Many businesses obsess with the cost of absenteeism, and it’s certainly merits attention. Often overlooked is the cost of presenteeism. Presenteeism impacts the whole of our working society. Illness and working sick have huge impacts on reputation, quality control and business in general. Working sick is just bad for business. Moving away from it requires cultural change, getting rid of the stigmas that are associated with calling in sick. The sick employees’ work production suffers, and they transmit illness to others. This is a global issue to which no nation is immune. We have to get smart and realize allowing – or even encouraging – folks to work sick quite simply is a harmful practice. Not only are they less productive but they also are infecting others, which creates a chain of events that takes a bite out of the bottom line.
Water is the most abundant resource on earth. And the most precious. It is the foundation for all life. When it becomes fouled for any number of reasons, we suffer. Maybe it’s Flint mismanagement. Maybe it’s just poor sanitation or no sanitation. In any event, when it’s threatened by bacteria, it becomes a serious threat in the post antibiotic world.
The microbial ecology of drinking water systems is now understood to play a critical role in a wide range of economic, water management, and health problems, including microbial-induced corrosion, nitrification in chloraminated systems and waterborne disease. Impact of Water Chemistry, Pipe Material and Stagnation on the Building Plumbing Microbiome concludes in part that “factors under control of the utility, including physical/chemical properties of the water and prior treatments, drive the composition of the building plumbing microbiome, including the occurrence of opportunistic pathogens. However, factors under control of building owners also clearly have an influence. These findings have important implications for water engineering and management, helping lay the groundwork needed to identify critical factors that may be manipulated in the future to beneficially manage the building plumbing microbiome.”
Some interesting information emerges when researchers take a look at major sporting events – the Super Bowl, Olympic Games and World Cup soccer, to name a few. Clearly, the events put people in close proximity and increase the chances that illness might spread. But those actually attending aren’t the only ones whose health can be adversely affected. Those with regional rooting interests invariably gather at house parties, sports bars and a variety of places, and that, in one study of the Super Bowl, spikes the mortality rate among at least one group. The psychology of these events attended by thousands has been looked at also, and we take a look at what one study shows at the second link in this piece.
But first, a Tulane University paper looks at mortality rates in counties that have a local interest in the outcome of the Super Bowl, using county-level statistics from 1974-2009. Success is Something to Sneeze at: Inﬂuenza Mortality in Regions that Send Teams to the Super Bowl found that, for the population over the age of 65, having a team in the Super Bowl results in an 18 percent increase in influenza deaths. At least one reason in believed to be increased local socialization brought on by the game. It says “mitigating inﬂuenza transmission at gatherings related to large spectator events could have substantial returns for public health.”
Adding a Psychological Dimension to Mass Gatherings Medicine says it is “inadequate to (conceptualize) mass gatherings as simply an aggregate of a large number of individuals. Rather, those present may (conceptualize) themselves in terms of a collective with a shared group identity. Thinking of oneself and others as members of a collective, changes one’s (behavior). First, one behaves in terms of one’s understanding of the norms associated with the group. Second, the relationships between group members become more trusting and supportive. Understanding these two (behavioral) changes is key to understanding how and why mass gathering participants may behave in ways that make them more or less vulnerable to infection transmission.”
Some other highlights:
Crowd members’ behavior differs from the same people’s everyday behavior
Crowd behavior involves conformity to shared norms and closer social relations
These norms and more intimate relations impact the risk of infection transmission
Interventions to mitigate risk must work with these crowd psychology processes
Hospital privacy curtains are rarely cleaned, and, like any surface, they harbor bacteria. These fomites also can be aerosolized, spreading infectious organisms through the air. The pieces we link to today make it abundantly clear that privacy curtains should be included in infection control plans.
Hospital privacy curtains laden with germs cites a study that found contamination within a week of being changed. That contamination happens so quickly is a serious concern. Better methods of cleaning them as well as treating them to protect against contamination by infectious organisms should be pursued.
Hospital curtains may spread drug-resistant infection, study notes that researchers at Cleveland Veterans Affairs Medical Center in Cleveland showed that C. difficile, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci or VRE can be found on hospital privacy curtains.
Even more importantly, they found that the bugs transfer onto the hands of people who handle the contaminated curtains – suggesting that health-care workers who pull curtains closed and then touch patients may be spreading bacteria.
Bacterial Contamination of Clothes and Environmental Items in a Third-Level Hospital in Colombia looks at a number of items that come into contact with patients and could contribute to the spread of infection. Among them: privacy curtains, cell phones, keyboards, white coats and ties. In part in concludes that “This hospital-based cross-sectional surveillance study demonstrates that a large proportion of health care workers’ clothing and personal effects were contaminated with bacterial pathogens that can result in nosocomial infections. Further research is needed to evaluate strategies to minimize the risk of patient-to-patient transmission of pathogens from other contaminated items.”
Particles of all sorts – dirt, biological and chemical – impact our health. We take a look at three nice pieces on non-biological particle pollution. Every breath we take: the lifelong impact of air pollution is a report from the Royal College of Physicians (RCP) and the Royal College of Pediatrics and Child Health (RCPCH) that examines the impact of exposure to air pollution across the course of a lifetime. Around 40,000 deaths annually in the United Kingdom can be traced to exposure to outdoor air pollution. The piece also takes a look the factors that impact indoor air quality. Among the reform proposals, the article spells out six steps each of us can take to improve air quality:
Be aware of the air quality where you live
Replace old gas appliances in your home
Ensure you have an energy efficient home
Alter how you travel. Take the active travel option: bus, train, walking and cycling
Talk to your Member of Parliament (MP)
Harness technology to stay informed and monitor air pollution effectively
Desert Dust Outbreaks in Southern Europe: Contribution to Daily PM10 Concentrations and Short-Term Associations with Mortality and Hospital Admissions stipulates that evidence on the association between short-term exposure to desert dust and health outcomes is controversial. The study attempts to estimate the short-term effects of particulate matter ≤ 10 μm (PM10) on mortality and hospital admissions in 13 south-European cities, distinguishing between PM10 originating from desert and from other sources. In conclusion: “PM10 originated from desert was positively associated with mortality and hospitalizations in Southern Europe. Policy measures should aim at reducing population exposure to anthropogenic airborne particles even in areas with large contribution from desert dust advections.”
Long-term air pollution exposure and cardio- respiratory mortality: a review notes there is growing evidence of mortality effects related to long-term exposure (i.e., exposures of a year or more) to ambient air pollution. Cardiovascular effects of short- and long-term exposure to particulate matter air pollution focusing on Particulate Matter (PM)2.5 have recently been comprehensively reviewed. Experimental and epidemiological studies in the recent decade have significantly increased our knowledge of mechanisms that could plausibly explain the associations observed in epidemiological studies between ambient air pollution and mortality. This review aims to evaluate the epidemiological evidence for cardiovascular and respiratory mortality effects of long-term exposure to fine particulate matter, including a meta-analysis.
Among the conclusions: “The review suggests several specific research questions. Research into the reasons for the heterogeneity of effect estimates would be extremely useful for health impact assessment. Better exposure assessment including spatially resolved outdoor exposures and more chemically speciated PM might in part be able to resolve the observed heterogeneity. Chemical speciation would allow assessing particles from different sources e.g. particles from combustion sources and non-tailpipe emissions separately, a question clearly relevant for air pollution control policy. Specific attention to motorized traffic emissions is important because (road) traffic is an important source of ambient air pollution. More work on coarse particles and at the other side of the particle size spectrum, ultrafine particles is needed. Ongoing new research in the USA in the Multi-Ethnic study of Atherosclerosis and Air pollution (MESA-AIR) and the European Study of Cohorts for Air Pollution Effects (ESCAPE) that use large cohorts and state-of the art spatially-resolved exposure methods will likely contribute significant new answers in the near future to these questions.”
Environmental Cleaning for the Technical Brief Number 22 Prevention of Healthcare-Associated Infections does a nice job of looking at how the cleaning of hard surfaces reduces the risk of spreading healthcare-associated infections. Though it doesn’t discuss the important airborne component to which continuous human shedding consistently contributes, it details in depth the different methods available for cleaning and their comparative effectiveness as it relates to porous and non-porous surfaces. It is done by the Agency for Healthcare Research and Quality. This Technical Brief is designed to summarize and map the current evidence base addressing EC to prevent HAIs and highlight future research needs.
Eighty studies were examined for the piece, leading to a number of conclusions. More research and study in the key area of cleaning is critical to determine best practices for best results. “Comparative-effectiveness studies directly comparing disinfection modalities and monitoring strategies are limited. Future research should examine and compare newly emerging strategies, such as peracetic acid, hydrogen peroxide wipes, enhanced coatings, and microfiber cloths as cleaning strategies, and adenosine triphosphate and ultraviolet light technologies as monitoring strategies. Patient colonization and infection rates should be included as outcomes when possible. Other challenges to be addressed include identification of surfaces posing the greatest risk of pathogen transmission, developing standard thresholds for defining cleanliness, and using methods to adjust for confounders such as hand-hygiene practices when examining the impact of disinfection modalities.”
The Nano Safe blog is about to change. Nano Safe, Inc., is very focused on antimicrobial coating for medical devices. In the near future we are going to turn this blog over to a sister company and they will continue to write on infection control issues for the built environment. Stay tuned for more news on the blog shift.