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The snot-spattered experiments that show how far sneezes really spread

  • From the Journal  NATURE May 31


The snot-spattered experiments that show how far sneezes really spread

Mathematician Lydia Bourouiba uses high-speed video to break down the anatomy of sneezes and coughs — and to understand infectious disease.

The physics of the sneeze

Lydia Bourouiba’s lab uses slow-motion footage to study the fluid dynamics of sneezing.

So, how do you get your research subjects to sneeze on cue?

“That’s a question I get a lot,” says Lydia Bourouiba with an easy smile. The solution turns out to be surprisingly simple: just take a small, rod-shaped device, use it to tickle a subject’s nostril for a few seconds, and — achoo!

For Bourouiba, a mathematician and fluid dynamicist, that sneeze is the pay-off. She and her team at the Massachusetts Institute of Technology (MIT) in Cambridge record the explosive aftermath in gross detail using one or sometimes two cameras running at thousands of frames per second. Played back in slow motion, the videos reveal a violent explosion of saliva and mucus spewing out of the mouth in sheets that break up into droplets, all suspended in a turbulent cloud.

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The videos that Bourouiba has recorded in this way allow her to measure everything from the diameter of the droplets to their speed — data that help her to learn more about how these particles carry viruses and other pathogens to their next host. She has shown that sneeze and cough particles can travel the length of most rooms and can even move upwards into ventilation shafts — suggesting that microbes in the droplets could potentially spread farther and over longer periods of time than current theories suggest.

Ultimately, says Bourouiba, her goal with this work is to ground epidemiology and public health in physics and mathematics. When trying to keep diseases from running rampant, she says, “we want to be giving recommendations that are based on science that has been tested in the lab”. In practical terms, such insights could lead to maps showing the contamination risks in the vicinity of infected people protective equipment optimized to shield hospital workers from specific kinds of germs, and better predictions of how diseases move through a population.

Bourouiba pursues this goal with the same energy and ambition that leads her to fill her leisure time with week-long bike trips, mountain climbing — she ascended Tanzania’s Mount Kilimanjaro in 2011 — and winter camping at −20 °C. Although she is hardly the first researcher to use high-speed video to study fluid dynamics, she is the first to realize its potential in the respiratory field, says David Ku, a biofluid-mechanics researcher at Georgia Institute of Technology in Atlanta. Bourouiba’s approach could be transformative in the field, says Ron Fouchier, a virologist at the Erasmus University Medical Center in Rotterdam, the Netherlands. “This kind of physics is absolutely needed to understand how transmission works.”

A fluid career

Bourouiba has been a natural explorer as far back as she can remember. As a child in France, she immersed herself in books about science and nature, including a biography of Albert Einstein. She soon fell in love with mathematics and physics, and made them her major subjects when she earned her undergraduate degree in France and Montreal, Canada.

But during her graduate work in fluid mechanics at Montreal’s McGill University, as she focused on narrower and narrower theoretical questions about turbulent flows, Bourouiba began to feel the itch for something more. She had spent some of her early years in Algeria during the civil war of the 1990s, and vividly remembered the turmoil and misery that she had witnessed there. “We know what the worst is, we saw a lot of it,” she says. “But what can we as a species do to push that boundary of what we can achieve, in terms of making the world a better place?”

In her search for an answer, Bourouiba soon homed in on health and epidemiology. This was the mid-2000s, and emerging diseases were all over the news. Severe acute respiratory syndrome (SARS) had killed nearly 800 people around the world in 2003, polio was making a comeback and avian flu was jumping across to humans. Infectious diseases seemed to Bourouiba like the perfect way to combine all of her interests and expertise.

She was tentative at first. A career in fluid mechanics promised to be secure and certain, whereas a head-first dive into biology seemed like a huge risk. But one day, about halfway through her PhD, she was mulling this conundrum as she made her way up the wall at a rock-climbing gym. “So what?” Bourouiba suddenly said to herself as she reached for the next handhold. “You can’t make decisions out of fear.”

Violent events

Having come so far, Bourouiba saw her fluid-dynamics PhD to completion in 2008. But from there she managed to land a postdoc appointment in mathematical epidemiology at York University in Toronto, Canada, where she started thinking about sneezes and coughs.

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These ‘violent expiratory events’ (as one of Bourouiba’s papers calls them) were assumed to be one of the main ways that respiratory diseases spread. But how, exactly? Epidemiological studies estimate how a disease is transmitted on the basis of people’s movements and activities at the time they got infected. Did they contract the disease by direct, person-to-person contact, such as shaking someone’s germ-covered hand, or from contaminated surfaces such as doorknobs? Was it through large droplets that make a short leap from one respiratory tract to another, or through smaller aerosol particles that are suspended in air and can travel farther before being inhaled? Or was the route some combination of these modes?

Such studies have helped researchers to work out that measles is typically spread by aerosols and that Ebola is transmitted mainly through direct contact with infected bodily fluids. But there is still a lot of uncertainty for many pathogens, which hampers the ability of public-health officials to control the spread of disease during outbreaks and to prepare for future ones. SARS, for example, is thought to spread mainly through close contact, yet the 2003 outbreak showed at least some evidence of airborne transmission1. And some researchers think that Ebola viruses might travel through air to some degree2.

At York, Bourouiba became convinced that these uncertainties could be reduced by pinning down some key details about the physics of sneezes and coughs that conventional disease-transmission models are missing.

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In 2010, a postdoc appointment at MIT gave her a chance to start filling those gaps with hard data. Up to that point, she had worked only on theory — but now she plunged into experimental research, learning through trial and error the subtleties of high-speed video and lighting to capture a sneeze. “Mathematicians are often uncomfortable in a lab setting,” says John Bush, a fluid dynamicist who was her mentor at MIT. “Lydia really took to it.”

Suspended spray

One thing that Bourouiba particularly wanted to pin down was the size distribution of the droplets coming out of the mouth, because size affects how many microbes a droplet can carry and how far it can travel through the air.

For her first set of experiments, published in 2014, she wanted to look at the entire spray of droplets3. Bourouiba posted adverts around the MIT campus to recruit volunteers, and filmed the coughs and sneezes of about ten healthy people. After much tinkering with camera positions, backgrounds and lighting levels — at one point, the lights made the room uncomfortably hot for participants — Bourouiba captured videos that showed that the droplets were propelled out of the mouth in a turbulent, buoyant cloud. The cloud grew and slowed down as it pulled in air from the environment, lifting and carrying the droplets away from the sneezer.

  1. Bourouiba/The Fluid Dynamics of Disease Transmission Laboratory/MIT

A sneeze captured on high-speed video. After a sneeze, large droplets of saliva and mucus (green) shoot out of the mouth, but fall relatively quickly. A turbulent cloud carries  smaller droplets (red) and allows them to drift for up to 8 metres.

The video evidence contradicted conventional thinking about sneezes, which held that larger droplets would fall to the ground within 1–2 metres, and that only the smaller ones would stay aloft as airborne aerosols. Feeding her video evidence into her mathematical models, Bourouiba concluded that, thanks to the cloud dynamics, many of the larger droplets can travel up to 8 metres for a sneeze and 6 metres for a cough, depending on the environmental conditions, and stay suspended for up to 10 minutes — far enough and long enough to reach someone at the other end of a large room, not to mention the ceiling ventilation system.

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That conclusion has implications for health-care workers, says James Hughes, an infectious-disease epidemiologist at Emory University in Atlanta. If a disease is thought to be transmitted within 1–2 metres, workers might assume that they are safe beyond that zone. “I think maybe we need to be a little bit more circumspect about that,” he says.

For Bourouiba’s next set of experiments4, she zoomed in closer to the mouth to film a 150-millisecond-long sneeze. Videos taken from the side and top at up to 8,000 frames per second revealed that the fluid breaks up in steps, like a slow-motion explosion produced by Hollywood: the fluid emerges from the mouth in sheets, which are then punctured and form rings as they are stretched by the airflow. The rings fracture, leaving filaments. Little beads of fluid form on the filaments, which elongate and fragment to finally produce droplets.

Bourouiba was surprised to find so much happening to the fluid outside the mouth — it countered the prevailing assumption that droplets exit the mouth fully formed. To Gerardo Chowell, a mathematical epidemiologist at Georgia State University in Atlanta, this is an important finding because it means that droplet formation could be strongly influenced by environmental conditions such as humidity and temperature. And that could help to explain why some diseases, such as flu, tend to occur more frequently at certain times of the year, he adds, perhaps because the ambient conditions favour the spread and survival of certain microbes.

Bourouiba’s research advances previous work measuring sneeze and cough droplet sizes, says Ku. Fluid particles can travel varying distances depending on a lot of different parameters, he says. “If I just tell you the size of the particles, I can’t tell you where they’re going to go. Her work actually shows where they go, with a real sneeze.”mansneezeBmlG490CUAAkGlm.jpg largevirus


Controlling the Spread of Germs in Restrooms

This article appears in the Sept 1 issue of Claning and Maintenance management Magazine.By Rosie D Lyles

The Nano-Shield Antimicrobial System is 99.99% effective against all of the microbes discussed in this article. We offer the answer to both health and aesthetic issues related to public restroom maintenance.

Cleaning for Health in Public Restrooms

In any number of public and commercial settings—from office buildings, hotels, restaurants, and schools to health care facilities and other businesses—restrooms are consistently cited as one of the toughest areas for cleaning and maintenance professionals to maintain—and the No. 1 source of customer complaints. This is due in large part to the dual imperatives of public restroom maintenance: cleaning for aesthetics and cleaning for health.

Eliminating odors and maintaining a visibly clean restroom is extremely important, as research has shown consumer perceptions of facilities’ restrooms can impact bottom lines. However, restroom cleanliness is also very important to public health.

The following is an overview of the critical role restroom cleaning and disinfection plays in protecting public health, and steps that in-house custodial professionals and building service contractors (BSCs) can take to help control and prevent the spread of germs in their facilities’ restrooms.

Public Restrooms and Public Health
Some people mistakenly assume that illness-causing germs and multi-drug resistant organisms (MDROs), or superbugs, are a health care-specific problem and don’t pose much of a threat in other public settings. However, there is a growing body of research that shows that many of these microbes are commonly found in public restrooms and are easily transmitted between individuals through contact with contaminated surfaces.
In a 2011 study published in the journal PLoS ONE, researchers took samples from 10 restroom surfaces on the University of Colorado at Boulder campus, including door handles into and out of the restroom, handles into and out of a restroom stall, faucet handles, the soap dispenser, toilet seat, toilet flush handle, floor around the toilet, and floor around the sink in restrooms. The study, “Microbial Biogeography of Public Restroom Surfaces,” found that human-associated microbes were commonly found on restroom surfaces.

From a public health perspective, the findings were significant because the high number of skin and gut-associated bacteria found throughout the restrooms suggested that “pathogens commonly found on skin (e.g. Staphylococcus aureus) could readily be transmitted between individuals by the touching of restroom surfaces.”
In another study of university restrooms at San Diego State University in California, researchers found within one hour of cleaning and disinfection, bathrooms were completely recontaminated with microbes, and fecal bacteria was found on a variety of surfaces from toilet seats to soap dispensers.

In a 2013 study, “Could Public Restrooms Be an Environment for Bacterial Resistomes?” published in PLoS ONE, researchers from the Queen Mary University of London took a closer look at Staphylococcaceae bacteria—which are commonly found in restrooms and are a major cause of infections both in hospitals and the larger community—to determine if non-health care restrooms could be a source of antibiotic-resistant bacteria. To test this theory, the research team collected samples from public restrooms in public buildings, testing samples from various sites in each restroom. The researchers identified 19 different types of Staphylococcaceae from the restroom samples, and more than one-third (37.8 percent) were antibiotic-resistant.

There’s no question that restroom cleaning is one of the toughest and most important jobs in the industry, but there is good news: Health-focused restroom maintenance can actually help ensure that restrooms are both aesthetically and hygienically clean.
Oftentimes, according to studies published in the Journal of Applied Microbiology and the Journal of Applied and Environmental Microbiology, seemingly aesthetic issues, such as unpleasant odors and visibly stained or soiled surfaces, can signal the presence of harmful microorganisms, such as Shigella, Salmonella, Hepatitis A, E. coli, and norovirus, so health-focused cleaning and disinfecting protocols must also address aesthetics.
Here are some cleaning and disinfecting tips that any facility can follow to help prevent the spread of germs and improve aesthetics in public restrooms:

• Pre-clean surfaces. Remove debris and bodily soils, such as urine, feces, and vomit, and then use a U.S. Environmental Protection Agency (EPA)-registered product with kill claims for contagious and hard-to-kill pathogens, such as methicillin-resistant Staphylococcus aureus (MRSA), influenza, and norovirus, to disinfect surfaces.

• Vet your products. Pay particular attention to disinfecting toilet surfaces and other surfaces frequently touched by hands by using products designed for those surfaces. Remember to check the product label and follow manufacturer’s instructions to ensure proper use and contact time. Different products  have different contact times for killing certain pathogens .

• Don’t mask odors. Eliminate restroom odors by breaking them down at their source. Not all products can actually break down and eliminate the root cause of urine odor—uric acid crystals. This is why it is important to choose products that include stable active ingredients, such as ready-to-use hydrogen peroxide-based solutions, which fight urine odors and stains and require no additional training for cleaning staff to use.

• Clean the floors. Remember that floor care is important, too. Remove grime and scuff marks on restroom floors, and also disinfect them. Restroom floors are often germ hot spots with about 230 bacterial species, compared to 150 species in other restroom locations, as reported in the survey, “Microbial Biogeography of Public Restroom Surfaces.”

• Clean mirrors and glass. Keep them shining by removing water marks, soils, and streaks with a general glass and surface cleaner. Scrub away soap scum on sinks, countertops, and other surfaces with products specifically formulated to break it down.

• Encourage hand hygiene. Remember, handwashing is an important part of preventing the spread of infections. Cleaning staff should wash their hands regularly with soap and warm water, especially after emptying waste baskets, touching used tissues, or using the bathroom.

The potential for germ transmission in public restrooms will always be high. However, by implementing thorough cleaning and disinfecting protocols that focus on tell-tale signs of contamination, such as unpleasant odors and visible stains or soils, and addressing key surfaces where germs are most common, cleaning professionals can help provide a healthy environment for building occupants and visitors.

Global Market Study on HAIs Control: Cleaning and Sterilization to Witness Highest Growth by 2020

The Nano-Shield Antimicrobial System represents the cutting edge of antimicrobial technology and can provide any surface with long lasting protection from the growth of bacteria, mold, mildew and fungi.  The Nano-shield Antimicrobial System achieves this goal by providing both biocidal and biostatic activity, killing germs and then inhibiting their regrowth. Strong, immediate germ eradication and 24/7 90 day residual protection is now a reality.

As awareness and concern rises with each new super bug outbreak Nano-Shield applicators can provide peace of mind and measurable protection from microbes to every business from daycare to assisted living facilities. Fitness clubs, medical offices, and school systems can not afford to operate without this protection.

For a referral to your nearest Nano-Shield applicator call 855-687-0976.
The study report, published by Persistence Market Research, provides an in-depth analysis of the HAI prevention and control market, as well as the estimated growth for the period 2014 to 2020, using 2013 as the base year for calculation. SEE REPORT BELOW

NEW YORK, Aug.24, 2015 /PRNewswire/ — Hospital-acquired infections (HAIs) refer to the infections that are acquired by patients during their stay in hospitals. These infections are caused by the transmission of pathogens, such as bacteria, viruses, fungi, and parasites, from one patient to another, or from a healthcare worker to a patient. Lack of proper sanitation in hospitals, poor infrastructure, and lack of awareness among healthcare workers are some of the common causes that are boosting the number of HAI cases. In addition, lack of training and poor infection control practices in hospitals also lead to the spreading of HAIs. Some other factors influencing the spread of HAIs include age and nutritional status. Aged people and people suffering from malnutrition have decreased levels of immunity and thus are more prone to acquire HAIs. HAIs are caused by the direct or indirect transmission of microbes. Globally, factors such as increasing government initiatives for controlling HAIs and rising prevalence of HAIs cases have helped in the growth of HAIs market.

North America dominates the global HAIs market. The U.S. represents the largest market for HAIs control in the North American region. This is due to technical advancements and more focus on improved healthcare facilities in the region. Asia is expected to experience high growth rate in the next five years in HAIs control market. This is due to high prevalence of HAIs in the region and increasing demand for improved healthcare facilities.

Some of the major factors that are driving the global market for HAIs control market include growing prevalence of HAIs, increasing initiatives by government and non-government organizations and rising aging population. However, factors such as lack of primary healthcare infrastructure in developing countries and lack of awareness about HAIs are restraining the global HAIs control market. Rising number of product launches and increasing popularity of gas plasma sterilization technology are some of the latest trends that have been observed in the global HAIs control market.
This report provides in-depth analysis and estimation of the HAIs control market for the period 2014 to 2020, considering 2013 as the base year for calculation. In addition, data pertaining to current market dynamics including market drivers, restraints, trends and strategic developments has been provided in the report. The HAIs control market is categorized on the basis of type of method, types of cleaning and sterilization techniques, diagnostics techniques, treatments, diseases and geography. Based on type of cleaning and sterilization techniques, the HAIs control market comprises instrument sterilization, wide-area sterilization, disinfection of linen. Based on type of diagnostic techniques, the market comprises manual testing, automated testing and confirmation testing. Based on the type of pharmaceutical treatment, the market comprises of viral HAI pharmaceuticals, bacterial HAI pharmaceuticals and fungal HAI pharmaceuticals. Based on the type of environmental treatment, the market comprises of air treatment, water treatment and chemical treatment. Based on the type of diseases, the market comprises of pneumonia, gastrointestinal illnesses, urinary tract infections (UTI), surgical site infections and primary bloodstream infections.

In the geographical analysis, the report identifies and analyses market size and forecast of North America, Europe, Asia and Rest of the World (Row). North America is further segmented into the U.S. and rest of North America. Similarly, Europe is further segmented into Germany, France, U.K. and rest of Europe. Asia is further segmented into China, Japan and rest of Asia. Some of the major players in the cleaning and sterilization segment in HAIs control market are STERIS Corporation, Getinge AB and Advanced Sterilization Products Some of the key market players for treatment of HAIs include Pfizer, Inc. and Merck & Co., Inc. Some of the key market players for the diagnostics segment in HAIs control market are Hoffmann-La Roche, Ltd. and bioMerieux SA. Companies have been profiled on the basis of attributes such as company overview, recent developments, growth strategies, sustainability and financial overview.
Read the full report: large

Infection Control Market worth $16.7 Billion by 2020

The Nano-Shield antimicrobial system represents the best available technology for microbial control on both porous and nonporous surfaces. Serving every industry from healthcare to daycare we are positioned to take advantage of the exploding infection control market. For a referral to the nearest Nano-Shield applicator call 1-855-687-0976,

The report Infection Control Market by Disinfection (Endoscope Reprocessing, Disinfectant, Disinfector, Surgical Drapes, Gowns, Disinfectant Wipes, Face Mask), Sterilization (Moist Heat, Dry Heat, Ethylene Oxide, E-beam, Contract Services) – Global Forecast to 2020”, The global infection control market is estimated to reach $16.7 Billion by 2020, growing at a CAGR of 6.7% during the forecast period (2015 to 2020).

Browse 262 market data tables with 43 figures spread through 370 pages and in-depth TOC on “Infection Control Market by Disinfection (Endoscope Reprocessing, Disinfectant, Disinfector, Surgical Drapes, Gowns, Disinfectant Wipes, Face Mask), Sterilization (Moist Heat, Dry Heat, Ethylene Oxide, E-beam, Contract Services) – Global Forecast to 2020”
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The infection control market witnessed healthy growth in the last decade owing to rising aging population and prevalence of chronic diseases, an increase in the number of surgeries performed, and the rising occurrence of hospital-acquired infections. However, stringent regulations and saturation in developed economies will restrict the growth of the market to certain extent.

In this report, the infection control market is broadly split into two product segments disinfection and sterilization.

The disinfection technologies segment accounted for the largest share of the global infection control market in 2014. This market comprises of disinfectors (equipment), disinfectants, medical non-woven products, and endoscope reprocessors. Medical non-wovens segment (comprising of surgical drapes, surgical gowns, sterilization wraps, face masks, and disinfectant wipes) accounted for the largest share of the disinfection technologies market in 2014. However, endoscope reprocessors is the fastest growing segments in the disinfection technologies market during the forecast period. This market is expected to grow at a highest CAGR of 9%–10% during the forecast period. Growing importance of diagnostic and therapeutic endoscopy procedures and increasing number of minimally invasive surgeries across the globe are some of the key factors contributing to the growth of this market.

On the other hand, growing demand for UV rays disinfectors is one of the key disinfectors markets.  UV rays disinfectors is the fastest growing segment in the disinfectors market. Replacement of chlorine-based disinfection with advanced disinfection techniques (UV and ozone being two major technologies) is the key trend boosting the adoption of UV rays disinfectors.

The sterilization technologies market is segmented into heat sterilization, low temperature sterilization, filtration, and ionization radiation sterilization markets. Low temperature

sterilization is the fastest growing segments in the sterilization technologies market. This market is expected to grow at a CAGR of 9%–10% during the forecast period. This growth is mainly attributed to fast sterilization and non-toxicity of low temperature sterilization method as compared to other sterilization techniques available in the market; it also has high material compatibility. The low temperature sterilization market consists of ethylene oxide (EtO), vaporized hydrogen peroxide (VHP), peracetic acid, hydrogen peroxide gas plasma, ozone gas, and formaldehyde sterilization methods.

On the basis of end user, the infection control market is segmented into hospitals, life sciences, medical device companies, pharmaceutical companies, food industry, and others. In 2014, the hospitals segment accounted for the largest share of the infection control market, whereas the medical device companies segment is expected to grow at the highest CAGR from 2015 to 2020.

North America represented the largest regional market in 2014, followed by Europe, Asia-Pacific, and RoW. Asia-Pacific is the fastest-growing region, primarily due to the rise in awareness on infection control technologies, growth of aging population and resultant increase in the prevalence of chronic diseases, and increase in number of surgeries.

Major players in the infection control market are 3M Company(U.S.), Getinge Group(Sweden), STERIS (U.S.), Medivators (U.S.), Advanced Sterilization Products (U.S.), Belimed AG (Switzerland), Sterigenics International Inc.(U.S.), Kimberly-Clark Corporation (U.S.), Sterigenics (U.S.), MÜNCHENER MEDIZIN MECHANIK GMBH (MMM) (Germany), and Synergy Health (U.K.).

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Towels Top the Kitchen Contamination Hazards List

From the March 19 issue of the online publication infection control today

The article featured below is the product of research carried out at Kansas State University where scientists study food handling safety. The study details how pathogens are spread in a kitchen environment, commercial or home, in spite of people being educated about safe food handling techniques. (see excerpt below)

The study found that all participants, regardless of food safety message group prior to the meal preparation, made mistakes in the kitchen that could lead to foodborne illness.
In addition to high levels of contamination in their cloth towels, about 82 percent of participants also left meat-originating contamination on the sink faucet, refrigerator, oven and trash container.
While the study paints a picture of the objects consumers often leave contaminated, it is important to note common mistakes that occur in the kitchen, which are often difficult to change.

The Nano-Shield antimicrobial system provides the answer to this pervasive problem by eliminating 99.99% of microbes on surfaces which are treated, and then inhibiting the pathogens from regrowing on those surfaces for up to 90 days. The Nano-Shield antimicrobial system reduces or prevents cross contamination from or to treated surfaces. Every touch point in a kitchen as well as the sponges and hand towels should be treated with the Nano-Shield antimicrobial system in order to reduce the incidence of food poisoning.

Towels top the Kitchen Contamination Hazard List

Although only 9 percent of reported foodborne illness outbreaks occur in the home, scientists estimate the actual number of incidents is much higher. Research shows a leading cause of cross contamination within the home is actually an object associated with cleaning, the kitchen towel. A study recently published in the journal Food Protection Trends highlights the work of several Kansas State University faculty and students.

Lead researcher and K-State food safety specialist Jeannie Sneed says the study showed some unique observations and areas of weakness when it comes to consumers’ kitchen behavior. “First, participants were observed frequently handling towels, including paper towels, even when not using them for drying,” Sneed says. “Towels were determined to be the most contaminated of all the contact surfaces tested.”

Video observation showed many participants would touch the towel before washing their hands or used the towel after washing their hands inadequately. Even after properly washing their hands, they reused the towel and contaminated themselves all over again. Researchers believe this could be one of the most critical findings of the study, because cloth towels can quickly and easily become contaminated at significant levels, including microorganisms that potentially can lead to foodborne illnesses.

Other researchers found that salmonella, bacteria commonly found in raw meat and poultry products, grows on cloths stored overnight, even after they were washed and rinsed in the sink. This is why Sneed recommends washing cloth towels after using them while preparing a meal, or using paper towels and discarding them after each use.

Another observation from the study was cell phone handling during food preparation and the lack of proper sanitation afterward. While electronic devices are useful tools for communication, entertainment and a method of gathering recipes, they add another potential source of contamination.

“We often take our cell phones and tablets into the kitchen,” Sneed says, “but what about all the other places we take them? Think of how many times you see someone talking on their cell phone in places like the bathroom, where microorganisms such as norovirus and E. coli are commonly found.”

If such devices will be used in the kitchen, Sneed recommends treating them as potential hazards and wiping the surfaces with a disinfectant solution frequently.

The U.S. Department of Agriculture (USDA) hopes to conduct further research on the use of cell phones and tablets in the kitchen.

The USDA Food Safety and Inspection Service funded the K-State study “Consumer Food Handling Practices Lead to Cross Contamination” ( to better understand the behavior of consumers with young children and observe the effects of food safety messages.

The 123 participants of the study were randomly assigned to three separate groups. The first group was given an education program on the four national Food Safe Families campaign messages of clean, separate, cook and chill. The second group viewed and discussed the Ad Council public service announcements that focused on the same Food Safe Families messages, and the third group did not receive any food safety education before preparing the meal.

The researchers set up a condominium on the K-State campus to reflect a home kitchen environment and videotaped the participants preparing a recipe using either raw ground beef or chicken and a ready-to-eat fruit salad. The raw meat was inoculated with Lactobacillus casei, a nonpathogenic organism commonly found in yogurt but not naturally present in meat.

The L. casei served as a tracer organism that allowed Randall Phebus, K-State food microbiologist and co-author of the study, to track the levels of meat-associated contamination spread throughout the kitchen while preparing these meals.

Phebus and his team of students found that more than 90 percent of the fruit salads prepared alongside the meat dish were contaminated with the tracer organism, suggesting that if the tracer represented a pathogen such as Salmonella, a high risk of foodborne illness was generated during the meal preparation.

The study found that all participants, regardless of food safety message group prior to the meal preparation, made mistakes in the kitchen that could lead to foodborne illness.

In addition to high levels of contamination in their cloth towels, about 82 percent of participants also left meat-originating contamination on the sink faucet, refrigerator, oven and trash container.

While the study paints a picture of the objects consumers often leave contaminated, it is important to note common mistakes that occur in the kitchen, which are often difficult to change.

“I think these days a lot of people learn on their own how to cook, so they may not know how to be conscious of cross contamination,” Sneed said. “People are becoming more aware of the hazards in raw meat products, but they may not know how to prevent those hazards through things like separation or raw and ready-to-eat foods and sanitation. I think it’s fairly easy to avoid cross contamination, but it’s also easy to cause it.”

Tips and Tricks for a Safe Kitchen

Kansas State University food safety specialists Jeannie Sneed and Randall Phebus will both admit that even with extensive education and experience in food safety, neither is perfect in the kitchen. With families of their own, they understand how hard it can be to prevent cross contamination in the home and have provided tips they use in their own kitchens.

  1. Wash your hands; don’t just splash and dash.
  2. Sneed believes the most important habit consumers should add to their routine is proper and frequent handwashing (, which is often not up to par. “You should wash them as soon as you get into the kitchen,” she said, “and you must do so with soap and water, not just splash and dash. You also have to think about where the potential for contamination lies and also wash them when handling fresh produce or raw foods such as meat or eggs.”

    The Academy of Nutrition and Dietetics ( estimates proper handwashing may eliminate nearly half of all cases of foodborne illness and significantly reduce the spread of the common cold and flu.

    Follow these recommended steps for proper hand washing: use warm water to wet hands, scrub with soap and water for 20 seconds, rinse well with warm water, and air dry or use single-use towels to dry hands.

    1. Wash your cloth towels.

    A K-State study identified cloth towels as the most common contaminated surface, and a major reason was simply how often they were handled. Sneed recommends refraining from using the same cloth towel for every task in the kitchen. Instead, use a paper towel for drying hands or to wipe something off the counter. Cloth towels also should be washed frequently; Sneed prefers consumers change out their towels every day or even after every meal prepared with raw meat and poultry.

    1. Don’t use sponges, but if you must, use proper sanitizing methods.

    The USDA does not recommend using sponges in the kitchen, but Phebus knows that most consumers use them despite that recommendation. “Sponges give me the creeps, because I know what grows in them,” Phebus says. “But, my wife insists on having a dish sponge to wipe down counters and cabinets so I’m constantly sanitizing it.”

    Consumers who can’t part with their dish sponge should frequently sanitize it to kill and prevent the spread of pathogens that use a sponge’s humid environment to thrive. Sanitation can be done in multiple ways, such as putting the sponge in the dishwasher or soaking it in a weak bleach solution. Phebus prefers placing the damp sponge in his microwave and zapping it for 30 seconds.

    1. Use a food thermometer.

    Most foodborne pathogens die when a food is cooked properly, which is why some ready-to-eat foods such as salads pose such a high risk for making people sick. The only way to know food has been cooked well enough to destroy any potential microorganisms is to go by temperature. Cook ground beef to 160 degrees F and poultry to 165 degrees F.

  3. “As part of the study we also asked participants if they have a thermometer and if they use that thermometer,” Sneed says. “The consistent finding was that many people don’t have one, and even if they do, they don’t frequently use it.”
    1. Separate duties of commonly used items.

    The spread of foodborne pathogens centers on contact with contaminated sources. As food is stored and prepared, separate ready-to-eat foods, such as fresh fruits and vegetables, from raw meat and poultry. This includes separating tools or surfaces used in preparation, including items such as dish towels, cutting boards and other contact surfaces. Sneed likes to separate her cutting boards by color by assigning a different color to those used with raw meats and those used with fresh fruits and vegetables. She also separates her cloth towels by usage, one for hand washing and the other for drying dishes.

    “Even though it is typically better for dishes to drain dry, I still keep a dish towel around, but it is only dedicated to dishes,” she says. “I do not use the same one for drying my hands. I know sometimes that is a challenge to keep them separate, especially when you have other family members or guests that come into your kitchen.”

    1. Think like a microbiologist; sanitization is your new best friend.

    “Anytime you’re handling food, especially if it’s a raw meat product, you have to slow down and think about where contamination exists,” Phebus says. “Don’t feel like you and your family are invincible, because these diseases can have drastic and deadly effects. Cross contamination is not an elementary thing. You need to put thought into it and try to improve.”

    Sanitation is the best defense for stopping the spread of contamination, but with busy lives it can be difficult to find time to properly sanitize a kitchen. Phebus recommends building sanitation into the daily kitchen routine. “I promote using a little bit of bleach in a bottle of water and to change it regularly,” he says. “While you’re in the kitchen, wipe down frequently used surfaces like the door knobs and handles of the refrigerator. And then after every major meal do a final wipe down of the whole kitchen, which is something most people don’t do.”

    Research found that regardless of the message or communication style, it all comes down to consumer behavior and the willingness to change old habits or take a little extra time to sanitize another surface.

    “People often know the risks,” Phebus says, “but they are willing to overlook them to continue things the old way and the easy way. In many instances, however, consumers don’t have enough understanding of basic microbiology to make good food safety decisions. We are always trying to get understandable information out to consumers and food service workers.”

    Source: Kansas State University

MRSA can persist in a home for over eight years, according to new study

Nano-Shield provides 24/7 protection from microbes, including MRSA, on all treated surfaces reducing or eliminating the threat of cross contamination.

MRSA Can Linger in Homes, Spreading Among its Inhabitants

Source: American Society for Microbiology

Households can serve as a reservoir for transmitting methicillin-resistant Staphylococcus aureus (MRSA), according to a study published this week in mBio®, the online open-access journal of the American Society for Microbiology. Once the bacteria enters a home, it can linger for years, spreading from person to person and evolving genetically to become unique to that household.

MRSA are strains of the bacterium Staphylococcus aureus that are resistant to almost all antibiotics related to penicillin, known as the beta-lactams. Since the 1990s, community-associated MRSA infections, mostly skin infections, have been seen in healthy people. The predominant community-associated strain of MRSA, called USA300, is virulent and easily transmissible.

For the study, researchers used a laboratory technique called whole genome sequencing on 146 USA300 MRSA samples. These samples were collected during a previous study from 21 households in Chicago and Los Angeles where a family member had presented to the emergency room with a skin infection found to be caused by USA300 MRSA. During that study, published in 2012 in the journal Clinical Infectious Diseases, investigators visited the homes of 350 skin infection patients, culturing their and their family members’ noses, throats and groins for bacterial colonization. Among 1,162 people studied (350 skin infection patients and 812 household members), S. aureus colonized at one or more body sites of 40 percent (137 of 350) of patients with skin infections and 50 percent (405 of 812) of their household contacts.

For the current study, investigators evaluated the samples to understand transmission dynamics, genetic relatedness, and microevolution of USA300 MRSA within households. They also compared genetic information from these MRSA samples with previously published genome sequences of 35 USA300 MRSA isolates from San Diego and 277 USA300 MRSA isolates from New York City, as well as with the completed genomes of the bacteria USA300 TCH1516 and FPR3757. They created an evolutionary tree to show the relationships among the bacterial strains.

The researchers found that isolates within households clustered into closely related groups, suggesting a single common USA300 ancestral strain was introduced to and transmitted within each household. Researchers also determined from a technique called Bayesian evolutionary reconstruction that USA300 MRSA persisted within households from 2.3 to 8.3 years before their samples were collected, and that in the course of a year, USA300 strains had a 1 in a million chance of having a random genetic change, estimating the speed of evolution in these strains. Researchers also found evidence that USA300 clones, when persisting in households, continued to acquire extraneous DNA.

“We found that USA300 MRSA strains within households were more similar to each other than those from different households,” says senior study author Michael Z. David, MD, PhD, an assistant professor of medicine at the University of Chicago. Although MRSA is introduced into households rarely, he said, once it gets in, “it can hang out there for years, ping-ponging around from person to person. Our findings strongly suggest that unique USA300 MRSA isolates are transmitted within households that contain an individual with a skin infection.”

USA300 broke down into two big groups or clades, with the vast majority of isolates from Los Angeles genetically different from those in Chicago. Fluoroquinolone-resistant USA300 clones emerged around 1995 and were more widespread in Los Angeles, San Diego and New York City than in Chicago.

“The study adds to the knowledge base of how USA300 MRSA has spread throughout the country,” said study coauthor Timothy D. Read, PhD, an associate professor of infectious diseases at the Emory University School of Medicine in Atlanta. “We’re also getting hints at how it evolves inside households. Decolonization of household members may be a critical component of prevention programs to control USA300 MRSA spread in the United States.”

The study was supported by the National Institutes of Health.

mBio® is an open access online journal published by the American Society for Microbiology to make microbiology research broadly accessible. The focus of the journal is on rapid publication of cutting-edge research spanning the entire spectrum of microbiology and related fields. It can be found online at http://mbio.​asm.​org.

Source: American Society for Microbiology

Combatting Cross-Contamination Concerns in Public Restrooms

From the March 4 issue of Cleaning and Maintenance Management online

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Combating Cross-Contamination Concerns in Public Restrooms

Tips to keep infectious agents at bay in these tough environments

By Dr. Rosie D. Lyles MHA, MSc

February 02, 2015

In any commercial setting—whether it is a hotel, office, school, airplane or even a hospital—public restrooms represent one of the biggest infection prevention challenges and are areas with the greatest potential for germ cross-contamination. Due to their function and constant use, everything from urine and fecal matter to other bodily fluids and dirt contribute to restroom cleaning challenges daily. Not to mention, every time a toilet is flushed, it releases a plume of aerosolized droplets that can carry bacteria to other restroom surfaces like floors, walls, and handles,1 heightening cross-contamination concerns.

Cross-contamination occurs when bacteria and viruses are transferred from one surface to another. The abundance of high-touch surfaces and objects in public restrooms make it easy for patrons and even cleaning professionals to inadvertently move illness-causing pathogens from one surface to another. For example, when a woman’s purse is placed on a restroom floor and then placed on a sink counter, the germs and bacteria on the floor can be transferred to the purse and then to the sink. One study even found that 20 percent of handbags contained more germs than the average toilet flush and could potentially cross-contaminate other surfaces.2

While the potential for germ transmission and cross-contamination in restrooms is high, it may not always be top of mind for cleaning professionals, who often face conflicting priorities when it comes to restroom maintenance. This article outlines some tips for helping facility managers and cleaning professionals manage cross-contamination concerns in their facilities, especially during the winter months.

Making Sure Public Health Doesn’t Get Lost in Translation

Consumer perceptions of restroom cleanliness can have a serious impact on a business’ bottom line, but it’s always important to remember—and to stress to employees—that restroom cleanliness serves a critical public health function: preventing the spread of bacteria, viruses, and fungi that cause infection.

Cleaning issues typically associated with restroom appearance such as visible stains, soiled surfaces and odors can signal the presence of harmful microorganisms. Influenza (flu) and norovirus germs are commonly found in restrooms and are associated with outbreaks of illness.1,2 With flu season in full swing, cleaning to stop the spread of infections is especially important now, as the flu virus and other illness-causing germs can survive on surfaces for extended periods of time and can spread when people touch infected surfaces and then touch their eyes, mouth, or nose.

A recent survey3 of cleaning industry professionals conducted by the Clorox Professional Products Co. in partnership with ISSA, the worldwide cleaning industry association, found that most cleaning professionals (85 percent) are fully aware of the importance of cleaning for appearance and health and the majority (95 percent) believe that restroom cleaning has an impact on overall public health. However, only half of respondents (49 percent) believe that their staff is aware of all the risks associated with the spread of germs in the restroom. In fact, most survey respondents (68 percent) say their staff does not understand or only somewhat understands the differences between cleaning, sanitizing, and disinfecting. These distinctions are important and are as follows:4

  • Cleaning removes germs, dirt, and impurities from surfaces or objects. Cleaning works by using soap (or detergent) and water to physically remove germs from surfaces, but does not necessarily kill them.
  • Sanitizing lowers the number of germs on surfaces or objects to a safe level as judged by public health standards or requirements to lower the risk of spreading infection.
  • Disinfecting kills germs on surfaces or objects using chemicals. The process does not necessarily clean dirty surfaces or remove germs, but killing germs on a surface after cleaning can further lower the risk of spreading infections.

Staff members should understand the role they play in preventing the spread of infection. Further, frontline cleaning professionals need the right products and appropriate training for the job.

Cleaning to Stop the Spread of Disease in the Restroom

Cleaning professionals can help prevent cross-contamination in restrooms by focusing cleaning and disinfecting efforts on germ-prone surfaces and objects such as countertops, urinals, toilets, door knobs, toilet handles, stall locks, and faucets. Since cleaning tools and equipment can become contaminated during the cleaning process, it is important not to clean multiple areas with the same supplies. Dirty cloths, sponges, and mops can spread viruses and bacteria to anything else they come in contact with, so it is important to regularly clean and disinfect or replace equipment as needed to avoid cross-contamination. Ready-to-use disposable disinfecting wipes can help decrease cross-contamination risks since they are designed to be thrown out after each use. Janitorial carts and closets should also be kept clean to prevent dirt and germs from traveling throughout a building on equipment.

Cleaning professionals should select disinfecting products that are specifically formulated and U.S. Environmental Protection Agency (EPA)-registered to kill illness-causing bacteria and viruses, such as influenza and norovirus, quickly. Remember that no matter which products are used, the best results are achieved when they are used correctly. Always refer to the product label and follow the manufacturer’s instructions for use and contact time, or the length of time the disinfectant needs to remain wet on the surface to properly kill viruses, fungi, and bacteria.

Finally, building occupants themselves also have a role to play in preventing cross-contamination, so it is important to encourage everyone to wash their hands regularly with soap and warm water—especially after sneezing or coughing, touching used tissues, or using the bathroom—and to stay home when they are sick to avoid spreading germs throughout the environment and to others.

Restrooms are one of the toughest jobs that cleaning professionals face in any industry or facility. However, with the right products, practices, and thorough cleaning and disinfecting, cleaning professionals can limit opportunities for cross-contamination and help ensure a healthy environment for building occupants and staff during flu season and year round.

1 Barker J, Jones MV. “The potential spread of infection caused by aerosol contamination of surfaces after flushing a domestic toilet.” Journal of Applied Microbiology. 99 (2005): 339–347.

2 Castillo, M. “Handbags may contain more germs than average toilet flush.” CBS News. (May 20, 2013). Web. Retrieved from:

3 Clorox Professional Products Co. and ISSA and ClearVoice Research. (May and June 2014). Cleaning Industry Professionals Public Restroom Survey. (Survey of 375 cleaning industry professionals).

4 NEA Health Information Network. “Cleaning, Sanitizing, and Targeted Disinfecting School Wide.” (2010). Web. Retrieved from: