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.

Our expertise is utilized by Infection Preventionists, Public Health Experts, First Responders, Dentists, Physicians, Nurses, Veterinarians, Aestheticians, Environmental Services professionals and janitorial product distributors to develop more sustainable cleaning and disinfection practices in North America.

Our commitment to providing chemical disinfectant education is more than business, it is a passion.

Saturday, November 16, 2019

Custodial Chemist - Mixing Acids and Bleach


I hate news that talks about death.  I especially hate it when it could be avoided.  Case in point was the death of a restaurant worker last week in Burlington, MA.  A 32-year-old man lost his life and 14 others were affected by the incident.  The cause of the accident was mixing of cleaning chemicals.
According to reports, an employee was cleaning the floor of the restaurant and used two different products.  One was a bleach-based product, the second an acid cleaner.  Unfortunately, when you mix these two chemicals together it causes a serious chemical reaction. When bleach is mixed with any acid, it releases highly toxic chlorine gas.  The acrid fumes of chlorine gas are capable of can destroying lung tissue and can cause the lungs to fill with fluid.  The end result in essence is death caused by drowning. 

Long story short, NO acid must ever be mixed with chlorine bleach. This includes acidic drain cleaners, rust removers and even vinegar (acetic acid).  

Back in 2011, I coined the term “Custodial Chemists”.   The Custodial Chemist is a group of people that believe that their collective years as professional cleaners make them far more knowledgeable then formulating chemists who have years of higher education and develop the products the Custodial Chemists use. The Custodial Chemist is someone who mixes products together in the belief they are making a better product (or simplifying their job). Why use a degreaser or glass cleaner followed by a disinfectant when you can mix them together and create a degreaser-disinfectant or the best disinfectant glass cleaner on the market.

The situation that lead to this happening was likely due to the fact that the employee (a Custodial Chemist) did not know or understand that bleach and acids should never be mixed and what the resulting consequences could be. 

Employers are required by law to provide training on the use of cleaning and other chemicals PRIOR to their use because chemicals pose such a wide range of health and safety hazards.  OSHA’s Hazard Communication standard (29 CFR 1910.1200) is designed to ensure that information about these hazards and associated protective measures is communicated to workers. Under OSHA’s standard, the required training should include:

  1. Health and physical hazards of the cleaning chemicals
  2. Proper handling, use and storage of all cleaning chemicals being used, including dilution procedures when a cleaning product must be diluted before use
  3. Proper procedures to follow when a spill occurs
  4. Personal protective equipment required for using the cleaning product, such as gloves, safety goggles and respirators
  5. How to obtain and use hazard information, including an explanation of product labels and SDSs


This is an unfortunate accident that left a 3-month old baby boy without his dad.  As employers, it is our duty to ensure our employees are kept safe and have the appropriate training to do their jobs safely.  As employees, it is our duty to ask questions, assume we do not know everything and work in a manner that is going to keep us safe.

Bugging Off!

Nicole

Friday, November 8, 2019

Common Sense or Panic & Paranoia?


Rightly or wrongly, a good outbreak can be exciting.  Don’t get me wrong, it’s not the impact of illness that interests me – I’m not that heartless.  What fascinates me is what we learn when a new “bug” pops up or what we “relearn” when we get hit by “bug” we know how to handle.  When it comes to infection prevention, we cannot relax and become comfortable because everything is ticking along smoothly and most importantly, just because nothing has happened in a while we cannot afford to lower our defences.

That said, keeping ourselves and others healthy is about finding the balance between being too cavalier and too paranoid.  Take a recent article I read about the cleanliness level of highchairs in restaurants in the UK.  The BBC revealed that restaurant highchairs are dirtier than tables at several different restaurants.  Surprisingly to some, the highchairs tested at McDonald’s were cleaner than the tables.  While the level of bacteria found on the highchairs was significantly higher than expected, it was still not at a level that would cause health concerns.  Of concern was the fact that coliform bacteria were found, as this type of bacteria is associated with waste from humans and animals.  In fact, coliform bacteria are often referred to as "indicator organisms" because they indicate the potential presence of disease-causing bacteria, particularly in water.   Thankfully, the bacteria found on the highchairs can easily be removed and/or killed with diligent cleaning, sanitizing or disinfection. 

The question is if as a society we need to start to panic that highchairs in restaurants could be the harbingers of doom for our babies.  Let’s mull this over and use a little common sense.

  1. Unlike viruses, bacteria have the ability to reproduce.  When conditions are favourable such as if the right temperature and nutrients are available, some bacteria like Escherichia coli can divide every 20 minutes. This means that in just 7 hours one bacterium can generate 2,097,152 bacteria.
  2. A large percentage of infections and outbreaks are spread by contaminated hands. Appropriate hand washing practices can reduce the risk of foodborne illness and other infections.  According to the WHO, adherence to HH by HCWs ranges from 5% to 89% with the overall average being 38%!  If healthcare workers have poor hand hygiene practices, you can be sure the public is much worse.
  3. Highchairs in many restaurants are often stored in readily accessible areas, meaning they could be considered a high touch surface.
  4. Depending on the restaurant, highchairs may sit for some time between usages. 
  5. Cloths used to clean surfaces where food is prepared need to be changed regularly or thoroughly disinfected to prevent the growth of bacteria.  Bacteria on uncleaned cloths can transfer to the hands of staff then on to work surfaces, equipment and utensils.


What does this mean?  Well, pathogens are easily spread from hands to surfaces and surfaces to hands.  Restaurants tend to use the reuse cloths for cleaning tables.  As the cloth picks up food and germs it has the ability to redeposit the soil and/or pathogens to another surface helping them spread and proliferate.  Bacteria can quickly reproduce, so if you have a highchair that has not been cleaned for a while, was poorly cleaned after its last use or in an area where you have umpteen people and kids touching it (most likely with dirty hands), you can be assured that germs will be present and they are likely multiplying at an alarming rate.

What is my take-home message?  If I’m concerned with protecting my loved ones - and young ones in particular who have undeveloped immune systems and are more susceptible to picking things up – then I’m not going to panic or become paranoid about how well a restaurant has cleaned the highchair.  I am going to assume that it has been touched by others after it has been cleaned.  I am going to assume that it has been sitting around for a while between usage and I’m going to assume that it’s dirty.  I am going to clean the highchair before I put my young one it in.

Thankfully, my young one is well past the highchair stage.  He has not yet gotten past the stage of me having to nag him to wash his hands before he eats!

Bugging Off!

Nicole

Friday, November 1, 2019

Turtles and Halloween Horrors


It’s a rainy Halloween Eve in my neck of the woods.  Thankfully, I have a cold so I pleaded the fact that I need to stay in and not get wet and chilled.  Instead, I sit here stuffing my mouth with chocolate, sipping on an adult beverage and while I wait patiently for the next trick-or-treater to arrive. 

The “turtle” part of the blog is because there is currently an outbreak of Salmonella across 13 states that has been linked back to pet turtles.  According to the CDC as of Wednesday, twenty-one people have been infected with Salmonella oranienburg with seven of those cases requiring hospitalization.  Thankfully there have not been any deaths.

California had the most reported cases at six, while Illinois, New York and Washington have also reported multiple cases. This is not the first outbreak associated with pet turtles.  People that own or come in contact with pet turtles should always wash their hands thoroughly with soap and water after handling.  While turtles may look cuddly, you should also avoid kissing or snuggling them or let turtles roam freely where food is prepared or stored (e.g. your kitchen).  Another thing to avoid is cleaning a turtle's tank, toys or supplies in the kitchen.  If can clean it outside the house, that would be the safest!

So how does an outbreak associated with turtles go with Halloween horrors?  Why Salmonella of course!  I mean who would not Google “Salmonella outbreaks associated with chocolate”!?  While I was hoping for none, that did not happen.  I’d forgotten the outbreak earlier this year associated with chocolate-covered cream puffs.  Back in 2006, Cadbury had to recall more than 1 million of its chocolate bars and ended up pleading guilty to nine charges relating to breaches of food safety regulations.  In 2018, the company that makes Duncan Hines desserts recalled four types of cake mix after Salmonella was found in their “Classic White” mix.

Symptoms of a Salmonella infection include diarrhea, fever, and stomach cramps about 12 to 72 hours after being exposed to the bacteria. The illness usually lasts four to 7 days, and most people recover without needing treatment.  So, if any of the candy you or your kids eat has been contaminated with Salmonella you can expect to be sick as early as tomorrow.  Since candy can be a bit like Russian roulette, assuming it takes you a week to finish anytime between tomorrow and up to the 10th of November puts you in the 12-72 hr window!

Bugging Off!

Nicole

Friday, October 25, 2019

Top 10 Health Hazards for 2020


You never know what can impact our health.  Certainly the media does a great job sensationalizing outbreaks.  If that’s not bad enough we can have disagreements among “experts” as to what is safe or what can pose a long term risk (aka the vaccine debacle of a falsified study linking vaccines to autism).  We know that hand hygiene and disinfection - or lack thereof - can directly impact our health through the spread of hospital associated infections. 

The ECRI Institute recently published their “Top 10 Health Technology Hazards for 2020”.  The intent of the report is to inform healthcare facilities of potential risks associated with the use of medical devices or systems.  The list is compiled from insights gained through investigating incidents, testing medical devices in the ECRI lab, observing operations and assessing hospital practices, reviewing literature and speaking with healthcare providers.  The 2020 list includes:

  1. Misuse of surgical staples
  2. Adoption of point-of-care ultrasound is outpacing safeguards
  3. Infection risks from sterile processing errors in medical and dental offices
  4. Hemodialysis risks with central venous line catheters (will home dialysis increase dangers?)
  5. Unproven surgical robotic procedures may put patients at risks
  6. Alarm, alert and notification overload
  7. Cybersecurity risks in the connected home healthcare environment
  8. Missing implant data can delay or add danger to MRI scans
  9. Medication errors from dose timing discrepancies in EHRs
  10. Loose nuts and bolts can lead to catastrophic device failures and severe injury



When it comes to cleaning and disinfection, sterile processing errors are unfortunately not a new thing.  In fact, in the 2018 ECRI report, a similar issue was identified.  As we know, failure to follow proper cleaning, disinfecting, and sterilization protocols can result in a compromised device—and devastating effects for patients. As our healthcare expands beyond hospitals to outpatient or ambulatory care clinics, medical offices or home care services we run the risk that these settings do not have infection control practices, certified medical device reprocessing technicians or practices in place to audit, monitor and validate that reprocessing practices are being completed appropriately.

What’s concerning is that while we know incorrectly reprocessed devices can be a source for infection transmission we have not yet found a way to stop this from happening.  Certainly, factors such as not cleaning and disinfectant or sterilizing correctly are obvious issues which leads us to question what training is needed and/or how frequently re-training is required.  But aside from human factors what else is at play?  Is the equipment becoming too complex?  In our need to increase throughput and provide services to as many patients as possible are we not giving enough time to correctly reprocess the devices we are using?  Due to the cost of the devices, do we run with too lean of an inventory?  We need to be contemplating more than just the physical reprocessing of devices as the risk; we need to stand back and look at things from every angle.

Bugging Off!

Nicole

Friday, October 18, 2019

Wrapping Up Infection Control Week



I admit, I love Infection Control Week.  In the past I have been fortunate enough to be involved with events at facilities, education days for infection prevention chapters and more recently, we have developed our own infection control week at our company to remind people of how we can keep healthy during cold and flu season.   It’s amazing how our entire company gets into it…..of course the gift certificates may help!

This week we played 'find the plushie bug'.   It took almost the entire day to find one of them so we’ve become great at hiding.  Of course, the message is that you never know what you might find so looking at how you can keep you environment clean via cleaning and disinfection and practicing good hand hygiene are important pillars for keeping healthy.

We’ve had drawing competitions, riddles, cross word puzzles, word searches and word scrambles to complete.  It was interesting how 3 of the winners work in the same area.  We’re pretty sure that they combined efforts in order to win the prizes…..but I guess that could be a discussion for collaboration and how it takes all of us working together to keep ourselves healthy.

Today was one of my favorites – guess how many bugs are in a jar (aka candy).  Unfortunately, since I bought the candy I was not allowed to guess.  What’s worse, I have a cold, so as much as I would like to steal some from who ever won the jars, in good conscience I can’t.  I want to.  It’s a proven fact that if you pass your cold on to one person you will start to feel better.  Which leads me to the next topic: we can learn to help keep ourselves healthy.  Understand the difference between a cold and a flu.
 
Both colds and the flu are contagious and are caused by viruses. The typical incubation period for influenza (aka the flu) is about one to four days, but some adults can be contagious from about one day before onset of symptoms for up to two weeks after symptoms start. For colds, most individuals become contagious about a day before cold symptoms develop and remain contagious for about five to seven days.  I’m on day 2 of symptoms, with luck I’ve passed it on to someone.  Otherwise, but Monday I should less infectious and starting to feel better!

We’re ending our infection control week with a Kahoot quiz.  We have some competitive people at my company, and its pretty fun watching the competition of everyone trying to win the top spot!  I hope everyone has had as much fun with infection control week as we have.  While it’s fun, the reason behind infection control week is not funny.  HAIs kill, and we all have our part to play in ensuring we keep our patients, our friends, our family and I suppose our colleagues healthy!

Bugging Off!

Nicole

Friday, October 11, 2019

#FF - Christmas is Almost Here!


I truly cannot fathom how we have flown through the year and that Canadian Thanksgiving is this weekend!  Fall used to be one of my favorite times of the year.  The weather is cool and crisp, the fall colours are breathtaking, and of course - Halloween. 


As we turn into fall and enter the last quarter of the year, I thought I’d share some upcoming education opportunities! 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.  Here's the list of teleclasses for the fourth quarter of 2019:
















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! After all, we’re entering into colder weather so it’s the perfect time to listen to a teleclass while snuggled under a blanket in front of a fire!

Bugging Off!

Nicole

Friday, October 4, 2019

How Dirty is Your Money?



As you know from past blogs, I travel for work.  Travel is a double-edged sword. On the positive you get to see new cities or countries, meet new people, catch up with old friends and if you’re lucky, make new ones!  The downside is that you’re often stuck in cramped places (aka planes), using taxis or Ubers that have not been cleaned after the last people left, often eating from buffet and handling money as you pay for everything.

This week I was in Seattle at a non-infection prevention conference with 4000 people.  I was able to catch up over coffee with an old friend and eat some wonderful local food, but without a doubt observed some questionable infection control practices (e.g. poor and/or non-existent hand hygiene practices made more difficult by the minimal soap that was dispensed….) so I avoided the using any ice and was careful with my choices in food in the buffet line at breakfast and lunch.  Of course, after reading a new study on the trip to Seattle by Andreas Voss from the Netherlands I also chose not to use any cash and stuck to the use of my MasterCard or Apple Pay.

Did you know that by time your money is taken out of circulation it will have touched hundreds and most likely even thousands of people’s hands?   Think about your use of money: we readily withdraw it from the bank, hand it over when purchasing and readily take back the change from strangers.  Just think about how many dirty hands the bill could have touched over the course of its life!  In Voss’ study, they looked at currency from the US, Europe, Canada, India, Romania, Morocco and Croatia and found that our currency can in fact harbor and spread some nasty bugs.  The upside is that currency used by the USA and EU that is made with a mixture of fibers like cotton and stabilizers like gelatin seem to minimize the ability to allow bacteria to proliferate and/or allow those bugs to transfer to the hands of the next users.  The downside is that currency that is more plastic-based seems to have more of an affinity for growing and sharing anything that may be on it.  The study concluded that the Romanian leu, is quite literally the dirtiest money known to humankind!

Voss’ team used MRSA, VRE and ESBL E. coli as their “bugs du jour”.  The bills were sterilized with UV light, squirted with bacteria, and then allowed to dry before being tested at 3, 6, and 24 hours post inoculation.  They also conducted trials with less-dangerous bacteria where test subjects rubbed the bills between their hands for 30 seconds, to see if anything rubbed off.  The good news is that while many bills retained their bacteria after 3 hours, by 24 hours most showed no more bacteria. The big exception was the leu, a polymer-based bill continued to exhibit growth of all bacteria after six hours, and some remaining MRSA even after a day.  When it came to the transfer test, the Euro did not transfer any of the bacteria tested and the US bill transferred single colonies of Staph.  The Leu on the other hand transferred multiple segments of Staph and E. coli.

All in all, the findings - while interesting and a bit gross - are not really a threat to public health.  However, after handling money you definitely want to wash your hands, so be sure to have a tube of hand sanitizer handy! 

Bugging Off!

Nicole

Friday, September 27, 2019

Quills, Hooks and Fungi


Have you ever gone for hike and gotten burrs stuck on your clothes?  Depending on the type of clothing you have on, the hooks or teeth on the burr can bury themselves in and make them virtually impossible to get out.  The same goes for long haired black cats that get up to no good on their nightly walk around.

What do burrs and porcupine quills have in common – aside from the fact that both burrs and quills can attach themselves into your skin and become difficult to remove?  The only reason that I’m talking about them together is that I was reading an article about porcupines when my no-good, very bad long-haired black cat came in covered head-to-toe in burrs.  He was so heavily covered with them he managed to get my son’s Teenage Mutant Ninja Turtle stuck to him as well.

The article I had been reading was discussing a fungal infection that had been found in several porcupines from three states (Maine, Massachusetts and New Hampshire).  The porcupines had been taken to different wildlife rehabilitators and although first thought to have mange, they were actually infected with Trichophyton mentagrophytes, a fungal organism that is commonly found in domesticated cats and dogs, livestock and even humans. 

In humans, Trichophyton is known to cause athlete’s foot.  It is also one of the causative organisms for ringworm.  While Trichophyton generally causes only minor skin infections in humans and most animals, in porcupines the lesions spread to infect the entire body and can become debilitating, and if not treated can be fatal.   While a common fungal organism, this is the first time that Trichophyton has been found in porcupines, and the fact that it has been found in porcupines in three states brings about the question of how the fungal infection is being spread.  While humans and porcupines do not chum around together, this does increase the concern of zoonotic transmission.

Trichophyton can be transmitted by direct contact, by contact with infected particles (of dead skin, nails, hair) shed by the host, and by contact with the fungi's spores.  Porcupines tend to stick close to trees, but can also be found alongside river undergrowth and maybe in the trees by a rocky ledge. They live in dens found in rock piles, caves, fallen logs and trees and like to stay close to home except when they forage for food.  Finding where and how they came across the fungi will be hard to find, but certainly as we expand our reach and take over natural habit of these interesting creatures, the unfortunate truth is that we or our pets could be the source of their woes.

Bugging Off!

Nicole

Saturday, September 21, 2019

Are you seeing blue?


Painting ceilings have to be one of the worst jobs there is when it comes to painting.  I would much rather scooch around on my bum painting baseboard then craning my neck staring at a ceiling and hope I do not miss a spot.  There’s nothing worse than ending up with a sore neck, finding the spot you missed and having to go back to fix it.   In my opinion, one of the best inventions was the tinted ceiling paint that went on with a purplish or pinkish tint and dried white.  You could see where you applied and didn’t end up with irritating unpainted areas.

When it comes to cleaning and disinfection two key points of success include ensuring that the product is actually applied to the surface and achieving the contact time.  In recent years a number of studies have looked at ways to improve cleaning and disinfection as there is a direct correlation between the transmission of pathogens and the cleanliness of the environment.  Implementation of training programs that include validation or verification processes using ATP or UV reflective gel to ensure surfaces are being cleaned and disinfected have successfully shown an improvement in cleaning and disinfection.  Additional visual cues to help the environmental services team or nursing staff see where a disinfectant has or has not been applied could further improve outcomes and be a handy training tool for new staff.

In the June ICHE, a study was published looking at the effectiveness of a novel colorant additive to bleach wipes.  Similar to the concept of tinted ceiling plant, the blue dye is applied to the disinfectant wipe via a battery-driven device attached to the top of the wipes canister.  While the concept seems sound and would intuitively be thought to improve outcomes the findings of this study proved differently.  The addition of the dye did improve the cleaning of inner bathroom door knobs, however overall the non-dye impregnated wipes provided better overall results.  The researchers verified that the application of the dye was not impacting or neutralizing the efficacy of the disinfectant and looked to obtain feedback from the environmental services staff.  While they liked how the dye reduced the odor of the bleach product making it easier to work with and the fact that they liked being able to see what areas had been cleaned or not, there was a concern over the fact that residual dye was left on the surface after drying which made for additional work and effort in wiping to remove it.  The researchers then wondered if the discrepancy in the results was due to the fact that larger surfaces were not being wiped down due to concerns with staining.

While it could be easy to assume that the study was not a success, however, we need to remember that innovation takes time and needs tweaks and refinements along the way.  The overall feedback and ability to have a visual cue was positive.  Being able to see what has or has not been cleaned without a doubt can have a very real and direct impact on patient outcomes.  The best part is as this was a prototype, following the study, the company did make modifications to improve the precision in the addition of the dye.  It will be interesting to follow this innovation along and see if it can be improved to remove any concerns regarding staining with its use!

Bugging Off!
Nicole

Friday, September 13, 2019

Do You Really Want that Ultrasound Probe Used on You?


For many, we’re closing in on the 2nd week of school.   My son has so far avoided catching his first cold of the school season but I’m sure one will hit soon enough - and of course, flu season is only a few short weeks away.  I just hope nothing too serious hits, so that we can avoid doctor’s visits or trips to the ER, especially after reading a recent article about cleaning mobile patient care equipment!

Like our personal devices, mobile patient equipment (MPE) like thermometers, blood pressure cuffs or bladder scanners can often be overlooked in terms of the frequency or thoroughness of cleaning.  While the practice can be relatively simple and effective in removing potential pathogens, it can be more difficult to effectively implement and monitor MPE cleaning and disinfection programs.  This is in part because MPEs tend to move from place to place, so unless you have a ‘tag and bag’-type process to clearly identify dirty from clean devices, it is harder to verify what ones have or have not been cleaned.  This then leads to the issue of potential transmission of pathogens when healthcare workers either fail to clean or use MPEs that have not been cleaned immediately after use on a patient.

A study published in ICHE by Reese et al discussed the implementation of cleaning and evaluation of MPE cleaning.  The study used ATP as their method for validating cleanliness.  ATP can have its challenges, and as the disinfectant or disinfectants used in the study were not disclosed, it is hard to determine if the results presented could have been skewed by quenching or enhancing of the ATP readings as a result from interactions by the disinfectant.    Regardless, the researchers started with a one-month baseline period to gain an understanding of the level of cleanliness of the MPEs.  Following the baseline period, there was a six-month implementation period with weekly ATP testing.  The results were shared with nurse educators and management, and subsequently shared with nursing staff with the provision of ongoing education.  They then entered a maintenance period for an additional six months where ATP results were collected bi-weekly.

Over all, the ATP results and therefore, the cleanliness of the MPEs did improve and was maintained with a 75% improvement in the levels of cleanliness.  The study also highlighted the areas where no significant improvement was seen.  The ultrasound probes tested in the ED consistently had higher than acceptable ATP readings, and this is consistent with similar studies looking at cleaning in the ED due to the large number of patients and high turnover of patients.

So what can we learn from this study?  It highlights that with focus on MPEs in most areas of a healthcare facility, sustained improvements in the level of cleanliness can be achieved which in turn should minimize the risk of transmission of infectious pathogens and improve overall patient outcomes.  It also highlights that the ED is an area of consistent issues in cleaning MPEs. Perhaps due to the nature of the ED with rapid patient turnover, high patient throughput and the fact that many patients can be critical and take more time, additional staff should be responsible for cleaning of MPEs (and perhaps even implementing a bag and tag program) to ensure that ED staff can immediately identify which MPEs are clean and safe to use and which MPEs are dirty and should not be touched.

If you happen to find yourself in an ED, feel free to do your own audit of cleaning.  Unless you’re in critical condition you’re likely going to have time to waste!  The only issue is that conducting your own audit may then make you wish you had just stayed home!

Bugging Off!

Nicole

Friday, September 6, 2019

Practicing Protection or Causing Contamination?


I think it would be safe to say that we have been told that Personal Protective Equipment (PPE) is intended to protect you from infections pathogens.   Gloves are the most commonly used PPE item.  We see healthcare providers (doctors, nurses, phlebotomists, dentists etc.) wearing gloves.  From a healthcare perspective the gloves work in two ways: they are intended to protect us as patients and of course protect the healthcare worker from picking up the bugs we carry.  If you travel, you likely see the TSA officers wearing gloves, and if you’re astute enough you may also see the fact that their hands are sweating in the gloves, meaning they’ve had them on for most of their shift.  In their case, they put them on with the belief they are protecting themselves from the germs we bring into the airport. In reality they really are just becoming a source for moving and most likely transmitting pathogens like colds and flus from all the surfaces they touch during the course of the time they are wearing gloves.  Then there are the food service workers who put on the disposable gloves on before they make our sub.  They change between customers, but do they wash their hands before putting on the next set?  Did they take them off to ring in your order and take your money?  Think on that.

A study published in the March 2019 Special Edition of The Journal of Hospital Infection looked at what role removing and disposing gloves has on contaminating the environment.  In the study, the researchers observed three disposal methods: an underhanded throw or overhand throw into or towards the garbage bin and my personal favorite: pulling on the gloves to stretch and launch into or towards the garbage bin. When surveyed, none of the participating healthcare workers indicated they disposed their gloves by “flinging” and most indicated they “placed” them into the garbage bin.  In practice, no one placed the gloves into the garbage bin.  Most “tossed” them and missed getting their second glove into the garbage bin 50% of the time.  The next favorite disposal method is the “fling” and that method led to a 40% success rate in getting the second glove into the bin.

When researchers sampled the area around the garbage bin, the vast majority of the sampled areas were contaminated by the gloves seeded with bacteriophage. In addition, the fluorescent dye used was found to extend outside of the sampled area and was widely found within a 0.61m circumference of the participant, as well as on their wrists, fingers and forearms.   As expected, the “flight path” of the glove did show contamination, with the highest contamination directly around the garbage bin.
It has been well established that mixed policies from facilities or government, policy ambiguity and lack of in-depth training leads to workplace non-compliance with PPE protocols. In this study it was assumed that all healthcare workers that participated were aware of the CDC doffing protocol and were not using a personally devised protocol.

The long and the short is during the doffing of gloves, the environment and the healthcare worker can be contaminated.  The question then becomes, if a healthcare worker (who undoubtedly at some point has had training on donning and doffing procedures for PPE and would certainly understand the potential impact on their health) can contaminate themselves and the environment so widely, what do you think is happening in industries outside of healthcare, where the training for donning and doffing likely does not take place?

It certainly makes me think of gloves in a different light and you can be sure I will be watching the doffing procedures for gloves.  If “flinging” is involved I just may choose the exit as quickly as I can, and will certainly try to avoid touching surfaces and wash my hands at the first chance I get!

Bugging Off!

Nicole

Friday, August 30, 2019

First Day, First Cold


For many, next Tuesday (September 3rd) is the first day back to school.   For my son, the emails of who his teacher will be next year arrived and with it, a flurry of texts to all my mom friends to find out who else was going to be in his class.  He got lucky; several of his buddies are with him.  A few of his friends, however, did not get so lucky.  I expect there will be a lot of grumbling around the dinner table on Tuesday as we try to pry out how the first day of school went.

The first day of school signifies a number of things; the end of summer, back to school shopping, nerves over meeting your new teacher and entering a new grade where you know the work is going to get harder.  For parents it also signifies cold and flu days. 

According to the CDC, 40% of children aged 5 – 17 missed 3 or more school days last year because of illness or injury.  If you count up all the students, that means nearly 22 million school days are lost due to colds and 38 million school days are lost due to the flu each year.  Although 3 days may not seem like a lot to our children, I’m sure that for many of you, 3 days of staying home with a sick kid seems like an eternity and invariably we, as the caretakers, end up getting sick.  Thankfully, it’s not that hard to keep germs at bay.

Teach Cough and Snot etiquette because 10,000 is the number of bacteria in a sneeze:
  • To avoid spreading germs, teach your child to cough into their elbow and not their hand.  This helps minimizing a germ-laden hand from touching all of the high touch surfaces.  
  • Pack tissue in your child’s bag or send a box of tissue they can keep at their desk so that they can blow their nose and dispose of the contents, rather than wipe their nose with the back of their hand and increase the chance for their secretions to be left on another surface for someone to touch.


Teach hand hygiene, because cold and flu germs can survive on surfaces for 72 hours:
  • Teach your children early the importance of washing their hands, especially before they eat and always after they have blown their nose or coughed into their hand.
  • Help your child’s teacher keep the classroom healthy by donating alcohol-based hand sanitizer.

Help keep the classroom clean, because on average, your kid touches 300 surfaces in 30 minutes:
  • This is not just the job of the teacher or custodian.  Send wet wipes with your child’s lunch and have them get into the practice of wiping down their desk top before they eat.  The more frequently the desk top is wiped the less chance germs have to stay on the surface and make your child sick.
  •  Provide sanitizing wipes to your child’s teacher for their use in the classroom.  The more readily available they are, the easier it is to wipe down high touch surfaces that everyone in the class touches, which will help stop the spread of germs.


Vaccinate:
  • Vaccination is one of the most effective ways to stop the spread of disease.  Before heading off to school, make sure your child’s vaccinations are up-to-date and that they get the annual flu shot.


You can be sure that on Tuesday, aside from taking the obligatory first day of school picture, I’ll be “reminding” my son to wash his hands and help keep the classroom clean! 

Bugging Off!

Nicole

Friday, August 23, 2019

Does Time Matter?


Has anyone ever told you “slow and steady wins the race”?  Even as a child I was an avid reader.  I had a large volume of Aesop’s Fables.  I quite literally read that book to death.  One of my favorites was The Hare and the Tortoise.



The Hare was once boasting of his speed before the other animals. "I have never yet been beaten," said he, "when I put forth my full speed. I challenge any one here to race with me."
The Tortoise said quietly, "I accept your challenge."
"That is a good joke," said the Hare; "I could dance round you all the way."
"Keep your boasting till you've beaten," answered the Tortoise. "Shall we race?"
So a course was fixed and a start was made.
The Hare darted almost out of sight at once, but soon stopped and, to show his contempt for the Tortoise, lay down to have a nap.
The Tortoise plodded on and plodded on, and when the Hare awoke from his nap, he saw the Tortoise just near the winning-post and could not run up in time to save the race.
Then said the Tortoise: "Plodding wins the race."

What does this do with cleaning and disinfection?  Well, as with many things, it takes time to do things right. There is enough published evidence to support the fact that when cleaning and disinfection is not completed correctly, or rushed, corners are cut which leads to adverse outcomes.  The question becomes: how much time does it take to clean and disinfect a patient room? 

The Association for the Healthcare Environment (AHE) recommends 20 – 45 minutes should be dedicated for terminal cleaning of a room.  A recent study by Chopin et al. investigated whether increased time spent on terminal cleaning would in fact lead to improved disinfection.  Surprisingly, it did not.  The study included 3 arms in which housekeepers were given 25mins, <45mins or >45mins to clean a room. They found that time spent beyond 25mins did not affect disinfection of the high-touch surfaces tested in the study.  In fact, the longer the time spent cleaning, the higher the post-cleaning bioburden was found to be.  The results could be due to random chance or may be a result of different cleaning activities, such as cleaning more surfaces without focusing on properly applying the disinfectant used.

As the researchers indicated, their study did not include observing environmental services (EVS) staff cleaning, so achieving contact time and product application was not recorded.  Again, in recent years a fair number of studies have been published investigating the role that contact time has in ensuring disinfection is achieved.  In general, the longer the contact time the harder it is to achieve the level of kill desired in healthcare facilities.  Similarly, there are different disinfectant chemistries that while contact times may be short their active ingredients dry so quickly that they cannot achieve the contact time as approved by the Health Canada or the EPA.

Does this mean we can skimp on the time we give our staff to clean?  No.  What it continues to highlight is that we need to find that balance between time (both contact time and the time given to clean rooms) and the process used by EVS to clean and disinfect.

Bugging Off!

Nicole

Friday, August 16, 2019

Pigs’ Ears – a Tasty Treat and Health Hazard


If you’re a pet lover you may be among those who like to spoil their pets.  My cats get the occasional treat, but being cats they’re finicky and the organic, meat-only healthy treats that cost an arm and a leg don’t pass muster.  They prefer the easy-to-find on sale Temptations Cat Treats.  I have also spent a fair chunk of change on fluffy, plush cat beds.  It was a waste of money.

Dog lovers have a never-ending supply of treats they can pick up for their beloved canine friends, from rawhide and animal bones to pigs’ ears and raw food.  If you think you dog may like it, you can probably find it.  Unfortunately, pet treats and raw food does have some pitfalls and can adversely impact not just your pet’s health, but yours as well.   Case in point, pig ears sold as dog treats in 33 states are being recalled due to an outbreak of Salmonella. At least 127 people have now been stricken with the bacteria, with 26 of them hospitalized.   Thankfully no one has died.

Salmonella can affect animals eating contaminated products as well as the humans who handle the sickened animals or the infected product. Affected pets may become lethargic and have diarrhea, fever and vomiting.  Dog owners who have come in contact with the pig ear treats should see if a doctor if they experience high fever (temperature over 102˚F), blood in stool, diarrhea, or frequent vomiting that prevents keeping liquid down, and are concerned about the symptoms. People infected with Salmonella are usually ill for 4-7 days and recover without treatment.

Some key recommendations from the CDC include:
1.  Do not feed any pig ear treats to your dog. Throw them away in a secure container so that your pets and other animals can’t eat them.
·     Even if some of the pig ears were fed to your dog and no one got sick, do not continue to feed them to your dog.
·     Wash containers, shelves, and areas that held any pig ear dog treats with hot, soapy water. Be sure to wash your hands after handling any of these items.
2.  Shop safely
·      Always wash your hands thoroughly with soap and water after touching unpackaged dog food or treats, including products in bulk bins or on store shelves.
3. Take extra care around young children
·     Children younger than 5 should not touch or eat dog food or treats.
·     Young children are at risk for illness because their immune systems are still developing and because they are more likely than others to put their fingers or other items into their mouths.

Thankfully, as a vegetative bacteria, Salmonella spp. are among the easier-to-kill pathogens.  Until recently, Salmonella was one of the 3 main bacteria that had to be tested in order to receive a Hospital-Level disinfectant designation by the EPA.  While it is no longer required to be tested, virtually every consumer and professional product carries the claim due to its importance and association with foodborne illnesses.

If you have any pig ears at home, please take care and make sure your home is Salmonella-free!

Bugging Off!

Nicole