Cleaning for Healthier Schools – Infection Control Handbook – 2010 offers up a three-pronged strategy for infection control in public schools, based on those that are most effective while using the smallest amount of hazardous material. The strategy’s three points include personal hygiene, cleaning for microbe control and disinfecting and sanitizing for microbe control.
Personal hygiene can be enhanced through education. It must be stressed that hand washing is critical to preventing the spread of disease through touching. And importantly, adequate time must be provided to allow for it. Additionally, sneeze etiquette is crucial. This involves the simple act of covering the mouth when sneezing. Posters, free and easily available from the Centers for Disease Control website, encourage these activities and can be mounted throughout the school as part of an infection-control program.
Cleaning for microbe control stresses comprehensive cleaning programs that include using less toxic products and updated tools and technology. “Frequent cleaning of high-touch areas with a third-party-certified all-purpose detergent and a microfiber cloth is considered by experts to be sufficient to reduce the number of germs or pathogenic microbes on most surfaces to an acceptable level for public health.” Research from the Centers for Disease Control and Prevention states that large numbers of microorganisms can be removed by “the physical action of scrubbing with detergents and surfactants and rinsing with water.” Using high-quality microfiber cloths and mops as part of your a cleaning program enhances this process because studies show that microfiber is superior at capturing microbes. A color-coded microfiber approach prevents cross-contamination and can help ensure that cleaning material is used where it should be. For example, restroom tools are kept in restrooms and kitchen tools are kept in kitchens.
Disinfecting and sanitizing for microbe control is a strategy that targets high-risk areas and allows response to “special events or incidents in which there is a specific biological hazard.”
The handbook (linked above) offers a wealth of information that can be used to significantly affect transmission of disease in schools, offices, hospital and any number of similar venues.
The results showed that “many environmental surfaces of MERS patient rooms, including points frequently touched by patients or healthcare workers, were contaminated by MERS-CoV. Viral RNA was detected up to five days from environmental surfaces following the last positive PCR from patients’ respiratory specimens. MERS-CoV RNA was detected in samples from anterooms, medical devices, and air-ventilating equipment. In addition, MERS-CoV was isolated from environmental objects such as bed sheets, bedrails, IV fluid hangers, and X-ray devices. During the late clinical phase of MERS, viable virus could be isolated in 3 of the 4 enrolled patients on day 18 to day 25 after symptom onset.”
Most touchable surfaces in MERS units were contaminated by patients and health care workers, emphasizing once again that strict environmental surface hygiene practices is critical to reduce the transmission of infection. Also important is “sufficient isolation period based on laboratory results rather than solely on clinical symptoms.”
During the winter of 2015, broiler producers on the Delmarva Peninsula, which lies east of Chesapeake Bay, were hit with a new infectious bronchitis variant, Delmarva 1639 (Veterinarian Discusses Managing E. coli in Broilers in the Face of IBV Infection). Avian infectious bronchitis is an acute and highly contagious respiratory disease of chickens. The disease is caused by avian infectious bronchitis virus (IBV), a coronavirus, and characterized by respiratory signs including gasping, coughing, sneezing, tracheal rales, and nasal discharge.
Mortality rates of 10 percent and condemnations at twice the national industry average occurred. Cold weather, decreased ventilation and increased ammonia levels compounded the stress on the birds, providing an opportunity for E. coli to add to the birds’ pathology. Any disease that challenges the respiratory or immune system opens the door for E. coli.
Warmer weather allowed for increased ventilation, reducing the airborne aspect of transmission. “With warmer weather, increased ventilation and lower ammonia levels, the IB threat subsided. “We saw our mortality levels drop as we moved into spring but our condemnation levels due to E. coli remained higher than normal into summer,” Don Ritter, DVM, of Mountaire Farms told Poultry Health Today.
The article goes on to say: For the winter of 2016, Delmarva broiler producers are looking to a new IB vaccine for cross protection. In addition, they are conducting an intense trial of E. coli vaccinations every two to three weeks in the coldest months.
Managing E. coli in broilers in the face of IBV infection is a YouTube piece where Ritter is interviewed by Poultry Today and talks about the IB issue. In it he points out that prevention not treatment is the only cost-effective approach. This would suggest not only vaccinations but also creating an environment where transmission via fomites and air can be reduced.
Noncommunicable diseases (NCDs) contribute to the largest share of environment-related deaths, according to new estimates released in March by the World Health Organization. Nearly one in four global deaths was a result of living or working in an unhealthy environment in 2012. That’s an estimated 12.6 million people. The risk factors include air, water and soil pollution, chemical exposures, climate change and ultraviolet radiation. The majority of these are related to air pollution, which includes exposure to second-hand smoke. Strokes, heart disease, cancers and chronic respiratory disease amount to nearly two-thirds (8.2 million) of deaths caused by unhealthy environments. As increased access to safe water and sanitation improves, deaths from infectious disease have declined. Better accesses to immunization, insecticide-treated mosquito nets and essential medicines also have helped.
Among other noteworthy items in the report:
Regionally, the report finds, low- and middle-income countries in the WHO Southeast Asia and Western Pacific Regions had the largest environment-related disease burden in 2012, with a total of 7.3 million deaths, most attributable to indoor and outdoor air pollution.
Low- and middle-income countries bear the greatest environmental burden in all types of diseases and injuries, however for certain NCDs, such as cardiovascular diseases and cancers, the per capita disease burden can also be relatively high in high-income countries.
Looking across more than 100 disease and injury categories, the report finds that the vast majority of environment-related deaths are due to cardiovascular diseases, such as stroke and ischemic heart disease.
The report cites proven strategies for improving the environment and preventing diseases. For instance, using clean technologies and fuels for domestic cooking, heating and lighting would reduce acute respiratory infections, chronic respiratory diseases, cardiovascular diseases and burns. Increasing access to safe water and adequate sanitation and promoting hand washing would further reduce diarrheal diseases.
Tobacco smoke-free legislation reduces exposure to second-hand tobacco smoke, and thereby also reduces cardiovascular diseases and respiratory infections. Improving urban transit and urban planning, and building energy-efficient housing would reduce air pollution-related diseases and promote safe physical activity.
Water and secondary infection go back to the beginning of man. Today’s waterborne infections are growing partly because of older infrastructure, and they are more difficult to control because of ever-growing antimicrobial resistance (AMR). But perhaps one object you might not imagine being a potential threat is your showerhead. You jump in with the notion of getting clean and you might leave only after being exposed to a variety of microbes sent to you from inside the showerhead, microbes that take advantage of ideal conditions to colonize. The microbes inside vary but certainly some can be opportunistic pathogens that have the potential to do harm.
One study at a hospital shows that the microbiome in showerheads offer a way for opportunistic pathogens to spread. Who are the microbes in your hospital’s showerhead? In your showerhead? In your showerhead?, which appears at microBEnet (microbiology of the Built Environment network) and does a nice job of summarizing the study. Among other things, it points out that the study predicts that potential opportunistic pathogens were present and that many of the organisms in the sample appear to carry antibiotic resistance gene.
10th death added to Legionnaires’ outbreak in Genesee, which appears at the Detroit News website, reports that a 10th death recently was confirmed in the 2014-15 Flint-area spike in Legionnaires’ disease cases. The death in Genesee County of a Shiawassee County resident fits into the time frame of when the city used Flint River water, although a direct connection hasn’t been established. Flint is the site of the much-publicized case where lead contamination resulted when corrosive Flint River water caused lead from aging pipes to leach into the city’s water supply. The newspaper story says that: “In total, 88 people contracted the respiratory illness, which comes from waterborne bacteria.”
Regular readers will see that comprehensive infection control has become something of a recurring theme at this blog. And for valid reasons. Too often we focus on just one way that disease is transmitted. But disease, be it viral or bacterial, is spread through a variety of means. It must be addressed on multiple fronts. Disease spreads through hands, contaminated surfaces, through the air and via laundry and clothing. Today, we cite two studies, one that looks at multiple research findings that look more closely at the role of fomites.
The goal of Significance of Fomites in the Spread of Respiratory and Enteric Viral Disease was to assess the significance of fomites in the transmission of viral disease by using existing published literature. It attempts to clarify the role of fomites in the spread of common pathogenic respiratory and enteric viruses. Both porous and non-porous surfaces and objects make up fomites, which can play a role as vehicles of transmission when contaminated. Several studies show that viruses can survive on surfaces for extended periods of time. While many respiratory infections are passed along via the aerosol route, ample evidence exists to indicate fomites play an important role, too.
Other points, quoted from the study, include:
Virus spread by person-to-person contact can be interrupted with isolation of the viral carrier. Yet, isolation may prove to be impractical or difficult if there are many people or if the source of infection is unknown. Consequently, interrupting disease spread via indoor fomites is one of the more practical methods for limiting or preventing enteric and respiratory viral infections.
A majority of respiratory viruses are enveloped (parainfluenza virus, influenza virus, RSV, and coronavirus) and survive on surfaces from hours to days. In contrast, most enteric viruses are non-enveloped and survive on fomites from weeks to months.
Studies have demonstrated that viral transfer from hands to surrounding surfaces is possible in 7 out of 10 viruses reviewed.
Hygiene and disinfection intervention studies have demonstrated two concepts that support transmission of viral infection via fomites. First, proper cleaning of hands decreases respiratory and gastrointestinal illness. Second, disinfection of fomites can decrease surface contamination and may interrupt disease spread (norovirus, coronavirus, and rotavirus).
Generally, research indicates that a significant number of enteric and respiratory illnesses can be prevented through improved environmental hygiene to include and increased effort at better hand and surface cleaning practices.
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.