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Food-borne illness, Handwashing Saves Lives, Infection prevention

Guess who’s coming to dinner? Salmonella and other food-borne illnesses if Senator Tillis has anything to say about it.

Handwashing is required by restaurant workers

Is requiring food workers to wash their hands after using the bathroom an onerous government intrusion? Senator Thom Tillis of North Carollina thinks so.

During a recent appearance at the Bipartisan Policy Center, Senator Tillis stated that businesses are bogged down by government regulations, so he thinks restaurants should be able to opt-out of the requirement that employees wash their hands after using the restroom—as long as they let customers know.

Tillis told the story of a time a woman asked him if hand washing wasn’t the sort of regulation that needed to be on the books. With his right hand raised for emphasis, Tillis concluded that in his example most businesses who posted signs telling customers their food workers didn’t have to wash their hands would likely go out of business. Tillis’s example takes pressure off businesses to provide safe food, and forces consumers to judge every meal’s likelihood of making them violently ill. Ah, the free market!

In case you didn’t know, the FDA requires handwashing and here’s why: “Proper handwashing reduces the spread of fecal-oral pathogens from the hands of a food employee to foods.” Gross! Recently, a restaurant in Mercer County, New Jersey was cited for handwashing violations—just a month before a worker tested positive for hepatitis A. The Centers for Disease Control and Prevention says hepatitis A is spread when an infected person doesn’t wash his or her hands after going to the bathroom and touches other objects or food.

In 2013, an All American Grill in Tillis’s home state gave a hundred people salmonella. The health department identified several health violations that could have contributed to food cross-contamination, including the fact that the hand washing sink was out of paper towels and soap, and didn’t have sufficiently hot water, all factors that “could serve as a deterrent to hand washing or render it ineffective,” according to the department. In that situation that market didn’t take care of the safety risks—100 ill guests and employees did.

Tillis was the butt of a lot of jokes after his comments went public. Jon Stewart even did this segment “Mr. Unclean,” on The Daily Show. Says Stewart, “You do realize that that’s a regulation too, right? … That’s not getting rid of a regulation, that just makes you an inconsistent ideologue with a light fecal dusting in your latte.”

Telling people to wash their hands never gets old around here. If workers are serving food and not washing their hands, they’re also serving up germs and sickness. So if free-market ideology means we can’t go out to eat without worrying about getting sick we’ll just stay home for dinner.

Infection prevention, Measles outbreak

How an Amish missionary & an amusement park visitor started measles hysteria

Measles: An unwanted guest at Disneyland

We considered opening with “an Amish missionary and an amusement park patron walk into a bar…” but the measles outbreak is most definitely not a joke.

Last year, there were 23 outbreaks of measles in the United States and 644 confirmed cases—the most since the disease was declared all but eliminated back in 2000. The 2014 outbreak was reportedly caused by an Amish missionary who’d traveled to the Philippines where he caught the measles, then returned to his community where many friends and family had refused the measles vaccine—and continued to pass along the disease.

Yesterday, new data released by the CDC shows that 288 cases of measles have been reported in the US since the beginning of the year and over 2,000 people are being monitored in Arizona after someone was exposed to an infected guest at Disneyland in December. And it may be far from over.

Measles is the one of the most infectious diseases known to man

A person with measles can cough in a room and then leave—and hours later (if you are unvaccinated) you could catch the virus from the droplets in the air that they left behind. No other virus can do that.

Measles is an entirely preventable illness

Nearly everyone who gets the proper vaccine will never get sick with measles, even if they’re exposed.

“The current increase in measles cases is being driven by unvaccinated people, primarily U.S. residents, who got measles in other countries, brought the virus back to the United States and spread to others in communities where many people are not vaccinated, says one assistant surgeon general, Dr. Anne Schuchat.

The measles and anti-vaxxers

It’s not just about “anti-vaxxers” (the people refuse vaccinations for a variety of reasons). It’s also about people who CAN’T be vaccinated.

Only about two percent of the U.S. population outright refuses vaccines. But every person counts. Vaccinations don’t just protect you or your children it protects everyone around you. People who are already ill and weakened immune systems, not to mention people who are unable to be vaccinated. The measles vaccine, for instance, is not licensed for use on babies younger than 12 months. That means that, for the first year of life, babies depend on the fact that everybody else around them gets vaccinated.

In most cases, measles isn’t deadly, but it’s almost always debilitating, bringing on a weeks-long fever, rash, and painful, watery eyes. According to an article from Vox, Up to forty percent of people experience serious complications, such as pneumonia and encephalitis (or swelling of the brain). One or two children in 1,000 die. Worldwide, measles kills 400 people a day, says Disease Daily. Yet it costs less than a buck to avoid.

The extremely high cost of a measles outbreak

The economic toll of measles is also astounding. Researchers at the Centers for Disease Control and Prevention (CDC) calculated that outbreaks in 2011—a total of just 107 cases—cost state and local taxpayers up to $5.3 million. And USA Today reports that a 2008 outbreak in San Diego cost taxpayers $10,376 per case to trace contacts and administer vaccinations. Why? Due to its high infectiousness and the potential severity of complications, a measles outbreak often constitutes a serious public health event entailing a vigorous response from local public health departments and can involve multiple states and counties. The World Health Organization (WHO) says during 2000-2013, measles vaccination prevented an estimated 15.6 million deaths making measles vaccine one of the best buys in public health.

Before the measles vaccine was introduced in 1963, there were four million cases (with 48,000 hospitalizations and 500 deaths every year). By 2000, the virus was declared eliminated in the U.S. because enough people were immunized so that outbreaks were uncommon—and deaths from measles were scarcely heard of. Take that, anti-vaxxers.

Do you have questions about measles and vaccines? Read this article by Julia Belluz: 9 things everybody should know about measles.

Ebola outbreak, Infection prevention

How fear-mongering over “Ebolanoia” helped improve infection control

Ebola virus

“Ebolanoia”—the unfounded hysteria over Ebola—has swept over North America. Now the Centers for Disease Control (CDC) says there’s a flu epidemic raging in America. Scary? The World Health Organization estimates that about 250k to 500k people worldwide die every year from influenza. Fortunately, doctors were ready to fight what is a common winter illness, despite the rise in cases. Beyond Ebola and influenza, there are still other emerging diseases of concern—Middle East Respiratory Syndrome (MERS), pandemic flu, Marburg virus, dengue fever and Enterovirus D68. Health officials are monitoring these, but there is still good news.

In 2014, we saw some unprecedented changes and an increased focus on infection control in hospitals in the United States and around the globe. The CDC released a report this week that shows hospitals in the U.S. have made progress in lowering the rates of infections for patients. Specifically, from 2008 to 2013, there was a 46% decrease in infections caused by germs getting into the blood (when tubes aren’t inserted into veins correctly). During that same period, hospitals cut surgical site infections by 19% as well as catheter-associated urinary tract infections by 6%.

CDC director Dr. Tom Frieden said in a statement to Time Magazine, “Hospitals have made real progress to reduce some types of healthcare-associated infections—it can be done. The key is for every hospital to have rigorous infection control programs to protect patients and healthcare workers, and for health care facilities and others to work together to reduce the many types of infections that haven’t decreased enough.”

Preventing infections saves lives—and money!

A new study published in the American Journal of Infection Control says preventing two of the most common healthcare-associated infections reduces the cost of patient care by more than $150,000. The cost of running an infection prevention program in the ICU is about $145,000.

The Ebola outbreak rages on in Africa. Time magazine even awarded the Ebola caregivers—those who fight Ebola across the world, for their incredible selflessness—as the Time Person of the Year. They write, “Ebola is a war, and a warning. The global health system is nowhere close to strong enough to keep us safe from infectious disease, and ‘us’ means everyone, not just those in faraway places where this is one threat among many that claim lives every day.”

Positive action around the globe

Last year, thanks to positive action in Ireland—including campaigns exhorting handwashing and a more cautious use of antibiotics—infection levels fell significantly. A proactive infection prevention plan implemented widely in a Hong Kong healthcare system also proved to be a significant factor preventing the spread of influenza strain A H7N9 (Avian flu) last year. You can find a detailed breakdown of five major infection control occurrences that affected U.S. hospitals this past year at Becker’s Hospital Review, too. And the list goes on.

Patricia Stone, PhD, RN, FAAN, director of the Center for Health Policy at Columbia University School of Nursing says, “The Ebola outbreak is a reminder that we cannot afford to let our guard down or grow complacent. Any death from preventable infections is one too many. We’ve known for decades what works to prevent infections and save lives and now our study shows just how much money can be saved by investing in prevention.”

Has your hospital, healthcare facility, school, or community implemented more training or action to prevent infections? Share your insights with us!

Handwashing Saves Lives

Join the project that captures the good, the bad & the ugly of hand hygiene.

#handhygienx

Handwashing assist or foul? We all follow in the footsteps, handprints—and germs—of everyone who has gone before us. (Not to mention the stranger who is sitting next to us right now.)

Handwashing pundits know proper handwashing is the most effective way to kill those germs and prevent the spread of illness, so we’re launching a new project—a social, visual declaration to all of mankind that we MUST wash our hands: #handhygienx.

To encourage the handwashing-averse or neglectful public to get on board, we’re leveraging picture and video sharing on social media to collectively capture handwashing habits—be it assists or fouls—through the lens of the camera/phone-wielding public. This project isn’t just for infection control specialists, germophobes, or epidemiologists (although they’ll love it). It’s a campaign is for all of mankind; we humans who work, play, eat, shop, learn, touch, breathe, and live in the mire of life every day.

All things will be at play here, including (and hopefully) the good stuff. We’d love to see people washing their hands correctly or wearing gloves when appropriate; businesses that post encouraging handwashing signs; stores making disinfecting wipes readily available; maybe even videos of adults washing their hands while they sing the ABC song twice through (or the equivalent of the required 20-seconds it takes to kill germs). If it’s for the good of all mankind, share it.

The bad (unfortunately) will also be at play, from man-on-the street nose pickers to woman-on-the-street “free” sneezers. See a restaurant worker leaving the restroom without washing his or herhands? Capture it. Handwash hygienx will put a spotlight on all of the contaminators and cross-contaminators out there in society. You know who they are and it’s time to shame them.

The rules are SIMPLE: When you see a handwashing hygienx (good or foul), snap a picture with your mobile device and upload it to Instagram, Twitter, Facebook, or Google+ with the hashtag: #handhygienx. 

If you’re not a social media user, you’re welcome to email photos to saralynn@brevis.com and we’ll share it on our Brevis Instagram page and other social sites. We’ve added samples of hand hygienx photos to our official project page, and we’ll maintain a running collection as the project goes along.

Citizens of project #handhygienx unite! Help us spot the handwashing fair and foul, fight the germs, and live healthier lives all around on planet earth.

Food-borne illness

What’s for dinner? You’re twice as likely to get sick eating at a restaurant.

Food-borne illness in restaurants

Cook at home or go out for dinner? Hungry Americans contemplate their options millions of times a day and going out for dinner wins out frequently. If you’re eating at restaurants, though, you’re twice as likely to get a food-borne illness. In fact, sit at a table with five friends or family members and you can expect that one of you will get sick.

It seems almost nonsensical (not to mention gross) that delicious, healthy foods—especially “real” foods, with all its life-sustaining and delicious qualities—can be tainted with deadly bacteria. Yet there are a whopping 250 different microbes or toxins that can cause foodborne illness (although 90 percent of the known outbreaks are caused by just seven microbes, including Salmonella and E. coli.) This year in the U.S. alone, 48 million people will get sick from contaminated food and roughly 3,000 Americans will die because of a pathogen in something they ate.

If you’re thinking about jumping into some cooking courses and staying “in” to eat for the rest of your mortal life, though, that’s not the solution. Although the issues restaurants face during food preparation are vastly different from a home cook’s, eating at home is a danger, too. A recent survey from the Center for Science in the Public Interest (CSPI) that says you’re chances of getting sick are doubled at restaurants probably doesn’t have all of the data (we’re pretty sure most people don’t report their mother or grandmother for giving them home-cooked illnesses), so don’t panic. Just keep a few key things in mind.

The National Restaurant Association depends on safe ingredients and the industry has trained more than 5.6 million food service workers in the safe handling and serving of food. That’s very. Very good. A few specific food items bear a large burden for food-borne illnesses, too, so be wary. Raw milk, for instance was linked to 104 outbreaks last year. And while your mouth is watering over the menu at your favorite diner, consider these tips (as strange as they may seem):

1. Stick to ordering the “popular” dishes on the menu. The turnover of these menu items is higher, so it’s far less likely that the food has been lying around in a fridge for a while.

2. If the Monday special is the catch of the day, don’t order it! In fact, NEVER order fish on a Monday. Chances are the chef bought it for their busy Saurday ight, but didn’t sell it, so it’s on been sitting in the fridge since then.

3. Ask to see the kitchen. If you think that’s overstepping your bounds, you’re dead wrong. Do you buy shoes without trying them on? The kitchen where your food is prepared is no different. It’s all part of the package you’re paying for and you don’t want to pay by getting sick!

4. Beware of menu specials. Ideally, they’re created with amazing produce or some farm-raised beef the chef has had his eye on. Unfortunately, specials also often the way restaurants move old stock. They dress it up, give it a new name, and voila—potential food-borne bacteria.

5. Put your nose down into that plate of food and really breathe in. Does it smell aromatic? Then dig in. If it doesn’t smell the way food should, send it back!

When you eat at home, make certain the food you’re buying, preparing, and cooking is safe, too. How? The nonprofit food safety watchgroup (the “food police”) has also published the definitive consumer’s guide to avoiding foodborne illness. Written by Sarah Klein, the senior food safety attorney for CSPI, From Supermarket to Leftovers: A Consumer’s Guide to Buying, Preparing, Cooking and Storing Food Safely offers tips for avoiding disease-causing microbes that can make you acutely ill.

Beware the Daily Catch

Superbugs

Bacteria that antibiotics can’t beat? We get to the gut of the matter.

Intestines Sketch

Hospital Acquired Infections (HAIs) are a serious problem throughout the world. There’s a growing recognition that surgical knives and operating rooms aren’t the only things that need a thorough cleaning. Spots like bed rails and even television remote controls in a hospital room can be highly contaminated. In fact, call buttons and bed trays are among the worst offenders. Bacteria can survive for extended periods of time on common healthcare “touch” surfaces. And it only takes a minute for a nurse or visitor with dirty hands to walk into a room, touch a vulnerable patient with germy hands, and undo the benefits of cleaning.

The emergence of a nasty strain of an intestinal bug called Clostridium difficile, or C-diff, triggered a renewed emphasis on hospital hygiene a decade ago. The diarrhea-causing C-diff superbug colonizes in the intestine and produces toxins that attack the gut, causing severe complications and sometimes death. Nearly 30,000 U.S. deaths annually are linked to C-diff. Complicating matters, a new strain of C-diff has emerged (NAP/0127). First identified in Canada, it produces a more severe colon infection that has now spread to all 50 U.S. states.

Why is C-diff worse than other hospital superbugs? They’re very difficult to clean away. Alcohol-based hand sanitizers don’t work and C-diff can persist on hospital room surfaces for days. The CDC recommends hospital staff clean their hands rigorously with soap and water. Or better yet, wear gloves. And rooms should be cleaned intensively with bleach.

Many patients also get C-diff infections as an unintended consequence of taking antibiotics for other illnesses. “Good” bacteria, normally found in a person’s intestines, help keep C-diff under control, allowing the bug to live in the gut without causing illness. But when a person takes antibiotics, both good and bad bacteria are suppressed—allowing C-diff to grow out of control because it’s resistant to most antibiotics that are used to treat common infections.

The rise of the C-diff superbug, along with increased pressure from the government and insurers, is driving hospitals to try all sorts of new approaches to stop their spread. Germ-resistant copper bed rails, call buttons and IV poles. Antimicrobial linens, curtains and wall paint. Cleaning machines that resemble Star Wars robots and emit ultraviolet light or hydrogen peroxide vapors. Insurers are also pushing hospitals to do a better job and the government’s Medicare program has even moved to stop paying bills for certain infections caught in the hospital.

If you get a C-diff infection, what can be done? One fairly new treatment is a fecal transplant. Yes, you read that right, and it’s just what it sounds like. A stool sample of a healthy relative is liquefied and infused into the colon of a sick patient via a colonoscopy or enema. The goal is to repopulate the infected patient’s intestines with healthy bacteria and so far it’s been highly successful. There’s a great video story about it here.

We’re facing the demise of our most effective means to treat disease because we’re overusing antibiotics. We need to treat them not as a commodity, but a valuable medicine. Enforced cleaning and sanitary precautions will go a long way to preventing infection, too. If you’re ever a patient, you can play a role by washing their own hands. And if a nurse or visitor stops by, tell them to wash their hands!

You can also download a report from the The U.S. Department for Health & Human Resources about preventing and treating C-diff infections here.

Science around the world

Forget germy handshakes. Do the fist-bump!

Humans are big on ritualistic touching. It’s an integral part of cultural exchanges throughout the world.

The traditional hongi greeting of the New Zealand Maori people involves pressing noses and foreheads together. In Botswana they lightly graze palms and fingers. In the U.S. we pat heads, offer high-fives, or connect with a pound hug (a one-armed “man” hug with a back slap). We’ve even been known to pat a bum or two. But the majority of the time, we shake hands.

Turns out, a handshake is FAR MORE LIKELY to spread bacteria. In fact, a handshake is about the grossest G-rated thing you can do with another person!

Scientists at Aberystwyth University in the United Kingdom recently conducted a study that compared how easily bugs migrate via a classic handshake, a high-five, and a knuckle-to-knuckle knock (or a “dap,” as the study calls it). It concluded that fist-bumps transfer 90% fewer germs than a handshake—followed by a “prolonged” fist-bump, then a high-five, and then a prolonged high-five. The handshake was the germiest. Why? It necessitates more flesh-to-flesh contact and lasts longer. Resesarch also showed that a firm grip spreads more than twice the number of bacteria than a “moderate handshake.” So the stronger your grip, the more germs you spread!

“People rarely think about the health implications of shaking hands,” says study lead Dave Whitworth, who was
inspired by increased measures to promote cleanliness in the workplace. “If the general public could be encouraged to fist-bump, there is genuine potential to reduce the spread of infectious disease.”

The study is of particular interest to healthcare providers, whose hands can spread potentially harmful germs to patients—and that can lead to healthcare-acquired infections (HAIs). HAIs are a leading cause of preventable harm and death in the U.S. In fact, the Centers for Disease Control and Prevention says that one in 25 hospitalized patients develops an HAI and 75,000 patients with HAIs die during their hospitalization each year. It’s unlikely we’ll see a lot of fist-bumping or high-fiving in hospitals anytime soon, but handshakes must be followed by effective handwashing!

Whether you call lit a dap, a fist-pound, or a fist-bump (our preference), this greeting is now being used by cool people everywhere—including President and Mrs. Obama, who popularized it during the 2008 Presidential campaign—because it’s the safest all of the ritualistic touching ways to exchange pleasantries. And if you think a fist-bump is strictly for the Obamas (or bromances, for that matter), think again: The Journal of the American Medical Association has called for a ban on handshakes in healthcare settings, recommending a fist-bump instead.

It’s germy world out there. So let up on that grip, champ. Grab our poster. Display it proudly. And spread the word (not the germs): Do the fist-bump!

Don’t miss this great video from CBS News, either.

Superbugs

What’s lurking on the surface can hurt you…

What you can't see can hurt you

Surfaces at facilities where we see our healthcare provider are just surfaces, right?

Healthcare facilities and hospitals are designed for function and efficiency, but the furniture and fittings are also designed to look good. Gurneys, beds, mobile x-ray machines…have you ever considered the impact of these devices on the materials like walls and floors? They’re a critical aspect of the healthcare environment.

It’s a well-known fact that bacteria can survive for extended periods of time on common healthcare “touch” surfaces. Bed rails, call buttons, and bed trays are among the worst offenders. In fact, an estimated 1 in 20 patients in U.S. hospitals pick up infections they didn’t have when they arrived, including some dangerous ‘superbugs’ that are difficult to treat. Which means the fight against Healthcare Acquired Infections (HAI) begins at the surface.

It’s also important to understand the unique nature of the healthcare environment when it comes to infection control. Unknowingly, microbial reservoirs are designed and built into healthcare environments via the surface materials that are selected.

How a surface looks—and especially what it costs—usually takes precedence over an evaluation of the surface function, cleaning recommendations, and how a surface might contribute to the spread of HAIs. Can the surface be cleaned and disinfected using standard products? And if we look at the surface after it has been cleaned and disinfected—at a microscopic level—is it truly clean?

Research has shown that pathogens live on surfaces for days, weeks, even months after they have been cleaned. Research has also shown that 20-40% of HAIs have been attributed to cross infection via hands or healthcare personnel who have become contaminated from direct contact with patients—or indirectly by touching contaminated surfaces. How can surfaces really be an issue?

Healthcare facilities employ rigorous cleaning and disinfection processes, and a wide variety of products and chemicals are used. Terminal disinfection often requires higher concentrations of chemicals like bleach-based products, which are effective in eliminating Clostridium difficile (“C-diff”). And they’re used frequently. Unfortunately though, the majority of surfaces used in our healthcare environments carry warnings against the use of harsh chemicals and disinfectants, many calling out bleach specifically. Damage can occur when these products are used, and the damage begins at a microscopic level—pits, cracks and fissures, the perfect environment for bacterial colonies to form and proliferate!

The Facilities Guidelines Institute for Design and Construction of Healthcare Facilities created a list of preferred surface characteristics (of the ideal product) published for the first time in 2006 and further refined and clarified in 2010 edition. Defining these surface characteristics was the beginning of a request that specifiers and healthcare professionals take a serious look at which surface materials are being placed where. You can find the guidelines here.

The rise of these superbugs, along with increased pressure from the government and insurers, is driving hospitals to try all sorts of new approaches to stop their spread. We’ll talk more about that in our next article. You’ll find a great article about surfaces in healthcare on the Healthcare Surface Consultants blog, too.