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Thursday, August 16, 2012

Life slime…the stuff nightmares are made of


JEAPARDY QUESTION: “What does plaque on your teeth, the slippery slime on river stones, the gel-like film on the inside of flower vases, the unsightly stains in toilet bowls, the gunk that clogs your drains, otitis media (ear infections) and bacterial endocarditis (infection of the inner surface of the heart) have in common?”

ANSWER: “Nicole, what are BIOFILMS?”

In Lee’s “Are there Monsters in your drain” blog he alluded to the issue of bacterial growth in the drains of sinks being the root cause of outbreaks within healthcare facilities.  The bacteria being “splashed” and contaminating clean surfaces or items could be attributed to biofilm. 

Biofilm as highlighted above is nothing new to the world and can be found almost ANYWHERE!  Literally translated, Biofilm means “life slime” and can basically develop in any environment that has bugs (bacteria, fungi, yeasts, etc), has a flow of water and has a surface on which to stick.  When these bugs adhere to the surface they excrete a slimy, glue-like substance that helps them stick to all kinds of surfaces such as metals, plastics, rocks, implanted medical devices, teeth and tissue.

Depending on where they are found and what organisms they are comprised of, biofilms can be dangerous or beneficial.  Biofilms are responsible for billions of dollars in lost productivity due to equipment damage by causing pipes to plug or corrode, however they can also be used to help treat environmental wastes such as sewage or be used to manufacture medicines.  As a society, we most commonly associate biofilms with their related infections where biofilms can develop on medical device surfaces such as catheters, medical implants or wound dressings.  However, don’t be fooled, biofilms happily colonize on many household surfaces such as toilets, sinks, countertops, cutting boards and coffee pots!  Poor disinfection practices and ineffective cleaning products may increase the incidence of illness associated with pathogenic organisms commonly found around the home.

An outbreak in 1994 that caused hundreds of infections in asthmatics pushed the concern of biofilms to the forefront.  Pseudomonas aeruginosa, in its biofilm state was able to survive the disinfection process during manufacturing of inhalers and when used by unsuspecting asthmatics, was transported directly to the lung tissue where it flourished.  At least 100 people died from the biofilm infection.

Closer to my home, in 2000 an outbreak of E.coli O157:H7 killed 7 people and sickened some 2500 residents, many of them children.  The drinking water system had been contaminated by manure following heavy rains and the water treatment system did not have appropriate levels of residual chlorine to kill the bacteria.  During the “clean up” of the town’s water-mains, flushing and swabbing of 41 kilometers of water-mains was conducted and it was noted that increased levels of Coliform and other bacterial populations were being isolated…..biofilm was being sloughed off the sides of the water mains and continued to contaminate the water.  Perhaps the next time your city undergoes water-main cleaning and / or upgrades during the summer and invariably slows down traffic you won’t grumble as much.  What are a few extra minutes for your commute when the alternative could lead to severe diarrhea or possible death?

Of course the most well known culprits for biofilm generation are whirlpool tubs, hydrotherapy tubs or foot spa baths.  I can cite several well published outbreaks associated with piping found in tubs.  Biofilm can be shed from the pipes into the water and if you have sores or breaks in the skin these may become infected as a result of this exposure.  Perhaps now it makes sense why spas tell you not to shave your legs before a pedicure or other treatment involving a tub?  If that’s not enough, the circulation of water can aerosolize the bacteria making it easy to inhale and as noted in the 1994 outbreak of asthmatics, inhaling biofilm bacteria directly into your lungs is not a good thing!

So now that you’ll never be able to drink tap water, have a pedicure or kiss your significant other in the morning for fear of coming in contact with biofilm, let’s talk about how we deal with it.  Oxidizing chemistries such as chlorine or hydrogen peroxide have been recognized as being effective at both removing and destroying biofilms.  Good old fashioned scrubbing (mechanical removal) can also help to remove most biofilms from surfaces, however, to completely clean off and remove the biofilm slime oxidizing chemicals will be needed.  The good news is that biofilms can be removed or destroyed by chemical and mechanical means with consistent cleaning and disinfection practices. BUT – it only takes a very short time for biofilm to re-establish itself and then you have to start the battle all over again.  As Lee suggested in his sink blog, having established procedures that detail how to clean and disinfect and with what frequency to disinfect areas that are harbingers of biofilm will help stop their growth and development.

I hope the next time you stay in a hotel you ask yourself “When was the last time the lines of the in-room coffee maker were cleaned?”  You may reconsider making yourself that pot of coffee……and people wonder why I’m a StarBucks girl……


Bugging Off!

Nicole

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