I just returned from a business trip to Kimball, Nebraska - a community of 2500 just off Interstate-80 at the border of Nebraska and Wyoming. At the Ogallala (NE) interchange I spotted a huge yellow sign on the side of a gas station that read, "The cleanest restrooms on I-80".  I had just made a pit-stop for a sandwich and a bathroom break so I wasn't interested in stopping again - though I was curious and tempted to make my own evaluation as an infection preventionist and self-proclaimed restroom sanitation expert. 

The sign was obviously a marketing tool that would help the gas station compete with all the others who claimed only, "clean restrooms".  I guess when you can't compete on the price of gas, you go for some value-added services.  We have all been in those situations where we have a toddler in the car whose all knotted up, in tears and screaming "I REALLY gotta go!"  If the quick choice you make for a "clean restroom" does  not measure up to the claim - who 'ya gonna tell?  The attendants seldom care -they are usually males who "use that 'can' all the time and have no problem with it".  They are just happy that the old method of quality assurance (locking the restrooms so we had to ask or sometimes beg them for a key) is no longer the standard.  And what are the criteria for "clean restrooms" anyway?  Does it mean clean floors? clean toilet? No paper towel waste on the floor?  Or just a sickening cover-up smell being squirted from a blinking machine above the door? Or blow dryers that turn on -but don't dry anything in less than 5 minutes? Do you ever wonder what the criteria are for the check marks in the little boxes on the back of the door in public restrooms - especially in fast food restaurants?  And what recourse do you have if there is check mark missing?  Or the checkmarks are all there, dated and timed but the place is a pit?  I think it is usually a teenager that is assigned to these duties and I wonder about their competency.  Have you seen their room at home???? 

It “feels like autumn” and the cool temps and shortening days are putting me in the mood for outdoor athletic events.  Loyal spectators watch and enjoy all that competition on the field expecting that consistent practice will contribute to the success of our favorite teams.  But as an infection preventionist, I am aware of the unobservable competition of microbes that takes place in the locker rooms and athletic areas of high schools, colleges and even professional teams.  So, it is time to study their game plan and offensive line-up. There are about a dozen microbes I like to call, “the locker room nanobugs”, that are anticipating a successful “season” this year, also. 

Here’s the usual line-up (in alphabetical order):

athlete’s foot fungus

community-associated MRSA

Herpes gladiatorum

Molluscum contagiosum

Pseudomonas aeruginosa

Trichophyton tonsurans (nickname: “ringworm”)

These are the key players.  They represent the microbial categories of bacteria, fungi and viruses. But they often call in some second string players like, Streptococcus pyogenes, Influenza virus, Rhinovirus and even Cryptosporidium. 

Some of these members of the offensive team of pathogenic microbes are already nanobug characters.  Now our design team is working to personify the others. Then I will create a powerpoint training program for coaches, athletes, and school nurses with relevant information for parents and school custodians.

The training of coaches and athletes should include each of the potential offenders (pathogenic microbes) but the critical element of our game plan is the list of “Locker Room Rules.  These rules are helpful to mothers, school custodians and athletic directors who develop all the other rules for athletics.  

1. Wash practice clothing, bags, knee pads and head gear after every practice.
2. Shower immediately after every practice, match or game.
3. Refrain from cosmetic shaving, i.e. chest, arms, legs or pubic regions.
4. Shower with liquid soap from dispensers- not bar soap.  Use your own personal hygiene products -don’t share. Use your own towels.
5. Always shower before using whirlpools
6. All wrestling mats should be cleaned before each practice and before every competition
7. Consider multiple cleanings during tournament play
8. Refrain from walking across mats with street shoes
9. Consider cleaning wrestling shoes before accessing the mat 
10. Wear clothing to cover arms and legs.  Consider leggings as part of uniform for competition to reduce skin exposure
11. Perform skin checks every day and before all meets or games

This week the Joint Commission unveiled a challenge to American hospitals to immunize more health care workers against  influenza.  “100% vaccination rates among employees and patients” has always been the goal in health care organizations but now it is time to pump up the compliance from the typical rates of 30-40%.  At the APIC international conference in June, we heard compelling research outcomes that indicate that high immunization rates of hospital employees produces lower mortality rates in hospitalized patients.  This research was passionately presented by Dr. Gregory Poland of the Mayo Vaccine Research Group at the Mayo Clinic in Rochester, MN.  Although education about influenza and its complications is an important part of the process of getting employees to get vaccinated, the most important factor in achieving compliance among employees is the endorsement, participation and support of the administration of the healthcare organization.  This has prompted a growing number of hospitals to make influenza vaccination mandatory for all employees and volunteers.  That kind of commitment takes a lot of courage but it has been shown to be an effective strategy for protecting hospitalized patients and keeping employees on the job during flu season.

As adults, we usually “catch” influenza from our children and grandchildren.  They bring it home from school – “that great mixing pot of nanobugs in a community” – typically, in January when everyone returns from holiday vacation amplifying the infection in the school population.  Hospitalized patients and residents of long-term care facilities, usually “catch” influenza from the employees who unintentionally transport the influenza virus from their homes to the workplace.

Improving influenza vaccination compliance is the project that every healthcare organization and community must begin to address this month.   Nanobugs, inc hopes to help institutions promote compliance with our influenza nanobug.  This nanobug was deliberately created to stimulate people to develop their own strategy to avoid this potential pandemic troublemaker and therefore promote personal health and wellbeing.  The influenza nanobug and its’ slogan, “It gives me a kick, to make you sick!” is intended to be one of those nanobugs “you love to hate”.  (It is better to hate the pathogen than to hate the institutional policy-makers, right?)

One idea we champion, is to put an influenza virus tattoo on the forearm of each person who gets a shot (not on their hand – they might not wash as ambitiously as they try to preserve the tattoo.)  The tattoo will wear off in about 10 days.  At that time the vaccine will have stimulated the body’s production of antibodies to influenza and the vaccine will be able to handle an invasion of influenza virus. We have a huge supply of influenza tattoos on hand if you want to use this tool in your strategic plan.  The images of the influenza nanobug, the profile information and the animation are also available to you for a fresh approach to improving compliance.  Please comment with ideas and successes in avchieving compliance in your setting.

“Microbes might play a role in premature births”-that was the headline in the Los Angeles Times over the weekend which reported the findings of a study at Stanford.  “Using a sensitive molecular technique, researchers found a greater quantity and variety of bacteria in women who gave birth prematurely”.  The amniotic sac and the amniotic fluid are supposed to create a protected environment for the fetus.  So when microbes invade that space, they can cause premature delivery and ultimately, the consequences associated with early delivery – like neurological problems, cerebral palsy, lung diseases and learning disabilities.  One of the most common microbes to cause premature delivery was Leptotrichia (an anaerobic bacterium found in the mouth and the vagina). (Maybe we need to create a new nanobug to communicate this message)  Gum disease and bacterial vaginosis have also been shown to increase the risk.  This “makes the case” for infection prevention in pregnant women and women who might become pregnant and the importance of prenatal care to identify and treat infections.