Welcome to Professional and Technical Services (PTS) – experts in chemical disinfection for infection prevention. Our goal is to educate and provide you the latest resources related to cleaning and disinfection of environmental surfaces, medical devices and hands. As specialists in disinfectant chemistries, microbiology, environmental cleaning and disinfection, facility assessments and policy and procedure creation we are dedicated to helping any person or facility who uses chemical disinfectants.

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Friday, July 31, 2015

#FF Summer Reading and Relaxing

As we have done for the last several years, during the summer months we review a couple books or blogs that we think are worth reading....or at least thinking about reading.  Since I’m on vacation this week the topic of summer reading is relevant and I’m doing just that; lounging in the sun, relaxing and catching up on some books I've been meaning to dive into.  Admittedly, not all my reading is educational.  I’m balancing my time between education and complete and utter fluff.  By utter fluff, I mean books that I only read on my Kobo so that people cannot see what drivel I am reading!

Here are a few of the blogs I have been checking out while enjoying the sun:


One Health Initiative: One Health (formerly called One Medicine) is dedicated to improving the lives of all species—human and animal—through the integration of human medicine, veterinary medicine and environmental science.  While they do not have a blog, they do have quite a library of newsletters that cover quite a wide range of topics and since the concept of One Health is something I intend to focus on this year this is definitely my go to site.

                                                                                                                                                    

Worms & Germs Blog: is an educational website coordinated by Drs. Scott Weese and Maureen Anderson of the Ontario Veterinary College's Centre for Public Health and Zoonoses.  I’ve had the pleasure of seeing Dr. Weese speak at numerous conferences.  As a great speaker and researcher, there is a plethora of information to be gleaned from this blog!  Similar to Talk Clean To Me, Worms & Germs will discuss published papers...who knew dog licks could be fatal?

 

ZED Blog: ZED stands for Zoonotic & Emerging Diseases.  Anyone who uses acronyms MUST be on my reading list!  ZED is a group that study a wide range of epidemiological issues revolving around domestic livestock, peri-domestic wildlife and humans, in particular the epidemiology of zoonotic and emerging and re-emerging diseases.  Sounds like a pretty cool group to me!  ZED can be followed on Twitter @ZoonoticDisease.

 

Marler Blog:  Okay, this may be an odd one to add to a list.  Bill Marler, the author of this blog is actually a personal injury and products liability attorney who specializes in litigating foodborne illness cases.  Mr. Marler spends most of his time addressing food industry groups, fair associations, and public health groups about foodborne illness litigation and issues surrounding it.  Being the litigator behind the famous Jack in the Box E. coli outbreak, his blog has some pretty interesting readings from a completely different perspective! Mr. Marler can be followed on Twitter @bmarler.

 

I hope you’ll take the opportunity to check these blogs out!  Now I’m off to go back to basking in the sun and reading a little more fluff!


Bugging Off!                                                                                                                                                                                      


Nicole

Friday, July 24, 2015

Armadillos – touch at your own risk!

If you’re an avid reader of the “Talk Clean To Me” blog you’ll have noticed over the last several months we’ve chatted about the concept of One Health and zoonotic diseases .  If you’re not as avid a reader, zoonotic diseases are diseases that can be passed between animals and humans and can be caused by viruses, bacteria, parasites, and fungi.  Unfortunately, zoonotic diseases are not rare; in fact, scientists estimate that more than 6 out of every 10 infectious diseases in humans are spread from animals.

While >60% of infectious diseases point directly to animals, I admit, I was thinking of chickens, pigs, primates and rodents as the primary causes.  Who knew Armadillos were just as concerning!  While Armadillos are not perhaps the cuddliest of creatures, you can’t help but want to touch them and if you haven’t had the opportunity, Armadillo racing is pretty fun! 

If you haven’t seen the headlines, Florida health officials are warning Floridians to stay away from Armadillos after 9 people have become infected with leprosy after coming into contact with these leather armored creatures.   Leprosy is not new.  It’s a century old bacterial infection caused by Mycobacterium leprae.  Also known as Hansen’s disease, it causes nerve damage and disfigurement.  While it mainly affects the skin and nerves, it can also affect the upper respiratory tract and eyes. 

The bacterium that causes Leprosy can be found in humans and feral armadillos found in Louisiana and Texas and while not native to Florida, it would appear that the armadillos that have made their way to that state are also carriers of the bacteria.  As a disease, Leprosy is not highly contagious and while it has been around for eons, we are still not exactly certain how it is transmitted, but believe that prolonged direct contact with infectious nasal discharge, skin secretions and of course respiratory droplets from coughs or sneezes can lead to transmission.  I’m sure no one is wittingly cuddling a snotty nosed armadillo, but chances are transmission is occurring if or when the perturbed creature spits on someone.

Perhaps most concerning point with Leprosy is that the bacteria can lie dormant for years and has been shown to take up to a decade for symptoms to appear!  The upside is that 95% of the human population is not susceptible to Leprosy meaning that only about 100 new cases of Leprosy are confirmed each year in the US, so while this current outbreak is interesting, the chances of catching it are slim!

I wonder what the next zoonotic outbreak will be!

Bugging Off!


Nicole 

Friday, July 17, 2015

Don’t believe everything you read!

One of the best courses I took in university was a wildlife biology ecology course.  OBVIOUSLY, the course material is not relevant to my current job, but the professor spent a better course of a month drilling into us that there are always two sides to every story and not to read and believe everything you see in print.  He did not care if it was a blog (admittedly those weren’t around in my university days), a newsletter article or a peer reviewed journal article.  We were taught to look at what was presented critically and determine if both sides of the story were being presented equally or if the story, article or study was being presented in a manner that was a little less balanced.  As a result of this course and a couple of great mentors, I admit I may be a bit jaded when reading articles and studies.  I generally don’t take things at face value and generally drive people insane with my sometimes never-ending stream of questions.  Much to the chagrin of my colleagues, I’m the self proclaimed “Ya, but..." girl.

However, there are times when this irritatingly inquisitive approach comes in handy.  Case in point was with a recent question as to the efficacy of a product against an arm’s length list of Salmonella strains where I was asked to answer yes or no to whether Product A was effective against the following:
  1. Salmonella enterica – pullorum
  2. Salmonella enteritidis
  3. Salmonella schottmuelleri
  4. Salmonella typhi
  5. Salmonella typhimurium

As we have discussed in several previous blogs, the number of kill claims is not what is relevant.  Microorganisms, particularly bacteria that have numerous strains, should be considered as a single pathogen – if you kill one, you kill them all! 

In the case with Salmonella spp, in order to obtain a disinfectant claim in Canada or the US Salmonella enterica is one of the three surrogate organisms used to ensure a product is considered a hospital disinfectant with broad-spectrum efficacy against vegetative bacteria.  My response to this question was as expected - If the product kills S. enterica it would be effective against all strains of Salmonella.

Upon giving that response however, I received an email citing a study conducted in 2002 that concluded “variations in susceptibility to disinfectants has been observed between Salmonella strains” so I did what anyone respectable person would do.  I found the reference, reviewed it and called someone far smarter than I (a world renowned microbiologist) to comment!  The response I received back nearly made me snort my coffee out my nose and took me back to my third year Wildlife Biology Ecology course.

The response I got back was “The paper is not even worth the paper it is written on, it was a good example of how one can make a mockery of the peer-review process and should not be given any further consideration”.  This respected microbiologist then went on to agree with my stance that if you kill one strain you kill them all.  But why did this microbiologist draw such strong conclusions?  For this person it was easy.  First, the study stated that the disinfectant test method it used was “close” to how the chosen products were used in the field.  Seems reasonable, BUT the test method, based on a Master’s thesis by the first author, was a carrier test using pieces of stainless steel and the test disinfectant was sprayed on the carriers with dried bacterial inocula, which is not a test method accepted by Health Canada or the EPA for disinfectant product registration.  Further, among its numerous weaknesses with the test method were: (a) no added soil load, (b) no mentioned neutralizer, (c) no quantitation of viable bacteria - the results were based on the presence or absence of turbidity in the inoculated tubes, (d) the fact that at the end of the contact time, the excess disinfectant was simply drained off into a filter paper - this has major implications for the degree of dislodgement of the bacteria from the carrier surface depending on the detergent activity of the formulation under test, (e) the inclusion of 3% hydrogen peroxide (unformulated) in the testing as a ‘disinfectant’, (f) the requirement of a complete kill as the product efficacy criterion, (g) no indication of the number of viable bacteria on the carriers after the inoculum drying process, and (h) the dipping of the entire carrier into the recovery medium, which could have resulted in turbidity (therefore, failure of product) from the growth of one single bacterium surviving the disinfectant treatment.

In a nutshell, there were numerous holes in the method used and while interesting, the test method used was not reflective of the requirements for manufacturers to register products, and therefore the results could be considered suspect. The conclusion of both the microbiologist and me on using representative strains of pathogens to draw conclusions on the overall field effectiveness of its products is valid in general, and also endorsed by regulatory agencies.

I hope the next time you read a study you’ll consider if both sides of the story are being told, particularly when reading a study on the efficacy of products you consider, and validate if the test method used is one that will be accepted by regulatory bodies for registration.  If it’s not, the study is interesting, but not necessarily one that you can apply to your practice.

Bugging Off!


Nicole

Friday, July 10, 2015

Who’s the last man/women (girl) standing!

If you’ve followed the "Talk Clean To Me" blog for a while, you’ll know that sharing others misfortunes for the sake of getting my point across is not something new.  Take the #FF – Micro Blog’s Viral Misfortunes blog from November 2013 as an example, outlining a Norovirus outbreak within his family.  This past week I had the “fortune” or “misfortune” to have lived through some sort of outbreak that spread through 5 of 6 people at my cottage.  The line listing looks something like this:

Wednesday July 1/15, Male aged 6.5, vomiting
Saturday July 4/15, Female aged 44, vomiting
Sunday July 5/15, Male aged 45, pooping
Monday July 6/15, Female aged 43, pooping
Tuesday July 7/15, Male aged 10, vomiting
Wednesday July 8/15, Female aged 7 strutting around the cottage bragging that she was the only healthy one (picture to prove it)

As someone in the “know”, perhaps I should have called my friend and had her postpone her arrival...when I came down sick on Saturday.  But she’s my best friend.  I wanted to see her and spend some time with her and her kids....I was hoping that by disinfecting everything and washing my hands like crazy I could stem the outbreak, but I knew I was putting my friend and her kids at risk.....

So why then do doctors, clinicians and nurses routinely work when sick and put their patients at risk? Well, an editorial in JAMA Pediatrics focused on just that.  For centuries, Primum Non Nocere (first do no harm) has been the guiding principle for healthcare workers which one would assume also means they should not spread infections by working while sick.  As the editorial goes to describe, a survey of healthcare workers  was conducted looking at the role of presenteeism and what the key reasons were for going to work while sick (and infectious). 

The top reasons for working while sick included; concern over who would fill in for them, concern that their patients could not get by without them and a widespread belief that if they stayed home because of a cold or flu they would be perceived as being weak or unprofessional.  Of the 280 healthcare workers who competed the survey 83% positively responded to working while sick at least once in the past year even though 95% stated that working while sick put their patients and colleagues at risk.  That rationale for working while sick was the belief of an unspoken understanding that you should be on your deathbed if you are calling in sick.  It was easier and less stressful coming into work than feeling they were letting their colleagues and patients down.  When asked about what symptoms they would come to work with 55% would work or have worked with symptoms such as a cough, congestion or sore throat and 30% said they would work with diarrhea!

The co-authors in reviewing the reasons for showing up while sick cited that there were systemic, logistic and cultural factors involved which created a climate where staff felt they had to work when sick.  With streamlining, budget cuts and the need to balance the books, hospitals have become a place where everyone is expected to work at peak capacity all the time and with a lean staff this means less redundancy and less flexibility to find a replacement to cover sick time.  The result being a culture where those who know they should not work while sick and know that by working sick they are putting their patients at risk come into work anyways. 

Changing a culture of a facility and changing the beliefs and norms of staff is no small feat.   But in the day and age where hospitals are under scrutiny by the public for infection prevention rates....perhaps it’s time to invest in developing a culture where when sick staff know “we’ve got your back”.  Stay home and get well because it’s better for all of us.  The alternative of course could be that the staff member with diarrhea in fact has C. diff....because we just never know when or how the next outbreak is going to start!

To my friend....sorry that you lost a day of your vacation being sick!

Bugging Off!

Nicole

Thursday, July 2, 2015

Adult Adventures and “Aducation” at APIC 2015

Okay, I made up a word.....but none of the “a” words for EDUCATION worked and since I so love alliterations this allowed me to string 6 “a” words together – a tie with my “PEDv Pooping Pigs Pose Pharaonic Problems” back in January 2014. 

I’m hoping some of you like me, were able to spend the last several days in Nashville, TN at the Music City Centre sopping up the posters, oral abstracts, education sessions and exhibitor hall.  Admittedly in my role I’m spoiled and get to attend all sorts of education events and tradeshows for both the Human and Animal Health markets.  It never ceases to amaze me, just when I think I have a good handle on all things cleaning, disinfection and sterilization for hands, surfaces and devices, something new pops up!

There are truly too many highlights from the conference to cover without creating a novel so I’m going to focus on the key messages I took away from the full day pre-conference disinfectant symposium which covered virtually every topic related to sterilization, disinfection and antisepsis for hands, surfaces and devices.  It was an intensive 9hr day broken into 20 minute presentations and panel discussions by key thought leaders (Dr. Bill Rutala, Dr. David Weber, Dr. Charles Gerba, Dr. Curtis Donskey, Dr. Elaine Larson, Dr. Michelle Alfa to name a few of the speakers). 

1.    According to Dr. Rutala we need to focus on ALL touch surfaces not just what we have defined as high touch surfaces as the level of contamination on the low and medium touch surfaces has been found to be just as high as that found on the high touch surfaces.
2.    According to Dr. Gerba, the toilet seat is cleaner than the surfaces in our kitchens.  He recommends making your sandwiches on your toilet seat AND more disgusting was the work he did on E. coli and fecal contamination on our hand and bath towels.  The basic conclusion for that work was if you wiped your face with your towel you may as well stick your head in the toilet and flush as the fecal and E. coli contamination would be the same.
3.    Drs Rutala and Alfa both agreed that stainless steel surgical equipment is far easier to reprocess than GI equipment like endoscopes and Duodenoscopes.  There is NO room for error in reprocessing GI scopes.  But with Stainless Steel equipment, sterilized “crud” is still unacceptable with Dr. Alfa giving several disgusting examples of finding bits and pieces of “body parts” in different surgical equipment after cleaning and sterilization.
4.    Dr. Rutala feels that it is time to up the level of disinfection requirement for GI scopes and make it mandated that sterilization is the required level of kill as HLD leaves room for error if a mistake is made or a corner is cut.
5.    Dr. Emily Sickbert-Bennett, the Epidemiologist at UNC presented their Hand Hygiene project and was able to show that by increasing their hand hygiene rates by 10% reduced their C. diff rates by 14%!
6.    Dr. Weber spoke about the fact that we are only a flight away from the next outbreak!
7.    Dr. Larson presented data to show that there is a strong correlation between hand hygiene compliance and the number of patients nurses have to care for.  As the number of patients and / or acuity of the patient increases, hand hygiene decreases.
8.    Dr. Donskey made a very interesting observation in terms of the use of room decontamination devices such as UV.  His concern based on observations he has seen is that EVS get lazy in their cleaning as they begin to believe that “the robots” will kill what they did not....

To my Canadian friends and colleagues I hope you had a wonder Canada Day yesterday and for my US friends and colleagues happy Independence Day!

Bugging Off!


Nicole