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Friday, November 30, 2018

Unobvious Items Cause Outbreaks

How many times in your life have you thought or said “knowledge is power”.  Knowledge is a powerful factor that empowers people to achieve great results. The more knowledge a person gains, the more powerful he or she becomes. It’s especially true when conducting outbreak investigations. The more we investigate and uncover the more we can understand what happened or is happening and the better we can resolve the issue and put safe guards in place to avoid similar occurrences in the future.  

The unfortunate part of this is that the knowledge we gain is after a set of unfortunate events where patients have gotten sick, or even worse, died.  Part of our quest for knowledge needs to consider the unobvious. I would hazard a guess that our protocols or standard operation procedures and our training programs could be vastly improved if we looked beyond the obvious and the merely obvious.  Children learn by experiencing their environment.  They’re curious, they touch and get into everything.  As we grow and learn, we start to believe we know everything. Many of us stop being curious.

What if we went into a patient room, or whatever room at whatever healthcare facility we work at and were as curious as kids?  How would you experience the room?  What would you look at?  What would catch your eye?  What if we touched and/or picked up every item in the room, looked at it in detail and asked ourselves how would it cause or could it cause and HAI?  Do you think our knowledge of what could or could not possibly cause an HAI change?  Or are you wondering why I am asking so many questions?

The reason for my curiosity is due to a study I read that was published in the October volume of ICHE the study discusses transmission of HCV in a liver transplant center.  The result of the investigation lead the researchers to conclude that the cause of the transmission was from a reusable blood collection tube holder that was not disinfected between uses.  During the course of the investigation, 34 environmental samples were taken from the inner and outer surfaces of 14 tube holders, a glucometer tray, a tray used for phlebotomy, and a phlebotomy trolley.  The virus was only found on the inner surface of 1 of the 14 tube holders.  The researchers postulate that rapid removal of vacuum-specimen tubes from the sleeved-needle can be followed by a fine splash that then contaminates the inner surface of tube holders.  Additionally, during removal of the double ended needle, the inner surface of the tube holder can also become contaminated.

The authors identified several limitations to the study, however, they also identified an unobvious way that HCV could be transmitted. They concluded that single-use disposable tube holders are preferable to not only prevent needlestick injury but to ensure that we minimize any possible transmission of HAIs.
Regardless of the situation, I hope you’ll consider acting like a child, be curious and explore your world looking for all of the unobvious ways HAIs can be transmitted!

Bugging Off!


Friday, November 23, 2018

Pretty Nails, Pretty Gross

I think I’ve mentioned before, while I love dressing up and have a bit of a shoe fetish, I’m not a girly girl.  Growing up on a farm, playing in the barn, riding horses and playing piano meant that my finger nails were not generally a focus.  The same holds true to this day.  I am generally a naked, short nail girl, but upon occasion I enjoy a manicure and pretty painted nails. 

This week happens to be one of those rare occasions.  I decided to pamper myself with a mani-pedi.  I went for shellac on my finger nails.  It’s harder and lasts longer.  The problem is that  it’s thicker so those tasks you use your finger nails for, like picking popcorn husks out of your teeth, become impossible leaving you suffering with a husk stuck between your teeth or searching around while muttering under your breath looking for the dental floss. 

Why am I telling you my woes?  Well, I just received my latest copy of the Journal of Hospital Infection and came across an article “Nail microbial colonization following hand disinfection: a qualitative pilot study”.  We know that healthcare worker (HCW) hand hygiene is one of the key measures to minimize HAIs.  The study investigated the microbial colonization of nails taking into consideration the nail length and the presence or lack thereof of nail polish.  The study included 99 HCW (nurses and midwives), 45 of which had natural nails, 44 had varying types of nail polish and of the 99, 40 had long nails.  Of interest, HCWs who worked in the surgical units were among the highest to have nails with some form of polish.  There was also a correlation between the length of the nail and the use of nail polish – the longer the nail the more likely it was to have nail polish on it.  After following proper hand hygiene, the researchers found that the presence of potentially pathogenic microorganisms was correlated with nail length. Also, when HCWs kept longer nails that had UV-cured nail polish (aka shellac) there was a high probability of ineffective hand hygiene being performed.

While most healthcare facilities have policies around the use of nail polish, it is also well known that policing of such policies is not always done.  While short, naked nails are preferred and proven to be the easiest to disinfect, this study shows that even if nail polish is used, shorter nails are more important when it comes to performing effective hand hygiene.  The study also highlights that UV-cured polish needs to be banned.

Not being a routine polish wearer, I would advocate for short nails and no polish when it comes to HCWs.  However, I think I may also expand this to include service providers such as waitresses, chefs, daycare providers, aestheticians etc.  Why?  Well, if a HCW who has been trained time and time again about the importance of hand hygiene and how to properly perform it cannot keep their long, painted nails free of infection causing bugs then what would we expect to find under the long, painted nails of people who have not had hand hygiene training?

As for me, I’ll keep my UV-cured polish on my nails for the next several weeks, but you can be sure they will be kept short and I will be scrubbing extra hard to keep them clean!

Bugging Off!


Friday, November 16, 2018

Let the sun shine in!

As I drove home from work tonight I was thinking how dark it was at 5:30pm – I’d been inside all day.  I hadn’t seen much sun. To make matters worse, my drive home that normally takes 15 – 20 minutes took 40.  It’s the first big snow of the year and much to my dismay, 4 hours later it’s still snowing.  Many love the first blanket of snow.  Those that love it are probably not the ones driving home during rush hour where everyone has forgotten how to drive, and the cloud cover was heavy making it particularly dark.   Tonight I was lucky.  The car behind me, not so much.  I witnessed a car slide into them from my rear-view mirror.  As I was watching, I moved forward to avoid being the 3rd vehicle in a chain reaction.

Why the talk about doom and gloom?  Well, according to researchers from the University of Oregon in dark rooms more bacteria was found to be alive and able to reproduce (e.g. viable and potentially infectious) as compared to rooms that were exposed to sunlight or even UV light.   Let’s be honest.  Many of us spend an inordinate amount of time indoors, particularly in the colder months.  The more time we spend indoors, the more time we are exposed to dust particles trapped inside with us and the bacteria that may be hiding in the dust.

The researchers found that dust that was kept in the dark contained microbes that were closely related to species associated with respiratory diseases and that these microbes were absent in dust exposed to daylight. They also found that a larger proportion of the bacteria found were outdoor air-derived bacteria, indicating that the microbiome of indoor dust exposed to daylight makes it resemble bacterial communities found in the great outdoors.

The study would suggest that the long held belief that sun is good for our health is true. Contemplating the design of buildings such as schools, offices, hospitals and homes in a way to allow as much natural light coming in as possible may reduce the risk of dust-borne infections. It also highlights the importance for routine cleaning and disinfection. As we now know that dust carries infectious pathogens and that the darker the space the more concentrated the bacteria is, we may want to rethink our cleaning programs as well.  Do we need to increase the frequency of dusting areas that we may touch on only a weekly or even monthly basis?  As the dust accumulates so too does the concentration of pathogens.  Air movement can move the dust which may lead to transmission of infections.

Bugging Off!

Friday, November 9, 2018

Virus Transmission – Sharing is Caring

Image from MemeGenerator
This year seems to be particularly bad for colds and other viruses.  We’ve had a couple of different viruses running through our office and I should have stocked up on “Kleenex” based on the amount my son has gone through since heading back to school in September!  I have a virus.  It’s just a cold.  I feel crappy, but I’ll push through it because isn’t that what good moms, wives and employees do?  If you’ve read some of my previous blogs you may recall that I also believe if I can pass my cold on to one other  person I instantly start feeling better.   Anyone want a hug?

The million dollar question is, how did I get it? Who knows, but after reading a recent study looking at fomite-mediated transmission of viruses I’ve come to the conclusion they can come from anywhere and everywhere.  The study looked directly at fomite transmission (direct shedding onto a fomite) and hand-fomite transmission (shedding onto a hand that then touches a fomite) of influenza, rhinovirus and norovirus.  The researchers concluded that both rhinovirus and norovirus direct fomite transmission is definitely a route of transmission whereas influenza did not show the same capability.  The hand-fomite route was shown to be more relevant for rhinovirus and influenza transmission. For norovirus, ability to transmit via the hand-fomite route versus the direct fomite route was dependent upon the amount of norovirus initially shed onto the hands.

Understanding the impact of the route of transmission helps to determine the most effect intervention to implement.  For influenza, increasing the frequency of environmental surface disinfection will help to prevent outbreaks. This is due to the fact that influenza demonstrated the lowest fomite reproductive number.   Conversely, rhinovirus and norovirus are so infectious that a single environmental intervention is unlikely to stop their spread via fomites. 

I guess if I want to start feeling better I had best start spreading my germs directly to fomites and of course, stop washing my hands to make sure they have the best chance possible to transmit to every surface I touch because “sharing is caring”!

Bugging Off!


Friday, November 2, 2018

Shower or Bath which is your preference?

I always thought that cleanliness was next to godliness.  When it comes to bathing however, I firmly believe there are two camps.  Those who like to lounge in a tub pretending to relax by reading a book while the bubbles dissipate, the water turns cold and you lay in your own filth, and then there’s those who do not find standing onerous and love the feeling of hot water spraying over their body.  I am firmly in the shower camp.  I try to enjoy a good bath, but truth be known, after 5 minutes I’m bored or I’ve gotten so hot that I’m sweating and need to take a shower to cool down.  The same can be said for me in hot tubs….

After reading a recently published study done by researchers at the University of Colorado Boulder, I may have to rethink how I bathe and contemplate bathing as opposed to showering.  Well, at least in some parts of the USA.   Researchers found that the prevalence of pathogenic mycobacteria in showerheads correlated to regions where nontuberculous mycobacterial (NTM) lung infections are most common.  It’s not unknown that bacteria thrive in showerheads and throughout household water distribution systems.  Generally, we have nothing to worry about, however upon occasion the type of bacteria found can lead to infections.  The researchers surveyed showerheads in households across the USA and found that the bacterial population differed by region and the type of water.  Surprisingly, households supplied with chlorinated treated water had higher levels of some types of mycobacteria.

Truth be known, we shouldn’t be surprised that showerhead biofilm can lead to infections. At least, I would hope not.  Most deaths from Legionnaires' disease are tied to hospital and nursing home showers according to a 2015 report by the CDC.

If you’re concerned about your shower water quality, the five regions identified in the study are Hawaii, Florida, The upper Midwest, Southern California and The Mid-Atlantic States.   Lucky me, I just spent 3 nights in Maryland in a hotel where, let’s just say, it was in a serious need of a facelift and based on the inconsistent shower spray, they do not have a cleaning and disinfection protocol to clean their shower heads.  I guess I’ll just wait and see if I get sick!

Bugging Off!