Did you know that about 9% of foodborne illness outbreaks occur in the home and it’s almost impossible to tell where the bacteria may live with the naked eye?
Research has identified the top kitchen items that are commonly cross-contaminated during the preparation of a meal (yuck!). Infectious disease specialist Susan Rehm, MD, outlines these top kitchen contaminators and how to make sure you don’t get sick.
1. Cloth towel
Like sponges, cloth towels were the most frequently contaminated article in the kitchen. How many times have you used a towel to wipe off the counter after cooking, washed your hands, and then wiped your clean hands with that same towel? It happens more often than you think.
“One of the best ways to prevent cross-contamination in the kitchen is to use paper towels,” says Dr. Rehm.
Research also shows that salmonellagrows on cloths stored overnight, even after they were washed and rinsed in the sink. To minimize the risk of contamination, either strictly use paper towels or use a new, clean cloth for each surface in your kitchen. Be sure to wash your towels with bleach or other disinfectants before using them again.
2. Smartphone or tablet
Just like if you take your phone to the bathroom with you, anything you touch in the kitchen following contact with raw meat can become contaminated. That includes your smartphone or tablet you use to follow a recipe or answer a call.
“Either don’t use it or clean it as frequently as you would wash your hands,” she says.
Consider covering your device with clear plastic or printing out the recipe so you don’t have to touch your device. If you don’t want to print it out, make sure to disinfect your phone afterward.
To disinfect your phone, Dr. Rehm recommends following these steps:
Take the case off and turn your phone or tablet off completely.
Mist a gentle cleaning cloth with 70% isopropyl alcohol.
Gently wipe down each corner of your phone or tablet.
Wipe down your case and any phone accessories with the same solution.
Let dry completely before turning your device on.
Never use harsh chemicals on your devices. Double-check with your phone brand on the proper way to disinfect their products so you don’t end up ruining your expensive tech.
When was the last time you disinfected your sink faucet, refrigerator, oven, or trash can?
“During food prep, be aware that there are bacteria in food, and touching it can spread it to other surfaces and potentially cause illness,” says Dr. Rehm. “Common bacteria found in the kitchen include E.coli, salmonella, shigella, campylobacter, norovirus, and hepatitis A.”
E.coli can survive for hours on a surface, salmonella can survive for about four hours and hepatitis A can survive for months. If those numbers make you nervous, lessen your chances of getting those germs by disinfecting each surface that bacteria could have come into contact with. And yes, that means wiping down or spraying each surface in your kitchen that you worked at just to be sure.
4. Cooking utensils
With so many different kitchen utensils, it’s important to be aware of how you use them, too.
“When you use tongs or a fork to put raw poultry on the grill, you should wash it immediately afterward if you plan to use the same tools to serve the meal,” says Dr. Rehm.
Sanitize your utensils by hand-washing in hot, soapy water and sanitizing solution. Make sure to air-dry them completely before putting them away into the cupboard.
Believe it or not, it’s common for people to not wash their hands with the frequency or quality needed to reduce bacterial contamination.
“When preparing food, it’s wise to wash hands beforehand, frequently throughout, and afterward,” says Dr. Rehm.
Each time you handle raw meat, wash your hands. Lather your hands with soap (don’t forget your nails, between your fingers and the back of your hands!) Scrub your hands for at least 20 seconds, and then use a paper towel to dry them and turn off the water faucets and don’t reuse it. Throw the used paper towel away immediately after use.
6. Fruit and vegetables
Bacteria can be found on your favorite fruit and veggies.
If you’re not careful, that bacteria could cause nausea, vomiting, and diarrhea. Cleaning up is less effective than not contaminating it in the first place, so make it a habit to keep surfaces as clean as possible the first time to avoid cross-contamination.
•Many strategies to reduce microorganism spread were adopted during the COVID-19 pandemic.
•We have retrospectively analyzed the period of the pandemic and previous years.
•Such strategies reduce healthcare-associated (HA) C difficile infection (HA-CDI) incidence.
•Maintaining these measures over time could reduce HA-CDI and related expenses.
•This study helps to understand effective hygiene interventions to prevent CDI.
Clostridium difficile is the most common pathogen between healthcare-associated infections and its incidence has increased during the last years. lack of enough evidence about effective hygiene interventions to prevent this disease. Due to the coronavirus disease 2019 (COVID‑19) pandemic, several strategies to reduce microorganism spread were adopted in a hospital setting. The objective of this study was to establish whether such strategies can reduce healthcare-associated C difficile infection (HA-CDI) incidence. We found that during the pandemic (2020) HA-CDI incidence was significantly lower with respect to the previous years. This work demonstrates that maintaining this level of attention regarding control activities related to the prevention of microorganism transmission significantly reduces HA-CDI and related expenses in terms of health costs and human lives.
Clostridium difficile (CD) is the most common pathogen among healthcare-associated (HA) infections.
An important obstacle in the prevention of C difficile infection (CDI) is the lack of enough evidence about effective hygiene interventions to prevent this disease. Although preventive contact precautions are recommended, there is no sufficient data on their effectiveness for its prevention.
The objective of this study was to establish whether such strategies can reduce HA-CDI incidence. The primary task was to identify differences in HA-CDI incidence in medical wards before and during the COVID-19 pandemic. The secondary task was to evaluate if severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection could influence the incidence of CDI.
We conducted a retrospective analysis on medical wards’ discharges (n. 1617) in S. Andrea Hospital (Rome) from March 1 to June 30, 2020, comparing data before (2017, 2018, and 2019) and during (2020) the COVID-19 pandemic. Intensive care units and paediatric wards were excluded. CDI diagnosis was confirmed by clinical suspicious (presence of diarrhea defined as ≥3 unformed stools in 24 hours) plus stool tests positive for CD. HA-CDI incidence was depicted as CDI diagnosed ≥72 hours after admission per 100 total discharges. Data was collected using Excel Office, and χ² test was performed to detect differences in HA-CDI incidence between different groups. Value of P< .05 was considered significant.
The number of discharges and HA-CDI diagnosis for each medical ward is reported in Table 1. No statistically significant difference of HA-CDI incidence between the years 2017, 2018, and 2019 was observed. Conversely, during the pandemic (2020) HA-CDI incidence was significantly lower with respect to 2017 (odds ratio [OR] = 2.98; P = .002), 2018 (OR = 2.27; P = .023) and 2019 (OR = 2.07; P = .047) (see Table 1 and Fig. 1). Interestingly, during 2020, COVID-19 departments showed higher HA-CDI incidence respect to Covid-19 free wards (not significative). This data suggests SARS-Cov2 infection as a possible risk factor for CDI in agreement with recent evidences that report altered gut microbiota in COVID-19 patients.
Protocols enacted by hospital environmental services (EVS) staff and healthcare workers to prevent the spread of the SARS-CoV-2 virus have also been effective against another infectious disease—Clostridium. difficile (C. diff).
A study in the American Journal of Infection Control found that the incidence of C. diff substantially decreased in 2020 compared to the previous three years due to steps taken to reduce COVID-19 infection, specifically greater attention to hand hygiene, the use of masks, and the proper donning and doffing of personal protective equipment (PPE).
Researchers with Sant’Andrea University Hospital of Rome in Italy compared data on people discharged from the hospital from March 1 to June 30, 2020, to discharge data from 2017, 2018, and 2019. While the investigators found that there was no statistically significant difference in C. diff incidence in 2017, 2018, and 2019, the 2020 results proved to be quite different.
In 2017, among 422 discharged patients, 39 were found to have C. diff. In 2018, 25 patients from 348 discharged had C. diff and in 2019, 24 patients from 364 discharged had C. diff.
In comparison, only 11 patients among 333 discharged from wards without COVID-19 patients in 2020 had C. diff and seven patients from 150 patients discharged from COVID-19 wards had C. diff.
Investigators could not determine which of the pandemic protocols played the biggest role in slowing C. diff spread, but they noted that previous studies have shown that hand hygiene alone wasn’t enough.
Interestingly, COVID-19 wards showed a higher incidence of C. diff, which suggests coronavirus infection as a possible risk factor for C. diff.
C. diff is the most common pathogen among healthcare-acquired infections (HAIs). Learn cleaning best practices to prevent HAIs in health care facilities.
The South Carolina Hospital Association (SCHA) has awarded Williamsburg Regional Hospital for their tremendous efforts eliminating medical errors as part of their Zero Harm program.
Williamsburg Regional Hospital won awards for CLABSI ICU 78 months,
CLABSI Hospital-wide 78 months,
Hospital onset C. diff. 24 months,
SSI Colon Surgery 30 months,
Hospital onset MRSA 66 months,
a testament to the dedication of their clinical staff and the facility’s commitment to the highest quality of care, even in the face of the extraordinary challenges posed by the COVID-19 pandemic.
SCHA’s Zero Harm Awards were started in 2014 to celebrate hospitals that have had extended harm-free stretches in major surgical areas like knee replacements, hip replacements, colon surgery, and abdominal hysterectomy or gone months without a Central Line-Associated Blood Stream Infection (CLABSI). These awards are indicative of a culture committed to patient safety and providing highly reliable care. All of the hospital data used for these awards is also independently verified by the South Carolina Department of Health and Environmental Control.
South Carolina hospitals are at the forefront of a larger movement towards high reliability and a Zero Harm mindset. Thanks to collaborations with BlueCross BlueShield of South Carolina and The Joint Commission Center for Transforming Health, South Carolina hospitals have been united in statewide efforts to create a culture of high reliability and reduce harm in our facilities by implementing robust, evidence-based practices that are making a positive impact on patients and the safety and quality of care.
According to Thornton Kirby, President, and CEO of SCHA, the Zero Harm Awards are also part of the Association’s efforts to guide and support the state’s hospitals in creating true “Zero Harm” cultures by recognizing the efforts of the amazing clinicians in South Carolina’s hospital and health systems who work every day to provide high-quality care.
“Zero Harm is about taking the principles of high reliability and applying them to how we deliver healthcare in South Carolina,” said Kirby. “The fact that the state’s hospitals increased the number of Zero Harm Awards in the midst of a global pandemic is a testament to their commitment to improving care delivery.”
For a full list of 2020 Zero Harm winners and to learn more about the program, please visit the SCHA Certified Zero Harm webpage.
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In early 2020, a simple online hand-washing demonstration went viral. The video, created by a restaurateur in India and imitated by health-care professionals and breakfast-television hosts around the world, showed a pair of hands in clean disposable gloves receiving a glob of children’s paint in one palm. The hands then went through all the motions of correct hand washing and, in the end, the gloves were fully coated with paint.
This message, and others like it, have helped to make 2020 a golden year for infection-prevention awareness. During the COVID-19 pandemic, public-health officials have reached the masses with their messages about how to avoid infection. Now, having seen how various nations have dutifully scrubbed, sanitized and distanced their way to try to bring down the number of coronavirus cases, researchers and public-health specialists are keen to keep the momentum going for another reason: to stall the spread of infections that are becoming resistant to antimicrobial drugs.
Antimicrobial resistance is a threat to human life that exceeds that posed by COVID-19 by orders of magnitude. Unless practices change, by 2050, an estimated 10 million people will be dying every year as a result of resistant bacteria1. Antibiotics are common treatments for illnesses — whether or not they are caused by bacteria. A 2016 analysis showed that only about 70% of antibiotic prescriptions in US hospitals were appropriate2. And a systematic review of reports published between 1970 and 2009 on non-prescription use of antimicrobials showed that the drugs were frequently used to treat non-bacterial diseases3. Unsurprisingly, it also found that resistant bacteria were common in communities with high levels of non-prescription use. The resistant bacteria then spread from person to person through surfaces such as mobile phones.
Preventing infection is an important facet of nearly all programmes designed to promote effective use of antibiotics, an area known as antimicrobial stewardship. According to the World Health Organization (WHO), global efforts to preserve the effectiveness of antibiotics must include strategies for preventing any infection that might be treated with the drugs, whether justifiably or not. Teena Chopra, an infectious-disease specialist at the Wayne State University School of Medicine in Detroit, Michigan, is fully behind this approach. Because infections are difficult to diagnose and treat quickly, Chopra says that the biggest impact will come from preventing infections in the community, not just in hospitals.
Christina Vandenbroucke-Grauls, a medical microbiologist at VU University Medical Center in Amsterdam, chairs a group that monitors hospital outbreaks of resistant bacteria in the Netherlands. Over the course of the COVID-19 pandemic, such infections have almost disappeared in the country, she says. “Apparently, people are a lot more careful.” The sharp reduction could be because hospital staff are more diligent about hand washing — and many suspect that this is also the case elsewhere.
Infection-control messages have been effective outside hospital settings, too. Many countries have seen a fall in the number of non-COVID-19 infections, such as seasonal influenza. In Australia, for instance, fewer people have died from flu this year compared with 2019. And Sweden declared the end of its flu season almost two months earlier than usual, despite its controversial light-touch approach to managing the spread of COVID-19.
Chopra is keen to keep this hygiene momentum going and points out that the pandemic has revealed considerable weak spots. “This COVID-19 pandemic exposed a lot of vulnerabilities in our core health infrastructure,” she says. “We dealt with a lack of infection control in alternative health-care settings, like nursing homes, schools, daycare centres, dialysis centres, nursing facilities and rehab facilities.” She thinks that those who run these services need to have a more prominent role in antimicrobial stewardship.
To help manage COVID-19, Chopra recruited medical students to assist with prevention efforts in residential care facilities in Detroit. They coordinated the regular testing of residents for SARS-CoV-2, the virus that causes COVID-19, and showed the staff how to group infected individuals together to contain any outbreaks. Community-level interventions have also been crucial in other parts of the world for slowing the spread of COVID-19.
Without such measures, people will continue to transfer microbes to each other. The risk of transmission can be limited by using microbe-destroying surfaces such as copper, and through rigorous disinfection with chemicals and exposure to ultraviolet light. However, such measures can be difficult to implement in communities. The only two universally effective methods are hand hygiene and staying away from others, Chopra says. “Hand hygiene is the cornerstone — not only in the hospital but everywhere.”
These strategies might seem simple, but they require people to change their behaviour, and that is easier said than done. Garth Graham at the University of Connecticut in Hartford, who developed the first US national plan to reduce health disparities, says: “Understanding of risk is the first step to getting people to adopt behaviours that help prevent infections.” In 2003, for example, people changed their behaviour by washing their hands more frequently and cleaning surfaces to prevent the spread of severe acute respiratory syndrome (SARS) virus once they understood the risk. Conversely, a lack of awareness of the effect of infections such as measles and polio has contributed to a growing hesitancy by some to vaccinate.
But after people understand the risk, says Graham, they then need information on how to change their behaviour effectively. And, he says, the campaigns that provide this information need to come from a trusted source and be tailored to the target group. “Some people trust government entities. Some trust their local physician. Some people trust their church,” he says.
In 2009, for example, a public-health team designed a hand-washing campaign called Hands up for Max! The team distributed posters to primary schools in the United Kingdom demonstrating the correct way to wash hands and distributed stickers to pupils. By contrast, a campaign run by the US Centers for Disease Control and Prevention (CDC) targeted parents using downloadable posters and social media posts with the hashtag #KeepHandsClean to drive home the message that family hand washing is an easy and effective way to prevent illness. “Public-health messaging starts with years of understanding the local infrastructure and the local community. Local organizations that have built trust for a long time with the target group are the most effective messengers.”
Chopra thinks that communities will now make permanent changes to keep infections at bay. “How we function, how we talk to each other, how we greet each other — all of that is going to change,” she says. Indeed, Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases in Bethesda, Maryland, has already declared the end of the handshake.
A broader view
Fervent measures aimed at preventing infection can come with downsides, however. Corinne Hohl, an emergency-medicine physician at the University of British Columbia in Vancouver, who leads the Canadian COVID-19 Emergency Department Rapid Response Network, points out that deaths unrelated to COVID-19 have increased during the pandemic in Canada and some other countries. Although the exact reason is not certain, physicians suggest that people might be choosing not to access emergency services because of fears that they might contract the coronavirus by leaving their homes.
In many parts of the world, behavioural change is unlikely to make a significant difference by itself. In some low-income countries, managing infection rates will require considerable investment in infrastructure. The WHO says that 1.1 billion people worldwide lack access to proper latrines, increasing the risk of bacterial infections that cause diarrhoea. Antibiotics can be seen as a quick fix to deal with deficits in basic infrastructure. India, which has one of the world’s highest rates of antimicrobial resistance, launched a country-wide initiative in 2014, with the goals of building toilets and stopping groups from manually collecting faeces for disposal.
Preventing infection is not an insignificant challenge, but perhaps now more than ever, the world is ready to talk about doing so. “I think infection control will generate, for a few years at least, much more interest,” says Vandenbroucke-Grauls. The coronavirus has brought an opportunity to raise awareness about the importance of infectious diseases as a cause of death. In the era of vaccines and broadly effective antibiotic medicines, Vandenbroucke-Grauls says, “this might be a kind of wake-up call for people — they shouldn’t think infectious diseases are a thing of the past”.
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