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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Friday, August 19, 2016

Green – the new official Olympic pool colour?

With the Olympic hype in the air, I thought I would keep the theme going.  Last week in the “Let down of Olympic proportions” blog, I lamented over the fact that all of the hype over hygiene conditions and illness seemed to be for naught.  Don’t get me wrong.  It’s not that I’m hoping that the athletes, their families or spectators get sick.  It's just amazing to me that a little media hype over the potential of getting sick is probably enough to remind people to do what they should be doing!  Washing their hands!

That said, I’m not sure any media hype would have helped the “green pool” situation……   I’m sure that many of you have seen the pictures of the bright green pool.   Who could miss it?!  A google search for “green pools in Rio” lead to 87,200,000 in just 0.67 seconds!  That has to be a world record of some sort!  Wading through the plethora of articles you need to be a bit of a detective and not believe verbatim everything that you read.

What seems to be consistent is that an inadvertent addition of a large quantity of hydrogen peroxide to the pools was added - around 160 litres or 42 gallons to be exact - which essentially inactivated the ‘chlorine’.  The fact that mixing hydrogen peroxide and chlorine together will inactivate each other is true.  This reaction essentially will degrade the chlorine to a point where it is no longer effective meaning certain “organic compounds” (i.e. algae, probably) could grow in the pool.  According to the various news articles I scoured, when the pools first turned green, officials were mystified as to why they suddenly had one blue pool, and one green one. Initially they put it down to a chemical imbalance, which was technically correct, but were uncertain of the root cause of the problem.  Then, according to accounts from some athletes, the green pools started smelling like farts.

While somewhat humorous, this really is not a laughing matter.  Mixing chemicals deliberately or inadvertently can lead to serious health risks.  In this case the mixing of chlorine and hydrogen peroxide seems to have been an error.  One that causes the water to turn green, but did not have a significant health threat.   As many articles indicate the green colour was a result of an algae bloom.  In chatting with my R&D experts it is also conceivable that the green colour was due to the use of an indicator that turns green when the chlorine levels are depleted in the pool.  In this scenario, if the water turns acidic by addition of an acidic formulation by mistake, the chlorine would degrade and the indicator would visually show this depletion.

Regardless, mixing of chemicals can be dangerous and this highlights the importance of effective training to ensure those tasked with using chemicals to chlorinate pools or clean environmental surfaces understand the potential deadly impact that mixing chemicals can have.  As I coined back in 2011, the “Custodial Chemist” is very prevalent. This group of people believe that their collective years as professional cleaners is far more knowledgeable then formulating chemists who have years of education in chemistry or chemical engineering and develop the products the Custodial Chemist 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?!

Of course in Rio we’re not talking about cleaning windows, but regardless of the root cause of how hydrogen peroxide was added to the pool, a Custodial Chemist was obviously lurking at the poolside!

Bugging Off!

Nicole



Friday, August 12, 2016

Let down of Olympic proportions….

I’m sure many of you are caught up in the hype of the Summer Olympics.  Who doesn’t like spending 16 days watching athletes compete and cheer on our countries?  I’m a fan, but not a super fan.  Unless of course I’m around during the Equestrian events - then I’m glued to the TV! As my husband can attest, if I am watching the Show Jumping events I am counting strides and leaning forward at the same time the rider is!

This year’s Olympics has been particularly interesting, as I cannot think of any other that has been as marred with concerns over potential infectious diseases.  From Zika virus concerns which lead to a number of golfers backing out over concerns for their health, the health of their spouses and future children to the coverage over concerns that have also been whirling for months for sailors and rowers over the contaminated water and what bugs lurk in there.

Whenever a group this large congregates, there is bound to be a bug or two that spreads through the athletes.  But have the concerns over contaminated water and other hygiene conditions come true?  Well, in my quick google search I certainly found numerous news channels prophesying that athletes risk getting sick, but I’ve only found 1 article published that talks to a Belgian sailor falling sick after racing.  While some illnesses may being kept low key so as not to ruin the chances of team sports etc., I would think with all of the hoopla leading up to the Olympics if people were getting sick we’d hear about it.  I mean we have heard about the pools turning green!

What about the horses?  Like humans they’re prone to getting sick and the riders at the Olympics and their horses are some of the most highly traveled athletes around!  According to several news sources, Dutch Olympic dressage rider Adelinde Cornelissen entered the arena on her horse Parzival, guided him through a few movements, and then rode off the field and out of the competition.  Parzival had been bitten on the face by a poisonous insect and developed a fever.  Cornelissen sensed something was wrong with her faithful mount and rather than risk his health, she gave up on her Olympic moment knowing it would also impact her entire team.   High fives to Cornelissen!

Now, I’m not jumping on the media hype band wagon.  Instead I am wondering if all the hype and concern about hygienic conditions has in fact increased the focus on preventative measures such as frequent hand washing.  Could it be that because there was a perceived risk due to the media hype the athletes and their trainers have stepped up their infection prevention measures?  I know I’m more vigilant when travelling, particularly to areas where hygiene is not the same as I am accustomed to!

As for watching the Olympics, now that I’m done my blog I can go check out what happened today.  You can bet I will keep an eye out to see what transpires in terms of people and horses getting sick!

Bugging Off!

Nicole


Friday, August 5, 2016

Dwell Time Disease

This week is our 4th and final pillar from our Disinfection Dysfunction education campaign.  If you answered yes to any of the questions we posed in the Label Deficit Disorder, Safety Indifference Syndrome, and Cross Contamination Conundrum blogs your product might just have Disinfection Dysfunction!  Shall we find out if your disinfectant has Dwell Time Disease?

In recent years, we have put a great focus on the contact time or dwell time of a disinfectant product.  I could go on ad nauseam about contact time citing numerous examples of why rapid contact times are important, but I think Drs. Rutala and Weber summed it up nicely in their “Selection of an Ideal Disinfectant” article with their statement "fast kill times are important because they give you confidence that you are killing the prevalent and most common healthcare-associated pathogens before the disinfectant solution can dry". If you want to read more on this topic, our “Dirty to Disinfected in 60 Seconds Flat!” will give you more background.  To see the validated results on this topic, a study looking at the efficacy of Improved Hydrogen Peroxide (IHP) products versus a Quaternary Ammonium Compound (QUATs) showing that IHP products kill more in a shorter period of time – something that is definitely relevant for any facility needing to kill germs!

Why has this become relevant?  As we see with many auditors during their observations of current wipe disinfection practices in busy healthcare facilities, surfaces tend to be wiped once and then left to air dry. We talked about this in detail in our “Premature Evaporation – Is your disinfectant fulfilling your every desire?” blog so I won’t repeat again.  But if I can direct you to a study that tested dry times against label contact times, only one disinfectant technology achieved the requisite wet time using this approach. In all other cases, the disinfectant dissipated or evaporated short of the contact time indicated on the label, requiring re-application (in some cases multiple re-applications) in order to achieve compliance.  If your wipe disinfection practice does not include multiple applications to achieve the requisite wet times, you may be leaving your healthcare facility open to HAIs.  

Ask yourself “Does your disinfectant dry before it’s time?”

Bugging Off!

Nicole

Friday, July 29, 2016

Label Deficit Disorder

Continuing the theme of using the four pillars from our Disinfection Dysfunction education campaign, this week I want you to ask yourself “Does your disinfectant have misleading claims?” If it does, you may be using a product that has Label Deficit Disorder!

We are inundated on a daily basis with emails, advertisements in journals and magazines, meetings with sales reps, vendor tables at education conferences, etc. it’s a wonder that anyone can make heads or tails out of the fodder. As Dr. Syed Sattar expressed in his blog “Stop the Smoke and Mirrors,” there are a number of areas that need improvement when it comes to the product development and registration of a disinfectant. But also from a decision maker perspective, to ensure we are asking and looking for relevant criteria when making a product choice. Aside from the contact times, product claims, and educational support, we should also refuse to receive or allow companies to pull the wool over our eyes when it comes to advertising or marketing claims.

Two of my personal pet peeves include the numbers game and chasing the non-existent efficacy claim.  This unfortunately occurs more frequently than one would think (or hope).  Contrary to some companies’ belief, advertising that a product kills X bugs while the closest competition only kills Y bugs is not relevant and frankly in some cases can be downright dangerous. We have to remember that it is more than just what the product kills that needs to be taken into account when choosing a disinfectant. 

When it comes to emerging diseases or obscure pathogens that have hit the news or are being promoted by a company as being relevant, we need to pause before running around looking for a product.  Case in point is looking for a disinfectant with an HPV claim.  It does not exist.  There is currently no Health Canada, EPA or FDA approved lab that can conduct testing in a manner required to obtain a label claim.   My other favorite story is a facility searching for the elusive disinfectant for use on soft surfaces as requested by the Joint Commissions during their last audit.  I shudder to think how many other facilities were sent scurrying looking for a product that does not exist.  The EPA only approves sanitizing claims against vegetative bacteria on soft surfaces.  There is no approved disinfection claim for soft surfaces.

As Drs Rutala and Weber’s “Selection of an Ideal Disinfectant” article so eloquently stated "using this accumulated knowledge of microbiological susceptibility should discourage unnecessary testing, listing irrelevant organisms on labels and avoid "bug-of-the-month" testing"

I hope the next time you read the label or marketing material of the product your facility is currently using or a new product you’re investigating you’ll stop and ask “Does my disinfectant have misleading label claims?

Bugging Off!


Nicole 

Friday, July 22, 2016

Safety Indifference Syndrome


If you’ve ever heard me speak at a conference you’ve probably heard me say “I don’t care what a product kills if the people who need to use the disinfectant won’t use it!”   In this context, I am not talking to the fact that environmental services or nursing staff are cutting corners or flagrantly disregarding protocols.  In my experience, if your staff are concerned for their safety in handling a product or perceive in any way that there could be a potential health risk to them, they will either not use the product at all or use the product in such a way that the intended purpose (e.g. reducing HAIs) the product was chosen for in the first place will be negated.

Case in point, with a simple Google search I found the following question posted to a forum. “Hello! I work at a hospital that uses XXXXXX for cleaning. I have heard that they may cause liver damage if used without gloves. I have been researching on line and cannot find any related material on this subject, though my coworkers are intent with their arguments about it.”   I’ve redacted the name of the product because my intent is not to single out specific products, but to make a point that this concern is very real.   All too often we focus on what a product kills with a single aim to stamp out every pathogen known to man from the surface in the fastest contact time possible, but do not always stop to consider the health impact and / or acceptance of the staff tasked to work with said product.

Via Talk Clean to Me, I have written a number of blogs on this topic because it is one that I truly am very passionate about.  But don’t just take my word for it.  Even Drs Rutala and Weber included a discussion on safety within their 2014 article “Selection of the Ideal Disinfectant”.  In my dissection of this article, the Over Easy: Why safety profiles and ease of use will improve disinfection summarized a number of attributes to look for with respect to safety and ease of use.

In the “Is PPE a necessary evil?”  I talked about the economic impact to facilities with respect to Occupational Exposure to chemicals.  A 2010 report by the CDC highlighted that the most common active ingredients responsible for illnesses were Quats (38%), glutaraldehyde (25%), and sodium hypochlorite (18%).  The majority of the types of injuries associated with the use of disinfectants were: 222 eye injuries, 130 neurologic injuries (headaches etc) and 121 respiratory injuries.  Of particular interest (at least to me) is that only 15% of the time did the injured worker wear eye protection.....how many products listed above require eye protection when using?  How often do you see HCWs (EVS, nurses, clinical therapists, etc) wearing eye protection?

If that’s not enough proof, “It’s getting harder and harder to breathe”  discussed the fact that several states conduct work related asthma surveillance as part of the Sentinel Event Notification System for Occupational Risks (SENSOR).  The surveillance system in California showed that custodians and cleaners had the highest incidence of work related asthma.  Furthermore, a study by Rosenman et al reported that a cleaning product was 1 or more of the 3 suspected agents identified in 12% of the confirmed cases that they reviewed.  The fact that bleach was the most frequently identified product should not be all that surprising considering that bleach was recently designated an asthma-causing agent by the Association of Occupational and Environmental Clinics. 

I’m not saying that in choosing the disinfectant products we do we are intentionally trying to harm the people we work with.  But it’s a delicate balancing act that we are tasked with to ensure the safety of our patients by minimizing the transmission of HAIs without causing harm to the staff who work in our facility.  The next time you’re looking to change disinfectant products I hope you’ll ask “Does this disinfectant suffer from Safety Indifference Syndrome?” and if you’ve never truly considered the safety of the products being used in your facility, I hope you’ll do a little investigation to see if your disinfectant is indeed suffering from Safety Indifference Syndrome.

Bugging Off!


Nicole

Friday, July 15, 2016

Summertime rashes, bug bites and infections

Living in Canada it’s often assumed that we live in igloos and wear winter clothes year round.  My cousins from Georgia often complain that it’s colder in Ontario than Georgia and even I, who took extra math  and science courses over Geography know that while Georgia is considerably further south than Ontario, the Southernmost tip of Ontario is well south of  a number of US states.  In fact yesterday (July 13th), it was 90F in Oakville, Ontario where I live and 94F in Orlando, Florida.  Considering Orlando is 2,024 km (1258 miles) almost directly south I’d say we get pretty darn hot in the summer!

Why am I talking about how hot it is? Because summertime infections are more common than you might think and the hot days of summer are the reason for some of them!  What are some of these pesky infections? Well if you’re an avid swimmer, you’ve probably had one or more inner ear infection, affectionately known as swimmer's ear.  In fact, according to the CDC, swimmer’s ear leads to an estimated 2.4 million doctor's visits and $500 million in health care costs each year.

What about all the picnics and BBQs you attend for work, with family or friends?  Have you ever had a touch of food poisoning? Bacteria that cause food poisoning grow fastest in hot and humid weather.  As a result foodborne illnesses are two times more common during the summer months than during other parts of the year.   YIKES!   And don’t forget about viral infections!  Stomach bugs such as enteroviruses, respiratory bugs like parainfluenza and even the common cold viruses are all lurking around during the summer.

With all of these summertime infections we thought we’d dedicate our July education campaign to help people from getting sick.  Our campaign aptly named Hot Mess provides you with a slew of pathogen fact sheets so you know what you’re up against and of course cleaning and disinfection protocols so you can clean up after yourself or your loved ones – assuming you’re sick of course!  If not, we hope you’ll use them to stay healthy!

Bugging Off!


Nicole

Friday, July 8, 2016

Candida is Cropping Up in Countless Countries


I can’t say for certain that the reason we’re hearing concerns over new pathogens is from the fact that they are newly rearing their heads or if because we are further ahead in our surveillance measures so finding them faster.  I’d like to think it’s the latter.

In the last 3 of 4 weeks I have blogged about new bugs of concern (“Has the sky fallen with mcr-1”) or a known bug causing problems in an unknown way (“Does your PICU have Burkholderia?”).  This week being the 3rd with the announcement that a new species of Candida is emerging as a fungal (yeast) organism associated with invasive infections.

According to the CDC, Candida auris has made its way to the Americas after it was found in a Venezuelan hospital.  It has been linked to invasive infections in the critically ill and other immunocompromised patients who are subject to broad-spectrum antibiotics and invasive procedures.  Candida auris was first described in 2009 in Japan and since then has also been found in India, Korea, South Africa, Pakistan, Columbia, the United Kingdom and Kuwait.  The CDC has found that isolates within each region are quite similar, but are relatively different across regions. These differences suggest that C. auris has emerged independently in multiple regions at roughly the same time.  From an infection perspective C. auris is known to cause bloodstream infections, wound infections, and ear infections. It also has been isolated from respiratory and urine specimens, but it is unclear if it causes infections in the lung or bladder.
The outbreak in Venezuela included 18 critically ill patients (mostly neonates) with 5 of the 18 patients dying.  Researchers and Infection Preventionists are warning others that C. auris needs to be considered as an emergent multidrug-resistant species, which can be a source of HAIs, which has a high potential for horizontal transmission and is difficult to eradicate from the hospital environment.

While it’s early on in our understanding of Candida auris, there is some anecdotal evidence to suggest that this yeast may be able to persist for extended periods of time in the environment, making effective cleaning and disinfection using an EPA or Health Canada registered disinfectant with a Fungicidal claim for both daily and terminal cleaning important and a key to minimizing further transmission.

Here’s hoping that next week I don’t have to report on yet another new bug!

Bugging Off!


Nicole