What’s for dinner? You’re twice as likely to get sick eating at a restaurant.

Food-borne illness in restaurants

Cook at home or go out for dinner? Hungry Americans contemplate their options millions of times a day and going out for dinner wins out frequently. If you’re eating at restaurants, though, you’re twice as likely to get a food-borne illness. In fact, sit at a table with five friends or family members and you can expect that one of you will get sick.

It seems almost nonsensical (not to mention gross) that delicious, healthy foods—especially “real” foods, with all its life-sustaining and delicious qualities—can be tainted with deadly bacteria. Yet there are a whopping 250 different microbes or toxins that can cause foodborne illness (although 90 percent of the known outbreaks are caused by just seven microbes, including Salmonella and E. coli.) This year in the U.S. alone, 48 million people will get sick from contaminated food and roughly 3,000 Americans will die because of a pathogen in something they ate.

If you’re thinking about jumping into some cooking courses and staying “in” to eat for the rest of your mortal life, though, that’s not the solution. Although the issues restaurants face during food preparation are vastly different from a home cook’s, eating at home is a danger, too. A recent survey from the Center for Science in the Public Interest (CSPI) that says you’re chances of getting sick are doubled at restaurants probably doesn’t have all of the data (we’re pretty sure most people don’t report their mother or grandmother for giving them home-cooked illnesses), so don’t panic. Just keep a few key things in mind.

The National Restaurant Association depends on safe ingredients and the industry has trained more than 5.6 million food service workers in the safe handling and serving of food. That’s very. Very good. A few specific food items bear a large burden for food-borne illnesses, too, so be wary. Raw milk, for instance was linked to 104 outbreaks last year. And while your mouth is watering over the menu at your favorite diner, consider these tips (as strange as they may seem):

1. Stick to ordering the “popular” dishes on the menu. The turnover of these menu items is higher, so it’s far less likely that the food has been lying around in a fridge for a while.

2. If the Monday special is the catch of the day, don’t order it! In fact, NEVER order fish on a Monday. Chances are the chef bought it for their busy Saurday ight, but didn’t sell it, so it’s on been sitting in the fridge since then.

3. Ask to see the kitchen. If you think that’s overstepping your bounds, you’re dead wrong. Do you buy shoes without trying them on? The kitchen where your food is prepared is no different. It’s all part of the package you’re paying for and you don’t want to pay by getting sick!

4. Beware of menu specials. Ideally, they’re created with amazing produce or some farm-raised beef the chef has had his eye on. Unfortunately, specials also often the way restaurants move old stock. They dress it up, give it a new name, and voila—potential food-borne bacteria.

5. Put your nose down into that plate of food and really breathe in. Does it smell aromatic? Then dig in. If it doesn’t smell the way food should, send it back!

When you eat at home, make certain the food you’re buying, preparing, and cooking is safe, too. How? The nonprofit food safety watchgroup (the “food police”) has also published the definitive consumer’s guide to avoiding foodborne illness. Written by Sarah Klein, the senior food safety attorney for CSPI, From Supermarket to Leftovers: A Consumer’s Guide to Buying, Preparing, Cooking and Storing Food Safely offers tips for avoiding disease-causing microbes that can make you acutely ill.

Beware the Daily Catch

Bacteria that antibiotics can’t beat? We get to the gut of the matter.

Intestines Sketch

Hospital Acquired Infections (HAIs) are a serious problem throughout the world. There’s a growing recognition that surgical knives and operating rooms aren’t the only things that need a thorough cleaning. Spots like bed rails and even television remote controls in a hospital room can be highly contaminated. In fact, call buttons and bed trays are among the worst offenders. Bacteria can survive for extended periods of time on common healthcare “touch” surfaces. And it only takes a minute for a nurse or visitor with dirty hands to walk into a room, touch a vulnerable patient with germy hands, and undo the benefits of cleaning.

The emergence of a nasty strain of an intestinal bug called Clostridium difficile, or C-diff, triggered a renewed emphasis on hospital hygiene a decade ago. The diarrhea-causing C-diff superbug colonizes in the intestine and produces toxins that attack the gut, causing severe complications and sometimes death. Nearly 30,000 U.S. deaths annually are linked to C-diff. Complicating matters, a new strain of C-diff has emerged (NAP/0127). First identified in Canada, it produces a more severe colon infection that has now spread to all 50 U.S. states.

Why is C-diff worse than other hospital superbugs? They’re very difficult to clean away. Alcohol-based hand sanitizers don’t work and C-diff can persist on hospital room surfaces for days. The CDC recommends hospital staff clean their hands rigorously with soap and water. Or better yet, wear gloves. And rooms should be cleaned intensively with bleach.

Many patients also get C-diff infections as an unintended consequence of taking antibiotics for other illnesses. “Good” bacteria, normally found in a person’s intestines, help keep C-diff under control, allowing the bug to live in the gut without causing illness. But when a person takes antibiotics, both good and bad bacteria are suppressed—allowing C-diff to grow out of control because it’s resistant to most antibiotics that are used to treat common infections.

The rise of the C-diff superbug, along with increased pressure from the government and insurers, is driving hospitals to try all sorts of new approaches to stop their spread. Germ-resistant copper bed rails, call buttons and IV poles. Antimicrobial linens, curtains and wall paint. Cleaning machines that resemble Star Wars robots and emit ultraviolet light or hydrogen peroxide vapors. Insurers are also pushing hospitals to do a better job and the government’s Medicare program has even moved to stop paying bills for certain infections caught in the hospital.

If you get a C-diff infection, what can be done? One fairly new treatment is a fecal transplant. Yes, you read that right, and it’s just what it sounds like. A stool sample of a healthy relative is liquefied and infused into the colon of a sick patient via a colonoscopy or enema. The goal is to repopulate the infected patient’s intestines with healthy bacteria and so far it’s been highly successful. There’s a great video story about it here.

We’re facing the demise of our most effective means to treat disease because we’re overusing antibiotics. We need to treat them not as a commodity, but a valuable medicine. Enforced cleaning and sanitary precautions will go a long way to preventing infection, too. If you’re ever a patient, you can play a role by washing their own hands. And if a nurse or visitor stops by, tell them to wash their hands!

You can also download a report from the The U.S. Department for Health & Human Resources about preventing and treating C-diff infections here.

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