Monthly Archives: November 2014

Prevent the Spread of Norovirus

The following bulletin is from the Centers for Disease Control (CDC) annual pre-Thanksgiving outreach, to educate the public about the hazards posed by the Norovirus germ. The illness is spread through cross contamination. This happens when a surface which has been contaminated by an infected individual is later touched by a healthy person who contracts the illness. Nano-Shield prevents cross contamination by creating a surface which is inhospitable to infectious microbes, thus breaking the chain of transmission. Nano-Shield can be applied to any touch point and will protect it for up to 90 days. 855-687-0976

Family eating at restaurantNorovirus causes many people to become ill with vomiting and diarrhea each year. You can help protect yourself and others by washing your hands often and following simple tips to stay healthy.

Noroviruses are a group of related viruses that can cause gastroenteritis (GAS-tro-en-ter-I-tis), which is inflammation of the stomach and intestines. This leads to cramping, nausea, vomiting, and diarrhea.

Norovirus is the most common cause of gastroenteritis in the U.S.

CDC estimates that each year Norovirus causes 19 to 21 million illnesses, 56,000 to 71,000 hospitalizations and 570 to 800 deaths. Anyone can get infected with norovirus and you can get it more than once. It is estimated that a person will get norovirus about 5 times during their lifetime. Many people usually get sick with norovirus in cooler months, especially from November to April.

Norovirus Symptoms

Common symptoms:

  • cramping
  • nausea
  • vomiting
  • diarrhea

Less common symptoms:

  • low-grade fever
  • chills
  • headache
  • muscle aches
  • fatigue

Norovirus spreads quickly. It is found in the vomit and stool of infected people. You can get it by:

  • Eating food or drinking liquids that are contaminated with norovirus
  • Touching surfaces or objects with norovirus on them and then putting your hand or fingers in your mouth
  • Having direct contact with a person who is infected with norovirus, for example, when caring for someone with norovirus or sharing foods or eating utensils with them

People with norovirus illness are contagious from the moment they begin feeling sick and for the first few days after they recover. Some people may be contagious for even longer. There is no vaccine to prevent norovirus infection or drug to treat sick people. Learn how to protect yourself and others by following a few simple steps.

Person washing hands with soapWash hands carefully with soap and water.

Protect Yourself and Others from Norovirus

  • Practice proper hand hygiene
    Wash your hands carefully with soap and water, especially after using the toilet and changing diapers and always before eating or preparing food. If soap and water aren’t available, use an alcohol-based hand sanitizer. These alcohol-based products can help reduce the number of germs on your hands, but they are not a substitute for washing with soap and water.
  • Take care in the kitchen
    Carefully rinse fruits and vegetables, and cook oysters and other shellfish thoroughly before eating.
  • Do not prepare food while infected
    People with norovirus illness should not prepare food for others while they have symptoms and for at least 2 days after they recover from their illness. Also see For Food Workers: Norovirus and Working with Food.
  • Clean and disinfect contaminated surfaces
    After throwing up or having diarrhea, immediately clean and disinfect contaminated surfaces using a bleach-based household cleaner as directed on the product label. If no such cleaning product is available, you can use a solution made with 5 tablespoons to 1.5 cups of household bleach per 1 gallon of water.
  • Wash laundry thoroughly
    Immediately remove and wash clothing or linens that may be contaminated with vomit or stool. Handle soiled items carefully—try not to shake them —to avoid spreading virus. If available, wear rubber or disposable gloves while handling soiled clothing or linens and wash your hands after handling. Wash soiled items with detergent at the maximum available cycle length and then machine dry.
Infographic: Setting of norovirus outbreaks reported through the National Outbreak Reporting System (NORS), 2009-2012. Health care facilities equalled 2,189 or 62.7% of outbreaks. Restaurants or banquet facilities equalled 771 or 22.1% of outbreaks. School or daycare facilities equalled 214 or 6.1% of outbreaks. Private residences equalled 69 or 1.9% of outbreaks. Other/multiple settings equalled 251 or 7.2% of outbreaks. Data on specific settings are restricted to outbreaks with a single exposure setting; for foodborne outbreaks, setting refers to the setting where implicated food was consumed.

Common Norovirus Outbreak Settings

Norovirus spreads quickly from person to person in enclosed places like nursing homes, daycare centers, schools, and cruise ships. It is also a major cause of outbreaks in restaurants and catered-meal settings if contaminated food is served.

Many Names, Same Symptoms

You may hear norovirus illness called “food poisoning” or “stomach flu.” Norovirus can cause foodborne illness, as can other germs and chemicals.

Norovirus illness is not related to the flu (influenza). Though they may share some of the same symptoms, the flu is a respiratory illness caused by influenza virus.

For most people norovirus illness is not serious and they get better in 1 to 3 days. But it can be serious in young children, the elderly, and people with other health conditions. It can lead to severe dehydration, hospitalization and even death. To learn more about dehydration and how to prevent and treat it see norovirus treatment.

 

Are scrubs making sick patients sicker?

Traditional liquid disinfectants are not EPA approved for use on fabrics or other soft surfaces. The biostatic component in the Nano-Shield two stage system is EPA certified for laundry on its label. Treating fabrics of any kind with Nano-Shield will impart antimicrobial properties for 50 or more launderings. Treating scrubs and other healthcare uniforms not only protects patients but also the families of healthcare workers at home from infectious pathogens.

From Beckers Infection Control and Clinical Quality online newsletter November 12, 2014

Are scrubs making sick patients sicker? How soft surface fabrics spread infection and what to do about it

Written by Staff | November 12, 2014

In a webinar hosted by Becker’s Healthcare on Oct. 14, Peg Luebbert, founder of Healthcare Interventions, discussed how soft surface fabrics in the patient care setting might contribute to the spread of infection.

Soft surface fabrics in the patient environment include scrubs, lab/white coats, privacy curtains and linens. According to Ms. Luebbert, numerous third-party studies have proven fabrics harbor bacteria after coming into contact with patients. One study found that 79 percent of operating room scrubs tested positive for some types of gram-positive cocci and another study showed that 92 percent of privacy curtains showed contamination within one week of being installed.

“These studies show that the strongest and deadliest of bacteria can live for a long time on fabrics,” said Ms. Luebbert. “So it is up to healthcare workers to keep their scrubs and uniforms clean and hygienic. Laundering alone is not the solution because we know the risk of cross contamination exists.”

However, surveys of healthcare workers have shown they launder their hospital garments infrequently. A survey of 160 healthcare providers revealed their white coats were washed every 12 to 13 days and scrubs every 1.7 days. “Also, healthcare workers may not honestly admit how often they wash their uniforms,” said Ms. Luebbert. “They may have only two uniforms and wash them once or twice a week at home or at a laundromat.  It’s easy to see how this contributes to the spread of infectious bacteria. However, even with proper laundering, it’s important to remember fabrics are rapidly contaminated when put back in use.”

One of the major issues surrounding the contamination of soft surface fabrics in facilities is the lack of standard guidance or protocols. Regulatory guidelines tend to be outdated and sparse, says Ms. Luebbert. The Society for Healthcare Epidemiology of America has recently taken charge in providing guidance on this issue, however it too admits that lack of evidence has made it difficult to create general recommendations, she notes.

According Ms. Luebbert, internal guidelines in hospitals typically address the issue of attire only in human resource materials. “They talk about how healthcare workers and providers should be neat and hygienically clean,” she said. “But these are loose terms and HR guidelines are the only

place where attire is mentioned. It is rarely talked about from a patient safety standpoint, but rather from an appearance standpoint.”

Healthcare facilities looking to prevent the spread of infection through soft surface fabrics can begin by performing a risk assessment process, such as the SWIFT method, said Ms. Luebbert. This involves evaluating the day-to-day activity of a particular healthcare worker and ascribing ‘what if’ situations to the worker’s routine to identify failures and risks. After conducting the assessment, the facility administrators can come up with plans to improve internal policies surrounding soft surface fabrics, she said.

Healthcare facilities should be looking into the role of antimicrobial fabrics in reducing bacteria load in the healthcare environment. For instance, products powered by X-STATIC technology, a registered antimicrobial with the U.S. Environmental Protection Agency, have been proven efficacious in the bacterial management of soft surfaces. A key benefit of these fabrics is that they don’t require behavior modification by healthcare workers. Other benefits include odor protection and temperature regulation, keeping healthcare workers comfortable during long shifts, said Ms. Luebbert.

Cold and Flu season in the workplace, gross habits foster transmission

The Nano-Shield antimicrobial system is a two step strategy for the prevention of the spread of illnesses due to cross contamination in business, medical, hospitality, school, and gym settings. The targeted surfaces are disinfected with a hospital grade disinfectant prior to being treated with a long term antimicrobial barrier which creates a hostile environment which has been demonstrated to inhibit bacteria and other microbes by 99.99%. Germs cannot survive on the common touch points thus reducing or eliminating the infection/transmission cycle.

The referenced study is from a recent survey commissioned by CINTAS CORP and published in Cleaning and Maintenance Management Magazine online.
Study Reveals Grossest Hygiene-Related Office Behaviors

CINCINNATI, OH— It’s cold and flu season, which means offices and workplaces across America will fill with a symphony of coughs, sneezes and nose blows. While these noises can be distracting and lead to the spread of viruses and bacteria, they can also be downright gross. To identify which behavior Americans cite as the “grossest,” Cintas Corp. facilitated a survey conducted online by Harris from October 23-27, 2014 among 2,011 adults ages 18 and older. The study found that of the 81 percent of Americans who have witnessed a gross workplace habit, the majority concluded that the act of wiping a runny nose on one’s hands or sleeve is the grossest.

“While workplaces are full of poor hygiene habits, their frequency tends to increase around cold and flu season,” said Dave Mesko, Senior Director of Marketing, Cintas Corp. “To reduce the spread of viruses and bacteria, businesses need to increase cleaning frequencies and encourage employees to practice proper hand-hygiene to keep them from getting sick in the first place.”

The top five “grossest” cold and flu behaviors include:

  • Wiping runny nose on hands or sleeve:16%
  • Not covering mouth/nose when sneezing: 15%
  • Not covering mouth when coughing: 12%
  • Not washing hands frequently: 9%
  • Leaving dirty tissues on desk: 8%

Survey respondents also cited a hacking cough, touching common-area surfaces while sick, persistent sniffling without blowing, and nose blowing in general as other gross cold and flu hygiene-related behaviors.

While respondents were also given the opportunity to submit “other” gross behaviors, most of them focused on a lack of basic hand-hygiene. A few of the other highlights include: “blowing nose into the sink,” “spitting in trash can or sink,” and “the fact that they are there at all.”

To minimize one’s risk of getting sick this winter season, Cintas recommends the following hand-hygiene practices:

  1. Always use soap when washing hands and be sure to scrub for a minimum of 15-30 seconds to effectively remove germs.
  2. Use hand-sanitizer in addition to–not in place of–handwashing as sanitizers are not as effective as soap and water at removing germs and bacteria.
  3. Always dry hands after washing as germs and bacteria can be more easily transferred to and from wet hands
  4. Dry hands with paper towels instead of air dryers to help remove germs and bacteria as air dryers can increase bacteria counts.“Although hand-hygiene is an important step in preventing the spread of infections and bacteria, facilities also need to plan for additional cleaning and disinfection during cold and flu season,” added Mesko. “Make sure your facility is ready with the proper cleaning tools, cleaning chemicals and techniques to ensure a healthy workplace.”

    Survey Methodology
    This survey was conducted online within the United States by Harris Poll on behalf of Mulberry from October 23-27, 2014 among 2,011 adults ages 18 and older. This online survey is not based on a probability sample and therefore no estimate of theoretical sampling error can be calculated.

Nano-Shield, your fail safe backup because people make mistakes

This post expands on the theme of portable medical devices as sources of infection which we wrote about last week (wheelchairs). The Nano-Shield two part Antimicrobial System consists of a high powered hospital grade disinfectant combined with a cutting edge organosilane based coating which inhibits the regrowth of germs for up to 90 days.

Because people, including cleaning staff, are fallible and make mistakes ( like not allowing sufficient disinfectant dwell time to kill germs or possibly missing an area completely) it is critical to have a fail safe backup plan in place. The Nano-Shield system protects surfaces from microbes 24/7, so an oversight on the part of someone in environmental services doesn’t become a fatal error.

From a blog entry by Nichole Kenny of Professional and Technical Services (PTS) – experts in chemical disinfection for infection prevention.

Have Wheels? Will travel….including invisible hitchhikers!

In recent years, there has been considerable focus around cleaning and disinfection by environmental services staff (EVS) as we become more in tuned with the risks associated by direct or indirect transmission mission due to a contaminated environment.  EVS have been audited, have received training and feedback and have I am certain been reprimanded for neglecting to clean and disinfect one, two or more high touch surfaces.   I know for fact, some of these surfaces get missed as a result of the pressure they get for trying to turn over rooms as fast as possible.  In the end, I think we would all agree that having a well trained staff, having an auditing and feedback process and a management team that genuinely appreciates the work EVS does as part of a facility’s infection prevention program helps to ensure that EVS are doing the best job possible.

At the other end of the scale are the nursing and other clinical staff who utilize patient care equipment – particularly the portable kinds, on wheels, that can easily move from place to place.  While there have been outbreaks associated with contaminated patient care equipment, there has not been as much focus on who cleans said equipment with what frequency or how to audit to ensure that cleaning and disinfection is in fact occurring.  The best example I have of this, and one that I have used for years to highlight the importance of developing roles and responsibilities of who cleans what is what I will refer to as the “case of the poop splattered commode”.

Imagine a facility, dealing with a C. diff outbreak, who utilized commodes in semi-private rooms as their way of maintaining private bathrooms.  This facility had an audit program in place using UV reflective markers and was in the process of conducting a clinical study.  In one room, for 5 days the underside of the commode seat was marked and the researcher noted there was fecal matter on the rim of the commode bowl.  For 5 days, the commode did not get cleaned.  There were 5 distinct UV marks that had not been removed or even smeared to show some form of wiping had occurred…  Long story short, when EVS and Nursing were brought together

to determine what was going on, EVS stated “a commode is on wheels, therefore is a patient care device that should be cleaned by nursing” and nursing stated “a commode is a toilet, which is a surface that EVS should be cleaning”.  Clearly, no one had thought to sit down and define who cleaned what.

It for this reason that Havill et al’s study titled “Cleanliness of portable medical equipment disinfected by nursing staff” is so interesting.  This facility has taken the time to clearly define roles and responsibilities for what items need to be cleaned and disinfected between use by nursing and clinical staff.  The researchers sought to find out if they were to audit for cleaning compliance and provide feedback, if like the improvements they had found in their EVS staff could they improve the cleanliness of patient care equipment.

During unannounced visits, mobile medical equipment used for patient’s vital signs were sampled using ATP (Adenosine Triphosphate Bioluminescence) as well as environmental cultures.  Sites tested included: the control button on the blood pressure unit, thermometer, BP Cuff, machine handle and pulse oximeter.  The results found that these pieces of patient care equipment were frequently contaminated with organic material as well as aerobic bacteria.  While VRE was not found on any of the sites sampled, MRSA was found on several surfaces.  The study showed there was a wide variation in cleaning compliance despite polices that clearly outlined who was responsible for cleaning and disinfection.  Similar to results found with EVS staff, implementing an auditing program and periodic education of nursing and clinical staff may be beneficial.

Which leads me back to the title of the blog – Have Wheels?  Will Travel.   Do you know the cleaning and disinfection compliance rates for patient care equipment at your facility?  Or better yet….are you confident that everyone knows who is responsible for cleaning and disinfecting what?  You never know where your “dirty commode” may turn up!

Workplace illness costs business $277 Billion annually according to report

The Nano-Shield antimicrobial system is a two step strategy for the prevention of the spread of illnesses due to cross contamination in business, medical, hospitality, school, and gym settings. The targeted surfaces are disinfected with a hospital grade disinfectant prior to being treated with a long term antimicrobial barrier which creates a hostile environment which has been demonstrated to inhibit bacteria and other microbes by 99.99% Germs cannot survive on the common touch points thus reducing or eliminating the infection/transmission cycle. An investment in the health of a companies workforce will yield measurable benefits to its bottom line as the article below demonstrates. Follow the link to the Integrated Benefits Institute report for the whole picture.

From a September 2012 article in FORBES magazine

U.S. Workforce Illness Costs $576B Annually From Sick Days To Workers Compensation

Poor health costs the U.S. economy $576 billion a year, according to a new study by the Integrated Benefits Institute (Photo credit: Wikipedia)

From absenteeism due to illness to the cost of disability and workers’ compensation, poor health costs the U.S. economy more than a half a trillion dollars a year, according to a new study by a nonprofit research organization.

The Integrated Benefits Institute, which represents major U.S. employers and business coalitions, says poor health costs the U.S. economy $576 billion a year, according to new research. Of that amount, 39 percent, or $227 billion is from “lost productivity” from employee absenteeism due to illness or what researchers called “presenteeism,” when employees report to work but illness keeps them from performing at their best.  Here’s a link to their report and statement.

The Institute represents some of the nation’s biggest employers, including Caterpillar (CAT), Chevron (CVX), Google (GOOG), Microsoft (MSFT), and Wells Fargo (WFC). The Institute also represents municipalities, unions and universities.

The Institute is hoping the study brings attention from both presidential candidates, who institute officials say have focused on the cost of health care but not on the “impact of health and productivity,” an institute spokeswoman said.

“There’s a reason that everyone in the U.S. is worried about the economy and health care,” said Thomas Parry, president of the Integrated Benefits Institute. “These are two fundamental issues that are tightly coupled through health’s impact on productivity, and shape our standards of living. Illness costs this country hundreds of billions of dollars, and this should serve as a wake-

up call for both candidates and employers to invest in the health of workers, for the sake of the people and the benefit of U.S. business.”

Of the remaining $576 billion tallied in the report, the cost of wage replacement costs $117 billion from absence due to illness as well as workers compensation and both short and long-term disability. Meanwhile, another $232 billion of poor health costs come from medical treatment and pharmacy related costs.

Due in part to chronic conditions like diabetes, heart disease or depression, which can all lead to prolonged illness. Such conditions can trigger absenteeism, disability and workers compensation claims.

The Institute said its estimate was drawn using 2011 data from the U.S. Bureau of Labor

Statistics that shows 128.3 million people in the U.S. workforce and their total wages and benefits of more than $7 trillion as well as the Institute’s “benchmarking data based on 60,000 U.S. employers.”

CDC guidance for recommended disinfectants and proceedures when Ebola is present

The Nano-Concepts 2 Stage antimicrobial system consists of a hospital/institutional grade disinfectant and a durable, long lasting antimicrobial surface coating. The disinfectant is included in the CDC list of recommended formulations.

On August 1, 2014, CDC released guidance titled,”Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Hemorrhagic Fever in U.S. Hospitals.”

Frequently Asked Questions

1. How can I determine whether a particular EPA-registered hospital disinfectant is appropriate for use in the room of a patient with suspected or confirmed Ebola virus infection?

Check EPA’s Disinfectants for Use Against the Ebola Virus for a list of EPA-registered disinfectants. Users should be aware that an ‘enveloped’ or ‘non-enveloped virus’ designation may not be included on the container label. Instead check the disinfectant’s label for at least one of the common non-enveloped viruses (e.g., norovirus, rotavirus, adenovirus, poliovirus).

2. Are there special instructions for cleaning and disinfecting the room of a patient with suspected or confirmed Ebola virus infection?

Daily cleaning and disinfection of hard, non-porous surfaces (e.g., high-touch surfaces such as bed rails and over bed tables, housekeeping surfaces such as floors and counters) should be done.4 Before disinfecting a surface, cleaning should be performed. In contrast to disinfection where products with specific claims are used, any cleaning product can be used for cleaning tasks. Use cleaning and disinfecting products according to label instructions. Check the disinfectant’s label for specific instructions for inactivation of any of the non-enveloped viruses (e.g., norovirus, rotavirus, adenovirus, poliovirus) follow label instructions for use of the product that are specific for inactivation of that virus. Use disposable cleaning cloths, mop cloths, and wipes and dispose of these in leak-proof bags. Use a rigid waste receptacle designed to support the bag to help minimize contamination of the bag’s exterior.

3. How should spills of blood or other body substances be managed?

The basic principles for blood or body substance spill management are outlined in the United States Occupational Safety and Health Administration (OSHA) Bloodborne Pathogen Standards (29 CFR 1910.1030).5 CDC guidelines recommend removal of bulk spill matter, cleaning the site, and then disinfecting the site.4 For large spills, a chemical disinfectant with sufficient potency is needed to overcome the tendency of proteins in blood and other body substances to neutralize the disinfectant’s active ingredient. An EPA-registered hospital disinfectant with label claims for non-enveloped viruses (e.g., norovirus, rotavirus, adenovirus, poliovirus) and instructions for cleaning and decontaminating surfaces or objects soiled with blood or body fluids should be used according to those instructions.

 

Disinfectants for Use Against the Ebola Virus

This list of registered disinfectants meets the Center for Disease Control’s (CDC) criteria for use against the Ebola virus on hard, non-porous surfaces. It is necessary to follow the specific use instructions on the label for each disinfectant in order for the disinfectant to be effective. The product label will not specifically mention effectiveness against the Ebola virus. Instead, it will mention effectiveness against a different virus, such as norovirus, rotavirus, adenovirus, and/or poliovirus.

CDC’s guidance recommends:

  1. The use of an EPA-registered hospital disinfectant with a label claim for use against a non-enveloped virus (e.g., norovirus, rotavirus, adenovirus, poliovirus); and
  1. The product label use directions for the non-enveloped virus or viruses should be followed when disinfecting against the Ebola virus.

Note: The list below is not a comprehensive list. There may be additional disinfectants that meet the CDC’s Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus and EPA will update this list with additional products as needed.

Hospital wheelchairs as vectors for disease transmission

From the November issue of American Journal of Infection Control.

Wheelchair cleaning and disinfection in Canadian health care facilities: “That’s wheelie gross!

Highlights

  • •Health care staff are very concerned about inadequate wheelchair cleaning and disinfection.
  • •Wheelchair cleaning and disinfection is not optimally performed at many health care facilities.
  • •Most facilities lack clear policies and procedures for cleaning and disinfection of wheelchairs.
  • •Key concerns include tracking dirty and clean wheelchairs and dealing with cushions and armrests.

Background

Wheelchairs are complex equipment that come in close contact with individuals at increased risk of transmitting and acquiring antibiotic-resistant organisms and health care–associated infection. The purpose of this study was to determine the status of wheelchair cleaning and disinfection in Canadian health care facilities.

Methods

Acute care hospitals (ACHs), chronic care hospitals (CCHs), and long-term care facilities (LTCFs) were contacted and the individual responsible for oversight of wheelchair cleaning and disinfection was identified. A structured interview was conducted that focused on current practices and concerns, barriers to effective wheelchair cleaning and disinfection, and potential solutions.

Results

Interviews were completed at 48 of the 54 facilities contacted (89%), including 18 ACHs, 16 CCHs, and 14 LTCFs. Most (n = 24) facilities had 50-200 in-house wheelchairs. Respondents were very concerned about wheelchair cleaning as an infection control issue. Specific concerns included the lack of reliable systems for tracking and identifying dirty and clean wheelchairs (71%, 34/48), failure to clean and disinfect wheelchairs between patients (52%, 25/48), difficulty cleaning cushions (42%, 20/48), lack of guidelines (35%, 27/48), continued use of visibly soiled wheelchairs (29%, 14/48) and lack of resources (25%, 12/48).

Conclusion

Our results suggest that wheelchair cleaning and disinfection is not optimally performed at many Canadian hospitals and LTCFs. Specific guidance on wheelchair cleaning and disinfection is necessary.

An opportunity for Nano-Shield applicators

Wheelchairs are among the many fomites (An inanimate object or substance that is capable of transmitting infectious organisms from one individual to another) which can be targeted for treatment with the Nano-Shield antimicrobial system.

Bacteria

Bacteria