Forget germy handshakes. Do the fist-bump!

Humans are big on ritualistic touching. It’s an integral part of cultural exchanges throughout the world.

The traditional hongi greeting of the New Zealand Maori people involves pressing noses and foreheads together. In Botswana they lightly graze palms and fingers. In the U.S. we pat heads, offer high-fives, or connect with a pound hug (a one-armed “man” hug with a back slap). We’ve even been known to pat a bum or two. But the majority of the time, we shake hands.

Turns out, a handshake is FAR MORE LIKELY to spread bacteria. In fact, a handshake is about the grossest G-rated thing you can do with another person!

Scientists at Aberystwyth University in the United Kingdom recently conducted a study that compared how easily bugs migrate via a classic handshake, a high-five, and a knuckle-to-knuckle knock (or a “dap,” as the study calls it). It concluded that fist-bumps transfer 90% fewer germs than a handshake—followed by a “prolonged” fist-bump, then a high-five, and then a prolonged high-five. The handshake was the germiest. Why? It necessitates more flesh-to-flesh contact and lasts longer. Resesarch also showed that a firm grip spreads more than twice the number of bacteria than a “moderate handshake.” So the stronger your grip, the more germs you spread!

“People rarely think about the health implications of shaking hands,” says study lead Dave Whitworth, who was
inspired by increased measures to promote cleanliness in the workplace. “If the general public could be encouraged to fist-bump, there is genuine potential to reduce the spread of infectious disease.”

The study is of particular interest to healthcare providers, whose hands can spread potentially harmful germs to patients—and that can lead to healthcare-acquired infections (HAIs). HAIs are a leading cause of preventable harm and death in the U.S. In fact, the Centers for Disease Control and Prevention says that one in 25 hospitalized patients develops an HAI and 75,000 patients with HAIs die during their hospitalization each year. It’s unlikely we’ll see a lot of fist-bumping or high-fiving in hospitals anytime soon, but handshakes must be followed by effective handwashing!

Whether you call lit a dap, a fist-pound, or a fist-bump (our preference), this greeting is now being used by cool people everywhere—including President and Mrs. Obama, who popularized it during the 2008 Presidential campaign—because it’s the safest all of the ritualistic touching ways to exchange pleasantries. And if you think a fist-bump is strictly for the Obamas (or bromances, for that matter), think again: The Journal of the American Medical Association has called for a ban on handshakes in healthcare settings, recommending a fist-bump instead.

It’s germy world out there. So let up on that grip, champ. Grab our poster. Display it proudly. And spread the word (not the germs): Do the fist-bump!

Don’t miss this great video from CBS News, either.

What’s lurking on the surface can hurt you…

What you can't see can hurt you

Surfaces at facilities where we see our healthcare provider are just surfaces, right?

Healthcare facilities and hospitals are designed for function and efficiency, but the furniture and fittings are also designed to look good. Gurneys, beds, mobile x-ray machines…have you ever considered the impact of these devices on the materials like walls and floors? They’re a critical aspect of the healthcare environment.

It’s a well-known fact that bacteria can survive for extended periods of time on common healthcare “touch” surfaces. Bed rails, call buttons, and bed trays are among the worst offenders. In fact, an estimated 1 in 20 patients in U.S. hospitals pick up infections they didn’t have when they arrived, including some dangerous ‘superbugs’ that are difficult to treat. Which means the fight against Healthcare Acquired Infections (HAI) begins at the surface.

It’s also important to understand the unique nature of the healthcare environment when it comes to infection control. Unknowingly, microbial reservoirs are designed and built into healthcare environments via the surface materials that are selected.

How a surface looks—and especially what it costs—usually takes precedence over an evaluation of the surface function, cleaning recommendations, and how a surface might contribute to the spread of HAIs. Can the surface be cleaned and disinfected using standard products? And if we look at the surface after it has been cleaned and disinfected—at a microscopic level—is it truly clean?

Research has shown that pathogens live on surfaces for days, weeks, even months after they have been cleaned. Research has also shown that 20-40% of HAIs have been attributed to cross infection via hands or healthcare personnel who have become contaminated from direct contact with patients—or indirectly by touching contaminated surfaces. How can surfaces really be an issue?

Healthcare facilities employ rigorous cleaning and disinfection processes, and a wide variety of products and chemicals are used. Terminal disinfection often requires higher concentrations of chemicals like bleach-based products, which are effective in eliminating Clostridium difficile (“C-diff”). And they’re used frequently. Unfortunately though, the majority of surfaces used in our healthcare environments carry warnings against the use of harsh chemicals and disinfectants, many calling out bleach specifically. Damage can occur when these products are used, and the damage begins at a microscopic level—pits, cracks and fissures, the perfect environment for bacterial colonies to form and proliferate!

The Facilities Guidelines Institute for Design and Construction of Healthcare Facilities created a list of preferred surface characteristics (of the ideal product) published for the first time in 2006 and further refined and clarified in 2010 edition. Defining these surface characteristics was the beginning of a request that specifiers and healthcare professionals take a serious look at which surface materials are being placed where. You can find the guidelines here.

The rise of these superbugs, along with increased pressure from the government and insurers, is driving hospitals to try all sorts of new approaches to stop their spread. We’ll talk more about that in our next article. You’ll find a great article about surfaces in healthcare on the Healthcare Surface Consultants blog, too.

 

Ah, the Staph of Life! Ether Frolics & Gas Gangrene…

Gangrene and Glory Book Cover

I have found very few good books on Civil War medicine. One of the better ones is “Gangrene and Glory” by Frank Freemon (1998). With an MD and a doctorate in American History, Freemon fills in many of the blanks. In the last post I mentioned that battlefield amputations were often done with only a shot of whiskey for anesthesia. While whiskey was ubiquitous and available, both armies supposedly had access to ether and/or chloroform.

“Ether frolics” were popular entertainments during the 1830s. Traveling lecturers dispensed diethyl ether to any audience member who wanted to test its mind-altering effects, which were similar to those of nitrous oxide.

William Edward Clarke (1819-1898) participated in these events. When he became a medical student, he administered ether to a Miss Hobbie to assist in a dental extraction, thereby establishing himself as the first to use an inhaled anesthetic for a surgical procedure.

In 1842 Crawford Long (1815-1878) used ether before removing a neck tumor from a James Venable. Later he used ether for limb amputations. A hospital in Atlanta is named after him and is now a part of Emory University.

In 1846 William T. G. Morton (1819-1868), a New England dentist, used ether as a general anesthetic at Massachusetts General Hospital.

In 1847 Scottish obstetrician James Young Simpson (1811-1870) used chloroform for general anesthesia. Chloroform became very popular thereafter at least partly because it was non-flammable, but its popularity waned after its toxicity to heart and liver was discovered.

During the Civil War (now there’s an oxymoron!) those dripping ether or chloroform had little, if any, training. But they did have one advantage I supposeif the patient died on the table they always had the excuse that it was because of their battle injuries and not their incompetent anesthetist. Under those primitive conditions it is a miracle that any patient survived. Yet thousands did.

With luck, the patient developed “laudable pus” instead of gas gangrene. Infection was expected, and if it was just staph the patient was considered well on the road to recovery (of course, in those days they didn’t know staph from staff). So that was the staph of life? How times have changed!

Civil War Medicine: Surgeons With Saws & A Stiff Shot of Whiskey

Civil War Polaroid Transfer_s

On April 29, I had a right half-knee arthroplasty. The procedure was done with epidural anesthesia and some additional propofol. I requested a minimal dose of the latter so that I could be more or less awake during the procedure — which happened — and I remember hearing the electric saw doing its thing and also apparently a mallet and chisel. The procedure went smoothly and with dozens of people taking care of me in the hospital, and several more from home health care, I am making a good recovery ahead of schedule.

What a contrast from Civil War medicine! If you have ever been to a Civil War battlefield, you may have seen what passed for a hospital then. At the Battle of Bull Run I believe it was a little one-room schoolhouse that was pressed into service by the Union army. The “service” consisted mainly of a surgeon with a saw who knew how to separate limbs from injured soldiers. Anesthesia was a stiff shot of whiskey and some helpers to hold the screaming patient immobile.

How the patient was sewed up didn’t attract much attention in the few books on the subject, but the suturing and dressing had to have been pretty primitive. If the patient was lucky, he was transferred to an “ambulance” for a very bumpy trip back to Washington or wherever and a “respectable” hospital. Pictures show some of these hospitals to have been large tents with hundreds of bunks lined up cheek by jowl.

How anyone could have survived this level of care boggles the bean, but thousands did from all accounts. The alternative to surgery they learned early, was likely to be gas gangrene with certain death. Why this nasty bacterial infection? Those noxious Clostridium spore formers lived largely in the guts of horses. And horses — the engines of the Civil War — were ubiquitous. They contaminated the soil and the soil contaminated soldiers.

I once did an autopsy on a case of gas gangrene. The man had been kicked on the shin by a horse with an injury that just barely broke the skin. When crepitation was first detected around the knee, a hindquarter amputation was performed immediately. The patient still showed up in the morgue a couple of days later. Makes one a believer in the power of Clostridium.

So, how did those survivors survive? They must have been some tough dudes!

There’s an interesting audio quiz and history lesson on the Public Radio International website about first responders and the Civil War. Have a listen here.

Win the war on food-borne bugs in 20 seconds

Call Homeland Security—there’s an invasion on restaurants and kitchens everywhere. We’re talking about bugs. Bacteria, viruses, fungi, parasites…the ones you savor during mealtime then pay a big price for later. These microorganisms would just love to ruin your day with a good case of accelerated peristalsis, forward or reverse (you know it as vomit, upchuck, puke and the Aztec two-step, Montezuma’s revenge, or the Greek’s own diarrhea). Don’t let them win. Declare war on these bugs.

The culprits have many names, so we’ll just refer to them collectively as food-borne illnesses. The Centers for Disease Control and Prevention (CDC) estimates that each year roughly one in six Americans (or 48 million people) get sick, 128,000 are hospitalized, and 3,000 die of food-borne illnesses each year. While outbreaks of this and that get a lot of attention and spur concerns over food processing and food imports, the reality is that as much as 70 percent of food poisoning cases originate in the kitchen.

That’s right—people, not products, are the main cause of food-borne illnesses—and they can be avoided by following some basic principles of food safety. That’s where we come in. The CDC says the first line of defense to protect against food-borne illness is to wash your hands the correct way: 20 seconds with soap and running water. And be sure to scrub the backs of your hands, between your fingers, and under your nails. Most people don’t wash their hands right but winning this war means that changes.

We’re a longtime partner with the Handwashing for Life® to advocate and teach correct hand washing techniques. You can buy a DVD that demonstrates the why, when and how of good handwashing practice to motivate your employees and more. Of course you can use our products to check that you’ve washed correctly, too. Ready to fight the invasion of food-borne bugs? Reach for the soap and water and leave the anti-diarrheal medication on the shelf.

The fickle finger of fate at the Treaty of Versailles

The Big Four
The Big Four at the Treaty of Versailles, photo courtesy of Wikipedia

This is the second post of a two-part article on The Great Influenza’s impact on World War II:

The war ended with an armistice on the eleventh hour of the eleventh day of the eleventh month in 1918 (who said generals don’t have a sense of humor?) In spring of 1919 the allies gathered to hammer out a peace agreement with “The Big Four” (or Council of Four) in attendance: David Lloyd George of Britain, Georges Clemenceau (“The Tiger”) of France, Vittorio Orlando of Italy, and Woodrow Wilson of the US. Wilson was for treating Germany kindly and allowing it to recover its place among the community of nations.

But not Clemenceau. Now aged 77, “The Tiger” wanted to destroy and humiliate Germany so that it could never again be a threat to France. Wilson fought back and was so disgusted with Clemenceau that on occasion he threatened to leave the peace talks altogether.

But then the fickle finger of fate in the form of flu touched Wilson. He recovered sufficiently to continue with the peace conference, but he was but a mere shadow of his former self. He quickly acquiesced to Clemenceau. Germany was forced to accept the humiliating Versailles Treaty with its demands for huge reparations.

Germany sank into a severe depression. When Hitler showed how it would be possible to rebuild Germany’s economy and military, the German public enthusiastically looked upon him as their savior. And when Germany overran France in 1940, Hitler rubbed France’s nose in it by forcing the French to sign the surrender document in the same railway car in which Germany had been forced to sign the 1918 armistice agreement. But what was the explanation for the mental collapse of Woodrow Wilson? One of the sequelae of influenza is mental illness or deterioration (and in some cases even schizophrenia). This combined with pre-existing cerebral arteriosclerosis did the trick. Wilson’s will to fight Clemenceau disappeared. His brain was incapacitated. Wilson had a severe stroke only four months later and he never recovered.

Once again the 1935 wisdom of Hans Zinnser (American physician, bacteriologist, and prolific author) that the history of humanity is more often determined by microbes than by men is shown to be on the mark.

The rise of Hitler & World War II: The impact of The Great Influenza

The Great Influenza by John M. Barry

The story of the 1918-1919 flu pandemic is fascinating on its own terms and is superbly recounted by John M. Barry in his book, “The Great Influenza.” But did you know that this flu was the direct cause of the rise of Adolph Hitler and World War II? Here’s the story.

The virus itself was probably circulating before 1918, most notably in Etaples, France in 1916. Be that as it may, the pandemic itself was enhanced by the congregation of vast numbers of immunologically naive young men in camps such as Fort Riley, Kansas, its site of first appearance in the U.S., and then spread by them as they were deployed to Europe. Somewhere in its migration from birds to pigs to humans, the influenza virus (H1N1) most likely mutated to its ultimate virulent form. Regardless, there were three waves of infection: In the spring of 1918, the fall of 1918 and again in the spring of 1919.

Why this flu pandemic preferentially targeted young people is still debated. One suggestion is that prior epidemics of flu were immunologically similar enough that older citizens still had some residual resistance. The other obvious suggestion is that forcing large numbers of immunologically naive young men into close proximity in military camps was an ideal scenario for rapid spread. If it started in France or in Kansas, why was it known as “The Spanish Influenza”? Seems the Spanish press was uncensored at the time since Spain was not a participant in the World War. Therefore most of the news was printed in Spanish newspapers and it became “The Spanish Flu.”

Mystery of the Misery

bug-eyes-narrow

Why is it that dogs can drink out of mud puddles with impunity but tots cannot? Or maybe we could but just don’t know it. I’m not about to suggest that we perform that experiment, but it does intrigue me that within the past several years there has been a lot of talk about the “hygiene hypothesis.” Since it doesn’t promote the wisdom of “hygiene,” maybe it should be called “antihygiene” or “lowgiene.” We have all observed with fear our little rug-rats wrapping their gums around all kinds of debris they have picked up off the non-hygienically approved floor. Do they survive in spite of—or because of—this activity?

The hygiene hypothesis claims that we are getting all kinds of diseases, such as asthma and Type I diabetes, because we are not training our immune systems adequately. How? By avoiding exposure to all the germs that used to visit us in early childhood before we began bathing in soap and alcohol twenty times a day.

World population was 2 billion when I was born and is now 7 billion. Would the 1918 flu pandemic have gotten off the ground in the absence of crowded military camps containing thousands of potential hosts waiting for the virus to arrive? Probably not.

Pandemics seem to be one of Mother Nature’s favorite strategies for population control. Earth could support several times its current people load if we went to a vegan diet, but does a world population of 20 billion humans sound like fun?

On our present course it seems certain that global warming will produce widespread effects that will not, in general, be desirable. But are we also setting ourselves up for a global pandemic that will prune the population to where it might have been in the first place if we had listened to those who have been warning us for some decades? Or will medical science give us enough vaccines and new antibiotics to shield us from whatever bugs come along?

Given our penchant for not doing anything until it is too late, I suspect that our experiment will continue but with Mother Nature at the controls—population controls. Keep your fingers crossed and your seat belt fastened. It may be a bumpy ride.

Gordon Short, MD
March 2014

Who was Shiro Ishii?

If you are a WWII history buff, you probably recognize the name of Josef Mengele, the ethically challenged Nazi physician who was known as “The Angel of Death.” Dr Shiro Ishii was his Japanese analog.

Dr Ishii, who later became a Lt General, was in charge of Unit 731 of the Imperial Japanese Army located in a suburb of Harbin, Manchuria. This was the most famous biological warfare death camp but not the only one. Others included even Nanking. Human subjects were inoculated and thousands died. The list of organisms included such delights as anthrax, meningococcus, influenza, smallpox, tetanus, typhoid, typhus, tuberculosis, plague and many others.

For effective Biological Warfare one has to know how to weaponize and disseminate the organisms. Aerosols? Bombs? Water supply? It was a difficult challenge. The heat of exploding bombs would kill organisms and those that survived that challenge would die off in the atmosphere from drying and UV exposure. This was also true of aerosols. Would there be person-to-person spread and could an epidemic be controlled? Many questions.

After the war, Ishii was captured. But instead of being executed for killing thousands of Chinese citizens and POWs, he was offered amnesty in return for turning over the records of his experiments to the Americans. Although medical ethics did not allow American researchers to perform experiments on living human beings, ethics did allow American authorities to exonerate the person who did the experiments.

General Ishii thus lived until October 9, 1959 dying at the age of 67. (“The Angel of Death” lived until February 7, 1979 also dying at the age of 67 in Sao Paulo, Brazil although assiduously hunted by the Israeli Mossad.)

Makes me wonder, what is ethics anyway?

Gordon Short, MD
24 Mar 2014

“The Cobra Event”

“Kate Moran was an only child” may not compete with “Call me Ishmael” or “It was the best of times, it was the worst of times” as an opening salvo, but it will do. In this novel, Richard Preston wanders from the arena of fact into fantasy. But when one deals with viral hemorrhagic fevers, the distance is very small. The “Cobra” virus in the story is a genetically engineered combination of a rhinovirus and smallpox that attacks the brain and liquefies it and is meant to be an agent of bioterrorism..

It’s reported that President Bill Clinton read the book and was so unnerved by it that he called his science advisers together for advice. That led to Donald Ainslie Henderson forming the Johns Hopkins University Center for Civilian Biodefense Studies. D.A., as he was always known, was the person mainly responsible for organizing the highly successful campaign to eradicate smallpox and was also one of my mentors in the Epidemic Intelligence Service course I took at CDC in 1957. At that time he was one of Alexander Langmuir’s bright young acolytes. Since the conclusion of the smallpox crusade around 1980, he has been a leading light in promoting bioterrorism defense.

Richard Preston, who is known for his meticulous reporting, has popularized the bioterrorism threat in a way that will get the public’s attention with books such as “The Hot Zone” and “The Cobra Event.” Especially when turned into a movie such as “Outbreak.”

If you have always longed for curly (or curlier) hair, you might check them out.

Gordon Short, MD
27 Mar 2014