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Wednesday, June 29, 2011
In our previous posts we have discussed chemicals from a cleaning and killing point of view, and certainly what a product kills and how clean it makes a facility looks are two of the key decisions factors (especially in healthcare), however the review of a product’s safety profile is just as important. The investigation into a product’s occupational and safety profile can be quite detailed so for the purpose of this blog I am going to focus on a class of chemicals called endocrine disruptors as this is where the commonality between boys and frogs occurs.
All people are exposed to chemicals with estrogenic effects in their everyday life, because endocrine disrupting chemicals are found in low doses in literally thousands of products. Endocrine disruptors are chemicals in our environment that interfere with hormones —natural chemical messengers that travel in the bloodstream and regulate many important physiological activities in amphibians, animals and humans alike. Endocrine disruptors may be natural phytoestrogens (estrogen-like chemicals that are made by plants) or synthetic chemicals used in pesticides, medications, dietary supplements, cosmetics, soaps or detergents and commercial and consumer products. Some of the more recognizable chemicals include DDT, PCBs, phthalates, bisphenol A, and alkylphenols - all of which have hit the news at some point over the past 20 years as scientists have unveiled their role in polluting not just the environment, but our bodies as well. Any system in the body controlled by hormones, can be derailed by hormone disruptors.
Some of the first eerie signs of a potential health catastrophe came as bizarre deformities in water animals, often in their sexual organs. Frogs are bioindicators—they provide a window, if you will to the environmental health of our planet. Their permeable skin makes them especially vulnerable to environmental contaminants, particularly endocrine disruptors. Frogs are manifesting reproductive deformities and hormonal disorders, resulting from the toxic stew of chemicals that find their way into the water in which they live. A study done in Potomac River in 2000 found 80 percent of the male fish collected had become feminized and their sex organs were not producing sperm, likely as a result of the chemical pollution found in the river. Further studies have linked endocrine disruptors as the cause for frogs, salamanders and other amphibians to sprout extra legs.
Many of these compounds act as weak estrogen, so that’s why developing males — whether smallmouth bass or humans — tend to be more sensitive. In June 2009, the Endocrine Society, an organization of scientists specializing in this field, issued a landmark 50-page statement. “We present the evidence that endocrine disruptors have effects on male and female reproduction, breast development and cancer, prostate cancer, neuroendocrinology, thyroid, metabolism and obesity, and cardiovascular endocrinology.” The society further states that “The rise in the incidence in obesity matches the rise in the use and distribution of industrial chemicals that may be playing a role in generation of obesity.”
As endocrine disruptors are in the water we drink and are in dozens of commercial and consumer products we use every day, we have reason to be concerned. The next time you’re choosing a cleaning product ask yourself “What’s in this bottle?”
Next week we’ll continue our look into occupational health and safety profiles of chemicals with a discussion on volatile organic compounds.
Wednesday, June 22, 2011
The CDC recognized this as a critically important aspect of disinfectant selection in their 2008 Disinfection and Sterilization Guideline. They listed that an ideal disinfectant should “have a wide antimicrobial spectrum”. This broad antimicrobial spectrum serves to support a pro-active or preventative approach to cleaning and disinfection. Rather than waiting for patients to be afflicted with infections from more difficult to kill pathogens and scrambling to implement a disinfectant that will control or intervene in the transmission of the organism, an ideal procedure will utilize a broadly effective disinfectant that will prevent the transmission of both easy-to-kill microorganisms such as Influenza A but also more difficult to kill pathogens such as Norovirus. In an era of drug resistant microorganisms that are immensely difficult to treat once contracted, the onus must switch to preventing the transmission of these pathogens in the first place.
The one caveat to this way of thinking is the daily use of sporicidal agents. These products are typically much more highly concentrated chemical solutions prepared to inactivate spores, the most difficult to kill microorganisms. While their use will also effectively annihilate all other microbial life forms, their safety profile inhibits their safe and effective ongoing or daily use. Therefore, these types of products are best suited for task oriented applications alongside a broad spectrum disinfectant that will address all other pathogens.
In next week’s blog we’ll further address this other critically important aspect of disinfectant selection – the safety profile of the product. But in the meantime, how does your healthcare institution approach the selection of disinfectants?
Hasta la vista
Lee – The Germinator
Wednesday, June 15, 2011
Now, unlike speedy sports cars which would be considered frivolous expenditures of a man going through a mid-life crisis, I believe I’ve effectively illustrated that top performing disinfectants with rapid and realistic contact times are a necessity for effective disinfection practices in healthcare institutions. Unfortunately, what these high performance disinfectants often share with their automotive equivalents is a premium price tag. In other words, you can’t get Porsche like performance at Honda Civic prices – both in the automotive world and in the disinfectant marketplace. Therefore, the business case must be made by infection prevention and control professionals as to the importance of effective disinfectants with rapid and realistic contact times. In particular, that their increased initial cost will likely lead to cost savings in the end by means of effectively disinfecting the surfaces which will result in a reduction of healthcare acquired infections.
Next week, please join us for a discussion on the other critical element of disinfectant performance - spectrum of kill.
Hasta la vista!
Lee - The Germinator
Thursday, June 9, 2011
Why do we have this aversion to cleaning? Is it laziness? Is it because most families are now dual income with a couple of kids and are too busy running from work to hockey games, practices or tournaments? Is it because in this day and age we have access to self-cleaning products and can afford to hire a housekeeper we simply choose to have the attitude that “it’s someone else’s problem”? We are certainly quick to point out stores, restaurants and even hospitals that we think are dirty so are we really too busy to give it any thought?
While I can hazard a guess, I certainly do not have the answer. I do know that the commercial and residential cleaning services industry in North America generates over $53.6 BILLION US dollars annually and that in 2008 over $700 MILLION in the US alone was spent on cleaning chemicals for the healthcare market. As an Infection Control history buff, I know that Florence Nightingale during the Crimean War (1853 – 1856) identified the link between overcrowding, hygiene and poor patient outcome and by instituting a cleaning program and increasing the space between patients, saw a marked decrease in infection transmission. Health Canada and the CDC clearly expound the importance of environmental cleaning programs within the various Infection Prevention and Control Guidelines that have been published. Not to mention the numerous publications in scientific journals worldwide investigating the link between the environment and infection transmission – in fact just last week, APIC (Association for Professionals in Infection Control and Epidemiology) published a collection of Environmental Cleaning articles. The key take home message is that cleaning is important. Cleaning needs to be done right – the first time. Cleaning can save lives.
Clean means free of dirt and organic matter. The physical action of cleaning removes dirt that can be used by some pathogens for food, it removes dirt that can harbor pathogens and lead to transmission and if measuring the log reduction of pathogens from a surface after cleaning, cleaning can almost achieve disinfection – at the very least, cleaning renders the surfaces safe. We have to remember; cleaning does not mean spray and walk away. We continue to look for that illusive silver bullet, but to my knowledge there are no self-cleaning hospitals and I’m pretty certain Cinderella and her merry band of mice and birds is a fairytale. Cleaning takes time and it takes manpower. Cutting corners by cutting down on the amount of time our cleaning staff have to clean a room or cutting back on the number of cleaning staff we have to clean our facilities is setting people up to fail. We are setting ourselves up for hospital acquired infections (HAIs). The importance of cleaning staff and their direct impact on infection prevention and patient safety needs to be elevated. I realize that the environmental services department is a cost centre, but perhaps rather than looking at silos, we need to look at the hospital at the holistic level. What is the cost of a HAI? Could twenty more minutes or one more person help stop HAIs and save facilities money? I think the answer is yes.
Is there any question about the importance of cleaning and the association that cleaning staff have on patient safety and stopping hospital acquired infections? I don’t think so. Perhaps we need to take the concept of Earth Day where people think nothing of cleaning up litter from road sides to healthcare. Wouldn’t you love to see a day where everyone from the CEO down rolled up their sleeves and helped keep your hospital clean? I know I would!