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

Wednesday, April 24, 2013

I TRIPLE DOG DARE you to wash your hands!

If you have seen A Christmas Story, you'll know the reference to "triple dog dare".  For those that haven't, it is a movie of a boy who wants nothing but a Red Ryder BB Gun for Christmas.  Set in winter in Indiana (think cold), the scene I am referring to has Ralphie's friends Flick and Schwartz arguing over whether a person's tongue will stick to a frozen flagpole. Schwartz ultimately issues Flick a "triple dog dare" and Flick's tongue gets stuck to the pole.
Aside from the obvious grossness factor that flag poles are likely a breeding ground for who knows what human or animal pathogens and certainly NEVER cleaned and the thought of sticking my tongue on it makes me gag a bit, there is no obscure infection control subplot.   It's all about the childhood concept of daring a friend to do something. 

To improve our  HAI rates and patient safety outcomes we have implemented infection control bundles, we have implemented auditing programs for environmental cleaning and for hand hygiene and we implemented antibiotic stewardship programs. Yet we continue to see HAIs and I think many of us can give more than a dozen samples of healthcare workers not following best practices.  Perhaps, it's time to change our tact - if you were DARED to do something by a friend or peer would that put enough pressure on you to do what's right?  What if that DARE was said out loud in front of your other peers - what then?

May 5th, is the global SAVE LIVES: Clean Your Hands campaign organized by the WHO.  As of this April 24th, 15, 596 healthcare facilities from around the globe have registered to partake in this campaign.  SAVE LIVES: Clean Your Hands campaign aims to galvanise action at the point of care to demonstrate that hand hygiene (HH) is the entrance door for reducing health care-associated infection and patient safety. It also aims to demonstrate the world's commitment to this priority area of health care.

Washing ones hands is such a simple action.  It is certainly one of the primary ways to reduce HAIs, yet worldwide the lack of compliance among healthcare workers (HCWs) is abhorrent.  According to WHO, adherence to HH by HCWs ranges from 5% to 89% with the overall average being 38%!  Further, the frequency with which HCWs cleaned their hands ranged from 5 to 42 times per shift.  Assuming an 8 hr shift, my guess is the 5 time/shift hand cleaner washes before morning and afternoon break, before lunch and assuming they only use the toilet twice - they wash after relieving themselves.  Sounds to me like that person cares about themselves and doesn't give 1 hoot about patient safety outcomes.

The fact is following contact with patients and/or the contaminated environment, pathogens can survive on hands for between 2 and 60 minutes.  Moreover, HCW's hands become more and more contaminated the longer the duration of patient care is.  When HCWs fail to clean their hands during patient care or between patients (e.g. they do not follow the Five Moments of Hand Hygiene), the likelihood for pathogen transfer from HCW to patient increases.

A study commissioned by the Joint Commission in 2008/2009, found that doctors and nurses fail to wash their hands with alarming frequency, contributing to the 247 deaths caused each day by preventable hospital infections.  Healthcare facilities around the globe have tried to address the problem of low hand hygiene compliance rates through numerous techniques such as constant monitoring and auditing, programs that involve the patient to promote hand hygiene prior to patient care and installation of hand hygiene surveillance equipment (cameras and RFID systems).  While compliance does improve, the long term sustainability varies.  It's appalling to know that regardless of what program is implemented there are still HCWs who believe they are "above the law".  Worse yet, is that their peers, their patients and in even in some cases, the C-Suite Executives are reluctant to call these people to task and point out to their faces their lack of compliance.

It's funny, as children we had no issue with daring our friends to do something.  We certainly had no qualms about shouting out for all to hear that "Johnnie just picked his nose!", why as adults have we lost this ability?  Stand up and call a spade, a spade!  The next time you see a friend or loved one, a peer, a boss or a patient miss an opportunity to wash their hands, call them on it!  Quite literally, the life of one of your loved ones could be in their hands some day!  If you know they do not wash their hands when they should, do you want to take that risk?

Come on, I TRIPLE DOG DARE you to!

Bugging Off!


Friday, April 19, 2013

Disinfectant Chemistry Report Card #13 – Triclosan - Where will its use stop?

While best known for its use in hand soaps, if you look hard enough you will find Triclosan in toothpaste, deodorants, laundry detergent, facial tissues, and antiseptics for wounds. Triclosan is also being infused in an increasing number of consumer products owing to its use as a preservative to ward off bacteria, fungus, mildew and odors in toys, mattresses, toilet fixtures, clothing (check the label for your PJs!), furniture fabric, and paints.

Triclosan is a competent antimicrobial agent against bacteria, viruses, and fungi, but not spores.  At biocidal levels Triclosan  reacts with multiple cytoplasmic and membrane targets while at lower concentrations, it is bacteriostatic and targets bacteria primarily by inhibiting fatty acid synthesis.  While indications that Triclosan does have fungicidal and virucidal capabilities, the mechanism of action have not yet been investigated in depth. Multiple resistances to Triclosan have been reported in peer-reviewed studies.  This has lead to quite an outcry in terms to the appropriateness of its use in household products.  

Triclosan can pass through skin  and is suspected of interfering with hormone function (endocrine disruption). U.S. Centers for Disease Control and Prevention scientists detected triclosan in the urine of nearly 75 per cent of those tested (2,517 people ages six years and older).  The European Union classifies triclosan as irritating to the skin and eyes, and as very toxic to aquatic organisms, noting that it may cause long-term adverse effects in the aquatic environment. Environment Canada likewise categorized triclosan as potentially toxic to aquatic organisms, bioaccumulative, and persistent. In other words, it doesn't easily degrade and can build up in the environment after it has been rinsed down the shower drain. In the environment, triclosan also reacts to form dioxins, which bioaccumulate and are toxic. A study conducted in 2006, found that exposing bullfrog tadpoles to levels triclosan commonly found in the environment can cause endocrine disruption and more recently, a study conducted by the University of Minnesota determined that triclosan is being found in increasing amounts in several Minnesota freshwater lakes. The findings are directly linked to increased triclosan use over the past few decades.

Here’s how we would score Triclosan on the key decision making criteria:

• Speed of Disinfection – C

o Primary uses of Triclosan are as a sanitizer or bacteriostatic agent
o Expected contact times to achieve disinfection will be dependent upon concentration and range from 5 to 10 minutes

• Spectrum of Kill – B to C

o Achieves disinfection against all microorganisms; bacteria, viruses and fungi but efficacy is concentration dependent

• Cleaning Effectiveness – D

o Triclosan itself does not have detergent properties; cleaning and detergency properties of Triclosan-based formulations results from the detergents added as part of the formulation.

• Safety Profile – C to D

o Has been proven to have endocrine disruption properties
o Status of Health & Safety profile differs between countries, but

• Environmental Profile – D

o Bioaccumulative in the environment and reacts  to form more toxic by-products (dioxins)
o Concerns with Aquatic Toxicity

• Cost Effectiveness – B to C

o Products are available from a number of suppliers

**For more in-depth scientific information about Alcohol and other disinfectant chemistries, stay tuned to www.infectionpreventionresource.com.

Bugging Off!


Friday, April 12, 2013

H7N9 - Is it time to hit the panic button?

Sick I know, but announcements of newly identified "bugs" both excite and depress me.  It's exciting to watch the developments unfold as scientists from around the world work to identify the "bug", determine where it came from, how it's transmitted and what the potential threat to humans is.  It's depressing because each time a new "bug" is found, I kick myself for deciding to enter the world of the working rather than moving onto a masters in Epidemiology. 

While there is still much to learn about the H7N9 Bird Flu strain, one thing for certain is that the death toll and number of infections in China from the strain of bird flu first found in humans last month has ticked up daily.  As of April 9, the virus has infected 28 people and killed eight in China. However, none of the people who have had close contact with the victims have shown symptoms of the flu (at least not yet), but the WHO is investigating two family clusters to who are suspected of having H7N9 to determine if transmission between close family members has occurred.  But for now, there is no evidence of human to human transmission.

So far, the H7N9 virus has only been found in farm-raised pigeons, chickens and quail and wild birds (which could be concerning as we are moving into migrating season).  It has yet to be found in pigs or other mammals.  However, one noticeable difference between the new H7N9 outbreak and the H5N1 avian influenza outbreaks of 1997 and 2003 is in how the virus is affecting birds.  The H7N9 virus does not seem to be noticeably deadly among birds where as the H5N1 strain was.

According to scientists, the gene sequences confirm that this is an avian virus, and that it is a low pathogenic form (causes only mild disease in birds),  but most importantly, the sequences also reveal  that there are some mammalian adapting mutations in some of the genes meaning that the H7N9 virus has already acquired some of the genetic changes it would need to mutate into a form that could be transmitted from person to person.  In which case, if it became easily transmissible between humans, it could cause a deadly pandemic.

For now, the big question is what will happen in the Southern Hemisphere which is just heading into their flu season.  Although human-to-human transmission has not been seen yet, should it occur experts are not expecting to see any immunity to H7N9 if it does happen. While the panic button hasn't been hit yet, everyone is watching very closely and until more information is gathered current recommendations are for healthcare workers  to manage all patients displaying influenza-like illness and with travel history to China in the past ten days with Routine Practices and contact, droplet and airborne precautions.  

Bugging Off!

Friday, April 5, 2013

ESKAPE stops here!

I admit, I'm passionate.  There are some who may even say on some topics I'm a zealot and the topic of efficacy claims on registered disinfectant products  is probably one such topic. 

In past blogs we have talked about the fact that comparing the number of claims between products is irrelevant. We have also talked about the fact that when it comes to disinfectant efficacy, there is no scientific evidence to support that a non-drug resistant strain of bacteria is easier for a disinfectant to kill than its drug or multi-drug resistant cousin.  Let me be clear - Antibiotic Resistant IS NOT equal to Chemical Resistance!

This all said, I am often "impressed" (dripping with sarcasm) in the marketing tactics of disinfectant manufacturers.  In 2004 the Infectious Diseases Society of America (IDSA) highlighted a group of antibiotic resistant pathogens that became coined as ESKAPE pathogens. These bacteria were identified as becoming increasingly resistant to available antibiotics and unfortunately there were, and still are, a scarcity of new effective antibiotics (without harmful side effects) being developed to combat their growing resistance. The ESKAPE pathogens include resistant strains of: Enterococcus faecium, Staphylococcusaureus, Klebsiella pneumonia, Acinetobacter baumanii, Pseudomonas aeruginosa and Enterobacter species; where particular strains of these organisms are resistant to certain commonly used antibiotics i.e. MRSA, VRE, Carbapenem-resistant Enterobacteriaceae, Multi-drug Resistant Acinetobactor species to name a few. 

As a result of this growing concern over the ESKAPE bacteria, some disinfectant companies have begun marketing efficacy of their products against ESKAPE implying superiority over disinfectants from other companies that may have missed the memo. Although it is the job of disinfectant manufacturers to monitor growing trends in health care as it pertains to cleaning and disinfection; before pulling the trigger, a disinfectant manufacturer needs to assess if a trend in healthcare warrants any action at all. For example, any good hospital grade disinfectant on the market would have efficacy against many of the ESKAPE bacteria and/or their related non-resistant species and strains. Why then would a manufacturer spend the tens of thousands of dollars in germicidal testing simply to add disinfection claims for the sake of adding claims?  The significance of showing efficacy against ESKAPE is simply to capitalize on this memorable marketing phrase that may gain the “buy in” of decision makers for the wrong reasons.

There is no dispute, these pathogens are responsible for a significant number of hospital and community acquired infections worldwide and without a doubt cause a significant burden on healthcare due to  prolonged duration of illness and associated increased morbidity and mortality.  BUT when it comes to disinfection, antibiotic resistant bacteria should be no more of a challenge to kill with hospital grade disinfectant than the non-resistant strains. Ultimately, ESKAPE pathogens can have a major impact on the treatment options available to healthcare professionals, but in the world of cleaning and disinfection - it’s just another day at the office.

Bugging Off!