…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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Noo Shoos

I love shoes and I buy lots but I have many pairs that I’ve never worn! I just don’t have the social life I used to, so often they are spur of the moment buys full of wishful thinking! I might wear them IF I go to…you know what I mean?

So, it is actually unusual for me to throw shoes out, however, the other day I did just that and neither pair were very old! The reason? Well in 2012 I was shopping in a famous department store and spotted a pair of sneakers that I thought were just fabulous. They were light tan suede with some leopard skin and gold embellishments!! I told my husband they would be ideal for dressing up my jeans for the 2013 Bon Jovi ‘Because We Can” Tour which I had a rake of tickets for. They were a bit pricey so I said I’d think about it and then, of course I forgot all about them. However, whilst Christmas shopping I spied them again, but this time they were half price in the sale! I bought them immediately.

I did exactly as I said I would and dressed up my jeans and T’s with my fab shoes. They fit like a glove and were really comfortable. They had to be because I walked miles and miles in them. The BJ tour took us to Glasgow, Manchester and Sunderland in the UK then my sister suggested going to New Jersey to see them on home turf. We had always said we would like to, so we did! It wasn’t worth travelling all that way for one gig at the Met Life Stadium, so we went to both. It was a good job as well because the seats for the second night were awful, with an obstructed view that hadn’t been mentioned when we were buying the tickets.

View of stage at Met Life Stadium, New Jersey 2013

 

photo-2

Other than that the trip to NJ was fabulous. We met some lovely people, including ‘Big Ed’ our taxi driver (we used him all the time) who took us back to the airport in his Hummer because we’d never been in one. Bless him!

photo-3

We went into New York and did a little shopping. We visited the Harley shop to get gifts for our husbands. They ride their bikes…we do the BJ gigs. Good trade!

My Husband, John on his Heritage Softail

 

Back to the shoes! They did a bit of travelling in 2013 and then with our usual trips to Spain and beyond in 2014 (cruised around Australia and had a few days in Kuala Lumpur and Bali to boot!)they had more walking to do. At the beginning of this year they had another long journey when we went to Hong Kong, Taiwan and Vietnam. Again the sightseeing saw us walking miles and wearing those shoes out a little more. They got wet a few times on that trip and that, I think was the beginning of a very speedy demise. They were a little down at heel and the gold edging had begun to crack. A couple of weeks ago I had them on whilst I was cooking and I dropped something greasy on them. That was it…in the bin. Goodbye shoes and thank you for the memories. I will never forget you!

But what, you say, about the second pair that you threw away? Well, they were a pair of sandals. Attractive, comfortable but when you’ve worn them a lot (told you, I wear the same shoes over and over)…smelly. My sister had a similar pair and said she threw them in the wash, so I tried it. DON’T ever put leather shoes in the washer if you value them at all. It washed all the colour out of them and they went from a blue/grey colour to beige. Last time I listen to my sister in matters of washing shoes!! In the bin!

There you have it; two pairs of shoes down, so a real need to buy more, particularly when we anticipate a Bon Jovi tour in 2016. So, last week, off I went. It wasn’t a long search. I knew immediately that these shoes were the ones! Pretty aint they? Kurt Geiger has at last come up with shoes I can wear!

Pretty aint they??
Pretty aint they??

I had gone out in another well worn pair of shoes, my favourite of all time…Skechers ‘Go Walk’. I can recommend them. They’re easy to slip on, comfortable and I have black so they go with most things. A bit pricey you may argue but worth the money in my opinion. Anyway, I didn’t have socks on so I had to ask for some little socks so I could try the shoes on. I kept them just so they couldn’t offer anyone else a used pair. Not that there is anything wrong with my feet you understand but from an infection control perspective, sock sharing is not to be recommended, particularly with the number of people who suffer from fungal nail infections. End result, shoes fit like a glove, comfy, stylish ‘the cat’s whiskers’! so I bought them. They’re in a box in my shoe cupboard now. Question is…will they ever see the light of day again? Time will tell. See ya!

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.

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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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