EMS personnel at great risk to face MRSA infections

indfFirefighters and EMS personnel are the backbone of the U.S. national disaster program. Infection, Methicillin-resistant Staphylococcus Aureus (MRSA) in particular, is a problem with those groups. If it cannot be controlled, it’s reasonable to be concerned about how our first responders will deal with a pandemic.

Study Reveals EMS MRSA Infection Risks, at the Journal of Emergency Medical Services and authored by paramedics Alexander L. Trembley (NREMT-P) and David Page (MS, NRP), says exposure to microscopic superbugs like methicillin-resistant Staphylococcus aureus (MRSA) “go undetected in our daily work and can be responsible for prolonged hospitalization, amputations and severe organ damage.” They two cite a recent study from the department of epidemiology at the Ohio State University that offers  some insight as to the prevalence of this bad bug.

The study determines that EMS providers have 10 times the risk of carrying MRSA if they don’t wash their hands after removing their gloves. “MRSA prevention is a major focus of healthcare organizations, but it appears we fall short in EMS. So-called superbugs like MRSA aren’t going away anytime soon. This study sampled providers in every EMS region of Ohio, which means this isn’t a problem that can be isolated to a single service. The presence of MRSA colonies provides a risk to the patients we treat, not to mention ourselves and our fellow EMTs and paramedics. It’s time to go back to basics. Simple hand washing is a critical process before and after taking care of patients, and wearing gloves makes all the difference.”

MRSA study leads to changes in fire station protocols (at Department of Environmental and Occupational Health Sciences, Environmental Health News): Snohomish County Fire District 1 in Washington state comprises 12 fire stations that field, on average, 13,000 emergency calls each year. As wellness coordinator for District 1, firefighter and paramedic Kevin Fetter was interested in a new disinfection system. But first he wanted to find out what kinds of germs were on the surfaces of the fire stations and medic units and which could be transmitted to personnel that might potentially cause infection or illness.

Fetter called labs all over the country, and he found help at the UW, where he connected with Professor Marilyn Roberts, an environmental microbiologist in our department. Their collaboration led to the first-ever environmental health study on methicillin-resistant Staphylococcus aureus in Northwest fire stations and on fire personnel to determine the extent of contamination. The study’s findings led to a number of protocol changes to improve decontamination of environmental surfaces inside the fire stations and trucks.

Roberts and her team determined which locations in the stations and trucks were most likely to be contaminated. And to better prevent bacteria from contaminating surfaces, protocol changes were proposed, such as lengthening how long disinfectants are left on surfaces before being wiped off; changing sanitizers and hand-towel dispensers to the touchless variety; and purchasing new station furniture made of easy-to-clean plastic or wood rather than furniture covered in fabric.

Compelling information shows HAI threat from hands, air, surfaces and laundry

If you ask microbiologist or a physical scientist or engineer focused on HVAC, they will tell you small particles move in our air constantly. Many of these particles are biological – fungi, virus and bacteria. We find that many in the medical community hide behind science. They want proof of everything as long as it meets their preconceived notions and needs. While attending a Centers for Disease Control conference on healthcare associated infection (HAI), we spoke with a doctor who flatly said it could not be proven that disease in the air could infect an individual. We agreed but said that was only because of the scale of what was being measure or assessed.  This same doctor uses electricity, which is also not proven. We know it works but it remains a hypothesis. Virtually all studies linked to environmental monitoring don’t meet the rigors a good scientific testing. There are too many variable in an active hospital, making the studies anecdotal. That being said, we have mountains of information that show the threat of HAI from hands, air, surfaces and laundry. Two examples follow:

Outbreak of Middle East Respiratory Syndrome at Tertiary Care Hospital, Jeddah, Saudi Arabia, 2014 studies a Middle Eastern Respiratory Syndrome (MERS) outbreak at King Fahd General Hospital (KFGH) that affected patients and health care workers in early 2014. It concludes that “illness most likely was transmitted in multiple settings, making it difficult to track disease from patient-to-patient. The contribution to MERS-CoV transmission at KFGH by asymptomatic persons is uncertain; transmission by asymptomatic persons is an area that needs further study. Heightened awareness of MERS, aggressive triaging of patients, prompt isolation, and strict infection control measures were associated with a rapid decrease in transmission. Continued vigilance and consistent adherence to infection control precautions is necessary to prevent future healthcare-acquired MERS outbreaks.”

Environmental Contamination and Viral Shedding in MERS Patients During MERS-CoV Outbreak in South Korea set out to investigate the potential role of environmental contamination by MERS-CoV in healthcare settings and to define the period of viable virus shedding from MERS patients. It found 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.

The study concludes that “most of touchable surfaces in MERS units were contaminated by patients and health care workers and the viable virus could shed through respiratory secretion from clinically fully recovered patients. These results emphasize the need for strict environmental surface hygiene practices, and sufficient isolation period based on laboratory results rather than solely on clinical symptoms.”

Biosecurity requires environmental protection from all transmission modes

bioBiosecurity, all procedures to prevent the introduction and spread of disease, requires environmental protection for all modes of transmission.  Air, hands and surfaces must be clean.

Significance of Fomites in the Spread of Respiratory and Enteric Viral Disease. “In 2006 the World Health Organization reported that diarrhea and respiratory infections were two of four major diseases influenced by environmental conditions. To limit or prevent the spread of viral infections, pathogen transmission needs to be fully understood. Both respiratory and enteric viruses have more than one route of transmission. Respiratory viruses are known to be spread by person-to-person contact, the airborne route, and contaminated surfaces or fomites. Enteric viruses are spread by the fecal-oral route via environmental and person-to-person contact. . . . 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). In addition, laboratory evidence from studies support viral transmission via fomites. Generally, research evidence suggests that a large portion of enteric and respiratory illnesses can be prevented through improved environmental hygiene, with an emphasis on better hand and surface cleaning practices.”

Titled The trouble with chicken, PBS’ FRONTLINE investigates the spread of dangerous pathogens in our meat — particularly poultry — and why the food-safety system isn’t stopping the threat. Focusing on an outbreak of Salmonella Heidelberg at one of the nation’s largest poultry processors, the documentary reveals how contaminants are evading regulators and causing more severe illnesses at a time when Americans are consuming more chicken than ever.

An evaluation of the impact of flooring types on exposures to fine and coarse particles within the residential micro-environment using CONTAM in part says “hardwood floors were thus identified as the most effective flooring type for the reduction of (daily, 24-h) incremental time-averaged exposure to either fine or coarse particles due to resuspension while walking. Particle size resolved floor loadings for individual rooms within a home are not currently available. As such, floor loadings were assumed to be the same for both the living area as well as the bedroom, for example. Other human activities in addition to walking which could contribute to resuspended PM in the home, namely cooking, cleaning, folding clothes, sitting and standing and other combustion sources were not factored into this research. Their addition would improve the resolution of the model presented in this paper.”

Surrounded by a Cloud of Dust: Particle Resuspension in Indoor Environments is a YouTube piece presented by Brandon E. Boor, Ph.D., Assistant Professor of Civil Engineering, Purdue University.

Poor air quality leads to myriad potential negative health issues

sick doctorThis is the final blog entry of a series of posts that illustrate the damaging effects on health that can be attributed to pollution and poor air quality in general. Today, we link to some studies that look at infectious agents and the diseases that can result when they are carried through the air.

From the abstract of: Ventilation grilles as a potential source of methicillin-resistant Staphylococcus aureus causing an outbreak in an orthopedic ward at a district general hospital.

The spread of methicillin-resistant Staphylococcus aureus (MRSA) in a hospital is thought to be mainly by direct contact. Environmental sources such as exhaust ducting systems have been increasingly recognized as a source for MRSA outbreaks in intensive therapy units. We describe an outbreak of MRSA related to ventilation grilles in an orthopedic ward. Six patients and one nurse were involved in an outbreak with EMRSA-15 during March 1996. The index case was transferred from a large university hospital in Leeds. One of the patients had shared the same bay with the index case. The rest of the patients were in another bay of the same ward and had no direct contact with the index patient. An environmental source was suspected and the ventilation grilles in boys 1 and 2 were found to be harboring EMRSA-15. The ventilation system at that time was working on an intermittent cycle from 4 p.m.-8 a.m. Daily shut-down of the system temporarily created a negative pressure, sucking air in from the ward environment into the ventilation system and probably contaminating the outlet grilles. It is likely that contaminated air was blown back into the ward when the ventilation system was started. The system was thoroughly cleaned, appropriate infection control measures were instituted and the ventilation system was put back on a continuous running cycle and the outbreak terminated. Six months after the outbreak no isolates of EMRSA-15 had been made on the ward.

The effect of environmental parameters on the survival of airborne infectious agents says in its abstract: The successful transmission of infection via the airborne route relies on several factors, including the survival of the airborne pathogen in the environment as it travels between susceptible hosts. This review summarizes the various environmental factors (particularly temperature and relative humidity) that may affect the airborne survival of viruses, bacteria and fungi, with the aim of highlighting specific aspects of environmental control that may eventually enhance the aerosol or airborne infection control of infectious disease transmission within hospitals.

Airflow Dynamics of Human Jets: Sneezing and Breathing – Potential Sources of Infectious Aerosols notes that “perhaps the most striking findings from this study are firstly, that the maximum cough and sneeze velocities are very similar, and secondly, that they are not extremely high – at least in this cohort of human volunteers. The range of cough velocities reported here are within the range of 1.5–28.8 m/s, as reported elsewhere by several other teams using different techniques.”

Droplets carried in exhaled breath may carry microorganisms capable of transmitting disease over both short and long distances, according the abstract found at The size distribution of droplets in the exhaled breath of healthy human subjects. The size distribution of such droplets will influence the type of organisms that may be carried as well as strategies for controlling airborne infection. The aim of this study was to characterize the size distribution of droplets exhaled by healthy individuals. Exhaled droplets from human subjects performing four respiratory actions (mouth breathing, nose breathing, coughing, talking) were measured by both an optical particle counter (OPC) and an analytical transmission electron microscope (AEM). The OPC indicated a preponderance of particles less than 1 mu, although larger particles were also found. Measurements with the AEM confirmed the existence of larger sized droplets in the exhaled breath. In general, coughing produced the largest droplet concentrations and nose breathing the least, although considerable intersubject variability was observed.

Also, Fungal pollution of indoor environments and its management.



Air pollution negatively affects prenatal, infant development

prenatal_diagnosisPreviously, we looked at studies about air quality in the built environment as it relates to mental health, air pollution and its effects on asthma and cardiopulmonary issues that have roots in poor air quality. Today, we link to some studies that discuss air quality as it relates to prenatal health and the health of infants.

In Utero Fine Particle Air Pollution and Placental Expression of Genes in the Brain-Derived Neurotrophic Factor Signaling Pathway: An ENVIRONAGE Birth Cohort Study suggests that “placental expression of BDNF and SYN1, two genes implicated in normal neurodevelopmental trajectories, decreased with increasing in utero exposure to PM2.5. Future studies are needed to confirm our findings and evaluate the potential relevance of associations between PM2.5 and placental expression of BDNF and SYN1 on neurodevelopment. We provide the first molecular epidemiological evidence concerning associations between in utero fine particle air pollution exposure and the expression of genes that may influence neurodevelopmental processes.”

Breathing dirty air during pregnancy raises odds of childhood ADHD-related behavior problems says “prenatal exposure to polycyclic aromatic hydrocarbons, or PAH, a component of air pollution, raises the odds of behavior problems associated with attention deficit hyperactivity disorder, or ADHD, at age 9, according to researchers at the Columbia Center for Children’s Environmental Health at the Mailman School of Public Health. Results are published online in the journal PLOS ONE.

Air pollution impacts on infants and children focuses on health effects that ambient and traffic related air pollution has on pregnant women, their infants, and young children in Los Angeles County in Southern California. “The question then arises what we can do to make the air cleaner and safer in terms of reproductive and children’s health.  Currently, air pollution impacts on pregnant women and infants are not taken into consideration in setting environmental standards on a state or federal level.  Since these populations are perhaps the most vulnerable to air pollution, taking these impacts into consideration would help strengthen air quality controls.”

Effects of Prenatal Exposure to Air Pollutants (Polycyclic Aromatic Hydrocarbons) on the Development of Brain White Matter, Cognition, and Behavior in Later Childhood sets out to identify the effects of prenatal PAH exposure on brain structure and to assess the cognitive and behavioral correlates of those abnormalities in school-age children. What the researchers detected was “a dose-response relationship between increased prenatal PAH exposure (measured in the third trimester but thought to index exposure for all of gestation) and reductions of the white matter surface in later childhood that were confined almost exclusively to the left hemisphere of the brain and that involved almost its entire surface. Reduced left hemisphere white matter was associated with slower information processing speed during intelligence testing and with more severe externalizing behavioral problems, including attention-deficit/hyperactivity disorder symptoms and conduct disorder problems. . . . The findings they say “suggest that prenatal exposure to PAH air pollutants contributes to slower processing speed, attention-deficit/hyperactivity disorder symptoms, and externalizing problems in urban youth by disrupting the development of left hemisphere white matter, whereas postnatal PAH exposure contributes to additional disturbances in the development of white matter in dorsal prefrontal regions.”


Cardiopulmonary issues potentially arise when air quality is poor

cardioPreviously, we looked at studies about air quality in the built environment as it relates to mental health; air pollution and its effects on asthma. Today, we look some studies that examine air pollution and its potential to create cardiopulmonary health problems.

An Integrated Risk Function for Estimating the Global Burden of Disease Attributable to Ambient Fine Particulate Matter Exposure developed a relative risk (RR) factor over the entire global exposure range for causes of mortality in adults: ischemic heart disease (IHD), cerebrovascular disease (stroke), chronic obstructive pulmonary disease (COPD), and lung cancer (LC). We also developed RR functions for the incidence of acute lower respiratory infection (ALRI) that can be used to estimate mortality and lost-years of healthy life in children less than 5 years old.

It concludes by saying: “We developed a fine particulate mass–based RR model that covered the global range of exposure by integrating RR information from different combustion types that generate emissions of particulate matter. The model can be updated as new RR information becomes available.”

Indoor Particulate Matter Air Pollution and Cardiovascular Health, published at YouTube, is 20-odd minutes and well worth the listen. The speaker is Ryan Allen, Ph.D. (presenting via web conference)
Associate Professor, Faculty of Health Sciences, Simon Fraser University.

Desert Dust Outbreaks in Southern Europe: Contribution to Daily PM10Concentrations and Short-Term Associations with Mortality and Hospital Admissions is based on the premise that evidence on the association between short-term exposure to desert dust and health outcomes is controversial. In its conclusion, it says that “particulate matter 10 originating from the desert was positively associated with mortality and hospitalizations in Southern Europe. Policy measure should aim at reducing population exposure to anthropogenic airborne particles even in areas with large contribution from desert dust advections.”

Next, we will look at how prenatal health and the health of infants is affected by poor air quality


Rapid industrialization brings air pollution, health risks

asthmaPreviously, we looked at air quality in the built environment as it relates to mental health. Today, we look at the effects of air pollution – indoors and outdoors – and its potential to negatively affect human health, particularly related to asthma.

The first study ( Link between environmental air pollution and allergic asthma: East meets West) makes notes that as industrialization increases rapidly in Southeast Asian countries, the associated issues related to asthma and allergic diseases is approaching levels previously found primarily in the Western World. It says, in part, that “epidemiological and experimental exposure studies indicate a harmful impact of outdoor air pollution from vehicles and factories both on the development of allergic diseases and asthma and the increase in asthma symptoms and exacerbations. The level of outdoor pollution in Asia is much higher and more diverse than those encountered in Western countries. This may increase the impact of outdoor pollution on health, particularly lung health in Asia.” The review looks at what makes up air pollution in Asia, drilling down especially on China and Taiwan, where air quality is generally abysmal. It suggests “the onus remains on regulatory and public health authorities to curb the sources of pollution so that the health effects on the population, particularly those with lung and cardiovascular diseases and with increased susceptibility, can be mitigated.”

Part of what the piece concludes is that “the solution to this problem is of course to reduce emissions of these pollutants and this reduction is possible as shown during the Beijing Olympic Games. On the other hand, efficacious preventive measures and treatments need to be found.”

Asthma and the Diversity of Fungal Spores in Air: This primer, authored by Ann Pringle, Associate Professor of Botany and Bacteriology at the University of Wisconsin-Madison, aims “to facilitate communication by providing doctors with a basic, modern guide to spores, by teaching mycologists the essential facts of asthma, and by providing patients with a succinct summary of what is known about spores and asthma. By highlighting the use of emerging metagenomics technologies in ecology, I intend to illustrate how these tools might be used to more thoroughly understand the potential diversity of fungi involved in asthma.”

Differences in grass pollen allergen exposure across Australia is an abstract of a study that looks to give perspective to pollen data in Australia, using a large, representative sample. Among the implications noted is “establishment of an Australian national pollen monitoring network would help facilitate advances in the clinical and public health management of the millions of Australians with asthma and allergic rhinitis.”

The indoor environment and inner-city childhood asthma points out that “inner-city children are exposed to various indoor allergens and pollutants that may lead to asthma development and exacerbation of existing asthma. Multifaceted environmental controls are beneficial in improving asthma symptom and maybe a viable prevention strategy. Further prospective studies of environmental intervention are needed to further identify effective strategies to improve and prevent asthma symptoms in inner-city children.”

Next time we will look at cardiopulmonary problems caused by poor air quality.

Previously: Microbiome of built environments (MoBE) impact mental health

Microbiome of built environments impacts mental health

Poor air quality can impact overall health in myriad ways. It can negatively impact mental health, exacerbate issues suffered by those with asthma, create cardiopulmonary problems, affect prenatal health and spread myriad disease, to name just a few issues. Total hygiene solutions clearly must account for air quality to enjoy true success. While poor air quality is not limited to the negative effects listed above, it is these categories on which we will focus with the next five blog items we publish. We begin with mental health.

The microbiome of the built environment and mental health notes that studies on the microbiome of indoor environments (MoBE) are relatively scarce. Some data exists on the MoBe as it relates to human microbiome and vulnerability to disease, but its effects on mental health are relatively unknown. This study endeavors to present a “brief summary of microbiome research in both areas and highlight two interdependencies including the following: (1) effects of the MoBE on the human microbiome and (2) potential opportunities for manipulation of the MoBE in order to improve mental health. In addition, we propose future research directions including strategies for assessment of changes in the microbiome of common areas of built environments shared by multiple human occupants, and associated cohort-level changes in the mental health of those who spend time in the buildings. Overall, our understanding of the fields of both the MoBE and influence of host-associated microorganisms on mental health are advancing at a rapid pace and, if linked, could offer considerable benefit to health and wellness.

“Despite the massive effort in the human microbiome project, researchers observed that variation in the healthy human microbiome was not well correlated with biometrics (gender, body temperature, blood pressure, etc.) and concluded that other factors might be important. One such factor could be the MoBE that surrounds individuals. It is likely that the MoBE alters immune system function through influences on the host-associated microbiota and, therefore, could have an effect on the mental health of the occupants. Furthermore, given the recent interest in the microbiome-gut-brain axis, if the MoBE does alters the gut microbiota, considerable research opportunities could follow for future studies of the relationships among the microbiota of the built environment, the host-associated microbiota, and mental health with the aim of intervening to decrease negative health-related outcomes. It is possible that intentional modification of the built environment to increase microbial biodiversity, or to increase exposure to immunoregulatory antigens or probiotics, would result in improved mental health conditions. Moreover, mental health and MoBE studies logically extend to autism spectrum disorders and other neurodevelopmental disorders, such as schizophrenia, that have been investigated with a human microbiome perspective.

“There is credible evidence that these two fields, if linked, could improve future mental health outcomes for both the community at large (e.g., prevention), as well as those with psychiatric disorders (intervention). Research studies will provide the most benefit if discussions among investigators with multiple specialties are initiated in the study design phase. With a combined effort between the MoBE consortia and mental health professionals, a greater understanding of the relationship between the MoBE, the microbiome of human occupants, and mental health can occur at a more rapid pace.”

Particulate Matter Air Pollution: Neurological and Psychiatric Disorders is an informative presentation of about 20 minutes at YouTube regarding air quality as it relates to mental health issues. The speaker is Marc Weisskopf, Ph.D., Sc.D. Associate Professor of Environmental and Occupational Epidemiology, Harvard.

Finally, Traffic-Related Air Pollution and Dementia Incidence in Northern Sweden: A Longitudinal Study observes some associations that, if casual, indicate that “air pollution from traffic might be an important risk factor for vascular dementia and Alzheimer’s disease.

Next time we will look at air quality and its implications as it relates to asthma.