Managing airborne bugs

With so much attention paid to cleaning and disinfecting surfaces and items like linens, infection control-minded facilities often over- look the source of more than one-third of nosocomial infections — the air. Long-established airborne precautions are rarely used in long-term care facilities, according to the Agency for Healthcare Research and Quality. Experts advise how to reverse that. 

1.Understand the risks. Influenza is by far the most prevalent airborne pathogen, and tuberculosis is the second most serious, according to Gina Pugliese, RN, MS, FSHEA, vice president emeritus of the Premier Safety Institute®. That's because the elderly are at high risk of reactivation of an old, latent infection, and early symptoms are not the usual cough and high fever.

Other common airborne infections include Norovirus, C. diff, MRSA, pneumonia, respiratory syncytial virus (RSV), parainfluenza, coronavirus, rhinoviruses, adenoviruses, disseminated shingles and human metapneumovirus.

Another surprise: Many of these also can spread in other ways.

“Illnesses transmitted through the air occur when infectious agents spread via the airborne or droplet routes. But contact with these germs can also spread these illnesses,” notes Deva Rea, clinical science liaison for PDI.

2. Know your facility's vulnerabilities. Airborne germs are opportunistic and seek weakness in places like heating, venting, air-conditioning and water systems.

“Legionella pneumophila does a great job of surviving in water and in ‘biofilms,' which can develop in water pipes and other man-made devices,” notes Deb Patterson Burdsall, Ph.D., RN-BC, CIC, FAPIC, an infection preventionist who also serves as faculty and author on various projects related to long-term care for the Association for Professionals in Infection Control and Epidemiology.

Ironically, the air itself is “a central yet often overlooked transmission vector for dangerous pathogens,” says Olivia Easly, marketing manager for Novaerus. And while airborne illnesses typically find a path through coughing and sneezing, germs easily can be aerosolized through such activities as bed making and vacuuming, she says.

Another vulnerability: group activities. “These activities may increase communicable infectious disease exposure and transmission,” Rea says. “The same is also true for occupational and physical therapy activities.”

3. Housekeeping and maintenance are vital to prevention. “Environmental service personnel are essential to infection prevention. Regardless of the pathogen, good environmental cleaning and disinfection are main prevention strategies,” Rea notes.

Facility maintenance workers are critical when dealing with certain airborne illnesses such as TB by providing monitoring of airborne isolation rooms under negative pressure, she adds.

Housekeepers should under- stand that shaking soiled linens can aerosolize germs, advises Bill Brooks, North American sales manager for UniMac®.

4. Preparing a rapid response to an emerging infection is critical. Pugliese notes that staff vigilance can prevent widespread infection. That's why it's important to understand the sometimes puzzling early symptoms of an illness such as TB. Once detected, “the usual principles of airborne isolation apply, which require negative pressure ventilation and t-tested respirators, per OSHA,” she adds. 

“If an outbreak of any airborne- related illness occurs, it may be necessary to restrict admissions, visitors, and cohort residents with the same illness,” Rea says. 

5. Know how to protect your most vulnerable residents. Immunocompromised residents can skew normal isolation precautions.

"With some viral illnesses such as influenza, RSV, norovirus and adenovirus, an immunocompromised patient may shed the virus for longer periods of time,” observes Rea. “So it's recommended to keep patients on isolation precautions for an extended duration.”

6. It bears repeating: Caregivers are often unwitting carriers and transmitters of airborne illnesses. That's why training and adequate and plentiful personal protective equipment are essential.

Basic, sound personal hygiene practices such as regular hand washing and staying home when sick should be enforced. It's also not too late to receive a u shot.

As noted, coughed or sneezed aerosolized droplets aren't the only way pathogens reach the lungs. Germs on contaminated surfaces and hands have an insidious way of reaching the mouths and noses of patients. As Easly reminds, “the CDC and WHO have declared hand disinfection as the most important standard measurement of hand hygiene in healthcare facilities as it can lead — if correctly performed — to a drastic reduction of nosocomial infections.” 

Mistakes to avoid

1. Relying on consumer-grade air filtration. The germ- laden air of nursing homes calls for industrial strength solutions. Consider air sterilization systems that eradicate, not filter, germs.

2. Overlooking vulnerable areas and practices. Biofilm in standing water is a breeding ground for illnesses. Shaking soiled linens can actually aerosolize numerous pathogens.

3. Neglecting to have air isolation precautions, including negative pressure rooms, available when a nasty airborne infection is first spotted.

 

SCRUBBING VS STRIPPING

 

Differentiating Between Stripping And Scrubbing Floors

"I get confused about stripping and scrubbing hard floors. What is the difference?"

 

Good question since it very important that you understand the difference. We can only briefly touch on the process in this article. You might want to check on past articles that go into the actual steps for these two processes. Both processes in it simplest form, utilize a low speed, rotary floor machine that using the appropriate pad. The primary differences between the two tasks are the chemicals and pads used that are intended to achieve different results.

 

Stripping is utilizing a high pH (9.5 - 11) chemical mixed in water that emulsifies the floor finish (also called wax) with the goal of its complete removal before new seal/finish is applied. In most cases, a black or brown stripping pad is used to aggressively remove any finish that was not immediately emulsified by the chemical. A neutralizer (think mild acid) may be necessary for bringing the floor pH close to 7 before floor finish or seal is applied. Please do not make the mistake that some people make of mixing a "little stripper" in their daily mop water since it damages the finish and may require complete stripping before it would have been necessary if the correct mop products were used.

 

Scrubbing is utilizing the same type floor machine but different chemicals (think 7.5 - 8.5) that have a detergency with the goal of removing the top soiled layer of finish without damaging the base coats. Floor techs have their preferences but in most cases, a blue or green scrubbing pad is utilized to safely remove the finish. After rinsing with water, the floor will be ready for more finish. Neutralizer is not necessary due to the low pH of the cleaner.

 

In today's green environment, you need to know whether you are using the old traditional finishes with zinc or other metals or environmentally friendly finishes that are not necessarily compatible with the old chemicals. That topic is another article to consider.

 

Your comments and questions are important. I hope to hear from you soon. Until then, keep it clean...

 

 

 

 

BIOFILMS

•
I Behi d Biofilms

and Their Impact on Cooling Towers

BY SIMONA VASILESCU

n 2017, a runner dressed as a camel completed the London lvfarathon.Run11ing 26.2 miles is a huge achievement in and of itself; doing it while wearing a highly insulating costume




makes it much more difficult. The costume trapped warmth,

making it harder for the runner to cool down. This same prin­ ciple applies to water cooling systems coated in biofilm. The good news is that maintenance managers in charge of these systems have the power to take control of the situation.



　



There are three stages ofbiofilm development:

1. Attachment: A biofilm starts when a few pioneer bacteria use specialized chemical hooks to adhere to a surface. This can occur in response to many factors, ranging from attachment sites present on the pipe surface, nutritional cues or sub­ inhibitory concentrations of stress factors such as biocides. It is thought that the first colonists of a biofilm adhere to the surface initially through weak Vander Waals forces and hydrophobic effects. Interestingly, the number of planktonic bacteria in the water does not correlate with either the for-



　

What are biofilms?



Many different types of planktonic (free-floating) bacteria can be found dispersed throughout water in a water cooling system. These come together to form a sessile aggregate, which adheres to the inside of the system's pipes. These attached bacteria then produce a matrix of extracellular polymeric substance (EPS), often referred to as slime, covering them completely.




This matrix is a collection of DNA, proteins and polysac­


charides that form a protective housing around bacteria, cre­ ating a safe space and preventing biocide treatment from reaching the bacteria. In fact, bacteria in a biofilm are 10 to

1,000 times more resistant to treatment than in their plank­

tonic, free-floating form.1

16 INDUSTRIAL WATERWORLD NOVEMBER/DECEMBER 2017



　


2. Growth: Biofilms develop slowly at first because only a few organisms can attach, survive, grow and multiply. However, after this initial colonization, populations increase exponen­ tially as bacteria continue to multiply, increasing the thickness of the biofilm rapidly. Furthermore, other bacteria and non-living debris in the water adhere to the sticky biofilm matrix to join the colony and advance the biofilm. This means the biofilm often includes many different bacterial species, which contribute to the complex slime matrix.
3. Dispersal: Dispersal of bacteria from the biofilm colony is an essential stage of the biofilm life cycle, enabling its spread to other parts of a water cooling system. This happens when bacteria within the biofilm spontaneously secrete enzymes, such as dispersin B and deoxyribonuclease, to break out of the slime matrix and back into the water.
This reverts some of the bacteria back to their free-floating planktonic state and thus free to start a new colony ofbiofilm elsewhere in the system. Researchers have tried to harness

www.industrialww.com

　


the signaling and chemical power used at this stage, as this could be the key to breaking down the biofilm matrix.





Resilience





Once a biofilm has advanced, it forms a complex structure in which different bacteria occupy different environments. This sophisticated approach means bac­

teria towards the outside of the commu­


nity have a very different structure from those deep within the matrix. It is this diversity that adds to the stubbornness, as treatment will need to target many different physiologies.
A biocide may be effective against one
bacterial strain while the other strains may remain unaffected. Without breaking down thiS complete protective layer, the bacteria will remain protected and free to multiply. Furthermore, the bacteria con­ tained within the matrix use quorum sensing, meaning they are constantly un­ dergoing genetic divergence. This gives biofilms phenomenal recovery and re­ growth abilities after a population hit, often caused by treatment attempts.



　

from the hot item to the cool water becomes much more difficult. It could be compared to someone trying to cool down but re­ fusing to remove their coat: it's inefficient. A biofilm layer of just 0.1 mm can reduce efficiency so much that the associated electricity costs to power your plant can increase by a factor of four compared to a system containing the same thickness of



　

Health Hazards ·

The United States National Institutes of Health says that 80 percent of chronic infections are biofilm-related. This re­ search looked specifically at biofilms in­ side the body, but biofilms can also occur in many other places, including industrial cooling towers. They are associated with the spread of Legionella bacteria, which can cause Pontiac disease, or worse, Le­ gionnaire's disease, a potentially deadly form of pneumonia.
The problems occur because of amoe­



bae. These single-celled organisms join the biofilm colony and feed on the bacteria within it, including Legionella bacteria. The ingested Legionella then proliferate within the amoeba as it provides suitable conditions for the Legionella to multiply. This makes them a significant health haz­ ard in many industries and is why it is so important to manage and control the pres­ ence ofbiofilms.







Costly Coats



Many industries with processes that de­ pend on heat being quickly removed from a production area rely on water cooling systems. If the water cooling system pipe is coated in biofilm, then the heat exchange



 



　

Biofilms are general­ ly just a few microns thick, 100 times smaller than the cross section of a strand of hair.






　

calcium carbonate scale.

Biofilms often aren't considered as the cause of increased electrical costs, perhaps because they are rarely detected. Bioftlms are generally just a few microns thick, 100 times smaller than the cross section of a strand of hair, and plant managers are not actively looking for them. A water treatment specialist, however, can inspect cooling systems using the latest techniques and analyze samples to detect the presence of biofilms and advise on appropriate treatment.

Biofilms are also a leading cause of microbiological corrosion.







Biofilms can contain sulfite-reducing or iron-depositing bacteria that destroy steel, wreaking havoc on water cooling system pipes. This microbiological corro­


sion is 1 0 to 1,000 times quicker to de­

velop and 10 to 100 times more aggres­




sive than standard corrosion.







They can contain sulfite-reducing or iron-depositing bacteria that destroy steel, wreaking havoc on water cooling system pipes. Microbiological corrosion accounts for up to 50 percent of the total costs of corrosion to economy. Compared with standard corrosion, it is 10 to 1,000 times quicker to develop and is 10 to

100 times more aggressive. Ifleft untreated, this cari have costly



18 INDUSTRIAL WATERWORLD NOVEMBER/DECEMBER 2017



　

consequences to mission-critical equipment in cooling systems

-leading to expensive repair work and downtime.







Breaking Down the Protective Layer



A treatment that breaks down the complex biofilm mech­ anism, exposing the bacteria hiding within, is critical. NCH Europe's Water Treatment Innovation Platform has developed a patented liquid-based treatment called BioeXile that has been designed to keep up with the diverse and resilient matrix of biofilms and to destroy it. The exposed bacteria can then be treated with biocide, preventing them from going on to recolonize.





Unlike completing the London Marathon in a camel costume, there's no sense of accomplishment for a cooling tower working extra hard. By treating biofilms, you are removing an unnec­ essary and costly insulating layer, allowing the cooling tower to work more efficiently, reducing the risks associated with Legionella, and addressing the problems of microbiological corrosion outlined above. liMN

About the Author: Dr. Simona Vasilescu has worked at NCH Europe for 18 years, the last three as product and marketing manager on the Water Treatment Innovation Platform. She graduated from the University of Bucharest with a biochem­ istry degree and finalized her PhD in molecular biology and genetics at UMIST, Manchester.





References



1.Monroe, D. "Looking for Chinks in the Armor of Bacterial Biofilms," PLoS Biology,

5(11): e307, November 2007.




Circle No. 151 on Reader Service Card

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HOW MUCH FOR QUALITY ?

20 QUALITY | October 2013 www.qualitymag.com

In 2011, Sipho Tjabadi, general manager, Eskom

Quality Management, South Africa, spoke at the

ASQ Audit Division Conference. To punctuate his

keynote address, Tjabadi brought a video titled,

“The Cost of Quality.” For seven minutes the audience

was transfixed while several quality failures

were presented, root causes offered, and total cost

in materials (and, too often, life) were calculated on

screen. After the conference the video was posted to

the Audit Division website, where it continues to be a

popular page.

The video powerfully illustrates cost of quality. But

what does cost of quality really mean? To answer the

question, let’s take a step back. Define quality. Take a

moment to ponder.

A visit to Dictionary.com will bring us to the

following list:

qual·i·ty (kwoliti)

1. an essential or distinctive characteristic, property,

or attribute: the chemical qualities of alcohol.

2. character or nature, as belonging to or distinguishing

a thing: the quality of a sound.

3. character with respect to fineness, or grade of excellence:

food of poor quality; silks of fine quality.

4. high grade; superiority; excellence: wood grain

of quality.

5. a personality or character trait: kindness is one of

her many good qualities.

Character. Nature. Excellence. Did any of these

terms appear in your definition of quality? While

most of us can identify what a quality product or

service is, it is often more difficult to convey that

to someone else. How many times have you—as a

quality professional—when a person asks you what

quality is, allowed the asker to supply the answer

and then filled in the gaps? That’s fairly common

with ASQ members. In fact, in recent informal polls

on ASQ social media, when asked “what is quality?”

a number of visitors answered “whatever the customer

says it is.”

The customer will generally relate quality to the

way in which a product works. While a good starting

point, quality is not only what a product is but

also what a methodology or tool does. This is certainly

the way a quality professional must think.

Stating what quality “does for me” is not only a

way of explaining to family, neighbors and coworkers

but a means of justifying its importance to

senior management.

So, where are we in our quest to define quality?

Quality is:

• Waste reduction

• Continuous improvement (which might include

process improvement)

• Performance excellence (there’s that word excellence)

• Product safety

• Service delivery

• Exceeding customer expectations

Depending on what you are trying to do, quality will

mean something different to you.

With quality more or less defined, we can finally

turn to cost of quality. With the multiple quality definitions

in circulation, it is no wonder cost of quality

is defined in different ways. Unlike the definition of

quality, however, many of the terms used to define

cost of quality are incorrect.

WHAT IS COST OF QUALITY?

Cost of quality is often thought of as the price of

creating a quality product. While on the surface

this appears to make sense, this definition is absolutely

incorrect.

In actuality, the cost of quality is the cost of NOT

creating a quality product or service. What is the

difference? The former (incorrect) definition covers

product/service costs only. Cost of quality covers any

cost that would not have been expended if quality

were perfect.

In 1999, ASQ Quality Costs Committee

published the third edition of “Principles of Quality

Costs: Principles, Implementation, and Use” (ed.

Jack Campanella, ASQ Quality Press), beginning

the book with references to costs associated

with quality.

• Prevention Costs—The costs of activities specifically

designed to prevent poor quality in products

or services.

• Appraisal Costs—The costs associated with measuring,

evaluating, or auditing products or services to

ensure conformance to quality standards and performance

requirements.

• Failure Costs—The costs resulting from products or

services not conforming to requirements or customer/

user needs. Failure costs are divided into internal

and external failure categories.

WHAT DOES

(COST OF) QUALITY MEAN?

MANY OF THE TERMS USED TO DEFINE COST OF QUALITY ARE INCORRECT.

SPEAKING OF QUALITY

020-QM1013-CLMN-ASQ.indd 20 9/17/13 3:33 PM

www.qualitymag.com October 2013 | QUALITY 21

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• Internal Failure Costs—Failure costs occurring prior to

delivery or shipment of the product, or the furnishing of a

service, to the customer.

• External Failure Costs—Failure costs occurring after delivery

or shipment of the product —and during or after furnishing

of a service—to the customer.

• Total Quality Costs—The sum of the above costs. This

represents the difference between the actual cost of a

product or service and what the reduced cost would be if

there were no possibility of substandard service, failure

of products, or defects in their manufacture.

Yes, this is a daunting list of costs. But quality is essential.

There is a cost to attaining and improving quality, but there

is a bigger cost in failing to produce quality work. Don’t allow

a definition to get in the way of your work. You know what

quality is. Achieve it!

You can fi nd more about cost of quality, including free articles and case

studies, at http://asq.org/cost-of-quality/index.html.

020-QM1013-CLMN-ASQ.indd 21 9/17/13 3:33 PM

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