Myriad environmental factors impact mothers and babies during pregnancy

pregnantA host of environmental factors can have a profound impact on the health of mothers and babies during pregnancy. From alterations to the immune system of expecting mothers to exposure to air pollution, a number of factors can affect the well-being of offspring. Below we list a number of articles and studies to increase awareness.

  • Benefit of Early Initiation of Influenza Antiviral Treatment to Pregnant Women Hospitalized With Laboratory-Confirmed Influenza describes the impact of early initiation of influenza antiviral treatment among pregnant women hospitalized with laboratory-confirmed influenza during the 2010–2014 influenza seasons. The study determines “that early initiation of influenza antiviral treatment to pregnant women hospitalized with influenza may reduce the length of stay, especially among those with severe influenza. Influenza during pregnancy is associated with maternal and infant morbidity, and annual influenza vaccination is warranted.”
  • Pregnancy and Susceptibility to Infectious Diseases reviews 1,454 abstracts to determine the susceptibility to pregnant women to infectious diseases and the severity of the resulting disease. The study found that: “Disease severity seems higher with advanced pregnancy. Pregnant women may be more susceptible to acquisition of malaria, HIV infection, and listeriosis, although the evidence is limited. These results reinforce the importance of infection prevention as well as of early identification and treatment of suspected influenza, malaria, hepatitis E, and HSV disease during pregnancy.”
  • Exposure to airborne particulate matter during pregnancy is associated with preterm birth: a population-based cohort study concludes “exposure to high levels of particulate air pollution, PM2.5, in pregnancy is associated with a 19 % increased risk of PTB; with greatest risk with high 3(rd) trimester exposure. Although the risk increase associated with high PM2.5 levels is modest, the potential impact on overall PTB rates is robust as all pregnant women are potentially at risk. This exposure may in part contribute to the higher preterm birth rates in Ohio compared to other states in the US, especially in urban areas.”
  • Air Pollution Impacts on Infants and Children studies and the gives a grade of “C” for Southern California’s air pollution in relation to the health of pregnant women, infants and children. It says “until policies are implemented to achieve the air quality standards, vulnerable populations will continue to suffer from higher morbidity and mortality.”
  • The Next Generation’s Brains Are In Danger says that harmful toxic affecting children’s developing brains has doubled over the last seven years, according to researchers. It suggests that “In 2006, they published five chemicals that impact brain development. They are lead, methylmercury, arsenic, polychlorinated biphenyls, or PCBs, and toluene. With more throughout review, manganese; fluoride; tetrachloroethylene; polybrominated diphenyl ethers: dichlorodiphenyltrichloroethane, or DDT and chlorpyrifos, two pesticides which is widely used in agriculture have been added to the list.”

Cleaning staff must have active hand in keeping touch points free of contamination

201102220154490.paddletrim bored hospitalAlmost everyone lends a hand in building up bacteria on touch points in hospitals. Many don’t even know they are contributing. It’s up to hospitals to have an active hand in keeping them clean to help avoid the spread of infection. Assessment of contamination using an ATP bioluminescence assay on doorknobs in a university-affiliated hospital in Japan shows that using an adenosine triophosphate (ATP) meter to detect the amount of organic matter that remains after cleaning a surface can help determine what areas might need to be re-cleaned as well as indicate where hospital cleaning processes need to be improved. This study concludes that “ATP assay is useful for measuring baseline doorknob contamination in clinical rooms. Our findings confirm the need to improve routine decontamination in clinical departments. We need to analyze further the relationship between hospital-acquired infections and doorknob contamination, as assessed by ATP assay in clinics.”

An effective cleaning program with a properly trained brigade shows that rooms are cleaned measurably better at Improving hospital staff compliance with environmental cleaning behavior. An intervention at three separate times to increase cleanliness in this hospital showed positive results. Random rooms were selected, staff properly trained and rooms retested. “The percentage of cleaned surfaces improved incrementally between the three trials—with values of 20%, 49%, and 82% showing that repeat training favorably changed behavior in the staff (P = 0.007). During the study period, during which other infection control interventions were also introduced, there was a decline from 0.27 to 0.21 per 1000 patient days for Clostridium difficile infection, 0.43 to 0.21 per 1000 patient days for ventilator-associated infections, 1.8% to 1.2% for surgical site infections, and 1.2 to 0.7 per 1000 central venous line days for central line–associated bloodstream infections.” The study demonstrates that it is critical to get buy-in from staff to address the importance to detailed, intensive cleaning.

Understanding and Preventing Transmission of Healthcare-Associated Pathogens Due to the Contaminated Hospital Environment says that “this special issue demonstrates the rapid strides being made in understanding the role the contaminated environment plays in the transmission of several key healthcare-associated pathogens. More importantly, several articles demonstrate that enhanced cleaning, the use of no-touch methods for terminal room disinfection, and potentially the use of self-disinfecting surfaces may aid in reducing healthcare-associated infections.”

Acinetobacter baumannii is an airborne threat, too


enterobacteria cre (1)Acinetobacter baumannii is a bacterium that is soil based and is multi-drug resistant that now shows it can travel through air. “Airborne Assault”: A New Dimension in Acinetobacter baumannii Transmission notes that it “has emerged to become a predominant cause of nosocomial infections in the United States and across the globe. During the past decade, the remarkable increase in the proportion of A. baumannii strains that are carbapenem resistant has ushered in an era of far more lethal infections.” It makes it even more important to understand the modes of transmission. It has been thought that A. baumannii wasn’t an airborne threat, but evidence in this piece suggests otherwise. It concludes: “The current study underscores that A. baumannii is a most elusive and misunderstood foe. The very name Acinetobacter is derived from the Greek term for lack of mobility (a-kineto); yet, we now know that it is motile not only on surfaces but through the air as well.”

High prevalence of oxacillinases in clinical multidrug-resistantAcinetobacter baumannii isolates from the Tshwane region, South Africa – an update says “the high prevalence of multi-drug resistant A. baumannii isolates has a severe impact on available treatment choices and this in return impacts on treatment outcomes in the studied healthcare facilities. The most dominant ST among the collected isolates was ST758, member of the EUI group. The presence of the OXA-23 gene was not restricted to a specific ST. Continuous research and surveillance is necessary to monitor the circulating β-lactamase genes in clinical settings to guide infection control policies in order to try and curb the spread of this bacterium.”

Endemic and epidemic Acinetobacter baumannii clones: a twelve-year study in a tertiary care hospital says that “Nosocomial outbreaks of multidrug-resistant Acinetobacter baumannii are of worldwide concern.” It concludes that “pulsed-field electrophoresis (PFGE) proved to be a vital tool for analysis of the temporal and spatial distribution of the clones. Multilocus sequence typing (MLST) and the multiple locus variable number tandem repeat sequence (VNTR) L-markers grouped the isolates into clonal clusters. The wide diversity of multiple locus variable analysis (MLVA) small (S)-markers, however, did not permit clustering. The present results demonstrate the persistence of several endemic PFGE types in the hospital, the involvement of some of them in outbreaks, and the inter hospital transmission of extensively drug-resistant ST-15 and ST-80.”

Two related pieces previously published at our blog:

Bacteria resistant to last resort antibiotics creates alarm

Doctors are reporting the first case in the U.S. of bacteria that is resistant to antibiotics often used as a last resort. The germ was found in a 49-year-old Pennsylvania woman with a urinary tract infection.

The event is covered in the piece Doctors Discover First U.S. Case Of Bacteria Resistant To Last Resort Antibiotics, which provides a transcript of a recent “All Things Considered” at National Public Radio. The article is a discussion between host Audi Cornish and Rob Stein, correspondent and Senior Editor of the Science Desk. Stein points out that that folks he talked to at CDC are taking it very seriously and are taking steps to determine how they might contain it. “And so the worry is we could get to the point where officials start to refer to as a post-antibiotic world where basically what were routine infections that were no big deal – there’s no way to treat them, and people start dying from them,” Stein says. Each multi-drug resistant organism (MDRO) moves us closer to simple infections killing us. Aggressive steps must be taken to arrest any spread become critical for public health.

Helen Branswell authors an informative article (Superbug resistant to last-resort antibiotics found in U.S.) about MDRO at the website STAT, which reports “from the frontiers of health and medicine.” She writes that “When swarms of bacteria are exposed to an antibiotic, the ones susceptible to it will die. But some will always survive. It’s the bacterial equivalent of survival of the fittest. Increased exposure to the drug gives the bugs that pose the biggest risk to humans a chance to survive and thrive.”

More connected world means pandemics can spread faster than ever


Pandemics can spread faster today than ever before because robust transportation infrastructure system. Outbreak! Watch How Quickly An Epidemic Would Spread Across The World says a new model can predict the spread of any disease across the planet.  All we need to do is reorganize our thinking of time and space.

Sydney Brownstone writes at Co.Exist: Within an increasingly globalized and mobile world, the spread of contagion doesn’t work how it used to. But by taking these factors into account, theoretical physicist Dirk Brockmann and his colleagues have a radical new model that could predict the arrival times of the next global pandemic. The model relies on something called “effective distance,” and it destroys a centuries-old way of thinking about maps. It’s a simple concept. Flight patterns and common aviation hubs are more accurate predictors of the spread of disease than distances traveled on foot, slow boat, or horse. Brockmann had a lightbulb go off when a student, Daniel Grady, biked to his office at Northwestern University and remarked that no matter how he traveled—by subway, bus, or bike—it always took the same amount of time to get there. “And that is when it started,” Brockmann said. “In the modern world that’s so connected, old school, conventional geographic distance is not so meaningful anymore.”

Previously at our blog, we published AIRLINE POOP STUDIED TO TRACK GLOBAL SPREAD OF AMR IN BACTERIAL PATHOGENS. Global spread of antimicrobial resistance in bacterial pathogens is major threat against human health, yet we don’t know much about how these genes travel and spread worldwide. In an effort to learn more about this, researchers at Technical University of Denmark studied the poop siphoned from airplane toilets from flights arriving from around the world.

Interdisciplinary approach across borders needed to control spread of disease

The spread of disease is enhanced by increased travel as the world figuratively shrinks more and more each year. Diseases don’t stop at borders, and they certainly don’t discriminate. An interdisciplinary, collaborative effort across governments, the private sector, scientists, behaviorists, international agencies of all kinds grows increasingly more important each day. Pandemic disease warnings are part of the science and the “press events” of today.  These threats are further complicated by the rapid move of drug resistant organisms from the healthcare environment to the general public. To combat this requires better use of our knowledge about basic infection control practices.  Getting back to the basics of source and amplification site control and the control of transfer routes (air and surfaces, not just people) and controlling vectors (physical surfaces, particles, and biologicals) is called for at all levels of human activity.

The Global Strategy of the U. S. Department of Health and Human Services identifies three primary goals. They are:

  • To protect and promote the health and well-being of Americans through global action
  • To provide international leadership and technical expertise in science, policy, programs, and practice to improve global health and well-being
  • To work in concert with interagency partners to advance U.S. interests in international diplomacy, development, and security through global action.

Ranging from the more obvious (to prevent and treat infectious diseases and other health threats) to perhaps the less apparent (increase the safety and integrity of global manufacturing and supply chains), HHS outlines 10 objectives to help accomplish its three chief goals.

Notably, HHS isn’t bent on centralizing global health decisions but rather it tries to encourage diverse entities to follow guidelines of shared interest as they make their own decisions about how best to accomplish established overall goals.

WHO notes gaps in information on pathogens affecting public health in its Antimicrobial Resistance: Global Report on Surveillance. Add to that a disjointed approach that lacks coordination and the result is myriad problems trying to get a reliable assessment of antibacterial resistance (ABR), without which organizing an effective approach to fight it is at best difficult and at worst near impossible.

Key findings and public health implications of ABR as state by WHO are:

  • Very high rates of resistance have been observed in bacteria that cause common health-care associated and community-acquired infections (e.g. urinary tract infection, pneumonia) in all WHO regions.
  • There are significant gaps in surveillance, and a lack of standards for methodology, data sharing and coordination.

Key findings from AMR surveillance in disease-specific programs as per the WHO are as follows:

  • Although multidrug-resistant TB is a growing concern, it is largely under-reported, compromising control efforts.
  • Foci of artemisinin resistance in malaria have been identified in a few countries. Further spread, or emergence in other regions, of artemisinin-resistant strains could jeopardize important recent gains in malaria control.
  • Increasing levels of transmitted anti-HIV drug resistance have been detected among patients starting anti-retroviral treatment.

How Can We Prevent The Next Global Health Epidemic? is found at National Public Radio. Entrepreneur and philanthropist Bill Gates discussed the need for the challenges of the next global health epidemic.

Encouraging diverse agencies and groups at all levels in multiple countries to get on the same page and adopt a uniform approach is critical as we try to advance global health. We must all be in this fight together. We would add, also, that  it is essential that the scientific, medical, solution-supplier professionals and real-world practitioners look beyond the microbes, their interface with the environment and humans, the patient-focused therapies, and the hygiene practices. And by doing so, integrate into their thinking and actions education and practices programs that bring to action the knowledge of all of these components as they “reduce dose and reduce transfer routes” to impact HAI’s and the threats of emerging and pandemic diseases.  Effective and evidence based tools are out there for interdictions and elimination of threat level microbes; they just need to be implemented.


Shared items represent threat for cross-contamination

keyboardShared items are a real and ongoing threat for cross-contamination.  NanoSafe did a survey at a fire station recently, where it swabbed the common emergency management computer. The enter button had more the 10,000 colony forming units (CFUs) on it. These common touch points can impact health.

Dr. Charles Gerba lists a number of everyday items that perhaps surprisingly are more contaminated than a toilet seat. The toilet plume: How does a UA professor get involved in studying toilets in the first place? Gerba worked with Joseph Melnick, an international leader in the identification and control of virus diseases and one of the founders of the field of virology. One day at work, Melnick took the usual bathroom break when a light bulb went off: He wondered if a plume of contaminated water droplets was ejected into the air every time a toilet flushed. He discussed it with Gerba, who since has made quite a name for himself by studying public toilets and other places where germs lurk. When this aerosol of contaminated water is ejected into the air, it lands on everything in the bathroom, including your toothbrush. According to Gerba, this isn’t just another scare tactic to get men to put the top down.

While the toilet stall was the beginning of Gerba’s distinguished hygiene studies, even he was astonished to find out that bathrooms aren’t the germiest of places. Your kitchen is. Gerba, who’s fond of quipping, “I’ve published several toilet papers,” says the kitchen is one of the germiest places in the house.

If this doesn’t make you wake up and smell the coffee, nothing will: Your kitchen is even more contaminated with bacteria than the toilet bowl. “That’s why your dog likes to drink out of the toilet,” Gerba says.

The worst offender in the kitchen is the sponge or dishcloth, followed by the kitchen sink. Third on the Most Contaminated list is the bathroom sink. Kitchen cutting boards come in next. The kitchen floor, bathroom floor and bathroom counter follow.

Coffee cups, laundry, remote controls, desktop keyboards, computer mouse, fax machine and photocopier all are test for more germs than toilet seats, Gerba says.,

Researchers track how germs travel and find common contamination hot spots in How Fast Can a Virus Spread? Faster Than You Think. At everyday HEALTH, a story says that “researchers from the University of Arizona, Tuscon, placed a tracer virus on commonly touched objects such as a doorknob or tabletop. At multiple time intervals – from two to eight hours – the researchers sampled a range of surfaces including light switches, bed rails, countertops, sink tap handles, and push buttons. They found that between 40 and 60 percent of the surfaces were contaminated within two to four hours.”

Why is it important to address different vehicles for disease to travel? Check out Top 10 Disease Outbreaks of the Century at YouTube. More than ever, it is time to understand how disease spreads and what can be d one to impact it. Simple things like hand hygiene and touch point control can limit transmission. Clean hands, clean water, clean surfaces and clean air can do a great deal to keep disease at bay.

Dangerous Norovirus can be spread in a variety of ways

Luxury cruise ship anchored in the port of Ocho Rios, Jamaica.The Public Library of Science (PLOS) recently did a collection of studies on Norovirus and estimated cost of the virus at $60 billion annually. Norovirus is the most common cause of viral gastroenteritis in humans.

The Global Burden of Norovirus & Prospects for Vaccine Development notes that “each year, Norovirus causes over 200,000 deaths. A highly contagious virus that most people will contract 5 times in their lifetime, the most serious outcomes of the disease – hospitalization and death – are far more common among children and the elderly, and in low and middle income countries. In this PLOS Collection global Norovirus experts fill critical knowledge gaps and provide key information to further development of a much-needed vaccine.” The series of studies are wide-ranging and are worth the read.

  • Every month we read about an outbreak on a cruise ship or in another place where people gather.  This bug has no vaccine and can be transmitted through the air, water, food and contaminated surfaces. Passengers recount ‘disappointment’ aboard cruise ship hit by virus offers some firsthand experiences with the bug on a cruise ship.
  • The viruses responsible for 50% of cases of gastroenteritis can be spread by air (you might need to hit the translate button on your browser or at top of the story) says that “Noroviruses, a group of viruses responsible for over 50% of global gastroenteritis cases, can spread by air up to several meters from an infected person according to a new study by Université Laval researchers. The discovery, details of which are presented in the latest issue ofClinical Infectious Diseases, suggests that measures applied in hospitals during gastroenteritis outbreaks may be insufficient to effectively contain this kind of infection.”
  • A YouTube piece titled “The Vomiting Machine” features Grace Tung Thompson, Ph.D., who demonstrates the vomiting machine she used to study aerosolization of virus particles during a vomiting event. Vomiting is a hallmark symptom of Norovirus and plays a role in Norovirus transmission. Grace recently graduated from the Jaykus Laboratory at North Carolina State University. It is a short piece that is worth viewing, although it neglects to mention the airborne aspects of Norovirus.

Any effective environmental program for infection control needs to address air, hands and all surfaces.  When gaps are left we expose ourselves to infection.

World Health Organization faces challenges to end TB by 2030

3Tuberculosis, specifically multi-drug resistant TB (MDR-TB), is a global threat. The World Health Organization has the ambitious aim to end TB worldwide by 2030 and has called on countries and partners to help accomplish the goal (WHO calls on countries and partners to “Unite to End Tuberculosis”).

At TB online (TBCAB, Global TB Community Advisory Board), it says while there has been significant progress in the fight against TB, with 43 million lives saved since 2000, the battle is only half-won: more than 4,000 people lose their lives each day to this leading infectious disease. Many of the communities that are most burdened by tuberculosis are those that are poor, vulnerable and marginalized. Ending TB will only be achieved with greater collaboration within and across governments, and with partners from civil society, communities, researchers, the private sector and development agencies. This means taking a whole-of-society and multidisciplinary approach, in the context of universal health coverage. . . . Despite advances, formidable challenges remain including fragile health systems, human resource and financial constraints, and the serious co-epidemics with HIV, diabetes, and tobacco use.

MDR-TB is another critical challenge. Urgent and effective action to address antimicrobial resistance is key to ending TB by 2030. So are increased investments, as the global tuberculosis response remains underfunded for both implementation and research.

WHO is committed to continuing its work with countries and partners around the world to address these challenges and to accelerate collective action to end the TB epidemic altogether.

Other related links:

Copper is golden when it comes to antimicrobial value

hand on rail in chileWith antimicrobial resistance growing and impacting health outcomes daily, it is time to look at persistent cleaning technologies available on the market today. Surface hygiene matters.

How long do nosocomial pathogens persist on inanimate surfaces? A systematic review concludes that “the most common nosocomial pathogens may well survive or persist on surfaces for months and can thereby be a continuous source of transmission if no regular preventive surface disinfection is performed. . . . Most nosocomial pathogens can persist on inanimate surfaces for weeks or even months. Our review supports current guidelines which recommend a disinfection of surfaces in specific patient-care areas in order to reduce the risk of transmission of nosocomial pathogens from inanimate surfaces to susceptible patients.”

“Copper Stopper” is a video that discusses some research that found coating hospital surfaces with copper helped battle microbes and the infections they spread. Placement of copper surfaces in intensive care unit (ICU) hospital rooms reduced the amount of healthcare-acquired infections (HAIs) in patients by more than half. The video narrated by Dr. Michael Schmidt, professor of microbiology at the Medical University at the University of South Carolina, offers a great bit of additional information on copper’s value as an antimicrobial.