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Wednesday, December 23, 2015

Year in Review

As 2015 draws to an end, it’s time to reflect back on the year.  What were the events that shaped this past year?  What did we learn and perhaps implement to improve our infection prevention programs?  As I write this last blog for the year I realize that if I gave myself a bit more time I may have been witty enough to create a blog using the cadence of “T’was the Night Before Christmas”, “The 12 Days of Christmas” or better yet “Jingle Bells”.  Alas (and perhaps for the best) I did not.  Instead I want to share with you my 12 favorite blogs for the year.
  1. Mommy this water Tastes Funny
  2. Is there an animal in your family closet?
  3. How full is your bucket?
  4. Reading the Fine Print
  5. Do you know who cleans your clinical workstations
  6. Zombies – Do they exist in real life?
  7. Who’s the last man/women (girl) standing!
  8. Reasons to Read the Fine Print....
  9. Would you eat off of your desk?
  10. Is your antibacterial soap providing a false sense of security?
  11. Clean that room STAT!
  12. Do you know what humans, birds, pigs and dogs have in common

The topics span from discussions on how to ensure people (and children) do not get harmed by disinfectants or other chemicals, how quickly germs can spread, why we should not believe everything we hear and ensure we investigate and understand the true abilities of the products we use, the fact that time is not always of essence in cleaning and disinfection and a reminder that regardless of where we are, who we are or what we are we have more things in common then we often realize.

To quote from Dr. Seuss “And the Grinch, with his Grinch-feet ice cold in the snow, stood puzzling and puzzling, how could it be so? It came without ribbons. It came without tags. It came without packages, boxes or bags. And he puzzled and puzzled ’till his puzzler was sore. Then the Grinch thought of something he hadn’t before. What if Christmas, he thought, doesn’t come from a store?  What if Christmas, perhaps, means a little bit more.” 

To put into the context of infection prevention, what if saving lives and reducing HAIs was not all about the quest for the silver bullet, focusing on what a product kills or who is or who is not doing their job? What if 2016 brings us wisdom, strength and courage?  What if 2016 brings us the wisdom to realize that we cannot continue on with the status quo?  What if 2016 gives us the strength to fight for what we know is right and courage to not back down in the face of adversity and put our patients and their lives first?

Wishing everyone a Happy Holidays!  Thank you for reading our Talk Clean To Me blogs.
Bugging Off for 2015!

Friday, December 18, 2015

All I want for Christmas.....

For many around the world, next week is a holiday that signifies something far more important than giving and receiving gifts.  For others it may simply be a day like any other.  Regardless of your nationality or religious belief, the spirit of giving lives in us all.  It is also a time of reflection and prediction, so it was with interest I read the WHO’s published list of the Top Emerging Diseases likely to cause major epidemics.

According to the WHO, a panel of scientists and public health experts met in Geneva to prioritize the top 5 to 10 emerging pathogens that are likely to cause severe outbreaks in the near future, which few or no medical countermeasures exist.  The initial list of diseases needing urgent R&D attention are Crimean Congo Hemorrhagic Fever, Ebola Virus, Marburg Virus, Lassa Fever, MERS and SARS Coronavirus diseases, Nipah and Rift Valley Fever.  Three other diseases were designated as serious, requiring action by WHO to promote R&D as soon as possible including Chikungunya, Severe Fever with Thrombocytopaenia Syndrome, and Zika Virus.

According to the WHO missive, this priority list forms the backbone of the new WHO Blueprint for R&D preparedness to help focus accelerated R&D programs on the world’s most dangerous pathogens – those most prone to generate epidemics. The intent by identifying these pathogens is also to advocate for the initiation or enhancement of the R&D process to develop diagnostics, vaccines and therapeutics for these identified diseases.  Additionally, the blueprint will also consider behavioural interventions, and how to fill critical gaps in scientific knowledge that will help in the design of better disease control measures.

What’s interesting in looking into the routes of transmission is several of these viruses are transmitted via vectors such as mosquitoes or ticks while others are zoonotic in nature and have found a way to infect humans and further transmission by direct human to human contact.  As the year draws to an end, this list reminds us yet again how small our world is.  Ebola, which was once thought to be a disease of Africa, has shown that it can with ease move around the world.  As our world increases in population, we generate more waste which provides fertile breeding grounds for mosquitoes, and as our cities grow and expand to areas that were once fields and forests we live closer to areas with higher rodents and other animals that have the ability to spread diseases directly to us or through other routes such as tick bites.

As this season of giving and receiving draws near, I hope you’ll take a few moments to reflect on your past year, your health, the health of your loved ones and the health of those who live in areas that have been ravaged by outbreaks.  While there are certainly a number of materialistic things I would like to see under the tree Christmas Day, for 2016 I hope for a year where researchers can make tremendous strides in developing vaccines or other treatments to fight these emerging diseases.  All I truly want for Christmas is a world where fewer people will have to suffer, be it from communicable diseases, hospital acquired infections or emerging pathogens.

Bugging Off!


Friday, December 11, 2015

Do you know who cleans your Clinical Workstations?

One of the common questions during many of the presentations that I give is asking if you know who cleans what.  As you’d likely suspect, the answers vary significantly.  The reason I call this out as an important consideration for your infection prevention program is to remind everyone that our jobs are not done once we have chosen what we think the optimal disinfectant is, and this I know for fact. 

The story I usually share is one about a commode.  It’s a true story.  It’s one that occurred during a clinical study I was working on, which was focusing on the cleaning of patient rooms comparing the cleaning compliance in a patient room with diarrhea, versus a patient room with confirmed C. difficile.  We were focusing on toilets (and commodes) so we put a UV marker on the underside of the toilet or commode seat.  After several days in a C. diff positive patient room the study researcher called the nursing and environmental services (EVS) staff together to discuss the fact that for several consecutive days she was finding that the commode in a particular room had not be cleaned (it had the same piece of feces on it), and none of the UV markers had been removed.  As you may guess the question was asked in terms of who is cleaning the commode.  The nursing staff said “not us”.  It’s a toilet, that’s the responsibility of EVS.  The EVS staff said “not us”.  It’s on wheels, that’s considered portable patient care equipment.  I think you get the picture.  Without communicating and setting clear roles and responsibilities things get overlooked.

Knowing this, the findings of a study recently published in AJIC titled “A pilot study into locating the bad bugs in a busy intensive care unit” did not surprise me.  The researchers wanted to find out where multi-drug resistant (MDRO) organisms were lurking in spite of the environmental cleaning practices.  To do so, the researchers traced the steps of healthcare workers between their workstations and patient bedsides then sampled high touched surfaces they found in the path of the healthcare worker.  What they found was that many of the high touch surfaces identified in the path of the healthcare worker, such as the chairs, clipboards, keyboards, telephones and computer mouse found at the clinical workstation, were contaminated with MDROs.  Perhaps more surprising was that when they dug a little deeper, these surfaces were not included in the EVS cleaning protocols.

The long and the short is developing a cleaning and disinfectant program is not simply about what a product kills, what the contact time is or if EVS staff are achieving 80% or higher cleaning compliance.  Developing an effective cleaning and disinfectant program also needs to ensure that everyone who works in a space and is responsible for keeping that space clean needs to get together, look at every surface in the unit – patient room and otherwise - and come to an agreement on who cleans what and with what frequency.  If we do not have clear roles and responsibilities, studies like this one will continue to be published and HAIs will continue to flourish.  We need to think beyond the obvious.  By focusing on the unobvious, we’ll really move the needle in stopping HAIs and saving lives.

Bugging Off!


PS – What happens if an EVS is cleaning a room, but the patient has used the toilet and has a note on file that a doctor / nurse needs to see it before its flushed?  Do you really think the EVS person is going to have time to come back and clean?  Do you think the clinical staff will notify EVS that the toilet can be cleaned?  Who should clean the toilet in this situation?  I ask because I’ve seen it.....and the toilet did not get cleaned and this was a semi-private room.  Gross right?

Friday, December 4, 2015

#FF Winter Woes Welcome Webber!

For our American friends last Thursday was Thanksgiving. For some, the excitement of Black Friday may have been more alluring as it kicks off the holiday shopping season.  This is of course followed by Cyber Monday....I tried shopping but gave up.  The internet was just too slow for my instant gratification personality. In Canada there is a new movement starting – Giving Tuesday.  The day after Cyber Monday, Giving Tuesday is the opening day of the giving season - a day dedicated to giving back.

In the spirit of Giving Tuesday, I thought I would share a list of the free Webber Training Teleclasses that were given throughout 2015.  As noted in past blogs, the Teleclass Education by Webber Training is an international lecture series on infection prevention and control topics. The objective is to bring the best possible infection prevention and control information; to the widest possible audience; with the fewest barriers to access. 

Title of Teleclass
Jan. 14th
Spotlight on the future of healthcare-associated infections – A case study to inform global actions
Dr. Raheelah Ahmad, UK
Feb. 25th
WHO guideline and systematic review on hand hygiene and the use of chlorine in the context of Ebola
Dr. Joost Hopman, The Netherlands
March 11th
Using the core component of infection control during the Ebola outbreak
Dr. Sergey Eremin, WHO
May 5th
10 Years of WHO Clean Care is Safer Care; Why you should be a part of the social pandemic that is Safe Lives: Clean Your Hands
Prof. Didier Pittet, WHO
May 13th
Understanding consumer perceptions of HAI and hand hygiene through a global survey
Claire Kilpatrick, WHO & Dr. Maryanne McGuckin, USA
May 21st
Is your phone bugged? The role of mobile technology in infection control
Richard Brady, UK
June 3rd
Preventing infections in healthcare workers: Strategies and challenges
Bruce Gamage, Canada
June 15th
The Power of Influence
Michael Grinder, USA
June 16th
Using infection prevention and control resources wisely in Africa
Prof. Shaheen Mehtar, South Africa
June 25th
Reducing catheter-associated urinary tract infections in resource-limited settings
Dr. Gayani Tillekeratne and Dr. Mariah Obino
June 28th
Healthcare infection control lesions learned from recent outbreaks
Dr. Ryan Fagan, USA
June 29th
Natural ventilation in healthcare facilities
Linda L. Dickey, Dick Moeller and Russell N. Olmsted, USA
Sept. 3rd
Is mandatory influenza vaccination for healthcare workers the best way to protect our patients?
Dr. Michael Gardam, Canada
Sept. 24th
Evidence vs. Tradition: Examining the evidence of bathing to reduce HAI’s
Kathleen Vollman, USA
Sept. 28th
What did the Romans ever do for us?
Carole Fry, UK
Sept. 29th
Faecal transplant to treat Clostridium difficile disease
Dr. Jonathan Sutton, Wales
Sept. 29th
Debate – Selective decontamination of the gut
Dr. Cliff McDonald, USA and Prof. Jan Kluytmans, The Netherlands
Sept. 30th
The emergence of MERS: From animal to human to human
Prof. Ziad Memish, Saudi Arabia
Oct. 14th
The use of social media in support of global infection prevention and control
Jules Storr and Claire Kilpatrick, WHO
Nov. 5th
Demystifying the CIC® certification examination
Roy Boukidjian and Linda Goss, USA
Nov. 17th
The role of water as a vector in the transmission of infections in hospitals
Dr. Jimmy Walker, UK
Dec. 3rd
HIV treatment as prevention: The key to an AIDS-free generation
Prof. Julio S.G. Montaner, Canada
Dec. 17th
Examining the “unmentionables” – Sanitation and the global agenda
Rose George, UK

For more information on Webber Training, including a full list of the upcoming Infection Prevention and Control Teleclasses for 2016 and to access these free 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!  Perhaps next year Giving Tuesday will become a bigger event then Black Friday or Cyber Monday.  In these troubled times it’s certainly a nice dream to hope for!

Bugging Off!