricane Harvey Support
• Houston Food Bank or Corpus Christi Food Bank
• Houston Humane Society

In the words of John Bunyan “You have not lived today until you have done something for someone who can never repay you.” 

Bugging Off!

Nicole

Are we crying wolf over Quats?

I’m not sure what exactly is going on in the world of cleaning, disinfection, and infection prevention, but I am LOVING all of the new studies being published and news bulletins being sent by a whole host of regulatory bodies!  I have topics galore for upcoming blogs!

Last week, I was in the Sacramento area visiting the UC Davis Veterinary Medicine campus.  I was meeting with two influential veterinarians who focus on Shelter Medicine.  Animals, cleaning and disinfection, infection prevention and biosecurity were of course our key topics of discussion.  I’m not sure if it was serendipity or just coincidence that after being on campus, a new publication came rolling across my desk published by researchers at UC Davis.  The study investigated the number of compounds and drugs found in household and pharmaceutical use. The study discovered that Quaternary Ammonium Compounds (Quats) were found in many different types of household products including disinfectants, hand wipes, shampoos, nasal sprays and even mouthwash could inhibit mitochondria (the powerhouse of the cell) as well as estrogenic functions in cells. 

Before we start to panic, it’s important to understand that the testing conducted was done using in-vitro testing using cells.  There is already some evidence to support that Quats can disrupt fertility in mice, therefore the fact that this study shows that Quats can impact the estrogen signalling process that is important for human fertility is something that should not be ignored.  While it’s true we do not yet know what levels these chemicals reach within the human body when exposed to Quats, the data certainly warrants further investigation including moving to investigation using animal models. 

With the ban on Triclosan and need to remove it from consumer products, some companies have been looking to utilize Quats in their place.  The thought of course was they were choosing a safer alternative.  This study demonstrates that this may not be a safer alternative.  This research is yet another to add to the growing pile of findings that Quats may not be as safe as previously believed.  As this study showed, six out of the ten most potent mitochondrial inhibitors were Quats.  The fact that almost everyone is exposed to Quats on a regular, if not daily basis, is certainly cause for concern.

I’m not crying wolf or inferring the sky is falling.  I do however, think this is yet another example of not considering what the wide spread use of antibacterial agents in our homes can lead to.  We know there is no need to use antibacterial hand soaps or antibacterial dish soaps because plain soap and water will do.  Do we really need to use antibacterial agents in our tooth paste?  If we’re concerned with bad breath why not brush more frequently or chew gum between brushings? 

Regardless, this is going to be an interesting topic to follow and see what unfolds as more testing and research is conducted.  I’ll be sure to keep you posted if I learn anything further!

Bugging Off!

Nicole

Fall Fair Fun

The end of August is bitter sweet.  On the sweet side, it marks the anniversary my husband and I started dating and got married and it marks the month we moved from a high-risk pregnancy to a “you’re good to go” pregnancy.  On the bitter side, it marks the end of summer, the return of cool nights and for children the return to school.  It also marks the start of Fall Fair season!

Growing up on a farm, Fall Fairs were where you got to show off your prized animal (in my case a purebred Hereford named Patience).  She was aptly named as it took all my patience to teach her to lead on a line, stand quietly to be judged and to stop dragging me through the manure pile.  I was a horse girl, so Fall Fairs were also high season for competition – hunter, equitation and jumping were my events.  My boy Wally, known in the show world as “The Other Man” was a bit fickle.  We had our good days and our bad days.  In hindsight, I should have named him “The Only Man” seeing as he was the reason for much of my teenage drama and losses of boyfriends.  If I had a show, you could be sure that I would cancel a date to go ride and groom my horse.

Fall Fairs are a great time for people to learn where our food comes from and to get to touch and feel different animals, learn their sounds and their smells, and for some unsuspecting child or adult it may also mark the first time you got nipped, bit or kicked it because you wrongly thought that all animals were pets.  Fall Fairs are also a time of food poisoning and catching a zoonotic disease such as Salmonella or influenza.  Because Fall Fairs result in the mixing of humans and animals, it is important that we all take steps to protect ourselves from picking up a zoonotic disease.  Whenever there is a human and animal interface, we need to recognize the risks that come with it.  Promoting simple things like good hand hygiene habits and ensuring there is adequate access to hand washing stations or hand sanitizers can go a long way to protecting people.  But it’s not just about our protection, animals can be susceptible as well, so we need biosecurity measures in place to prevent animals getting sick because we traipsed something in to their area on our shoes.

In fact, a study recently published in Emerging Infectious Disease looked at how novel viruses can evolve in an agricultural fair setting highlighting how quickly influenza and other potential diseases can spread from pigs to humans.  The study looked at samples from 161 pigs from 7 different fairs.  They found that for 6 of the 7 fairs, 77.5% of the pigs were infected with Influenza A. Interestingly only 2 of the fairs showed extensive influenza-like illness among the pigs, meaning subclinical infections with influenza pose a potential public health threat.  Influenza viruses can jump from humans to pigs and back to humans.  Biosecurity measures at Fall Fairs and the need to conduct surveillance within the pig population is an important method for detecting novel influenza A viruses that threaten swine and human health alike.

Don’t let this stop you from attending these fun events.  There is much to see and do, and of course eat!  If you happen to attend any in Southwestern Ontario you may come across my niece!  She’s gone the “western” route meaning she runs barrels, poles and flags, but I still love her even if she picked the wrong events!

Bugging Off!

Nicole 

It was the stethoscope in the ER, my dear Watson.

If you ever read or watched the Sherlock Holmes books, movies or the TV series you will recall the line “Elementary, my dear Watson”.  It was the explanation that Sherlock Holmes gave to his assistant, Dr. Watson, when explaining deductions he had made.  Science, like solving murders, is all about deduction and solving mysteries and puzzles.

The same can certainly be said with infection prevention and trying to find out who or what are transmitting infections and how.  In recent years, there has been a huge push on improving hand hygiene rates.  There has also been a focus on improving cleaning and disinfection processes, particularly when it comes in environmental surfaces.  Studies have looked at different types of disinfectant actives, different cleaning processes, changing frequency of disinfection, increasing staff (or decreasing staff), and implementing verification methods to ensure that cleaning and disinfection has in fact occurred.  Several studies have shown that changing products, processes and including a validation program could in fact improve cleaning and disinfection showing a direct link to reducing HAIs. 

Regardless of the implementation of hand hygiene programs or improving environmental surface disinfection, HAIs were not eliminated.  Improved hand hygiene and enhanced cleaning certainly showed a reduction in HAIs, but HAIs still occurred.  Several years ago after conducting a cleaning audit at a facility that was in the midst of an outbreak one of the observations I made was that I never saw any cleaning and disinfection of patient care equipment by nursing staff.

Don’t jump to conclusions.  I’m not saying that nurses are to blame for outbreaks, but the thought came back in flash after reading a study that hoped to improve both hand hygiene and stethoscope hygiene. The researchers’ intervention sought to educate staff regarding the importance of stethoscope hygiene. Expectations were set that stethoscopes needed to be disinfected between each patient encounter due to the fact that they are repeatedly used throughout the day and can become contaminated after contact with patients.  This repeated use throughout the day and between multiple patients make stethoscopes a key fomite that can transmit pathogens from patient to patient.  Unfortunately for the researchers (and maybe the patients) of the 128 initial observations disinfection of the stethoscopes never occurred.  Post-intervention, an additional 41 observations found that even with an education intervention to discuss the importance of disinfection of the stethoscopes, no stethoscope hygiene was performed.

Do I hear crickets chirping? 

I wonder just how wide spread the lack of stethoscope hygiene is? I know the next time I’m at my doctor’s I’m going to ask when the last time she disinfected her stethoscope was and may just offer to clean it for her myself!

Bugging Off!

Nicole