This last year has been incredibly hard, but the future looks a little brighter. With the number of vaccinations increasing significantly every day, and the CDC’s new guidance on how kids can safely return to school, there is a real reason to be hopeful that we are heading toward better times, and into our long anticipated “new normal.”

For those of us in the cleaning industry, the future presents us with another glimmer of hope. The pandemic brought to light the importance of cleaning, not only for aesthetics and building preservation, but also for health. In fact, it can be argued that the public had very little knowledge and appreciation of cleaning for health prior to the pandemic. Hundreds if not thousands of articles have been written about cleaning for health, and terms like “disinfecting” and “contact time” (also called “dwell time” or “wet time”) are now household words.

Google trends graph for the search term "cleaning and disinfecting" from 2018 through 2020 (accessed via https://trends.google.com/trends/?geo=US March 20, 2021)

This public awareness has spilled over into the commercial cleaning industry, and businesses have adapted to ensure they are addressing their customer’s concerns and desires for cleaner environments. As a result, the focus on cleaning has increased and I don’t know about you, but as a consumer and public health professional, I LOVE where we are heading. Gone are the days of grimacing every time I need to pump gas or put my pin number into one of those retail or gas station keypads. We have COVID-19 to thank for this new awareness, and I do not want to go back!

But with progress comes reflection, and it is important to recognize that, while we’ve come a long way, we are not done yet. While “disinfecting” and “contact time” may be household words, there are still far too many accounts of misinformation and inappropriate cleaning practices. Some examples include:

Not only are these examples problematic from a resource perspective, but they have caused many to question the true value of cleaning, leading to concerns about “Hygiene Theater.”

Clearly, there is more work to do.  If we want to see the positive changes from COVID-19 continue post-pandemic, we must prioritize correcting the misinformation and inappropriate practices. Here is what I recommend:

COVID-19 is not the first pandemic, and it certainly will not be the last. Many public health professionals are already working on advocating for better preparedness because it is clear now that the lack of preparation was, at least in part, the cause of so much devastation. The cleaning industry can also help prepare, starting with remaining vigilant with the progress we have made. Yes, we have made great progress, but our journey to be as good as we can be is not quite over yet.

For help with preparing for the New Normal, including the area risk assessment tool I mentioned above, please visit our website: https://www.cloroxpro.com/resource-center/preparing-for-the-new-normal/.

 “Never a doubt that a small group of thoughtful committed citizens can change the world. Indeed, it’s the only thing that ever has." ~Margaret Mead

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:

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:

  1. What? No way, cleaning isn’t in my job description and I don’t have time for that!
  2. Great, cleaning is easy enough. I just use common sense, right?
  3. 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?

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:

How can I be sure I’m using a product that kills “xyz” germ?

What else is important to understand about the product, and where can I get the information?

What else do I need to know to clean and disinfect properly?

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 Statesreport, 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.

Image/Content Provider/Photo Credit — CDC/Antibiotic Resistance Coordination and Strategy Unit; Medical Illustrator: James Archer

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:

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.

Originally published by Cleaning & Maintenance Management. For more information on SARS-CoV-2, click here.

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

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.

Step 3: Execute and recognize

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.

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:

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.

For more information on norovirus, visit the CDC website or refer to our Norovirus Education Sheet.


References:

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

Originally published by Cleaning & Maintenance Management.

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:

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.

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:

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:

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:

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:

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:

  1. 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.
  2. 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)?
  3. Using the information gathered in steps one and two, create your plan of attack.

Tips for Particularly Problematic Odors:

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.

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