Daily Mail Exposes Hidden Bacteria In The Home

Help, Teddy’s got a bug: The (very) alarming results when one family asked a science lab to test their home for germs

By Isla Whitcroft

Last month, a Which? report found that a mobile phone keypad could contain up to 18 times more harmful bacteria than the average family toilet flush handle.

Worse still, of the 30 phones they tested, one showed high enough levels of contamination to cause a serious stomach upset.

The results show what many hygiene experts have been warning for some time: that harmful bacteria is not where we expect, but lurking in the most unlikely places.

Hidden bacteria: Isla Whitcroft was stunned by the results when she asked a science lab to test her home for germs

‘We often find that the family loo is one of the cleaner places in the average family home,’ explains Dr Lisa Ackerley, MD of hygiene Audit systems and an expert on TV shows such as Watchdog and The Secret Tourist.

She says: ‘Loos are bleached and disinfected. On the other hand the same, apparently clean, home may be crawling with bacteria elsewhere.’

But where exactly are these germs lurking in the average family home? A recent protect Kids play report conducted by Dettol showed 61 per cent of mothers were worried about germs.

The only way to find out is to swab various items and send the results off to the lab  -  and that’s what I did.

My husband and I, our three boys aged eight, 11 and 13, two guinea pigs and one cat live in our Victorian, four- bedroom cottage in rural Northamptonshire.

Like most working mothers, my cleaning routine has been honed to make it as time-efficient as possible. Every weekend the entire family spends a couple of hours blitzing the house. For the rest of the week, I just tidy as I go.

THE EXPERIMENT

Lisa swabbed 12 household items and her lab searched for five different bacterial readings per square centimetre. The bacteria are:

1 Good, bad and live bacteria: the total number of harmful and harmless germs on the object  -  and a good indicator of cleanliness. Fewer than 1,000: satisfactory. 1,000-100,000: unsatisfactory. More than 100 , 000 : heavily contaminated.

2 Enterobacteria: mainly harmless germs, but if present in large enough quantities they can indicate that disease- causing bacteria such as salmonella are present.
Fewer than 100: satisfactory. 100-10,000: unsatisfactory. More than 10 , 000 : highly contaminated.

3 E. coli bacteria: carried in human waste, this can cause serious infection starting with sickness and diarrhoea, leading to kidney failure and even death. A reading of anything above ten is bad news.

4 Staphylococcus aureus: germs found on the skin. The germs are passed by contact and become harmful only when they enter the body either orally or through a cut. They can cause food poisoning, skin and urine infections, pneumonia and blood poisoning.
Fewer than ten: good. Ten-20: unsatisfactory. More than 20: unhygienic levels.

5 Two moulds: Aspergillus and penicillium. These are germs carried into the house from outside on our clothes, hair and skin and can be responsible for allergies and respiratory infections. Anything over ten is considered to be highly contaminated.

‘Vile’: The family computer had high levels of bacteria and mould

COMPUTER KEYBOARD

The family computer is used by everyone. I use it for several hours a day to write on and the kids use it to play games. While I do clean the screen, I don’t always do the same with the keyboard, as it’s so tricky to do.

LAB RESULTS

Total bacteria: 33 million  -  highly unsatisfactory.

Entero: under ten  -  good.

E. coli: nil.

Staphylococcus aureus: under ten  -  good.

Mould: 10million  -  highly contaminated.

EXPERT’S VERDICT: ‘ This is absolutely vile,’ says Lisa. ‘These are shockingly high levels of bacteria and mould, caused by food being eaten over the keyboard.

‘All those leftovers give the bacteria a great breeding ground to grow on. Then we use our hand to type again and then eat our sandwiches and crisps. The answer is to not eat at our desks.’

FRIDGE DOOR HANDLE

With three hungry boys, our two-year-old fridge is constantly being opened and closed. I give the inside a good clean every two weeks.

LAB RESULTS

Total bacteria: 850,000  -  highly contaminated.

Entero: 10,700  -  highly contaminated.

E. coli: nil.

Staphylococcus aureus: nil.

Mould: 150  -  highly contaminated.

EXPERT’S VERDICT: ‘Grim results, but also pretty common. Fridge door handles are a classic harbinger of germs and can be found in the cleanest kitchens,’ says Lisa.

‘You chop some raw meat, then go to the fridge and grab an onion. Then you wash your hands afterwards, but the fridge door is contaminated.

‘The high levels of Entero indicated that it contained disease- causing germs, which can include salmonella.’

Breeding ground: Cuddly toys, particularly older ones, will usually have something lurking

TEDDY

This is a very old family teddy that’s been used by all the kids and has, to my shame, never been washed.

LAB RESULTS

Total bacteria: 1,500  -  unsatisfactory.

Entero: 500  -  unsatisfactory.

E. coli: nil.

Staphylococcus aureus: ten  -  unsatisfactory.

Mould: 40  -  highly contaminated.

EXPERT’S VERDICT: ‘Cuddly toys, particularly older ones, will usually have something lurking,’ says Lisa.

‘Think about how often very small children get tummy bugs and colds and then how they need comfort from their teddy when they are poorly.

‘Teddy bears start to get splits and tears, which is a perfect environment for bacteria to sit and multiply. The main danger is if the child cuddles their teddy and then eats at the same time.

‘The safest thing is to pop them in the washing machine when the children are at school. They’ll never know.’

MOBILE PHONE

A flip model, two years old. Used constantly by me and occasionally the kids, but, I admit, never cleaned.

LAB RESULTS

Total bacteria: 32,000  -  unsatisfactory.

Entero: fewer than ten.

E. coli: nil.

Staphylococcus aureus: nil.

Mould: Ten  -  borderline unsatisfactory/highly contaminated.

EXPERT’S VERDICT: ‘ You find most contamination on objects that are used by several people,’ explains Lisa. ‘Unless you are in the middle of nasty bacterial stomach upset or infection, or have some rather unpleasant hygiene habits, personal use objects are usually relatively germ free. The flip design also protected your keypad.’

TEN-YEAR-OLD WOODEN CHOPPING BOARD

Used every day, but washed in hot soapy water after every use.

LAB RESULTS

Total bacteria: 4,200  -  unsatisfactory.

Entero: fewer than ten.

E. coli: nil.

Staphylococcus aureus: nil.

Moulds: 50  -  highly contaminated.

EXPERT’S VERDICT: ‘This isn’t a bad result for such an old board,’ says Lisa. ‘You must be washing it in very hot water after use, although you certainly should think about sanding down the source to get rid of the cracks. ‘It is essential to keep a separate board just for chopping raw meat. Chicken contains salmonella, which can survive for several days, and campylobacter, which lives for several hours.

‘ Both strains of bacteria can cross- contaminate other foodstuffs if not cleaned in between use. E. coli can survive for a couple of days and can be found in raw meat.’

PIANO

Everyone plays the piano in our house and the kids’ friends love having a bash on the keys whenever they come over, too. It’s five years old and I clean it once a week with a standard furniture spray polish.

LAB RESULTS

Total bacteria: 7,500  -  unsatisfactory.

Entero: fewer than ten  -  good.

E. coli: nil.

Staphylococcus aureus: fewer than ten  -  good.

Mould: 890  -  highly contaminated.

EXPERT’S VERDICT: ‘A piano is a typical multiple-hand contact surface,’ explains Lisa. And these results reflect that. Nobody would ever think to wash their hands before playing, but small children may have remnants of food on their hands which they transfer on to the keyboard, which then becomes the perfect breeding ground for bacteria. The high mould reflects the fact that people often come in from outside and as they walk past the piano they have a little play. Mould is almost always carried inside on the hands.’

GEARSTICK

Our family Saab is only three months old, so we’ve never had it valeted, although it regularly goes through the car-wash.

LAB RESULTS

Total bacteria: 1,900  -  unsatisfactory.

Entero: fewer than ten  -  good.

E.coli: nil.

Staphylococcus aureus: Ten  -  unsatisfactory.

Mould: 80  -  highly contaminated.

EXPERT’S VERDICT: ‘All the readings are well within safe limits, although the mould reading is quite high. This is because people are outside and then get into the car, bringing with them bacteria and spores from mould which they then leave on the gear stick or the steering wheel . An enclosed environment which is highly contaminated with mould can exacerbate respiratory problems or existing allergies.’

DOWNSTAIRS LOO TOWELS

Our downstairs cloakroom is mostly used by the boys and their friends. The towels do get pretty grubby, but I change them twice a week at least.

LAB RESULTS

Total bacteria: 4,000  -  unsatisfactory.

Entero: Ten  -  good.

E. coli: nil.

Staphylococcus aureus: 20  -  unsatisfactory/highly contaminated.

Mould: 20 – highly contaminated

EXPERT’S VERDICT: ‘If you sat and thought up the perfect way to breed harmful bacteria, you would probably come up with the bathroom hand towel,’ says Lisa.

‘Nice and moist with a constant supply of bacteria from people who haven’t washed their hands quite enough  -  or at all  -  after using the loo.

While the readings aren’t sky-high, there is a variant of contamination including quite high readings of Staphylococcus aureus which can enter the bloodstream through a cut.

‘On the positive side there was no E. coli, which is a sign people are at least washing their hands properly. Towels really do have to be washed at 60C at the very least.’

‘Highly contaminated’: The family’s Playstation handset contained levels of MRSA

PLAYSTATION HANDSET

The boys got a Playstation for Christmas, so it’s eight months old. I never use it, but they are on it all the time and it’s never cleaned at all.

LAB RESULTS

Total bacteria: 1,900  -  unsatisfactory.

Entero: fewer than ten  -  good.

E. coli: nil.

Staphylococcus aureus: 360  -  highly contaminated.

Mould: ten  -  unsatisfactory.

EXPERT’S VERDICT: ‘The handset was highly contaminated with Staphylococcus aureus, a potentially harmful bacteria,’ says Lisa.

‘If this germ enters the body it can cause skin and urine infection, pneumonia and blood poisoning. The risk with the Playstation is that the boys may be playing and eating at the same time.’

BATHROOM LIGHT SWITCH PULL TOGGLE

I’m paranoid about bathroom germs and clean very carefully.

LAB RESULTS

Total bacteria: 1,000  -  unsatisfactory.

Entero: fewer than ten  -  good.

E. coli: nil.

Staphylococcus aureus: fewer than 10  -  good.

Mould: ten  -  unsatisfactory.

EXPERT’S VERDICT: ‘A perfect example of the bathroom being cleaner than other places,’ says Lisa. ‘People will clean every inch of their bathroom, but neglect food preparation areas.’

IPOD HEADPHONES

These belong to my eldest son and are about 12 months old. I do borrow them sometimes and we both wipe them clean before use.

LAB RESULTS

Total bacteria: 230  -  satisfactory.

Entero: fewer than 10  -  good.

E. coli: nil.

Staphylococcus aureus: fewer than 10  -  good.

Mould: fewer than 10  -  good.

EXPERT’S VERDICT: ‘ The cleanest item in the survey,’ says Lisa ‘They hit a low bacterial and mould score. This probably reflects the fact only two people use it and also that we’re often reluctant to put something visibly dirty in our ear.’

CONCLUSION

‘Apart from the headphones, none of the items could be considered entirely clean and free from germs and mould,’ says Lisa.

‘But many of the items rated well and it was a very good sign we didn’t detect any E.coli anywhere. This means handwashing is of a high standard.

‘I would advise you regularly wipe things like the Playstation handset and your computer keypad and give them a regular antibacterial spray. But overall, your bacterial levels were typical of a family home.’

How can Q shield protect us from our changing environment?

How can we as individuals protect ourselves from each other, our friends and family and still live together successfully?  To understand how we can do this we must understand how these diseases are spread.

The current UK Health protection agency web site has the following statement on it;

“Hands continue to play a major role in the transmission of infection in all healthcare environments. Hand cleansing is the single most important factor in the prevention of infection and curbs the spread of potentially pathogenic organisms”.

The potential for the spread of infections at work or in the home depends on many factors, number of people, proximity to each other, sharing of equipment from computer key boards to steering wheels on cars/ vans and all points in between.  In the case of the swine flu pandemic, the vast majority of the cross infection has been shown to be spread from hard surfaces to hands.  “Frequent hand washing is probably the single most effective and simplest intervention you can do to protect yourself and your family,” according to Dr. Judy Daly, spokesperson for the American Society for Microbiology.

Some viruses can survive for weeks on hard surfaces before being picked up on hands and then to the mouth/ nose etc.  In a recent study from Hong Kong hand hygiene was shown to be the most effective way of preventing the spread of Swine Flu.  Wearing masks showed no real additional benefit.   So “Catch it – kill it – bin it” seems to be good advice.   Advice from the Centre for Disease Control (CDC) and the World Health Organisation (WHO) has for a long time been that hand hygiene is the most effective way of preventing many diseases spreading including E coli, MRSA and Listeria.

Q Shield hand and hard surface sanitizers don’t just clean the surfaces and then leave nothing to continue to kill harmful microbes.  They stay on the surface for more than 24 hours, and continue to kill the microbes with no reduction in effectiveness.  They have been proven to be the most effective and safe antimicrobial it is possible to buy today.  The real issue here is l.ong lasting protection.  Any antimicrobial that does not have a persistent action is of little to no real use, as surfaces or skin become re colonised as soon as they come into contact with new micro organisms.  In fact if all the micro organisms have not been killed after application (which is very common), then the microbes left on the surface or skin, simply start to multiply again.

The active ingredient in Q shield has also been shown to kill the harmful Norovirus, which has been responsible for many outbreaks of diarrhoea and vomiting in hospitals, on cruise ships and in hotels.  Alcohol gels that are dispensed in these places DO NOT kill Norovirus.   In fact Q shield kills many bacteria and viruses that alcohol gels do not.

China – ahead of the world in infection prevention

It has long been known in the medical/ infection control industry, that China leads the world when it comes to hand cleanliness and prevention of transmission of viral type diseases.  It is no coincidence that Hong Kong was the first place in the world to produce a study on the transmission of Swine flu last year.  Even though it was one of the last areas to suffer from an outbreak, they take such matters so seriously, they want to study and understand them so they can STOP the spread, not just treat it.  In the west, the focus was on treatment, not prevention, it was almost accepted by the political medical elite that infection spread was inevitable.  Millions of doses of Tamiflu were purchased by governments, even though it had been shown to have little effect.  Many people would not take it as they experienced horrible side effects, worse than the disease. Not so in China and the far east, the emphasis was on prevention of spread.  China spent less than a 3rd of the UK on treatments, even though they have many times the number of people living there.

Many healthcare professionals will not use alcohol based hand sanitizers for many reasons, but mostly because they know they do not work.  The NHS has spent hundreds of millions of pounds on alcohol gels, which have not been proven to reduce infections.  Prisoners get drunk on alcohol hand-gel. Many Muslims can’t even use it. Alcohol hand-gel should be “a thing of the past”, which is exactly what is happening in China now.

So what are we doing in the UK to learn from China?

Healthcare experts gathered in Harrogate last week for a conference hosted by the Infection Prevention Society, the leading medical conference in the field of infection control.

Groundbreaking research was presented to the conference that suggests alcohol-based hand cleaners are no longer the most effective first line of defence in infection prevention.

Alcohol-based hand gels have several significant drawbacks, which have led manufacturers to invest heavily in finding a safer, easier and more effective hand sanitizer.

One such manufacturer is Q Technologies Group, who have set themselves the task of leading a “hygiene revolution.”

Q Shield hand-foam, based on new “micro-polymer’’ technology, has been proven to demonstrate superior protection against the swine flu virus, and is unique as it delivers long lasting anti microbial protection compared to alcohol based products which stop working as soon as they dry.

Charlie Pillans, the company’s Managing Director, developed their water-based hand-foam that actually out-performs leading alcohol hand-washes in killing and preventing the germs which cause swine flu and hospital superbugs.

Mr Pillans says “Alcohol hand-washes have run their course. They are no longer the most effective products. Nurses complain of dry and damaged skin caused by alcohol hand gel, prisoners are getting drunk on the stuff, many Muslims can’t touch alcohol and, to top it all, it isn’t even very effective when you consider that it stops working as soon as it evaporates – which is almost immediately.”

Are your hands ever really clean?

The problem with hand hygiene has always been that no one ever knows when their hands have become contaminated by any dangerous microbes.  Washing hands with soap and water or cleaning with alcohol gels has always been good advice, but both are limited in that they provide no ongoing protection.  Without the ongoing protection that Q shield hand sanitizer offers, there is no real protection – worse still in the case of alcohol gels, a recent study 76% of people using alcohol gels thought that the gels gave lasting protection.  This could be dangerous if people believe they are protected, it may mean they do not take as many precautions, stop washing hands etc.  In fact once the alcohol has evaporated there is no residual effect, if it has evaporated too quickly it may not have killed all the microbes on your hands (depends on the air temperature and amount used), in which case your hands will begin to re colonise immediately, if you are lucky enough to have killed all microbes, as soon as you touch anything else that is colonised, your hands will pick up the microbes and they will start to multiply.

The best defence against microbes including flu viruses on hands is to have the long term effect given by Q shield.  That means regular treatment of safe persistent agents that will keep hands free of microbes.  This advice is particularly important for people such as pregnant women and children, in fact anyone who is at particular risk from the Swine Flu virus.  Until recently soap and water and alcohol gels were the best and only option, however there is now Q shield which lasts 24 hours.  This new  hand sanitizer provides real protection provided it is used regularly and at the recommended intervals will give long lasting real protection.  Q Shield hand sanitizer has proven to be more effective than regular use of alcohol gels, is safer to store and causes less problems than alcohol gels.  Q Shield is more cost effective than alcohol gels in use and will kill microbes for up to 24 hours providing protection against re infection from touching contaminated surfaces for all that time.

Are there problems with alcohol gel?

Prisoners get drunk on alcohol hand-gel. Many Muslims can’t even use it. Alcohol hand-gel should be “a thing of the past.”

Healthcare experts gathered in Harrogate last week for a conference hosted by the Infection Prevention Society, the leading medical conference in the field of infection control.

Groundbreaking research was presented to the conference that suggests alcohol-based hand cleaners are no longer the most effective first line of defence in infection prevention.

Alcohol-based hand gels have several significant drawbacks, which have led manufacturers to invest heavily in finding a safer, easier and more effective hand sanitizer.

One such manufacturer is Q Technologies Group, who have set themselves the task of leading a “hygiene revolution.”

Q Shield hand-foam, based on new “micro-polymer’’ technology, has been proven to demonstrate superior protection against the swine flu virus, and is unique as it delivers long lasting anti microbial protection compared to alcohol based products which stop working as soon as they dry.

Charlie Pillans, the company’s Managing Director, developed their water-based hand-foam that actually out-performs leading alcohol hand-washes in killing and preventing the germs which cause swine flu and hospital superbugs.

Mr Pillans says “Alcohol hand-washes have run their course. They are no longer the most effective products. Nurses complain of dry and damaged skin caused by alcohol hand gel, prisoners are getting drunk on the stuff, many Muslims can’t touch alcohol and, to top it all, it isn’t even very effective when you consider that it stops working as soon as it evaporates – which is almost immediately.”

Q Shield’s micro-polymer technology forms an invisible protective layer on any surface, be it human hands or a hospital floor. Independent laboratory tests have demonstrated Q Shield’s effectiveness in killing the flu viruses and have also shown that Q Shield kills viruses for at least 24 hours after application to hard surfaces – unlike conventional disinfectants which stop working when dry.

Lord Warner, the former government Health Minister, has been quoted as saying “The scientific evidence proves that persistent products mark a step-change in the fight against the swine flu pandemic. The long-lasting nature of the product, combined with its safety, means that persistent hygiene products have the potential to revolutionise the way we deal with flu and superbugs.”

Mobile Phones harbours harmful bacteria

Mobile phones can harbour 18 times more living bacteria than a flush on a men’s toilet, according to research for consumer group Which?.

A hygiene expert who swabbed and analysed 30 handsets for the study found seven had warning or high levels of environmental bacteria.

One harboured levels of bacteria, including faecal coliforms, high enough to give its user a serious stomach upset.

Which? said the findings suggest millions of UK mobiles would exceed the recommended acceptable levels of bacteria.

While not immediately harmful, elevated levels indicate poor hygiene and can act as a breeding ground for more serious bacteria.

Hygiene expert Jim Francis told Which?: “The levels of potentially harmful bacteria on one mobile were off the scale. That phone needs sterilising.”

The tests showed how easily bacteria could linger on the surface of a phone, which could be passed on to other people if they held the handset to look at photos or other applications.

Preventing Swine Flu in Schools Poster

This  new poster is available to download for use in schools and nurseries. Click the picture to open a pdf version which can be saved to your computer where you can print out as many as needed to display around your

swine-flu-school-poster

Preventing the Spread of Infection in Schools

The CDC posts influenza prevention and response guidelines for schools and school nurses, for each educational level. The CDC’s latest K-12 recommendations for situations with severity similar to that of the spring 2009 outbreak include:

Staying home when sick. Any student or staff member who comes down with flu-like illness should be sent home and stay at home for at least 24 hours after they no longer have a fever, or signs of a fever, without the use of fever-reducing medicines. They should stay home even if they are taking antiviral drugs. The most common signs of influenza are fever (temperature > 100 degrees F), sore throat, and coughing. Headache and weakness have also been reported.

Using hand hygiene and respiratory etiquette. These are the first lines of defense against influenza. Everyone should wash hands frequently with soap and running water when possible, and cover noses and mouths with a tissue when coughing or sneezing (or a shirt sleeve or elbow if no tissue is available). Hand sanitizer should be widely available, especially in areas where there is no running water.

Separating ill students and staff. Students who appear to have flu-like illness should wait in a room separate from healthy students until they can be sent home. The CDC recommends that the ill student wear a surgical mask and be placed in a separate room. School nurses and health room attendants should wear protective gear, such as a mask, when in contact with a sick child or staff member.

Initiating early treatment of high-risk students and staff. Students or staff at high risk for influenza complications who present with influenza-like illness should contact their healthcare provider as soon as possible. Early treatment with antiviral medications is very important for people at high risk because it can prevent hospitalizations and deaths. People at high risk include those who are pregnant, have asthma or diabetes, have compromised immune systems, or have neuromuscular diseases.

Routine cleaning. School staff should routinely clean areas that students and staff touch often with the cleaners they typically use. The CDC does not believe that any additional disinfection of environmental surfaces beyond the recommended routine cleaning is required.

Considering school dismissal. School dismissal might be necessary for select schools. For example, a community might decide to dismiss a school that has a large population of high-risk students to better protect the high-risk students.

These recommendations could change if we encounter influenza conditions with increased severity compared with spring of 2009. Supplementary measures might include active screening of students, telling high-risk staff and students to stay home (even if they are not symptomatic), telling students with ill household members to stay home for 5 days after the first person became ill, increasing the distance between students, and extending the period for ill students to stay home to 7 days. If a school closure is necessary, the school should remain open to staff so that they can continue to provide instruction by other means.

School closure has a ripple effect throughout the community. The benefits of reducing illness and complications of influenza can be rapidly outweighed by negative consequences, including students being left home alone, healthcare workers missing shifts when they must stay home with their children, students missing meals, and interruption of students’ education.

“School closure will be a local decision, unless the pattern of illness increases in severity,” explains Delack. “Right now, the only reason to close a school is if you have so many staff home sick that you can’t staff the school.” She also contends that if schools are closed, students need to stay home, acknowledging that this poses problems for parents who are working. Delack recommends telling parents at the beginning of the school year that they need to make contingency plans for childcare should the schools close or their children become ill.

If conditions are more severe than they were last spring, there is a greater chance that school closure will occur as schools find themselves unable to maintain normal functioning (a reactive dismissal). Alternatively, preemptive dismissals could be recommended if the flu is causing more severe disease than expected. If a decision is made to close one or more schools, this must be reported to the CDC via the Novel Influenza A (H1N1) — Related School Dismissal Reporting system. An online reporting form is available.

The H1N1 Vaccine
Current projections of vaccine supply indicate that, at least initially, 5 specific groups will be targeted for vaccination when the vaccine becomes available. These are

  • Pregnant women;
  • Persons who live with or provide care for infants age < 6 months (eg, parents, siblings, and daycare providers);
  • Healthcare and emergency medical services personnel;
  • Persons age 6 months to 24 years; and
  • Persons age 25-64 years who have medical conditions that put them at higher risk for influenza-related complications.

If the vaccine supply is even more limited than expected, the most vulnerable of these 5 groups (eg, pregnant women, persons with medical conditions that connote high risk) will be vaccinated first. Therefore, in a setting of extremely limited availability of vaccine, school-age children (age 5-18 years) who are otherwise healthy would not be among the first recipients of the vaccine. All children, however, should receive the seasonal influenza vaccination as soon as it becomes available.

The news is full of reports that the US government and many state departments of health are gearing up for mass vaccinations of students within the schools, much like the mass polio vaccinations of students in the 1960s. Although no definitive decisions regarding dissemination of the vaccine to students have yet been made, Delack believes that schools are the “logical choice” to serve as vaccination clinics. In any case, mass vaccinations of healthy, low-risk students and staff may be a long way off according to other reports suggesting that only about one third of the needed supply of vaccine will be available in October 2009.

Conclusion
In their issue brief, “Role of the School Nurse,” the NASN notes that in 1902, the earliest function of school nurses was “to reduce absenteeism by intervening with students and families regarding health care needs related to communicable diseases.” Although in subsequent years the role of the school nurse has expanded far beyond this responsibility, it seems that in 2009 we have come full circle. The school nurse must assume a leadership role in the prevention of a pandemic influenza, a role that involves education, collaboration, planning, decision-making, and many other functions. Schools that have nurses should consider themselves very lucky in the days and weeks to come.

About the NASN. The NASN is the leader in advocacy for student health and professional development of school nurses. The Association supports the health and educational success of children and youth by developing and providing leadership to advance school nursing practice by specialized registered nurses. Every child deserves a school nurse.

Hospital hand wash gels ‘unreliable’

Disinfectant gels recently introduced in UK hospitals may not be reliable for hand hygiene and could contribute to ward infections, research suggests. They are said to be less effective than both disinfectant rinses and soap and water.
The gels were introduced because they caused less skin irritation, were quicker to administer, and were thought to encourage hygiene compliance.

Hand hygiene among health-care workers is a major priority to prevent the spread of infection in hospitals.

The introduction of any of the tested gels would be a backward step and unnecessarily lower the hygiene standard

Professor Didier Pittet, research co-ordinator
Researchers from Switzerland and Germany carried out research on 10 alcohol-based gels and four alcohol-based hand rinses and compared them to a reference disinfectant.
The reference disinfectant, derived from propanol, complies with European antiseptic standards known as EN 1500.
According to the research, published in The Lancet, none of the gel formulations, most of which were ethanol-based, were as effective as the reference disinfectant within 30 seconds of application.

Contamination risk

All of the hand rinses were equally as effective as the reference disinfectant.

The researchers concluded the hand gels should not be used to replace alcohol-based liquid rinses.
Research co-ordinator Professor Didier Pittet said: “In hospitals where most health-care workers use alcohol-based solutions that already meet the EN 1500 requirements, the introduction of any of the tested gels would be a backward step and unnecessarily lower the hygiene standard.

“An increased risk of cross-transmission would certainly result because the application time in daily practice averages eight to 15 seconds and is unlikely to exceed 30 seconds.”

Two brands tested in the survey – Levermed and Spirigel – are used in UK hospitals.
Guy’s and St Thomas’ hospitals in London use both gels and handwashes, but stress the gels are used only in very specific circumstances.

A hospital trust spokeswoman said: “Gels are used where staff are going between one patient and another and would not come into contact with blood or bodily fluids.

“If they have come into contact with blood or fluid then they should wash with liquid hand wash.”

Guidelines on Management of 2009 H1N1 Influenza – Swine Flu

September 9, 2009 — The US Centers for Disease Control and Prevention (CDC) have updated its guidelines on the reporting and management of the 2009 influenza A (H1N1) virus, according to a media briefing yesterday.

Topics covered include characteristics of 2009 H1N1 influenza based on ongoing surveillance and guidance regarding use of antiviral agents for 2009 H1N1 influenza and seasonal influenza.

Although the recommended drugs and groups of patients requiring antiviral treatment remain unchanged from the previous update, the latest recommendations include a “watchful waiting” option for prophylaxis and emphasize the need for prompt treatment in high-risk patients.

“The 2009 H1N1 influenza virus] never went away this summer — it’s still around, and we need to pay attention,” said Anne Schuchat, MD, director of the CDC’s National Center for Immunization and Respiratory Diseases. “The good news is that the spectrum of illness doesn’t seem to have changed, but we really don’t know what the trajectory will be. Our principal prediction is that it will be a busy and long season, and we need to be prepared.”

The most recent increase in 2009 H1N1 influenza activity appears to be centered in the southeastern states, including Georgia, Mississippi, Alabama, and Florida. On September 4, 24 primary and secondary schools in Georgia, Indiana, Missouri, and Tennessee announced that they had sent home a total of 25,000 students with flu-like illness thought to be caused by the H1N1 strain. The reason for this geographic predilection is unclear, but 2 important factors may be that schools in the southeastern states resume classes earlier than do schools in other regions and that the southeastern states had relatively less H1N1 activity in the spring.

“We expect more variability in the H1N1 virus going into next spring,” Dr. Schuchat said. “But the good news is that the virus is unchanged in its appearance so far, so that the vaccines that have been prepared against this strain should still be effective.”

Compared with CDC guidance issued on May 6, 2009, the latest guidance differs in the following ways:
Additional context and guidance for clinicians is provided to help ensure that antiviral drugs are prescribed appropriately this season and that they are administered quickly to those in greatest need. As before, the priority for use of antiviral drugs is for patients who are hospitalized with influenza-like illness and for those patients who are ill with influenza-like illness and who are at high risk for influenza-related complications.
To shorten possible delays between illness onset in high-risk patients and treatment, clinicians should consider providing prescriptions for antiviral medications ahead of time for such patients. Should the patient develop symptoms, he or she could call the clinician for guidance about whether to fill the prescription.
More information is given concerning the appropriate (and limited) situations in which antiviral medications should be used for chemoprophylaxis. Antiviral agents should not be used for prevention in healthy persons based on community exposures. Rather than immediately treat all persons at high risk who have been exposed to H1N1, it may be appropriate in some closely monitored patients to watch expectantly, giving antiviral agents immediately if symptoms develop, but not as prophylaxis in asymptomatic individuals.
The new recommendations emphasize using antiviral drugs for early treatment instead of for prophylaxis to provide clinicians with the information needed to reach those at greatest risk with appropriate and timely treatment, to lower the risk of developing antiviral resistance, and to recognize the importance of clinical judgment in making patient-specific decisions regarding treatment and chemoprophylaxis.
Thus far, there have been “only a handful” of cases of reported H1N1 resistance to antiviral agents, according to Dr. Schuchat.

As the CDC recommended previously, all persons with suspected or confirmed influenza requiring hospitalization should be treated with oseltamivir or zanamivir, as should those who are at increased risk for complications (children younger than 5 years, adults aged 65 years and older, pregnant women, persons with certain chronic medical or immunosuppressive conditions, and persons younger than 19 years who are receiving long-term aspirin therapy).

“Timing of antiviral therapy is important, and it should be started in high-risk patients within 48 hours of symptom onset,” Dr. Schuchat said. “But clinical judgment is still important, and we want clinicians to customize their care for each patient.”

The latest guidelines emphasize starting treatment as early as possible in hospitalized patients or in those at high risk for complications, because studies have shown that treatment started within 48 hours of illness onset is more likely to provide benefit.

Treatment should not be delayed pending laboratory confirmation of influenza, because a negative rapid test for influenza does not rule out influenza and sensitivity ranges from 10% to 70%.
In addition to hospitalized patients and those at high risk for complications, any patient with suspected influenza presenting with warning symptoms or signs should promptly receive empiric antiviral treatment. These “red flag” findings include dyspnea, tachypnea, fever, unexplained oxygen desaturation, and/or lower respiratory tract illness.
Clinicians should educate their patients about these warning symptoms and encourage them to seek treatment as soon as possible if the symptoms are present. In infants and young children, additional warning signs are lethargy, irritability to the point of not wanting to be held, and symptoms initially appearing to improve and then getting worse.
Persons who are not at higher risk for complications or do not have severe influenza requiring hospitalization generally do not require antiviral medications for treatment or prophylaxis.
“Antivirals are a critical part of our tool kit in countering influenza, both H1N1 and other strains,” Dr. Schuchat said. “But a key point is that most children, adolescents, and adults do not need antiviral medication if they develop a flu-like illness. Giving these medications when they are not needed could actually make things worse by promoting viral resistance.”
The reporting and management guidelines are available on the CDC’s H1N1 Flu Clinical and Public Health Guidance page.

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