Our Latest Perspectives Posts

Reduce Your Risk of Getting Sick at the Office
Written by Barbara Soule, R.N., MPC, CIC, FSHEA

officeOffice workers share more than reports and chit-chat when they show up for work each day. They also share germs, according to a new study by University of Arizona microbiologist Dr. Charles Gerba.  A recent article in Mother Nature Network describes how Dr.  Gerba tracked the spread of a harmless virus across surfaces in offices, hotel rooms and health care facilities.

The harmless virus was a surrogate for the flu and norovirus.  Norovirus is a highly contagious virus that annually causes about 20 million cases of illness and up to about 71,000 hospitalizations and 800 deaths. The flu can cause between 3,000 and 49,000 deaths in a given year, according to the US Centers for Disease Control and Prevention.  Gerba found from an initial contamination of one or two surfaces (also known as fomites) in these environments, 40 to 60 percent of available surfaces became contaminated with the surrogate virus within two to four hours.  This can happen in your office and any indoor work setting as well!

Knowing how quickly germs can spread through an office, here are some tips employees can use to avoid getting sick at work through the upcoming cold and flu season:

Tips to Reduce Your Risk of Getting Sick at the Office

  • Wash your hands frequently during the day. Hand washing is one of the most important steps you can take to prevent infectious illness.  Wash your hands with soap and warm water after using the bathroom, after sneezing or coughing into your hands (see 3rd bullet below) or a tissue, before preparing or eating food or touching a contaminated object/surface.  Wash correctly by rubbing your hands together—back and front—and interlocking and releasing your fingers to cleanse between fingers.  Wash for at least 20 seconds. (If you sing the “Happy Birthday” song twice in your head while washing, you’ve met the minimum requirement.)
  • Use hand sanitizer when hand washing facilities are inconvenient or unavailable. Small bottles of alcohol hand rub can be kept at your desk or in key locations in the office, such as the “break room”. To be effective, the alcohol-based hand rubs should be used following instructions (e.g., using recommended amounts of hand sanitizer per use) and rubbed until dry.
  • Be mindful of the potential to spread germs via handshaking.  Refrain from touching your face after shaking hands. Keep hand sanitizer in your desk, purse or brief case for discreet use after handshaking.
  • Cough into the crook of your elbow instead of your hands. Your elbow is not the germ transporter that your hands are!  Practice good respiratory hygiene.
  • Use a clean paper towel to act as a barrier between you and the bathroom door handle as you exit the restroom.  Door handles are a common source of infection.
  • Prepare your lunch on a disposable plate or paper towel instead of directly on the counter of the employee kitchen. In Dr. Gerba’s study, the coffee break room was the first place to be contaminated. Ask your employer to provide disinfecting wipes for kitchen surfaces such as microwave touch pads, refrigerator and cabinet handles and drawer pulls.  Gerba found that the spread of viruses could be reduced by 80 to 99 percent by using a combination of disinfecting wipes and proper hand hygiene.  The US Environmental Protection Agency lists all disinfectants that are registered for use against norovirus. These disinfectants are also effective against flu viruses.
  • Keep disinfecting wipes near commonly used computers and telephones and use them to wipe down keyboards, computer mice, telephone push keys and receivers.
  • Use your knuckle instead of the pad of your finger to depress elevator keys or automatic door openers.
  • Keep your hands away from your face to help prevent germs travelling from fingers to your eyes, nose and mouth.
  • Cleanup with chlorine bleach.  CDC recommends applying a chlorine bleach solution or other EPA-registered disinfectant to surfaces affected by vomiting or diarrhea (see downloadable poster directions in English and Spanish).
  • Stay home when you are sick! It may be the perfect time to telecommute, if you feel up to working. Your fellow employees will appreciate your courtesy, and just might follow your good example when they become sick.
  • Make sure you are getting adequate sleep, eating a healthy diet, and exercising to shore up your immune system.
  • Get a seasonal flu shot.  According to the CDC, the single best way to protect against the flu is to get vaccinated each year. The flu vaccine is recommended for all people over the age of six months, with rare exception.  See your doctor if you have questions about getting a flu shot.

Barbara M. Soule, R.N. MPA, CIC, FSHEA is an Infection Preventionist and a member of the Water Quality & Health Council. 

Chikungunya in the States
Written by A Guest Article by Sabrina Jacobson

chikungunya

Have you heard about the Chikungunya virus? Although it is rarely fatal, its symptoms include fever and severe joint pain. Originally only present in countries in Asia, Europe, and Africa, it is gaining a presence in the United States after being carried to the Caribbean. Starting in late 2013, a few Carribbean vacationers contracted Chikungunya, but the number of cases there has increased exponentially. This article will update you on what is happening with Chikungunya in the US since the Water Quality & Health Council’s first report on the virus.

Recently St. Lucie County health officials in Florida have been going door-to-door in order to warn citizens about the spread of the Chikungunya virus. Why should they warn people of this virus that has previously only existed as imported cases? If people contacted this virus only by vacationing in the tropics, why would we need to warn local people? Actually, a few people who did not vacation in the tropics have acquired this disease. CDC reported on the first locally acquired case of Chikungunya on July 17, which was picked up by a man in Florida. Since then, there have been at least four officially reported locally acquired cases of Chikungunya in Florida.

Locally Acquired vs. Imported Cases

What is a locally acquired case and how does it differ from an imported case? An imported case occurs when a person gets bitten by a mosquito while vacationing overseas and shows symptoms of the virus 3-7 days later, usually back at home. A locally acquired case occurs when someone who has the virus gets bitten by a mosquito while at home allowing the mosquito to acquire the virus through their blood. Then, the same mosquito bites someone else who develops Chikungunya.

Activity in the States

chikungunya_map

Data from CDC Website

So what should you do? Make sure to take precautionary measures against mosquitos- especially if you are vacationing in the Caribbean. Also, if you know of someone with Chikungunya, make sure that they avoid mosquitos as well so that they don’t help transfer it to other people. Although Chikungunya has only been locally transmitted in Florida, it would not be very difficult for it to be transmitted in another state as well. If a mosquito were to pick it up, it could easily be spread to more people in a state. Lastly, keep your eyes open for more news about Chikungunya.

To Protect Yourself from Mosquitoes, EPA recommends:

  • Choosing the right repellant and using it safely
  • Removing all still water at least once a week from outside of your house (birdbaths, trash can lids, etc.) and keeping swimming pools chlorinated and circulated
  • Wearing long-sleeved shirts and pants when possible and tucking in shirts
  • Staying indoors when mosquitos are active
  • Using yellow “bug” lights instead of ordinary lights
  • Filling in cracks around your home and repairing broken screens to keep mosquitos out

 

Sabrina Jacobson is a summer intern at the American Chemistry Council’s Chlorine Chemistry Division.

Cleaning up Safely after Flooding
Written by Joan B. Rose, PhD

Cleaning up Safely after FloodingTorrential rainfall in the Midwest and Northeast US this week led to flash flooding, filling basements with water and sewage, which can contain hundreds of pathogens. Residents should assume flood waters are contaminated and that exposure to these waters may raise the risk of diarrhea, dysentery, even hepatitis, skin and eye infections and respiratory disorders.

The first step in the cleanup operation is to remove flood water and sewage and dry the affected area. Powerful fans and enhanced ventilation are helpful for drying damp structural surfaces. Meanwhile, it is important to evaluate items contacted by flood waters, deciding what to discard and what to keep. Whenever possible, a disinfecting solution of water and chlorine bleach should be applied to affected surfaces of saved items.

To help prevent disease transmission associated with flood cleanup, the Water Quality and Health Council offers the following tips:

  • When using a disinfecting solution to clean up after a flood, remember to:
    • Wear gloves and protective clothing. Do not touch your face or eyes.
    • Change the disinfecting solution often and whenever it is cloudy.
    • Be thorough. Wash and dry everything well.
    • When finished, wash your hands thoroughly with soap and water for at least 20 seconds, even if you have worn gloves.
  • If an item got wet, assume it is contaminated.
  • Disinfecting works best when all loose dirt and debris are removed first.
  • Use a disinfecting solution (3/4 cup regular strength chlorine bleach or 1/2 cup concentrated bleach to one gallon of water) to disinfect walls, floors and other surfaces touched by floodwaters. Keep the area wet for at least two minutes, then rinse thoroughly and dry.
  • Carpets and rugs that have been soaked for more than 24 hours should be discarded. If carpets and rugs were soaked for less than 24 hours, evaluate as follows: Carpets that contacted sewage-contaminated floodwater should be discarded. Carpets contacted only clean basement seepage or lawn runoff into a sub-basement, for example, may be dried and cleaned. Washable throw rugs usually can be cleaned adequately in a washing machine. For more information on cleaning flood-damaged carpets and rugs, see this North Dakota State University website.
  • When addressing exterior surfaces, such as outdoor furniture, patios, decks and play equipment, keep surfaces wet for 10 minutes (this may mean wetting the surface more than once), then rinse thoroughly and dry.
  • Chlorine bleach solutions degrade quickly- be sure to make a fresh solution daily as needed. Unused solution may be discharged into toilet or sink.
  • Contaminated clothing should be washed in the hottest possible water with detergent and chlorine bleach if fabric instructions permit.

Disinfecting Private Wells

If the wellhead has been submerged by floodwaters, the well has most likely been contaminated.

If microbial contamination is suspected (if well was flooded or if water is unusually cloudy, odorous or tastes different), immediate disinfection is recommended. If contamination is discovered through water sampling, disinfection is required. Private well water consumers may choose to have their water sampled again immediately after disinfecting to be certain water is safe to drink. Thereafter, periodic sampling can help provide assurance of good drinking water quality.

Consumers of private well water may contact the local health department for advice on well disinfection. This task can be carried out either by ground water professionals or by the homeowner using an array of information resources available from state and local health departments and government agencies. See, for example, the US Environmental Protection Agency’s website, “What to Do After the Flood” at: http://water.epa.gov/drink/info/well/wh atdo.cfm

Note: Depending on the local geology, it is possible for an aquifer (underground water-bearing formation) to become contaminated by floodwater. In such cases, disinfecting the well may not ensure safe water. Aquifer contamination by floodwaters usually clears up after a period of time, but until water sampling confirms good water quality, the household served by a private well should disinfect all water used for drinking and food preparation.

Joan B. Rose, PhD, is the Homer Nowlin Chair in Water Research at Michigan State University and a member of the Water Quality and Health Council.

Ebola: What You Should Know
Written by Ralph Morris, MD, MPH

The deadly Ebola virus is on the move in the West African nations of Guinea, Sierra Leone, Liberia and Nigeria (see outbreak map.) As of August 7, CDC reports the outbreak has infected over 1,700 people and claimed the lives of more than 900. Ebola Hemorrhagic Fever – the formal name of the disease – first appeared in 1976 in Sudan and the Democratic Republic of Congo. The virus was introduced to humans through close contact with the organs, blood, and other bodily fluids of infected animals, such as chimpanzees, gorillas, fruit bats and monkeys.

Ebola has closed schools in Liberia and prompted the president of Sierra Leone to quarantine affected neighborhoods and conduct house to house searches for people who might have been exposed to the virus. What should you know about Ebola?

Important Facts about Ebola1

  • Ebola becomes contagious only when symptoms appear in infected people. It is NOT contagious in an individual without symptoms.
  • Symptoms of Ebola include: fever, headache, joint and muscle aches, weakness, diarrhea, vomiting, stomach pain, lack of appetite and abnormal bleeding.
  • Symptoms may appear anytime from two to 21 days after exposure to the virus; most commonly, symptoms appear between eight and ten days after exposure to the virus.
  • Ebola infections are fatal up to 90 percent of the time.
  • Transmission of the Ebola virus is through direct contact with bodily fluids2 of an infected individual or through exposure to objects like needles that have been contaminated with infected bodily fluids. Based on a 2012 experiment in which Ebola was spread from pigs to monkeys without direct contact between them, CDC and the World Health Organization (WHO) are also concerned about the potential for limited airborne transmission.
  • Ebola is not transmitted from contaminated food or water.
  • Although researchers are working on vaccines, as of now there are no medicines or vaccines to cure Ebola. However, a highly experimental serum, “ZMapp,” a monoclonal antibody, is showing promising results in reversing the course of the disease (see CNN Health report).

The Role of Infection Control

CDC Information for Travelers

On July 31, CDC issued a “Level 3” alert to avoid nonessential travel to Guinea, Sierra Leone and Liberia. A Level 3 alert protects travelers and limits their use of overburdened clinics and hospitals in outbreak-affected regions. Consult the CDC Ebola Hemorrhagic Fever webpage for updates on Ebola’s geographic spread.

Practice good hand hygiene, washing your hands frequently with soap and warm water for at least 20 seconds; if soap and water are unavailable, alcohol-based hand sanitizer may be used.

Because Ebola symptoms usually take between eight and ten days to appear, and early symptoms may be nonspecific, it is possible that the virus will continue to spread geographically by travelers from West Africa who do not know they are infected. That is why it is so important, according to the WHO, that healthcare workers “apply standard precautions consistently with all patients – regardless of their diagnosis – in all work practices at all times. These include basic hand hygiene, respiratory hygiene, the use of personal protective equipment (according to the risk of splashes or other contact with infected materials), safe injection practices and safe burial practices.”

WHO notes further measures for healthcare workers caring for patients with suspected or confirmed Ebola virus include avoiding exposure to the patient’s blood and body fluids and direct unprotected contact with the possibly contaminated environment. WHO provides explicit directions for preparing bleach solutions for disinfecting reusable equipment, gloved hands between patients, spills of infectious body fluids and more.

Halting the Outbreak

The World Health Organization documents 24 Ebola outbreaks between 1976 and 2012. Commenting on “the biggest and most complex Ebola outbreak in history,” CDC Director Tom Frieden, MD, MPH noted CDC would supplement its current staff of approximately 24 disease control experts in West Africa with 50 additional workers to assist efforts to prevent Ebola-infected people from boarding airplanes. In the event that a sick passenger does board a plane, CDC has issued guidance to airlines for managing ill passengers and crew and for disinfecting aircraft.

There is no question that in addition to CDC participation, this outbreak will require harnessing a strong global public health partnership among the nations of the world. It’s what we need to do to combat the Ebola killer.

Ralph Morris, MD, MPH, is a Physician and Preventive Medicine and Public Health official living in Bemidji, MN.


1 Based on CDC information at: http://www.cdc.gov/vhf/ebola/outbreaks/guinea/qa.html and World Health Organization information at: http://www.who.int/mediacentre/factsheets/fs103/en/
2 Bodily fluids that may transmit Ebola include blood, urine, stool, semen, saliva and sweat.

Avoiding Chikungunya and Other Mosquitoborne Illnesses
Written by Ralph Morris, MD, MPH

Chikungunya
Chikungunya is spread by Aedes mosquitoes, which are found throughout much of the world.

A pediatrician returned home to Minnesota recently after providing voluntary medical service in Haiti. She arrived with “crushing joint pain” from chikungunya (pronounced: \chik-en-gun-ye), a viral infection spread by mosquitoes. The exotic-sounding disease can cause high fever in addition to joint and muscle pain. These symptoms are similar to those of dengue, another mosquitoborne illness that currently threatens the popular FIFA World Cup™ games in Brazil.

According to the Centers for Disease Control and Prevention (CDC), chikungunya is rarely deadly and most people feel better within a week, but for some, joint pain may persist for months.  The Minnesota pediatrician declared to the Minneapolis Star Tribune:  “I’ve broken a bone. I’ve had other medical issues. I don’t think I’ve ever been in so much pain.”

“That which bends up”

The term “chikungunya” comes from the African Kimakonde language, meaning “that which bends up,” a reference to the stooped appearance of those suffering with joint pain brought on by the virus. Mosquitoes become infected with the virus after biting someone with chikungunya; they then spread the virus when they bite others. CDC notes that people at risk for the most severe symptoms include newborns infected around the time of birth, older adults and people with medical conditions such as high blood pressure, diabetes or heart disease.  If you develop symptoms of chikungunya, seek medical attention and be sure to tell your doctor if you have traveled recently.

A Spreading Infection

The World Health Organization reports outbreaks of chikungunya have occurred in Africa, Asia, India and Europe.  The virus appeared in the Caribbean region late in 2013; since then, over 100,000 cases have been recorded.  CDC is monitoring the spread of chikungunya, which so far has not been transmitted locally on the US mainland.  According to a CNN interview with a CDC expert, however, based on a current major outbreak in the Caribbean, “it’s just a matter of time before it starts to spread within the United States.”

Tips for Avoiding Chikungunya1 and Other Mosquitoborne Illnesses

There are no vaccines available to avoid mosquitoborne chikungunya, dengue and West Nile Virus.  Control depends upon a multi-barrier approach to mosquito exposure:

  • Physical Barriers:  Use air conditioning or window/door screens to keep mosquitoes out of indoor areas.  Keep screens in good repair. If you are not able to protect yourself from mosquitoes inside your home or hotel, sleep under a mosquito bed net.
  • Chemical Barriers:  Use insect repellent2 before going to tropical (e.g., the Caribbean region) or wooded areas near water.  Be sure outdoor swimming pools and hot tubs are properly chlorinated.  If you use both sunscreen and insect repellent, CDC recommends applying sunscreen first, followed by insect repellent.3
  • Habitat Protection:  Remove standing water where it may collect in depressions, buckets, flower pots and other open containers.  These are choice locations for mosquito breeding.  If standing water cannot be easily drained, treat with chlorine bleach.
  • Clothing:  Wear long sleeves and long pants outdoors when possible.  Aedes mosquitoes—transmitters of chikungunya and dengue viruses—are most active during daylight hours. According to a CDC Fact Sheet, many of the mosquitoes that transmit West Nile Virus are active from dusk to dawn.
  • Transmission to Others:  Finally, if you are sick with a mosquitoborne illness, avoiding mosquitoes and their bites will help prevent spreading the virus to others.

A Word to the Traveler:  CDC’s interactive Travelers’ Health website can help you stay healthy while away from home.

 

Ralph Morris, MD, MPH, is a Physician and Preventive Medicine and Public Health official living in Bemidji, MN.

 


1 Based on CDC “Protect Yourself from Mosquito Bites” and the World Health Organization “Chikungunya”.

2 According to CDC, repellents containing DEET, picaridin, IR3535, and oil of lemon eucalyptus and para-menthane-diol products provide long lasting protection against mosquitoes.

3 Always follow label instructions when using insect repellent or sunscreen.

Middle East Respiratory Syndrome Corona Virus: MERS-CoV
Written by Barbara Soule, R.N. MPA, CIC, FSHEA and Joan B. Rose, PhD

Norovirus Season  Its Not Over Til Its OverAn Emerging Virus

Middle East Respiratory Syndrome, “MERS,” is a respiratory illness caused by an emerging coronavirus1.  Although other coronaviruses are common, the MERS coronavirus (“MERS-CoV”) has only recently been reported to infect people.  Symptoms of MERS include fever, cough and shortness of breath.  MERS has proven fatal for approximately 30 percent of individuals infected.  There is no vaccine or antiviral treatment for MERS, according to the Centers for Disease Control and Prevention (CDC).  Supportive therapy, such as assisted breathing devices may be provided to patients during the illness.

First reported in Saudi Arabia in September, 2012, CDC recently noted the frequency of reporting of MERS cases has increased since mid-March of this year.  Most cases of MERS are in the Middle East. Headlines were made in May when single cases of MERS were announced in Indiana, Florida and Illinois; the Illinois diagnosis was later determined to be in error.  The Indiana and Florida cases involved individuals who contracted MERS in Saudi Arabia and then traveled to the US.  CDC notes that most US residents have a very low risk of contracting MERS.

Animal Origin?

MERS Outbreak Statistics

The World Health Organization reports since April, 2012, 636 laboratory-confirmed cases of human infection with MERS, including 193 deaths (statistics as of May 28, 2014). Most MERS cases represent people in the Middle East, but also include people who had recently travelled from Middle Eastern countries. The latest MERS disease outbreak news can be found on the World Health Organization’s Global Alert and Response web page.

According to the CDC, it is likely that MERS came from an animal source, possibly camels or bats; the virus has been detected in these animals in the Middle East.  Some people who were infected with MERS had close contact with camels or with other persons infected with the virus.  The potential mode of transmission from animals to humans is not understood, but human to human transmission through close contact and contact with contaminated surfaces and/or virus transfer to the hands are all probable.  Viruses on the hands are transmitted to the eyes, nose or mouth through touching.

Who is at Increased Risk?

According to CDC, you may be at increased risk of contracting MERS if you:

  • Traveled recently to the Arabian Peninsula
    • If you develop fever and symptoms of respiratory illness within 14 days of travel to countries in or near the Arabian Peninsula, notify a healthcare provider of your recent travel and stay home to reduce the possibility of spreading the illness to others.
  • Have close contact with an ill person who recently traveled to the Arabian Peninsula
    • Monitor your health for 14 days after having had close contact with the ill person. If you develop fever and symptoms of respiratory illness, call ahead to a healthcare provider and mention your recent contact with the traveler.
  • Have close contact with a confirmed or probable case of MERS
    • Contact a healthcare provider for an evaluation.

Prudent Precautions

Disinfecting Surfaces

University of Michigan researchers showed that keeping surfaces disinfected is just as important as hand washing to reduce your risk of viral infection.2 The research was done as part of the Center for Advancing Microbial Risk Assessment, supported by the US Department of Homeland Security and the Environmental Protection Agency.

To reduce your risk of MERS, CDC recommends:

  • Wash your hands often with soap and water for 20 seconds and help young children do the same; alcohol-based hand sanitizer may be used when soap and water are not available.
  • Clean and disinfect frequently touched surfaces such as toys and doorknobs. A  Colorado State University fact sheet recommends one minute of surface contact with a 1:10 solution of household bleach and water3
  • Cover your nose and mouth with a tissue when you cough or sneeze, and then throw the tissue in the trash.
  • Avoid touching your eyes, nose and mouth with unwashed hands.
  • Avoid personal contact, such as kissing, or sharing cups or eating utensils, with sick people.

For more information on MERS, please see this CDC website.

 

Barbara M. Soule, R.N. MPA, CIC, is an Infection Preventionist and a member of the Water Quality & Health Council.

Joan Rose, PhD, is the Homer Nowlin Chair in Water Research at Michigan State University and a member of the Water Quality and Health Council.

 


1 Coronaviruses are named for the crown-like spikes on their surfaces.  Coronaviruses cause everything from the common cold to Severe Acute Respiratory Syndrome (SARS).

2 Li, S. et al. (2009).  “Dynamics and Control of Infections Transmitted From Person to Person Through the Environment,” American Journal of Epidemiology, 170(2): 257-65.

3 5,000 parts per million free available chlorine

What Can You Safely Mix with Bleach?
Written by Linda Golodner

Can bleach be mixed with…?1

Toilet bowl cleaner?

NO

Rust remover?

NO

Acids, such as vinegar or lemon or lime juice?

NO

Ammonia?

NO

Cleaning products containing ammonia?

NO

Plain water?

YES

Laundry detergent2?

YES

Mixing Cleaning ProductsWhen tackling household cleaning chores, soap and water and a little “elbow grease” are sufficient for ridding many surfaces of dirt and grime. When cleaning kitchen and bathroom surfaces, however, disinfectants are needed to destroy bacteria and viruses like E. coli, norovirus, salmonella and listeria, methicillin-resistant Staphylococcus aureus (MRSA) and other microorganisms that can spread illness.

One effective and inexpensive option for disinfecting surfaces is a simple solution of chlorine bleach and water. Most routine household disinfection can be done using just one teaspoon of bleach in one quart of water. Disinfecting surfaces can help ensure a healthier environment for your family. Disinfecting safely is another matter.

Mixing bleach with other cleaning products could produce hazardous gases! The key to using bleach safely is keeping it simple: Avoid mixing bleach or bleach-containing products with other cleaning products. And never, ever mix bleach or products containing bleach with ammonia or acids! For example, toilet bowl cleaners, which often contain acid, should never be mixed with bleach in a bucket, toilet, or anywhere. Always read and follow manufacturers’ directions carefully

Keep it simple: When disinfecting surfaces with bleach, just add water.

Linda Golodner is President Emeritus of the National Consumers League and Vice Chair of the Water Quality & Health Council.


1This list is not comprehensive of all the potential substances that are incompatible with chlorine bleach.
2Follow manufacturers’ directions on bleach or laundry detergent label.

How a Norovirus Outbreak Ruined Summer Camp

wrestling
Norovirus is notorious for spoiling a good time wherever it shows up, whether onboard a cruise ship1,2, in a restaurant3,4, or even at a musical performance5. In 2005, norovirus made fast work of a summer wrestling camp at a residential college. The camp closed early after over 100 people became sick.  A new scientific study6 of the outbreak provides evidence that norovirus is transmitted by contaminated surfaces and hand contact and airborne spread. It also shows a surface cleaning only approach—without disinfection—may actually increase the severity of an outbreak.

Outbreak Timeline

The timeline below tracks the percentages of the college surfaces testing positive for norovirus against cleaning and disinfecting activities:

wrestling

The illness spread very quickly, as illustrated by the timeline; between July 5 and July 6, the number of sick individuals jumped from three to 38.  The researchers surmise that close physical contact and the common use of mats likely contributed to the rapid spread of the virus to over 100 people ultimately.  Three other camps that shared space with the wrestling camp were also affected by norovirus. These cases may have arisen from contact with contaminated surfaces or from being in close proximity to someone who was vomiting.  (When someone who is ill with norovirus vomits, the virus can become airborne and contaminate surfaces over wide vicinity.)  Surface swabbing of 10 surfaces (doorknobs and toilet seats) on July 21-22, prior to any cleaning or disinfecting, determined 40 percent of surfaces tested positive for norovirus.

Surfaces were cleaned with soap and water on July 30. On August 1, 73 percent of 51 surfaces swabbed (toilet handles and seats, bathroom sink faucet handles, bathroom doorknobs, walls, mattresses, urinal handles, chairs, drinking fountains, and floors) were found to be contaminated.  On August 14, surface cleaning with soap and water was followed by disinfecting with 5,000 mg/l free chlorine (2 cups of chlorine bleach per gallon of water) or disposable disinfecting wipes (quaternary ammonium wipes were used for surfaces that could be damaged by the bleach solution).  The next day, after resampling only those surfaces that had tested positive for norovirus on August 14, the percentage of surfaces testing positive for norovirus had declined to 33 percent.

Cleaning without Disinfecting May be Worse than Not Cleaning at All

Data from this study can help us understand how to help curtail the spread of norovirus in institutions, such as schools and college campuses. The authors conclude that the outbreak could have been fueled by cross-contaminating surfaces when, on July 30, cleaning with soap and water was not followed by disinfecting.  Cleaning cloths and sponges can spread the virus without destroying it. In this way, cleaning without disinfecting may be worse than not cleaning at all.

As this summer camp case study shows, when it comes to wrestling norovirus from contaminated surfaces, only cleaning followed by proper disinfecting will put norovirus “down for the count”.

Barbara M. Soule, R.N. MPA, CIC, is an Infection Preventionist and a member of the Water Quality & Health Council.

 


6Fankem, S.L. (2014). Outbreak of Norovirus Illness in a College Summer Camp:  Impact of Cleaning on Occurrence of Norovirus on Fomites, Journal of Environmental Health, v. 76, no. 8

The Surprising Sneeze
Written by Water Quality & Health Council

Video courtesy of Lydia Bourouiba and John Bush

Ahhh-choooo! An uncovered sneeze projects mucous particles into the air in a way that MIT scientists say permits the resulting “cloud” to travel farther than scientists had previously estimated (MIT press release). The short video above captures this “cloud” using high speed imaging. This research could help improve infection control in hospitals, workplaces, airplanes and other environments.

“Like a Puff Emerging from a Smokestack”

The MIT researchers tell us that a sneeze is more than an expulsion of mucous droplets; a sneeze is an expulsion of mucous droplets within a gas cloud, not unlike “a puff emerging from a smokestack”. The gas medium of this “puff” supports the buoyancy of small mucous droplets, carrying them from five to 200 times farther1 than they would travel in the absence of a gas cloud. In fact, when we sneeze, small droplets travel farther than large droplets because they are more readily entrained in swirling air currents within the cloud. In the absence of the gas cloud, we would expect larger droplets, which have greater momentum, to travel farther than smaller ones.

Coughs and Sneezes Spread DiseasesThe Sneeze

Sneezing is an involuntary response to triggers like allergies, colds, mold, mildew, dust, pepper, cold air, strong fumes and odors. Sneezing, a runny nose and coughing are efficient vehicles for spreading infectious illnesses like colds and flu. The sneeze projects mucous droplets forward where they may be inhaled by others or contaminate commonly touched surfaces.

The Centers for Disease Control and Prevention (CDC) notes that personal hygiene recommendations for preventing the spread of illness through sneezing has changed over the years (see website). The vintage poster at right from World War II urges the use of handkerchiefs to “trap the germs”. Modern CDC recommendations urge the use of disposable tissues and hand washing following tissue disposal. That’s a little different from raising your elbow to your face to cover up the sneeze, which the MIT press release suggests. If a disposable tissue is not available, the next best option is to cough or sneeze into your upper sleeve or elbow, not into your hands.

In their study of the fluid dynamics of the sneeze, the MIT researchers have made an important contribution to our knowledge of the propagation of infectious illnesses. According to the researchers, droplets less than about 50 micrometers in diameter can remain airborne long enough to reach ceiling ventilation units. Once entrained in these units, the potential reach of droplets could increase considerably. What are the implications, then, for ventilation systems, air filters and surface disinfection in the indoor environment? We look forward to future work building on this impressive foundation.


1The researchers found that droplets 100 micrometers (a micrometer is a millionth of a meter) in diameter travel five times farther than previously estimated. Droplets 10 micrometers in diameter travel 200 times farther.

Norovirus Season: It’s Not Over ‘Til It’s Over
Written by Linda Golodner

Norovirus Season  Its Not Over Til Its OverNorovirus—sometimes dubbed “the stomach bug” – is making notable appearances around the nation as winter gives way to spring. Asheville, North Carolina and Alexandria, Virginia schools closed their doors in recent days to disinfect in an effort to stem outbreaks. Virginia students on a class trip to New York City were hospitalized after becoming sick at a performance of “Phantom of the Opera.” Norovirus is being cited as a possible factor in four deaths in a Minneapolis Veterans Home, leading to a hold on new admissions. Weld County, Colorado health officials report at least five outbreaks, most in nursing homes. And norovirus still shows up on cruise ships. According to the Centers for Disease Control and Prevention (CDC), 80 percent of norovirus outbreaks occur between November and April. As the old saying goes, “it’s not over ‘til it’s over,” and norovirus season is definitely not yet over.

Most Vulnerable: The Young and the Old

Norovirus Stats

According to CDC, norovirus is the most common cause of acute gastroenteritis in the US each year, causing approximately:

  • 19-21 million cases of illness
  • 56,000-71,000 hospitalizations
  • 800 deaths

Not to be confused with the flu, which affects the respiratory system, norovirus is a highly contagious virus that targets the human gastrointestinal tract, resulting in diarrhea and profuse vomiting. The CDC notes norovirus can affect anyone, but that symptoms can be serious for some people, especially young children and older adults. Norovirus thrives in closed environments, such as daycare centers, nursing

Tips for Combating Norovirus

  • To protect yourself and others, wash your hands frequently with warm water and soap for at least 20 seconds (the time it takes to hum the “Happy Birthday Song” twice), and dry thoroughly.
  • Stay home if you are sick, and even after symptoms subside, take extra precautions to avoid spreading norovirus, e.g., wash hands frequently and avoid handling food for others for at least three days.
  • Disinfect frequently touched surfaces with a solution of bleach plus water (see posters below).

The Water Quality & Health Council worked with CDC, the Somerset County, New Jersey Department of Health and the American Chemistry Council to develop two downloadable posters on norovirus disinfection (downloadable here). “Clean-up and Disinfection for Norovirus (“Stomach Bug”)” gives directions for responding to a vomiting or diarrhea incident. “Help Prevent the Spread of Norovirus (“Stomach Bug”)” offers tips on disinfecting when norovirus is known to be affecting the community. It is our hope that these posters will be of use in schools, veterans’ homes, nursing homes, cruise ships, and other environments in which norovirus spreads easily.

Linda Golodner is President Emeritus of the National Consumers League and Vice Chair of the Water Quality & Health Council.