Archive for the ‘Front Page’ Category

Kitchen Sponges: Cleaning Tool or Germ Dispenser?

Friday, August 18th, 2017

The notorious kitchen sponge—that germ-ridden object found in many households—is at the center of a new controversy about controlling the spread of infections in the home. Several years ago we reported a University of Florida research team found microwaving spongevery wet sponges for two minutes at high power killed or inactivated over 99 percent of all the living pathogens in sponges and cleaning pads that had been soaked in a “witch’s brew of germs.” Easy and convenient, right? Think again: A team of German researchers using genetic techniques to characterize sponge microbes says that neither boiling nor microwaving sponges may be particularly effective in the long run. Careful testing of alternative sponge treatments is needed, but in the meantime, the researchers recommend the best course may be ditching your kitchen sponge once per week for a new one.

Sponge Microbe Dynamics

First, the German team found the density of bacteria in some portions of 14 German kitchen sponge samples to be equivalent to that found in feces! Significantly, their data show “…regularly sanitized sponges (as indicated by their users) did not contain less bacteria than uncleaned ones.” But in an interesting, Darwinian twist, the researchers suggest the most resistant bacteria in sponges preferentially survive boiling or microwaving, only to repopulate the sponge rapidly after these treatments. Some of these are more pathogenic too, for example, “RG2-related bacteria” identified in the test sponges may have the potential to cause diseases in humans. The scientists state, “…a prolonged application of sanitation measures of kitchen sponges is not advisable.” In other words, the more you “challenge” sponge microbes with disinfection, the more you may encourage the survival of the fittest and most likely to make you sick.

Because kitchen sponges are moist, have high surface area, and are frequently wiped over food preparation and dining surfaces, they are a major agent of cross-contamination. Ironically, the more kitchen surfaces are wiped by the conscientious house cleaner with a contaminated sponge, the more contaminated the surfaces may become. For example, one of the resistant bacteria shown to survive treatment, Moraxella osloensis, is common in sponges and is found consistently on sink, faucet, refrigerator door and stove surfaces. You may have smelled Moraxella; it imparts a disagreeable odor to sponges and laundry.

Scientific Inquiry is Open-ended

The new study demonstrates the ongoing nature of scientific investigation: What we once thought true may not stand the test of the next investigation. The scientific method requires continual testing and reformulation of hypotheses based on meticulously collected data. The scientific method does not guarantee that any given conclusions are correct. The German researchers correctly note that additional studies in this area are needed. We agree and wonder if soaking kitchen sponges regularly in appropriate chlorine bleach and water solutions would be effective. For now, the advice to replace sponges weekly is prudent, but stay tuned!

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Preparing for the Next Flood and its Aftermath

Friday, August 11th, 2017

If you live in a flood-prone area, are you prepared for the next deluge? According to the National Oceanic and Atmospheric Administration (NOAA), fast moving water that reaches just over your ankles can knock you off your feet. And don’t try to drive through it. Driving on flooded roads is the floodmost common thunderstorm-related hazard that can kill you, according to NOAA. It is especially difficult to recognize flood danger in darkness or other conditions of poor visibility. As the National Weather Service urges, if you come to a flooded portion of roadway, “Turn Around Don’t Drown®”.

Head for the Hills

If it is necessary to evacuate your home, head for higher ground at a pre-designated meeting place known to your family. Pet owners should have an emergency plan for their pets that includes shelter, food and water. If possible, turn off electrical power, gas and water supplies before leaving. If flooding is a common risk where you live, you may be able to avoid the backflow of unsanitary flood water into your house by installing backflow valves or plugs on drains or other sewer connections.

Each member of the household should have a pre-packed emergency bag or kit that can be grabbed on the way out the door during a rapid evacuation. The bags should contain at least a change of clothes, a supply of needed medicines to last several days, personal hygiene items, flashlight, drinking water and some packaged emergency food that doesn’t require cooking. At least one bag should contain a first aid kit. Your cell phone can help you stay informed about flooding conditions and in contact with loved ones, so keep it charged especially during “flood season.” A hand-crank radio can be useful for prolonged power outages. Keep your car gassed up and some emergency cash on hand.

When Sheltering in Place

The American Red Cross recommends each household have at least two weeks of supplies at home, including:

  • One gallon of water per person per day or the ability to purify this volume with chlorine bleach
  • Nonperishable food
  • A manual can opener
  • Flashlights
  • Battery-powered or hand-crank radio
  • Extra batteries for flashlights and radios
  • First aid kit
  • Seven-day supply of medications
  • A multi-purpose tool
  • Sanitation and personal hygiene items (e.g., soap, toothpaste and wipes)
  • Copies of important personal documents

Floods may cause public water systems to issue precautionary boil water notices due to turbidity or water main infiltration. If you have electric or gas service for your range, bring tap water to a rolling boil for one minute (or for three minutes if your elevation is greater than 2,000 meters or about 6,500 feet). To augment your water supply, the Centers for Disease Control and Prevention (CDC) recommends sanitizing bathtubs and sink basins with bleach [use about 1 tablespoon of regular bleach (5.25%) or 2 teaspoons of high strength bleach (8.25%) per gallon of water], rinsing, and then filling them with clean water and doing the same with empty soda bottles. (See Water Storage Tips to Assist in Emergency Preparedness.) Stay current with tetanus shots in the event that you sustain a puncture wound or a wound becomes contaminated during or after a flood. Children receive tetanus shots as part of their normal vaccination plans; adults require tetanus boosters every ten years.

Flood Cleanup: Chlorine Bleach Is Your Friend

Flood cleanup starts with removing flood water (usually contaminated with sewage) and drying the affected areas. Evaluate all items touched by flood waters, deciding which to keep and which to toss. Whenever possible, use a disinfecting solution of chlorine bleach to disinfect items touched by flood waters.

  • 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.
    • Wash contaminated clothing in the hottest possible water with detergent and chlorine bleach if fabric instructions permit.
  • If an item got wet, assume it is contaminated.
  • Disinfecting works best when all loose dirt and debris are removed first. That’s why the CDC recommends first washing surfaces with soap and warm, clean water. Next, use a household bleach solution to disinfect.
  • Prepare a bleach 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.
  • When addressing exterior surfaces, such as outdoor furniture, patios, decks and play equipment, keep surfaces wet with disinfecting solution for 10 minutes after removing loose dirt and debris with soap and warm, clear water. This may mean wetting the surface with disinfecting solution more than once.
  • 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 that contacted only clean basement seepage or lawn runoff 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.
  • Chlorine bleach solutions degrade quickly, so be sure to make a fresh solution daily as needed. Unused solution may be discharged into the toilet or sink.

Finally, if you have a private well on your property that is below flood level, it is recommended that under non-flood conditions you extend the top of the well above the expected flood level and install proper seals on all openings into the well to prevent entry of flood waters. If a well is flooded, refer to the US Environmental Protection Agency’s What to Do After the Flood for directions on decontaminating your well.

Fred M. Reiff, P.E., is a retired official from both the U.S. Public Health Service and the Pan American Health Organization, and lives in the Reno, Nevada area.

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Sepsis: A New Global Health Priority

Friday, August 4th, 2017

“Sepsis,” according to the Centers for Disease Control and Prevention (CDC), is “a complication caused by the body’s overwhelming and life-threatening response to infection, which can lead to tissue damage, organ failure, and death.” More commonly known as “blood poisoning,” sepsis strikes “with equal ferocity in resource-poor areas and in the developed world,” according to Dr. Konrad Reinhart, Chairman of the Global Sepsis Alliance. Sepsis is now front and center for the world health community: At a May 2017 World Health Assembly1, sepsis was designated a new global health priority and a resolution was adopted to improve its prevention, diagnosis and management.

Although reliable data are unavailable, globally there are an estimated 31 million cases and some six million deaths from sepsis annually.2 Most of those deaths are preventable, however, with early detection and timely treatment with antibiotics. According to one study involving over 2,000 septic shock patients, following the onset of hypotension (abnormally low blood pressure), each hour of delay in administering an antimicrobial was associated with an average decrease in survival of 7.6%.3 A Perspective in the New England Journal of Medicine by Dr. Reinhart and others notes, “The progression from infection to sepsis can be insidious and is unpredictable.”4


Difficult to Diagnose

The signs and symptoms of sepsis are represented in the CDC poster above. In its early stages, sepsis is difficult to diagnose because many of the signs and symptoms match those for other conditions. A combination of two of these symptoms should be sufficient to suspect sepsis.

Anyone can develop sepsis from an infection, but it is most common in people aged 65 years old or older, children under the age of one and people with weakened immune systems or chronic medical conditions, such as diabetes.

Why are sepsis cases on the rise?

According to the Global Sepsis Alliance, sepsis cases may be on the rise due to a combination of potential factors, including:

✔   Poor socioeconomic conditions

✔   Increased awareness and tracking of the condition

✔   An aging population with more chronic diseases

✔   An upsurge in major surgical interventions and invasive procedures

✔   Broader use of immunosuppressive and chemotherapeutic agents

✔   The spread of antibiotic-resistant organisms


Preventing sepsis starts with preventing infection through:

  • Appropriate hand hygiene
  • Access to vaccinations
  • Access to clean water, sanitation and hygiene
  • Proper disinfection of wounds with iodine, hydrogen peroxide or sodium hypochlorite (see, for example, Vibrio Infection: Rare, but Worth Knowing About)
  • Clean childbirth and surgical practices
  • Increased awareness of sepsis among the public and the medical community so that asking the question, “Could this be sepsis?” becomes more routine

Sepsis has been called “one of the oldest and most elusive syndromes in medicine,”5 and it remains largely unknown to the public. Meanwhile, there are indications that sepsis is on the rise in the US where hospital admissions for the condition have overtaken those for heart attack and stroke6. Sepsis also causes or contributes to half of all deaths in US hospitals and is a leading cause of annual hospital costs. Improvements are needed so that healthcare providers everywhere can better define and code the disease to enable reliable global statistical data.

As Dr. Reinhart and his colleagues note, the World Health Assembly resolution on sepsis has the potential to save millions of lives. We agree and look forward to measurable progress in the struggle to control this subtle killer.


Ralph Morris, M.D., M.P.H., is a Physician and Preventive Medicine and Public Health official living in Bemidji, MN.

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1 The World Health Assembly is the decision-making body of the World Health Organization.

2 Fleischmann, C. et al., (2016). Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations, American Journal of Respiratory and Critical Care Medicine, v. 193, No. 3. On line, available:

3 Kumar, A. et al. (2006). Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock, Critical Care Medicine. On line, available:

4 Reinhart, K. et al., (June 28, 2017). Perspective: Recognizing Sepsis as a Global Health Priority — A WHO Resolution, New England Journal of Medicine. On line, available:

5 Angus, D.C, van der Poll, T. (2013). Severe sepsis and septic shock. New England Journal of Medicine. On line, available:

6 Fleischmann, C. et al. op. cit.

Keeping Your Reusable Water Bottle Clean

Friday, July 21st, 2017
Louisville Water Company promotes filling reusable water bottles with tap water

Louisville Water Company promotes filling reusable water bottles with tap water

The reusable water bottle is one of those “grab and go” items that travel with many of us on a daily basis. The filled water bottle provides a handy means of hydrating on the spot. As we’ve noted, many water fountains now conveniently include water bottle-filling features. There’s just one caveat to deriving the maximum health benefit from reusable water bottles: They should be thoroughly cleaned and sanitized on a regular basis to avoid contamination.

Germs Love Moist Environments

Germs thrive in moist environments such as parts of the cap and interior of your water bottle. As Dr. Charles Gerba of the University of Arizona notes, if you use your fingers to open and close the water bottle cap, there is a good chance that bacteria will be introduced into the cap, where moisture will support its growth. This is yet another reason for appropriate hand hygiene, but we recognize washing your hands before using a water bottle is usually not possible. Perhaps these situations call for portable hand sanitizer use?

According to Gerba, although germs from your mouth transferred by backwash into your water bottle will not harm you, germs from someone sharing your water bottle can make you sick. And if your water bottle buddy is opening the bottle with his or her own hands, well, there’s another opportunity for contaminating the bottle.

Water Bottle Maintenance

It simply won’t do to refill your water bottle day after day without a regular maintenance plan. Here are some suggestions to help keep it sanitized:

  • Open and run top and container body through the dishwasher (if dishwasher-safe)
  • Wash components with soapy water and then sanitize with a dilute solution of bleach. To mix up a sanitizing solution, add 1/2 teaspoon of 8.25% bleach to one quart (4 cups) of water (or 1/4 tablespoon of 5.25% bleach to one quart of water); allow water bottle parts to remain in contact with the solution for two minutes, and then rinse
  • Use dedicated water bottle cleansing tablets purchased online or at sporting goods and camping supply stores

Reusable water bottles have become part of our everyday gear. Get the maximum health benefit from their use by keeping them clean and sanitized!

Chris Wiant, M.P.H, Ph.D., is president and CEO of the Caring for Colorado Foundation.  He is also chair of the Water Quality & Health Council and a member of the National Drinking Water Advisory Council.

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Avoiding Salmonella from Backyard Poultry

Friday, June 16th, 2017

BackyardPoultryBackyard poultry farming is an increasingly popular trend in urban and suburban areas that permit it, giving families a fun way to raise food while learning to care for animals. Assuming roosters are banned in the neighborhood for their earsplitting “cock-a-doodle-doo,” what could be the downside of raising poultry in the backyard? The answer is illness. Unfortunately, outbreaks of Salmonella infection linked to backyard poultry are on the rise. We have described this type of disease in a previous article as a “zoonotic disease,” which is one that can spread between animals and humans under natural conditions, e.g., in your own backyard.

According to the Centers for Disease Control and Prevention (CDC), Salmonella bacteria reside in poultry droppings and on the feathers, feet and beaks of poultry, even though the chicks and ducklings may appear clean and healthy. Any human contact, whether through handling poultry directly or contacting cages, coops, feed and water dishes, hay, plants and soil in the area in which the poultry live, can expose backyard poultry farmers to Salmonella bacteria.

Multistate Outbreaks

According to the CDC, there were a record number of illnesses associated with backyard poultry in 2016. Currently, CDC advises there are eight Salmonella outbreaks linked to backyard poultry nationwide. As of May 25, 2017, there were 372 cases of illness reported from Salmonella bacteria in 47 states; 71 people have been hospitalized. The outbreaks have been associated with chicks and ducklings from several hatcheries. Are these outbreaks grounds for abandoning your dream of a backyard flock? Hardly! As always, knowledge is power, and understanding how poultry can transmit bacteria to humans is half the battle when it comes to avoiding infection. The other half is implementing safe practices around live poultry.

Tips for Backyard Poultry Farmers1

  • Wash Your Hands with soap and water after touching live poultry or objects in their environment. Wash your hands after touching shoes or clothing that have come in contact with live poultry or their environment. This is especially important for children, who frequently put their hands in their mouths.
  • Keep Poultry Out of Your Living Space. Do not let live poultry inside your house or even on your patio, deck or porch.
  • Do Not Eat Where Poultry Live and Roam. Your risk of infection rises if you eat where poultry live and roam.
  • Protect the Most Vulnerable. Children under the age of five, adults older than 65 and people with weakened immune systems are the most vulnerable to infection and should not handle live poultry or related equipment.
  • Clean and Disinfect all Poultry Equipment Outdoors, including cages, feed and water containers. According to the University of Minnesota Extension, undisinfected coops frequently carry Salmonella. Always clean before disinfecting for best results. Those who clean chicken manure should wear a proper face mask and ensure good ventilation while working.
    • The US Department of Agriculture provides a handy cleaning and disinfecting checklist for backyard poultry owners and recommends applying a US Environmental Protection Agency (EPA)-registered disinfectant, such as chlorine bleach2, that is effective against avian influenza virus or other diseases of concern, such as salmonellosis. Information on the effectiveness of the disinfectant and disinfecting directions will be on the product label.
  • Chlorinate Poultry Drinking Water. The University of Minnesota Extension website notes that routine chlorination of poultry drinking water to a minimum of 1-1.5 ppm free chlorine has been reported in research to reduce the spread of Salmonella.
  • Do Not Snuggle or Kiss Poultry or Let Children Do So, as cute as chicks and ducklings may be.
  • When Collecting Eggs
    • Wash hands after collecting eggs.
    • Collect eggs often to avoid eggs becoming dirty or breaking; throw away cracked eggs.
    • Dirt and debris clinging to egg shells can be removed with fine sandpaper, a brush, or cloth.
    • Do not wash eggs as cold water can pull bacteria into the egg.
    • Refrigerate eggs after collecting them.
    • Cook eggs thoroughly to destroy Salmonella, which could be present in eggs.

A breakfast of fresh eggs from the hens in the backyard coop is a delicious reward for the work that goes into raising poultry. Stay well and productive by being an informed backyard poultry farmer!

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1 Tips are based on CDC’s “Advice to Backyard Flock Owners.” Online, available:

2 According to Clorox, Salmonella on surfaces can be destroyed with a solution of ½ cup of 8.25% chlorine bleach added to one gallon of water; apply to surface free of dirt and droppings (clean surfaces first) and leave wet for 5-7 minutes. Finally, rinse with plain water.


A New Resource to Help Curtail Norovirus: Pictogram Disinfection Posters

Friday, May 12th, 2017

Norovirus, the dreaded illness popularly known as the “stomach bug,” is the leading cause of gastrointestinal upset in the US. According to the US Centers for Disease Control and Prevention (CDC), there are 19 to 21 million cases of norovirus in the US annually. The highly contagious virus is an unwelcome visitor in schools, day care and elder care settings, offices, sporting venues, cruise ships and more. Norovirus presents the greatest health risk to young children and the elderly. norovirus prevention poster norovirus cleanup posterGlobally, the economic burden of norovirus hovers around $60 billion in healthcare costs and lost productivity.

The Perfect Pathogen

As described by CDC’s Dr. Aron J. Hall in an “Editor’s Choice” article in The Journal of Infectious Diseases in May, 2012, norovirus may be the “Perfect Pathogen,” because, among other factors, it:

  • Is quickly and profusely shed through diarrhea and vomiting.
  • Only requires a minimum of about 18 viral particles to infect an individual (up to five billion infectious doses are present in each gram of feces from an infected person).
  • Is environmentally stable; it can survive both freezing and heating, although not thorough cooking; it is resistant to many chemical disinfectants; it can persist on surfaces for up to two weeks.
  • Rapidly evolves before the population develops immunity.
  • Is associated with a low mortality rate. Of nearly 700 million annual cases of norovirus worldwide, there are approximately 219,000 deaths, a mortality rate of only about 0.031%. Its low mortality rate helps keep the virus alive and spreading to others.

Given these characteristics, norovirus will continue to be a force to be reckoned with at least until a successful vaccine is developed and disseminated.

Norovirus Disinfection Posters

In 2013, a team of public health and consumer advocates was convened by the American Chemistry Council’s Chlorine Chemistry Division to develop a set of clear instructions for disinfecting surfaces against norovirus using appropriate solutions of chlorine bleach. The need for simple-to-follow directions was great, according to a request from the New Jersey Somerset County Department of Health. The ad hoc task force included representatives from the New Jersey Somerset County Department of Health, CDC, the National Environmental Health Association, the Water Quality and Health Council and the American Chemistry Council. The posters developed by the group are available on the “Resources” page of the Water Quality and Health Council website, and have been downloaded tens of thousands of times.

Discussions at the Albuquerque Norovirus Conference in the summer of 2016 identified the fact that some food industry and other workers do not read in any language (not even their own), prompting the need for a set of norovirus “pictogram” posters to illustrate with as few words as possible norovirus surface clean up and disinfection steps. The ad hoc group that developed the first set of “language” posters (now in English, Spanish and French) reconvened and welcomed the input of our colleagues from the City of Albuquerque Environmental Health Department in developing the new poster resource. The pictogram posters, illustrated at the top of this article, are the proud product of our careful collaboration, and join the “language” posters as freely downloadable resources from the Water Quality and Health Council website. It is our sincere hope that all of these posters will be used widely to help curtail the spread of the notorious norovirus.


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

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Fancy Meeting You Here! Targeting Household Germs in Unexpected Places

Friday, April 7th, 2017

PerspectivesPic1When the weather warms up after a long winter, I get the urge to throw open windows and tackle spring cleaning chores. It’s a great feeling of accomplishment to complete these chores, but I recently learned from WebMD that some of the germiest places in homes are not even on most people’s radar. The table below, based on information from WebMD, lists the most unexpected hiding places for household germs, the reasons why they thrive in those places, and how you can reduce their unwanted presence.


Germ Hangout

Why They Love it There

What to Do About it

Kitchen sponge For germs, the kitchen sponge is a moist maze of top-notch dwelling places. Not only is there regular contact with water, but there is also often plenty of food debris swept up in sponges to sustain germs.

According to WebMD, your kitchen sponge is probably the dirtiest thing in your house.

Researchers from the University of Florida report microwaving very wet sponges for two minutes at high power kills or inactivates more than 99 percent of all sponge germs. (See For Disinfecting Sponges, Microwaving is a Simple Solution.)

Kitchen towels and dish cloths should be replaced daily and laundered using chlorine bleach, if fabric instructions permit.

Kitchen sink Lots of germs are washed into the sink when meals are being prepared; germs may originate from raw vegetables, fruit, meat, fish or poultry. The constant supply of water and food in the sink encourages germs to proliferate. Disinfect sink sides and bottom twice per week using a kitchen sanitizer. And pour a solution of one teaspoon of bleach in one quart of water down the drain once each month.
Toothbrush holder Toothbrushes harbor bacteria from your mouth, and when kept near the toilet in your bathroom, can even become contaminated with fecal bacteria. Toothbrush holders harbor these same germs. First, position your toothbrush holder as far away from the toilet as possible. Do not allow adjacent toothbrushes to touch, and run the toothbrush holder through the dishwasher once a week. The good news is that toothbrush holders keep brushes vertical, which permits better drying between uses, and germs want moisture. Want to cut down on the germs you transfer to your toothbrush? Use an antibacterial mouth rinse before you brush your teeth.
Dog bowl Fido might appear to lick his food and water bowls “clean,” but don’t be fooled: Pet bowls are havens for microscopic “pets,” such as bacteria. Wash pet bowls daily with hot, soapy water. Once per week, soak bowls for about 10 minutes in a solution made by adding a cap of chlorine bleach to one gallon of water.
Coffee maker The chamber that holds the water in your coffee maker is dark and moist, “home, sweet home” for bacteria. Give those bacteria a jolt by filling the water chamber with a few cups of white vinegar. Wait 30 minutes, then turn the machine on and let the vinegar run through. Follow up by running clean water through the machine.
Stove knobs Stove knobs are frequently touched, but often overlooked during cleaning. Stove knobs contact the hands of cooks, who shift back and forth between the stove and other food preparation spots, transferring germs and food debris to the knobs. Remove stove knobs and give them a hot, soapy bath once per week. If knobs cannot be removed, clean them in place.
Bathroom faucet Bathroom faucets are contacted by hands in need of washing by virtue of the reason people enter the bathroom in the first place. According to WebMD, faucet handles in the bathroom sink have more germs on them than the toilet handle or the bathroom doorknob. Motion-sensing faucets are an ideal solution, but short of that major investment, sanitize your bathroom and kitchen faucet handles daily using a kitchen or bathroom disinfectant.
Countertops Countertops are like bus stops for germs. These surfaces are where we may drop off and pick up the “germ du jour.” Daily, we deposit all manner of objects on countertops, and then proceed to wipe them down with our kitchen sponge (see public enemy #1 at the top of this list).   Is it any wonder that they become contaminated? Wash countertops with warm, soapy water, rinse and use a disinfectant recommended by the manufacturer of your countertop.

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

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Preventing Infection with Environmental Controls: A “Broad-spectrum” Approach

Friday, March 31st, 2017

Environmental ControlsAs reports of the dangers of antibiotic-resistant bacteria and “superbug” infections continue to make headlines, we think the time is right to consider the environmental controls at our disposal for fighting the spread of infectious illness. Environmental controls lower the risk of infection by taking the fight against pathogens into the environment. Once implemented, environmental controls can be thought of as offering “broad-spectrum” antibiotic protection.  

Examples of Environmental Controls in Preventing Infection

Disinfecting frequently touched surfaces: Hand contact with pathogens on frequently touched surfaces, such as door knobs and hand rails, is a common way to spread infection. Surfaces may look clean but looks can be deceiving, and the surface may be teeming with germs invisible to the naked eye.  Once hands are contaminated, the host has only to touch his or her face—especially the eyes, nose or mouth—to increase the likelihood of infection. Regularly disinfecting frequently touched surfaces with disinfectants, such as dilute chlorine bleach solutions, can go a long way toward lowering the risk of infection.  

Appropriate handwashing: Handwashing for at least 20 seconds with warm, soapy water can send most hand-clinging germs down the drain (see “The Right Way to Wash Your Hands”). When soap and water are unavailable, alcohol-based hand sanitizer (with at least 60 percent alcohol) is a good compromise. Attention to hand hygiene is particularly important before preparing food, eating, and after using the bathroom or changing diapers.  

The Centers for Disease Control and Prevention calls handwashing a “’do-it-yourself’ vaccine that is “…one of the best ways to remove germs, avoid getting sick, and prevent the spread of germs to others. It’s quick, it’s simple, and it can keep us all from getting sick. Handwashing is a win for everyone, except the germs.” In many situations, especially in public settings, handwashing is the most proactive measure an individual can take to avoid infection.  

Engineering solutions: We can also dodge pathogens with smart engineering solutions. Recently we wrote about a “staged mode of transmission” of superbug bacteria which, once washed down the drains of hospital sinks, colonize the P-shaped portion of the drainpipe and grow slowly back up toward the sink strainer. From there they are strategically positioned to be launched into the environment when running water impacts the strainer area. One way to avoid this exposure could be to relocate sink drains to an area of the sink not directly below the default faucet position.

Other engineering solutions that can help curtail the spread of germs are:

  • Antimicrobial copper alloy (such as brass or bronze) door knobs and countertops. 
  • Motion-activated faucets, soap dispensers and towel dispensers in public restrooms.
  • Disposable sanitizing wipes positioned at the entrances to grocery stores to wipe down shopping cart handles.

There is some speculation that the wonderful effectiveness of early antibiotics gave way to a relaxed attitude toward environmental controls. As the development of new antibiotics lags behind the evolution of resistant bacteria, it makes sense to harness all of the tools available to us, including time-tested, “broad-spectrum” environmental controls.  

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Superbugs: Rising from Hospital Drainpipes

Friday, March 10th, 2017

SuperbugsSuperbugs are sneaky creatures. A new University of Virginia (UVA) study reveals how these microbes, once washed down the drains of hospital sinks, colonize the drainpipe and rise up slowly along the sides of the pipe, eventually reaching the sink strainer. The researchers hypothesize that when the sink faucet is operated, the potential pathogens and superbugs may be splashed from the strainer over a distance of more than two feet, presenting an infection risk to vulnerable hospital patients.

A Significant Issue

Superbugs are multidrug resistant bacteria that are responsible for two million cases of illness and some 23,000 deaths per year, according to the Centers for Disease Control and Prevention (CDC) website. A CDC report notes that over 720,000 infections were contracted in hospitals in 2011 and that 75,000 of those patients died. The UVA researchers found over 32 recent reports describing the spread of bacteria resistant to the important antibiotic carbapenem via sinks and other reservoirs of water within hospitals. Most of the reports are associated with “outbreaks in the intensive care setting, affecting the critically ill and the immunocompromised,” according to a related study.

A “Staged Mode of Transmission”

The UVA team describes a “staged mode of transmission” to explain how hospital patients and staff may be exposed to superbugs. The microbes colonize the P-shaped traps, or “P traps,” of hospital sink drainpipes just below the bowl of the basin, where water pools. From there, nourished by various discarded liquids, such as intravenous fluids, feeding supplements and leftover beverages, they migrate back toward the sink at the rate of about one inch per day, moving as a growing biofilm. Biofilms are slimy mats of microorganisms that are difficult to wash away or destroy.

Based on the design of most sink plumbing, in approximately one week’s time the superbugs are present in the sink strainer area. From there, they are well-positioned to be dispersed around the sink and onto adjacent counters by water streaming from the flowing faucet. The frightening scenario culminates with the exposure of patients, who can least fight infection, to antimicrobial resistant superbugs.

Findings from the “Sink Lab”

To better study the stages of transmission of superbugs from hospital sink plumbing, the UVA research team constructed a unique “sink lab.” The lab features five identical sinks modeled after the intensive care unit (ICU) sinks in UVA’s Charlottesville hospital and connected in wastewater plumbing. A harmless form of E. coli was used as a surrogate pathogen. One significant finding from the “sinks in series” design is that the bacteria can spread through plumbing connections to neighboring sinks, demonstrating that the superbugs spread both upward and downward out of P traps.

Preventing Superbug Infections from Sink Drains

Does the design of the hospital sink and its plumbing require modification to help prevent this mode of exposure to superbugs? Is the P-shaped trap—originally designed to prevent the escape of sewer odors—an inadvertent public health risk? Ironically, the sink is often the first destination for people entering and the last stop for those leaving the ICU, as hand-washing is a well-known and strongly endorsed infection prevention control measure. Should hospital sinks be redesigned to prevent water from the faucet splashing into the drain area and casting superbugs into the ICU environment? Or can the P-shaped section of the drain be treated in a way that prevents colonization by bacteria?

Between 2011 and 2012 a superbug outbreak at the National Institutes of Health Clinical Center killed 11 patients. According to an interview with Dr. Tara Palmore, a hospital epidemiologist at the Center, bleach and scrubbing helped end the outbreak. The sink traps were removed and “scrubbed out with wire brushes and bleach,” followed by daily bleach spraying down the drains. Over time, the drug-resistant bacterial colonies were removed. Yet, Palmore notes that there are some very difficult cases in which nothing seems to work.

The UVA team is now working with the CDC to understand exactly how patients may be infected with superbugs emerging from drainpipes. This will help inform the solution to the insidious problem of deadly hospital-acquired superbug infections. We congratulate the researchers on their significant work to date and eagerly await further results of their important efforts.

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

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The Secret Life of Bleach

Friday, January 13th, 2017

Chlorine bleach – that household staple usually parked in the laundry – has additional uses besides “whitening your whites”. During cold and flu season, dilute bleach solutions can be used to wipe down frequently touched surfaces to help prevent the spread of viruses and other pathogens (disease-spreading germs) among family members.

Bleach solutions also destroy bacteria, including Salmonella and E. coli, common foodborne pathogens that may lurk on kitchen work surfaces. Used smartly, bleach solutions pack a powerful punch against germs that can make your family sick.

How Does Bleach Destroy Bacteria?

Several years ago, a University of Michigan research team led by Dr. Ursula Jakob, studying the effects of heat stress on bacteria, inadvertently discovered the mechanism by which bleach destroys bacteria. The short, entertaining video above, “The Secret Life of Bleach,” features creative animation that describes the mechanism of bacteria destruction.

As the video demonstrates, exposure to bleach causes proteins—which are complex, three-dimensional structures that control the life functions of bacteria—to permanently unfold, an effect that is analogous to a house collapsing. 

Bleach in Our Bodies

One of the fascinating points made in the video is that the human body produces and uses chlorine bleach internally as a natural disinfectant. White blood cells are “little bleach factories,” according to Dr. Jakob, that are activated to destroy bacteria detected inside the body, helping to fight disease. How interesting to think that the inventors of bleach probably never realized their own bodies were creating and using this substance naturally!

Thanks to Dr. Jakob and her team, we now know how bleach destroys bacteria both within us and around us. Bleach is giving up some of its age-old secrets…

Using Bleach for Household Chores*

Task Regular Strength (5.25%) Bleach in 1 Gallon of Water High Strength (8.25%) Bleach in 1 Gallon of water
Wall and floor disinfection following flooding ¾ cup ½ cup
Laundry disinfection and whitening (for a full load of laundry in a washing machine) ½ cup 1/3 cup
Disinfecting nonporous surfaces (e.g., vinyl, ceramic tile, porcelain) against norovirus (“the stomach bug”) 1 cup 3/4 cup
Disinfecting hard surfaces against flu transmission ¼ cup 2 ½ tablespoons
Disinfecting kitchen cloths 3 tablespoons 2 tablespoons
Routine disinfection of food-contact surfaces 1 tablespoon 2 teaspoons

*Table recommendations are partially based on Guidelines for Determining How Much Clorox® Concentrated to Use in Continuous Chlorination Disinfection Systems in place of Clorox® Regular and Clorox® Ultra bleach, Maine Center for Disease Control and Prevention

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