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Friday, August 28, 2015

How full is your bucket?

I admit there are times I get a “bit” riled up but to be fair, sometimes I get riled up because some people find it amusing to “push my buttons”.  I will also openly admit there some topics that I am passionate about, probably to the point of being a zealot. Tonight I was flipping through my latest copy of Infection Control Today when I came across an article written by the editor Kelly Pyrek “Room Turnover Times: Trash-and-Dash Approach Jeopardizes Patient Outcomes”. One a scale of 1 to 10 in terms of having strong feelings and opinions over cleaning of patient rooms, I am about an 11, and just reading the title started to make me quiver.

I have long said that focusing on what a disinfectant product kills is not the answer to our environmental hygiene issues.  Certainly, choosing a product with contact times faster than 10 minutes will help ensure contact time compliance which will help ensure we are killing the bugs we are concerned with, but don’t be fooled. A faster contact time is not the silver bullet we are looking for either. The truth is there is no silver bullet. We have had the answer for years. The answer is understanding that cleaning and disinfection is a process that requires meticulous attention and sufficient time allowed to ensure corners do not get cut. As one of the people interviewed by Pyrek had stated “When I talk about processing, this includes cleaning and disinfection practices, because healthcare environmental services (EVS) is process-driven, just as surgery and nursing is process-driven. EVS is finally standing up and stating we cannot cut out parts of our process and expect to get proper results. We must follow our processes, and we require sufficient time to perform the job properly, and if we don’t, we risk poor patient outcomes.”

EVS staff genuinely want to do a good job and like doctors, nurses and other clinical staff they want to be acknowledged for the work they do and their role in improving patient outcomes.  How often have you heard someone (or you being that person saying) “Get this room done in 10 minutes!”  I know how I feel when rushed and end up cutting corners or producing work that is not to the standard that I set for myself.  I become frustrated.  I become angry.  I feel bad about myself.  My invisible bucket tips over and big invisible drips spill out.

As the article states if you were to tell a surgeon to remove a gall bladder in 10 minutes or a nurse to insert a central line in 5 minutes they would revolt.  They would push back stating they cannot do it properly or safely in that length of time.  They would cite the fact that they have standards and a code of conduct they must adhere to.  It’s interesting that we do not allow EVS staff to do the same.  It’s interesting that there is a plethora of published data supporting the importance of cleaning and disinfection and the importance that achieving compliance (e.g. contact times, wiping all high touch surfaces, etc) has on improving the status of environmental hygiene, reducing bioburden, reducing HAIs and improving patient outcomes. 

It’s interesting that we acknowledge the work of our doctors, nurses and other clinical staff.  We’re quick to fill their buckets.  Similarly, it’s also interesting that we do not applaud and celebrate the important work that our EVS staff does.  We’re quick to empty their buckets by pushing them to do more with less and by pointing fingers and blaming them for environmental transmission of HAIs.  We’re less apt to applaud them for their work and ensure their buckets are full.
What is this bucket I talk of?  We all have an invisible bucket.  It’s that part of you that when it’s empty you feel bad and when it’s full you feel great.  It’s that happy feeling you get when you’ve helped someone or have been nice to someone and that sad feeling you get when you’ve been hurt by someone or know that you’ve done something wrong.  If you still don’t get it read “How full is your bucket – for kids” by Tom Rath and Mary Reckmeyer.  It’s a favorite bedtime story of my son’s and tonight he rightly told me I make him feel bad when I rush him in the morning.  He doddles...I get impatient....our buckets start emptying.....

I’ll leave you to read the full ICT article.  It’s well worth the read and I hope will change your attitude on the time it takes to clean the room, and if you have the authority I hope you’ll help your EVS team to strengthen the importance of their roles.  I hope you’ll solidify the importance of following processes and not cutting corners.  I hope you’ll help EVS justify their budgets and FTE levels the next time they are told to cut their budgets and fire some staff. I hope you’ll start filling the buckets of your EVS staff!

Bugging Off!                                                                                                       

Friday, August 21, 2015

Crisp sheets can lead to death....

I admit there are times when I could and often consider living in a bubble.  I wholeheartedly believe that there is such a thing as knowing too much and today tipped the scales.  I have placed my order and hope my bubble arrives in 3 – 5 business days.  Why you ask?  It’s simple.  I love crisp sheets.  Seriously, is there anything better than climbing into a bed that has been freshly made with clean, crisp sheets that smell like lavender, linen or whatever dryer sheet or fabric softener you use? 

My morning seemed to start out normally; I checked my emails, scanned through my various e-newsletters and alerts.  It was really a fairly quiet day...and then I saw the article “Bed linen scare at Hong Kong hospitals shows needs for all sectors to pitch in for a clean city”.  I’ve been to Hong Kong, it’s a great city and while I admit it was not as clean as we may be accustomed to in many North American cities I didn’t really give it much thought.  Perhaps I should have, because according to the article, linens can be contaminated with fungi and can lead to transmission of fungal infections in patients. 

Certainly I knew from a previous blog “Environmental Contamination – is the cloth more concerning than the patient?” that laundering of cleaning cloths could still result in bacterial contamination which theoretically could potentially contaminate surfaces via redeposition.  The study certainly highlighted the fact that from an infection prevention perspective we need to thoroughly consider how dirty cleaning cloths (cloths that we would EXPECT to be contaminated with bacteria and other bugs) are laundered.  I never really considered that the laundry process itself could serve as the reservoir for contamination that would lead to infection.  Wasn’t I wrong!  In the Hong Kong case, 6 patients were infected and through the outbreak investigation fungi were detected in the washing, drying and ironing stages.  Further, the bed sheets were packaged while still moist and warm....perfect conditions to nurture fungal growth.  I don’t even want to try to visualize what the laundry department looked liked based on the article’s description as “a dusty and stuffy prison”.

The truth is that this is not an anomaly.  According to an article published in 2014 in The Pediatric Infectious Disease Journal, five children died at Children’s Hospital in 2008 and 2009 after coming in contact with a deadly fungus transmitted to them through the linens they slept on. 

Needless to say, my excitement of sniffing freshly cleaned linens and basking in the glory that only crisp sheets can bring has dwindled.  I will now endeavour to make sure I move my laundry along, ensure that I leave the door to the washing machine open to dry out and bake my linens on the highest temperature setting my dryer can do.  In the meantime I will wait with baited breath until my bubble suit arrives and try to contemplate how I am going to handle laying my head on the pillow and pulling up the sheets in the next hotel room I’m in......

Bugging Off!


Friday, August 14, 2015

Summer cough due to cold...or Legionnaires’ disease?

Summer is the time for family vacations and idyllic thoughts of travelling to new destinations.  Reality generally includes squabbles with your spouse or significant other and your ungrateful and often whiny children repeatedly asking ‘are we there yet?” or stating “I want to go home so I can play with my friends”.  New York City or NYC is definitely one of the those places that many summer vacationers flock to, but this summer some people may be considering alternative plans in light of the fact that NYC (or at least The South Bronx) has been experiencing a Legionella outbreak since early July.

To date 12 people have died and more than 120 people have been diagnosed with the infection caused by bacteria breathed in with contaminated water droplets.  The NYC Health Department has been actively investigating and is testing water from cooling towers and other potential sources in the area to determine the source of the outbreak.  New Yorkers with respiratory symptoms, such as fever, cough, chills and muscle aches, are urged to promptly seek medical attention.   Thankfully, Legionnaires' disease cannot be spread from person to person.  Groups at high risk for Legionnaire’s disease include people who are middle-aged or older, especially cigarette smokers and people with chronic lung disease or weakened immune systems.

Warm temperatures can help the bacteria to thrive, so to contain the outbreak the city's health department ordered that all buildings with cooling towers be tested within the next two weeks and any that are contaminated must be disinfected.  Within the “hot zone”, 111 sites have tested positive and 6 sites outside of the “hot zone” have also been confirmed positive.   As a result of not knowing what buildings have cooling towers city council approved new regulations to force building owners to register and inspect their cooling towers.  The law requires building owners to register all existing cooling towers within 30 days and any new cooling tower must be registered before it is used on the property. The city will also require quarterly inspections of all cooling towers and owners will be required to develop and implement a maintenance plan in line with the current engineering standards to prevent bacterial contamination.  If they do not comply they could face fines of up to $5,000.

Thankfully, since August 3rd, no new cases have been confirmed.                            

Outbreaks of Legionella are not new.  The first known outbreak occurred in 1976 when many people who went to a Philadelphia convention of the American Legion suffered from this disease...hence the name Legionnaires’ disease.  This summer’s NYC outbreak should serve to remind us that infection prevention needs to be part of our daily routine and not just something that gets addressed when an outbreak hits the news.  This is not the first time cooling towers have been implemented in such an outbreak.  Was NYC behind the times in having regulations in place to ensure a maintenance and inspection program or are they now ahead of the curve?  I suppose it will take the next outbreak for us to find out!

Bugging Off!


Friday, August 7, 2015

The Plague is not just for the Middle Ages....

You have to love when a plan comes together or when a new story ties perfectly into a previous blog and gives you the perfect jumping off point!  That’s the case for this week’s blog.  If you recall a few weeks ago I wrote a blog about “Where the next hotspot for zoonotic diseases would be” where according to a model developed by researchers, Kansas and Nebraska were highly likely to be added to the likes of China, Kazakhstan and parts of the Middle East as zoonotic hotspots.  It appears the model may have been a little bit off and Colorado should have been included among the upcoming hotspots.

Why you ask?  Well according to the Pueblo City-County Health Department a second person in Colorado has died of the plague this year.  Plague, which killed roughly a third of the population of Europe at the end of the Middle Ages, causes fever, chills, and swollen and painful lymph nodes as it spreads throughout the body. While normally treated by antibiotics, the disease can become deadly if untreated.  According to health officials, the victim may have contracted the disease, caused by the bacterium, Yersinia pestis, after being bitten by fleas on a dead rodent or other animal.

The bacterium that causes the plague maintains its existence in a cycle involving rodents (e.g. rock squirrels, wood rats, ground squirrels, prairie dogs, chipmunks, mice, voles, and rabbits) and their fleas. But rodents are not the only animal to be implicated with the plague.  Cats are particularly susceptible to Y. pestis, and can be infected by eating infected rodents.  In fact there have been several documented cases of human plague that have occurred in the United States in recent decades as a result of contact with infected cats.   While there are generally a few cases each year in North America, the last outbreak of the plague occurred in Los Angeles in 1924-1925 and was attributed to rats and not cats.  

There are actually three (3) types of plague:

  1. Bubonic Plague which is the most common form of plague is usually contracted when an infected rodent or flea bites you. However, in very rare cases, the bacteria can also be transmitted from material that has come into contact with an infected person.
  2. Pneumonic Plague which is the most serious form of the disease occurs when the bacteria multiply in the lungs. When a person with pneumonic plague coughs, the bacteria from their lungs are expelled into the air. Other people who breathe that air can also develop this highly contagious form of plague, which can lead to an epidemic.
  3. Septicemic Plague is caused when the bacteria multiply in the bloodstream. When untreated, both bubonic and pneumonic plague can lead to septicemic plague.

As with other zoonotic diseases, vigilance and prevention is a cornerstone as close proximity between humans and animals will continue lead to disease transmission.  Speaking of which....I’d best go find my cat.  He’s outside chasing mice and rabbits and likely picking up fleas......

Bugging Off!