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Friday, February 24, 2017

Do disinfectants pose health risks?

Whether we’re talking politics, religious beliefs, vaccination, science or the use of disinfectants as part of an infection prevention program, there will always be differing opinions and there will always be that polarizing personality that you either love or hate.  As a wise woman (or man) once said “there are two sides to every story and the truth lies somewhere in the middle”.

A great example of this is the use of disinfectants and their role in occupational or worked-related asthma.  According to sources I have read, more than 300 workplace substances have been identified as possible causes of occupational asthma.  These substances can be broken down into the following categories: animal substances, chemicals, enzymes, metals, plant substances and respiratory irritants.  If you’re luckier than me, I hope you’ve never experienced an asthma attack.  If you’re not familiar with asthma, symptoms start when your lungs become irritated which leads to inflammation.   This inflammation causes a restriction of the airways which makes breathing difficult.  With occupational asthma, lung inflammation may be triggered by either an allergic response to a substance or irritation of the lungs caused by an inhalation of a substance, such as chlorine.

Enter the differing opinions.  A study published in May 2016 in AJIC titled “Occupational healthrisks associated with the use of germicides in health care” concluded that the data reviewed in the study demonstrate that occupational asthma as a result of chemical exposures, including low-level disinfectants, are exceedingly rare.  However, unprotected exposures to high-level disinfectants may cause respiratory symptoms. 

On the other side of the story, a study by Rosenman et alreported that a cleaning product was at least 1 of the 3 suspected agents identified in 12% of confirmed work related asthma 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 (Sastre 2011).   Furthermore, Quaternary ammonium compounds (Quats or QACs) also tend to be frequently identified as potential asthma causing agents due to their prevalence in numerous cleaning and disinfectant products.  Michigan’s SENSOR program published a detailed report on the link between asthma and Quats in their 2008-2009 newsletter.  The newsletter includes several case reports and a review of several peer reviewed studies completed on the subject. 

This leads me to try to figure out what the “truth” is.  I think there is enough evidence to support the fact that the use of some chemicals (including some disinfectants) can lead to occupational asthma particularly with our increased reliance on disinfectants as part of our infection prevention program.  However, I also believe that we cannot with broad strokes state that all disinfectants will cause occupational asthma.  I think there are products available on the market that meet the criteria of non-asthma inducing agents that can be used safety and effectively.

As a person with asthma, I know I can state categorically that some disinfectant actives irritate my airways more than others.  I can also state without a doubt that the method of application can also dramatically increase or decrease the level of irritation.  Perhaps the next investigation should be to look at the method of application – spray and wipe versus wiping with a cloth or pre-moistened wipe to see which method reduces the likelihood of inducing respiratory irritation.  Not to say I already know the answer, but I do know which method bugs me the least!  Wiping!  I also happen to believe that wiping is the best method of application for disinfectants to ensure even distribution of the disinfectant solution and physical friction to help lift and remove soils and bugs from the surface you are wiping.  But, I’ll let you decide for yourself!

Bugging Off!


Friday, February 17, 2017

Do engineering and cleaning have anything in common?

Regardless of the fact that we are into the second month of 2017, for some the concept of cleaning has not progressed much past Florence Nightingale’s introduction to the concept of hygienic needs during the Crimean war in 1854.  For others however, we are looking past the mop and bucket, the cotton versus microfiber cloths, or the difference between disinfectant chemistries. Instead, we are considering change management and implementation science as ways to improve our cleaning and disinfecting practices.

Being someone who actively seeks to learn and develop processes or behaviors to improve our cleaning practices and perhaps more importantly ways that we can elevate the importance of the environmental services department from the CEO downward, I was most excited to read an article from Health Facilities Management about a new three year study that has just begun.  I am dismayed of course that I will have to wait three years to learn of the outcomes, but the fact that the study is using human factors engineering as a way to improve and optimize cleaning and disinfection practices is extremely exciting to me!

The study is aimed at using a human factors engineering approach to measure and improve patient room cleaning and disinfection processes. The study will explore work systems, tools and technologies that environmental services staff use as they go about their day.  However, the study will go beyond just the methods and process of how the work is done, it will also look at training, education and how environmental staff are valued within the hospitals organization.

After auditing 7 environmental staff clean a total of 70 rooms, the researchers noted that many surfaces were only cleaned about half of the time (or less).  They were quick to point out that missing these surfaces was not an issue of the staff being inattentive or careless, but in many cases the missed items were in use during the time they were cleaning the room and/or staff would be asked to vacate the room before they had completed their work.

While it is still in the early days of the study, it’s exciting to see that unlike the focus of many studies where the assumption is that housekeeping staff are simply not doing their jobs, this study is looking at why the job is not getting done and realizing that that there are extenuating circumstances that makes achieving 100% compliance virtually impossible…..at least by today’s methods and by today’s organization standards.  The focus on the need to have multidisciplinary collaboration at a unit level is also exciting.  If we think of the adage “it takes a village to raise a child” perhaps at the end of the three years we will realize that “it takes everyone on a unit working together” to keep the area clean.

It reminds me of my favorite definition of insanity – doing the same thing over and over and expecting different results.  Perhaps through this out-of-the-box approach to investigating the processes, tools or materials used, the training and the collaboration between disciplines working on a unit will finally get us to nirvana…..or at least a place where cleaning and disinfection can happen 100% of the time.

Bugging Off!


Friday, February 10, 2017

Short Staff, Short Cuts

According to the National and State Healthcare-Associated Infections Progress Report released in May 2016, on any given day, about 1 in 25 hospital patients have at least one healthcare-associated infection. While the number of HAIs has decreased overall, we certainly have a long way to go.  The stats currently spewed in so many studies or reports estimate that there are 722,000 HAIs in US hospitals each year, with 75,000 patients dying during their hospitalization as a result of an HAI.  The attributed cost for these HAIs according to a 2013 study is an estimated $96-147 billion annually.

I think we can all agree there has been a significant focus on trying to reduce HAIs.  I’m sure we can all agree that there is not one single magic bullet.  Reducing HAIs is a bundled approach where we need to ensure environmental surfaces and medical devices are cleaned and disinfected, everyone cleans their hands, and antibiotic stewardship programs are put into place.   Unfortunately, we also know that hospitals need to balance their budgets.   HAIs and outbreaks are expensive.  There are times when a hospital is forced to rob Peter to pay Paul.  The ugly truth is that Environmental Services staff are often on the chopping block when it comes to having to make cut backs.

I realized it may seem logical when you are just looking at numbers on a piece of paper, but let’s think about the unintended consequences of such an action.  Does the size of the facility change?  No.  Can you cut back on cleaning and disinfection?  No, there is a plethora of data linking the fact that effective cleaning and disinfection can reduce HAIs.  What then is the reality of cutting back on the number of staff when the workload has not been reduced?  Corners get cut.  Short cuts are taken.  The result is a potential increase in HAIs.

According to a survey conducted in 2016, understaffing in environmental services is getting worse, with reports of layoffs and cuts occurring regularly.  Concerns are growing among environmental service workers that hospitals do not have the capacity and enough cleaning staff to keep key surfaces like bedrails, mattresses, taps, door handles and chairs clean.  The survey revealed a disturbing pattern of having to speed through the cleaning, being short staffed due to vacations or sick days, employees admitting to having high levels of stress and injuries occurring at work.  In fact, a large majority reported that more duties have been added to their already heavy workloads. Over half of the respondents believe the situation is unsafe.

A study from 2014 noted that cleanliness in hospitals can be characterized as less than optimal. Nearly 40% of respondents did not judge their hospital to be sufficiently clean for infection prevention and control purposes.  If we admit the truth, we know there is reams of data to support the fact that infection rates would decline and fewer people would die if we just cleaned.  The problem is determining how to apply the science and the data generated into mathematical models that can calculate the return on investment (ROI) and define what the value proposition is for supporting a fully staffed Environmental Services department.

We know that cleaning works.  We know that cleaning is time and labour intensive.  We know that having adequate staff will impact the budget.  Are we willing to risk the lives of patients when we know the harm that can be prevented by improving our cleaning and disinfection programs?  I’m hoping the answer is no.

Bugging Off!


Friday, February 3, 2017

What does your nose tell you?

Regardless of whether you’re male or female, at some point in your childhood you likely read the book or watched the movie Cinderella.  Cinderella was overworked and forced to clean, cook and sew by her nasty step-mother and her step-sisters.  Luckily, as with all fairy tales, the story has a happy ending with Cinderella falling in love and living happily ever after, but prior to that did you ever consider what those cleaning chemicals could have been doing to Cinderella and her animal friends? 

I’ll admit, I hadn’t.  Truthfully, I don’t really think it had mattered in the movie either.  Really, my intent of using Cinderella and her friends was to ease into my dirty little secret. While I know quite a bit on the topic of cleaning and disinfection and have certainly conducted my fair share of in-service training to teach people how to clean and disinfect, I am too lazy to do it myself.  I have a housekeeper; however, unlike Cinderella’s nasty step-mother, I do not force anyone to work.  In fact, I recently had to change housekeepers as my previous one retired.  So what does this have to do with anything?

How many of you have ever reacted negatively to the smell of chemicals – too pungent, too lemony, too anything.  Have you ever had a reaction that caused respiratory irritation or any other form of distress?  While many of us know that animals have an acute sense of smell, researchers have concluded that our noses are in fact exquisitely sensitive instruments that guide our everyday life. They have found that even very subtle smells can change your mood, your behaviour or the choices you make without you even realising it. In fact, a study out of the University of Utrecht found that the hint of aroma wafting out of a hidden bucket of citrus-scented cleaner was enough to persuade students to clean up after themselves even though most had not even registered the smell.  I may have to try that with my son!

Completely opposite to making you want to clean, there is also research to show that when there has been a change in a cleaning product, regardless of how small, some people will pick up on this immediately.  Depending on the circumstance, this change in odor profile may simply require a period of adjustment to get used to the new product.  However, it is possible that some will experience chemosensory irritation (a sensation of burning in the nose, eyes, mouth or respiratory pathways) associated with the change in odor profile of a disinfectant.  The reason being is that as people become accustomed to the smell or odor profile of a product, any change in odor profile regardless of how slight a change can result in perceived irritation. Studies investigating chemosensory irritation resulting from both agreeable and disagreeable odors have found that people often report health symptoms associated with the use of a chemical at concentrations well below the concentration that is actually capable of eliciting upper respiratory tract irritation.  Because odor properties can often be detected at much lower concentrations than those capable of eliciting upper respiratory tract irritation, confusion between odor and irritation can create an obstacle during the transition to a new product. Researchers believe that the perception of a malodor elicits a stress-induced reaction and raises the concern for adverse health effects from exposure.

How many of you have chosen to change cleaning and disinfecting products in your facility only to have a rash of complaints about the odor or respiratory irritation?  People do not like change.  Even if the product you are moving to is safer for them to use, this serves as a reminder that “the nose knows” and if you want a smooth transition, we need to be thoughtful in our introduction of a new product.

You may be wondering why I even brought up my housekeeper.  I did because I have experienced the reaction to a change in products first hand.  I have gone from coming home to my house smelling clean – meaning there was no smell at all.  To a house that smells like harsh chemicals.  Sure, my place looks great, but man do my eyes and nose burn when I walk in the door and I’m pretty sure my cat loses all sense of smell for a couple of days.  I now know the next time I provide an in-service for a facility conversion, I’ll spend more time prepping the staff on the odor they can expect with their new product and I hope you will too!

Bugging Off!


Friday, January 27, 2017

Triclosan has been banned!

Back in July 2012 I wrote a blog Rub-a-Dub-Dub There’s a Rubber Duck in my Tub.”  It was a book review of Slow Death by Rubber Duck: How the Toxic Chemistry of Everyday Life Affects Our Health. The book describes in detail an experiment in which the author turned himself into a human guinea pig.  The results were remarkable.  In fact so compelling that like the "Triclosan Challenge" in the book, at home we changed the type of canned tuna we eat, we no longer use non-stick cooking pans, we do not use any products that contain Triclosan and I can say I have probably only had 2 bags of microwave popcorn since reading this book several years ago.

The reason that I bring this up is that the data on Triclosan and its potential concern for human health is not new.  Discussions on this have been going on for some time.  As I outlined back in April of 2013 in the Triclosan Chemistry Report Card, over the years the use of Triclosan has been increasing and can be found 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. A study conducted in 2006, found that exposing bullfrog tadpoles to levels of Triclosan commonly found in the environment can cause endocrine disruption.  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.

The reason that I’m including the dates of some of my previous blogs is that the concerns associated over the use of Triclosan have been well documented for well more than a decade.  It’s unfortunate that with politics and with lobbying, some things are slow to change.  Thankfully in Sept of 2016 the FDA issued a final rule banning over-the-counter (OTC) consumer antiseptic wash products from containing certain active ingredients.  Triclosan was among those ingredients.  Finally science prevailed.  According to the FDA Press Release “Companies did not provide the necessary data to establish safety and effectiveness for the 19 active ingredients addressed in this final rulemaking. For these ingredients, either no additional data were submitted or the data and information that were submitted were not sufficient for the agency to find that these ingredients are Generally Recognized as Safe and Effective (GRAS/GRAE).” 

Even more exciting, Minnesota has become the first state to officially ban Triclosan.  The reason in part for being trail blazers in this ban is due to the fact that the University of Minnesota has for years been so involved in research into the human and environmental health impacts of Triclosan.
Admittedly, this ban is currently only present in consumer products.  The ban has not spread to professional products such as hand soaps or surgical scrubs, etc.  The question I have is, if the FDA has deemed Triclosan to be unsafe for us to use at home because of health risks, would these same health risks not occur if we’re using Triclosan laced products at work?  I for one, as I noted above since 2012, have “banned” the use of Triclosan in my house and check labels in facilities when I am using the soap provided.  With every possible effort I can give I avoid the use of this harmful chemical.  Isn’t this something you would also want to do to given the risks?

Bugging Off!


Friday, January 20, 2017

#FF New Year Education Resolutions

Do you set New Year’s resolutions?  I don’t.  I stopped years ago.  I was often disappointed with myself in breaking the resolution by the middle of January.  I suppose some could say that perhaps I was setting resolutions that were not realistic, and I will admit there is some truth to that.  I suppose with me being a sugarholic, setting a resolution that has me giving up sugar could be something that leads to disaster…   Now that we’ve hit mid-January I wonder how many of you have broken your resolution.

One resolution I never break is trying to capitalize on any opportunity I have for educational opportunities.  The Webber Training teleclasses are a great example as I can join in from wherever I am; and if I miss the teleclass the day of a recording, then the presentation is available for me to download and listen to at my convenience.  As noted in past blogs, the Teleclass Education by Webber Training is an international lecture series on topics related to infection prevention and control. The objective is to bring the best possible education to the widest possible audience with the fewest possible barriers when trying to access it.  Here's the list of teleclasses for the first quarter of 2017.

Date Title of Teleclass
January 19th The role of intersectional innovations in preventing infections Prof. Sanjay Saint, USA
January 26th Heater-Cooler unit associated Mycobacterium chimaera infections: An outbreak in slow motion Prof. Michael Edmond, USA
February 2nd Knowledge Gap about Ebola virus disease among health workers in hotspots in Sudan Musaab Mohamed Nour Abdelrahim Alfaki, Sudan
February 22nd Catheter-associated urinary tract infection prevention in the continuum of acute care Jan Gralton, Australia
February 23rd Using expert process to combat Clostridium difficile infections Isabelle Guerreiro and Camille Achonu, Canada
February 28th The role of dry surface contamination in healthcare infection transmission Prof. Jon Otter, UK
March 9th Evaluation of Infection Control Training Martin Kiernan, UK
March 16th How to become CIC certified without becoming certifiable Sue Cooper, Canada
March 28th Treatment of severe MRSA infections: Current practice and further development Dr. Philippe Eggimann, Switzerland
March 30th Screening for Staphylococcus aureus before surgery….Why bother Dr. Hilary Humphreys, Ireland

For more information on Webber Training, including a full list of the upcoming Infection Prevention and Control Teleclasses, please visit
www.webbertraining.com.  If you’re a Twitter follower you can also be part of the conversation during the sessions by following #WebberTraining.
I hope many of you will take the opportunity to listen to these teleclasses and share them with your colleagues! 

Bugging Off!


Friday, January 13, 2017

In like a Lion, out like a Lamb

I suspect many of you automatically thought “March” when you read the title of this week’s blog.  You may think I’m lamenting over winter and wishing that spring was right around the corner.  You’d be partly correct - there are approximately 129 days and 12 hours until we put our boat back in the water.  The truth is weather sayings are as colorful as our imagination. Many sayings are based on careful observations and do turn out to be true while others are merely rhymes or beliefs passed down from generation to generation. 

The real reason behind my reflection on this phrase is because we have similar rhymes or beliefs in the infection prevention world.  In Canada, the sounds of hacking, sneezing and sniffling have been filling the halls of healthcare facilities, workplaces and schools.  In fact, in the last 2 weeks of December, >3100 people tested positive for Influenza.  That’s a 10-fold increase over the same time last year, and is particularly frightening when you think that only a fraction of people who have the flu actually seek medical treatment and are tested for confirmation.  I’ve been tested for the flu once and frankly have absolutely NO intention of ever having another nasal swab in my life.  I would far prefer the sinus burn from too much wasabi on my sushi than the pain from a swab being stuck so far up my nose it comes dangerously close to impaling my brain.

The flu strain that seems to be circulating primarily is H3N2.  It’s a nasty strain that hits the elderly and other frail people particularly hard. While this year’s flu shot is a good match to the strains circulating, H3N2 has the ability to mutate quickly so while the flu shot may be helping now, it may not be as helpful much later in the flu season.  If H3N2 is not bad enough, RSV is also out and about with a vengeance.  The symptoms for RSV are very similar to the flu, however this virus’ prime target is children with breathing problems and premature babies.

If you’re looking for how to combat the cold and flu virus, go no further than our educational campaigns such as last month’s Ba-Hum Bug campaign or the numerous Talk Clean To Me blogs that have been written on how to keep colds, the flu and RSV at bay.  I’ll also throw in a link to a blog on Norovirus because….it is the “winter vomiting disease”!

While I have not come across any rhymes that support a belief that if a year closes out with high flu numbers, the peak will either wane in the New Year or continue to pile up like the winter snow,  I can say that as I write this blog, I have that irritating scratchy feeling in the back of my throat.  My ears are a bit achy.   My sinuses are filling up and I had a bit of a cough today.   Except for the cough I could not hide, I’ve kept my other symptoms to myself.  Why?  Well, if this is “just” a cold it means I was probably starting to be contagious yesterday and will continue to be contagious for the next 5 to 7 days.  If this is the flu (fingers crossed, no fever yet!) the period I’m contagious is the same as if this is a cold.  The good news is that I’ve been holed up in my office mostly to myself the last 2 days.  Tomorrow, however, is a different story! 

Bugging Off!


PS - I’ll let you know next week if I’m in the group who have the flu but did not seek medical attention!