ACTE HYGIENE IN THE 21st CENTURY
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Transcript of ACTE HYGIENE IN THE 21st CENTURY
HYGIENE IN THE 21st CENTURY
Sheri L. CarlinoDr. Charles P. Gerba
Department of Soil, Water and Environmental Science
University of ArizonaTucson, AZ
Life in the 21st Century Most of our time is spend indoors (80 - 90%) More people work in offices than ever before We travel more than ever before We spend less time cleaning than the last
generation (50% less than 50 years ago) We are less clean (e.g. laundry practices) We spend more time in public places We are more mobile and have more electronic
equipment (e.g. cell phones, ipods) We share more common surfaces (fomites) with
more people than ever before in history
Challenges in Infection Controlin the 21st Century
Infectious diseases are the 3rd leading cause of death in the United States today. They are 1st in the developing world.
Continued emergence and re-emergence of pathogens (SARS, MRSA, bird flu, etc)
A more susceptible population (aging population, cancer treatment) – 30 to 40% of
U. S. population at greater risk of serious illness and death)
Cleaning vs. HygieneCleaning is “the removal of
unwanted matter”Hygiene is “reducing the risks of
infection”Good hygiene had more impact
on human health than the development of vaccines and antibiotics
Did you know??
80% of all common infections (colds, flu, diarrhea) can be spread through the environment (air, water, food, fomites)
~800,000,000 cases of respiratory and enteric infections per year in the U.S.
Unmarried males experience one cold per year and unmarried women 1.3. Couples with school children experience 2.3 colds per year each. School children experience an average of 3.5 colds per year.
What are Fomites?
Inanimate objects involved in the spread of disease
Hand vs. Sneeze
Role of fomites in transmission of a disease
Sick person sneezes, coughs and pathogens falls on fomite or get aerosolized.
Pathogen falls on fomites e.g. phone, computer
Person picks up pathogen through contaminated fomite. Person touches nose or eyes
with Contaminated fingers and Becomes infected with pathogen.
Mouthing Events in Children (per hour)
81 times under two years42 times two thru five years
A child swallows the about of dirt on six kitchen floor tiles per day
Hand Contact in Adults
Adults touch their face 15.5 times per hour 2.5 eyes 5 nose 8 lip
Identifying Critical Control Points
Home/Work/Play/Shopping
Coliform Bacteria and E. coli
Coliform bacteria and E. coli are found in feces and their presence on surfaces indicates……………..contamination by feces and the potential presence of disease causing microorganisms
Germs at Home
Coliforms in the Home by Location
-2
-1
0
1
2
3
4
5
6
7
Geo
met
ric
mea
n pe
r cm
2 or
per
mL
Bath Sink
Kitchen Floor
Bath Counter
Bath Floor
Toilet Seat
KitchenSink
Sponge Cutting Board
The Importance of Cleaning Tools in the Spread of Germs
“Breeders”
“Spreaders”
• The kitchen is more heavily contaminated than the bathroom.
• Ordinary cleaning practices do little to reduce the microbial load.
• Risk of infection could be reduced by greater than 99.99% on cutting boards and kitchen counter- tops by use of hypochlorite cleaning products.
Germs at Home Summary
Bacteria on Shoes Shoes worn at least three months Total bacteria
13,600 to 8,000,000 sq cm Coliform bacteria
10 to 72,000 sq cm Present on 96% of shoes
E. coli Present on 27% of shoes
A Microbial Zoo Living on the Bottom of your Shoes
E. coli Aeromonas hydrophila Klebsiella pneumoniae Serratia marscesens Pseudomonas fluorescens Pseudomonas luteola Pantoea spp.
Shoes and Microbial Transport
Germ viewpoint –Shoes are made for walking
Left Shoe Right Shoe
1 ft 1,000 110
2 ft 400 10
3 ft 10 20
4 ft 240 90
5 ft 140 30
6 ft 100 640
66,000,000
Bacteria (105)
Virus (107)
68,000,000
23,000,000
27,000,000
21,000,000
15,000,000
61,000,000
27,000,000
11,000,000
17,000,000
4,200,000
2,600,000
Movement of organisms on shoes during walking – keeping in step with you
Another Brief Run Down of Bacteria Comparisons
(per square inch)200,000 – Carpeting49 –Toilet Seat1,686 Kitchen counter top2,546 Kitchen tile floor - home18,025 Bathroom floor - home
Vacuum Cleaners – Meals on Wheels for Bacteria
Concentrate bacteria and food in one place
E. coli detected on 50% of brushes from homes
Bag less: E. coli and Salmonella growth in collection container
Move bacteria and virus around
Why Do Shoes, Carpet and Vacuums Matter?
Exposure from Laundry
Changes in practices in the U.S
Hot water used only 5% of the time. Most use cold water
Only 12 minute wash Dry for only 3 minutes
Feces in the Laundry
Average pair of underwear contains 0.1 grams of feces (1/2 a Southwest Airlines peanut)
Salmonella 1010 per gram of feces
29
Hospital Scrubs
Total Bacteria
Type of scrub Number of
garments Average CFU/sq
cm
Unwashed hospital 18 180
Home- laundered 26 143
Hospital- laundered 20 4
Hospital Cafeterias
Bacteria isolated from tables MRSA C. difficile Enterococcus E. coli coliforms
31
Household Bath Hand Towels(442 towels tested)
HPC Bacteria Coliforms E. coli
Average 9.2E+08 3.9E+05 1.1E+04
Dayca
re
Playg
rounds
Bus tra
vel
Park
Gym
Theate
rPool
Resta
urant
Work
Doctor's
offi
ce0
5
10
15
20
25
30
35
40
45
5046
3635
2928
26
14 14
1110
% S
urf
ac
es
Po
sit
ive
Environments Most Contaminated With Body
Fluids
52
OCCURRENCE OF COLIFORMS (%) IN YOUR DENTIST OFFICE
64
70
0
0
63
76
67
18
53
50 22
4
OCCURRENCE OF E. COLI (%) IN YOUR DENTIST OFFICE
20
25
48
7
25
Microbiology of Automobiles
Dash board has the most germs followed by drink and change holders
Most bacteria detected in cars was Florida
Most molds in cars was detected in Chicago
Bacteria in Offices
Men Women0
200
400
600
800
1000
1200
Comparison of Bacteria in Men vs Women Offices
HP
C C
FU
/4 s
q in
Ave
rag
e
Comparison of Offices that Use Disinfectant versus Offices that Don't Use Disinfectant
1.00E+01
1.00E+02
1.00E+03
1.00E+04
1.00E+05
Don't Use Disinfectant Use Disinfectant
Ave
rage
Bac
teri
a
Impact of Wiping Table Top in Restaurants with Cleaning Cloths
Germs at School
Germiest Office Occupations
#1 Elementary School Teachers#2 Accountants#3 Bankers#10 Lawyers
Average Toilet Seat
Cafeteria Table Computer Mouse Desk1.00E+02
1.00E+03
1.00E+04
1.00E+05
1.00E+06
1.00E+074.77E+06
1.70E+068.60E+05
Top Three Contaminated Sites in All Schools
To
tal B
acte
ria/
app
roxi
mat
e 10
0 cm
sq
School Study Grade K thru 12
Classrooms
Areas most contaminated with bacteria Pencil sharpener Student desk top Computer Sink in classroom
Viruses isolated Influenza Norovirus Parainfluenza
Impact of Disinfectant Wipes on Absenteeism -Seattle
Study Two school semesters 3rd and 4th graders
Intervention Children’s desk wiped with a disinfectant wipe
at the end of each school day Results
50% reduction in absenteeism
The Curse of the Cruise Ships
Detection of Noroviruses on Fomites –University of Arizona
Winter of 2008 Norovirus most commonly isolated on
• Desk tops (20%) Libraries Dorm rooms
• Vending machines buttons (5%)
Shopping with Germs
Coliform Bacteria in Reuseable Grocery Shopping Bags
51%Coliforms49% Yes
No
Reusable Shopping Bags
E. coli detected in 10% of the bags
Are Food Groups Separated?
25%
75%
Different Bags for Meats & Vegetables
Yes No
Grocery Store Touch Screens(self service)
100% contain bacteria (average 13,000)
Bacteria isolated MRSA E. coli Klebsiella oxytoca Coliform bacteria
(65%)
E. coli Isolation from Shopping Carts
Maine 80% Atlanta 79% Chicago 70% Tucson 0% Los Angeles 10%
Recent study has associated Salmonella and Campylobacter infections in children and placement in shopping carts
Going to the Toilet with Germs
Everybody uses the toilet
Average time in the aircraft restroom for adults
Men 106 seconds
Women 154 seconds
Aerosols are Produced during Toilet Flushing
Fecal bacteria and viruses are ejected from the toilet during flushing.
The droplets settle out in the restroom contaminating the restroom with fecal microorganisms
Commodeograph Water sensitive paper held over toilet seat when
flushed. Purple spots represent water droplets.
E.coli Detected in Droplets
Perti dishes held over toilet when flushed.
Dark spots are colonies of E. coli.
Refillable Liquid Bulk Soap Dispensers
25% are contaminated with millions of bacteria per milliliter
Coliform bacteria was found in 22% of samples
No bacterial contamination was found
in soap dispensed from
sealed systems
No bacterial contamination was found in soap dispensed from sealed systems
Traveling with Germs
Bus Travel increases Risk of Respiratory Infections
The more you ride a bus the more likely you will get a cold (6 times more likely)
Troko et al 2011 BMC Infectious Diseases
Seat – Bacteria/mold growing on Petri Dish
Airplane Trays MRSA – positive on
four different flights Norovirus isolated on
one flight
Vehicle Bacteria per 100 sq. cm.
CommuterTrain
117,000
Bus 83,176
Airplane 3,127
Family Car 5,220
Toilet Seat 186
ANOTHER COMPARISON TO THE TOILET SEAT!!!
Virus Spread between Hotel Rooms
Virus added to one person hand or bathroom counter top
Sample next series of rooms after maids clean and conference room at end of day, tested for virus.
Conference attendees hands
Results Virus detected
Next four rooms cleaned by the maid On surfaces (table tops) in the conference
room On 1/3 of the conference attendees hands On the coffee pot handle
of the breakfast area
Occurrence of fecal bacteria on the hand (United States)
Preparing a meal Greatest
Children after playing
Doing the laundry Least
Person exiting a toilet
Hand WashingTucson, Arizona
95% of people say they wash their hands after using a public washroom67% actually wash their hands
33% of those use soap 16% really wash long enough
Stopping the Spread of Germs
Reducing Risk of Infection from Fomites
Hand washing 30 to 50 % reduction in illness
Alcohol gel sanitizers 30 to 50% reduction Disinfection of fomite surfaces 50% reduction Use of bleach and hot water in laundering reduces risk of transmission
How fast does a virus move inan office building?
Added a virus to the entrance door handle of an office building with 80 persons
Collect samples after 4 and 7 hours from fomites and hands
First place virus detected is the
coffee break room
Virus detection on office workers hands/fomites after times indicated
Results
• The number of people with viruses on their hands was reduced in half (50%). The occurrence of viruses in communal work areas was reduced by more than 80% after four hours and by 70%-100% after seven hours
Hand sanitizers
Just as good as hand washing for bacteria and viruses. New formulations more active against norovirus.
However, not effective against spores like C. difficile.
Proper hand washing is effective in removal of spores.
UV light at the Tap
Point of dispense purification keeps the tap free from contamination
Antimicrobials Disinfectants
Chlorine• In use for more than 100 years• Wastewater treatment plant in Tucson, AZ uses more
chlorine in one day than a household uses in 10,000 years• Usually >99.999% reduction in target organisms
Quats• In use for more than 70 years
Some increase in tolerance by some bacteria, but still effective at normal use applications
Sanitizers Usually >99.9% of target organisms
The FutureSelf-Sanitizing Surfaces
Copper Silver Titanium Dioxide
Summary Fomites will continue play a major role in
disease transmission now and into the future
Good hygiene is not cleaning more, but smarter with a targeted use of disinfectants and cleaning tools
Germ exposure is more likely increasing not decreasing
No long term immunity for common infections
PROPER HANDWASHING
Questions?