I just attended my favorite conference — APHA (American Public Health Association) 2020. Quoting APHA, “The APHA Annual Meeting and Expo is the largest and most influential yearly gathering of public health professionals, bringing the public health community together to experience robust scientific programming, networking, social events, poster sessions and more.”
I was particularly excited this year as the conference was scheduled to be in my “backyard” (Bay Area, California). However, as a result of COVID-19, the event was cancelled and instead moved to a virtual format. That said, I was grateful for the opportunity to experience it in this way. While I did miss the ability to connect with colleagues and meet other passionate public health professionals face to face, I appreciated the ability to jump from session-to-session easily, and the ability to post questions in the chat box. Gone were the days of nervously standing up in front of the crowd and waiting for someone to bring over the mic.
What didn’t change was that the content was relevant and inspiring, and I’m excited to share three top takeaways, with lots of references for you to peruse.
Get ready: The time to prepare for the COVID-19 vaccine is now.
Vaccines are one of the most important tools in the public health toolbox, and I know we are all anxious for a safe and effective COVID-19 vaccine when it becomes available. The good news is that there are currently eight COVID-19 vaccines in stage three (final robust stage to ensure efficacy and safety) of development, and therefore it is likely that we will see one with approval soon. The FDA has also taken measures to ensure approved vaccines will be safe and effective and that the benefits outweigh the risks.
When a vaccine is approved, however, it will take time to vaccinate a significant part of the population, which will be essential in order to move forward as quickly as possible. In fact, until herd immunity is reached, which is the goal of any successful vaccination campaign, current prevention measures will remain important to help mitigate the spread of the infection. So, while a vaccine is coming, social distancing, wearing masks, and hand and environmental hygiene won’t be going away for a while.
Another thing to prepare for is who will get the vaccine first, as demand is surely going to outpace supply. The National Academies of Sciences, Engineering and Medicine has published a Framework for prioritization of vaccines, based on those who need it most. Take a look and see where you and your employees line up.
Double check: Workplace safety is more important than ever.
According to the Occupational and Safety and Health Administration (OSHA), current requirements apply to preventing occupational exposure to SARS-CoV-2 (the virus that causes COVID-19). In addition, there are 28 OSHA-approved State Plans, operating statewide occupational safety and health programs, with standards and enforcement programs that are at least as effective as OSHA's and may have different or more stringent requirements.
Despite these facts, there continue to be concerns about too many workplace related deaths, injuries and illnesses each year, and concern continues to build as the U.S. works to keep the economy strong while controlling the spread of COVID-19. A recent assessment published by The Harvard Center for Population and Development Studies found a correlation between COVID-19 complaints to OSHA, and U.S. deaths 17 days later, suggesting ineffective workplace protections may be a driving factor behind the high U.S. death toll.
This and other data has led to a number of states, including Virginia, Oregon, Michigan and California to take additional measures (in the form of Executive Orders and/or Emergency Temporary Standards) to protect workers against COVID-19. Public health leaders like David Michaels, Ph.D, MD from George Washington University believe that ensuring employee health and safety is essential if we are going to stop the pandemic. With COVID-19 cases at an all-time high, it’s a good time to double check that you are doing everything possible to protect yourself and your employees from the consequences of infection with the virus.
OSHA also requires employers to protect workers from exposure to hazardous chemicals used for cleaning and disinfection, which is another important consideration given the increase in cleaning and disinfecting that many businesses have adopted as a result of the pandemic.
Get involved: Public Health is everyone’s business.
While much of public health is funded by government and non-profit organizations, public health helps everyone and should be a shared responsibility. The more we can all get involved, the less reliant we will be on the government for this basic human right.
Getting involved is easy. Here are some ideas to help you get started:
- Learn more about public health and public health issues. This can be done by reviewing the recently published Healthy People 2030 priorities, the renewed 10 Essential Public Health Services, attending free webinars sponsored by APHA, and by attending APHA 2021 in Denver Oct 22–27.
- Provide health and wellness programs for all employees, and prioritize keeping them safe at work by preventing exposures to dangerous situations and workplace accidents. As an added bonus, helping employees stay physically, mentally and emotionally healthy can pay dividends for businesses later on.
- Prioritize the development of products and services that seek to make a difference to public health.
- Donate funding, expertise and/or time to groups that work hard to improve public health.
- Volunteer in Public Health.
If you’re already involved, these ideas can help you continue with your public health journey. Remember, as the late C. Everett Koop (former pediatric surgeon and U.S. Surgeon General) once said, “Health care is vital to all of us some of the time, but public health is vital to all of us all of the time.”
Have you been asked to take on the role of part time cleaner in your facility or business? If so, welcome to the club!
With the COVID-19 virus still widespread across the U.S., employers everywhere, from schools, offices, athletic facilities, movie theaters, hotels, restaurants, hospitals, and more, are asking non-cleaning staff to clean.
In a recent back to school survey, more than half (58%) of 120 educators polled responded that they would be asking current staff members/teachers to do some cleaning and disinfecting as part of their regular duties. In other facilities, box office staff, airline gate attendants, check-out clerks, nurses, receptionists and more are being asked to help out with daily cleaning and disinfecting of frequently touched and shared surfaces. The CDC has even stated in the Reopening Guidance for Cleaning and Disinfecting Public Spaces, Workplaces, Businesses, Schools, and Homes, that “This guidance is intended for all Americans.”
Depending on your personality and past experiences, you may have had any one of these three reactions:
- What? No way, cleaning isn’t in my job description and I don’t have time for that!
- Great, cleaning is easy enough. I just use common sense, right?
- OK, but I don’t know how to clean properly. Where do I get training?
The good news is that no matter which group you fall into, the COVID-19 pandemic is offering up an opportunity to learn about something many of us wouldn’t have taken the time to do before. And that is how to clean and disinfect properly.
The truth is, although many don’t realize it, properly cleaning and disinfecting surfaces takes education, training, and even practice to perfect. In fact, there is an entire industry focused on helping to ensure that cleaning professionals get what they need to do their job well. IICRC, ISSA, and AHE are just a few examples of organizations with this goal in mind.
While your employer is ultimately responsible for making sure you are educated and trained, here are some basics to help get you started. You can use this information to talk to your employer about what’s important, and potentially even as a starting place for a “new cleaner” training guide for your facility.
What is the difference between cleaning, sanitizing, and disinfecting?
- Cleaning is the physical removal of unwanted matter, including dirt, dust, soil and some pathogens.
- Sanitizing is the killing of bacteria, and is most often applicable in food service.
- Disinfecting destroys or inactivates both the bacteria and viruses (like SARS-CoV-2) on hard, nonporous surfaces.
Does cleaning always need to be done before disinfecting?
No. Cleaning and disinfecting can be done at the same time if these criteria are met:
- The surface is free of visible soil.
- The product is a “one-step” cleaner disinfectant, which means the product is both a cleaner and disinfectant.
How can I be sure I’m using a product that kills “xyz” germ?
- Check the back label on the product. If the product has an EPA Registration number and says that it kills “xyz” germ then you can be confident that the product works. Just make sure to also read the directions for use, including the dilution ratios if appropriate, on the label and follow them in practice.
- For SARS-CoV-2, the virus that causes COVID-19, make sure you are using an EPA-registered product on list N.
- Never mix cleaning products! This is important for efficacy AND safety.
What else is important to understand about the product, and where can I get the information?
- What the contact time is — see the product label
- What Personnel Protective Equipment (PPE) and precautions are needed to protect you from:
- The product — see the product label
- The contaminants (e.g., SARS-CoV-2) in the environment — check with your employer and the CDC website.
- How to store and dispose of the product safely — see the product label
- Mixing/dilution information — see the product label
What else do I need to know to clean and disinfect properly?
- Know what you are responsible for and how often you should be cleaning and disinfecting. Ask your employer for clarity if not clear.
- Focus on preventing cross contamination — this is what happens when germs are inadvertently spread from one area to another. Here are some best practices to help avoid cross contamination during cleaning and disinfecting:
- Always clean from top to bottom so the dirt, dust and pathogens that fall down will get cleaned up as you move lower.
- Always clean from clean to dirty to avoid spreading germs from dirty areas to clean areas.
- Fold each cloth until it is the size of your hand. After each use, find a clean side of the cloth to use on the next surface.
- Know what jobs require the professional custodial/EVS team (e.g., blood and body fluid clean-up) and call them when needed instead of doing it yourself.
COVID-19 has presented us with quite a challenge to say the least. Fortunately, there have also been a few “silver linings” along the way. One is the knowledge and skills about cleaning and disinfecting properly that few had before. If you have been asked to take on additional cleaning and disinfecting responsibilities as part of your current role, as in any profession, education and training on how to do the job right are essential. This will not only help ensure goals of the job (e.g., to reduce the spread of germs in the environment) are achieved, but to also ensure that the job is done safely.
Late last year I wrote about The Good and Bad News of Antibiotic Resistance…in a Post-Antibiotic Era. The Centers for Disease Control and Prevention (CDC) had just published the second “Antibiotic Resistance Threats in the United States” report, calling for continued aggressive actions to prevent infections, improve antibiotic stewardship, and stop the spread of resistance when it does develop.
And then COVID-19 happened.
On the surface there doesn’t seem to be much of a connection between COVID-19 and antibiotic resistance. After all, COVID-19 is caused by the virus SARS-CoV-2 and antibiotics are not used to treat viral infections, right? Well, unfortunately, that may not be the case. Initial data from Wuhan identified that antibiotics were used in approximately 53% of patients with non-severe disease and more than 90% of patients admitted to the hospital or the ICU. Since then, there have been multiple reports and scientific papers highlighting the high use of antibiotics to treat COVID-19 patients. Given that antibiotic use is a main contributor to antibiotic resistance, the treatment of COVID-19 infections may have an impact on the growing antibiotic resistance problem.
Why are COVID-19 patients receiving antibiotics? COVID-19 patients are receiving antibiotics to treat secondary bacterial lung infections and hospital acquired infections. In some cases, they are also being used as a last resort effort. Empiric therapy for suspected bacterial infection in COVID-19 patients, which is recommended by the WHO, may be complicating the issue as non-specific antibiotics are prescribed prior to identifying the specific bacteria causing the infection. Although this approach may be necessary at this time, it is counter to the antibiotic stewardship best practice of conducting microbial analysis before prescribing antibiotics and could be contributing to an increase in “antimicrobial pressure” on pathogens to become resistant.
What types of antibiotics are being prescribed? There have been reports of the use of azithromycin, amoxicillin, tetracycline, doxycycline and teicoplanin (which is a last-resort antibiotic used to treat methicillin-resistant Staphylococcus aureus (MRSA) infections). Azithromycin has been shown to cause antibiotic resistance in some bacteria, such as Streptococcus pneumoniae. Drug-resistant Streptococcus pneumoniae (S. pneumoniae) is a leading cause of bacterial pneumonia and meningitis in the U.S., and is estimated to cause 900,000 infections and 3,600 deaths in the U.S. each year. It is listed as a serious antibiotic-resistant threat in the CDC 2019 report.
What is the potential impact? With currently (as of May 27, 2020), almost 1.5 million cases and almost 100,000 deaths from COVID-19 in the U.S. alone, the potential for increased antibiotic resistance is high. While all antibiotic use has the potential to increase antibiotic resistance, so much in such a short amount of time has potentially sped up the process. Without having new antibiotics to replace the ones that no longer work, there could be additional risk of not surviving an infection for both COVID-19 and non-COVID-19 patients now and in the future.
The potential short-term impact was recently summarized in this way by Dr. Julia Gerberding, former CDC director and infectious disease expert: “The challenge of antibiotic resistance could become an enormous force of additional sickness and death across our health system as the toll of coronavirus pneumonia stretches critical care units beyond their capacity.”
In the longer term, an increase in antibiotic resistance threatens the progress that we have made in recent years and undermines current efforts. The CDC’s 2019 report estimated that almost 3 million infections from antibiotic-resistant bacteria still occur in the United States each year, resulting in almost 36,000 deaths. Antibiotic resistance also has a significant economic impact such as extended hospital stays, additional follow-up visits to healthcare providers, and the use of treatments that may be more costly and potentially more toxic. Ultimately, this adds to the burden of high healthcare costs we are already facing.
So what can we do about it? Time will tell the true impact that COVID-19 will have on antibiotic resistance. However, there are actions we can take today to help offset any additional negative impact we may see. For clinical staff, antibiotic stewardship principles should remain at the forefront of our efforts. For pharmaceutical companies and government, we need to do everything in our power to develop new antibiotics for the future. And finally, for everyone, perhaps the most important and impactful thing we can do is to help prevent infections in the first place. These infection prevention fundamentals, which I believe should also be part of every child’s early childhood education, will help us recover from COVID-19 and combat continued antibiotic-resistance threats. As Kiran Mazumdar-Shaw has said: “Ultimately, the greatest lesson that COVID-19 can teach humanity is that we are all in this together.”
Fundamentals of infection prevention from the CDC:
- Stay home if feeling sick
- Contact your health provider if you think you have COVID-19 (or any other infection). For COVID-19, use the CDC’s self-checker to help you make decisions and seek appropriate care
- Don’t touch your face with your hands
- Perform frequent hand hygiene — especially before eating, cooking, and after interacting with others or in environments where others have been and using the restroom.
- Clean and disinfect commonly touched and shared surfaces frequency
- When respiratory illnesses are a concern, as is the case with COVID-19, stay six feet apart from other people and wear a face covering. Note: Healthcare staff should follow facility protocols for the use of PPE, including proper donning or doffing
To learn more and keep up with the scientific community on this topic, a new website, Secondary Infections, Antibiotic Chemotherapy and Antibiotic Resistance in the Context of COVID-19, was created to be a resource of peer-reviewed publications, preprints, blogs and commentaries on this very important topic. Additionally, you can read the latest insights from CloroxPro here on CloroxPro.com.
As some states begin to ease shelter-in-place restrictions and many shuttered nonessential businesses begin to reopen, our nation’s journey toward our “new normal” has begun. Of course, with COVID-19 still present, it’s a scary time for everyone involved, including building occupants and staff. If you manage a building’s cleaning and disinfection program, here are some guidelines to help you protect people and minimize the spread of SARS-CoV-2, the virus that causes COVID-19.
Step 1: Pre-work
- Inspect the building: As the late John Walker once said, “The difference between a ruin and a building in use is the janitor.” This holds true for many of the buildings that have sat empty for the last few weeks or months—they have also been without their cleaning crew. With this in mind, step one is to inspect the building. A thorough inspection should include looking for areas where mold may have grown (e.g., in the restrooms, kitchens, on walls and in HVAC systems), and surfaces that may have been damaged. Moldy and damaged surfaces should be addressed right away including remediation or replacement if necessary.
- Review applicable (and reputable) guidelines: Below are several U.S. Centers for Disease Control and Prevention (CDC) and Environmental Protection Agency (EPA) resources to get you started:
- General cleaning and disinfecting
- Guidance for cleaning and disinfecting public spaces, workplaces, businesses, schools and homes
- Guidelines and resources to reopen facilities and public spaces
- Interim guidance for businesses and employers to plan and respond to coronavirus disease 2019 (COVID-19)
- Schools, daycare centers, offices or other facility that do not house people overnight
- Institutions of higher education
- Confirm funding/budget: Ensure you have the budget for the required cleaning products and tools, as well as staff required to implement the proper cleaning protocol.
Step 2: Update policies, procedures and protocols
In February, I wrote about how clear and robust policies and procedures are needed to maintain a high-quality cleaning and disinfecting program. This is not only true during times of enhanced concern, but also in the regular day-to-day operations. If there was a silver lining to our current situation, it’s that the importance of cleaning and disinfection is now more widely understood. Below are the fundamental pieces needed to run a high-quality and effective cleaning and disinfection program.
- A written cleaning program policy: Cleaning program policies should outline how often procedures will be reviewed and updated, what procedures should be in place, and the frequency of and situations when employees will receive training and feedback on procedures.
- Clear and detailed everyday preventative procedures: A strong cleaning program has written procedures in place that specify cleaning processes for different areas in your facility.
- Each procedure should include what surfaces need to be cleaned, who is responsible for each area, and the products to be used to clean each surface.
- Other product details should include the directions for use, the contact (or dwell) time, and details on how to avoid cross-contamination.
- Procedures should be updated each time a new product is introduced, or a best practice is identified.
- Include public health basics such as washing hands, staying home when sick and the responsibility of building occupants to help the cleaning and disinfecting team reduce the spread of germs. This should be aligned with the occupants’ management. Actions, such as putting up posters like this example from the CDC, can go a long way to support the work of the cleaning staff.
- Outbreak preparedness procedure: Ensure you have outbreak preparedness procedure in place for when viruses, like SARS-CoV-2, may be present your facility. The outbreak preparedness procedure should be separate from everyday preventative cleaning procedures and cover the extra measures that need to be taken. This includes details on the microbial threat and how it is spread, helping employees understand how to identify the signs and symptoms of the illness of concern, knowing the correct personal protective equipment (PPE) to wear, and additional changes such as products used, frequency of cleaning and disinfecting, or the surfaces that should be disinfected.
- Spotlight on products: Make sure that disinfectants have EPA-approved claims against pathogens that cause the illnesses of concern in your facility. EPA’s list N is a great resource to determine if a product is approved for use against the SARS-CoV-2 virus. The list is updated regularly, but if a disinfectant you use isn’t on the list, check the manufacturer’s website, or contact the manufacturer directly. Given product shortages faced by many manufacturers right now, you may need to switch to a new product. If this is the case, it is even more important to ensure all disinfectants are EPA-registered, approved for use against SARS-CoV-2, and that staff are adequately trained on proper and safe use.
- Educate, train, and engage staff: Ensure cleaning staff are adequately trained on your facility’s cleaning and disinfecting procedures and the outbreak preparedness procedure. Competency should be verified on the use of the products.
Step 3: Execute and recognize
- Reconfirm the funding/budget based on updates procedures and protocols: Adjust the budget created in step one, as needed.
- Do regular check-ins with staff: Make sure staff are meeting the expectations of the program and ask them for regular feedback on how things are going. Adjust procedures and protocols as necessary, as per outlined in the program’s policy.
- Bring awareness: Put all the hard work into practice and help the cleaning and disinfecting team shine as occupants start to reenter the building. One way to help do this is to send a letter to building occupants to share efforts or share the program with leadership to bring visibility to all actions taken to protect employees’ health and safety.
April 6–12, 2020 is the 25th annual National Public Health Week (NPHW) brought together by the American Public Health Association (APHA). NPHW is a week set aside to recognize the contribution of public health workers as well as raise awareness of issues that are important to improving public health within the United States.
The theme this year is “looking back, moving forward,” which is particularly relevant given the current COVID-19 pandemic. Each day of NPHW is focused on a health topic that is important to improving U.S. public health and identifying ways to make a difference on each. The daily themes this year are Mental Health (Monday), Maternal and Child Health (Tuesday), Violence Prevention (Wednesday), Environmental Health (Thursday), Education (Friday), Healthy Housing (Saturday) and Economics (Sunday). Here is how the APHA is thinking about each day of NPHW in light of COVID-19: http://www.nphw.org/nphw-2020/covid-19.
In honor of NPHW, I’ve begun to look back and think about the focus of my daily work as a public health liaison. The value of cleaning in public health has never been as clear or as relevant in each of the daily themes. Keeping surfaces clean helps to prevent infections by reducing the spread of germs (or pathogens) from person to person through indirect contact. In turn, this is good for mental health, violence prevention, and helps to create healthier homes and environments.
To bring this to light, we don’t need to look much further than the current COVID-19 pandemic. In addition to social distancing, clean hands and clean surfaces work together to help minimize the spread of this virus, as well as many other germs. With an unprecedented public health and economic impact, COVID-19 reminds us of the importance of infection prevention, particularly as we move forward.
COVID-19 has also highlighted the importance of education for professional cleaners to ensure facilities are cleaned properly to help prevent the spread of illness and protect human health. From choosing the correct product for each cleaning job to knowing the proper process to implement, there is much for cleaning professionals to learn and know to ensure cleaning is done safely and efficiently. The industry has made progress with programs such as AHE’s CHEST, ManageMen’s Janitor University, and ISSA’s Cleaning Management Institute, but cleaning professionals are public health workers who deserve quality education and the utmost gratitude. Cleaning correctly, like any other professional skill, requires time, training, knowledge, and practice.
To help keep industry professionals informed and help them navigate this difficult time, CloroxPro has developed a COVID-19 resource page where cleaning and healthcare professionals can access all our educational resources and tools to respond to COVID-19, relevant blog posts on the latest developments in the pandemic, and webinars.
Overall, I am looking forward to hearing about all the NPHW events this week, and also attending the annual APHA meeting in San Francisco October 24-28 (assuming we are able to gather by then). It is my hope that the important role of maintaining clean indoor and built environments will be highlighted during both these public health events as the benefits of cleaning become amplified with further attention to its importance.
Norovirus. You might not know it by name, but you’ve definitely heard about it before. News headlines go something like this, “School closes due to large sudden outbreak, many students and staff sick,” or “Dozens sick after meal at favorite local restaurant.” While the news references “food poisoning,” “gastroenteritis” or even the “stomach flu,” the truth is norovirus isn't really the flu at all.
For those of us who monitor infectious disease outbreak news daily, the culprit at play in these situations can be fairly obvious. This is because norovirus has a unique way of making people sick compared to other germs. Main symptoms of a norovirus infection include diarrhea and vomiting, and ingesting very little (as few as 10 viral particles) is required to make someone sick. This is why norovirus spreads so easily, especially in busy, enclosed environments such as schools and daycare centers, and why so many people can get sick at once. Additionally, norovirus spreads easily by contaminated hands when restaurant and healthcare employees aren’t diligent about hygiene.
Why is norovirus a concern?
Simply said, norovirus is a concern because it causes a lot of illness both domestically and globally, and can even cause death.
In the U.S., norovirus is the leading cause of vomiting and diarrhea. It is responsible for 19 million to 21 million illnesses each year. Almost two million people seek outpatient treatment, and a further 400,000 seek treatment at hospital emergency rooms. Annually, 56,000–71,000 people are hospitalized, and approximately 570–800 die.1 There is no vaccine for norovirus, and because there are many types of norovirus and it mutates quickly, you can get it multiple times in your lifetime.
Furthermore, between 2009 and 2012, almost 3,500 norovirus outbreaks were reported to the Centers for Disease Control and Prevention’s (CDC) National Outbreak Reporting System. Of those, 63% were in healthcare settings, with the overwhelming majority of those outbreaks occurring in long-term care facilities and nursing homes. Restaurants and banqueting facilities accounted for 22% of the outbreaks, while 6% occurred in schools.2 While norovirus is the cause for most of the diarrheal outbreaks on cruise ships, cruise ships account for only 1% of reported norovirus outbreaks.4 From August through December 2019, there were 285 norovirus outbreaks reported to the CDC’s NoroSTAT network, a norovirus surveillance and tracking collaborative.3
How do you know if you have norovirus?
As mentioned, norovirus illness shows up in a unique way so it can be easily identified if you know what to look for.
- The symptoms are the first clue. The most common symptoms of norovirus are diarrhea, vomiting, nausea, and stomach pain.
- Secondly, a person usually develops symptoms 12–48 hours after being exposed to norovirus.4 While it may be difficult to know when the first person in a facility was exposed to the virus, there are usually a number of “close-contacts” that will become sick with the same symptoms within the 12–48 hour time frame. This is a tell-tale sign of norovirus: waves of people get sick approximately every 12–48 hours.
- Finally, norovirus illness is short-lived, and for most people only lasts for a 1–3 days.
Additionally, since norovirus and the flu are often confused with one another — as they are both illnesses that spike in the winter months — here is a quick “cheat sheet” of the differences:
How can norovirus be prevented?
Vaccines are the number one way to prevent most infectious diseases, but since a vaccine is not yet available for norovirus, other prevention measures are critical. The best ways to help prevent norovirus from impacting a facility are:
- Practice excellent hand hygiene. Everyone should be carefully washing their hands with soap and water, especially after using the toilet and changing diapers, and always before eating or preparing food.
- Safely handle and prepare food and DO NOT let anyone prepare food or care for others if they are sick. Fruits and vegetables should be washed and seafood cooked thoroughly before serving and eating. Sick food service employees in restaurants, schools, daycares and long-term care facilities should not return to work until at least two days after symptoms, such as diarrhea, stop.
- Regularly and properly clean and disinfect surfaces. Ensure the use of proper cleaning techniques and best practices (e.g., clean to dirty, top to bottom, color coded cloths) and follow label instructions for ready-to-use EPA-registered cleaner disinfectants with efficacy claims against norovirus. Surfaces should stay wet for the contact time listed on product labels, and disposable cleaning cloths should be used, unless using pre-moistened disinfecting wipes. Clean and disinfect all touchable surfaces daily, especially in busy facilities where immunocompromised individuals may be present, such as hospitals, schools, daycares, oncology and dialysis clinics, and long-term care centers.
How to contain a norovirus infection?
If you or someone in your building has been infected with norovirus, the best thing to do is follow the same prevention practices above, which will help to contain the spread. You can also adopt these additional best practices for up to two weeks after the last person has been sick, which is the amount of time it takes for some people to stop shedding the virus in their stool.
- Wear appropriate protection. ServSafe®, the ANSI-accredited National Restaurant Association’s food safety and certification program, recommends that before cleaning up an area where vomiting and diarrhea has taken place, employees should don disposable masks, nonabsorbent disposable gloves, eye protection and aprons.5
In healthcare settings, patients with suspected norovirus should be placed on standard and contact precautions for a minimum of 48 hours after the resolution of symptoms. This means that for anyone entering the area of a norovirus patient should at minimum wear gloves and a gown.
- Wash laundry with precaution. If an item has been contaminated with feces or vomit from someone with norovirus infection and cannot be disposed of, wear gloves and take care not to agitate it too much before placing it in the laundry. Run the washer and dryers on their longest cycles, consider using a laundry sanitizer or disinfectant as an additive, and wash hands thoroughly and immediately after handling a contaminated load. It’s also a good practice to wipe down all touched surfaces with an EPA-registered disinfectant effective against norovirus.
- Increase the frequency of cleaning and disinfecting touchable surfaces. In healthcare settings, the CDC recommends that cleaning and disinfecting should be performed twice daily, with frequently touched surfaces cleaned and disinfected three times daily.6 Following a similar recommendation for non-healthcare facilities is also warranted if norovirus is suspected or confirmed.
1. Centers for Disease Control and Prevention. Preventing Norovirus Outbreaks. https://www.cdc.gov/vitalsigns/norovirus/index.html Accessed Dec 11, 2019.
2. Centers for Disease Control and Prevention. MMWR. Vital Signs: Foodborne Norovirus Outbreaks — United States, 2009–2012 https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6322a3.htm Accessed Dec 11, 2019.
3. Centers for Disease Control and Prevention. NoroSTAT Data. www.cdc.gov/norovirus/reporting/norostat/index.html Accessed Jan 31, 2020.
4. Centers for Disease Control and Prevention. The Symptoms of Norovirus. https://www.cdc.gov/norovirus/about/symptoms.html Accessed Jan 31, 2020.
5. ServeSafe National Restaurant Association. Norovirus: The Notorious Dangers. https://www.servsafe.com/media/ServSafe/Products/Norovirus/Norovirus-The-Notorious-Dangers-Whitepages-(Final).pdf Accessed Jan 31, 2020.
6. Centers for Disease Control and Prevention. Norovirus in Healthcare Facilities Fact Sheet. https://www.cdc.gov/hai/pdfs/norovirus/229110-ANoroCaseFactSheet508.pdf Accessed Jan 31, 2020.
Proactive steps to help prevent the spread of germs in facilities
By now, we are all aware that a novel coronavirus has arrived in the U.S. The 2019 novel coronavirus (COVID-19) outbreak that started in Wuhan, China in December 2019 has infected almost 25,000 people in over 25 countries — including 11 confirmed cases in the U.S. as of February 5, 2020 according to the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). As public health leaders across the world have jumped into action, there is still much to learn about how this outbreak will play out.
While the CDC still considers the risk level to be low in the U.S., concern still exists and many facility managers of schools to businesses are wondering what, if anything, they should be doing. Fortunately, there are simple and proactive steps that can be taken to help prevent the spread of germs in facilities amid concern over COVID-19.
To this end, I recommend a three-part approach to implementing a robust and effective program. It is also important to point out that facility managers can use these same behaviors and practices to prevent the spread of germs every day and in readiness for the next outbreak, even when COVID-19 isn’t a concern.
Part 1 – Public health basics: These activities form the foundation of any public health and infection prevention plan. Cleaning teams likely understand they are responsible for cleaning and disinfecting surfaces, but they may not realize they can also spread germs. Encourage the following behaviors and practices with your staff to help prevent germs from coming into and spreading in your facility:
- Get vaccinated: In the case of COVID-19, it’s not available yet, but staff should be up to date on their vaccines. Learn more about what vaccines the CDC recommends for adults here.
- Keep hands clean: Wash hands frequently with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer if soap and water are not available.
- Cover coughs and sneezes: Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing. Dispose of tissue properly and perform hand hygiene.
- Stay home when sick: Remain at home and avoid contact with others when sick, except if needing to visit a medical provider. Do not travel or go to work while sick.
Part 2 – Environmental stewardship: From common cold and flu viruses to COVID-19, cleaning and disinfection are critical to prevent the spread of germs via surfaces. In fact, almost 80% of infectious diseases are transmitted via contact or touch and surfaces act as reservoirs for germ transfer to hands if they aren’t cleaned and disinfected as cited in The Secret Life of Germs by Philip M. Tierno Jr., Ph.D. If you are doing the job right, you are helping to prevent the spread of pathogens and thus breaking the chain of infection. The following steps will ensure your cleaning and disinfection program has a strong foundation.
- Specify procedures: A strong cleaning program has written procedures in place that specify cleaning processes for different areas in your facility. Each procedure should include what surfaces need to be cleaned, who is responsible for each area, the products to be used to clean each surface. Other product details should include the directions for use, the contact (or dwell) time, details on how to avoid cross contamination by cleaning from clean to dirty. Update procedures each time a new product is introduced or a best practice is identified.
- Products to use: Make sure that disinfectants have EPA-approved claims against pathogens that cause illness or concern in your facility. These may include cold viruses, influenza, norovirus, or MRSA. In the case of COVID-19, the EPA’s Emerging Viral Pathogen policy allows for the quick determination of products that have demonstrated effectiveness against viruses similar to the emerging virus. Check your manufacturer’s website or contact your disinfectant manufacturer if you are unsure of claims.
- Educate and engage your staff: Ensure your cleaning staff are trained adequately on your facility’s cleaning and disinfecting procedures. In addition, engage your employees as engaged employees often have higher performance. For more on developing and sustaining employee engagement, click here.
Part 3 –Ensure ongoing quality and preparedness: Here are two additional practices that facility leaders should tackle to be adequately prepared to prevent illness and outbreaks:
- Written cleaning program policy: Policies are overarching documents that identify key components of your cleaning program. Policies should outline how often procedures will be reviewed and updated, what procedures should be in place, and the frequency in which employees will receive training and feedback on procedures.
- Outbreak preparedness procedure: Ensure you have an outbreak preparedness procedure in place for when outbreaks do impact your facility. Your plan should be separate from your everyday preventative cleaning procedures and cover the extra measures that need to be taken. These include helping employees understand the importance of identifying the signs and symptoms of any outbreak infection, knowing the correct personal protective equipment (PPE) to wear if needed, how germs are generally transmitted, and how to determine if different products need to be used.
Once the behaviors and practices above are in place, facility managers should feel confident in their ability to take on any infectious disease challenge, whether it be COVID-19, a spike in flu rates, or the next new pathogen of concern to come our way.
Earlier this month, the Centers for Disease Control and Prevention (CDC) published the second “Antibiotic Resistance Threats in the United States” report. Antibiotic Resistance (AR) is considered one of the most important public health issues we face today. According to the CDC, the new report serves as an up-to-date reference tool on AR, provides the latest AR infection data, including a list of the disease-causing microorganisms (also called “pathogens” or “germs”) of greatest concern, and highlights what needs to be done to ensure that antibiotics are available in the future. The first report on Antibiotic Resistance was published by the CDC in 2013 and was the catalyst for much of the work that has been done since. In this blog, I seek to provide a high level review of the report, share with you what CloroxPro is doing to help, and inspire you to also take action. Whether you act as an individual or as part of an organization, there are things we all can be doing now that will benefit us, our families, and society for years to come.
What Is Antibiotic Resistance and a Post-Antibiotic Era?
Antibiotic resistance is when pathogens or germs develop ways to reduce or eliminate the effectiveness of antibiotics. Bacterial and fungal, but not viral or other types of pathogens, are included in the CDC report. A post-antibiotic era means that we are now living in a time where people are dying from pathogens or germs that we used to be able to cure with antibiotics.
The Report Includes Good News and Bad News
The good news is that progress has been made — the number of antibiotic resistant (AR)-related deaths in the U.S. per year has gone down 18% (from 44,000 to 35,880) since the 2013 estimates were revised (due to some improvements made in how the data was collected). Even greater decreases in deaths were seen in hospitals (down 28%) and decreases in some specific types of infections were also seen (e.g., Vancomycin-resistant Enterococcus or VRE was down 41% and Methicillin-resistant Staphylococcus aureus or MRSA was down 21%) since 2013. This suggests that many of the U.S. efforts (preventing infections, stopping the spread of bacteria and fungi, and improving antibiotic use in humans, animals, and the environment) are working.
The not-such-good news is that the number of AR infections and deaths are still far too great, and in some cases the rate of infections caused by AR pathogens has gone up substantially (e.g., Erthromycin-resistant invasive group A strep was up 315% and ESBL-producing Enterobacteraeae was up 50%). Perhaps the most alarming statistic to come out of the report is that on average, someone in the United States gets an antibiotic-resistant infection every 11 seconds and every 15 minutes someone dies. Moreover,the data used to generate the report was collected in 2017 and are assumed to be underestimates of the true data, as not everyone who gets an infection seeks medical care, and thus becomes a recorded case.
Across Three Threat Levels and 18 Antibiotic-Resistant Pathogens (+ a new Watch List)
The new report identifies 18 AR threats total, and breaks these threats down into three threat levels: urgent, serious, concerning, and a new watch list. The threat levels were determined based on seven factors:
- Clinical impact
- Economic Impact (when available)
- 10-year projection of incidence (new infections over the next 10 years)
- Transmissibility (how easily a germ spreads or causes infections
- Availability of effective antibiotics
- Barriers to prevention
The report includes a lot of valuable information about the pathogen threats, including some of the trends as noted above. I’ve included a couple of the highlights here, but you can find a full list of ARs listed in the report here, as well as information about each pathogen.
Of the five urgent threats, two are new since the 2013 report: drug-resistant Candida auris, a fast-spreading yeast of concern, is completely new to the list, and carbapenem-resistant Acinetobacter was listed as a serious threat (as multidrug resistance Acinetobacter) in the previous report.
Clostridioides difficile (C. difficile), while not technically an AR-resistant pathogen, continues to be on the “urgent” list because it is caused by the same factors that cause AR — antibiotic use and the spread of germs. While cases of C. difficile have declined in hospitals, it is still the most prevalent healthcare associated infection (in 2017, nearly 224,000 people in the U.S. required hospital care for C. difficile and almost 13,000 people died) and infection rates in the community have not followed suit.
The “watch list” is a new addition to the report and includes three threats: Azole-resistant Aspergillus fumigatus, drug-resistant Mycoplasma genitalium, and drug-resistant Bordetella pertussis. These “watch list” pathogens are rare, and/or not completely understood yet, but based on both domestic and international data, the CDC believes there is potential for international spread of these germs, and that they also have the potential to cause significant amounts of illness and death in years to come.
Antibiotic-Resistant Infections Aren’t Just a Healthcare Problem, They Are an Everywhere Problem
AR infections are a significant issue in healthcare because those who receive medical care are often the most vulnerable. They are vulnerable because they are more susceptible to getting an infection, as well as being able to recover from it. It is for these reasons that the CDC says that resistance threats are amplified in healthcare.
But healthcare isn’t the only place AR infections occur. The CDC is also concerned about rising resistant infections in the community, which includes people, animals and plants, and environments in which they exist. To address the cross-sector complexity of AR, a “One Health” approach is the collaborative initiative that has been identified to help reduce the spread of AR, prevent AR infections, and ultimately saves lives. This means that AR is everyone’s problem, and that there is something we all can do to help combat it.
Across settings, industries, and even countries, the CDC believes that addressing AR requires continued aggressive actions, which include:
- Preventing infection in the first place
- Slowing the development of resistance through improved antibiotic use
- Stopping the spread of resistance when it does develop
CloroxPro Is Committed to Fighting Antibiotic Resistance
The CDC identifies contact with contaminated surfaces — such as hospital bedrails, kitchen counters or even personal items like towels — as one way that AR pathogens are spread. Surface disinfection is one way to help combat the spread of AR from these surfaces in both hospitals and communities, by killing the pathogens or germs before they can be spread (usually by hands). To this end, CloroxPro made a pledge to the CDC’s Antimicrobial Resistance (AMR) Challenge earlier this year to educate and advocate for antibiotic resistance education and stewardship. I believe that industry’s involvement in helping to solve large societal issues such as this one is essential, and I am excited that CloroxPro is committed to take continued action on this topic.
Some of the things we are doing or plan to do include:
- Raising awareness about antibiotic resistance and the importance of infection control and antibiotic stewardship.
- Educating on how proper cleaning and disinfecting of surfaces can help prevent the spread of infections in critical settings. Preventing infections will help to limit the need for antibiotics and reduce the spread of antibiotic resistant pathogens/germs.
- Providing high-quality products, protocols and tools help create efficient and effective cleaning and disinfecting programs.
Please join me and CloroxPro by doing your part to combat antibiotic resistance. We all have a role to play. For more details, facts, figures and inspiration, you can find the full report here: https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf
Odor removal is one of the most difficult problems cleaning professionals face. Smells have a powerful and immediate impact on the way we perceive our environments.1 In commercial settings, a pleasant odor communicates quality and cleanliness to employees and visitors and can have a significant impact on a business’ bottom line.
So, what is bad odor, and where does it come from? Read on to learn a three-step process for winning at odor removal, and get tips on how to address the more problematic odors we hear about.
What Is Bad Odor and Where Does It Come From?
An odor is a distinctive smell, sometimes unpleasant, caused by volatile compounds that rise into the air and are detected by the human nose. What many people don’t realize is that odor comes from a source, and if you can remove (or seal off) the source you can effectively remove the bad odor.
What Are Common Sources of Bad Odor?
Bad odor sources include feces, urine, sweat, smoke particulates and rotten food. In many cases, odors come from bacteria and fungi in those sources. In fact, the smell we most often associate with dirt and feces is bacteria while musty smells are usually caused by fungi.
Odor sources can be present on hard surfaces, in carpets or fabrics, inside walls and/or HVAC systems, which means they can sometimes be hard to find.
Three Steps for Winning at Odor Removal in Buildings:
- Identify the odor source. This can be relatively easy or difficult to do, but either way it is the most important step to take. To help with sources that are not obvious, look for patterns for when and where the odor is present, the conditions in the room when the odor is smelled, and even the weather outside. Things like a dirty HVAC, an open window during rainy weather or even another person can be the source of the odor.
- Identify what type of odor source you have. Is the odor source temporary (e.g., a child has an accident in a classroom), repetitive (e.g., a busy lobby bathroom with continuous deposition of feces) or embedded (e.g., unsealed grout that has become saturated with urine)?
- Using the information gathered in steps one and two, create your plan of attack.
- If temporary, removal and cleanup of a surface is usually sufficient. Don’t forget to clean and disinfect, though, especially if the odor source is a biohazard (feces, blood, vomit).
- If repetitive, frequent cleanup is important, but consider an ongoing odor eliminator product for times in between cleanups. After all, cleaning staff cannot clean 24/7.
- For embedded odors, cleanup is also important but may not be able to completely remove the source. In these cases, consider using products that can deeply penetrate porous surfaces and can work without the need for physical removal of the odor source (oxidative chemistries like bleach or hydrogen peroxide can work well for this.) or consider sealing the surface so the odor cannot escape.
Tips for Particularly Problematic Odors:
- For rooms with heavy smoke contamination, it’s important to clean walls, ceilings and carpets even if they don’t look dirty.
- For musty odors, use a cleaner-disinfectant that is EPA-registered to kill mold and mildew (fungi). Ensure there is good ventilation in the room to keep the mold from coming back. Odor-causing bacteria and fungi thrive in moist environments. Indoor relative humidity should be kept below 60 percent — ideally between 30 percent and 50 percent, if possible.2
- Odor neutralizer may be helpful when needing to quickly cover up an odor or in between cleanings. But be careful — not all sprays are created equal, and some products only coverup odors instead of eliminating them. Additionally, some people may find fragrances unpleasant, leading to concerns about their impact on human health.
- Clean and disinfect spaces, areas and surfaces regularly, especially in heavily used areas such as bathrooms and breakrooms.
- If odors persist, consider calling in an odor or mold remediation professional to help. Special equipment may be needed to get to the source of the odor, and it may also be necessary to replace some surfaces that cannot be cleaned. When replacing surfaces, consider the “cleanablility” of the new surface, and avoid porous or textured surfaces that cannot be easily cleaned.
Pleasant-smelling environments are good for everyone. No one wants to visit, work or do business in a smelly building. Odors in buildings can influence occupant satisfaction rates3 and impact employee and consumer behavior and the degree to which a service transaction is successfully concluded.4
Identifying the odor source and type of odor source can help you plan your odor removal attack and ultimately win the battle.
1. Herz RS. A Naturalistic Analysis of Autobiographical Memories Triggered by Olfactory Visual and Auditory Stimuli. Chemical Senses. 2004;29(3):217-224. doi:10.1093/chemse/bjh025.
2. Mold Course Chapter 2: Why and Where Mold Grows. https://www.epa.gov/mold/mold-course-chapter-2.
3. Cain WS, et al. Ventilation requirements in buildings 1: Control of occupancy odor and tobacco smoke odor. Atmospheric Environment.1983;17(6):1183-1197. doi:10.1016/0004-6981(83)90341-4.
4. Bitner MJ. Servicescapes: The Impact of Physical Surroundings on Customers and Employees. Journal of Marketing. 1992;56(2): 57-71. doi: 10.2307/1252042.
There is a reason wellness experts like Andrew Weil, MD, suggest turning off the news. It can be stressful to watch due to the focus on violence, death and disaster.
Prolonged stress has been associated with many health problems, such as high blood pressure, heart disease, obesity and diabetes.1
One news topic that can be particularly stressful is that of infectious disease outbreaks. Measles, hepatitis A and Ebola are just a few of the recent disease outbreaks that have made headlines.
Media Plays Up Fear in Infectious Disease Outbreak Situations
While infectious disease outbreaks are important to be aware of, the ways the media portrays them can create unnecessary fear.
Last year, Yotam Ophir, Ph.D., from the University of Pennsylvania, published results of his research into the coverage of outbreaks in U.S. newspapers.
Ophir suggested that coverage of outbreaks can lead to feelings of uncertainty and lack of perceived control. He also found that while there were many articles about disease outbreaks, very few offered solutions on how one should think about protecting themselves.2
In other words, not having the information needed to make decisions on how to protect yourself during a disease outbreak can be stressful and potentially damaging to your health.
The Substance Abuse and Mental Health Services Administration (SAMHSA), a division of the Department of Health and Human Services, also recognizes that infectious disease outbreaks can cause stress and lead to more serious consequences.3
Four Ways to Manage Outbreak-Related Stress and Anxiety
In addition to eating well and getting regular exercise and sleep, here are a few tips to help you stay calm the next time you hear about an infectious disease outbreak of concern:
Have updated emergency kits and a plan
Just like preparing for natural disasters helps us feel more in control, having a plan in place for infectious disease outbreaks can also help. Ensure you’re prepared for an infectious disease emergency at home and at your place of employment.
Preparedness includes having enough emergency kits or supplies to cover all family members and/or employees. This ensures items such as masks, gloves, hand sanitizer and disinfectant are available to help prevent person-to-person transmission.
Here are a couple resources to get you started at work and home:
Center for Infectious Disease Research and Policy (CIDRAP) Toolkit: http://www.cidrap.umn.edu/sites/default/files/public/downloads/cidrap-shrm-hr-pandemic-toolkit.pdf
San Francisco Department of Public Health Outbreak Preparation Overview: https://www.sfcdcp.org/health-alerts-emergencies/prepare-for-an-infectious-disease-emergency/
Protect yourself from disease outbreaks
Vaccination, hand hygiene, environmental cleaning and safe food handling practices are great ways to help prevent the spread of infection.
Many of the infectious diseases we fear are also vaccine preventable. The Centers for Disease Control and Prevention (CDC) have many resources to help you learn what vaccines are available, how to properly wash hands and prepare food safely.
Get the facts on recent outbreaks
Seek out credible sources of health information that offer the facts about who is really at risk and solutions on how to protect yourself and your employees.
Know the signs of stress and anxiety, and seek medical attention if you need help managing them
If you or someone you know shows signs of stress, such as having trouble sleeping or relaxing, worrying excessively or crying frequently for several days or weeks, seek professional help right away.
SAMHSA offers a variety of resources and also recommends contacting the National Suicide Prevention Lifeline (1-800-273-8255) if you or someone you know mentions or threatens hurting themselves or someone else.
1. Mayo Clinic Staff. Stress symptoms: Effects on your body and behavior. MayoClinic.org. https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress-symptoms/art-20050987. Updated April 4, 2019. Accessed July 11, 2019.
2. Ophir Y. Coverage of Epidemics in American Newspapers Through the Lens of the Crisis and Emergency Risk Communication Framework. Health Security. 2018;16(3), 147–157. https://www.liebertpub.com/doi/pdf/10.1089/hs.2017.0106.
3. Coping With Stress During Infectious Disease Outbreaks. Samhsa.gov. https://store.samhsa.gov/system/files/sma14-4885.pdf. Accessed May 3, 2019.