Friday, May 28, 2010

Cleaning To Blame For C-diff Outbreak

According to the Nanaimo Daily News, infection-control experts with the Vancouver Island Health Authority largely blamed inadequate housekeeping practices for the deadly 2008 outbreak of Clostridium difficile at Nanaimo Regional General Hospital.
Documents previously withheld by VIHA and obtained this week by the Nanaimo Daily News through the Freedom of Information Act show health officials knew by July 2008 that the virus, which first appeared at NRGH in April of that year, rapidly spread to five different hospital floors because of inadequate cleaning. Personal contact was an issue, but "housekeeping is really the biggest problem," the documents reveal.
Some members of the public questioned the effectiveness of the private housekeeping contractor, Compass Group Canada, but VIHA signed a second five-year contract in 2009. This time, however, the health authority created an escape clause that allowed health officials to retender the contract at any time. VIHA announced this week that it is looking for another private company to take over the housekeeping and food services for Island hospitals and residential care facilities.
Compass and its subsidiaries have held the Island contracts for six years, during which time hospitals had regular infection outbreaks, failed housekeeping audits and damaging WorkSafe B.C. inspections. This led VIHA to explore other options, according to Joe Murphy, vice-president of operations and support services.
"We need to find a provider to consistently hit quality standards that are written into the contract and that we would expect everywhere in the province," he said.
Other factors led to the spread of C. difficile in 2008, including overcrowding, but improper cleaning methods and insufficient cleaner strength had a significant effect in the 11-month outbreak that began in 2008 and infected 94 people.

Article Taken From "Cleanlink News" May 21, 2010

Wednesday, May 19, 2010

INFORMATION REGARDING BEST PRACTICE GUIDELINES AND STEAM VAPOUR CLEANING

INFORMATION REGARDING BEST PRACTICE GUIDELINES AND STEAM VAPOUR CLEANING


In a continued effort to provide the best and most responsible practices to the Healthcare industry, the Provincial Infectious Diseases Advisory Committee (PIDAC) has recently released the Best Practices for Environmental Cleaning for Prevention and Control of Infections. The latest updated document - December 2009, provides guidelines and recommendations for cleaning the environmental surfaces in a healthcare setting. In addition to practices recognized as effective and traditional, this document includes a Section (6.4) on New and Evolving Technologies in an effort to provide those entrusted with the maintenance of facilites with a tool set to most effectively achieve the best results.

With regards to New and Evolving Technolgies, the recommendations concerning implementation can be summarized as follows:

  1. Efficacy of New Product versus Current Method
  2. Ease to Implement New Technology in the Healthcare Setting
  3. Is the New Technology Non-Toxic
  4. Are there any resulting effects on patient care from implementing the New Technology
  5. Is the New Technology Ergonomic, Safe for Staff Use and in compliance with Occupational Health and Safety requirements
  6. Cost Implications of implementing New Technolgy

The PIDAC document reinforces the importance of involving all areas - Infection Prevention and Control, Environmental Services and Occupational Health and Safety - in all decision making processes relating to changes in cleaning and disinfection procedures and products.

Part D of Section 6.4 follows:
Reference 160 cites the study in the American Journal of Infection Control, performed with a portable steam vapour cleaning system equipped with the TANCS disinfection system. TANCS offers lab proven performance against C.diff spores, MRSA, VRE and more.

Using the tools supplied with a steam vapour cleaning system equipped with TANCS, cracks, crevices, large surfaces (vertical and horizontal), soft and hard surfaces and equipment can be cleaned and disinfected in one step.
Table 1 in the document lists the items found to harbour microorganisms in the Healthcare Environment. The use of steam on these items will disrupt the transmission of microorganisms. Eliminating the need for dwell time on bed frames, bed rails, door and faucet handles combined with the unique ability of steam to reach areas such as bed frames, all areas of overbed tables, crevices in hoist/lift and slings, mattressess, sink drains, and hinges on toilet seats and commode chairs provides the opportunity for a thorough clean and disinfection.

The process of cleaning with steam eliminates several concerns addressed in the document associated with chemical methods:

  1. Dilution ratios
  2. Dwell times
  3. The need to appropriatley label and safely store cleaning chemicals
  4. Risk of contamination, inhalation, skin contact or personal injury
  5. Requirement for MSDS and WHIMIS Training
  6. The belief that no one product is compatible with all surfaces or effective against all viruses, bacteria, fungi and spores.
  7. Effectiveness at varying temperatures
  8. Irritant and allergy concerns
  9. Reactions with other chemical products existing on surfaces
  10. Environmental Responsibility
  11. Requirement for automated dispensing systems
  12. The need for pre-cleaning prior to disinfection

The use of this broad spectrum cleaning method also aids in the ability to improve the accuracy of a visual assessment to measure cleanliness. When steam is used to provide a visibly clean surface, the heat transfer associated ensures removal of residues (organic or inorganic).

Box 16 offers a sample procedure for room cleaning. All critera are met with a steam vapour cleaning system, including the following concerns:

  1. Eliminate ‘double-dip’ concerns
  2. Eliminate need to monitor cloth saturation
  3. Perform tasks such as tape removal, stain removal and glass cleaning with one tool
  4. Refresh privacy curtains
  5. Perform bed and mattress cleaning and pest control without a prolonged bed drying time
  6. Clean bathroom and shower
  7. Clean floors

Box 19 is another example of tasks made easier and safer with a steam vapour system:

  1. No need for cleaning solution, PPE or MSDS
  2. No wet floor is created with steam
  3. Avoid repetitive action of wringing out mop
  4. Eliminate concern over splashed walls and furniture
  5. No need to change mop head
  6. No need to monitor cleaning solution in bucket.

Box 30 is the Sample Procedure for VRE Situations - again made simpler and more efficient and thorough using a steam vapour cleaning system.

Within the document, many disadvantages and comments are presented to provide an unbiased and thorough evaluation, allowing for best informed decisions and best practices to be followed in our Healthcare system. The disadvantages of all chemical applications are listed, and should be evaluated. The use of tap water to create steam vapour continues to be the most environmentally responsible and broad spectrum cleaning option available. Lab reports and clinical trial updates are available upon request to verify the efficacy of steam vapour in Healthcare settings.

Further information is available from the writer.

Elle Dietrich
Intersteam Technologies
1-800-281-4413
www.intersteam.com
elle@intersteam.com

Article taken from PIDAC "Best Practices for Environmental Cleaning for Prevention and Control of Infections" December 2009.

Monday, May 3, 2010

Road salt is poisoning water bodies, study finds.
By Martin Mittelstaedt – Environment Reporter


One of the most detailed investigations ever conducted in Canada into the fate of road salt has found that it is polluting groundwater and causing some streams during winter thaws to have salinity levels just under those found in the ocean.
The elevated salt readings were detected in Pickering where researchers from the University of Toronto have been studying how the salt spread on the highways, such as the 401, and other roadways through suburban sprawl affects water quality. They found that so much salty water from the community is ending up in Frenchman’s Bay, a scenic lagoon on the shores of Lake Ontario, that the small water body is being poisoned.
“Our Findings are pretty dramatic, and the effects are felt year- round,” said Nick Eyles, a geology- professor at the university and the lead researcher on the project. “We now know that 3,600 tones of road salt end up in that small lagoon every winter from direct run off in creeks and effectively poison it for the rest of the year.”
He called the findings, which were published recently in the journal Sedimentary Geology, “a really bad-news story” involving a “relentless chemical assault on watershed.”
The Pickering area provided researchers with an ideal place to study the effects of road-salt spreading, because most of the city lies within a relatively compact 27-square-kilometre watershed, where salt spread on roads ended up.
About 7,600 tones of salt is applied each year to roads in the community. About half of this amount seeps into groundwater, which in turn flows into streams year-round, making the water courses more salty than they should be, according to the research. The rest drains into Frenchman’s Bay, which is visible to commuters on the 401 and has a struggling fish population because salt levels are more than double the amounts typically found in the Great Lakes.
The salt water “knocks out fish,” Dr. Eyles said, adding vive, while younger ones move to areas of the lagoon closer to Lake Ontario and its fresher water.
The finding of major impacts on Pickering’s ground and surface water suggests a far greater toll from the use of salt elsewhere across Canada, where an estimated five million tones, or approximately 150 kilograms per Canadian, is used on roads each year to make them safe for travel in winter. The vast majority is applied in Ontario and Quebec.
“It’s a general problem… There are lots of other areas like this,” Dr. Eyles said, referring to the Pickering findings.
Environment Canada has recognized that salt has adverse impacts on wildlife, plants, water and soil, and in 2001 considered adding it to the country’s list of the most toxic substances. Instead, in 2004, the government instituted a voluntary code of practices to encourage municipalities and others to use the de-icer more sparingly, while maintaining highway safety. But with the vast amount used, huge quantities are still polluting soil and water, according to Dr. Eyles. “It’s a toxic material and yet we continue to throw it with gay abandon on our roads,” he said.
The University of Toronto’s research was based on water monitoring between May 2002, and March 2003, before the code went into effect.
It noted that after winter thaws, there were spikes in the amount of salt in streams, with those taking runoff from the 401 having approximately doubled the concentration of the pollutant than water-courses nearby that don’t take its storm water. Runoff from the highway, Canada’s busiest, also contains benzene, toluene, and xylene, hydrocarbons associated with contamination from underground gasoline storage tanks.
Environment Canada says it is currently reviewing whether the voluntary practices code has lead to any reduction in the amount of salt being spread on the roads. “If it is concluded, based on the review of progress, that other steps are needed for the management of road salts, Environment Canada will consider a range of possible options,” the department said in reaction to the study.



Taken from: The Globe and Mail, Friday March 5, 2010

Monday, April 19, 2010

UNCLEAN SWEEP

UNCLEAN SWEEP


Dr. Philip Tierno, director of clinical microbiology and immunology at New York University Medical Center and author of the “Secret Life of Germs,” says that 80 percent of all infectious diseases are spread through direct or indirect contact like kissing or touching doorknobs.

Here’s a list of the five filthiest spots in the city:

1. Touch screen ATM machines: “These machines are dirty because everyone touched the screen but nobody seems to wash them,” he says.
2. Public bathrooms: “People for some reason behave differently in these than in their own, and that’s what makes them disgusting,” he says.
3. Buses, trains and taxis: Tierno says that organisms, like fecal matter, linger in public transportation. Add a smoker, and the bacteria and germ levels skyrocket.
4. Escalators: Handrails, especially on hot and humid days, are germ covered. Plus, it’s easy to indirectly spread bacteria, particularly after you touch the handrail and touch your face.
Theaters and stadiums: Tierno says that any place in which people congregate is a breeding ground for bacteria.



Taken from the New York Post. Tuesday June 27, 2006. Pulse Health.

Thursday, April 15, 2010

Study shows antibacterial wipes can spread germs.

Study shows antibacterial wipes can spread germs.

By Helen Branswell.

Antibacterial wipes used in hospitals may not be having the intended effect, a new study from Wales suggests.
The work, done by researchers from Cardiff University’s School of Pharmacy, shows that the wipes do not kill high numbers of Staphylococcus aureus bacteria. So if they are used on more than one surface, rather than cleaning they may just be spreading germs around.
The researchers studied three types of wipes – one containing detergent, another containing disinfectants and a third containing a natural antimicrobial product.
“We found that all three wipes suffered from the same problem, in that they were transferred high numbers (of bacteria) and in fact in most cases uncountable numbers to consecutive surfaces,” said Gareth Williams, a microbiologist who presented the findings this week at an American Society for Microbiology conference in Boston.
Williams wouldn’t name the products and it’s unclear if they are used in Canadian hospitals.
Dr. Andrew Simor, head of microbiology at Toronto’s Sunnybrook Health Sciences Centre, said he wasn’t surprised by the findings.
“These disinfectants don’t kill all the bugs. You’re physically removing a layer of the organisms. But that doesn’t necessarily kill them. And so it’s easy to pick them up and transfer them to another area.”
Simor said in North America infection control recommendations would specify that a wipe should be used to clean a single area and then should be discarded.
Williams and his colleagues tested whether the three types of wipes could transfer methicillin-resistant Staph aureus – MRSA – or the antibiotic sensitive form of the bacteria from a surface inoculated with the bugs and whether the germs died if they were directly applied to the wipes.
All three types transferred MRSA, though in differing amounts. And none killed sufficient quantities of the bacteria to make reuse of a wipe safe.
Simor said that in his estimation these types of products aren’t needed in homes. “Our households are not settings where you’ve got the same risk of spread of infection (as in hospitals), he said.


Taken from the Hamilton Spectator. Thursday June 5, 2008

Monday, April 12, 2010

Private hospital rooms lower risk of C. difficile

Private hospital rooms lower risk of C. difficile.

BY ANDRE PICARD - PUBLIC HEALTH REPORTER
Article taken from the Globe and Mail - January 6, 2010

The more roommates you have during a hospital stay, the greater your risk of acquiring a dangerous infectious disease such as Clostridium difficile, according to new Canadian research.
The study, published in the American Journal of Infection Control, shows that each roommate a patient is exposed to hikes his or her risk of infection by 10 per cent.
“That is a significant risk,” Dick Zoutman, a professor of community health and epidemiology at Queen’s University in Kingston, Ont., said in an interview. He noted that, in Canada, most hospital rooms have either two or four beds and “there is a lot of turnover,” meaning that patients are routinely and unnecessarily exposed to a lot of infectious diseases.
Dr. Zoutman said that the research provides powerful evidence that single rooms are the safest, and should be the norm. “The take-home message is that our hospitals should be designed with private rooms for everyone,” he said.
While there would be an upfront cost, Dr. Zoutman noted that, over the long term, savings would be substantial: “This research provides the direct proof that should settle the discussion about the need for private rooms.”
Earlier research showed that about 225,000 patients a year suffer from hospital-acquired infections that substantially extend their stays, and between 8,000 and 12,000 people die annually as a result.

Shared washrooms may be the culprit

The new study was conducted at Kingston General Hospital, which was has 451 in-patient beds and about 17,000 patients a year. There are 107 single-occupancy rooms, 83 double-occupancy, six triple-occupancy, plus open bay areas and specialized units such as intensive care.
The study, which began as a master’s thesis by Queen’s student Meghan Hamel, examined patient records from 2001 to 2006. The research team looked for patients who suffered from three common but dangerous infections – C. difficile, methicillin-resistance Staphylococcus aureus (MSRA) and vancomycin-resistant Enterococcus (VRE) – and examined those patients’ exposure to other patients.
For each roommate to whom a patient was exposed, the risk of contracting C. difficile increased 11 per cent; for MSRA, 10 percent, for VRE, 15 per cent.
The median number of roommates was just over two, but some patients had as many as 46 roommates, whether due to a lengthy stay or to a heavy rotation of roommates.
Dr. Zoutman, who is also head of infection control at Kingston General, said that although the research was conducted at only one institution, “it is pretty typical of a Canadian hospital, and there is no reason to think this situation doesn’t exist everywhere.”
The infections that were studied- C. difficile, MSRA and VRE- are not airborne, but spread by contact.
Dr. Zoutman said the likely reason that roommates increase the risk of infection is that patients share a washroom. (The mantra in infection control is: One bum per toilet.) Another likely explanation involves inadequate hand washing by patients and health professionals alike; doctors sometimes don’t wash their hands between patient visits in a single room.
“The goal should be private rooms, or at the least, semi-private rooms,” Dr. Zoutman said. “But in the meantime, there are things we can do: We should be cleaning our hands, and we should really scrutinize how we clean our hospitals.”

A lack if roommates can help prevent routine and unnecessary exposure to infectious diseases.

Thursday, April 8, 2010

A great article about steam cleaning

MBCR INTRODUCES NEW SANITIZING STEAM CLEANING SYSTEM

To ensure the cleanest possible riding environment for its customers, Massachusetts Bay Commuter Railroad Company (MBCR) has announced the introduction of a new vapour sanitizing system to clean passenger coaches. This system is said to safely remove grease, grime and stains in a cost- effective manner without harming the environment.
"A sanitary, comfortable passenger coach is an essential part of a commuter's experience," said Richard A. Davey, general manager of MBCR. "The introduction of Advanced Vapour Technologies' proprietary steam vapour cleaning equipment into service will help us provide cleaner, fresher coaches for passengers during travel."
By using AVT's Mondo-Vap 2400 system, MBCR is able to utilize vapour cleaning technology, which eliminates bacteria, while using tap water. The cost effective system removes everything from old gum to stains that previously were impossible to remove. The system works on a wide range of materials, including vinyl, stainless steel and plastic type surfaces.
For more information, visit www.MBCR.net

Article taken from Sanitation Canada.