2020 microbiology columns - Healthcare Hygiene magazine

Let’s Go Campy(ing)

By Rodney E. Rohde, PhD, MS, SM(ASCP)CM SVCM, MBCM, FACSc

This column originally appeared in the December 2020 issue of Healthcare Hygiene magazine.

According to the most recent 2019 CDC publication, Antibiotic Resistance (AR) Threats in the United States, Campylobacter causes an estimated 1.5 million infections and $270 million in direct medical costs every year. Of those infections, 29% have decreased susceptibility to fluoroquinolones (e.g., ciprofloxacin) or macrolides (e.g., azithromycin), the antibiotics used to treat severe Campylobacter infections. CDC ranks AR threats from high to low as urgent, serious, concerning and watched. Campylobacter currently sits in the serious threat rank.

Campylobacter (meaning "curved bacteria") is a genus of Gram-negative bacteria. These bacteria typically appear as comma- or S-shaped and are motile. The genus is pronounced as cam·pylo·bac·ter | (kam-pi-lō-ˈbak-tər). Some species can infect humans, sometimes causing campylobacteriosis, a diarrheal disease in humans. In many instances, these infections are self-limiting and do not require treatment unless one is immunocompromised. However, there is a growing issue of antibiotic resistance with this genus. There are about a dozen known Campylobacter spp. implicated in human disease. The primary human pathogens are C. jejuni (~80-90%) and C. coli (~5-10%) which are the most common.

Campylobacter causes an estimated 1.5 million illnesses each year in the United States. People can get this infection by eating raw or undercooked poultry or eating something that touched it. The most known source for Campylobacter is poultry. However, due to its large and diverse natural reservoir, the infection can also occur from eating other foods, including seafood, meat, and produce, by contact with animals, and by drinking untreated water. Sources of infection can also be direct contact with infected animals (e.g. chickens), which often carry Campylobacter asymptomatically. C. jejuni leads the cause of bacterial foodborne disease in many developed countries, including Europe and the United States.
In this article, I will introduce Campylobacter and information aimed at a general understanding of the characteristics of this pathogen in the environment. Primarily, I will utilize information obtained from the Centers for Disease Control and Prevention along with professional experience.

How does one prevent infection? Since Campylobacter spp. are found in such a large and diverse number of environments, including animal reservoirs there are a number of public health measures one should follow to prevent infection.
• Wash your hands!
• Keep certain foods separated; especially keep raw poultry away from other foods. Use separate cutting boards and clean them properly.
• Cook food properly, especially poultry (minimum internal temperature of 165°F). It is one of the top causes of Campylobacter illnesses in the United States. Poultry includes chicken, turkey, duck, goose, and other farmed birds.
• Drink pasteurized milk (raw milk can carry Campylobacter and other harmful germs that can make you very sick).
• Do not drink untreated water.
• Be careful with pets and livestock since they can carry Campylobacter and other germs.

Can an outbreak occur with this bacteria? Outbreaks are not commonly reported, considering how often people get sick from this bacterium, but the frequency has been increasing. Typically, poultry, raw milk, and untreated water have been the most commonly identified sources.
• In a very recent example of an outbreak, CDC and public health officials in several states are investigating a multistate outbreak of multidrug-resistant Campylobacter jejuni infections linked to puppies purchased from pet stores. To date, 30 people infected with the outbreak strain of Campylobacter jejuni, which causes diarrheal illness, have been reported from 13 states. Four hospitalizations have been reported and currently there has been no mortality.
• Epidemiologic and laboratory evidence indicate that contact with puppies, especially those at pet stores, is the likely source of this outbreak.
• Campylobacter bacteria isolated from clinical samples from ill people in this outbreak are resistant to commonly recommended, first-line antibiotics.

How is this organism diagnosed and what are the typical treatment options?
Campylobacter infection is diagnosed when a laboratory test detects Campylobacter bacteria in stool, body tissue, or fluids. The test could be a culture that isolates the bacteria or a rapid diagnostic test that detects genetic material of the bacteria (e.g. PCR testing). Sometimes a direct examination of a stool sample using contrast microscopy or Gram’s strain provides for a rapid presumptive diagnosis that must still be confirmed by stool culture. Blood cultures are often not performed and in most cases, one does not detect sepsis in this infection.

Campylobacter infections often do not need antibiotic treatment. Individuals experiencing an infection should drink extra fluids as long as diarrhea lasts. Some people with, or at risk for, severe illness might need antibiotic treatment including anyone 65 years or older, pregnant women, and the immunocompromised (e.g. AIDS or cancer patients receiving chemotherapy). Due to growing antibiotic resistance, some types of antibiotics may not work for some types of Campylobacter. When antibiotics are necessary, healthcare providers should use standard medical laboratory testing (antibiotic susceptibility testing) to help determine which type of antibiotics will likely be effective. If prescribed antibiotic(s), one should always take them exactly as directed by their physician. Campylobacter infections with decreased susceptibility are more common in low- and middle-income countries, putting travelers at risk for infections that may be harder to treat.
What are the symptoms of an infection? Campylobacter infections usually cause people to have diarrhea (often bloody), fever, and stomach cramps. Nausea and vomiting may accompany the diarrhea. These symptoms usually start two to five days after the person ingests Campylobacter and last about one week. Sometimes these infections cause complications, such as irritable bowel syndrome, temporary paralysis, and arthritis. Those individuals with weakened immune systems (e.g. blood disorder, AIDS, or chemotherapy patients), Campylobacter occasionally spreads to the bloodstream and causes a life-threatening infection.

Rodney E. Rohde, PhD, MS, SM(ASCP)CM SVCM, MBCM, FACSc, serves as chair and professor of the Clinical Laboratory Science Program at Texas State; associate director for the Translational Health Research Initiative; as well as associate dean for research in the College of Health Professions. Follow him on Twitter @RodneyRohde / @TXST_CLS, or on his website: http://rodneyerohde.wp.txstate.edu/

What About Flu During the COVID-19 Pandemic?

By Rodney E. Rohde, PhD, MS, SM(ASCP)CM SVCM, MBCM, FACSc

This column originally appeared in the November 2020 issue of Healthcare Hygiene magazine.

The Centers for Disease Control and Prevention has published Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2020-2021 Influenza Season. This report updates the 2019–20 recommendations of the Advisory Committee on Immunization Practices (ACIP) regarding the use of seasonal influenza vaccines in the United States (MMWR Recomm Rep 2019;68[No. RR-3]). Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications.

Why is it so important to receive the flu vaccine during the ongoing pandemic? For starters, global efforts to lower the transmission of SARS-CoV2 which is responsible for the COVID-19 illness, such as reduced travel, staying home, telecommuting for work and online education, have led to a reduction in the number of people taking advantage of routine physician visits for a number of services, including getting one’s vaccines up to date. Overall, healthcare is already under dangerous workloads and shortages in both healthcare professionals and healthcare PPE, as well as other essential medical items due to the pandemic. It is vital that everyone get their routine vaccinations during the COVID-19 pandemic to protect people and communities from vaccine-preventable diseases and outbreaks, including flu.

We can never perfectly predict how bad an upcoming flu season will be for a particular year. It is always critical to prepare for the upcoming flu season since we know that it can lead to high morbidity and mortality for certain populations. It will be even more important this year to reduce flu because it can help reduce the overall impact of respiratory illnesses on the population and thus lessen the resulting burden on the healthcare system during the COVID-19 pandemic. A flu vaccine may also provide several individual health benefits, including preventing one from getting flu, lowering the severity of a flu illness and reducing one’s chances of having to go to the hospital.

Influenza (flu) is an RNA virus that is notorious, and some might say diabolical, in its ability to mutate from year to year. RNA viruses (like SARS-CoV2) are unfortunately very smart and mischievous in this aspect. Flu, like SARS, also has the ability to live as a zoonotic agent. The flu virus has long been an inhabitant of swine, fowl, and humans, which continually allow for antigenic drift (small changes in the virus genome) and shift (major changes in the virus genome). It is a contagious respiratory illness, which can cause mild to severe illness resulting in hospitalization or death. Some people, such as older people, young children, and people with certain health conditions, are at high risk of serious flu complications. There are two main types of influenza (flu) virus: Types A and B. A third, Type C, is not clinically relevant to humans. The influenza A and B viruses that routinely spread in people (human influenza viruses) are responsible for seasonal flu epidemics each year. Here, I will focus on the types of influenza of medical and clinical importance aimed at a general understanding of the characteristics of this pathogen in the environment. Primarily, I will utilize information obtained from the Centers for Disease Control and Prevention (CDC) along with professional experience.

How does transmission occur with influenza? Flu viruses typically circulate in the United States each year, most commonly from the late fall through the early spring. Flu viruses spread mainly by tiny respiratory droplets made when people with flu cough, sneeze or talk. Respiratory droplets can move through the air to other hosts (people) and end up in their eyes, mouth or nose especially when they are nearby to each other. Likewise, flu viruses can be expelled in respiratory droplets and land on surfaces. People might touch these surfaces, and then rub their eyes, nose or mouth with their fingers. This action is known as indirect transmission and is less of a primary transmission route versus person-to-person (direct transmission). Thus, being aware of physical distance and high-touch surfaces, as well as hand hygiene are primary preventative measures for influenza much like SARS-CoV-2.

Could I get flu and COVID-19 at the same time? Yes. It is possible and “mixed infections” do occur with other microbial agents. Experts are still studying how common this might be for flu and COVID-19. Due to similar symptoms for both agents, it can be difficult to tell the difference between them based on symptoms alone.

So, is there a laboratory test that can detect both viruses? Yes. CDC has developed a test that will check for Type A and B flu, and SARS CoV-2, the virus that causes COVID-19 at the same time. This test will be used by U.S. public health laboratories and has been granted EUA by the Food and Drug Administration (FDA) to CDC.

A Visit From an Old Nemesis, Streptococcus

By Rodney E. Rohde, PhD, MS, SM(ASCP)CM SVCM, MBCM, FACSc

This column originally appeared in the October 2020 issue of Healthcare Hygiene magazine.

Recently, a group of infectious disease scientists at Houston Methodist Hospital identified strains of group A streptococcus that are less susceptible to commonly used antibiotics like penicillin and other related beta-lactams. While this genus of bacteria has not been seen as worrisome in regards to antibiotic resistance, these findings remind us that the agent of strep throat, flesh eating disease, rheumatic fever, glomerulonephritis and other dangerous illnesses must never be overlooked or neglected when it comes to research, diagnosis and treatment. James M. Musser, MD, PhD, lead author of the study and chair of the Department of Pathology and Genomic Medicine at Houston Methodist Hospital and members of his department collaborated with nearly a dozen institutions across seven countries; discuss this research study in the Jan. 29, 2020 online issue of the Journal of Clinical Microbiology.

Streptococcus is a genus of gram-positive coccus (plural cocci) or spherical bacteria that belongs to the family Streptococcaceae, within the order Lactobacillales (lactic acid bacteria), in the phylum Firmicutes. The streptococcus bacteria are found in the form of twisted chains (“strepto”) of coccus (spheres, circular body). At present, there are over 50 medically significant species of this genus. Most streptococci are oxidase-negative and catalase-negative, and many are facultative anaerobes, which means that they are capable of growing both aerobically and anaerobically. In 1984, many bacteria formerly grouped in the genus Streptococcus were separated out into the genera Enterococcus and Lactococcus.

Many of the species found in the genus are known to be a part of the respiratory and salivary microbiome. Some species can survive on a dry surface for three days to six months. Here, I will focus on the streptococci of medical and clinical importance aimed at a general understanding of the characteristics of this pathogen in the environment. Primarily, I will utilize information obtained from the Centers for Disease Control and Prevention (CDC) along with professional experience.
How does transmission occur with these bacteria? These bacteria are transmitted primarily by direct contact with secretions from oral and nasal discharges of infected people or by coming into contact with wounds (sores) on the skin. Risk of transmission to a new host is highest when one comes into contact with an ill person exhibiting these conditions. In the medical setting, the most important groups are the alpha-hemolytic streptococci S. pneumoniae and Streptococcus viridans group, and the beta-hemolytic streptococci of Lancefield groups A and B (also known as “group A strep” and “group B strep”).

Which species are of medical significance and what primary diseases do they cause. This group of bacteria are taxonomically classified based on their hemolytic properties (ability to lyse red blood cells). The alpha-hemolytic species cause oxidization of iron in hemoglobin molecules within red blood cells which leads to incomplete or “partial hemolysis” causing a greenish color on blood agar. Beta-hemolytic species cause complete lysis of red blood cells appearing as wide areas clear of blood cells surrounding bacterial colonies (known as zones of hemolysis) on blood agar. The gamma-hemolytic species do not cause hemolysis (non-hemolytic). Rebecca Lancefield (scientist) developed a classification scheme known as the Lancefield groups, a serotype classification (that is, describing specific carbohydrates present on the bacterial cell wall). Within the Lancefield grouping, the beta-hemolytic streptococci are named Lancefield group A-W.
Species, primary host and their diseases include:
• S. pyogenes (human) – pharyngitis, cellulitis, erysipelas [Group A, beta hemolytic],
• S. agalactiae (human, cattle) – neonatal meningitis and sepsis [Group B, beta hemolytic],
• S. dysgalactiae (human, animals) – endocarditis, bacteremia, pneumonia, meningitis, respiratory infections [Group G],
• S. gallolyticus (human, animals) –urinary tract or biliary infections, endocarditis
• body aches [Group D],
• S. anginosus (human, animals) – subcutaneous/organ abscesses, meningitis, respiratory infections [viridans streptococci group, alpha hemolytic],
• S. sanguinis (human) – endocarditis, dental caries [viridans streptococci group, alpha hemolytic],
• S. mitis (human) – endocarditis [viridans streptococci group, alpha hemolytic],
• S. mutans (human) – dental caries [viridans streptococci group, alpha hemolytic], and
• S. pneumoniae (human) – pneumonia [Alpha hemolytic group].

How can physicians (clinicians) and medical laboratory (clinical microbiologists) help track this genus?
Clinicians and microbiologists evaluating pneumococcal or other streptococcus isolates with the following characteristics should contact their state or local health departments for further assistance:
• Pneumococci with potentially novel features, such as an unusual antibiotic susceptibility profiles, and
• Concern about outbreaks related to pneumococci, streptococci (other than pneumococci), or other catalase-negative, Gram-positive cocci.
The CDC is available to offer epidemiologic assistance to state and local health departments.

Prevention and treatment
A single-dose, 23-valent vaccine to prevent infection by the most common serotypes of S. pneumoniae is available in the United States (see CDC for vaccine recommendations). Antibiotic (chemoprophylaxis) therapy with penicillin for those with rheumatic heart disease from streptococcus may be given monthly (intramuscular) or daily (oral) for lifetime to prevent development of bacterial endocarditis on a damaged heart valve. Penicillin may also be necessary to control outbreaks of S. pyogenes (military, nurseries, households, etc.).

Norovirus: It’s Not Just on Cruise Ships

By Rodney E. Rohde, PhD, MS, SM(ASCP)CM SVCM, MBCM, FACSc

This column originally appeared in the September 2020 issue of Healthcare Hygiene magazine.

When one reads or hears about the noroviruses (NoV), they likely think about a rough voyage on a cruise ship. Norovirus illness may be called “food poisoning,” “stomach flu,” or “stomach bug.” They are the leading cause of foodborne illness and can be found in healthcare setting outbreaks as well as in community outbreaks. NoV may be referred to as the winter vomiting bug but it is not related to influenza (flu). These viral agents can survive for long periods outside a human host depending on the surface and temperature conditions. Since they are non-enveloped viruses, NoV survive for weeks on hard and soft surfaces. Studies show survival for months and possibly even years in contaminated still water. Typically, they will be viable on surfaces used for food preparation for up to a week after contamination.

NoV are a genetically diverse group of single-stranded positive-sense RNA, non-enveloped viruses belonging to the family Caliciviridae. According to the International Committee on Taxonomy of Viruses, the genus Norovirus has one species: Norwalk virus. Serotypes, strains and isolates include Norwalk virus, Hawaii virus, Snow Mountain virus, Mexico virus, Desert Shield virus, Southampton virus, Lordsdale virus, and Wilkinson virus. Noroviruses are genetically classified into at least seven different genogroups (GI, GII, GIII, GIV, GV, GVI, and GVII), which can be further divided into different genetic clusters or genotypes. GI and GII are responsible for most human acute gastroenteritis and other genogroups are found in bovine and mice.

Unfortunately, one of the hallmark characteristics of NoV is the incredible effectiveness in transmission and infection. Those who are experiencing an illness with this viral agent can shed billions of norovirus particles. It only takes a few virus particles to make other people sick. Vomiting, in particular, transmits infection effectively and appears to allow airborne transmission. Studies have shown that one person can infect up to 14 other people and there are numerous outbreaks involving hundreds (or more) of people especially in close quarters (cruise ships, daycares, schools, etc.).

This organism is notorious for its survival on surfaces in all environments. Here, I will introduce NoV and information aimed at a general understanding of the characteristics of this pathogen in the environment. Primarily, I will utilize information obtained from the Centers for Disease Control and Prevention along with professional experience.

How does this virus spread? This virus spreads easily and efficiently primarily via the fecal – oral route, including the following:
• eat or drink NoV contaminated food or drink,
• touch surfaces or objects contaminated with norovirus then put your fingers in your mouth, or
• have direct contact with someone who is infected with norovirus, such as by caring for them or sharing food or eating utensils with them,
• septic tank leaking at the source (into a well),
• when an infected person vomits or poops in the water,
• improperly treated water sources, such as not enough chlorine,

What are the common symptoms? NoV causes inflammation of the stomach or intestines (acute gastroenteritis). Symptoms usually develop 12 to 48 hours after exposure and resolve within 1 to 3 days. If you have norovirus illness, you can feel extremely ill, and vomit or have diarrhea many times a day. This can lead to dehydration, especially in young children, older adults, and people with other illnesses. Symptoms can include:
• diarrhea
• vomiting
• nausea
• stomach pain
• or less commonly, fever
• headache
• body aches

Can NoV be treated?
Since a virus causes this infection, there is not any specific treatment required if there are no complications such as dehydration. Severe dehydration may require hospitalization for treatment with fluids given through your vein (intravenous or IV fluids). One should watch for signs of dehydration in children who have norovirus illness. Children who are dehydrated may cry with few or no tears and be unusually sleepy or fussy.

What should one do for prevention of this infection?
This virus, and other microbes, may be transmitted to patients because of their persistence on environmental surfaces in the healthcare environment. As I have often mentioned, all #SurfacesMatter all the time to everyone in the war on pathogen transmission. NoV can live for long periods on environmental surfaces and shared equipment when they are not properly cleaned and disinfected. Likewise, the same applies in the community environment.
Practice proper hand hygiene by washing your hands thoroughly with soap and water
• especially after using the toilet or changing diapers,
• always before eating, preparing, or handling food (cook seafood thoroughly), and
• before giving yourself or someone else medicine.

Laboratory diagnosis
This virus (infection) is diagnosed by detecting viral RNA (genetic material) or viral antigen. Diagnostic tests are available at all public health laboratories and many clinical laboratories, and most use reverse transcription- real-time polymerase chain reaction (RT-qPCR) or immunoassays to detect norovirus.

Just What Do You Know About Gonorrhea?

By Rodney E. Rohde, PhD, MS, SM(ASCP)CM SVCM, MBCM, FACSc

This column originally appeared in the August 2020 issue of Healthcare Hygiene magazine.

In the most recent publication of CDC’s Antibiotic Resistance Threats in the United States, 2019 (2019 AR Threats Report) the latest national death and infection estimates underscore the continued threat of antibiotic resistance in the United States. Did you know that there are 2.8 million antibiotic-resistant infections in the U.S. each year, and more than 35,000 people die as a result? While many of us have heard about MRSA and other more common antimicrobial threats, most people do not realize that Neisseria gonorrhoeae belongs to this threat category. This bug causes gonorrhea, a sexually transmitted disease (STD) that can result in life-threatening ectopic pregnancy and infertility, and can increase the risk of getting and giving HIV.

N. gonorrhoeae and Neisseria meningitidis are genetically very closely related human pathogens. The genus Neisseria is composed of 17 species that may be isolated from humans and 6 species that colonize various animals. The Neisseriaceae are a family of Beta Proteobacteria consisting of Gram-negative aerobic bacteria from multiple genera, including Neisseria, Chromobacterium, Kingella, and others. While there are numerous commensals in this genus, N. gonorrhoeae causes gonorrhea, and N. meningitidis is the cause of meningococcal meningitis. N. gonorrhoeae infections have a high prevalence and low mortality, whereas N. meningitidis infections have a low prevalence and high mortality.

Unlike several of my past month’s articles in which I discussed bugs that are typically found in the natural environment, N. gonorrhoeae has no reservoir outside of humans. N. gonorrhoeae also known as gonococcus (singular), or gonococci (plural) is a species of Gram-negative diplococci bacteria isolated by Albert Neisser in 1879. Most members of this genus are fastidious and require nutrient supplementation to be cultured in the laboratory. Neisseria spp. are facultatively intracellular and typically appear in pairs (diplococci) which classically look like coffee beans in a gram stain. They do not form endospores and are capable of twitching motility. They are obligate aerobes (requires oxygen to grow) which must be considered for culture.

How common is gonorrhea?
This disease, unfortunately, is very common. CDC estimates that approximately 1.14 million new gonococcal infections occur in the United States each year and as many as half occur among young people aged 15-24. In 2018, 583,405 cases of gonorrhea were reported to CDC. It is a STD via infection of the mucous membranes of the reproductive tract, including the cervix, uterus, and fallopian tubes in women, and the urethra in women and men. N. gonorrhoeae can also infect the mucous membranes of the mouth, throat, eyes, and rectum. Importantly, a mother can give the infection to her baby as the baby passes through the birth canal during delivery sometimes causing blindness.
How is gonorrhea diagnosed?

This STD bug, historically was diagnosed by traditional microbiology tests, including oxidase positive (possessing cytochrome c oxidase) and catalase positive (able to convert hydrogen peroxide to oxygen) as well as by its ability oxidize only glucose (negative for the other carbohydrates lactose, maltose, and sucrose). However, in today’s microbiology world this drug resistant STD is most commonly rapidly diagnosed by a molecular test.

Urogenital gonorrhea can be diagnosed by testing urine, urethral (for men), or endocervical or vaginal (for women) specimens using nucleic acid amplification testing (NAAT). It can also be diagnosed using gonorrhea culture, which requires endocervical or urethral swab specimens.

If a person has had oral and/or anal sex, pharyngeal and/or rectal swab specimens should be collected either for culture or for NAAT (if the local laboratory has validated the use of NAAT for extra-genital specimens).

What do you need to know about antibiotic resistance?
Gonorrhea has quickly developed resistance to all but one class of antibiotics, and half of all infections are resistant to at least one antibiotic. Tests to detect resistance are not always available at time of treatment. Gonorrhea rapidly develops resistance to antibiotics—ceftriaxone is the last recommended treatment. Gonorrhea spreads easily. Some men and most women are asymptomatic and may not know they are infected, increasing spread. Due to this growing problem, clinicians and patients should seek out information on treatment regimens.

How can gonorrhea be prevented?
• Latex condoms, when used consistently and correctly, can reduce the risk of transmission of gonorrhea
• Abstain from vaginal, anal, and oral sex
• Long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected

Healthcare providers with STD consultation requests can contact the STD Clinical Consultation Network (STDCCN). This service is provided by the National Network of STD Clinical Prevention Training Centers and operates five days a week. STDCCN is convenient, simple, and free to healthcare providers and clinicians. More information is available at www.stdccn.org

While not traditionally found in the natural environment, we must all continue to work to help fight this antibiotic resistant organism with respect to its overall impact on the growing global antimicrobial resistance threat.

(Bio)filming in the Environment

By Rodney E. Rohde, PhD, MS, SM(ASCP)CM SVCM, MBCM, FACSc

This column originally appeared in the July 2020 issue of Healthcare Hygiene magazine.

The Pseudomonads include many “true” Pseudomonas species as well as several other genera formerly classified with this group. Over 100 species once made up the genus Pseudomonas but in the past decade or so, many of these have been reclassified into other genera. Like last month’s bug, Acinetobacter, the bacteria found in this group are typically associated as natural residents of soil and water. They rarely cause infections in healthy people. However, there are several groups within the Pseudomonads that can cause medical problems, including the fluorescent Pseudomonas spp., Burkholderia spp., Brevundimonas spp., Stenotrophomonas maltophilia, and other less frequent ones occasionally found in clinical specimens and the hospital environment.

Pseudomonas aeruginosa is the most common infection-causing species and are usually encapsulated, Gram-negative, rod-shaped bacterium that can cause disease in plants and animals, including humans. P. aeruginosa is an opportunistic species especially with existing diseases or conditions – most notably cystic fibrosis (CF) and traumatic burns. It generally affects the immunocompromised but can also infect the immunocompetent as in hot tub folliculitis. Treatment of P. aeruginosa infections can be difficult due to its natural resistance to antibiotics.

This organism is notorious for its survival in all types of man-made and artificial environments. It can live in diverse atmospheres at normal or low oxygen levels. It is most famous for thriving in moist environments and subsequent colonization of surfaces via extensive biofilm production. In cases of human infection, its versatility enables the organism to infect damaged tissues or those with reduced immunity. Inflammation (general) and sepsis are common symptoms.

Colonization in critical body organs, such as the lungs, the urinary tract, and kidneys, can be fatal. CF patients will often deal with life-threatening “blue-green” phlegm from lung infections while burn victims will also exhibit the common pigmented skin infection.

In 2017, multidrug-resistant Pseudomonas aeruginosa caused an estimated 32,600 infections among hospitalized patients and 2,700 estimated deaths in the United States [Source: 2019 AR Threats Report]. Like many of the microbes I have discussed in my column, this one is considered a healthcare-associated infection (HAIs).

Here, I will introduce P. aeruginosa and information aimed at a general understanding of the characteristics of this pathogen in the environment. Primarily, I will utilize information obtained from the Centers for Disease Control and Prevention along with professional experience.

Those most at risk include patients in hospitals, especially those:
• CF patients
• on breathing machines (ventilators)
• with devices such as catheters
• with wounds from surgery or burns are in intensive care units
• premature infants and neutropenic cancer patients
• urinary tract infections (UTI)
• have prolonged hospital stays

Infection can be increased by many factors, including prior antibiotic exposure, ICU admission, use of a central venous catheter, and mechanical ventilation or hemodialysis use. P. aeruginosa can be transmitted to patients because of their persistence on environmental surfaces and because of biofilms on medical devices and equipment. As I have often mentioned, all #SurfacesMatter all the time, to everyone in the war on pathogen transmission. Pseudomonas spp. can live for long periods on environmental surfaces and shared equipment if they are not properly cleaned and disinfected.

Pseudomonas aeruginosa lives in the environment and can be spread to people in healthcare settings when they are exposed to water or soil that is contaminated with these germs. Resistant strains of the germ can also spread in healthcare settings from one person to another through contaminated hands, equipment, or surfaces. Recently, research has shown that this organism (and others) can create problematic, long-standing biofilms in sink drains and other water based environmental areas and surfaces.

Pseudomonas aeruginosa infections are generally treated with antibiotics. Unfortunately, in people exposed to healthcare settings like hospitals or nursing homes, Pseudomonas aeruginosa infections are becoming more difficult to treat because of increasing antibiotic resistance.

Depending on the nature of infection (UTI, soft skin, etc.), an appropriate specimen is collected and sent to a medical laboratory for identification. Typically, a Gram stain is performed, which should show Gram-negative “thin long” rods and/or white blood cells. P. aeruginosa produces colonies with a characteristic "grape-like" or "fresh-tortilla" odor on some growth media. In mixed cultures, it can be isolated as clear colonies on MacConkey agar (as it does not ferment lactose) which will test positive for oxidase. Confirmatory tests include production of the blue-green pigment pyocyanin on cetrimide agar and growth at 42°C. A Triple Sugar Iron slant is often used to distinguish non-fermenting Pseudomonas species from enteric pathogens.

Following identification and to specify the best antibiotic(s) to treat P. aeruginosa infections, the laboratory will perform an antibiotic susceptibility test which allows for growth against a set of antibiotics to determine which are active against the bacteria. The best antibiotic(s) is then chosen based on the activity of the antibiotic and other factors, like potential side effects or interactions with other drugs. For some multidrug-resistant types of Pseudomonas aeruginosa, treatment options might be limited.

How you can avoid getting an infection:
• Hand hygiene from healthcare professionals and patients (and others)
• Wash hands with soap and water or use alcohol-based hand sanitizer, particularly before and after caring for wounds or touching medical devices
• Allow environmental services (housekeeping staff) and healthcare staff to clean their room daily when in a healthcare setting

Tuberculosis: It Keeps On Keeping On

By Rodney E. Rohde, PhD, MS, SM(ASCP)CM SVCM, MBCM, FACSc

This column originally appeared in the June 2020 issue of Healthcare Hygiene magazine.

Tuberculosis is an ancient disease that infects about a third of our global population, and each year we see almost 9 million new cases. Mycobacterium is a genus of bacteria in the family Mycobacteriaceae with over 190 species. The genus is well known for two notorious species, M. tuberculosis (M. tb) and M. leprae (leprosy), as well as other species causing disease in mammals. Robert Koch, who received the Nobel Prize for his finding in 1905, first described M. tuberculosis, then known as the “tubercle bacillus”, in 1882.

The genus is characterized by an acid-fast, aerobic bacillus with a high cell wall content of high-molecular-weight lipids known as mycolic acid. A Gram stain will not penetrate these organisms due to this waxy mycolic acid, and as a result, they can appear Gram-negative or Gram-positive. Acid-fast stains such as Ziehl-Neelsen, or fluorescent stains such as auramine are used to identify the characteristic thin long curved rods that often exhibit “cording” (rods / bacilli wrapped around each other) morphology under microscopy. M. tuberculosis can be cultured in the laboratory on Middlebrook or Lowenstein Jensen media but they are considered slow growers. These bacteria divide about every 18–24 hours whereas other common bacteria (E. coli) divide about every 20 minutes. Visible colonies require weeks (3 – 8) for growth and can be distinguished from other mycobacteria by production of catalase and niacin. However, more rapid and accurate differentiation is obtained with MALDI-TOF or other molecular platforms.

Humans are the only known reservoir for Mycobacterium tuberculosis [prounounced mī-kō-bak-ˈtir-ē-əm \ too-bur-kyuh-loh-sis]. Historically, this microbe targets the lungs but TB bacteria can attack any part of the body such as the kidney, spine, and brain. It gets its name from the Latin word tuber, which is a botanical term for an underground structure consisting of a solid rounded outgrowth of a stem of a more or less rounded form. The tubercle is a diminutive of tuber and comes from the Latin, tuberculum, or a small swelling. Thus, tuberculosis is the condition of patients exhibiting small, round, firm and white swellings on the surface or within an organ, usually the lungs. Those infected with M. tuberculosis do not always become sick. Therefore, two TB-related conditions exist: latent TB infection (LTBI) and TB disease. Tuberculosis can be fatal if not treated properly.

Many believe that casual contact like shaking hands, touching bed linens or sitting on toilet seats, sharing food or drink, or kissing, can spread M. tuberculosis. However, this agent is an airborne organism originating from a person with TB disease and transmits it by coughing, sneezing, speaking, or singing. When in the lungs, M. tuberculosis is phagocytosed by alveolar macrophages, but they are unable to kill and digest the bacterium (intracellular). Treatment of TB infections has become difficult due to antibiotic resistance. Multidrug-resistant tuberculosis (MDR-TB) indicates resistance to both isoniazid and rifampin. Extensively drug-resistant tuberculosis (XDR-TB) indicates resistance to isoniazid, rifampin, a fluoroquinolone, and a second-line injectable drug.

In 2019, there are 8,920 provisionally reported TB cases in the United States (a rate of 2.7 per 100,000 persons). The complete 2019 TB surveillance data report will be available in late 2020. There are 60 jurisdictions (states, cities, and US territories) in the United States that report TB data to the CDC. It is estimated that up to 13 million people in the United States are living with latent TB infection. Like many of the microbes I have discussed in my column, this one is considered a healthcare-associated infection (HAIs). Here, I will introduce M. tuberculosis and information aimed at a general understanding of the characteristics of this pathogen in the environment. Primarily, I will utilize information obtained from the Centers for Disease Control and Prevention along with professional experience.

What are the common signs and symptoms for TB?
Those with TB disease will show symptoms that align with where in the body the TB bacteria are growing. TB bacteria usually grow in the lungs (pulmonary TB). TB disease in the lungs may cause symptoms such as
• persistent bad coughs (3 weeks or longer)
• chest pains
• coughing up blood or sputum (phlegm from deep inside the lungs)

Other symptoms of TB disease are
• weakness or fatigue
• weight loss
• loss of appetite
• chills / fever
• night sweats

Symptoms of TB disease in other parts of the body depend on the area affected. Those with latent TB do not feel sick, do not have any symptoms, and cannot spread TB to others.

Who is most at risk for these infections? Tuberculosis is an ongoing globally challenging disease to diagnose, treat, and control. While anyone can be infected by this bacteria, those individuals with health disparities and who are part of certain populations should be targeted with prevention and control efforts. These groups include, but are not limited to:
• African-American Community
• Asian Community
• Children under 15 years of age (also called pediatric tuberculosis)
• Correctional Facilities
• Hispanics/Latinos
• Homelessness
• International Travelers
• Pregnancy
• Health Disparities in TB (gender, race or ethnicity, income, comorbid medical conditions, or geographic location may be considered).

Generally, persons at high risk for developing TB disease fall into two categories: 1. Persons recently infected with TB bacteria, and 2. Persons with medical conditions that weaken the immune system (e.g. HIV, drug abuse, Diabetes mellitus, organ transplants, cancer, autoimmune diseases, etc.).

The majority of mycobacteria species are found in the environment across a range of soil types and water distribution systems, which act as a reservoir for potential human and animal infection. Due to its cell wall richness in lipids such as mycolic acid, M. tuberculosis is inherently resistant to desiccation and is a key virulence factor. It can withstand weak disinfectants and survive without moisture for weeks. As I have often mentioned, all #SurfacesMatter all the time, to everyone in the war on pathogen transmission. Mycobacterium spp. can live for long periods on environmental surfaces and shared equipment if they are not properly cleaned and disinfected.

The Environment Can Be a Dangerous Place

By Rodney E. Rohde, PhD, MS, SM(ASCP)CM SVCM, MBCM, FACSc

This column originally appeared in the May 2020 issue of Healthcare Hygiene magazine.

Comprising about 50 species, Acinetobacter are mostly nonpathogenic environmental organisms. They are common in places like the soil and water. The most common infection-causing species is A. baumannii (pronounced AH-sin-neto-bacter) which is a pleomorphic aerobic gram-negative bacillus. These bacteria cause infections in the blood, urinary tract, and lungs (pneumonia), or in wounds in other parts of the body. It can also “colonize” or live in a patient without causing infections or symptoms, especially in respiratory secretions (sputum) or open wounds.

In 2017, Carbapenem-resistant Acinetobacter baumannii (CRAB) caused an estimated 8,500 infections in hospitalized patients and 700 estimated deaths in the U.S. They constantly find new ways to avoid antibiotics used to treat the infections they cause. Antibiotic resistance occurs when the germs no longer respond to the antibiotics designed to kill them. If they develop resistance to the group of antibiotics called carbapenems, they become carbapenem-resistant. When resistant to multiple antibiotics, they are multidrug-resistant. Carbapenem-resistant Acinetobacter are usually multidrug-resistant. Like last month’s column on Clostridioides difficile (C. diff), CRAB is considered a healthcare associated infections (HAIs).

Which patients are at increased risk for A. baumannii (CRAB)? Acinetobacter infections typically occur in people in healthcare settings. People most at risk include patients in hospitals, especially those who:
• are on breathing machines (ventilators)
• have devices such as catheters
• have open wounds from surgery
• are in intensive care units
• have prolonged hospital stays

Acinetobacter infection can be increased by many factors, including prior antibiotic exposure, ICU admission, use of a central venous catheter, and mechanical ventilation or hemodialysis use. Acinetobacter species can be transmitted to patients because of their persistence on environmental surfaces and because of colonization of the hands of healthcare workers. As I have often mentioned, all #SurfacesMatter all the time, to everyone in the war on pathogen transmission. Acinetobacter can live for long periods on environmental surfaces and shared equipment if they are not properly cleaned and disinfected.

Where is this microbe found? Are there special environmental niches for it?
A. baumannii is an aquatic organism and preferentially colonizes those environments. This organism is often cultured from hospitalized patients' sputum or respiratory secretions, wounds, and urine. In a hospital setting, Acinetobacter commonly colonizes irrigating solutions and intravenous solutions.
When these infections occur, they usually involve (multi-) organ systems with a high fluid content (e.g., urinary tract, respiratory tract, peritoneal fluid, CSF, etc.). Outbreaks from these infections are more often than isolated cases of nosocomial pneumonia. Infections may complicate continuous ambulatory peritoneal dialysis (CAPD) or cause catheter-associated bacteriuria.

What are the differences between colonization and infection?
Acinetobacter species tend to be of low virulence but capable of causing infection in organ transplants and febrile neutropenia. Most isolates recovered from hospitalized patients, particularly those recovered from respiratory secretions and urine, represent colonization rather than infection. Thus, one must exercise caution in determining whether the isolate is due to colonization or is a true infection. As an example, Acinetobacter isolated from the sputum of a ventilated patient is more likely to represent colonization than infection in the absence of fever, leukocytosis, increased respiratory secretions, need for additional respiratory support, or a new abnormality on chest imaging. The difference is critical for proper antibiotic stewardship.

Which laboratory tests are commonly used for diagnosis?
To identify the best antibiotic to treat a specific infection, healthcare providers will send a specimen to the medical laboratory for a typical culture workup and test any bacteria that grow against a set of antibiotics (antibiotic susceptibility test) to determine which are active against the microbe.

How can you avoid getting an infection?
• Hand hygiene: healthcare professionals and patients (and others) must keep their hands clean to avoid getting sick and spreading germs that can cause infections
• Wash hands with soap and water or use alcohol-based hand sanitizer, particularly before and after caring for wounds or touching medical devices
• Remind healthcare providers and caregivers to clean their hands before touching the patient or handling medical devices
• Allow environmental services (housekeeping staff) and healthcare staff to clean their room daily when in a healthcare setting

In addition to hand hygiene, healthcare providers should pay careful attention to recommended infection control practices, including rigorous environmental cleaning (e.g., cleaning of patient rooms and shared equipment), to reduce the risk of spreading these germs to patient. As a final reminder, environmental services professionals (and others who have responsibility for cleaning / disinfection) are the secret weapon in proactive prevention of antibiotic resistant and other pathogen transmission.

Exactly What is Clostridioides difficile (C. diff)?

By Rodney E. Rohde, PhD, MS, SM(ASCP)CM SVCM, MBCM, FACSc

This column originally appeared in the April 2020 issue of Healthcare Hygiene magazine.

Clostridioides difficile (C. diff) is a bacterium that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon. It is a spore forming, Gram-positive anaerobic (does not prefer oxygen rich environments) bacillus that produces two exotoxins: toxin A and toxin B. Illness from C. diff. commonly affects the elderly in hospitals or long-term care facilities and typically occurs after use of antibiotics. However, studies show increasing rates of C. diff. infection among people traditionally not considered to be at high risk, such as young and healthy individuals who haven't used antibiotics or been in a health care facility. Generally, C. diff. considered a healthcare-associated infection (HAI).

Each year in the U.S., about a half million people get sick from C. diff., and in recent years, these infections have become more frequent, severe and difficult to treat. Recurrent C. diff. infections also are on the rise. It is a common cause of antibiotic-associated diarrhea (AAD). It accounts for 15 percent to 25 percent of all episodes of AAD. The range of diseases caused by this bacterium is known as C. diff. Infection (CDI).

In my personal experience of discussing HAIs, antibiotic resistant pathogens, and other microbes that are transmitted in the healthcare or community setting, I often try to put myself in the place of an individual that little experience or understanding of these pathogens. Effective science communication, and ultimately raising the health literacy of the public, is everyone’s job in healthcare.

Here, I will introduce C. diff. and information aimed at a general understanding of the characteristics of this pathogen in the environment. Primarily, I will utilize information obtained from the Centers for Disease Control and Prevention (CDC), along with professional experience.

Which patients are at increased risk for CDI? The risk for disease increases in patients with:
• antibiotic exposure (e.g., fluoroquinolones, third/fourth generation cephalosporins, clindamycin, carbapenems)
• gastrointestinal surgery/manipulation
• long length of stay in healthcare settings
• a serious underlying illness
• immunocompromising conditions
• advanced age
• other possible causes include Proton pump inhibitors, H2-blockers

Where is C. diff. found and what are the causes of CDI?
C. diff. bacteria are ubiquitous in the environment — in soil, air, water, human and animal feces, and food products, such as processed meats. A small number of healthy people naturally carry the bacteria (colonized) in their large intestines and do not have ill effects from the infection.

Spores from C. diff. are passed in feces and spread all over the environment (food, surfaces and objects) when people who are infected do not wash their hands thoroughly. Spores are primarily a way for bacteria to survive in harsh times or conditions. They persist for weeks or months. If you touch a surface contaminated with C. diff. spores, you may not realize you’ve swallowed the spore which can then become a viable bacteria.

Once established, C. difficile can produce toxins that attack the lining of the intestine. The toxins destroy cells, produce patches (plaques) of inflammatory cells and decaying cellular debris inside the colon, and cause watery diarrhea.

What are the differences between colonization and infection?
Colonization is more common than CDI. The patient exhibits no clinical symptoms (asymptomatic) but does test positive for the C. diff. organism or its toxin. With infection, the patient exhibits clinical symptoms and tests positive for the C. diff. organism or its toxin. The difference is critical with respect to understanding when an individual should be considered positive for CDI (confirmatory medical laboratory test AND clinical symptoms).

Which laboratory tests are commonly used for diagnosis?
Most people are not experts in the world (or language) of medical laboratory tests. The following is a list of common tests that are often utilized in a medical or public health laboratory to identify C. diff. and many pathogens. If you do not understand a test, ALWAYS ask for clarification. This will increase your health literacy.
• Molecular tests: FDA-approved PCR assays, which test for the gene encoding toxin B, are same-day tests that are highly sensitive and specific for presence toxin-producing C. diff.
• Antigen detection for C. diff: Rapid tests (<1 hour) that detect the presence of C. diff. antigen. Nonspecific and often used in combination with other tests.
• Toxin testing for C. diff:
o Tissue culture cytotoxicity assay detects toxin B only.
o Enzyme immunoassay detects toxin A, toxin B, or both A and B. Due to concerns over toxin A-negative, B-positive strains causing disease, most laboratories employ a toxin B-only or A and B assay.
o C. diff. toxin is unstable. The toxin degrades at room temperature and might be undetectable within two hours after collection of a stool specimen. False-negative results occur when specimens are not promptly tested or kept refrigerated.
• Stool culture for C. diff: Most sensitive test available, but it is often associated with false-positive results due to the presence of nontoxigenic C. diff. strains.

Uncovering the Novel Coronavirus

By Rodney E. Rohde, PhD, MS, SM(ASCP)CM SVCM, MBCM, FACSc

This column originally appeared in the March 2020 issue of Healthcare Hygiene magazine.

Novel outbreaks from any microbe are always of public health concern. The risk from these outbreaks depends on characteristics of the virus, including whether and how well it spreads between people, the severity of resulting illness, and the medical or other measures available to control the impact of the virus (e.g., vaccine or antivirals).

The novel coronavirus (SARS CoV2/COVID-19) is a serious public health threat. The fact that it has caused severe illness and sustained person-to-person spread in China is concerning, but it is unclear how the situation in other parts of the world will unfold.

With the growing concern over COVID-19, exactly what questions should healthcare professionals and others (EVS, medical laboratory, etc.) be asking.
1. How does SARS CoV2 spread? While there is much to learn regarding the transmission of this novel virus, spread is thought to occur from person-to-person via respiratory droplets among close contacts. Close contact can occur while caring for a patient, including:
• Being within 6 feet (2 meters) of a patient with COVID-19 for prolonged time periods.
• Direct contact with infectious secretions from a patient with 2019-nCoV. Infectious secretions may include sputum, serum, blood, and respiratory droplets.
If close contact occurs while not wearing all recommended PPE, there may be risk of infection.

2. How long (duration) can 2019-nCoV survive outside of a host? All viruses require a host to reproduce and survive. It is currently unclear if a person can get SARS CoV2 by touching a surface or object with virus on it and then touching his or her own mouth, nose, or their eyes. Some reports show coronavirus strains (229E) have survived more than three hours after drying onto porous and non-porous materials, including aluminum and sterile sponges; strain OC43 remained infectious up to one hour. Thus, it is prudent to remain vigilant in both the use of PPE and disinfection of surfaces in the control of SARS CoV2.

3. How can healthcare personnel (and other related professionals) protect themselves? According to the CDC, healthcare personnel caring for patients with confirmed or possible COVID-19 should adhere to CDC recommendations for infection prevention and control (IPC):
• Assess and triage patients with acute respiratory symptoms and risk factors to minimize chances of exposure, including use of facemasks on the patient and isolating them in an Airborne Infection Isolation Room (AIIR), if available.
• Use Standard Precautions, Contact Precautions, and Airborne Precautions and eye protection when caring for patients.
• Perform hand hygiene with alcohol-based handrub before and after all patient contact, contact with potentially infectious material, and before putting on and upon removal of personal protective equipment (PPE), including gloves.
• Practice proper use PPE in a manner to prevent self-contamination.
• Perform aerosol-generating procedures, including collection of diagnostic respiratory specimens, in an AIIR, while following IPC practices, including use of appropriate PPE.

4. What about environmental cleaning and disinfection? CDC states routine cleaning and disinfection procedures are appropriate for COVID-19 in healthcare settings. Products with EPA-approved emerging viral pathogens claims are recommended. Management of laundry, food service utensils, and medical waste should be performed in accordance with routine procedures.

5. What do we currently know about the human-to-human transmission of this novel coronavirus? More specifically, once one person is infected, does the coronavirus appear to be significantly contagious in a human-to-human context? The modes of human-to-human transmission of the virus are still being determined, but given current evidence, it is most likely spread by the following, according to the CDC.
• Through the air by coughing and sneezing
• Close personal contact, such as touching or shaking hands
• Touching an object or surface with the virus on it, then touching your mouth, nose or eyes before washing your hands
• In rare cases, fecal contamination

With current data available and my professional experience, I do not believe this novel virus is any more contagious than the influenza virus. At this time, both appear to have similar transmission rates (1.4 – 4) and case fatality rates (currently holding steady at about 2 percent). Of course, this could change, and it is why we must monitor the outbreak closely and rely on “confirmed and accurate” laboratory test results.

Everyone should pay attention to reputable sources and heed the advice of the government and public health experts. The U.S. Department of State has issued a level 4 “do not travel” advisory for China. Proper perspective is critical. There is no need to panic. We should all do our part in not becoming part of the problem as a “super-spreader” of inaccurate or unchecked information surrounding this virus outbreak.

Walking Through the Microscopic Valley of Death

By Rodney E. Rohde, PhD, MS, SM(ASCP)CM SVCM, MBCM, FACSc

This column originally appeared in the February 2020 issue of Healthcare Hygiene magazine.

Have you ever stopped and thought about how fortunate we are to live during this time? I am talking about the advancement of healthcare in general and medical procedures/devices in particular. Take a moment to consider how an artificial hip or knee may have changed a loved one’s life. What about the diagnostic medical devices utilized for visualizing possible life-threatening conditions or disease? Truly, I think we all probably take these wonders of medical science for granted.

Globally, medical devices have prolonged our lives, as well as improved the quality of life for millions. Most of us probably think of replacement knees and hips, vascular stents and pacemakers as representative of these engineering marvels. Endoscopes and catheters, used for diagnostic and therapeutic procedures, are categorized as medical devices too since they are placed into the body and retain their original form. To clarify, a needle that is inserted into the body is classed as a medical device, but the solution injected through that needle is specifically classified as a pharmaceutical. Given that medical devices enter the body, the need to be free of contamination is paramount for patient safety.

Berkshire Corporation via U.S. Food and Drug Administration (FDA) guidelines explain contaminants and their removal well. Prior to the introduction of the device into the body (whether temporarily for diagnostic purposes or permanently for therapeutic purposes), we want it to be as free of contaminants as possible. Medical device contaminants can include traces of lubricants, oils, and other processing residues (e.g. polymers, adhesives), viables (microorganisms), and non-viables, such as particles and fibers. In the manufacturing process, medical devices are packaged and then terminally sterilized as the last step. The sterilization procedure does not remove contaminants; it only ensures that any viables left on the device cannot proliferate further–any residual surface contamination left on the device before sterilization remains after the process and can pose a risk to patient safety. Fortunately, simple wiping techniques employed with proper wipers and solvents prior to packaging and sterilization can produce a clean medical device.

The FDA Center for Devices and Radiological Health (CDRH) Microbiology and Infection Control states that with the increased use of medical devices and their promise to improve quality of life, preventing device-associated infection is a top public health priority. Every medical device is prone to microbial colonization and biofilm formation, resulting inevitably in device failure and patient harm. In addition, the association of colonized devices with development of drug resistant organisms is a serious and under-investigated area of importance. The Medical Device Biofouling and Biofilms Research Program addresses medical-device failure and patient harm caused by the combined effects of biofouling, colonization, and biofilms. Rather than study these phenomena as individual events, the research uses sophisticated high-throughput microfluidic approaches to assess how variables such as biofouling, cleaning and material properties affect bacterial adhesion and biofilm progression. The group uses optical and electron microscopy, surface plasmon resonance (SPR), and other biosensing and surface analysis methods to study biomolecular interactions at the interface of device, host and microorganism. In laymen’s terms, this group is trying to determine the best way(s) to understand not only what invisible inhabitants are found in the microscopic valley of death (aka surfaces), but how to best remove (clean and sterilize) them.

Some of the current research areas addressed include:
• Bacterial interactions with soft medical device materials (contact lenses, dermal fillers, ophthalmic surgical devices
• Development of better test methods and endpoint measurements for antimicrobial device technologies (wound dressings, catheters)
• Biofilm specific diagnostics (optical coherence tomography, biomarkers)
• Detection of biofouling and biofilm on reprocessed devices (endoscopes, surgical tools)
• Influence of material, device design, roughness, and presence of soil on cleanability
• Performance testing of one-way valves Intended to prevent cross-contamination and infections in patients
• Reprocessing flexible endoscopes
• Chemically defined clinically relevant test soils for cleaning validation of reusable medical devices

While medical advances and devices have advanced the health of civilization in ways we never fathomed, let us not forget that the microorganisms have outpaced human advancement every step of the way, including finding ways to survive the microscopic valley and surfaces of arguably every niche known.

A Microbial Home for the Holidays?

By Rodney E. Rohde, PhD, MS, SM(ASCP)CM SVCM, MBCM, FACSc

This column originally appeared in the January 2020 issue of Healthcare Hygiene magazine.

The holidays are a time for family and friends to get together and share memories. These times often include visits to see grandparents and others in a variety of settings, whether it is the home or a long-term care or assisted living facility. Likewise, as we approach 2020, we often surround ourselves with not only loved ones, but others that have traveled from across a vast geographic landscape. These gatherings are full of wonderful times of reconnecting, sharing food and drink, and visits with old and new acquaintances.

The holidays are an amazing time and we should all enjoy them to the fullest. However, there is a bit of a dark side to holiday season. Our own microbial population also comes along with us and/or we encounter new microbial visitors in our travels. Exposure to more people than usual can increase our chances of becoming ill. So, during this holiday season, spending some time to take extra precautions may help keep you from catching someone else’s illness or if you are ill, preventing the spread to others.

One thing we do not want to give or receive during the holidays is an infection. One of the major concerns during the holiday season in North America is how this time of the year coincides with cold and flu season. Everyone catches a cold (usually a rhinovirus) from time to time and, for most people, a cold causes a week or so of feeling miserable: stuffy nose, headache, cough, and more, and then it goes away. The cough associated with a cold can last for a while longer, sometimes weeks if it is a particularly nasty one. However, some people can become seriously ill if they catch a cold. The virus can make them vulnerable to developing other illnesses, like bronchitis or even pneumonia, particularly among the very old, very young, or those who have weakened immune systems or chronic illnesses. Pneumonia is the most common cause of sepsis and septic shock, according to the American Thoracic Society.

Influenza is another easily spread virus in close quarters. The flu is not a gastrointestinal illness; there is no such thing as the stomach flu. Influenza is a serious respiratory infection. According to the Centers for Disease Control and Prevention (CDC), depending on the flu season, between 9.3 million and 49 million people in the U.S. are affected annually, with 140,000 and 960,000 flu-related hospitalizations, and up to 79,000 deaths each year. Grandparents visiting their grandchildren could be particularly at risk. Children are "super-spreaders" of flu and the over-65s are one of the "at-risk" groups that can develop health complications, such as pneumonia, if they catch it.

To make matters worse, the flu virus can live on surfaces (doorknobs and tables) — and potentially infect people — for 48 hours, according to the CDC. This serves as an important reminder that all surfaces matter in the war on healthcare associated infections (HAIs) and pathogen transmission. Remember, a home or community environment can serve as a reservoir too for any pathogen or antimicrobial resistant microbe such as respiratory syncytial virus (RSV), parainfluenza (croup), or even pertussis (whooping cough) to name a few others.

Flu may spread to others up to 6 feet away. Droplets can land in the mouths or noses of people who are nearby or inhaled into the lungs. Less often, a person may touch a surface contaminated with the flu virus, and then touch their mouth, nose or eyes. Someone with the flu is most contagious for the first three to four days after becoming sick. However, adults can infect others a day before symptoms are apparent and up to five to seven days after becoming sick. Young children and people with weakened immune systems are contagious for longer.

Gastroenteritis (GE) is another illness often mistakenly referred to as a “stomach flu.” GE occurs when a microbe infection irritates and inflames the gastrointestinal lining, resulting in nausea, vomiting, cramping, stomach pain, fever, and diarrhea. The infection spreads either through direct contact with someone who is already ill, through touching objects that have the bacteria or virus on it, or through contaminated food or drink. Because of the many ways it spreads, it is particularly important to be vigilant when you are at a large gathering.

To avoid giving or receiving these unwanted microbial “gifts,” one can do several things for prevention:
• Wash your hands and properly discard of tissues, etc.
• Ensure that cold food is kept cold and hot food hot.
• Get the seasonal flu vaccine (and other recommended vaccines).
• Stay away from gatherings if you are ill.
• Avoid others who are ill.