…and don’t forget to dry them!

I went to Alexandra Street Junior School way back when Goole was still in the West Riding of Yorkshire and we were still force-fed warm bottles of milk and cod liver oil on a daily basis. The school isn’t there any more, which is a pity. I believe it closed in 1976. The red brick building was far more attractive than those that now inhabit its space.

I didn’t spend a lot of time at that school. Actually some might argue that I didn’t spend much time at any of the schools I went to for one reason or another. I got by though. The reason for my absence from Alexandra Street between the ages of 5 and 7 was because I developed a nasty infection in my bone marrow called href=”http://www.bjj.boneandjoint.org.uk/content/89-B/5/667.full”>Osteomyelitis. Cause? Probably S. aureus in the first instance but the subsequent chronic infection may have been caused by a number of organisms, including S. epidermidis, Pseudomonas aeruginosa or Serratia marcescans. I was hospitalised for long periods of time and went through some painful surgery and aftercare. Antibiotics were few and far between at the time and the emerging resistance of S. aureus to what was available was perhaps one of the reasons my recovery was so slow. About three years as I recall. Although I wasn’t at Alexandra Street that much, there are lots of things I remember about it. One thing in particular is the toilets!

The toilets were situated across the playground from the school main building. It was a brick-built block with girls toilets on one side and boys on the other. The inner walls were brick as far as I remember and there was no heating in there. The toilet seats were wooden and if one of them had a crack in it you avoided it because it could give you a vicious nip when you got up! The whole place smelled of disinfectant; a little bit like hospitals at the time. The toilet paper was ‘Izal’…and each piece was printed with the message

‘now wash your hands’.izalmessage

It was fascinating stuff; smooth and slippery on one side and a bit more absorbent on the reverse. If you didn’t rub it together to soften it up a bit, it wasn’t very efficient, in fact, it made much better tracing paper than toilet paper. It was great for doing ‘rubbings’ to reproduce coins etc. It was absolutely no good for blowing your nose. The toilet paper was described by the makers as ‘medicated’ and it did smell of disinfectant, contributing to the overall smell in the room and your hands!

Having to walk across the playground to get to the toilet was no problem in the warmth of Spring and Summer but an absolute nightmare in the wet and cold months. Hat, coat, scarf and gloves were required for a visit at this time. You had to be very quick to do the business and I would guess that despite the message on the toilet paper, we were less likely to wash our hands in the Winter months than in the Summer. This remains a factor today.

The sinks (or hand wash basins) were in a row on the right as you entered the building, or left as you came out of the toilet. There was cold water only and the pipes would constantly freeze in the winter. We used to get some excellent icicles from the guttering. I can’t really remember how we dried our hands but I think it was a roller towel; constantly wet and hopelessly ineffective.

Drying your hands, as I have mentioned in previous blogs, is an important part of the hand-washing process. Any item used (outside of the home) for drying the hands that is communal, i.e. roller towel, cotton towels is inappropriate and only serves to redistribute micro-organisms. Either paper towels or jet stream dryers are preferable in these areas. Hot air dryers have been criticised for not being efficient in drying hands because they take too long,  using too much energy and redistributing dust, skin scales and microorganisms into the environment thus posing a cross contamination and infection risk.

How many times have you been into a toilet in a restaurant or motorway services for example and had the opportunity to observe other people’s hand hygiene habits? I can’t help but take note when someone comes straight out of the loo and through the exit, or washes their hands and shakes them a bit before wiping them on the back of their trousers and walking through the door. Very few large public places like railway stations or airports provide paper towels nowadays, although arguably they are the most efficient way of drying your hands and removing bacteria from the skin surface. Rather they, like many other places, opt for the new generation of hot air jet stream hand dryers that, if used as directed dry your hands thoroughly in 10-12 seconds. The Dyson Airblade was the first but it is way too noisy, particularly if there is more than one in use. This has now evolved and the dryers are more compact and 50% quieter. Arguably this system is still not appropriate for clinical areas but certainly ideal for high traffic areas such as motorway services.

The arguments about how efficient hot air hand dryers are is ongoing. I was in a motorway service station the other day and used a hot air dryer with an added beam of UV light that shone onto parts of my hands whilst I was drying them. I had come across UV light as an antibacterial agent before in water purification but thought I would investigate it in relation to hand dryers.The broad aim with the new hand dryers (and I am sure there are variations) is to filter the air that dries your hands so that 99.9% of any harmful organisms present are removed.I really don’t think that’s too important in a motorway service station, is it? I would like to see everyone washing their hands using a reasonable technique and then drying them thoroughly, by whatever means. Let’s face it, as soon as you walk out the door, you’re recontaminating those hands again. BUT, that’s not an excuse for not washing them. We have to remember it’s often the germs that you pick up in the toilet that have the potential for causing infection, for example, E.coliE. coli. Anyway, the jet stream dryers are great; fast and efficient. But what about that UV light?  I think the general consensus of opinion is that it really has no effect on your hands via the hand dryer; they aren’t exposed to it long enough in the time it takes to dry them. Great in theory maybe…but not convincing to me.

Now, the use of UVC in e.g. Asda toilets may be a different thing. The air in the toilets is pretty static so it may be that the constant UV light can effectively kill organisms in the air created by the aerosols from flushing the loo…IF it’s the right concentration. But that’s another story.

Basically, UV kills cells because of the cumulative DNA damage. UV radiation disrupts the chemical bonds that hold the atoms of DNA together in the microorganism. If the damage is severe enough, the damage cannot be repaired and the cell will die. Longer exposure to UV light is necessary to ensure complete kill off of all micro-organisms. Unlike chemical treatments, UV treated air or water does not resist re-contamination.

Inevitably, drying your hands is an important final step in the hand-washing process and should be carried out thoroughly, ensuring no moisture remains on the hand surface, between the fingers or underneath jewellery. I think the arguments can continue in health care as to which is the best method to achieve this but for me the most important thing is to get the public on board and make sure when they wash their hands, they understand how to complete the process.

We have come a long way since I was at Alexandra Street School but the message given out on that toilet paper remains relevant. After using the loo, ‘please wash your hands’. Perhaps we should then write on the mirrors above the sinks…’and don’t forget to dry them!’

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cats, coffee and cash

How clean is your kitchen? If it looks clean, is that good enough? Whatever you do to clean in your kitchen, there are a few simple things that can help. Kitchens, like anywhere else are easier to keep clean if they are actually cleanable. Does that sound daft? It’s not really.

Firstly, it’s important to avoid clutter. A place for everything and everything in its place is a great goal to have. Don’t use worktops as storage areas if it can be avoided. If they are covered in equipment such as toasters, mixers, storage coontainers, kettles and coffee makers, the potential for contamination and the need for regular cleaning are increased.

Do you need to wipe down the surfaces with disinfectant? Well, that depends. Surfaces shuld be kept clean and free from dust and other contaminants. Wipe them down regularly with a cloth rinsed in hot soapy water. I have cats and I don’t know if at night they investigate my kitchen surfaces. The likelihood is that they do, so I use a hypochlorite solution (e.g. Milton or Domestos)to disinfect, or an antibacterial spray and wipe surfaces down before I prepare food in a morning.

my hands are clean!
Look, they’re clean!

 

 

Apparently, there are some ways to discourage your cats from getting up on to those kitchen worktops…they can’t walk on kitchen (tin foil), they can’t stand bubble wrap and they can’t stand the smell of oranges, so if you get an orange kitchen cleaner they won’t get up there ! If you’re really concerned about them jumping up there (and it’s only natural) try one of the above  and let us know what happens.

The cloth that I use may be a disposable one but I don’t change it on a daily basis, rather at the end of the day I soak it in bleach for ten minutes, rinse and then leave to dry overnight. I dispose of it at the end of the week, or sooner if it becomes grossly contaminated or the fabric begins to deteriorate. If it’s a cotton cloth I treat it the same way on a daily basis but wash it in the machine once a week. Research has identified dish cloths as being harbours of potential pathogens but I like to take a common sense view when dealing with them.One thing you can be sure of, if your dish cloth begins to smell, the bacteria levels are…disturbing. Soak it in a bleach solution first, then wash in the machine and leave to dry (preferably on a line outside where the UV rays help to kill any bacteria left) or, throw it out and buy a new one!

Your sink in the kitchen is also a potential reservoir of infection, Sinks should be kept clean and free from limescale. Rinse debris away and then use a disposable coth and hot soapy water to remove grease. A descaler may be needed periodically to remove limescale but not bleach, this just takes colour out of the problem. Limescale presents a nice uneven surface in which germs can breed and it can’t be guaranteed that bleach gets in to all those little crevices, so don’t bother. Use a descaler, leave for the allotted time, rinse with hot soapy water, then dry. You should be left with a nice even surface that is cleanable

Germs…

FAT TOM…need warmth, moisture, food and time to reproduce (they may or may not require oxygen, and some do prefer a slightly acidic environment but not all) so if you remove one or more of those factors then they can’t.Drying is very important in breaking the chain of infection, not only in surface cleaning but handwashing also.Similar attention should be paid to taps and the drainer. Never put bleach down the sink , for all sorts of reasons.It won’t help unblock sinks, it won’t get rid of smells but it will interfere with the environmental bacteria down there which helps to keep unwanted organisms in low numbers and the drain smell free. If you have a septic tank, bleach should only be used in small amounts so as not to interfere with the bacteria levels necessary for breaking down organic waste.

More often than not, it’s not your kitchen you should be worried about but those of places where you and many others go to eat, drink, socialise. One of my biggest complaints is the failure of these big franchises to monitor hygiene standards in their establishments. I went for a coffee and snack with my sister the other day. It was to a coffee shop in Hull, near the Ice Arena. It was quite busy and we had to wait a while to be served because everyone seemed to be having food. I counted three staff on duty. Two serving and one clearing and cleaning. Coffee was prepared by ‘the Barista’ and food was served by another girl. Both took turns in taking money. Neither at any stage washed their hands. The Barista had a disposable cloth in front of the coffee machine which had obviously been in use for a while because it was covered in coffee grounds. Each time a coffee or other drink was made, coffee grounds, milk, foam, ice or syrup potentially were spilled in front of the coffee machine. I saw the surface wiped a couple of times with the same cloth which was then tucked under the coffee machine.I accept, there was no cleaning going on there, it was just physical removal of debris but the cloth should at least have been rinsed out and importantly, hands washed!

Now, I have mentioned how dirty dish cloths are. How do you think they compare to the money we have in our purses and pockets? Money is handled by potentially thousands of people without ever being laundered (well, not by being washed anyway).So, should people who handle money be handling food?

Dirty money.

Some studies have involved swabbing the  hands, currency and credit cards of people in various locations in the UK, and then testing for the presence of faecal bacteria (bacteria from the gut) which can cause nasty tummy upsets if ingested. As you might expect, the subjects’ hands were pretty disgusting, but also, some of the cards and the paper money had as much fecal bacteria on them as you would find in a dirty toilet bowl.No reason to believe that coins, with their uneven surfaces and in many cases, visible dirt, are any different.

So the message is Costa, Starbucks, Nero and others: If your staff prepare drinks and food and then take money, they MUST wash their hands before going on to the next customer. AND, perhaps you should take a leaf out of the NHS book and give them badges stating ‘it’s OK to ask’ so that we can make sure the hands that deliver us the sandwich, cake or coffee are clean by asking “have you washed your hands?”

If you need further advice…get in touch!

A day in the life – retrospectively

Saturday 20th June

Things to reflect on this day…

Chris Evans taking over Top Gear. I think he’ll certainly polarise the audience, not those who are petrol heads and those who are not but those who love Chris Evans and those who don’t. I actually don’t fall in to either category but I will not watch the programme because I liked Top Gear as it was and I can just imagine the new version being TFI Friday on wheels. Yuk! I wait in anticipation for whatever Clarkson Hammond and May can come up with to entertain us in the future.

Contraband. Every time I go into Ikea I help myself to tape measures and pencils. I find the Ikea pencil definitely superior to those of Argos or Screwix and very useful for all sorts of things. It was only the other day when purchasing another piece for my new kitchen that I observed a plastic carton at the checkout desk asking customers to place used pencils in there. Well, of course, my stash of four or five remained in my handbag legitimately because they were unused but they prompted the contraband comment from my son. I wrote the notes for this blog with one of said Ikea pencils.

Now, with my infection control head on and considering the material of the pencils (wood), I could make a case for not making them available for re-use. The wood is porous, the ends  may be chewed and our hands are generally dirty or germ laden so we can assume the pencils are contaminated to varying degrees. Re-using them is just spreading the  risk of cross contamination to other people.If Ikea are to persist with the idea of re-use then maybe they should make hand sanitation available for  use at the checkout after customers have placed them in the pot.

Hand sanitizers may not be as effective when hands are visibly dirty or greasy.

a small magnifying glassWhy? Many studies show that hand sanitizers work well in clinical settings like hospitals, where hands come into contact with germs but generally are not heavily soiled or greasy 1.  Some data also show that hand sanitizers may work well against certain types of germs on slightly soiled hands. However, hands may become very greasy or soiled in community settings, such as after people handle food, play sports, work in the garden, or go camping or fishing. When hands are heavily soiled or greasy, hand sanitizers may not work well. Handwashing with soap and water is recommended in such circumstances CDC.

That airline

I’m currently on a flight back from Spain having spent the last 13 days doing yet more work at the Spanish house. We still didn’t get everything done that we wanted but some progress was made. The dip pool is now tiled and grouted but we can’t fill it with water for two weeks. Let’s hope it’s water tight when we do! Anyway, back to our hosts, Ryanair. At this time of year there is never enough food left for the  passengers on the late return flight to the UK. I know you have to be really desperate to eat on any flight but today we were hungry and the only thing left was chicken sandwiches. In normal circumstances I would say ‘no’ to airline food and ‘no’ to any sandwich with lettuce or salad in it because if the latter is washed properly there tends to be water left on it that finds its way nicely to your sandwich to make it disgustingly soggy. The juice from the tomato doesn’t help either. To get round this problem the producers solution is to smother everything in mayonnaise and create a barrier to protect the bread. Does it work? Today it did for me. The granary bread was fresh, the chicken identifiable and not a trace of  sogginess. All hail Ryanair’s sandwich supplier! I do wonder though, was the lettuce washed and did someone actually dry it and then was it inspected to ensure my sandwich wouldn’t be soggy? I doubt it. I once went to a seminar on food hygiene where an eminent speaker suggested that our salad vegetables should be washed in a weak solution of hypochlorite to reduce the risk of ingesting contaminants such as E. Coli a common cause of diarrhoeal illness. This is not generally accepted but the thorough rinsing with water is most important.

Just a couple more things to say about Ryanair who probably don’t have much of an infection control policy…the tray tables were dirty and…I never saw any attempt by any of the staff to wash their hands. The cabin stewards served food and drinks and handled money without any hand hygiene at all. You watch them and see.

Tick talk…

…time to protect your pets

If you spend any time in the great outdoors, walking, camping, rambling, gardening, farming or you have pets that go outdoors, you need to have some awareness of ticks and how they may pose a danger to you and your pets.

According to http://Wikipedia.org/ , ticks are small arachnids in the order Parasitiformes. Ticks, along with mites constitute the subclass Accrinia. They are ectoparasites that live on the outside of their mammal hosts, feeding on blood. According to Furman and Lewis (1984) who provided a comprehensive study of ticks in California, they are among the most important ectoparasites affecting the health of man and domestic and wild animals. They serve as reservoirs and vectors of many organisms pathogenic for humans and other animals, and cause direct harm by their bites, including irritation, anemia, toxemia, allergic sensitisation, and paralysis.

There are approximately 850 species of tick throughout the world. Scientists have classified them into two families, based on their structure of hard (Ixodidae) or soft

(Argasidae) outer covering. A third family, the Nutalliellidae are known only from a single African species.

Ixodidae

These have a hard outer covering called a scutum. All ticks have three pairs of legs in their immature stage and four pairs as an adult. They cannot fly but crawl towards their food source which they detect through sensory apparatus called ‘Haller’s Organ’ which locates odour, heat and humidity. They climb up on tall grass and when they sense an animal is close by they crawl on to it. Geographic distribution of Ixodidae depends on various factors, including temperature, humidity, vegetation and host density (Estrada-Pena 2001). (http://www.researchgate.net/publication/11828266_Forecasting_habitat_suitability_for_ticks_and_prevention_of_tick-borne_diseases ).

Life Cycle

All ticks have four stages to their life cycle: egg, larvae, nymph and adult.

Spring: Adult lays eggs on the ground.

Summer: (Depending on temperature and moisture) Eggs hatch into larvae. The larvae find their first host; usually small bird or rodent. They feed off their host for several days, then detach and fall onto the ground.

Autumn: The well fed larvae now molt into the next cycle and are called nymphs.

Winter: The nymphs remain inactive during the winter months.

Spring: The nymphs become more active and find their second host (usually a rodent, pet or human) and feed again

Once the nymph is well fed it detaches and falls to the ground where it molts and changes into an adult.

Autumn: During the Autumn months the male and female adults find another host (usually a rodent, deer, pet or human and feed and mate, falling back on to the ground. The male tick now dies and the female lives on, laying eggs in the Spring. On average, each female tick lays approximately 3000 eggs.

Before feeding, ticks that infest pets are very small, typically less than 1mm. Nymphs are 1-2mm long and adults 3-5mm. Engorged adults however can be up to 2cm long and 50-100 times larger than when unfed!

Engorged tick

Tick borne diseases.

Tick borne illnesses are caused by infection with a variety of pathogens.

Apparently, dogs are more likely to be affected by ticks than cats,the rationale being that dogs are more likely to get into ‘tick territory’. For pet owners like me that regularly find ticks on my dog and cats it is not necessary to know the particular species of tick, only how to remove them safely. Tick bites are not usually painful to the pet because of the natural painkillers introduced during the biting process. This supposedly increases the risk of the tick avoiding detection during the day long feeding process. The blood loss incurred from a few ticks is irrelevant but if a pet is bitten by hundreds, blood loss can lead to anaemia.

If you notice your dog or cat scratching more than usual, it is more likely to be fleas than ticks

Because of the grooming habits of cats, they are more likely to dislodge ticks than dogs.

Major threats for pets

Almost all tick species transmit one or more tick borne diseases which alter by region. Most vets will be aware of local risks and if presented with a dog or cat that has been bitten by ticks and infection is suspected, they will be able to initiate appropriate treatment. It has to be said that it is mainly dogs that are at risk but cats can also fall victim.

#http://www.dailymail.co.uk/news/article-3068133/Invasion-danger-ticks-Europe-Disease-threat-pets-owners-multiplies-relaxation-controls.html#i-fc21ff216011e75a

Heyman et al (2010) discuss the dangers presenting to both humans and animals from tick borne infections in Europe:

Animal symptoms of these disease are often unspecific and early diagnosis of infection is not always easy to make. It is not uncommon for diagnosis to be too late to save a pet and it is therefore important to ensure that they receive appropriate and timely preventive treatment.

Control

There are chemical pesticides that, applied periodically, keep pets free of ticks. Repellents do not kill ticks but keep them away from potential hosts. Their efficacy is reported as being very weak, lasting a few days, if at all.

Some people advocate the use of home made natural remedies against ticks found on cats and dogs. They are certainly not as efficient as the currently available synthetic pesticides but they are reported to bring only partial relief for a few hours. I have heard of citronella oil, lavendar, rosemary, lemon balm and tea tree oil being used but I have personally been reluctant to go down this path given the lack of evidence regarding their safety. There certainly has to be a balance between potency and safety in their dilution. I would never use a pure oil. Natural does not necessarily mean safe.

#www.huffingtonpost.com/ricjard…/pet-aromatherapy_b_877199.html

There are basically three types of products containing tickisides for pets. They are all for external use only and include:

Spot ons: for monthly administration

Tickiside impregnated collars

Shampoos, sprays, lotions, powders (the low cost alternatives). These products should be used to treat the whole body of the pet, not just the area where adult ticks have been seen. This is because the immature ticks (nymphs, larvae) can’t always be seen with the naked eye.

The spot ons and collars are often able to target parasites other than ticks, including fleas and worms. To me, it makes sense to select these types of products, particularly if your pet is not strictly a house pet.

Removal of ticks

To inspect a pet for attached ticks, carefully and thoroughly feel the body surface for any lumps under the hair. It’s important to pay close attention to areas around the face, ears and eyes. There are conflicting thoughts on how ticks should be removed from either pets or humans. Some people advocate spreading oil, butter, petrol, alcohol or even tea tree oil over the tick and wait until it detaches. I prefer to remove them using tweezers. I grab the tick as close to the skin as possible and pull firmly. After I have removed the tick, I check to ensure the head and body are intact. If the mouth parts are left in the animal they can cause abscess but they usually slough out, just like a splinter. Clean the detachment site after removal of the tick with soap and water and similarly ensure the tweezers are washed, dried and disinfected with a chlorine solution after use. Ensure the tick is destroyed either in an organic solvent such as alcohol or place it in tissue and kill using a hammer or some other heavy device to ensure the outer casing is breached and the tick destroyed.

www2.epa.gov/pets/epa-evaluation-pet-spot-products-analysis-and-plans-reducing-harmful-effects

Furman and Lewis (1984)

Low Gillard P (2012) How to pick your way through the jungle of ectoparastic treatments for dogs and cats Companion 2012 pp 14-18

www.bsava.com/portals/4/knowledgevault/publications/files/companion_january2012.pdf

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#http://www.dailymail.co.uk/news/article-3068133/Invasion-danger-ticks-Europe-Disease-threat-pets-owners-multiplies-relaxation-controls.html#i-fc21ff216011e75a