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INFECTION CONTROL


observed, with higher levels when JAD (jet air dryers) were present versus paper towels in washrooms.24


A need to continue to innovate In conclusion, it is now understood that bio-aerosols containing harmful pathogens can come from a number of apparati within healthcare premises, including showers, taps, washbasins, sinks, and toilets. Hand dryers are also a potential cause for concern. I believe that in order to reduce the instances of people becoming sick and sometimes dying due to healthcare-acquired infections caused by such bio-aerosols, manufacturers should continue to innovate and design better products that reduce aerosol risk. These new designs need to ensure that aerosol production and contamination is minimised – for example the unique tubular washbasin which is part of the Angel Guard clinical unit that helps to reduce aerosol dispersal and splashing. In addition, there should be very careful consideration of when and where to site sanitary apparatus, and the risks associated with toilets within an immunocompromised patient area.


References 1 Pittet D, Mourouga P, Perneger TV; Members of the Infection Control Program. Compliance with handwashing in a teaching hospital. Ann Intern Med 1999; 130: 126-30.


2 Tellier R, Li Y, Cowling BJ, Tang JW. Recognition of aerosol transmission of infectious agents: a commentary. BMC Infect Dis 2019; 31 Jan: 19. doi: 10.1186/s12879-019-3707-y.


3 Morawska L, Cao J. Airborne transmission of SARS-CoV-2: The World Should Face the Reality. Environ Int 2020; 139: 105730. doi: 10.1016/j.envint.2020.105730.


4 Judson SD, Munster VJ. Nosocomial transmission of emerging viruses via aerosol-generating medical procedures. Viruses 2019; 11 (10): 940. doi: 10.3390/v11100940.


5 Tang JW, Li Y, Eames I, Chan PKS, Ridgway GL. Factors involved in the aerosol transmission of infection and control of ventilation in healthcare premises. J Hosp Infect 2006; 64 (2): 100-14.


6 ASHRAE. ASHRAE position document on airborne infectious diseases. 19 January 2014 [https://tinyurl.com/rmm5mft].


7 Barker J, Jones MV. The potential spread of infection caused by aerosol contamination of surfaces after flushing a domestic toilet. J Appl Microbiol 2005; 99 (2): 339-47. doi: 10.1111/j.1365- 2672.2005.02610.x


8 World Health Organization. Infection prevention and control measures for acute respiratory infections in healthcare settings: An update. 2007: 39-47.


9 Szymanska J. Dental bioaerosol as an 26 Health Estate Journal September 2020 Elaine Waggott


Elaine Waggott, AMRSPH, began her working career in the building and construction sector, and co-owned a distribution company by the age of 24. She first worked within the plumbing industry in 2000, heading up a 60-strong team responsible for customer service and technical support across the UK for Ideal Standard/Armitage Shanks. She led several large projects within the company, and, harnessing her experience from customer service, got involved in new product development. After moving back to her home country of Scotland, she continued her career with Ideal Standard, running the Business Development team within Scotland for Ideal Standard/Armitage Shanks.


Over the past three years, she has been fully involved in the setting up of both Angel Guard and Water Kinetics, with both companies having recently launched ‘cutting edge and highly innovative’ plumbing products. She is director of Operations for both companies.


Six Sigma trained, she has written articles for newspapers and magazines, been editor for a leadership magazine, and undertaken both television and radio work. She has extensive experience in public speaking, and has recently been awarded membership of the Royal Society of Public Health.


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occupational hazard in a dentist’s workplace. AAEM 2007: 14 (2): 203–7.


10 Laheij AM, Kistler JO, Belibasakis GN, Valimaa H, de Soet J. European Oral Microbiology Workshop. Healthcare- associated viral and bacterial infections in dentistry. J Oral Microbiol 2012; 4: 10.3402/jom.v410, 17659.


11 Brankston G, Gitterman L, Hirji Z, Lemieux C, Gardam M. Transmission of Influenza A in human beings. Lancet Infect Diseases 2007; 7 (4): 257-65. doi: 10.1016/S1473-3099(07)70029-4


12 Tellier R. Aerosol transmission of influenza A virus: a review of new studies. J R Soc Interface. December 6 2009; Suppl 6: S783–90.


13 Gralton J, Tovey E, McLaws ML, Rawlinson WD. The role of particle size in aerosolised pathogen transmission: A review. J Infect 2011; 62 (1): 1–13. doi: 10.1016/j.jinf.2010.11.010


14 Tuttlebee CM, O’Donnell MJ, Keane CT et al. Effective control of dental chair unit waterline biofilm and marked reduction of bacterial contamination of output water using two peroxide-based disinfectants. J Hosp Infect 2002: 52 (3): 192–205.


15 Roberts K, Smith CF, Snelling AM et al. 2008. Aerial dissemination of Clostridium difficile spores. BMC Infect Dis 2008; Jan 24; 8: 7.


16 Cordes LG, Wiesenthal AM, Gorman GW et al. 1981. Isolation of Legionella pneumophila from hospital shower heads. Ann Intern Med 1981; 94 (2): 195-7.


17 Meenhorst AL, Reingold GW, Gorman JC et al. Legionella Pneumonia in Guinea Pigs Exposed to Aerosols of Concentrated Potable Water from a Hospital with Nosocomial Legionnaires’ Disease. J infect Dis 1983; 147 (1): 129-32.


18 Bollin G, Plouffe JF, Para MF, Hackman B. Aerosols containing Legionella pneumophila generated by shower heads and hot-water faucets. Youngstown Hospital Association, Youngstown, Ohio 44501,1 and Department of Medicine, Division of Infectious Diseases, The Ohio State University Medical Center, Columbus, Ohio 432102 Received 2 May 1985/Accepted 10 August 1985. Appl Environ Microbiol 1985; 50 (5): 1128-31.


19 De Geyter D, Blonmaert L, Verbraeken N et al. The sink as a potential source of transmission of carbapenemase- producing Enterobacteriaceae in the intensive care unit. Antimicrob Resist Infect Control 2017; Feb 16; 6: 24.


20Jessen CU. Airborne microorganisms: occuence and control. Copenhagen: G.E.C. Gad Forlag; 1955.


21 Barker J, Jones MV. The potential spread of infection caused by aerosol contamination of surfaces after flushing a domestic toilet. J Appl Microbiol 2005; 99: (2): 339-47.


22 Best EL, Sandoe JA, Wilcox MH. Potential for aerosolization of Clostridium difficile after flushing toilets: the role of toilet lids in reducing environmental contamination risk. J Hosp Infect 2012; 80 (1): 1-5. doi: 10.1016/j.jhin.2011.08.010. Epub 2011 Dec 2.


23 Knowlton, SD. Boles CL, Perencevich EN et al. Bioaerosol concentrations generated from toilet flushing in a hospital-based patient care setting. Antimicrobial Resistance Infection Control 2018; 7: 16. 24 Best E, Parnell P, Couturier J et al. Environmental contamination by bacteria in hospital washrooms according to hand-drying method: a multi-centre study. J Hosp Infect 2018; 100 (4): 469-75.


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