It is Halloween and that means the season for bats is here.  I recently read an informative article about autumn exposures to bats which was based on an interview with the state veterinarian for Nebraska - Dr. Annette Bredthauer.   Immediately I flashed back to my TWO experiences with bats inside my house at Halloween.  One experience was 3 years ago and the other was 5 years ago.   Both situations occurred at dusk.  After the fact, my neighbor told me that he was outside at dusk and saw a bunch of bats (is that a flock?  Or a covey? What do you call a bunch of bats, anyway?) flying over and around our houses.  My house is in the city - not out in the country and it is not a big old haunted house!  But that night after dark, one bat was in my house flying around on the first floor.  I was home alone and suddenly in a big panic.  Being an infection control nurse, I was aware of the risk of rabies when bats come inside your house especially your into your bedroom.   I had no butterfly net to trap it and with the "radar" mechanism that bats have, I thought a broom was useless.  To make this long story short, I was rescued by my younger daughter, Mary.  She has a biology degree with a specialty in animal behavior - thus qualifying her to respond to my hysterical phone call and come over to see if it was truly a bat.  When she pulled into my driveway with her headlights beaming, I opened the door and the bat flew out the door.  I searched for any droppings, and finding none, I was able to get to sleep that night and rest well. 

My second experience was much the same - same prelude- one bat flying around on the first floor making that horrible wing-flapping sound.   This time I ran across the street to beg the neighbors to come and help me.  While I was out of the house, I lost the bat. Seth and I searched everywhere and could not find him- her - or it.   I knew better than to go to sleep in the house with a live bat.  Eventually, we located the sleeping bat - hanging upside down in a hat on my hall tree.  Seth took the hat outside and set the bat free.  Then I threw the hat in the trash can! 

Well, besides the creepy appearance of bats and the strong emotions they create when they invade our spaces, there are health reasons to avoid bats - the main one is the transmission of Rabies Virus.  This is a nasty nanobug and so I feel compelled to pass on what I know about preventing rabies from bats:

 - Late summer and fall is the time of year that bats are most often found inside houses and buildings in increased numbers. Dr. Bredthauer says this is partly because the time for their migration and hibernation is coming. Additionally, the young baby bats raised in the summer become disoriented and enter buildings.

- Bats carry the rabies virus in their saliva and transmit the virus when they bite a person. The bite is usually superficial and often overlooked.

- Children should be told to never PLAY with bats if they find them in a cave or on a tree or bush outside. If there is one on the ground, it should be left alone. This is an important message to give children and to reinforce seasonally - don't touch bats or dead birds or squirrels or dogs behaving badly.

- Bats can bite you while you are asleep and you might not be aware of it. So bats should be captured and tested if: one is found in the bedroom where someone is sleeping, or a bat is found in a room with individuals who are unaware or can't communicate about it (small children or those individuals with disabilities), or if someone steps on a bat or has some other direct exposure to a bat.

- To catch a bat - leave it to the experts - call your local animal control center. The bat should be captured when it lands on a wall or curtains, according to Dr. Bredthauer. A butterfly net and a stiff piece of cardboard are the best tools. If you find a bat in the room of someone who has been sleeping, don't shoo it out the door. Call someone (animal control) to capture it for testing. And don't smash it with a broom - the brain needs to be intact for the testing.

The slogan for the Rabies Virus nanobug is, "I love rats and bats and feral cats".  Rabies is most commonly found in bats, skunks and raccoons but could be found in dogs cats, and squirrels - actually, any biting mammal - wild or domestic.   No wonder bats contribute to the scary ambiance of Halloween. Just remember that avoidance is how you do prevention with this nanobug.  

For me, the decision is not, whether to get a flu shot - but rather, when?  and where? Influenza is one nanobug I really want to avoid - I hate having my sleep interrupted with all that coughing.  And fever and body ache are not my thing either.   Last year I went to a local grocery store and I waited in a long line to get my flu shot before I traveled to Japan.  The year before that it was at the Walgreen's store 5 blocks from my home - short walk but long wait when I got there.  Today I went on a tour of LifePointe, a new health club and spa which is associated with BryanLGH Medical Center - a former employer of mine. They offered flu shots at this gorgeous facility from 9-5 - so while I was there, I just took care of business - It involved $20 , no wait and no pain.  As I drove home, I reminisced about my former role as infection control coordinator for Lincoln General Hospital (the name before the merger).  My job included enhancing employee compliance with the hospital's influenza immunization program.  I would always try to be the first injectee and get the hospital photographer to document my compliance.  The photo would be published in the hospital internal newspaper along with my invitation to fellow employees to get their shot too.   One year I made a really dramatic facial expression for the picture to be funny and to prove that it was a fresh experience and not just a previous photo submitted again.  Some years, I was able to secure funding for some little bribes to increase compliance - like a coupon for a free cup of coffee in the cafeteria for anyone who got a flu shot.   Kinda crazy - the shots are offered free to employees and then we bribed them to take the free gift.   Most Japanese hospitals give flu shots to employees but they are not always free.   This year Nanobugs, inc. sold influenza tattoos to a number of hospitals to offer as a reward to employees who get a flu shot. (The tattoos are high quality, non-toxic and made in the USA.)

If you apply the tattoo to your forearm, it will last about 10-14 days - the same length of time it takes to develop full immunity after vaccination - makes a nice reminder.

Flu shots are absolutely essential for hospital employees and other healthcare workers. People who are already sick and immune-system challenged, should not be exposed to caregivers who are sick with influenza or incubating the infection and communicable.   Additionally, from a human resources perspective, it is important to have employees well and on the job during the flu season when the hospital census increases.  If you are a healthcare worker or medical professional or childcare provider or a family member of someone who is elderly or has a chronic illness, then get in line somewhere in the next 2-4 weeks and get your flu shot.  Don't procrastinate.  Do it today: Celebrate International Infection Prevention Week with a shot in the arm.  

Tips for the wimps and the high achievers:  #1. When you get the injection, support your elbow and keep the muscles in your upper arm relaxed.  And don't watch.  It will be almost painless.   #2.  After you get the shot, try to get more rest for 1-2 nights.  The body can focus more on the business of making antibodies if you don't keep it up late or stress it to the max.   Use this immunization event as an excuse to treat yourself nice for at least a day.   

It is Day 4 of International Infection Prevention Week and I write with sad news today.  You probably heard the announcement yesterday on national news of the death of a high school student in Virginia.  The 17-year-old high school senior, Ashton Bonds, died of complications of MRSA infection.  Announcements like this really bring home the reality of community-acquired infections.  The July (?) 2007 issue of Readers' Digest had a really emotional story about athletes who have died of MRSA infection.  The reality is that >90,000 Americans get infections caused by MRSA - methicillin-resistant Staphylococcus aureus.   Most of them are just mild skin infections but some are invasive bloodstream infections causing death.  We have been dealing with MRSA in hospitals and long-term care facilities for many years - in the USA, Europe and Japan.  MRSA has become more prevalent in prisons, gyms, locker rooms in schools, even NFL locker rooms and in poor urban neighborhoods.  Let me back up:  MRSA is an antibiotic-resistant form of Staph aureus.  Staph aureus once caused deaths in newborn nurseries in the 1950's - back when I was a baby.  Treatment with Penicillin put a stop to these horrible outbreaks.  But overuse, misuse, and abuse of Penicillin and other antibiotics over the years have pushed this nanobug to develop protection and resistance to the drugs intended to destroy them - it is an evolution/survival thing.   The image we chose for the MRSA nanobug begins with the shape of Staphylococcus aureus (a cluster of grapes) and has a mean face and a forcefield around it to symbolize the resistance.   The bacteria are transmitted in the same way and are essentially the same EXCEPT for treatment.  The environment is full of Staphylococcus aureus - it is considered normal flora on the skin of humans. The Stapylococcus aureus nanobug says, "I'm OK on your skin, but don't let me get in!"  But now we know that a good percentage of the Staphylococcus aureus that colonizes our skin is resistant (MRSA).  So when we "let it get in" - we have big treatment challenges and potential failures - especially if the person is diabetic or has an underlying chronic illness or infection.  

In the district where Ashton had attended school, 21 schools were closed yesterday for "cleaning".  I would never criticize thorough cleaning of schools, but I wonder if the school officials, students, parents are aware of the magnitude of the issue of MRSA and the true means of transmission.   Yesterday, while the environment was being cleaned, I thought maybe they should have done some intensive training for everyone on the subject of hand hygiene.  I also wonder if people are getting the message about "good stewardship" of antibiotics.   More on that later.

My condolences to Ashton's family and to all the families of people who have suffered with MRSA infection (or any other infection, for that matter).

It's Day # 3 of International Infection Prevention Week and my topic for today is hand hygiene.  Now before you start in with, "Yeah, yeah, yeah, . .. I will do that.....later..." , let me plead my case:  Infections claim more lives than any other diseases except cancer and heart disease.  And some infections can lead to cancer (like liver cancer following chronic hepatitis) and some infections can cause heart disease (like rheumatic heart disease following Streptococcal infection).   They say that Americans spend more than $20 billion annually to fight infections -with all the diagnostic tests, treatments, antibiotics and hospitalization.   There are so many infections to get - common cold, influenza, pneumonia, diarrhea, vomiting, foodborne infections, sexually-transmitted infections, hepatitis, urinary tract infections, skin infections - and many, many more.  Rather than spending our money on treatment and control of infections - I say, "Don't even go there!"  Avoid the pain and discomfort, the pus, the loss of productivity, and all the other expenses related to infections - prevent them!  The single most effective method of preventing and controlling infection is simple HAND HYGIENE.  We used to say, "handwashing" but now that we have proven effectiveness with alcohol-based hand sanitizers, we refer to either or both techniques as "hand hygiene".

Your hands are collecting nanobugs all day because you are constantly interacting with your environment and your own body.   So when should you wash or apply sanitizers?  Here's the short list:  before you handle or eat food, after you use the toilet or restroom, after you change a diaper, after you handle a pet, after you take out the garbage, after you handle money, after you blow your nose, sneeze or cough into your hands, after you handle uncooked food (especially meat, poultry and eggs), before entering a hospital room or leaving it and of course, when your hands are visibly dirty from gardening, fishing, or working on the car. 

Here's the simple technique for Handwashing:

Apply soap to the hands - liquid or bar - and rub vigorously for 20 seconds (the time it takes to sing the "Happy Birthday" tune in your head) and then rinse under warm (not HOT) running water until all the soap and the nanobugs are gone - down the drain.  Dry your hands well with a clean towel or a paper towel.  In a public restroom, leave the water running and use the paper towel to turn off the faucets so you don't recontamination of your clean hands.  If your hands are not visibly soiled, an alcohol-based hand sanitizer will work fast and effectively to get rid of the nanobugs.  Apply a dime-sized or nickel-sized amount of the sanitizer and rub your hands vigorously until they are dry. 

 

It's Day 2 of International Infection Prevention Week and I want to stimulate you to exercise good cough and sneeze etiquette.  Webster defines etiquette as "behavior that is conventionally acceptable or required in society".  Believe it or not, lots of study has been directed toward human behavior as it relates to transmission of infection.  Since many common infections are transmitted by the droplet or airborne routes, it is appropriate to focus attention on behavioral changes that can limit this kind of spread.  It is natural to just cough or sneeze into the air and your immediate environment.  You and your body are responding to the stimulus to cough or sneeze and usually you don't have much warning.  If we lived in a bubble (or a cave) this might be acceptable.  But covering the mouth and nose to limit the dispersion of mucous droplets and nanobugs is not only polite but also a healthy behavior for your community.  Years ago the CDC developed a campaign called "Cover Your Cough" and it has been taught in our public schools for years reaching many children.  Here is the essence of good cough / sneeze etiquette:  Cover your mouth and nose with a tissue when you cough or sneeze OR cough or sneeze into the upper sleeve of your shirt - NOT into your hands.  Put any used tissues into the waste basket pronto.  Then good hand hygiene is needed even after coughing or sneezing properly.  Either use soap and water or an alcohol-based hand sanitizer.

It is not easy to change behaviors that come so naturally- takes practice and reminders.  In order for children to keep their nanobugs contained, they need demonstration of appropriate ways to cover their cough or sneeze and constant reminders.  Teachers (often out of self protection) teach and remind.  But I worry that parents may not have received proper instruction themselves and therefore they won't be reinforcing this behavior in their children.  And what about other adults we are exposed to in the workplace?  That is why I designed the Nanobugs Training Shirt - to be a wearable instruction tool.  It comes in adult sizes to facilitate teaching and role-modeling and also in kid sizes to teach and encourage the under-age cougher.

In Japan, when someone has a common cold, he/she wears a face mask when they go out in public to cover their coughs and sneezes.  The mask announces to those in their community that this person is polite and communicable.  It is a nice social behavior but not a perfect solution to living together in close proximity - packed on subways and trains, etc.  After a while the mask becomes moist from respiration and is also ladened with nanobugs.  As the person touches the mask, adjusts it, and scratches their nose under it - their hands become contaminated.  Even though the culture of Japan does not include shaking hands, the hands are still a primary tool for transmitting nanobugs.  So, hand hygiene is always an appropriate behavior.  Don't offer your hand in a handshake to anyone wearing a mask or with obvious signs of a respiratory infection.  And don't kiss babies with what Bill Cosby calls "a glazed donut" face - no matter how cute they are or how you are related!  Rhinovirus loves everyone and is just looking for a free ride.