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Pseudomonas aeruginosa is a water-loving bacteria, organism of concern

1An organism of concern, Pseudomonas aeruginosa is a water-loving bacteria that works and builds biofilms with other threatening bacteria. Understanding that disinfection alone will not rid an engineered water system of bacteria means we need to look toward biofilm-resistant material and disinfection at the source of use as opposed to where the water enters the building.

Antibiotic Resistance of Pseudomonas aeruginosa in Pneumonia at a Single University Hospital Center in Germany over a 10-Year Period determines that “while Paeruginosa and MDR Paeruginosa were resistant to a variety of commonly used antibiotics, they were not resistant to colistin in the few isolates recovered from patients with pneumonia.”

Inhibition of Aspergillus fumigatus and Its Biofilm by Pseudomonas aeruginosa Is Dependent on the Source, Phenotype and Growth Conditions of the Bacterium reports that “Aspergillus fumigatus (Af) and Pseudomonas aeruginosa (Pa) are leading fungal and bacterial pathogens, respectively, in many clinical situations. Relevant to this, their interface and co-existence has been studied. In some experiments in vitroPa products have been defined that are inhibitory to Af. In some clinical situations, both can be biofilm producers, and biofilm could alter their physiology and affect their interaction. That may be most relevant to airways in cystic fibrosis (CF), where both are often prominent residents. . . . The differences in Pa shown from these different sources are consistent with the extensive evolutionary Pa changes that have been described in association with chronic residence in CF airways, and may reflect adaptive changes to life in a polymicrobial environment.”

Also: Antibiotic resistance profiles of Pseudomonas aeruginosa isolated from various Greek aquatic environments.

Schools need to take comprehensive approach to disease control

Cleaning crews in schools are just like their counterparts in hospitals on the front lines of the war on disease.  Cleaning Schools for Health, Not for Appearance discusses this in some detail. How schools are cleaned can and will impact the health of all building occupants, including students and faculty. Hygiene is involves much more than seemingly clean surfaces.

Creating Healthy Indoor Air Quality in Schools is a comprehensive piece put out by the Environmental Protection Agency, focusing largely on surface hygiene. The EPA has created apps and a series of webinars outlining the threat of poor air quality. The air-surface interfaces in schools also impact air quality.

An evaluation of the impact of flooring types on exposures to fine and coarse particles within the residential micro-environment using CONTAM notes that walking across the floor will aerosolize particles on the floor and put them back into the air. If those particles are viruses or bacteria, it creates the threat of infection. If it is dirt, pollen or chemicals, the risk moves toward asthma triggers.

Hand hygiene is and always will remain critical to controlling infection. Proper hand hygiene will impact the health of staff and students.   Effects of Hand Hygiene Campaigns on Incidence of Laboratory-confirmed Influenza and Absenteeism in Schoolchildren, Cairo, Egypt  studies the effectiveness of intense hand hygiene.

Reducing Absenteeism From Gastrointestinal and Respiratory Illness in Elementary School Students: A Randomized, Controlled Trial of an Infection-Control Intervention concludes that “A multifactorial intervention including hand sanitizer and surface disinfection reduced absenteeism caused by gastrointestinal illness in elementary school students. Norovirus was found less often on classroom surfaces in the intervention group. Schools should consider adopting these practices to reduce days lost to common illnesses.”

Clean air, hands and surfaces will impact the health of your employees, volunteers and students.  An ounce of prevention is worth a pound of cure.  Infection control is for everybody, even schools.

Fostering environment where employees work sick costs more than it saves

Faced with the choice of working while sick or sitting out and not getting paid, most will work while sick. Pros and Cons of Sick Pay Schemes: Testing for Contagious Presenteeism and Shirking Behavior takes a look at the ramifications. Most organizations’ human resource policy is focused on short term goal. It is clearly that way with sick pay. While it might take some logistics wrangling, there generally are duties that can be accomplished at home. It is time to get smart and realize that working sick hurts business as well as the bottom line.

The spread of disease in a facility happens quickly, as noted in Office Germs: Viruses Spread Everywhere in Just Hours, Study Shows. Bacteria and viruses move through the water system, on the air, and are moved around a facility on shoes, hands and clothes. Dr Gerba’s study showing how quickly the bacteriophage MS-2 virus moved throughout and office was enlightening.

How long do nosocomial pathogens persist on inanimate surfaces? A systematic review shows that bugs can remain viable on surfaces for hours, even weeks.

Bugs (viruses, bacteria and fungi) all move through the air.  The CDC always talks about droplet precaution.  It contends that droplets fall out of the air to a surface within six feet of the patient. MIT showed droplets moving 6-8 meters through the air in Studying the Science of 100 Sneezes. High-speed video shows how far sneezes spread in The snot-spattered experiments that show how far sneezes really spread. Droplet nuclei can remain suspended in air for extended periods, according to ASHRAE.

Focusing on cleaning for health, hand hygiene and sub-micron air filtration is a must for a healthy environment.

Taking a look at Legionella bacteria and its sources, impact

twoLegionellosis is a respiratory disease caused by Legionella bacteria. Sometimes the bacteria cause a serious type of pneumonia (lung infection) called Legionnaires’ disease. The bacteria can also cause a less serious infection called Pontiac fever that has symptoms similar to a mild case of the flu. The bacteria can be found in most water systems, and is fairly common. Below are a few pieces that discuss the bacteria and the disease.

Legionnaires’ disease: Can it be found in water systems? says that “it is important to note that Legionella can be effectively controlled. When controlled properly, the bacterium represents a minimal health risk and emergency actions should not be required. The key to preventing an outbreak of Legionnaires’ disease starts with the municipal water system.  Additionally, a good building water management plan, responsibly implemented, should control the bacteria from colonizing to dangerous levels within individual building water systems.”

Monochloramine for controlling Legionella in biofilms: how much we know? concludes that “The presence of Legionella within a biofilm makes eradication from water system very difficult. Among the antimicrobial agents, monochloramine (MC) seems to be more effective for decreasing Legionella within the biofilms in vitro as well as in model plumbing systems. As of to date there are no published reviews on this topic, a critical and comprehensive update on the progress in the field is necessary.”

Legionella Control in Institutional Water Systems suggests that “a residual of chlorine-based disinfectant is indispensable because it is effective against the majority of bacteria and viruses and other germs that commonly cause waterborne disease, and it provides continuing protection as water journeys from the treatment plant to your glass.”

Also:

·         Relationship between antibiotic- and disinfectant-resistance profiles in bacteria harvested from tap water.

·          Water heater temperature set point and water use patterns influence Legionella pneumophila and associated microorganisms at the tap

Studies explore the impact of environment on productivity

The environment can have a profound impact on productivity, and below are links to a series of studies that explore this with a variety of approaches.

The office experiment: Can science build the perfect workspace? – Windows, desks and employees are being wired up in a quest to create healthy, evidence-based environments. is a study that seeks to determine  how the indoor environment influences health, well-being and performance, from stress to sleep quality, physical fitness to productivity.  Related podcast.

Airborne Respiratory Diseases and Mechanical Systems for CONTROL OF MICROBES notes that airborne respiratory pathogens and diseases in health care facilities are numerous and dangerous. HVAC systems are critical in controlling them.

BUILDING INVESTMENT DECISION SUPPORT (BIDS™): Cost-Benefit Tool to Promote High Performance Components, Flexible Infrastructures and Systems Integration for Sustainable Commercial Buildings and Productive Organizations is a study that shows the cost of dirty air in the work place is much more than the cost of energy per person.

Also: What Your CEO Is Reading: Office Science; Fonts Save the World; Luxury of Work

Forced migration creates health problems, enhances spread of disease

twoForced migrations designed to contain disease generally don’t work as planned, as several studies and articles listed below show.

Refugee camps a “breeding ground” for illnesses: “United Nations aid agencies say hundreds of thousands of refugees are living in unacceptable conditions at camps. These people fled their homes because of violence in the Middle East and Africa. The U.N. agencies are blaming serious food and water problems at many refugee camps for the spread of life-threatening diseases. Officials say cholera, malaria and jaundice — combined with malnutrition — are threatening refugees who had hoped to be safe after they entered the camps.”

Refugees, Forced Displacement, and War notes that “women make up high proportions of refugee and internally displaced populations, and they suffer unique consequences of war and conflict because of gender-based violence, discrimination, and caretaking roles. Refugee women are especially vulnerable to infectious disease, as well as threats to their mental health and physical safety.”

Mental Health at Refugee Health Technical Assistance Center says that “Since 2000, over 600,000 refugees have been settled throughout the U.S., coming from countries as disparate as the former Soviet Union, Somalia, and Vietnam. The often traumatic reasons for leaving the host country as well as the potentially long and hazardous journey and process of resettlement increase the risk for refugees to suffer from a variety of mental health issues. While the screening for and treatment of infectious diseases has been studied and practiced for decades, the identification and treatment of mental health problems has lagged far behind. Complex and varied cultural contexts and languages, scattered refugee populations, and the relative lack of evidence-based interventions have made it difficult to carry out concerted and standardized efforts.”

Restricting population movement is a largely ineffective way of containing disease, yet governments sometimes resort to it where health crises emerge, according to Health crises and migration. In 1951, the World Health Organization (WHO) adopted the International Sanitary Regulations – renamed International Health Regulations (IHR) in 1969 – with the objective of maximum prevention of the spread of infectious diseases with minimal disruption of travel and trade. The assumption was that “migration was unidirectional, and that diseases could be stopped at international borders. Individual and collective responses to health crises contribute to an orderly public health response that most times precludes the need for large-scale displacements. … Despite their adherence to the IHR, countries sometimes revert to isolation and restriction, threatening or deciding to close borders or to impose travel restrictions in an attempt to prevent infections from entering their territory. Here’s an audio version of the article.

Also: Tuberculosis in migrants moving from high-incidence to low-incidence countries: a population-based cohort study of 519 955 migrants screened before entry to England, Wales, and Northern Ireland

 

Water is a source of secondary infection that cannot be overlooked

threeWater is a source of secondary infection. Chlorination is commonly used to control levels of bacteria in drinking water; however, viable bacteria may remain due to chlorine resistance, according to a piece at PubMed (Relationship between antibiotic- and disinfectant-resistance profiles in bacteria harvested from tap water.) What is concerning, the piece notes, “is that surviving bacteria, due to co-selection factors, may also have increased resistance to common antibiotics. This would pose a public health risk as it could link resistant bacteria in the natural environment to human population. . . . The presence of chlorine-resistant bacteria surviving in drinking-water systems may carry additional risk of antibiotic resistance.”

Healthcare costs for infections linked to bacteria in water supply systems are rising at Science Daily, is a  new analysis of 100 million Medicare records from US adults aged 65 and older reveals rising healthcare costs for infections associated with some disease-causing bacteria, such as Legionella, which can live inside drinking water distribution systems and household plumbing.

Impact of Water Chemistry, Pipe Material and Stagnation on the Building Plumbing Microbiome at PLOS One reports that “a unique microbiome establishes in the portion of the potable water distribution system within homes and other buildings (i.e., building plumbing). . . .  Data were examined across utilities to identify a true universal core, special core, and peripheral organisms to deepen insight into the physical and chemical factors that shape the building plumbing microbiome.”

Building design must include health considerations as well as energy concerns

Emergency Room SignLeadership in Energy & Environmental Design (LEED) might be missing the mark by focusing on energy more so than health. While we believe the energy implications of design are important, we don’t think those concerns trump building for health. We think focusing on the human health aspect is critical, designing for infection control. Most existing data is tied to hospitals but can be generalized into virtually all other industries. Design principles going forward need to focus on removing human error as well as persistent cleaning technologies. We need to focus on air, surfaces, water and hands.

Infection Control for Design & Construction Projects: Minimizing risks to maximize recoveries is a comprehensive look at construction design and processes and their impact. It’s put together by Linda D. Lee, DrPH, for the Waste Management 2010 ASHES Conference and is well worth taking a look at.

Engineering Infection Control through Facility Design, done by Centers for Disease Control, notes that “many medical centers have modified their facility design to provide a safer environment for patients. From an infection control perspective, the primary objective of hospital design is to place the patient at no risk for infection while hospitalized. We describe historical landmarks about hospital design, modern facility design, and specific designs to prevent acquisition and spread of infections such as tuberculosis and aspergillosis”.

BUILDING INVESTMENT DECISION SUPPORT (BIDS™): Cost-Benefit Tool to Promote High Performance Components, Flexible Infrastructures and Systems Integration for Sustainable Commercial Buildings and Productive Organizations discusses best design option, cost-benefit factors and organizational scenarios. Notably, among the benefits of high performance buildings, the piece notes that there is health cost savings related to workman’s compensation, medical insurance costs, health litigation costs, environmental evaluation & remediation and lost work time.

Mass transportation provides ideal conditions for disease to spread

twoMass transportation is most probable path for future pandemics. The need for better hygiene is needed. A few studies below support this and are worth taking the time to have a look at.

A measles infection at Kansai International Airport in Japan has recently created concern. Thirty-two employees were found to be infected with measles, creating risk for other employees and travelers alike, who if infected could carry the disease to faraway places. It’s important to recognize the outbreak of illness to keep it from spreading.

The air quality in mass transport buses, especially air-conditioned buses may affect bus drivers who work full time. Microbial air quality in mass transport buses and work-related illness among bus drivers of Bangkok Mass Transit Authority is a study where bus numbers 16, 63, 67 and 166 of the Seventh Bus Zone of Bangkok Mass Transit Authority were randomly selected to investigate for microbial air quality. The standard deviation of the buses studies indicated they had elevated fungal and bacterial counts.

Bacterial contamination on touch surfaces in the public transport system and in public areas of a hospital in London aimed to investigate bacterial contamination on hand-touch surfaces in the public transport system and in public areas of a hospital in central London. The researchers concluded hand-touch sites in London are frequently contaminated with bacteria and can harbor MSSA, but none of the sites tested were contaminated with MRSA. The significance and impact noted is “hand-touch sites can become contaminated with staphylococci and may be fomites for the transmission of bacteria between humans. Such sites could provide a reservoir for community-associated MRSA (CA-MRSA) in high prevalence areas but were not present in London, a geographical area with a low incidence of CA-MRSA.”

The Role of Human Transportation Networks in Mediating the Genetic Structure of Seasonal Influenza in the United States highlight the importance “of utilizing host movement data in characterizing the underlying genetic structure of pathogen populations and demonstrate a need for a greater understanding of the differential effects of host movement networks on pathogen transmission at various spatial scales.”

Previously, at our blog:

Norovirus can be transmitted in variety of ways, including through the air

Norovirus is a seriously contagious virus that can infect anyone, according to Centers for Disease Control. You can get it from an infected person, contaminated food or water, or by touching contaminated surfaces. Additionally, ample research says it can be transmitted through the air. The virus causes your stomach or intestines or both to get inflamed. This leads you to have stomach pain, nausea, and diarrhea and to throw up. These symptoms can be serious for some people, especially young children and older adults, the most vulnerable among us.

Norovirus can have significant economic impact, too. Global Economic Burden of Norovirus Gastroenteritis is a study at PLOS One that “developed a computational simulation model to estimate the economic burden of Norovirus in every country/area (233 total) stratified by World Health Organization region and globally, from the health system and societal perspectives. We considered direct costs of illness (e.g., clinic visits and hospitalization) and productivity losses.” It says that globally, Norovirus resulted in a total of $4.2 billion (95% UI: $3.2–5.7 billion) in direct health system costs and $60.3 billion (95% UI: $44.4–83.4 billion) in societal costs per year. In part it concludes that “the total economic burden is greatest in young children but the highest cost per illness is among older age groups in some regions. These large costs overwhelmingly are from productivity losses resulting from acute illness. . . . Our findings can help identify which age group(s) and/or geographic regions may benefit the most from interventions.”

NoroCORE Food Virology at YouTube is an informative piece that takes a look at food-borne Norovirus illness. NoroCORE and the Perfect Pathogen: USDA-NIFA Efforts to Control Norovirus is a related piece at Contagion Live that reports Norovirus is the leading cause of food-borne illness in the United States, with 5 million of the reported 21 million annual cases linked to contaminated foods. The cost of illness is estimated to be billions of dollars per year.

‘Cruise Ship’ Norovirus Bug Can Spread by Air, Study Finds is a piece at U.S. News and World Report discusses Norovirus and its connection to a series of cruise ship illness. It cites research that finds Norovirus can spread through the air and infect people several feet away.

Norovirus GII.4 Detection in Environmental Samples from Patient Rooms during Nosocomial Outbreaks explores transmission, including through fecal-oral vectors as well as airborne transmission through aerosolized vomitus.