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HYGIENE IN THE 21st
CENTURY
Sheri L. Carlino
Dr. Charles P. Gerba
Department of Soil, Water
and Environmental Science
Univ...
Life in the 21st Century
 Most of our time is spend indoors (80 - 90%)
 More people work in offices than ever before
 W...
Challenges in Infection Control
in the 21st Century
 Infectious diseases are the 3rd leading cause of
death in the United...
Cleaning vs. Hygiene
Cleaning is “the removal of
unwanted matter”
Hygiene is “reducing the risks of
infection”
Good hyg...
Did you know??
 80% of all common infections
(colds, flu, diarrhea) can be spread
through the environment
(air, water, fo...
What are Fomites?
 Inanimate objects involved in the spread of
disease
Hand vs. Sneeze
Role of fomites in transmission of a disease
Sick person sneezes, coughs and pathogens
falls on fomite or get aerosolized....
Mouthing Events in Children (per hour)
81 times under two years
42 times two thru five years
A child swallows the about of...
Hand Contact in Adults
 Adults touch their face 15.5 times per
hour
 2.5 eyes
 5 nose
 8 lip
Identifying Critical
Control Points
Home/Work/Play/Shopping
Coliform Bacteria and E. coli
 Coliform bacteria and
E. coli are found in
feces and their
presence on surfaces
indicates…...
Germs at Home
Coliforms in the Home by
Location
-2
-1
0
1
2
3
4
5
6
7
Geometricmeanpercm2orpermL
Bath
Sink
Kitchen
Floor
Bath
Counter
Ba...
The Importance of Cleaning
Tools in the Spread of Germs
“Breeders”
“Spreaders”
• The kitchen is more heavily contaminated than
the bathroom.
• Ordinary cleaning practices do little to reduce
the microb...
Bacteria on Shoes
 Shoes worn at least three months
 Total bacteria
 13,600 to 8,000,000 sq cm
 Coliform bacteria
 10...
A Microbial Zoo Living on the
Bottom of your Shoes
 E. coli
 Aeromonas hydrophila
 Klebsiella pneumoniae
 Serratia mar...
Shoes and Microbial Transport
 Germ
viewpoint
–Shoes
are made
for walking
Left Shoe Right Shoe
1 ft 1,000 110
2 ft 400 10
3 ft 10 20
4 ft 240 90
5 ft 140 30
6 ft 100 640
66,000,000
Bacteria (105)
...
Another Brief Run Down of
Bacteria Comparisons
(per square inch)
200,000 – Carpeting
49 –Toilet Seat
1,686 Kitchen coun...
Vacuum Cleaners – Meals on Wheels
for Bacteria
 Concentrate bacteria and
food in one place
 E. coli detected on 50%
of b...
Why Do Shoes, Carpet and
Vacuums Matter?
Exposure from Laundry
 Changes in practices
in the U.S
 Hot water used only
5% of the time. Most
use cold water
 Only 1...
Feces in the Laundry
 Average pair of
underwear contains
0.1 grams of feces
(1/2 a Southwest
Airlines peanut)
 Salmonell...
29
Hospital Scrubs
Total Bacteria
Type of scrub
Number of
garments
Average CFU/sq
cm
Unwashed
hospital 18 180
Home-
launde...
Hospital Cafeterias
 Bacteria isolated
from tables
 MRSA
 C. difficile
 Enterococcus
 E. coli
 coliforms
31
Household Bath Hand Towels
(442 towels tested)
HPC
Bacteria Coliforms E. coli
Average 9.2E+08 3.9E+05 1.1E+04
46
36
35
29
28
26
14 14
11
10
0
5
10
15
20
25
30
35
40
45
50
%SurfacesPositiveEnvironments Most Contaminated
With Body Flu...
52
OCCURRENCE OF COLIFORMS (%) IN YOUR DENTIST OFFICE
64
70
0
76
67
18
50 22
4
OCCURRENCE OF E. COLI (%) IN YOUR DENTIST OFFICE
20
48
25
Microbiology of Automobiles
 Dash board has the
most germs followed
by drink and change
holders
 Most bacteria
detected ...
Bacteria in Offices
0
200
400
600
800
1000
1200
Men Women
Comparison of Bacteria in
Men vs Women Offices
HPCCFU/4sqinAverage
Comparison of Offices that Use Disinfectant versus
Offices that Don't Use Disinfectant
1.00E+01
1.00E+02
1.00E+03
1.00E+04...
Impact of Wiping Table Top in Restaurants with
Cleaning Cloths
Germs at School
Germiest Office Occupations
#1 Elementary School Teachers
#2 Accountants
#3 Bankers
#10 Lawyers
Average
Toilet Seat
4.77E+06
1.70E+06
8.60E+05
1.00E+02
1.00E+03
1.00E+04
1.00E+05
1.00E+06
1.00E+07
Cafeteria Table Compu...
Classrooms
 Areas most contaminated with bacteria
 Pencil sharpener
 Student desk top
 Computer
 Sink in classroom
 ...
Impact of Disinfectant Wipes on
Absenteeism -Seattle
 Study
 Two school semesters
 3rd and 4th graders
 Intervention
...
The Curse of the Cruise Ships
Detection of Noroviruses on Fomites –
University of Arizona
 Winter of 2008
 Norovirus most commonly isolated on
• Desk ...
Shopping with Germs
Coliform Bacteria in Reuseable
Grocery Shopping Bags
51%
Coliforms
49%
Yes
No
Reusable Shopping Bags
 E. coli detected in
10% of the bags
Grocery Store Touch Screens
(self service)
 100% contain
bacteria (average
13,000)
 Bacteria isolated
 MRSA
 E. coli
...
E. coli Isolation from Shopping
Carts
 Maine 80%
 Atlanta 79%
 Chicago 70%
 Tucson 0%
 Los Angeles 10%
 Recent study...
Going to the Toilet with
Germs
Everybody uses the toilet
 Average time in the
aircraft restroom for
adults
 Men
 106 seconds
 Women
 154 seconds
Aerosols are Produced during
Toilet Flushing
 Fecal bacteria and
viruses are ejected
from the toilet during
flushing.
 T...
Commodeograph
 Water sensitive paper held over toilet seat when
flushed. Purple spots represent water droplets.
E.coli Detected in Droplets
 Perti dishes held over
toilet when flushed.
 Dark spots are
colonies of E. coli.
Refillable Liquid Bulk Soap
Dispensers
 25% are contaminated with millions of
bacteria per milliliter
 Coliform bacteria...
No bacterial
contamination
was found in
soap dispensed
from sealed
systems
Traveling with Germs
Bus Travel increases Risk of
Respiratory Infections
 The more you ride
a bus the more
likely you will get a
cold (6 times...
Seat – Bacteria/mold growing
on Petri Dish
Airplane Trays
 MRSA – positive on
four different flights
 Norovirus isolated on
one flight
Vehicle Bacteria per 100 sq. cm.
Commuter
Train
117,000
Bus 83,176
Airplane 3,127
Family Car 5,220
Toilet Seat 186
ANOTHER...
Virus Spread between Hotel
Rooms
 Virus added to one
person hand or
bathroom counter top
 Sample next series of
rooms af...
Results
 Virus detected
 Next four rooms cleaned by the maid
 On surfaces (table tops) in the conference
room
 On 1/3 ...
Occurrence of fecal bacteria
on the hand (United States)
Preparing a meal Greatest
Children after playing
Doing the laundr...
Hand Washing
Tucson, Arizona
95% of people say they wash their hands
after using a public washroom
67% actually wash their...
Stopping the Spread of
Germs
Reducing Risk of Infection from
Fomites
 Hand washing
 30 to 50 % reduction in illness
 Alcohol gel sanitizers
 30 to ...
How fast does a virus move in
an office building?
 Added a virus to
the entrance door
handle of an office
building with 8...
First place virus
detected is the
coffee break room
Virus detection on office workers
hands/fomites after times indicated
Results
 • The number of people with viruses on
their hands was reduced in half (50%).
The occurrence of viruses in commu...
Hand sanitizers
Just as good as hand washing
for bacteria and viruses. New
formulations more active
against norovirus.
How...
UV light at the Tap
Point of
dispense
purification
keeps the tap
free from
contamination
Antimicrobials
 Disinfectants
 Chlorine
• In use for more than 100 years
• Wastewater treatment plant in Tucson, AZ uses...
The Future
Self-Sanitizing Surfaces
 Copper
 Silver
 Titanium Dioxide
Summary
 Fomites will continue play a major role in
disease transmission now and into the
future
 Good hygiene is not cl...
Questions?
ACTE HYGIENE IN THE 21st CENTURY
ACTE HYGIENE IN THE 21st CENTURY
ACTE HYGIENE IN THE 21st CENTURY
ACTE HYGIENE IN THE 21st CENTURY
ACTE HYGIENE IN THE 21st CENTURY
ACTE HYGIENE IN THE 21st CENTURY
ACTE HYGIENE IN THE 21st CENTURY
ACTE HYGIENE IN THE 21st CENTURY
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ACTE HYGIENE IN THE 21st CENTURY

Hygiene in the 21st Century Presentation presented to Health Career Teachers at the ACTE AZ 2013 Summer Conference in Tucson, AZ on July 16, 2013 from 8:00 am - 9:30 am.

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ACTE HYGIENE IN THE 21st CENTURY

  1. 1. HYGIENE IN THE 21st CENTURY Sheri L. Carlino Dr. Charles P. Gerba Department of Soil, Water and Environmental Science University of Arizona Tucson, AZ
  2. 2. Life in the 21st Century  Most of our time is spend indoors (80 - 90%)  More people work in offices than ever before  We travel more than ever before  We spend less time cleaning than the last generation (50% less than 50 years ago)  We are less clean (e.g. laundry practices)  We spend more time in public places  We are more mobile and have more electronic equipment (e.g. cell phones, ipods)  We share more common surfaces (fomites) with more people than ever before in history
  3. 3. Challenges in Infection Control in the 21st Century  Infectious diseases are the 3rd leading cause of death in the United States today. They are 1st in the developing world.  Continued emergence and re-emergence of pathogens (SARS, MRSA, bird flu, etc)  A more susceptible population (aging population, cancer treatment) – 30 to 40% of  U. S. population at greater risk of serious illness and death)
  4. 4. Cleaning vs. Hygiene Cleaning is “the removal of unwanted matter” Hygiene is “reducing the risks of infection” Good hygiene had more impact on human health than the development of vaccines and antibiotics
  5. 5. Did you know??  80% of all common infections (colds, flu, diarrhea) can be spread through the environment (air, water, food, fomites)  ~800,000,000 cases of respiratory and enteric infections per year in the U.S.  Unmarried males experience one cold per year and unmarried women 1.3. Couples with school children experience 2.3 colds per year each. School children experience an average of 3.5 colds per year.
  6. 6. What are Fomites?  Inanimate objects involved in the spread of disease
  7. 7. Hand vs. Sneeze
  8. 8. Role of fomites in transmission of a disease Sick person sneezes, coughs and pathogens falls on fomite or get aerosolized. Pathogen falls on fomites e.g. phone, computer Person picks up pathogen through contaminated fomite. Person touches nose or eyes with Contaminated fingers and Becomes infected with pathogen.
  9. 9. Mouthing Events in Children (per hour) 81 times under two years 42 times two thru five years A child swallows the about of dirt on six kitchen floor tiles per day
  10. 10. Hand Contact in Adults  Adults touch their face 15.5 times per hour  2.5 eyes  5 nose  8 lip
  11. 11. Identifying Critical Control Points Home/Work/Play/Shopping
  12. 12. Coliform Bacteria and E. coli  Coliform bacteria and E. coli are found in feces and their presence on surfaces indicates…………….. contamination by feces and the potential presence of disease causing microorganisms
  13. 13. Germs at Home
  14. 14. Coliforms in the Home by Location -2 -1 0 1 2 3 4 5 6 7 Geometricmeanpercm2orpermL Bath Sink Kitchen Floor Bath Counter Bath Floor Toilet Seat Kitchen Sink Sponge Cutting Board
  15. 15. The Importance of Cleaning Tools in the Spread of Germs
  16. 16. “Breeders”
  17. 17. “Spreaders”
  18. 18. • The kitchen is more heavily contaminated than the bathroom. • Ordinary cleaning practices do little to reduce the microbial load. • Risk of infection could be reduced by greater than 99.99% on cutting boards and kitchen counter- tops by use of hypochlorite cleaning products. Germs at Home Summary
  19. 19. Bacteria on Shoes  Shoes worn at least three months  Total bacteria  13,600 to 8,000,000 sq cm  Coliform bacteria  10 to 72,000 sq cm  Present on 96% of shoes  E. coli  Present on 27% of shoes
  20. 20. A Microbial Zoo Living on the Bottom of your Shoes  E. coli  Aeromonas hydrophila  Klebsiella pneumoniae  Serratia marscesens  Pseudomonas fluorescens  Pseudomonas luteola  Pantoea spp.
  21. 21. Shoes and Microbial Transport  Germ viewpoint –Shoes are made for walking
  22. 22. Left Shoe Right Shoe 1 ft 1,000 110 2 ft 400 10 3 ft 10 20 4 ft 240 90 5 ft 140 30 6 ft 100 640 66,000,000 Bacteria (105) Virus (107) 68,000,000 23,000,000 27,000,000 21,000,000 15,000,000 61,000,000 27,000,000 11,000,000 17,000,000 4,200,000 2,600,000 Movement of organisms on shoes during walking – keeping in step with you
  23. 23. Another Brief Run Down of Bacteria Comparisons (per square inch) 200,000 – Carpeting 49 –Toilet Seat 1,686 Kitchen counter top 2,546 Kitchen tile floor - home 18,025 Bathroom floor - home
  24. 24. Vacuum Cleaners – Meals on Wheels for Bacteria  Concentrate bacteria and food in one place  E. coli detected on 50% of brushes from homes  Bag less: E. coli and Salmonella growth in collection container  Move bacteria and virus around
  25. 25. Why Do Shoes, Carpet and Vacuums Matter?
  26. 26. Exposure from Laundry  Changes in practices in the U.S  Hot water used only 5% of the time. Most use cold water  Only 12 minute wash  Dry for only 3 minutes
  27. 27. Feces in the Laundry  Average pair of underwear contains 0.1 grams of feces (1/2 a Southwest Airlines peanut)  Salmonella 1010 per gram of feces
  28. 28. 29 Hospital Scrubs Total Bacteria Type of scrub Number of garments Average CFU/sq cm Unwashed hospital 18 180 Home- laundered 26 143 Hospital- laundered 20 4
  29. 29. Hospital Cafeterias  Bacteria isolated from tables  MRSA  C. difficile  Enterococcus  E. coli  coliforms
  30. 30. 31 Household Bath Hand Towels (442 towels tested) HPC Bacteria Coliforms E. coli Average 9.2E+08 3.9E+05 1.1E+04
  31. 31. 46 36 35 29 28 26 14 14 11 10 0 5 10 15 20 25 30 35 40 45 50 %SurfacesPositiveEnvironments Most Contaminated With Body Fluids
  32. 32. 52 OCCURRENCE OF COLIFORMS (%) IN YOUR DENTIST OFFICE 64 70 0 76 67 18 50 22
  33. 33. 4 OCCURRENCE OF E. COLI (%) IN YOUR DENTIST OFFICE 20 48 25
  34. 34. Microbiology of Automobiles  Dash board has the most germs followed by drink and change holders  Most bacteria detected in cars was Florida  Most molds in cars was detected in Chicago
  35. 35. Bacteria in Offices
  36. 36. 0 200 400 600 800 1000 1200 Men Women Comparison of Bacteria in Men vs Women Offices HPCCFU/4sqinAverage
  37. 37. Comparison of Offices that Use Disinfectant versus Offices that Don't Use Disinfectant 1.00E+01 1.00E+02 1.00E+03 1.00E+04 1.00E+05 Don't Use Disinfectant Use Disinfectant AverageBacteria
  38. 38. Impact of Wiping Table Top in Restaurants with Cleaning Cloths
  39. 39. Germs at School
  40. 40. Germiest Office Occupations #1 Elementary School Teachers #2 Accountants #3 Bankers #10 Lawyers
  41. 41. Average Toilet Seat 4.77E+06 1.70E+06 8.60E+05 1.00E+02 1.00E+03 1.00E+04 1.00E+05 1.00E+06 1.00E+07 Cafeteria Table Computer Mouse Desk TotalBacteria/approximate100cmsq Top Three Contaminated Sites in All Schools School Study Grade K thru 12
  42. 42. Classrooms  Areas most contaminated with bacteria  Pencil sharpener  Student desk top  Computer  Sink in classroom  Viruses isolated  Influenza  Norovirus  Parainfluenza
  43. 43. Impact of Disinfectant Wipes on Absenteeism -Seattle  Study  Two school semesters  3rd and 4th graders  Intervention  Children’s desk wiped with a disinfectant wipe at the end of each school day  Results  50% reduction in absenteeism
  44. 44. The Curse of the Cruise Ships
  45. 45. Detection of Noroviruses on Fomites – University of Arizona  Winter of 2008  Norovirus most commonly isolated on • Desk tops (20%)  Libraries  Dorm rooms • Vending machines buttons (5%)
  46. 46. Shopping with Germs
  47. 47. Coliform Bacteria in Reuseable Grocery Shopping Bags 51% Coliforms 49% Yes No
  48. 48. Reusable Shopping Bags  E. coli detected in 10% of the bags
  49. 49. Grocery Store Touch Screens (self service)  100% contain bacteria (average 13,000)  Bacteria isolated  MRSA  E. coli  Klebsiella oxytoca  Coliform bacteria (65%)
  50. 50. E. coli Isolation from Shopping Carts  Maine 80%  Atlanta 79%  Chicago 70%  Tucson 0%  Los Angeles 10%  Recent study has associated Salmonella and Campylobacter infections in children and placement in shopping carts
  51. 51. Going to the Toilet with Germs
  52. 52. Everybody uses the toilet  Average time in the aircraft restroom for adults  Men  106 seconds  Women  154 seconds
  53. 53. Aerosols are Produced during Toilet Flushing  Fecal bacteria and viruses are ejected from the toilet during flushing.  The droplets settle out in the restroom contaminating the restroom with fecal microorganisms
  54. 54. Commodeograph  Water sensitive paper held over toilet seat when flushed. Purple spots represent water droplets.
  55. 55. E.coli Detected in Droplets  Perti dishes held over toilet when flushed.  Dark spots are colonies of E. coli.
  56. 56. Refillable Liquid Bulk Soap Dispensers  25% are contaminated with millions of bacteria per milliliter  Coliform bacteria was found in 22% of samples  No bacterial contamination was found in soap dispensed from sealed systems
  57. 57. No bacterial contamination was found in soap dispensed from sealed systems
  58. 58. Traveling with Germs
  59. 59. Bus Travel increases Risk of Respiratory Infections  The more you ride a bus the more likely you will get a cold (6 times more likely)  Troko et al 2011 BMC Infectious Diseases
  60. 60. Seat – Bacteria/mold growing on Petri Dish
  61. 61. Airplane Trays  MRSA – positive on four different flights  Norovirus isolated on one flight
  62. 62. Vehicle Bacteria per 100 sq. cm. Commuter Train 117,000 Bus 83,176 Airplane 3,127 Family Car 5,220 Toilet Seat 186 ANOTHER COMPARISON TO THE TOILET SEAT!!!
  63. 63. Virus Spread between Hotel Rooms  Virus added to one person hand or bathroom counter top  Sample next series of rooms after maids clean and conference room at end of day, tested for virus.  Conference attendees hands
  64. 64. Results  Virus detected  Next four rooms cleaned by the maid  On surfaces (table tops) in the conference room  On 1/3 of the conference attendees hands  On the coffee pot handle of the breakfast area
  65. 65. Occurrence of fecal bacteria on the hand (United States) Preparing a meal Greatest Children after playing Doing the laundry Least Person exiting a toilet
  66. 66. Hand Washing Tucson, Arizona 95% of people say they wash their hands after using a public washroom 67% actually wash their hands 33% of those use soap 16% really wash long enough
  67. 67. Stopping the Spread of Germs
  68. 68. Reducing Risk of Infection from Fomites  Hand washing  30 to 50 % reduction in illness  Alcohol gel sanitizers  30 to 50% reduction  Disinfection of fomite surfaces  50% reduction  Use of bleach and hot water in laundering  reduces risk of transmission
  69. 69. How fast does a virus move in an office building?  Added a virus to the entrance door handle of an office building with 80 persons  Collect samples after 4 and 7 hours from fomites and hands
  70. 70. First place virus detected is the coffee break room
  71. 71. Virus detection on office workers hands/fomites after times indicated
  72. 72. Results  • The number of people with viruses on their hands was reduced in half (50%). The occurrence of viruses in communal work areas was reduced by more than 80% after four hours and by 70%-100% after seven hours
  73. 73. Hand sanitizers Just as good as hand washing for bacteria and viruses. New formulations more active against norovirus. However, not effective against spores like C. difficile. Proper hand washing is effective in removal of spores.
  74. 74. UV light at the Tap Point of dispense purification keeps the tap free from contamination
  75. 75. Antimicrobials  Disinfectants  Chlorine • In use for more than 100 years • Wastewater treatment plant in Tucson, AZ uses more chlorine in one day than a household uses in 10,000 years • Usually >99.999% reduction in target organisms  Quats • In use for more than 70 years  Some increase in tolerance by some bacteria, but still effective at normal use applications  Sanitizers  Usually >99.9% of target organisms
  76. 76. The Future Self-Sanitizing Surfaces  Copper  Silver  Titanium Dioxide
  77. 77. Summary  Fomites will continue play a major role in disease transmission now and into the future  Good hygiene is not cleaning more, but smarter with a targeted use of disinfectants and cleaning tools  Germ exposure is more likely increasing not decreasing  No long term immunity for common infections  PROPER HANDWASHING
  78. 78. Questions?

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    Mar. 14, 2016

Hygiene in the 21st Century Presentation presented to Health Career Teachers at the ACTE AZ 2013 Summer Conference in Tucson, AZ on July 16, 2013 from 8:00 am - 9:30 am.

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