Steps can be taken to reduce the role of shoes in spreading bacteria

shoesWe often discuss cross-contamination issues. Shoes play a growing role in moving bacteria throughout hospitals. The Microbiome Project: Hospitals at YouTube and Design present evidence of this.

Germ Tracker: Study Reveals High Bacteria Levels on Footwear: New Research Commissioned by Rockport Unveils Benefits of Machine Washable Footwear notes that “more than 90 percent of bacteria collected on worn shoes can be eliminated with one wash cycle, according to a study released today by Dr. Charles Gerba, microbiologist and professor at the University of Arizona.” Investigating germs and microbes collected on footwear, the study “found large numbers of bacteria both on the bottom and inside of shoes; averaging 421,000 units of bacteria on the outside of the shoe and 2,887 on the inside. Some of the bacteria found on the shoes included: Escherichia coli, known to cause intestinal and urinary tract infections, meningitis and diarrheal disease; Klebsiella pneumonia, a common source for wound and bloodstream infections as well as pneumonia; and Serratia ficaria, a rare cause of infections in the respiratory tract and wounds. The goal of the study was to verify bacteria levels on footwear and the effectiveness of machine washable shoes in reducing those levels inside and outside the shoe surface. The project also investigated the role of shoes in the movement of bacteria from contaminated floor spaces to other surfaces.”

This Is Why You Absolutely Need To Stop Wearing Shoes In Your House, among other tidbits, notes that “not only do shoes contain bacteria but they also contain germs, chemicals and oil or petroleum by-products. The bottom of your shoes are full of plenty of chemicals and pathogens that you do not want to spread all over your home then walk barefoot on later.”

In Something’s afoot . . . , Nik Mahida and Tim Boswell collected socks from seven wards over two hospitals, collecting 54 pairs and sampling them the same day. The results were interesting. MRSA (9%) and Vancomycin-resistant Enterococci (85%) were isolated from of the socks (vast majority E. faecium) indicating  extensive floor coverage with these organisms.

We need to improve ability to monitor air quality in hospitals

Emergency Room SignIt appears as though shotgun metagenomic sequencing approach can be used to characterize multi-drug resistant organisms. We need to improve our ability to monitor air quality in hospitals. The largest surface in the hospital is the air, and somehow many act as if it doesn’t exist. It is time to get serious about secondary infection.

Longitudinal Metagenomic Analysis of Hospital Air Identifies Clinically Relevant Microbes examines more closely this technique and its benefits.  We would ask: Is your facility manager part of your infection control team? If not, that person should be. American Society of Heating, Refrigeration and Air-Conditioning Engineers (ASHRAE) suggest Minimum Efficiency Reporting Value (MERV) 14 or higher.    ASHRAE wants MERV 14 or better filters in clinical spaces. We normally see no higher than MERV 8, which doesn’t get the job done.

Improved Control of Microbial Exposure Hazards in Hospitals: A 30-Month Field Study shows how treating surfaces with a long-term antimicrobial dramatically changes biological counts in the air. It is time to think outside the box, recognizing that surfaces and air are impacted at the same time. Long-term antimicrobial protection needs to incorporated into the overall hygiene solution. Standard ultraviolet or disinfection works when the light is on or when the surface is wet. However, because of continuous shedding, we need to change how we are combating the HAI problem.

Here are few more of our blog posts featuring persistent antimicrobial technologies that are worth reviewing:


Toilet aerosols flush with harmful pathogens, potential disease sources

twoMost know they don’t want their towels hanging near the toilet. Human waste is filled with bacteria.  Some of it is good, other is potentially pathenogenic. It is time to get smart about toilet aerosols.

The potential spread of infection caused by aerosol contamination of surfaces after flushing a domestic toilet sets out “to determine the level of aerosol formation and fallout within a toilet cubicle after flushing a toilet contaminated with indicator organisms at levels required to mimic pathogen shedding during infectious diarrhea.” In part it concludes that: Although a single flush reduced the level of micro-organisms in the toilet bowl water when contaminated at concentrations reflecting pathogen shedding, large numbers of micro-organisms persisted on the toilet bowl surface and in the bowl water which were disseminated into the air by further flushes.

Potential for aerosolization of Clostridium difficile after flushing toilets: the role of toilet lids in reducing environmental contamination risk attempts “to substantiate the risks of airborne dissemination of C. difficile following flushing a toilet, in particular when lids are not fitted.” It finds that “the mean numbers of droplets emitted upon flushing by the lidless toilets in clinical areas were 15-47, depending on design. C. difficile aerosolization and surrounding environmental contamination occur when a lidless toilet is flushed.”

In a Mist appears at the New York Times and says that “toilet plumes could play a contributory role in the transmission of infectious diseases but that additional research is warranted to assess the risks. In the meantime, when someone in the house is sick or at risk of illness, it might be prudent to protect toothbrushes and drinking glasses by putting them in the medicine cabinet.”

Aerosol Generation by Modern Flush Toilets is a study that “provides additional support for concerns that flush toilets could play a role in airborne transmission of infectious disease via droplet nuclei bioaerosols. Further research is needed to separate the incidence of toilet flush aerosol-related airborne infectious disease transmission, if it exists as seems likely, from transmission by other routes.”

Related pieces:

Imperative for schools to reduce infection risk to enhance learning environment

Schools remain a hot spot for community-acquired infection. All parents remember sending their kids to school for the first time. Weeks later, the family falls ill to the latest and greatest bug moving through the school system. It is important to consider using all the tools available to prevent and control the spread of infection and illness to reduce absences of staff and students and make the learning environment as positive as possible. Below are links that illustrate some of the problems schools and other facilities face as well as potential methods to reduce infection risks. 

Effects of Hand Hygiene Campaigns on Incidence of Laboratory-confirmed Influenza and Absenteeism in Schoolchildren, Cairo, Egypt: This intensive hand hygiene intervention was effective in reducing transmission of influenza among schoolchildren and was feasible and acceptable. . . . Identifying strategies that provide national, long-term, cost-effective alternatives to promote hand hygiene is critical in preventing transmission of diarrheal diseases and emerging respiratory viruses of pandemic potential.

Locker Rooms Front Line Of MRSA Defense: Eyewitness News 5’s Kimberly Lohman takes you inside the University of Oklahoma football locker room, which is a front-line of defense against an aggressive “superbug.”

Health Day takes a look at a study that examined five years of data on skin infections among athletes in 22 high school sports. Nearly 74 percent of skin infections occurred among wrestlers, and just under 18 percent among football players, the investigators found. Skin Infections Common in High School Wrestlers, Study Finds: Germs on mats, helmets are likely culprits, but skin checks and hygiene might help cut risk, experts say. Mats and headgear are likely sources among wrestlers.

Characterization of Methicillin-resistant Staphylococcus aureus Isolates from Fitness Centers in Memphis Metropolitan Area, USA characterizes Methicillin-resistant Staphylococcus aureus (MRSA) isolates from fitness Center in metropolitan Memphis.

Indoor Air Quality and Health: Managing Asthma for Improved Health and Academic Performance is an enlightening piece at YouTube.

Nursing homes, assisted living facilities need detailed infection control protocols

Our elderly in nursing homes and assisted living facilities live in at-risk communities – more than 4 million are admitted or reside in these facilities – because many times they have immune systems that are are compromised. We recommend talking to administration at your nursing homes and assisted living communities to get a feel for their infection control programs because there are no national standards. We need to move from simply cleaning for dust bunnies to cleaning for health. Below are links to studies and stories that offer a few reasons why.

From the Center for Disease Control, Nursing Homes and Assisted Living (Long-term Care Facilities [LTCFs]) prevention tools appears. Nearly one million reside in assisted living facilities. Data about infections in LTCFs are limited, but it has been estimated in the medical literature that:

  • 1 to 3 million serious infections occur every year in these facilities.
  • Infections include urinary tract infection, diarrheal diseases, antibiotic-resistant staph infections and many others.
  • Infections are a major cause of hospitalization and death; as many as 380,000 people die of the infections in LTCFs every year.

Infection Control in Assisted Living Facilities: From the Idaho Department of Health and Welfare and authored by Christine Hahn, MD, this piece outlines the disease risks and preventative measures and guidelines. It offers specific methods to prevent and manage Norovirus, C-Diff, influenza and other respiratory infection and tuberculosis.

Infection control practices in assisted living communities: Few states require assisted living communities (ALCs) to have an infection control plan (ICP), nor do they provide guidelines about infection control practices in ALCs or require communicable disease reporting to appropriate health agencies or even within the community itself. In part, it concludes: There is wide variation in how assisted living facilities are regulated in the United States. States may wish to consider regulatory changes that ensure safe health care delivery, and minimize risks of infections, outbreaks of disease, and other forms of harm among assisted living residents.



Health care workers could benefit from NASA clothing approach

laundryNASA equips its space crews with long-lasting, antimicrobial clothing. We should consider doing the same with the uniforms worn by health care workers. It’s not rocket science, after all, to enhance apparel with antimicrobial properties. It adds a safety measure and reduces costs.

Intravehicular Activity Clothing Study (IVA Clothing Study) speaks to the space applications of antimicrobial clothing, which could have beneficial aspects on the ground: “Longer-lasting and lighter-weight clothes reduce storage and launch requirements for crew member apparel, which brings down costs. Clothing with antimicrobial properties helps to eliminate odor problems.”

At one time the only surface that mattered was hands. Eventually, we more carefully considered hard surfaces. However, clothing and sheets remain largely overlooked, which is illogical. We need to get smarter about infection control. Astronaut Apparel, Crystalline Cities, which appears at Chemical and Engineering News and is written by senior editor Jyllian Kemsley, talks about clothing issued to astronauts that is “lighter and possibly better at resisting microbes and odor than previous astronaut apparel, will last longer.” It notes that according to Discovery News, some of the exercise clothes are treated with a formulation of 3-(trimethoxysilyl)propyldimethyloctadecyl ammonium chloride, which manufacturer PureShield says disrupts microbial membranes. Others are impregnated with copper, which is supposed to be toxic to microbes at high doses.

We’ve discussed previously the importance of clean uniforms for health care professionals at our blog. If you’ve not had the chance to read them, they are worth the time. The pieces note some of the challenges and problems as well as the importance of addressing clothing and other fabrics as part of a comprehensive infection control protocol.

Taking a look at microbiomes and their effects on asthma, other disease

The microbiome of your home can impact asthma threats. The Built Environment and Childhood Allergic Asthma, presented by Susan Lynch at a gathering of the National Academies of Science, Engineering and Medicine that addressed microbiomes of the built environment, discusses potential links between the built environment and childhood allergic asthma. Lynch is Associate Professor, Department of Medicine, Gastroenterology, University of California at San Francisco; Director, Colitis and Crohn’s Disease Microbiome Research Core.

Particulate matter also impacts asthma. Well-documented data shows impact on asthma, chronic obstructive pulmonary disease (COPD), heart disease and emerging data on mental illness. Particulate air pollution and asthma: a review of epidemiological and biological studies.