The “Superbug” Civil War

A few days ago I was thinking of the coincidence that the American Civil War had a widely reported military death toll of 620,000 and that is about the same as the death toll from Covid-19 in this country since the pandemic began.

Then magically an article appeared in Time magazine by Rachel Lance, PhD, that summarizes the situation better than I could. I draw pertinent information from her article. (Incidentally, Rachel has written a fascinating book on the Hunley story called, “In the Waves: My Quest to Solve the Mystery of a Civil War Submarine.” I would hope Clive Cussler, who discovered the final resting place of the Hunley, approves. I certainly do. It’s a fascinating story.)

In recent years our civilization has been confronted with a dizzying array of new, or at least newly discovered, diseases Many of these are viral hemorrhagic diseases such as Hanta, Marburg and Ebola. And then there are other viruses such as SARS and its offspring, SARS-CoV-2. And along came ZIKA to join the well known influenza and diarrhea and common cold viruses. Get rid of smallpox and polio and there are always other volunteers to fill their ranks.

And unless we think we are so smart, our old bacterial friends have become antibiotic resistant to keep us humble. That old scourge, Mycobacterium tuberculosis hangs around waiting to catch the unwary. Not wanting to be ignored, fungi are represented by Candida auris along with Cocidioides and Histoplasma. And parasites like the Plasmodium family have never gone away.

So lets compare the Civil War scourges with our current crop.

Here in no particular order are some prominent Civil War diseases (The list is not exhaustive.):

  • Typhoid fever
  • Typhus
  • Malaria
  • Yellow fever
  • Cholera
  • Gas gangrene
  • Gonorrhea
  • Syphilis
  • Diarrhea and Dysentery
  • Measles
  • Mumps
  • Whooping cough (Pertussis)
  • Chickenpox
  • Pneumonia
  • Erysipelas
  • Smallpox

Giant Microbes

It’s worth noting that malnutrition exacerbated the pathogenicity of these bugs. Accounts of the diets of many Civil War soldiers makes one wonder how they were able to function at all. Salt pork? Hardtack? Ugh! And “sanitary” facilities were worse than primitive. A bench across a latrine ditch excavating in one direction with the dirt filling in behind. And handwashing facilities? Are you kidding? It’s no wonder diarrhea and dysentery were rampant. And also why an army on the march was much healthier (think Sherman’s “March to the Sea”).

In spite of vaccines for many of these diseases, especially the childhood diseases, all of these delights are still of current interest.

Here are some current goodies to brighten your day:

  • C difficile (Clostridioides difficile)
  • Covid-19 (SARS-CoV-2)
  • MRSA (methicillin resistant Staph aureus)
  • C auris (Candida auris)
  • VRE (Vancomycin resistant enterococci)
  • CRE (Carbapenem resistant Enterobacteriaceae)
  • Zika virus
  • Malaria
  • Tuberculosis
  • Ebola virus
  • Influenza
  • Diarrhea
  • Pneumonia
  • Venereal diseases
  • Hanta virus

Standard Precaution Signs

This, of course, is just a sampling and many more could be listed. But you get the point. While it is still true that most microorganisms are harmless, or even beneficial, there are many that lurk around ready to pounce. If you’re not familiar with it already, you owe it to yourself to look up that old song, “Some little bug is going to find you someday.” (Google it.) The poem dates back to the late 1800s and a number of people have put it to music.

And with that cheery note. . . .

Gordon Short, MD
Brevis Corporation

Mercy, Mersa! Where did you come from?

Methicillin resistant Staphylococcus aureus may always have been with us. It appears to be a genetic variant whose origins are unknown. But ever since those intrepid Brits, Fleming and Florey, discovered that some microorganisms may produce substances that inhibit the growth of other organisms, we have become dependent on these miraculous substances to treat all our infections. So far, so good. But Penicillium notatum probably never intended to be the savior of mankind. Furthermore, P. notatum is not the best critter to produce significant quantities of the magic substance.

Contact Precautions Signs & Labels

In the Sept 2021 Scientific American there is a little item about the related P. rubens. Fleming discovered penicillin in 1928 and its usefulness was appreciated by the beginning of World War II. How to ramp up production? Here is the story as told by Jim Daley in the article on page 22:

Andrew Moyer, a microbiologist there [Peoria, Ill], took on the problem. Moyer’s fellow researcher Mary Hunt found a moldy cantaloupe at a Peoria market and brought it to the lab for analysis. . . .As was the case with many women conducting research in that era, Hunt’s contribution to the discovery and study of that mold – which turned out to be Penicillium rubens – was diminished at the time. Moyer’s 1944 publication on P. rubens mentions Hunt only in the paper’s acknowledgments, and the press referred to her as “Moldy Mary.” P, rubens could better tolerate a new fermentation process that let it quickly produce hundreds of times more penicillin than previously studied strains, which let the Allies massively scale up antibiotic production. The same strain is still used to manufacture penicillin today.

Clean Up the Staph Button

But what does this have to do with MRSA? As the susceptible strains of Staph aureus have been killed off, the resistant strains that have maybe always been lurking around in small numbers have been allowed to flourish. Hence the search for modifications of penicillin that would still be effective. Methicillin has been the last candidate in the congregation to do the job. When bugs resistant to it showed up, we were in trouble. Which we still are. Especially since MRSA has an increased incidence in hospitals. What that means is that it is especially important to practice excellent hygiene procedures such as surface disinfection and frequent, good handwashing. Guess what. Brevis can help.

Gordon Short, MD

C. Diff. (Clostridioides Difficile)

C. diff used to go by the moniker Clostridium difficile. Now it has been upgraded to Clostridioides difficile because the gurus in charge of nomenclature have to justify their existence. Of course the bug itself is unaware of the name change and so it just goes on producing colitis and diarrhea especially in guts that have been made susceptible by prior treatment with antibiotics that suppress the normal flora. C. diff is uncommon in the general population (about 3%) but likes to hang around hospitals where maybe 30% of patients are inhabited by this critter. Metronidazole and vancomycin have been used as treatments but the bug may become part of the normal flora and subject the person to repeat bouts of diarrhea.

Elimination of this bug from the environment is a challenge because it forms spores that are resistant to the usual alcohol antiseptics. Physical removal by good hand washing procedures is effective but who knows how to wash their hands? (Brevis can help!)

Contact Precautions Signs & Labels

Incidentally, the rest the Clostridium family consists of a bunch of bad actors that cause such delightful conditions as botulism, tetanus, and gas gangrene, a particular scourge of Civil War battlefield injuries that led to early amputations of injured limbs. Seems Clostridium perfrinens and related bugs were in the guts of horses and horse were ubiquitous on the battlefield. (I once had an autopsy on a man who was kicked by a horse in his leg. In a matter of hours, doctors noticed crepitation around the wound. Within a couple more hours they had performed a hindquarter amputation – disarticulation of the hip – but it was not soon enough and in several more hours he was in the morgue. Several years later my wife and I did a 5 day backpack trip from north to south across the Uinta mountains. On the final day we were hiking down a rough trail that thad been heavily traveled and damaged by horse packers. I warned my wife to be careful and not fall. Which she promptly did. Her knee hit a rock producing a superficial abrasion that drew a little blood. When we got down to the town of Roosevelt, I insisted Lee go to the local hospital where I knew the doctor. Terry thought I was being a little melodramatic but the autopsy had definitely focused my attention.)

Protective Environment Precautions Sign

New Product Announcement

This new sign can be used for communicating precautions required for accessing rooms with allogeneic hematopoietic stem cell transplant (HSCT) patients. Protective Environment Precautions are used to reduce exposure to environmental fungi (e.g., Aspergillus sp).

This sign is consistent in style and design with the Standard Precautions Signage series from Brevis. This sign is printed on quality card stock and is also available with Plastic Lamination for ultimate durability.

Protective Environment Precautions

Hints for happy and healthy hand washing

Teaching kids healthy habits is important. But how do you get them to pay attention to a dull topic such as how to wash their hands? With a little creativity, both learning about hand washing and implementing that knowledge can be fun for kids.          

Make the Process a Game

Correctly washing hands is essential to be effective. There are five steps: #1 wet, #2 lather, #3 scrub, #4 rinse, and #5 dry. Making a game out of learning these steps helps kids wash the right way. A parent can stand near the sink as the child prepares to wash his hands and say “1.” The child responds with “wet” and takes the corresponding action. This process is repeated for the next four steps. Kids are both saying and doing the step, which reinforces what they are learning.

Lave and Learn

Older children can use the required 20 seconds for hand washing to practice  learning other things. For instance it is the perfect opportunity for them to count to 20 in a foreign language they are learning. Cleanliness can be next to language fluency.

Use of warm, soapy water is suggested for hand washing. Demonstrate the difference between hot, cold, and warm at the sink. Ask a young child to be Goldilocks. She can say the appropriate phrase depending on the water temperature: “This water is too hot,” “This water is too cold,” or “This water is warm and just right for hand washing!” 

Even English lessons can occur while hand washing. Challenge your child to list as many adjectives as he can to describe the soap he is using. How does it smell? What does it feel like? What color is it?

Engage brains while hands are washed. Have kids recite where they got the germs being washed off. While scrubbing they can say, “I’m washing the germs off I got from petting Fido.” “I’m washing the germs off from the garbage can I took out for Mom.” This exercise opens their eyes as to how and where germs can be picked

Check It Out

Soap is key for hand washing. Pump soap comes in various smells and colors. Let your child choose the soap to use. If her favorite color is pink, she might be fascinated with pink-tinged Himalayan salt soap.

Hand washing can spark an inquiring mind. Offer both hand sanitizer and pump soap for use in the bathroom. Ask your child to report her observations. How do they compare? Are the textures different? Does one make her hands feel cleaner? 

Be Creative

Encourage your child’s creativity during hand washing. Have him pretend he is doing a commercial for soap while washing his hands. He can talk to the mirror about why he likes this particular soap and why others should buy it. Or challenge him to think up a cool new scent of soap he would like to use. Would kids scream to wash their hands with ice cream soap?

Children need to understand hand washing is not a “splash and dash” activity. Effective hand washing lasts at least 20 seconds. People often sing “Happy Birthday” while washing their hands since it takes 20 seconds to sing it. Challenge your child to compose his own song to sing while washing his hands. A personalized song makes the hand washing time fun for them.

The More the Merrier

Siblings can enjoy a group activity. Tell them they are participating in a consumer survey. Offer three different soaps. After they have tried each one, ask them to rate the soaps as #1, #2, and #3 in preference. Are the children’s rankings different?         

Sudsy Science

Perhaps your child would have a blast washing his hands if he is a mad scientist testing out his creation. Seeing is believing so have your children apply GlitterBug Potion with invisible glowing marker before washing. After washing have them view their hands under a blacklight. See any residual glowing? If so those are the most likely trouble spots. Task children with making a record of how many glowing areas they can see. Are certain areas glowing more commonly? Did they follow the five steps carefully? Do certain techniques minimize the glowing?

Only your imagination limits the number of ways to engage kids in hand washing. Making the activity enjoyable encourages kids to participate and results in healthy, happy, hand washing children.

Hand Sanitizer 101

What’s the best way to keep from getting sick and making others sick? Washing your hands! If soap and water aren’t handy, you may reach for the next-best thing: hand sanitizer. These sanitizers contain active ingredients such as ethyl alcohol, ethanol or isopropanol designed to conquer those hard-to-kill bacteria and viruses that love to make you cough and sneeze. 

Goodbye to Germs

When you squirt that hand sanitizer on your hands, rub vigorously. The friction will help get in the nooks and crannies of your hands. In these brief moments, the alcohol is attacking the bacteria’s outer casing or cell membrane. The bacteria cannot survive without its supportive walls, meaning you have cleaner, more germ-free hands. 

Tips for Use

A catch exists for alcohol-based hand sanitizers: The sanitizers must contain enough alcohol to make an impact. Look for a hand sanitizer that has at least 60 percent alcohol. Otherwise, your hand sanitizer is a dud in terms of keeping your hands clean. To make matters worse, using a low-percentage hand sanitizer spreads germs around your hand, making them easier to spread, according to The New York Times. 

You can tell you are using enough hand sanitizer by how fast the sanitizer evaporates. Once you apply the sanitizer to your hands, the product should take at least 15 seconds to evaporate, according to the Centers for Disease Control and Prevention. 

Versus Handwashing

While effective, using hand sanitizers isn’t always the answer. Washing with soap and water is your best bet when your hands are visibly soiled. Hand sanitizers stop germs, but they don’t remove dirt, blood or stool. They also do not kill certain bacteria types, such as E.coli, a common bacteria present in raw or uncooked foods. When you’re cooking or have just gone to the bathroom, go with washing your hands with soap and water for at least 20 seconds over using alcohol-based hand sanitizers. 

Hand sanitizers do have an advantage over handwashing in that they are easier to access. You may not have a sink handy, but you can keep a small bottle of hand sanitizer in your desk, car, pocket or purse. This convenience appeals to healthcare workers and others who are always pressed to save time.

Secondly, frequent warm water and soap usage can dry out and crack your hands. This effect attracts bacteria to your hands. Hand sanitizer manufacturers can incorporate moisturizers to reduce cracking while keeping your hands clean. 

How To See If Your Hands Have Been Properly Sanitized

GBX 1-2-3

One great way to see if you have applied hand sanitizer properly is by using GlitterBug® Gel. This product is formulated to be very similar to popular hand sanitizers but it has a special ingredient that glows when illuminated by black light. Apply the GlitterBug Gel and rub it in as if it were regular hand sanitizer. Then examine your hands under black light from the Brevis GlowBarLED lamp. The GBX molded disclosure center is ideal for viewing the results because it shields out extraneous or ambient light thus enhancing perception. After using the GlitterBug Gel you should see the entirety of your hands glowing. Any dark areas that do not glow are areas that may not have been safely sanitized. Visual feedback to help improve technique and therefore safety.

Best teaching products for hand sanitizer use

You may find these products helpful in your mission to improve hand hygiene:
GBX Disclosure Center with Gel
GlowBar LED Lamp
GlitterBug Gel

The Best Ways to Prevent the Flu

As anyone who has suffered from it knows, catching the flu is a horrible experience. The fever, chills, aches, soreness, muscle pain and extreme fatigue that flu causes will keep the afflicted in bed for days. Besides being in pain and miserable, the sick person will have to miss days or weeks of work – their entire life will be put on hold. Worse, in extreme cases the illness can be fatal. While the vast majority of sufferers survive, every year hundreds of thousands die from the flu worldwide. Clearly, flu prevention is vitally important.

Flu Posters

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Luckily, concrete steps can be taken Continue reading The Best Ways to Prevent the Flu

The Science of Handwashing

We all know that keeping hands clean helps keep us from getting sick, but how does handwashing actually work?  Can we really get rid of all the germs on our hands?  Is there a single best technique for handwashing?  Do antibacterial soaps really work?  Scientists have studied these questions, and some of the answers may be surprising.

What exactly are germs?  Can handwashing really get rid of them?

Microbes, microscopic organisms, are everywhere, including on human skin.  Many of the microbes on hands are single-celled bacteria.  Many of the bacteria are always there, living harmless and unnoticed; these are called resident bacteria.  Other bacteria are picked up from the environment; these are called transient bacteria.  Transients can persist on skin for days to months, but can’t live there forever.  They may include pathogens — disease causing organisms, or germs.

Handwashing can never completely remove resident bacteria; there may be 10,000 or more individual bacteria on each hand, and they are adept at sticking to skin and slithering down between the cracks in skin cells to avoid removal.  Transient bacteria are present in fewer numbers and are not adapted to living on skin surfaces; they can be completely removed by handwashing.  Therefore, the purpose of handwashing is not to make hands sterile; it is to get rid of any potential pathogens that have hitched a ride.  However, handwashing technique can vary, and as we will see, some variables are more important than others in making sure pathogens have been removed.     

Does it matter if the water is hot or cold?

Although germs aren’t likely to be destroyed by water temperatures we can tolerate, health experts have long recommended washing hands with warm or hot water.  The reason is that warmer water should help dissolve oils and other substances coating skin, helping to wash away germs with them.  Unfortunately, recent studies comparing the numbers of bacteria on hands washed with cold, warm, and hot water have shown no difference in the results — just as many bacteria remain no matter what water temperature is used.  Since using hot water uses more energy and might irritate the skin if handwashing is frequent, cold water might be a better option.

What does soap actually do?

In general, soap doesn’t kill germs.  In fact, populations of bacteria have been found thriving in liquid soap dispensers in public restrooms.  Instead, the purpose of soap is to help remove contaminants and bacteria from the skin surface.  There is an extra benefit as well; some studies have examined how thoroughly volunteers washed their hands with and without soap; the volunteers using soap did a much more thorough job.  Using water alone will reduce the number of germs on hands, but using soap is more effective.  

Should antibacterial soap be used?  What about other sanitizers?

Although antibacterial soap is everywhere, there is no scientific evidence that it is any better at removing germs from hands than regular soap.  There is also concern that triclosan, a common ingredient in antibacterial soap, could cause bacteria to become resistant to antibiotics.

For how long should hands be washed?

The length of handwashing depends on the circumstances; for example, very dirty hands or hands exposed to more pathogens need a longer period.  In general, studies show that 20-30 seconds of handwashing is all it takes to remove most germs.  To help time handwashing, you can hum the “Happy Birthday” song two times – this should take approximately 20 seconds.

Which areas get missed?

Worldwide, the same areas are missed again and again when hands are washed.  Fingertips, cuticles, between the fingers, and the back of the hand, especially the thumb and ring finger, are areas which get the least attention; therefore, these are the areas where most germs remain.

GlitterBug is designed to disclose where hand washing can improve.

Research-based handwashing technique

In order for handwashing to work, proper technique is a must.  Begin handwashing by wetting hands with warm or cool water.  Apply soap and lather hands; remember commonly-missed areas such as around the nails, between the fingers, and the backs of the hands.  Scrub hands together for at least 20 seconds (or two rounds of the “Happy Birthday” song) before thoroughly rinsing and drying.

As long as the proper technique is used, handwashing is an excellent way to reduce or eliminate transient bacteria, including disease-causing pathogens.  

What Everyone Should Know about Hand Sanitizers

Hand sanitizers have been a popular commodity since the emergence of Covid-19 in the Spring of 2020. There was even a shortage for a while, as everyone rushed to stores to stock up. As sales continue to rise consumers should be aware of the ingredients of the product and the marketing techniques that manufacturers use to increase sales.

Alcohol Content

According to the FDA, in order to be effective, hand sanitizers should contain at least 60% alcohol. The label may list this as ethanol, ethyl alcohol, or isopropyl alcohol. If the label does not show the percentage of alcohol contained in the product, do not buy it. 

Some types of alcohol are extremely dangerous, and it is doubtful that a manufacturer would list these on the label if they are present, but the FDA has found contamination with methyl alcohol or 1-propanol in some hand sanitizers manufactured in Mexico and sold in the U.S. Methyl alcohol, or wood alcohol as it is sometimes called, is used to make antifreeze. 1-propanol is an ingredient of industrial solvents.

False Claims

Claims that hand sanitizers can prevent Covid-19, influenza or other diseases are misleading. Any product making these claims should be avoided. Hand sanitizers, when used properly, can only kill germs that are on your hands, and only lasts until you touch something else.

Misleading Marketing Practices

Some hand sanitizers on the market are scented with appetizing smells such as chocolate or strawberries. If a child smells these, he or she may think they are good to drink. Hand sanitizers packaged in containers that resemble beverage cans, water bottles or food pouches can also mislead young children into thinking that the contents are edible food products.

There have been cases where a person has mistakenly believed that a product that contains alcohol is OK to drink. Since alcoholic beverages contain alcohol, why not drink Nyquil, extract of Vanilla, mouth wash, or hand sanitizer and get a similar “buzz”?  Ingesting any of these products could produce headaches, diarrhea, vomiting, irregular heart rate, seizures and if a very large quantity is consumed, possibly coma or death could result. 

Since hand sanitizers seem to be everywhere these days it is important to understand what the ingredients are. Make sure the contents are clearly labeled and contain a minimum of 60% alcohol. Ignore claims made on labels that the hand sanitizer you are buying will prevent influenza, Covid-19 or anything else. It does not. Never ingest hand sanitizer. It is not safe for human consumption. Small children should be supervised when using hand sanitizers. When shopping for hand sanitizers, avoid packaging that could be mistaken for food products. Steer clear of those with appetizing scents. 

Teach people how to apply hand sanitizer correctly with Glitterbug Gel.

Three Easy Ways to Avoid the Flu

Flu season is no longer coming–it is here. No one wants to stay at home with fever, nausea, and the other unpleasantries that come with being sick. Even if you got the flu shot, with the dismal effective numbers for this year’s vaccine, odds are pretty good you’ll still get sick. It never hurts to do your part when you want something. If good health is high on your list, check out the tips below. Practicing these three tips can help reduce the possibility of becoming a victim of this year’s debilitating strain of influenza.

Wash Your Hands: Everyone hears that handwashing is important but what most people don’t hear frequently enough is how to do it right. To avoid infection, hands must be scrubbed with soap for at least twenty to thirty seconds. Thirty seconds is approximately the time it takes to sing the ABC song. Rinse your hands thoroughly with clean water and dry them well. Regular handwashing is by far the easiest, cheapest, and most convenient protection against contracting the flu.

Avoid Germ-Laden Surfaces: You don’t have to refuse to use your hands to open doors or wear gloves everywhere to protect yourself from germy fixtures. A little knowledge about germ hotspots can help you decide what to touch and what you’d rather not handle. Gas pump dispensers are much dirtier than toilet seats and wiping down shopping carts is definitely a good idea. Carrying a small container of hand sanitizer in your pocket will allow you to instantly zap any germs. However, keep in mind that sanitizers kill good germs that help build your immune system as well as bad germs that make you sick, so use it sparingly.

Flu Posters

Stay Away From Crowds: Chilly winter weather makes indoor activities much more appealing. Unfortunately, it is much easier to pass germs around in close quarters. If at all possible, avoid venues that you know will be crowded. Do your grocery shopping at times that are less busy, such as the middle of the week. Try to stay away from locations such as malls, crowded theaters, or events where a lot of people will be in a confined space.

The tips above do not guarantee you’ll make it through the season illness-free but they can certainly decrease your chances of getting sick. As an added bonus, protecting yourself from the flu also prevents you from spreading it to others. When you consider the loss of time, money, and the terrible feeling of having the flu, a little handwashing or grocery shopping at odd hours seems like no big deal.

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