Three new studies confirm germs are everywhere

These ubiquitous germs don’t seem to be harming anyone, but reporting on the studies generates lots of clicks.

For many years kitchen sponges have been known to harbor bacteria. Now comes the news that cleaning those sponges not only doesn’t work, it may make the situation worse by promoting the overgrowth of potentially disease-causing bacteria—for example Moraxella osloensis.

The New York Times reports German researchers found kitchen sponges contained 362 different types of bacteria and as many as 82 billion bacteria per cubic inch of space. The senior author of the study said, “That’s the same density of bacteria you can find in human stool samples” [but not the same types of bacteria] and suggested replacing kitchen sponges frequently.

These revelations were based on bacterial DNA and RNA samples from 14 [yes, just 14] used sponges. Note the use of the word “potentially” to describe the pathogenicity of Moraxella. A PubMed search for this microbe back to 1968 yielded only 82 references, many of which were not pertaining to any human illnesses. The few case reports of infections involved patients who were immunosuppressed.

Epidemic viruses contaminate healthcare workers’ mobile phones

As if bacterial contamination of cell phones wasn’t enough of a problem, a new paper finds that viral RNA can also be found on the devices. But before you put your phone in the autoclave, read on.

The study was conducted in France and involved 114 healthcare workers (35 senior physicians, 30 residents, 32 nurses, 27 nurse assistants) who used both mobile and cordless phones in a university hospital.

Phones were swabbed and tested for viral RNA, and the subjects answered anonymized questionnaires regarding their behavior.

Viral RNA was recovered from 38.5% of the phones with rotavirus RNA on 93% of the virus-contaminated phones.

About two-thirds of the healthcare workers used their mobile phones while caring for patients, and 28% of them said they never wash their hands before using the phones, 37% never used hand hygiene after using the phone, and 21% said they never performed hand hygiene either before or after using a phone. This held true for personnel who interrupted caring for patients to answer their phone.

In an article about the study, one of the authors said, “It was surprising that 20% of them admitted never carrying out any hand hygiene procedures, either before or after using their phone, even though all said they knew phones could harbor pathogens.”

More germs: Planes, desks, and even kisses

Airplanes are so permeated with bacteria that it is truly a wonder that anyone survives a flight. I'll bet you thought it was the air in the cabin, but a recent story in USA Today says otherwise. "The real problems lie on the chair upholstery, the tray table, the armrests and the toilet handle."

What should germophobic passengers do? "First, they should travel with and use an alcohol-based hand sanitizer. They should also travel with a small pack of disinfectant wipes," said the microbiologist who did the study. "The first thing I do when I sit down is to wipe down the armrest and tray table because that's where my arms will be. You need to decontaminate where you'll be spending your time and eating."

From MailOnline: "Millions of us spend our days slaving over a keyboard. But lurking between the keys, hidden on the mouse and nestled in your phone lies [sic] more than 10 million bacteria—400 times more than on the average toilet seat." [Despite what I reported in my last post, the toilet seat will remain the gold standard for comparing contamination levels until it is unseated.]

At least that is way fewer bacteria than the next study found.

"Every Kiss Begins With 80 Million Germs" headlines WebMD about a paper published in the journal Microbiome. WebMD story says, "In one experiment, the researchers gave 21 couples a probiotic drink containing bacteria before they kissed. Swab samples afterwards showed the transfer of those 80 million germs."

From the methods section of the paper: "One of the partners was invited to consume 50 ml of a probiotic yogurt drink containing L. rhamnosus GG, L. acidophilus LA5, and B. lactis BB12 [all non-pathogens]. After 10 seconds, saliva and tongue swabs were collected from this partner (donator) and after a second intimate ["full tongue contact and saliva exchange"] kiss of 10 seconds, saliva and tongue swabs were directly collected from the other partner (receiver)."

Saliva has some antibacterial properties. Maybe the researchers didn't wait long enough to test for bacteria after one of the partners drank the yogurt? People who have 80 million pathogenic bacteria in their mouths probably have bad breath and poor oral hygiene. I doubt they are indulging in 10 second tongue kissing.

And here's an excerpt from the conclusion. "This study indicates that a shared salivary microbiota requires a frequent and recent bacterial exchange and is most pronounced in couples with relatively high intimate kiss frequencies of at least nine intimate kisses per day [my emphasis] or in couples sampled no longer than 1.5 hours after the latest kiss."

Ten second kisses? Nine intimate kisses per day? Other than perhaps high school kids, who is kissing 9 times a day for 10 seconds at a time?

Bottom line? After eating yogurt, wait at least 90 minutes before tongue kissing someone.

Germs found on credit cards, but there's hope for civilization

Regular readers of my blog know that I am a connoisseur of studies about bacteria in the environment and on human tissue. If you click on the "Infection" label to your lower right, you can read my previous posts on the subject. Not surprisingly, I am skeptical of inflammatory headlines claiming that germs on various surfaces are dangerous.

Money has been the subject of many studies, most of them showing it is covered with bacteria. A recent video from the Cleveland Clinic discussed a study from England which found bacteria on the hands of 11% of people tested, on 8% of the credit cards tested, and either 14% or 6% of paper money [the accompanying story was contradictory].

This is old news. A 2012 study from the European Cleaning Journal [not a peer-reviewed journal] found that 26% of paper money, and 47% of credit cards showed "high levels of bacteria including E.coli and Staphylococcus aureus," and "around 80% of banknotes and 78% of credit cards tested showed traces of bacteria, and some carried more germs than [wait for it…] the average toilet seat."

For those of you new to the field of culturing everything in sight, the toilet seat has been the gold standard for comparison of contamination as I noted in a 2013 post.

Should healthcare workers stop shaking hands and "fist bump" instead?

Some well-intentioned researchers from West Virginia University published a small study claiming that substituting a fist bump for a handshake might reduce the transmission of bacteria.

Since many illnesses can be transmitted by contaminated hands, the idea is plausible, but it's a good example of the media misinterpreting a study and misleading naïve readers..

They measured the surface area of open hands and fists in 10 subjects. Not surprisingly surface area of an open hand was significantly greater than that of the fist—30.206 vs. 7.867 sq. in. respectively, p < 0.00001.

They also measured the contact time of handshakes and fist bumps. The handshake took 2.7 times longer than that of the fist bump (0.75 vs 0.28 seconds). [No statistical analysis provided]

Preventing infection: The "bare below the elbows" rule for doctors doesn't go far enough

Here's a post about a paper on the possible transmission of bacteria on doctors' clothing that drew over 1000 comments on reddit in 24 hours.

It linked to a blog by an infectious disease/hospital epidemiologist physician. He discussed a small study which showed that bacteria could be transmitted by neckties.

The study looked at four different combinations of dress—long sleeves with and without ties and short sleeves with and without ties worn by a single physician who rounded on five mannequins simulating patients.

From the Methods section of the paper. "Micrococcus luteus (ATCC) was suspended in sterile saline and adjusted turbidometrically to a concentration of ~1.5X10 8th colony-forming units (cfu)/mL .A Dacron swab was dipped into the bacterial suspension and was rubbed over the terminal 6 cm [about 2.4 inches] of the tie for those tests involving the tie and the corresponding location on the front of the shirt for tests involving no tie. The terminal circumferential 2 cm of the cuffed portion of long and short sleeve shirts were inoculated in a similar manner."

The study found that wearing an unsecured (I guess meaning no clasp) tie was significantly associated with elevated level of contamination of the mannequins. The degree of mannequin contamination was not significantly different whether long or short sleeves were worn.

The blogger concluded that everyone should wear short sleeves and no ties.

But wait a second—6 cm of tie covered with bacteria? How many people are getting that much contamination on their ties? If you are, then you need to reassess your approach to not only infected patients, but maybe activities of daily living in general.

Some might counter that even though the short sleeve portion of the experiment was not conclusive, what is the harm of having everyone wear short sleeve shirts and no ties?

In a recent editorial in the BMJ, Stephanie J. Dancer, a consultant microbiologist in England, wrote that there is no evidence to support the "bare below the elbows" rule [which has been in effect in the UK for several years], and it may be having some unforeseen consequences.

From her piece: "It could be argued that ditching the white coat and tie for hygiene purposes has had the converse effect, in that the informal attire now gracing our wards has encouraged a less robust view of infection control." She based this on the fact that since the bare below the elbows rule, junior doctors have adopted "scruffy" [her word] attire and slovenly personal hygiene.

She went on to say, "The dress code for UK doctors was imposed more as a political gesture than as an evidence based strategy likely to reduce infections acquired in hospitals."

A surgeon from the UK designed what he thought was the perfect uniform for doctors and published a description of it in the BMJ in 2012. Here is how it looked.

He said the "S" stands for "Surgeon." It was not accepted, probably because of the cape.

Maybe bare below the elbows doesn't go far enough.

I think all hospital personnel should dress like this.

Notice he has no stethoscope, no ID card, no cell phone or pager—they can harbor bacteria!