Science! MIT experiencing gastroenteritis outbreak

The boffins at MIT Medical need a refresher course in handwashing following an outbreak of acute gastroenteritis on campus.

scienceAccording to associate medical director Howard Heller, MIT Medical saw two patients with nausea, vomiting, and diarrhea at the beginning of the week and 16 during the day on Wednesday. MIT-EMS responded to a few more cases overnight, and as of noon on Thursday, a small number of additional patients with similar symptoms had come into Urgent Care. Heller notes that cases do not appear to be linked to any specific dorm or dining hall.

“This may or may not be norovirus,” Heller says. Norovirus, which causes a severe and acute form of gastroenteritis, can spread quickly, especially in dense, semi-closed communities. “But whether it’s norovirus or not,” Heller continues, “our response should be the same — paying extra attention to practicing good hygiene. Frequent and consistent hand-washing is the best way to prevent the spread of this type of virus.” 

Hand dryers, even the fancy ones, suck: new study

Paper towels are rare in Australian restrooms, and it’s the same in Japan.

But new research confirms what we’ve been saying for a decade: hand dryers spew bacteria into the air and onto people.

hand-dryerConventional (warm air) and high-velocity (jet air) dryers alike spread bacteria into the air, according to the study. Airborne germ counts near warm-air dryers were found to be 4.5 times higher than the counts near paper towel dispensers, and the counts near jet air dryers were a whopping 27 times higher.

It doesn’t take a lot to figure out what’s probably going on here. As study leader Prof. Mark Wilcox, professor of medical microbiology at the University of Leeds, told The Huffington Post in an email:

“While jet air dryers are good at hand drying, they achieve this by using air velocities of about 400 miles an hour … Unfortunately, this means that the dispersed water droplets (containing more or less bacteria/viruses depending on how hands were washed and how contaminated they were in the first place) will be fired longer distances and some will remain suspended in the air for many minutes (possibly hours).”

For the study, the researchers contaminated people’s hands with harmless Lactobacillis bacteria that normally aren’t found in bathrooms. Then they measured levels of the bacteria in the air at distances of up to two meters away from the dryer after the people had dried their hands.

“This research was commissioned by the paper towel industry and it’s flawed,” a spokesperson for dryer maker Dyson told The Telegraph.

Wilcox acknowledged that the study was funded by the European Tissue Symposium, an association of tissue paper producers. But the group “played no part in the results analysis,” he said, adding that he had no ties to ETS other than the financial support for the study.

The study was published in the Journal of Hospital Infection and presented at a recent meeting of the Healthcare Infection Society in Lyon, France.

 

Louisiana: school credits handwashing stations with drop in absences

Pink eye, stomach bugs, flu, strep throat: the list can go on and on with reasons students miss school.  When one local school took a deeper look at absences from the previous school year, they incorporated a simple action plan to minimize school germs. 

handwash_south_park(2)Throughout the school day, two handwashing stations at Immaculate Conception Cathedral School in Lake Charles are put to use.  It is all in an effort to reduce the spread of germs at the root of many absences, says ICCS Director of Development, Erin Lang.  “In order to best educate them, we need them here and well,” said Lang.

When Lang and other school administrators reviewed absentee data from the previous school year, they knew something more needed to be done to keep students at their prime.  “If a good number of students are absent from a class, a teacher is unable to continue with a lesson,” said Lang, “it can slow down the learning process, it makes it difficult for those students who are out for an extended period of time.”

Dr. Tyson Green with Imperial Health has two children who attend school ICCS.  He says the spread of germs is rapid on school campuses.  “Whether it’s bacterial or viral, you start talking about the flu, you start talking about stomach viruses and things like that,” said Dr. Green.  “They’re going to get these with cross-contamination if they don’t wash their hands.”

The solution came through handwashing stations.  “What we found as the best way to protect our faculty and our students was basic handwashing with plain soap and water,” said Lang.

The biggest procedural change for students this school year is that as soon they walk into the school building, they go straight to the handwashing stations.  That’s the first wash of the day.  Then every bathroom break gets another hand wash, along with every entrance and exit from the school’s cafeteria.

Lang says the absentee numbers are already showing the success of the additional scrubbing.  “We have looked at our absentee rates from last year to this year, from the start of school through November, and we are already down 12 percent,” said Lang.

Proper handwashing, pooping require proper tools: Dirty school bathrooms give students diarrhea in Vietnam

And it’s not just Vietnam.

Dirty toilets and bathrooms gave 40 per cent of Ho Chi Minh City students diarrhea, according to UNICEF Viet Nam.

dirty.bathroomLast month, the city’s Health Department reported that 220 students at District 12′s Nguyen Khuyen Elementary School were unable to go to school, as they suffered a digestion-related disease caused by unclean school toilets. Two children in the southern city died in July from a similar condition.

The Ministry of Health reported 3,719 diarrhea cases in HCM City in the first six months of 2014 out of 301,570 nationwide in the first eight months.

School bathrooms and toilets in urban areas of the city are often in poor condition due to the large number of students and teachers that use them, as well as the lack of soap and fresh water for cleaning.

vietnam.ToiletThe problem is even worse in rural areas of HCM City, where schools have no bathrooms at all. In those areas, 27 per cent of children have to go to the toilet outside the school.

Why are hospital patients the critical control point for doctor handwashing?

People in the hospital are invariably immunocompromised. They shouldn’t be fed things like deli meats that may harbor Listeria.

jon.stewart.handwashing.2002And it shouldn’t be the patient’s responsibility to ask if their doctor or nurse washed their hands.

A February audit shows more than 40 per cent of health-care workers and support staff at hospitals in the Regina area (that’s in Canada) failed to wash their hands properly. 

A follow-up report in June also reveals that 67 per cent of 204 doctors observed didn’t follow regional handwashing rules before patient contact. 

Regina Qu’Appelle Health Region (RQHR) requires all staff to wash their hands with soapy water or alcohol-based gels for a minimum of 20 seconds before and after contact with patients. They’re not allowed to wear excessive jewellery on their hands or wrists and can’t have gel nails. 

Kateri Singer, the woman in charge of infection prevention for RQHR said the region’s goal is 100 per cent compliance with handwashing rules “because it is the single most important thing we can do as health-care workers.” 

CBC’s iTeam has combed through RQHR’s February and June reports and has highlighted some of the least compliant facilities. The following percentages indicate non-compliance rates:

Broadview Union Hospital (February) - 94.8%​

Grenfell Health Centre (June) - 77.4%

Regina Lutheran Home (June) - 77.8%​

Wolseley Memorial Hospital (June) - 66.7%

Regina General Hospital – Day Surgery (February) - 86.7%

Regina General Hospital – Labour and Birth (June) - 94%

Pasqua Hospital – Day Surgery (February) - 100%

Pasqual Hospital – Short Stay (February) - 95.2%

Pasqua Hospital – Operating Room (February) - 68%

Pasqual Hospital - 3A (June) - 97%

Transparency is a key to change

handwashing.junk.apr.13Singer said though these numbers look bad, she’s committed to disclosure because “the public has the right to know” whether or not their doctor or nurse is keeping their hands clean. And she said patients have the right to hold them to account.

RQHR seems to have taken the lead in Saskatchewan when it comes to transparency regarding handwashing practices. Its public reports are far more comprehensive than any other region in the province.

Singer said transparency can be a catalyst to change behavior.

Michael Gardam, director of infection, prevention and control at Toronto’s University Health Network, told CBC Saskatchewan’s Morning Edition host Sheila Coles patients often do not feel they can stand up for themselves.

“I have seen patients get screamed at by health care providers,” Gardam said. “I’ve seen patients be told, ‘Don’t come back to my clinic. How dare you challenge me.’”

One Health: UI grad’s passion has taken her all over the globe

We had lunch yesterday with a friend from Slovenia.

She had been a researcher at a university there, and then moved to Brisbane and worked in the private sector before landing another research job at a uni.

She said, Doug, don’t you want to try and get a uni job here in Australia?

No. I’m done with universities.

But I do miss the students, although I still get to interact with several.

maureen_birmingham_150pxDr. Maureen Birmingham, a 1983 graduate of the UI College of Veterinary Medicine, is the kind of student I miss.

Describing herself as a “fortunate victim of a lot of fortunate opportunities,” Birmingham has been all around the world helping to prevent and resolve disease — in both people and animals.

After veterinary school, Birmingham worked as a clinician in a large animal practice in upstate New York for a few years but realized that she wanted something else from her career.

“Every other night, I was on call,” she said. “It was not sustainable in the long term but a wonderful experience for locking in my veterinary skills and the art of veterinary practice as well as building communication skills with clients.”

She spent the late 1980s working for nongovernmental organizations, first in Haiti and later in Bolivia, where she taught veterinary technicians critical skills to help subsistence farmers improve their economic situation.

“In rural Haiti, families kept a pig as their living savings account, to be cashed in for special circumstances, like paying for school or an unforeseen family crisis or event. So pigs were critical to the rural economy,” said Birmingham, who was part of a program to reintroduce pigs to the island after all had been slaughtered to eradicate African swine fever there.

one.health.slide.dp.10“In Bolivia, we taught veterinary technicians not only about basic veterinary medicine and animal husbandry but also about how to maximize the fiber yield from alpacas and meat from guinea pigs for better profits,” Birmingham said. “Bolivians raise guinea pigs as a cost-effective and traditional food source, so we helped them manage these animals as well.”

Over the next several years, she and Dr. Peter Quesenberry, a veterinarian who spent most of his life working in Asian countries, wrote “Where There Is No Animal Doctor,” a manual on basic measures to prevent and treat animal diseases for people living in remote areas around the world.

The next phase of Birmingham’s career was earning a master’s degree in public health at Harvard. From there, she joined the Epidemic Intelligence Service (EIS), part of the Centers for Disease Control and Prevention (CDC), and was deployed to Africa for most of the next two years to work on child-survival issues.

“This EIS program provides excellent training in field epidemiology, for example, by participating on the frontline in outbreak investigations both domestically and internationally. Some of the more well-known investigations of EIS officers include the emergence of Legionnaires’ disease, polio, cholera, Ebola, HIV/AIDS, West Nile virus and influenza, as well as the public health aspects of disasters such as Hurricane Katrina to name a few,” she said.

Eventually, the CDC transferred Birmingham to Geneva, Switzerland, to work on global polio eradication in a program led by the World Health Organization (WHO). She and her husband spent the next 12 years in Geneva, where she completed a CDC residency program in preventive medicine and cultivated her skills as an epidemiologist, manager and administrator.

From there, Birmingham and her husband moved to Bangkok, Thailand, to get closer to fieldwork.

After more than six years in Thailand, she moved with her family to become a WHO/Pan American Health Organization (PAHO) representative to Mexico.

“My role now is as a generalist, managing the various WHO/PAHO programs of cooperation with the government,” Birmingham said. “My team delves into all sorts of topics, such as environmental health including pesticide/chemical management, strengthening preparedness and response to public health emergencies, addressing the health effects of climate change, applying public health approaches to reduce violence, addiction prevention/treatment, reducing maternal mortality, reducing the very high rates of road injuries and addressing childhood obesity and the soaring diabetes rates.”

Promoting public health is a collective effort among many sectors. Veterinarians like Birmingham play an important role. Moreover, the One Health movement seeks to bring animal and human health fields closer together to better predict, prevent and control emerging diseases, given that 75 percent of all emerging diseases in humans come from animals. Veterinarians are well-positioned to address this problem.

“Even something as simple as effective public communications to wash hands for the prevention of bird flu makes a difference,” she said. “Veterinarians are very relevant in public health.”

Pay attention: Hospital workers wash hands less frequently toward end of the shift

At the International Association for Food Protection meeting last year, I called out to Chapman and said, what is the best part of my day?

sorenne.hockeyWalking with Sorenne, to and from school, and elsewhere.

Later I asked Chapman, in front of all those people, what’s the most important thing we do?

He muttered and stumbled something.

The answer, that I repeat to all my kids, and all the kids I coach, is pay attention.

The hockey numbers are so low in Brisbane that I’ve got 11-year-olds on the ice with 5-year-olds. First lesson: pay attention, don’t kill the little kids (the older kids are actually quite protective of the younger kids and it is gratifying to watch).

So it’s not surprising that at the end of a long hospital shift, hospital workers wash their hands less frequently.

I see the same thing in hockey practice, where the kids are drifting off towards the end of 90 minutes on the ice, and that’s when problems happen.

The impact of time at work and time off from work on rule compliance: The case of hand hygiene in health care

03.nov.14

Journal of Applied Psychology [advance online publication]

Dai, H., Milkman, K. L., Hofmann, D. A., & Staats, B. R

Abstract

braun.hockeyTo deliver high-quality, reliable, and consistent services safely, organizations develop professional standards. Despite the communication and reinforcement of these standards, they are often not followed consistently. Although previous research suggests that high job demands are associated with declines in compliance over lengthy intervals, we hypothesized—drawing on theoretical arguments focused on fatigue and depletion—that the impact of job demands on routine compliance with professional standards might accumulate much more quickly. To test this hypothesis, we studied a problem that represents one of the most significant compliance challenges in health care today: hand hygiene. Using longitudinal field observations of over 4,157 caregivers working in 35 different hospitals and experiencing more than 13.7 million hand hygiene opportunities, we found that hand hygiene compliance rates dropped by a regression-estimated 8.7 percentage points on average from the beginning to the end of a typical 12-hr work shift. This decline in compliance was magnified by increased work intensity. Further, longer breaks between work shifts increased subsequent compliance rates, and such benefits were greater for crosby.hockeyindividuals when they had ended their preceding shift with a lower compliance rate. In addition, (a) the decline in compliance over the course of a work shift and (b) the improvement in compliance following a longer break increased as individuals accumulated more total work hours the preceding week. The implications of these findings for patient safety and job design are discussed.

Good ole’ timey science-off: what’s the best way to wash hands, do sanitizers have a role?

Science is about a world–view of a topic and providing the data to back up that view.

Biology is especially messy.aust.handwashing.oct_.151

International handwashing day was October 15, but I was busy making a mess.

In Australia, the feds have a nice poster and how paper towel is to be used to dry hands, and I’ve never been in a Western country that has more hand driers than paper towel dispensaries.

Proper handwashing requires proper tools.

Ludwig writes in the current issue of Public Understanding of Science (November 2014 vol. 23 no. 8 982-995) to propose a methodological externalism that takes knowledge about science to be partly constituted by the environment. My starting point is the debate about extended cognition in contemporary philosophy and cognitive science. Externalists claim that human cognition extends beyond the brain and can be partly constituted by external devices. First, I show that most studies of public knowledge about science are based on an internalist framework that excludes the environment we usually utilize to make sense of science and does not allow the possibility of extended knowledge. In a second step, I argue that science communication studies should adopt a methodological externalism and accept that knowledge about science can be partly realized by external information resources such as Wikipedia.

Style is important, but content rules.

In this corner, Dr. Keith Warriner of the University of Guelph (that’s in Canada), who writes there are many old-wives tails, rumors and stories that are so ingrained that we don’t know if they are fact or fiction. The list is so long that a popular TV show called “The Myth Busters” is totally devoted to applying science to verify if myths are true or false. The show is for entertainment but it is when myths or non-substantiated knowledge, are actually applied in regulations and guidelines with the thought that someone must have done the science at some point in time.

As many new mothers in the latter part of the 19th century will verify, hand washing has been an essential intervention for minimizing the transfer of pathogens in clinical, food and other environments. The recommended method for washing hands was developed in 1980’s and has not changed significantly through the years. But is the method supported by science?

Myth 1: Antimicrobial soap provides superior hand washing results compared to normal soap

It has been widely accepted that antimicrobial soap is preferred over normal soap for increasing the efficacy of hand washing. Of all the aspects associated with hand washing the comparison of antimicrobial vs. normal soap has been studied to the greatest extent. The general conclusion is that antimicrobial soap supports a marginal increase in the number of bacteria removed from hands. If high inoculation levels are applied to hands then the removal with antimicrobial soap is statistically significantly compared to normal soap. However, with natural skin microflora there is no difference between the efficacy of normal and antimicrobial soap.  

There has been recent research that has suggested that antimicrobial soap can detrimental through disrupting the balance of the skin microflora and irritating the skin. On this basis all the evidence would suggest that antimicrobial soap has no advantages over normal soap.

Myth: Busted

Myth 2: Warm or hot water is better for hand washing than cool water

The FDA have reviewed the recommended water temperature used for hand washing no less than three times. The results of the deliberations was that 110F (43°C) should be set as the recommended temperature in the belief a greater proportion of microbes can be removed. However, all the scientific evidence available suggests that water temperature has no effect on the removal of microbes in the range of 4 -49°C. However, other research in this area has illustrated that water temperature does influence the duration of hand washing with cold or hot water leading to shorter rinse times due to user discomfort.  

Myth: Busted

Myth 3: Paper towels are perform better than air dryers

The method used for drying hands following washing is one of the most contentious issues in the hand hygiene arena. The general thought pattern when devising the hand washing guidelines was that hands needed to be dried to prevent acquisition of contamination from surfaces. This is true to a degree but it should also be noted that hand drying can contribute significantly in reducing microbial levels on hands following washing.

The majority of papers published to date have been pro-paper towels and even the “The Myth Busters” returned the same conclusion. However, it should be noted that many of the comparative studies performed the researchers used hot air hand driers that generated a gentle breeze making the user resort to completing the drying process using ones pants. More modern high speed (air blades) driers certainly can dry hands to the same extent as paper towels within 20 seconds. When a comparison is made between air blades and paper towels there is no difference in terms of microbial log reduction or degree of hand dryness. Given that high speed hand driers are not universally available, the evidence would support the view that paper towels are indeed better that hot air driers.

Myth: True

So does it matter if hand washing protocols are not science based?

It is apparent that many aspects of the hand washing protocol are not based on hard scientific evidence but this does not mean it is the wrong thing to do. Still, by reconsidering if anti-microbial soap is really necessary then skin health could be improved. The savings on energy and water usage by reducing the recommended wash time and temperature could also have a positive impact. Regardless of this, we always need to consider the science when devising guidelines.

In the other corner we have Don Schaffner of Rutgers University (that’s in Jersey). Don writes that an Internet troll is defined by Wikipedia as “a person who sows discord on the Internet by starting arguments or upsetting people… with the deliberate intent of provoking readers into an emotional response…”. Doug knows the way to troll me is to send a link and ask me to blog about it (he really just wants to call me a troll).

An article from weau.com features the headline “Simple Sickness Prevention: Hand-Washing vs. Hand-Sanitizer”, and asks: what is more effective, old fashioned soap and water, or the alcohol based hand sanitizer?

Not a bad start. The story goes on to feature Doctor Jaime Marks, Assistant Professor of Medicine at UW-Health, who offers a variety of opinions on hand washing and hand sanitizer use.

Dr. Marks says it’s okay to use either hand-washing or hand-sanitizer.

Hmm. the FDA CFSAN Food Code 2–301.16(A)(3) would disagree, but I think I’m starting to like Dr. Marks…

If you notice your hands are soiled, you’ll want to wash your hands. Hand washing is at least 45–60 seconds, like singing through “Happy Birthday” twice in your head. With hand sanitizer, you’d want to use it for 20–30 seconds.

Whoops. That went off the rails quickly. Dr. Marks is certainly entitled to his opinion, but I’d like to see the scientific peer-reviewed basis for those statements. I’d waged they don’t exist. At least I’ve never seen them.

Dr. Marks continues…

Both are about equal as far as getting your hands clean as long as your hands are not soiled.

Hmmm. Dr. Marks wins me back. Sort of. In fact sometimes hand sanitizers even work when your hands are soiled.

The story concludes with some muddled statements about good bacteria and bad bacteria, building an immune response and getting a flu shot that don’t really hang together, but I’ll give Dr. Marks partial credit for trying. More credit next time if you cite the literature.

Or, according to The Smashing Pumpkins, “Emptiness is loneliness and loneliness is cleanliness and cleanliness is godliness and god is empty, just like me.”

Nosestretcher alert: no studies showing impact of diseases spread to customers from animals in petting zoo, but NY requires handwashing anyway

New York now requires petting zoos to provide for hand washing.

The new law says establishments providing an area where animals are grouped so visitors can view, touch or fondle them must provide appropriate facilities for washing.

claudia.e.coli.petting.zoo.may.14They should be located either at the exit of the petting area or within 50 feet. Signs are required.

The law also authorizes state and city health officials to formulate rules against the spread of bacteria and viruses carried by animals displayed at carnivals, fairs and amusement parks.

Sponsors say there have been no studies so far showing the impact of diseases spread to customers from animals in petting zoos.

And people wonder why journalism sucks.

A table of petting zoo outbreaks is available at http://barfblog.com/wp-content/uploads/2014/04/Petting-Zoo-Outbreaks-Table-4-8-14.xlsx.

Best practices for planning events encouraging human-animal interactions

Zoonoses and Public Health

G. Erdozain , K. KuKanich , B. Chapman  and D. Powell

http://onlinelibrary.wiley.com/doi/10.1111/zph.12117/abstract?deniedAccess

Educational events encouraging human–animal interaction include the risk of zoonotic disease transmission. It is estimated that 14% of all disease in the US caused by Campylobacter spp., Cryptosporidium spp., Shiga toxin-producing Escherichia coli (STEC) O157, non-O157 STECs, Listeria monocytogenes, nontyphoidal Salmonella enterica and Yersinia enterocolitica were attributable to animal contact. This article reviews best practices for organizing events where human–animal interactions are encouraged, with the objective of lowering the risk of zoonotic disease transmission.

Chipotle still sucks at food safety

A Chipotle restaurant in Gwinnett County, Georgia, has failed its health inspection.

chipotle_ad_2The restaurant, located at 860 Macon Highway in Lawrenceville, scored 60 out of 100.

The Gwinnett County health inspector noted that employees handling food at the restaurant were not washing their hands frequently enough to prevent contamination of food.

Other violations included:

  • Chicken not cooked to an internal temperature of 165 degrees Fahrenheit or above
  • Dining counters and tables not cleaned and sanitized by correct methods
  • Held potentially hazardous foods not maintained below 41 degrees Fahrenheit

Channel 2’s Carol Sbarge visited the packed restaurant where one customer said he wouldn’t have come if he knew the score.

“It’s very upsetting. I didn’t go to another restaurant because they had a low score. Now that I know that they had that 60, I’m (not) even going to come here. I had no idea,” said customer Steve Sessa.

The restaurant was still posting an old score of 90, which is a violation. 

http://www.wsbtv.com/videos/news/gwinnett-chipotle-fails-health-inspection/vCtD5K/