11982 Fall_ .- ,. ." -

11_1 Tm_tmeda_ dram391933

CANADIAN INSTITUTE OF PUBLIC C lintonHEALTH INSPECTORS

m-_ L'INSTITU,T CANADIEN DES INSPECTEURS

[ONTARIO BRANCH] INC. ,= EN HYGIENE PUBLIQUE

ISSNNumber 0710-345X4_4 L

-ONTARIOBRANCHNEWSFall 1982 Volume III No. 3

,,i BREAKINGTHECHAINOF INFECTION

RapLO accuraleioenldicatlon

of organisms

iNFECTIOUS AGENT

Fur_gi Viruses

Rff:kettsiae_ Protozoa

x reatrnent ot

undei'lying d,sease: SUSCE RESERVOI RS Emolovee nea,itlHOST

immunosuopresslon Peoole EnvironmentalDiabetes

Surgery _,_ sanitahon

Burns Equipment

INVOLVES_Waler Dis itection

Hecognitlon of Cardlo-oulmonaryhigh-risk diseaseootieo,s ALL HEALTH sterilization

PROFESSIONALS

PORTAL V/'_l I PORTALOF 'lrUU OF P,ope,

ENTRY EXIT _t_,e,Aseptic "Mucous _"

Techniquemembrane Excretions

GI tract HandwashmgRespiratory Secretions

Catheter tract Skin" care Broken Droplets

skin Control of• excretions

secretlons

wou_dCor_ MEANS OF

TRANSMISSION Trash&wastedlsposal

Direct contact FomitesIngestion

Isolation

Food hanolmg

Sterllization _.

Air how conlro_

,°

" NOTICES .::iiElectionSlate " . ':

' togi o.oo.o ,n,.t,oo,o Deadline rrunfor electionforCouncilloronthe C.I.P.H.I. Ontari0 Branch: Executive. Five positions are available for the term 1983-84.

Yourballotandproxyshouldbeinyourpossessionbythetime Winter Issue, "youread this notice. The ideal method of voting is to attend theOntarioBranchconference in Hamiltonand voice your opinion

on the various issues at the business meeting. If unable to J Sattend, send your proxy with someone that is attending. The •

followingpersonsarerunningforiectionandarelistedin November 15alphabetical order:ARMAND BARRETTE;PAMELACOOK;,EDWARD MEYER; PETER MOCCIO; BEN MUELLER; : _THOMASSTEWART; MICHAELSTRACHAN. . . . .

September 20-24 -, )Annual Conferenee-C.I.P.H.L Ontario Branch Inc. at the - _ "- .. ;_- _:1:_:

Holiday Inn, King St., E., Hamilton. Theme: "New GlimpsesHorizons": Contact: William Hunter, Hamilton-Wentworth .past ::,RegionaiH.U., P.O. Box 987. Hamilton L8L 3RI (416) - _ .-: : ._,528-1441.

Editor'sNote: Following are some excerats from ;the "- October 24-27 Scientific American regular column, called :S0 and 100 Years '-

Annual C0nfei'ence-=Ontario Public Health Association at Ago'. The articles first, appeared during the months July,the:Park Plaza Hotel, Toronto.- Theme .... " " • August, and September 1882.Third.Revolution in _ , - -_ -

PUblic Health' _Contact. Kay', Sutherland, Office Secretary, JULY _ " :.... p . . i . -• - _ O HA, State 412, 131 Bluer St. WI, Toronto. M5S.IRI "(4i6) "The demonstration of the intim_ite relation of bacteria tO " ',_XI,-"92J_.7993.,. -'., -...... _._'J:- : __ . : ... certain fevers and other diseases would seem at first-t0 greatly, _.,-:_. - " : " . _simplify the work of the physician .in searching for efficient.._.

-:-"_ Ontiario. Public Health Assoc: " :: = .remedies.PutinplainEnglishthe problemis:Find=some".:. .-- : " _ _. element or compound that is fatal to bacteria and administer it " -, "-

_OPHA offices moved to Suite 412..131 Blo0r!St W..Toronto " in the waybest calculated to reach the mischievous fungi in the ._ _!_:- . . . ' patient's blood:.Theproblem is easier stated than Soived.'The _'-

- _-i_" ExeautiveMSS1RI onDirectorJUlyl,,1982ofthe(}lloPHA6)921-7993.onJulyGeraldr,1982.Nas°n:became _- i "_...loUverformsof life that appear to cause the trouble _ireable to -! . " '.:-: "' .- "-" .... . -_. . - -'- live.and thrive under the Widest possible range of conditions. ".:,_:: _.-

• "" - so that, as far as is known, any reagent able to kill them Would = j'.o;_:_'::::i-": . ,-, ., N,ov,,ember 20 : . be_uchmorequicklyfataltothe,patien(s.itisbarelypossibie.:.,__.i:,ii...... . Culling Funspiel'83-version. that-these, vicious organisms may be reached and killed'by

: .. some drugin doses the human system.can tolerate, but the "):Hosted by the Sudbury and District H.U. Bud O'Donnell is prospect is certainly not bright." - . • _ _ -' i-.

• the chairperson forthe bonspiel. The November date was AUGUST " " - " " =-'

chosen to allow those travelling long distances a good chance "Robert Koch has endeavored to ascertain what agents'are o. °:• : for decent...reads/to and from Sudbury. Additional information_ : able to destroy the. spores of bacilli, how they.behave toward '- :

will be rended soon: Plan forthis popUkir Institute event, . .. the microphytes most easily destroyed, such as .the molds, _:_":_- ':_:4" . - ferment_ and micrococci, and.whether they.suffice at. least to--'. _"i),_:',,

-- ' Baseball, leftovers ::-_ ' ':_ )" .-.i_irrestthedevelopmentoftheseorganismsiniiquidst_a;corable. . _.:.-- - - - ", .,' " - to their multiplication. His results With phenol, thymol and- -" " ,€ _,-

Would the person who picked upthe black 'CoOper' baseb_ill •salicylic acid have been unfavorable. Sulphurous acia and Zinc ..' °: ; -_:o_:- ..glove with'white paint on the back. please contact: MICHAEL _ " chloride have also failed to destroy all the germs of infection.- _-:- .._

-, HUJWAN, ETOBICOKE COMMUNITYHEALTHDEPT., OR" . .. Chlorine, bromine and mercuric chloride gave the_best results. ":_ _ :_,7--- -'_PHONE416_626-4211.HEOWNS IT!!! . . ,:_ .'.........• . ** ***,., . . -, ., . - solutions of m6rcuric chloride, n.itrate orsuphate diluted to one.

. . -- • part inq,000 destroy spores in 10 minutes." : -

• "j: ' :'_°i-_' SEPTEMBER ::.,::,:-?:,::... Important - , . '_":. .-- " "The cause of' malarial diseases is said i:o-have been .-.... -_

= . . " .- _-- .> , ... - .disc°vered by Prof. Laveran, a: French physician :of ::. -:_. If you have or intendto move and change your name or. t" ' • Vii-de-Grace. It is a very minute ,organism,"named by him ,_.-'_"_'- _i_i

address make sure you let the Institute know. Conh_ctBrian Oscfllariamalariae. M. Richard, _vhoannounced the discovery.-, .: .: "Hatton, National CIPHI; See-Treas, 1975 CARIBOUCOURT, in-theFrench Academy of Sciendes. has found these microbes. "_

-: :: SUDBURY, ONT.P3A 4W6; PatidcO'Donneli, Ontario Branch inall the fever patients of the Philippevil]e Hospital inAlgeria, u ._!: :: _-: Sec-Treas, 575 Summerhill Cres.'Sudbury, Ont. P3A 4T3; : " " • They reside in the re'dbl0od corpuscles and completely destroy S,i.::.

" . .Edit°r, OntarioBranch News, Box 687 Clinton, Ont. N0M 180. ". . their .contents.. They can easily be ren.dered. _visible by -

. -Note: the'change of addressteards can be Obtainedat yourpost. " ; _ _he: merit Withacetic acid; but otherwise it is difficult to detect- '_:.._.;_offieefree and thei-eis no chargefor postage. If youWantall the _ " :. _ - "n_thecorpusc!es. They looklike a necklace of black beads w_-:

'-_)ii. .info-and "publications"from -y6ur -Institute-kei_p the above • ' / _:>Withone;el-mgre: projections ,, which :penefi'ate the cell of_:.-_:Liliformed: - _ :.' " " ". • , ".-, :- : ,'- .... .-.. : _ - _!_. _.: ":/':i)cbrpuscle arid Oscillate oi:move like W'hips. ....... "_:_

._ .:. .-.::::. -..... • ..,.. _,, .-: .': ... :. '( "2_,_,:_:-"..,.:.-L:'-::_'--_.._=:">._..... '_ . -: ::_ -- , --".. ^-:,_,..-. .?,

/ CANADIAN INSTITUTE OF PUBLICHEALTH INSPECTORS

L'INSTITU,T CANADIEN.DES INSPECTEUR6EN HYGIENE PUBLIQUE

FLIblishadQuarterlybyltheCanadianInstituteof PublicHealthInspectors

U ti--naro Telephone 519-529-7238, EDITOR, KLAUS SEEGER. The Opinions=pressed hereinare thoseof the authorsand are not necessarilythoseofmembersof the Instituteor theC.I.P.H.I., ONTARIOBRANCH.Full rightsare reserved.Material may be reproducedwith permissionof the Editorand Author• SubscriptionIs $4. per year.

Branch News Letters toTheEditorarewelcomeandshouldbe• mailedto:

i Edlt_ . PublishedQuarterly

KLAUSSEEGER InsertonDeadlinesVolume III No. 3 Fall 1.982

• alnton,Ont.N0M11.0 Spring Feb. 15" I_bllshed by the . SummerMay 15

CanadianInstitute of Public Fall August 15; , f'_alth Inspectors(Ontario Branch)Inc. Winter Nov. 15

Features *This issue

Have _welostyou.... ...... Pg. 7 It is hard to believe that the summer is Over.When you read• Ideal weather, idealtourney . . ; . . Pg. 9 this issue, it is likely that the conference in Hamilton is in full

Public Health Inspector's renewed role in swing or has finished, It is also likely that it was a complete _hospitals ............. Pg. 11 success.Onthe lighter side Pg. !2 In this issue the theme is the Public Health Inspector's roleInfection ControlCommittee ..... Pg. 15 in a hospital communitybeginning on pg. 11- Articles include:Disinfectants and their uses .... Pg. 20 The function of the Infection Control Committee; Micro-=lit=11$ * _ _ * _ .'

_, _ organisms that cause nosoeomlal infections; Microbiology, refresher, relating to organisms which can cause infections;

and much mtich more.A review of the 8thannual baseball tournamentcan be found

on page 9. Annual committee reports and the PresJdent'smessage are included in this issue.

In ourregular departments-'On the Lighter Side' discusses• ONTARIOBRANCH 'Hospital Blues'. 'Running at,both ends' relates the incidenceEXECUTIVE

, of Campylobacter in dogs.Prseld_t $_.-Tmsurer immediateP=Stpr_la_t There is some godd reading ahead asyou turnthe pages. WeMikeGr_avel PatrickO'Oomwll BrianHetttm need your input to enable us to continue providing the /R.R. #'11 575 Summerhlll Cres? 1975 CarJbou Cout, .Peterborough. Sudbury Sudbury informationyouwant. We want to read aboutyouropinions.KgJ6Y3 P3A4T3t P3A4WS Write in. It takes but a few minutes.

c...=,,o.,,,,.,,, Next I ssuePamelaCook PaterFltnlmons Tom Steward

448 Victoria Park Ave 12 Putney Rd. 647 Otterscn st.Toronto, ,SaultSte.Marie Ottawa Complete coverage of the Hamilton Conference will beM4E3T2 P6B2Y5 KtV7A7 found in oui" Winter issue. We want your opinion of theHenryGin=It PaulMclnnls _ speakers presenting papers at the conference. Write us.1298 Jenina Bird P.O. Box 34

Burlington,Ont. OwenSound If you are taking pictures send yourpublication a copy. ThisL7P1K3 N4K5PI goes for any Institute eventyou are attending. Share your

Caun_l,on_1_-_1 photo discoveries,JimCave "" JermmWatt Coverage of Curling bonsplel to be held in Sudbury on

24 Stoney CreekDr. 496 Esther St: November20 will alsobe included.We_thlll, Ont. Pembroke,Ont. Photosofthenewcouncillorsyouhaveelectedwill gracethe

/ MIE 3L3 K8A 3E5 pages of the next issue.

Hugh G_xlfellow JimStone Deadline is November 15. Get your news in today.'Call your107GlenburnleCr. 123DonaldDr.London,Ont. NorthBay,Ont. correspondent or write to: Editor, Box 687, Clinton, Ontario,

NbX 2A1 PtA 3H2 NOM 1LO.

i, PG. 2 ONTARIO BRANCHNEWS/FALL.1982 • - -'-,

.\

"President's message.:. :.. '

Strength lies in members

M{ke Gravel ' /

It is indeed a pleasure-to present my first Annual'Report to Although, we continue to attract new members?many of ourthe membership._ I must say that the past year" has been old ones have seen fit not to renew their membership with the

eventful and filled with both satisfaction and disappointment, result being the maintenance of the status quo as far, asOnthe positive side, the "Ontario Branch News" continues numbersare Concerned.The real disappointment is not being

in its high standards and innovative approach Which gives abletofindthecauseofthis phenomenon. Branch continues to-interested, members the opportunity o'f sharing their be accessible to its members, but those who have "dropped

•++knowledge and expertise with the 'reStof us. I must express out" seem reluctant to make their views known. It is my hope+_ Branch's gratitude to K[aus Seeger andffis wife Rhea fo_ the that our membership chairperson will take it upon himself to

excellent quality of this publication and our hopes for _their come up witl_some answers.+_ continued interest. The second disappointment is the lack of progress towards\

Through our input on various committees, Branch has .Licensing and Registration. At this writing, it' would appearbecome highly visible throughout the province. The 'input of that the Professional Designations Act, the vehicle bywhich'we

"'_---our committee members has servedto point out the fact that .were to reach our goal, has beenp[aced on the "back burner"Public Health Inspectors have a lot to. say and express bythe Otario Legislature. We have contacted our legal peoplethemselves with both knowledge and concern. This approach who have outlined a plan of action which will come up Under

• , • / _ ,has certainly opened qmte a few eyes and serves to enhance committee reports. Nevertheless, thisissue is not dead as farthe prestige of,Public Health Inspectors as a whole. To ' as this Branch isconcerned and we shail endeavour to keep youcontinue in this vein, Branch has been asked, by the Ministry, advised on our progress.

. toparticipate in a Roster of consultant resources. Accordingly, Thirdly, the question ,most commonly asked by theI am asking those members with expertise in various fields to membership is that concerning "in-service training courses.".suipplyme with a precis of that knowledge which will be A recent surlveypinpointedyour needs and wishes; may I take

" catalogued and forwarded to.the Ministry. this opportunity of saying that the individual: charged withMore recenlty, Branch attended a meeting with the handling this committee will be mandated to carry out your

Honour_tbleLarryGrossman, MinisterofHealth forOntario, to preferences _. May I further state that this committee will

express our concerns vis a vis the Minister's Mandate in the assume a higher profile and I pledge that we will endeavour tO ifield OfEnvironmenta| Health, "l_he,resultbeing the formation provide you with at least two yearly c0_urseson an ongoingof an adhoc 'committee to outline these concerns in a final bi_sis.report for presentation to th_+Minister. At this writing, that As you can see, the past year has been quite varied and :

" rep_orthas notbeeii finalized but.wewill continue to informyou \ chal!enging. With yoursupport, we shall endeavour to expand /of our brogress. , .. on oursuccesses and hopefully make progress on some of our

Personally, l feei that "Branch's strength lies with its ' disappointments. Nevertheless, we shall continue to representmembership, and therein lies my first disappointment. , YOUto the best of our ability.

...+ +,

AVE YOU SUBMITTEDYOUR !982. MEMBERSHIPFEE?

+i

WEI ALLFORGET t DO ITTODAY!+ .

-+ , t

, .+.

,B.

ONTARIO BRANCH NEWS/FALL 1982PG. 3

Committee report

Membership and Area MeetingsHUGH GOODFELLOW, MEMBERSHIP CHAIRPERSON membership chairperson to assist the Branch in obtaining a

The Institute is a national body which works for the 100%membership and hopefullythis could be repeated in the

advancementof public health and environmental programs, to coming year.raise the status of the inspector, to provide training and In most cases the correspondence between the areas andqualification, works to achieve representation by inspectors in Branch Executive was very good during the past year. It isthe major health associations and government committees, through the area meetings that you as a member can give

It is a body which speaks with authority in representing our direction to your Branch Executive.profession. You, as a qualified inspector, should consider During the coming year there should be greateryourself a professional and be an active member within the communication between the areas and Branch ExecutiveInstitute to ensure and be part of its success, regarding the concerns of the Public Health Inspectors.

Your Union or Employee Associations may look after your Correspondence between the different areas located within

I local working conditions but the Institute is the only the Branch also should be encouraged. We can all learn fromorganization which we have to represent us with government, each other and it would also create a stronger organization.and other professional bodies to help protect our welfare and SPECIALTHANKS

* prevent fragmentation of our work. I would like to express my appreciation to the followingYousay the dues structure is toohigh? Ask aroundaboutthe area representatives who worked with me in carryingon the

dues structure of other professional organizations and youwill Institute affairs during the past year:wonder why ours is so low. Remember it is also income tax Jane Carruthers MichaelStrachandeductible. Pamela Cook Dave Strenaeh

Manypeople Ihave talkedto, that were not members always Jim Debenham Wes Terryasked "Why should I join, what has the Institute done for DavidDudgson , Jane Urquhartme?" Probablyunknown to these people the Institue has done BobFrattinl Alphle Wolf,many things for them. Remember, let us not ask "What can Bruce Jamesthc Institutedofor us?", but "How can we utilize the Institute Besides those mentioned, I an/ sure there are some notto accomplish what we want?" mentioned who a'ssisted in one'way or another and to those

lfyou knowof an inspector that is not a member you should people, I.would also like to extend my appreciation.

encourage him to j°in-REAAMEETINGS Active MembersMEMBERSHIP-419 AS OFAUGUST30,1982

As per the Branch By-laws, each area should now have Student Members - 42appointed an area chairperson and secretaryfor the coming Retired Members - 18year. This past year each area has requested to appoint a Life Members - 7

Committeereport " ..

Resol.utionsBYJAMES WATT The Resolution Committee is of the opinion that:

Chairperson 1) Nine councillors is not an excessive number whenSubmitted herewith is areport of the Resolutions Committee considering the true potential andfunctions which the Branch

arising from Resolutions carried at the 1981annualmeeting of could and should pursue from time to time.the Branch. 2) It is apparent that all areas listed under Article 9 of. theResolution No. 1 By-laware not always active and are beyond the control of the

This Resolution requires that a report of the Branch BranchExecutive. The areas defined are provided to expeditestructure be pt'eparedto be presented at thenext meeting with geographical area consideration as opposed to inspectorappropriate recommendations and notices of motion to be population and would therefore not necessarily provide.prepared if required, representation by inspector population.

The Ontario Branch By-laws provides that the Branch 3) The OntarioBranch has witnessed overthe years that someE_ecutive be comvris_d of a President, 5ecretar3-Treasurer, elected representatives choose not to continue on the Branchand nine councillors, and further provices that in calendar Executive formorethan one ortwoterms ofoffice. Therefore, ayears ending' in odd numbers a slate of officers, listing reductioninnumber of the Executive Committee may result innominees for President and a minimum of four councillorsbe a reduced continuity of representation to the detriment of theprovided for; that in calendar years ending in even numbers a Branch.slate ofofficers listing nominees for Secretary-Treasurerand a I believe that the function of the Committee Chairman asminimum of five councillors be provided for. The By-lawalso related to his/her particular committee should be set downbyprovides for Standing Committees which include nominations, the President clearly stating the objectives of that committeemembership, education training, by-laws, projectsand salary, and be approved by the Branch Executive at the first meeting

It has been proposed on a number of occasions in the past after the annual meeting and further that efforts be made tothat the number of councillors on the Ontario Branch be assure that the committee function is being carried out by thereduced and thatthose councillors be chosen, one fromeachof Chairman. This should be the responsibility of the Presidentthe five areas, contained under Article 9 of the BranchBy-law. Please turn to page 4

PG. 4 ONTARIO BRANCH NEWSIFALL 1982

Committee report .,Continued from page 3 provides for notificationto all Branch members of the annual

meeting at least 60 days-prior to the annual meeting underand members of the Executive Committee. Aticle 16, Section 4, and Article 17, Section 4. My recollection

The status quo does provide for each and every area to of this particularresolution from the 1981annual meeting wasproiaosea candidate for office and nothing existing prevents the concernofthe membership that Branchbusiness was beingthe promotionof i_candidatetoth.e membership as a whole. It conducted at a .time other than published in the programis therefore recommended that the Branch structure be (earlier). This was necessitated as I recall because of theunchanged fromapoint ofviewofthenumber on the Executive inability of a previously scheduled portion of the annualCommittee or the form in which these candidates are meeting tocommenceas schedules, beyond the control of thepresented or voted on. Conference Committee or the Executive Committee. I am of \Resolution No. 2 the opinionthat the business of the Branch must be expedited

Dealing with proxy ballots to enable members not in in the mos(" effficientmanner and -members wishing toattendance at the annual meeting to vote by proxy .... This participatein the Branchbusiness must availthemselves of theResolution has been forwarded to the Secretary-Treasurer in opportunity during all normal hours of the annual meeting. Itthe form of a Resolution to amend the Branch By-law as must be appreciatedthat the periodoftime requiredto conductdirected by the 1981 annual meeting, the business of the Branch may be more lengthy than theResolution No. 3 program calendar anticipates and may from time' to time

Deals with notification in writing at least 30 days prior to an requirean adjustment of the program to suit. No amendment 1annual Branch business meeting. The present Branch By-law to the Branch By-law is recommended. ,_

.Committee report • ....

Public Policy.JIMSTONE, CHAIRPERSON _ ,_ Too ma.nypeople including those in the Health field, do not

During the past year, as Chairman of the Public Policy and undei'standthe role served by Health Inspectors: The InstituteInformationCommittee Ihave attempted to gain publicity by would serve its members well by provid!ng such informationproviding news releases for circulation by the press. to the general public and our co-workers in related fields.

While successful in having the material printed 10cally,kthe The Editorof the Ministry publication, Community Health' slant of the story has been altered to suit the needs of the Matters, has requested updates from the committee on

editor. " : Institute affairs. This is a positive step in our means ofI strongly feel that the best wayto disseminate information communication and should be used as much as possible. It is

to the public is by publishing pamphlets on behalf of the only by having information constantly in print can we hope toInstitute and having them distributed by the local health gain the recognition we desire for our profession.agencies. These pamphlets would fill the present void in Inconclusion, I cannot emphasize enough the importance ofresource material available on Environmental Health and maintaining the viability of our two publications: therelated issues. " Environmental Health Review and the Ontario Branch News.

CommitteereportRole Expansion and Projects

HENRY GARCIA, CHAIRPERSON Stronach 'forhis tremendous contribution in helping to reviseThis Committee's prime objective was to set up a formal . and formulate the'brochure.

system to introduceto Industry the qualifications of a CertifiedPublic Health Inspector. ' Committeereport

The procedures for achieving this goal were divided into two [ t'!steps: (1) To compile a list of.Barnes of contact persons in So..ry Surveyspecific industries and (2) to formulate a professionallydesigned brochure on the Certified Public Health Inspector in PETER FITZSIMONS,CHAIRPERSONCanada. • During the year forty letters were sent to Health Units in

Step(1) has been accomplished. Step(2), a primitive skeletal • the Province requesting salaries and beenfits information forbrochureof the CPHI(C)was formulatedanddistributed to this 1982. Twenty-fixieagencies replied,-A secoiad letter was sentExecutive and to some othe_"Public Health Inspectors. The out in July and an additional four replies were received. Somefeedback from those who have read this preliminary draft has agencies had submitted 1982 information from last year'sbeen tremendous, enquiries. Total replies' are from 32 out of 43 Health Units.

Mainly due to the feedback received on this issue, this . Once again I would like to stress to the membership theCommittee now has.the adequate foundation and research importance of the Salary'Survey as a bargai_ningtool. Most ofnecessary to undergo the task of compiling a brochure on the the Health Units co-operate very well with the Institute, but'CPHI(C). unfortunately, We still have a small core on non-participants.

Hopefully in'the future we will have the co-operation of allThe combination of Steps (1) and (2) can be of great Health Units.

, asset to Inspectors wanting to find employment in Food or I wish to take this Opportunity of thanking the membershipFood Related Industry. for electing me to the position of Councillor in the past. I found

The Ontario Branch Brochure has been revised. Copies of the job interesting and challenging. I would encourage thosethis brochure might be available for general distribution at the members who feel they have a contribution to make, to run forOntario Branch Conference in Hamilton.. election. Most Councillors run more than once before they are

A, not'e of appreciation must be giv.en to Inspector David ' elected so don.'tbecome discouraged if you fail the first time.

°

ONTARIO BRANCH NEWSIFALL 1982PG. 5

Secretory. treasurers reportFollowing is the financial statement for the period from note that although this amount is not shown as part of the total

April 1 to June 30, 1982. It should be noted that during this income, it is reflected in the Closing Ledger Balance.time periodaninvestmentcertificatein the amount of$3000.00 Todate,I have received dues from 419 members. There arematured and was deposited into the c'urrent account. Please also 7 life members, 18 retired members and 42 students.

VOLUNTARY REGISTRATION ACCOUNT

i Opening Ledger Balance 871.45 ,i Expenses O.OO

Ledger Balance at

CURRENT ACCOUNT

Opening ledger balance: 4327'37 Closing Ledger Balance: 57]5.64

i INVESTMENTS: 4000.00 , SURPLUS: 9735.64

INCOME AcTuAL YEAR TODATE/

}nvestments (Term Deposit Cashed) _000,00 - 3OOO.OOMembership Dues 2940.00 ' " 5980.00Education 9?5.00 !380.OONewsletter . O.00 87.00Conference 0.00 O.00Miscellaneous O.00 O.00Interest 264.33 264.33Donations O.00 0.OOLicensing & Registration O.OO O.OOWays & Means O.OO O.OO ,

TOTALS _ 4179.33 2,711,33

EXPENSES ACTUAL , YEAR TO DATE

Newsletter , 730.35 1719.97Conference 0.O0 120.OOPresident's Expenses 13].71 172.09 "Sec.-Treasurers's Exp. 275.84 546.91Executive Meetings 1368.57 2479.1]Memb.,Area Meetiflgs,PrSxies 18.90 _8.O4Education 1236.95 1360.33Salary Survey 0.00 0.O0Federation 0.00 0.OOPublic Policy & Info. 1 0.00 " 0.O0Conference Com_hittee 0.00 0.O0Role ExpansioniProjects O.OO 0.O0Nominations & By-Laws "0.OO 138.00Advisory Committee-R.P.l. 0.00 0.00AdVisory Committee-M.O.E. 0.00 0.00Ways & Means 300.00 600.00

National Me_tings 253.73 608.23National Conference _69.50 469.50Awa_ds-Ryerson 0.00 0.O0Historians Expenses _ 0.00 O.O0LardersFees 0.00 0.00Insurance 0.00 0.00Ba_ik Charges 0.00 12.OO

Postage 3.00 _1.70Miscellaneous , 83.35 163.35Envir. Health RevieW; 802.5,0 8??.50Office Equipment, Supplies 95.66 255.87_lational Expenses 0.00 O.00Licensing & Regis. 0.00 O.00Investments _ 0.00 0.00

TOTALS 5771.06

q

PG, 6 ONTARIO BRANCHNEWSIFALL 1982 .=

Committtee report. ' •

ONTARIO BRANCHNEWSBYKLAUS SEEGER, EDITOR many members who wish to relay their experiences on the

' theme.•The Fall issue, Volume Ill, Number 4, marks the third I wish to thank those who have contributed and also our

anniversaryof the ONTARIOBRANCH NEWS in its vresent . regular contributors,Pamela Cook, William Vaughan, and Timformat. Sly. ' '. :, The past year has seen the following events that will Shouldyou have theme topics you would like covered, writeeffect the publication of the Ontario Branch News. me. Send your paper if you have written on a topic of public

1. Wehave obtained a second class mailing status which will health interest. If there is an article you don't like, write me.result in aconsiderable postage savings. Ourper copycost will Input from other members is wanted.decrease: from 30c to .04c. 6. ADVERTISING.I would like to discuss 'thispoint further.

2. McLean Publishing has been sold, thus requiring us _ TheExecutive must decide whether the Ontario Branch Newssearch for another printer. !t is likely we will use Si_xlal,Star , should have advertising to offset publishing costs or to have '

Publishing the purchaser of McLean's holdings, at least until . :none at all. ' tthe local competition has been checked out, This move may .Ifadvertising is desired then it should be activelysolicited by- also increase our production costs, one or morepersons. Ourpreviously adopted policy on what is _'

3. There_has been virtually no advertising in the past four orisn't acceptable advertising canbe given to the individual(s)issues. This has resulted in no incoming revenue 'tooffset our who are interested. A commission is provided. It is suggested

' increasing publishing costs in the past year. that advertising found in the Environmental Health Review be4. There has been a severe lack of interest from tffe priced inapackage rate to include space in the Ontario Branch

memb_ership in providing the "newsy" items, (i.e. births, News, "

• ; marriages, promotions relocations; etc.). Three years ago this In making'the decision on advertising, I must remind youwas stressed as an importantitem allowing the meinbership to that in the present economic climate it is_not likely that verystay _'intouch" with one another. It appears only the northern much advertising will comeunless it is in a package deal with'area members w_sh to keep the rest of us informed because the EHR. Nowmany advertisers would consider Ourreaders aBud O'Donnell, our northern correspondent, makes an honest ., potentialbuying marketand would refrain fromadvertising ateffort to obtainthe information. It is important that members iri this tinie.

• [ .other areas keep their correspondent informed. In conclusion, I want to thank the Executive for their

!f you are interested in becoming an area correspondent continuous support of my role as Editor. I _ill strive forwrite to the Editor, Ontario Branch News, Box 687, Clinton, improvement in our, publication. With the help of theOntario, N0M 1L0. ' " membership we will reflect th opinions and activities of our

' ' 5. Even though a theme topic is provided for each issue to profession, while at the same time provide 'educationalgiven incenti,¢e for contributions, there does not appear to be information to update our members' on public health issues.

\[

CASH DRAW WHEREARE YOU?

WINNERS METRO TORON:TO, WESTERN\

JUNE' ' SOUTHWES,TERN , °

Andre Lafrance, Pembrokeq EASTERN AREA q

JULY CENTRAL AREAGroup of Ten, I

Peterborough H.U. NORTHERNj_

AUGUSTEd Fleming, Sudbury CALL YOUR CORRESPONDENT

" TODAY! t. ,

"\

%,

ONTARIO BRANCHNEWS/FALL 1982PG. 7

Editorial

HAVE WE LOSTYOU 9' •

When the current version of our newsletter, the ONTARIO issue the informationdwindled to the scimpy bits and piecesBRANCH NEWS began three years ago, one of its main we have now. Some of the correspondents said it felt like theypurposes was to provide ,'newsy' items for readers. The term had to practically draw blood before information was obtained.'newsy' refers to the personal news that happen to our - So what is the answer? Do we need to stop publishing forcolleagues, such as promotions, changing job location, awhile io get the interest up again? If the 'Where Are You'marriages, family additions, i.e. newsworthy items of interest , section was the first to be read, does that mean ihat nothing isto the Public Heaffh Inspectors who you went to school with, or read now? Do the members want a newsletter, that is, twoworked with in another agency. News to help keep Track of typewritten pages with newsy info that nobody submits? Is theeach other. Also, info of new programmes started in your current format acceptable?agency. It was felt that this would help keep our Institute and This is your publication, your dues pay for the costs ofBranch unified and progressive. For thefirst several issues the producing It. if you want the Ontario Branch News to be a'newsy' items were sufficient to take upabout two pages under reflection of the views of Public Health Inspectors in Ontariothe heading of'Where AreYou'. We were toldon occasion that , your input is needed now!this was one of the first sections that was read, and apparently NOTE: If you have some info for your correspondent theirthe most important. \ names follow. EASTERN AREA: Tom Steward, Ottawa-

" WHAT HAPPENED??Are 'newsy' items hot important CarletonH.U._ METRO-TORONTO:Pam Cook, TorontoH.U.;anymore? Hav'ewe become to complacent?_lt appears that CENTRAL:Paul McInnis, Grey-OwenSound; Western; Petersomeone else is digging up the info, '_or T don't have to Reaburn, London-Middlesex; SOUTHWESTERN: Henrycontribute', or 'Is the deadline already passed?' are the Garcia, Halton Regional H.U.; NORTHERN:Bud O'Donnell,rationale used that has made the 'Where Are You' section of Sudbury, (Bud would prefer someone to take over his'the Ontario Branch News' a box asking where are you? correspondent duties since his Sec-Treas position demands

To make information gathering easier, correspondents had most of his time). It should, be noted that' the more, volunteered in each area of the province who in turnappointed correspondents there are the better it is to keep you informed.

agency contacts. For each issue a phone call was made to each If youare interested contact the Editor, Box 687, Clinton, Ont.,contact to get the latest info. Sowhat happened? Afterthe third N0M 1L0, phone (S19) 482-3416 or (SI9) 529-7238.

)

We should have been thereIt is certainly tragic that Salmonella caused the death of a been utilizedto help' the personnel ilsed by the Ministry of

baby at the Peterborough General Hospital, and caused an Health.outbreak at the Oshawa General Hospital. It is fortunate, " Yes, we do have a role to play in the hospital community, ashowever, that the frequency of Salmonella outbreaks in some of the articles in this issue try to illustrate. Perhaps ourhospital environments have been reduced in recent years, or at credibility in this area needs to be promoted more often andleast not identified as such. , moreintensely. Ourlearning institution'sshould ensure that all

As a Public Health Inspector, one wonders why we were not students understand the role Public Health Inspector's caninvolved in the investigation to help determine the cause(s) at i1 play in a hospital. The Institute;in establishing themes for itsthe hospitals mentioned, in-service programmes can iJse infection controlas one topic to

Most Public Health Inspectors have had experience in , help promote and update the Pubiic'Health Inspector.,investigation the incidence of food borne illness and other ' Public Health Inspectors in general do have the expertise tocoKamunicable diseases. We know the .epidemiological condui:t the investigations, and as a minimum-act asprocedures to use, and microbiological principles are a consultants, we must promote our credibilitynow and not usenecessity in understanding the purposes of much of our work. the degree status as the image of credibility.There are many P.H,I.'s in Ontariowho's expertise couldhave

Grabwell GrommetOn the mornmg of his' 42nd birthday, Grabwell Grommet "Who?" she asked with horror. Grommet slowly stirred

woke to a peal of particularly ominous thunder. Glancing out •the cream and sugar into-his coffee and shook his head, "Ithe window with bleary eyes, he saw written in fiery letters don't known," he said. Convinced though he was, Crommetacross the sky, "Someone is trying to kill you, Grabwell couldn't go to the police with such a story. He decided his onlyGromet." course was to go about his daily routine and hope somehow to

With shaking hands, Grommet lit his first cigarette of the outwit his would-be murderer. He tried to think on the drive today. He didn't question the message. You don't question the office. But the frustrationsofmaking time by beating lightsmessages like that. His only question was "Who?" At and switching lanes occupied him wholly.breakfast as he salted his fried eggs, he told his wife, Gratia,"Someone's trying to kill me." Please turn to page i0

PG. 8 ONTARIO BRANCH NEWSIFALL 1982 • " t" '

8th annual baseball tournament " i/

Idealweatherfor,idealStourneyAn air of festivity surroundedthe fellowsh!p which was

created early Friday evening when the Eighth Annual'_ : C.I.P.H.I..OntarioBranch, Baseball tournamentgot underway

with two games. Goderich, the vacation resort, was thelocationand the staff0fthe HuronCounty Health Unitwere thehosts. The weather was'perfect, since the order had beenplaced early for the weekend of August 6 7 and 8. The jovialatmosphere created bythe participants and the high calibre ofbaseball played .resulted in an Unprecedented Successful

/ weekend_ /

The action began :when Huron County, the hosts, _were"confrontedwith the hot Perth-Oxford combined county team .tOnthe 'A' diamond, while London played Halton on the 'B'diam_ond.Baseball fans of the 1982tournament will remember

the Perth-Oxford team had been noted as one of the hottestteams and one to watch out for this year.

The Perth-Oxford, Huron game was an exciting closecliffhanger as the score see-sawed back and forth. Huronfinallyfaltered and Perth-Oxford triumphed by one run. !twaslater heard that the reason for Huron's defeat \was thecombinatiofioftheirplanned game strategy, (to psyche out theopponents of the Boat Races held later in the evening) and thestubborness of the first basemen's reluctance to sj_to!Jt thegame after being run over and partially disabled.

The other game on the second grandstand diamond sawLondon eliminate Halton. However, Halton wasn't finishedyet. Their trueteam spirit camethrough during the Boat Raceswhen they r.eachedthe finals against Huron.-The reader mayask, what the hec.k are the boat races, and why were they heldat night?' ' _ ".

Since Gode_ich is a port town, the Huron hosts felt itappropriatethat a new event, the Boat Races, be held duringthe annual tournament. Part of the race involv.ed a team'sability to consumethe P.H.I.'s favourite yeast and hopsbeverage faster than theirlopponent. Since this was the firsttimefor this even_tmany teams were hesitant to enter until theyfound out a!l the necessary equipment was provided. Theenthusiasm fromthe spectators Wishing 'good-cheer' to theirfavourite team, provided the participants the' necessary

' Photo by Klaus Seeger

I

/

4

, ,, i

ONTARIO BRANCH NEWS/FALL 1982 PG. 9t

• j

Teams representing Kingston, Halton, Scarborough, North Saturday morning to defeat their hosts thus eliminating HuronYork, Ottawa, Toronto, and Huron entered the races with the from the basebal hall of fame for this year.hope of winning the grand prize of the full use of a thirty-eight Of the eighteen teams entered in the tournament, London,foot yacht for an entire year, donated, by Don Huilah. Niagara, Scarborough, and of course Ottawa had their sights

The final race saw Halton and Huron competing for the aimed for the 'A' division finals. Halton, (yes, Halton), Peel,yacht. The anchormen for both teams were so fast it is unlikely Toronto and Muskoka Parry Sound were survivors to competethey ever noticed the 'draught'. The race was very close, so for the 'B' division finals.

close that everyone involved 'gulped' to see Huron surface as Our heroes, Perth-Oxford were suspiciously defeated bythe winners of the 1982 Boat Races. London in theii" second game. Why suspiciously? As

However, Halton obtained their revenge against Huron mentioned earlier, Perth-Oxford had great potential and werewhen they (Halton) emerged in better shape (not much) on destined for the finals. For the 1982 tournament history

records the emphasis will have to be on 'had' and 'were'. Asfate would have it, London was defeated in the semi-finals bythe Niagara, and Halton was eliminated by Peel in the 'B"division. Toronto, the almost champions of 1980, defeatedMuskoka-Parry Sound and enthusiastically began their gamefor the 'B' championship' against Peel. Toronto wil! have, toexcept the term 'almost' again as Peel triumphed with greatzeal,

_ :: History was again being made on the 'A' division ganles.Searborough almost eliminated Ottawa in the semi-finals untilOttawa came to their senses and emerged the ,winfiers.

_ Niagara, who like Ottawa, play in organized ball, were a good

......_!_iii_!:::_!_: match for the team from our capita I. However, when the last........... , inning was finished, Ottawa once again had illustrated that

i_. ' : they indeed were the champions, even against a hard playing• _.._.___:_._<_, determined Niagara team.

It was not easy to pick the MVP from the many outstandingplayers. The umpires had chosen for the 'B' division KarenWark, Toronto and Ron Marehand, Peel._For the champion-ship team Frank Prevost was the most outstanding, and Mike

,_ Minor excelled on the Niagara team. The awards dance wasagain held Saturday night where the trophy presentations weremade to the champs, the MVP- and the draw was also made.

Niagara received unanimous approval when they offered tohost the 1983 tournament. Danny Panelll stated that theywould like to hold the tournament in September rather than inAugust.

A hearty thanks goes to the Huron Committee fororganizing this years successful tournament, and they wish tothank all the participants for their co-operation and interest.

_. The eighteen teams which played ball were: Toronto,Perth-Oxford, London, Ottawa, Leeds, Grenville, Kingstone,

Wayne Desormeaux receives tournament championship Halton, Brant, Peel, Etobleoke, North York, Searborough,trophy for Ottawa. Hugh Goodfellow representing the Ontario Niagara, Muskoka-Parry Sound, Windsor, Hamilton, York andBranch makes presentation. Huron.

Frank Prevost receives MVP award presented by JackMacKinnon. Anchorman Paul Dawson rounds ben€l at boat races.

\

PG. 10ONTARIO BRANCHNEWS/FALL 1982 " ,. . ,-

-- -"'Grabwell GrommetContinued from Page 7 proudlyto his wife,."hasn't got me yet. I'm too sma_ for him. '

Noronce behind his desk, couldhe find amoment, what with Ladling him a' second helping of beef Stroganoff, she replied,jangling phones, urgent memos and the problems and "Oh, please be careful."decisions piling up as they did each day. It wasn't until his ' Th'epridegrew as he managed to go on living for years. But,secondmartiniat lunchthat the full terrorof his position struck _isit must to all men, death 'came at last to Grabwell Crommet.him. It was all he coulddo to finish his Lasagna Milenese. "I It came at his desk on a particularlybusy day. He was 53. Hiscan't panic," he said to himself, lighting his cigar, "I simply griefstrickened widow demanded a full autopsy. But it showedmust live my life as usual." So he workedtill seven as usual, only emphysema, arteriosclerosis, duodenal ulcers, cirrhosisDrove homefast as usual Ate ahearty dinner as usual. Had his of the liver, cardiac necrosis, a cerebrovascular eneurism,two cocktails as usual. Studied business reports as usual. And 'pulmonary edemia, Obesity, circulatory insufficiency and atook his usual second two Seconal capsules in order to get his touch of lung cancer. •usual six hours sleep. "How glad Grabwell would have been to know," said the

As the daypassed, he manfully stuck to his routine. And as widow smiling proudly through her tears, "that he died ofthe months went by, he began totake aperverse pleasure in his natural causes."ability to survive. "Whoever's trying to get me," he'd say (From the San Francisco Chronicle.)

Inspector's Notebook:

Glass,like crystals in canned seafoods'' BYTIMSLY Where do they ,come from? The separate chemical_)n occasions small crystals having some resemblance, to substances capable of uniting to form crystals of magnesium

'pielces of broken glass may, be found in canned fishery ammonium phosphate are always present in the bodies ofpr6ducts. They are colourless, transparent and tasteless. The fishes, animals andman, but it is only under certaifi conditionssiz_ varies; sometimes they are so small, as to impart only a that these, substances unite to form the crystals. Thesesligh.t grittiness to the product, wher.eas sometimes, several conditions are occasionally encountered inside the can of fish,crystals up to tA" long may be found. ' and may form over the storage period.

What arethey? Such crystals have been frequently analyzed,' How may they be distinguished from pieces of broken glass?and invariably have been identified as the chemical substance The crystaline structure renders them sufficiently friable, to bemagnesium ammonium phosphate, Crystals of this'substance" readily crushed between a fingernail and a hard surfaceare found as the naturally-occuring mineral "struvite", and without scratching the fingernail; they will not acually scratchthe same substance has also been found in a healthy human the surface of an aluminum cooking, utensil or copper coin,body. although they may make' a mark on the oxidized surface layer of

Are they harmless? Yes. In fact, the chemical substances in the metM. Polishing the mark with a cloth Willdisclose that nothe crystals are necessary in one form or another for normal actual scratching of the metal has taken place, whereas glasshealth. The crystals have about the same hardness as a crystal easily scratches these two metals. A convincing test is to pi_ceof or_!inary salt, hence they will not injure the enamel of 'the suspected crystal ina teaspoon then add a few drops ofhealthy teeth. They are practically insoluable in the saliva of weak hydrochloric 'acid or vinegar, and heat by means of athe mouth, but should they be swallowed, no harm will result, . match, candle or cigarette lighter until the acid is hot. Theas they dissolve in the juices of the stomach, crystal will dissolve. ."

Tournament Postscript - believe it or notMost PublicHealthinspectorsarealsoEnvironmentalistsin land in front of them.Just as oneof the P.H.I.'s, who also

onefarmoranother,andtry topi'omotepreservationwhenever happenedto be a bird lover,approached to determinethethe opportunity arises. So it is encouraging to witness, on status of Ryan's victim they overheard the elderly chap say to

,occasion ' how the public's consciousness on the subject has his wife, in response to her queries on the bird's condition, thatincreaseo. As one anecdote was recently related, some of the 'it was dead' and concluded with authority that 'the pollutionparticipants and spectators of the tournament decided to cool mas bound to get them sooner or later'.off from the hot sun by taking advantage of Lake Huron, while

there was abreak in the baseball action on the diamonds. After TOURNAMENTcooling off, one of the sun worshippers (his initials are Bill , DRAW WINNERSRyan) decidedto warm up his arm by throwing stones across

the water. During this exerc!se, Bill noticed a balloon floating $ ] 50 O2 RAYMOND ""on the water some distance away. To perfect his accuracy, he

decidedtousetheballoonasatarget.Hethrewhisfirststone " BRAN] _ CNTY. HIU.: at the target, and instead of witnessing the probable splash in

the water from missing the balloon, the oniookers heard a hard $100 cHER¥PARLETTBRACEBRIDGEthud as "an unsuspecting seagull hit the ground, dead. : , ..: Meanwhile, close to the area where the seagull landed, an .

elderly couple were strolling alon[_the beach, oOltvl0us to the 'target practice, were astonished to have the birdjust miss and $50 BRANT CO UNTY H.U.

ONTARIO BRANCHNEWSIFALL 1982PG. 11

.. Renewed role

in hospitals!

[ Editor's Note: Following is a report which was sent to "all Environmental Survey• hospitals in Huron County. The intention was to explain and Anenyironmental survey of the entire hospital should be

encourage an increased role of the Public Health Inspector in made on an annual or bi-annuaibasis. Athorough inspection ofeach hospital. At present the P.H.I. is a member of the allthe hospital departments provides the administratorwith aInfection Control Committee in most hospitals in the county, status report of the sanitary and physical conditions of the

facility.PUBLICHEALTH:INSPECTOR'SROLEINA CO_MMUNITY An assessment of cleaning and disinfecting practices in the

HOSPITAL hospital can be made with the use of Rodac touch plateBYKLAUSD. SEEGER,CPHI[C] cultures. These consist of small petri dishes, prepared by the

Many people believe that a hospital's "cleanliness" and , ,regional Ministry of Health lab which uses a blood agar"safeness" makes it infallible in causing illness. A hospital is growth medium. Various pathogenic bacterial can be isolatedconsidered by many as one of the cleanest institutions. Onthe and provide an indication on the effectiveness of the cleaningsurface these assumptions are ac¢urate. However,.a patient's and disinfecting compounds being used. The frequency andstay may be lengthened due to an infection acquired while in methods used by the housekeeping staff also determine thethe hospital. Several factors can contribute to a hospital bacterial populations found, In the past Pseudomonasacquired infection, aeruginosa and Staphyioccus have been isolated. In at least

1. Personal hygiene practices of the staff handling the one case the reason for the existence of staph ,andpatient, lfahospitalisunderstaffedandanR.N, orR.N.A, has pseudomonas was due to the change in cleaning andto look after several patients and does not take basic disinfecting compounds, Since the Rodac program providedhand-washing precautions then an infection can easily be regular testing, the bacterialincrease was picked up before thesPread.• situation became serious. In additionto rodacuse, the cleaning

2. If isolation techniques are not followed by all staff, procedures of the staff was also scrutinized and someproblems could also occur. Example: If the R.N.'s, Orderlies inconsistencies were noted'. Some staff had been cleaningand Housekeeping stafffoll0w isolation rulesbut the attending areas where others had not and their methods also varied.physician walks into the isolaiton room in street clothes then \ Some aspects of patient care and disinfection of utensils andthere is the,potential for cross-infection from the isolation equipment ig performed by the R.N.'s and R.N.A.'s. soiledpatient to another patient on the ward. Depending on the circumstafices, there are occasions (short

3. If the housekeeping staff are not ,c°nsistent in cleaning staffed and lackof time) when adequate disinfection cannot beprocedures, cross-infection may also occur. One person's performed. The Rodac testing program isolates these areasprocednre may not be as effective as another. ; and brings attention to them.' Rodac testing provides

I' meaningful information on whether the operating rooms and, 4. The chemcials used forcleaning and disinfecting may not be nurseries are adequately disinfected to maintain aseptic

effective. The frequency OfUse may also be insufficient. The conditions.chemicals may also have been contaminated prior to delivery lnservice Programs for Staffor while in storage. If the chemicals were purchased in large A review of cleaning practices and techniques is made withlots their effectiveness could deteriorate due to ag#. or the housekeeping staff to ensure consistency. Informationonimproper storage, frequency of cleaning is discussed stressing that one chemical

5. Inadequate screening of patients treated or.admitted in when used properly is effective for a limited time before aemergency. Example: If faeces samples (both CS & surface or piece of equipment requires treatment. Isolationparasitology) are not obtained when a patient is admitted or roomtechniques are also discussed. Preventionof cross-infect-treated for diarrheaas an out patient cross-infection may occur ion in the hospital __sals_odiscussed. Handling of clean andfrom delayed diagnosis and precautions not taken, soiled laundry is also reviewed. The use of rodacs are used to

As a'member of the hospital's infection control committee, demonstrate bacterial growth and their spread.the Public Health Inspector is an objective observer of the Kitchen and Food Service

existing programs in a hospital. Since he is not in the hospital The Public Health I_spector's traditional roleof the hospitalon a daily basis some procedures which have lapsed may be was restricted to the food preparationarea. Inserviceprogramsnoticed and changes recommended. He can offer information on foodhandling are provided periodically. The equipment andfrom experience obtained from other areas of public health, facilities when maintained properly ensure that safe andObservations based on a prevention point of view will enhance wholesome food reaches the patient. Regular inspections arethe cure viewpoint, as well as relay information from other made of the kitchen by the Public Health Inspector andareas of public health, recommendations are usually acted on quickly by staff and

Following are some of the services that the Public Health administration.lnspe_or can provide to a hospital community. Please turn to page 12 ..

PG. 12 ONTARIO BRANCHNEWS/FALL 1982

Renewedrole in hospitalsContinued from page 11 , The.infection control committee has •recommended that the

Analysis of VariousProgrammes .disposable bottles are used, or as an alternative gas sterilizerManydifferent types of waste are created and handled by a purchased.

hospital staff. Since a large proportion of the wastes are Conclusionsdeemed hazardous, special precautions should be taken. It has The Public Health Inspector's expertise and objectivity inbeen found that precautions in handling hazardous wastes are preventing practices enables him to become a valuablenot given the same priorities from one hospital to another, member of the hosPital team. As a member of the infectionAnalysis of procedures used in each hospital should be made control committee a good °liason working relation can bewith recommendations Riven. established with the hospital staff. The intention of the liason is

.. Analysis of screening procedures used when patients ate to compliment the work of the family physician,. (example:seen in emergency departments could also be done. Some further any investigations he may have initiated in hi'soffice).hospitalk do not submit faeces samples when patient are seen The Public'HealthInspector can screeen other family members

\ that have diarrhea as a symptom, to find asymptomatic carders and affempt to find the source ofAnalysis of reporting procedures by staff when a patient is ' illness. He can also provide the family additional precautions ,

treated that has been bitten by a dog or other animal. This which should be taken to curtail'further fainilyillness from the 'reinforcement iS needed occasionally to stress the importance same organism, f •of reporting the incident and the time factors involved when a ! When aliason is established with hospital Staff, reporting of 'dog orcat cannotbe found. The decisionhas to be made by the incidents, to the health unit is more efficient and thephysician on whether treatment should begin and. all investigation can be more successful.'Where there is no liason

, .\

information should be available, with the hospital, information is delayed and not obtainedAtone hospital datawas required to support the purchase of ' whichmayhelp in finding the cause of illness. When the Public "

disposable humidifier bottles for patients. The infection Health Inspector does a follow up situation such .as thecontrol nurse questioned the sterility of the reusable Salmonella outbreakin Peterb0rough where the families werehumidifier bottles currently being used. Water samples from • confused about what to do to prevent further spreadsare lessthe reusable bottles •were taken and the results indicated a likely to occur.Pseudomonas contamination. _The bottles were disinfected With an increased involvement in hospital programmes thewith a produ_ used elsewhere in the hospital, and was not Public Health Inspector's contribution in the prevent!on_ofeffective. A gas sterilizer was not available for disinfecting illness will Certainlyincrease the staff's objective in providingplastic utensils and equipment. The results supported the the best possible care "and also minimize the patient'sconcern of potential infection when using the reusable bottles, convalescent in the hospital.

ON THE LIGHTER SIDEr • •

Hospital bluesNot very longago,the mediareportedthe tl:agicdeathofa incidentswasthat I begantO wonderjust howmany of our

baby at a hospital :in one of oiJr southern Ontario cities'. The health units and city health departments actuaily carry outdeath Ofanyinfantcan sadden allof us at anytime, but this one routinehospital inspection, either under the aegis of CAPHIS

_vas rather singular in tl_at the cause :was salmonella or otherwise?• meningitis and it 'came after a rather lengthy coma. I have Aeverseen any statistics on this but none of the

The details are not known to me since any information I past health_egencies I worked for ever did this on a routine orhavewas gleaned from the newspapers just as the rest of you regular basis'.did. I'm willing to bet that our Correctional Institutes andBut the purpose of this little diatribe is not to ferret out / Detention Centres, were the true perils to our sociefy reside in

:. responsibility forthe loss of the child, norto point the fingerof complete comfort and safety, are.inspected more often than' blaineat anyone. It is really too late forthat except to correcta our hospitals!

• situation which might have avoided th e consequences. Oh I know, many of you will say that no amount of hospitalSince then, there, has been another case in a newborn at inspection could have prevented those infants from getting

another of the eastern region hospitals and the death of an salmonella in the hospital or being administered the wronginfant at the Hospital for Sick Children, Toronto, due to an drug. Well don't be too sure. I believe that we _are likeaccidentally administered dose of. epinephrine (adrenalin), ' scarecrows in a wheatfield (some of us look like it too, ain't thatinstead of the prescribed Vitamin "E" from an almost So Freeman? - that just our presence isenough to scare offidentically labelled bottle, some of the sloppy practices which are carried out in most

What came to my mind when I read the newspapers and hospitals form time to time.watched TV and listened to the radio accounts of these _ Please turn to page 13

ONTARIO BRAN(_H'NEWSIFALL 1982 PG. 13

On the lighter sideContinued from page 12 and Our recently striking medicos on the other.

And that brings me to the Course at Ryerson. How much is _' In addition,'it made for seven or eight individual viewpointstaught about hospital inspection to our aspiring public health and seven or eight differing reports to sort out'.inspectors? How much communicable disease in relation to The year l"arrived here, the high mucky-mucks.- (that was[ •hospital infection control is taught on the course? How much Big Five-O Freeman and Old AI) decided that one inspectoremphasis on this important aspect of our work and for that should do the whole thing and produce one standard reportmatter, just how much communicable disease, its control, containing one viewp6ing. /

i investigation and follow-up is delved into at that esteemed Very commendable_ Good enough. But who to pick for thislearning establishment? much-to-be avoided assignment?

I suspect the answer may be "very little." Yours truly was once again in his career thrust intd theIt seems strange to me that many of our stalwart directors limelight due to his big mouth at iLprevious staff meeting

get terribly uptight if the little corner grocery hasn, t been having mentioned the hospital inspection done in an earlierinspected in accordance with that bloody interminable era. 'CAPHISschedule and yet at the same time overlook that the That was a job and a half I can tell you. It.was a big hospitallocal hospital has never been inspected at all. but instead of a who!e herd of us tripping the light fantastic up

And don't believe that you can leave it to the hospital and down the halls and wards and corridors, there was only• infection control officer to look after things. Everyone known little me. For a whole week. My God it was debilitating. I

that when you worklong enough in the woods you fail to see the became progressively more weary as the week wore on,trees. Some institutions even appoint individuals as "infection sniffing atbed pans, cocking an eye at cobwebs and eyeballingcontrol officers" who do not know wbat/shlmonell ; or shigella .urine bottles as well as swabbing ev_erythingthat didn't moveis[ , as Wellas a few that did.

Most health units take their cue from the upper echelons, "I'mnot going intothe detaiis of that inspection or the horrorssuch as the MOH, nursing director and director:of inspection that confronted me o_"how long it took me to write that report,services, except to say that my hand developed writers cramp after a

I have been lucky enough to have worked in at least two week and it was an inch thick when typed. ,progressive health units. One when I first started off way \ Myintention was to makethe report so lengthy, so tedious_backin the dim mists of antiquity and the one I am with at so boring, that they's never send me on that kind of foray everpresent, again. It certainly succeeded in its length and tediousness and

In the first instance, the MOH was the guiding light. He capacity to make one yawn, but it had the opposite effect tothrust me into the maelstrom Ofhospital inspection with a what I intended.vengeance during a severe Outbreak of staphylococcal They drafted me out to'the other hospitals too and detailedinfection in a local geriatric hospital and later i_n, during an me off as a volunteer in subsequent years. That's when Ioutbreak of tyl_hoid. I learned a lot the hard way. rebelled and suggested that the inspector in whose dlstr_ctthe

The need for such inspections on a routine basis became ' particularhospital was located might like to try his hand at thisobvious to me duringthose early days. !campaigned actively at most intei,esting portion of. workl9."" I

area and other meetings, along with a former Etobicoke chief From being apathetic aboutour inspections if not downrightinspector. We hoped our group would become involved in the hostile, the hospitals have begun requestil_g our continuedworkbut the lackof response frompublic health inspectors was coverage. The hospital administrations' mind had changedso resounding, we dropped the issue, from one of impatient tolerance at our presence to one of

It takes a get-up-and-at-em MOHor director of inspection to appreciative acquiescence -especially at hospital accreditationinitiate a program of hospital inspection and our present time.director is one of that kind. At least he was a gct-up-and-at-em - They were eventually put onto CAPHISand became routineguy until he Wentto Hawaii earlier this year and feasted'his There is no point in going into details and anecdotes ofjaundiced and perpetuaUy bloodshot eyes 6n those lissome things I observed during my initial inspections but some ofwahines. Now he's become a ready-to-lie-down-with-em guy. them would raise the eyebrows of even the most disinterestedAin't tha_tso Freeman?? inspector_ I like to feel that our inspections and reports have

The former director- Old AI(well he_s old now 'cause he's brought about a greater awareness of some of theretired, though when Ithink about it he was Old AIback in the shortcomings in infection control. They may have beenfifties - ain't that so Old AI? engendered by complacency or even by lack of knowled_ oninstitued our Health Unit hospital inspections. But the format the part of staff, both professional and non-professionaWwas a bit different in those days. Every inspector that could be Notthat we as inspectors are by any means "experts" in themustered to the colours was called to serve. They would ' field of hospital inspection and infection control. But manydescend on the luckless hospital like wolves on a sheep fold and times a fresh eye can bring a laser beam of light to any field ofeach was assigned a section of the hospital on which he endeavour and. sometimes cut right through to the heart of aconcentrated. I see from. the old reports that one :.fortunate problem which may have escaped the tired eye of an expertinspector only had the reception hall to. do. who - "cannot see the wood for th,e trees".

It sure made for speed but the sight of/_ horde of inspectors, Those of you who do not at present carry out hospitalarmed to the teeth with pencils and clipbords and inspections should re-examine your motives for not doing sothermometers and all the other paraphernalia of our trade, and assess whether they are valid or not.clumping up and down the hallowed halls, goosing the nurses Who knows, your inspection may just be the means ofand prematurely bursting,the stit(hes of the patients, was preventing another salmonella meningitis or another accident-enough to raise the hackles:of the hospital staffon the one hand ai death by poisoning. WDV

!

PG. 14 ONTARIO BRANCH NEWS/FALL1982 _ -' " "

,/

Microbiology refresherBYKLAUSSEEGER - Corynebacterium species (diphtheroids) \

If you as the Public Health inspector have in the past "not - occasionallyother such as: rparticipated in' hospital programmes and suddenly find Streptococeus pyogenes(andotherB haemolytic Streps.) ""yo'urseif in the midst of the hospital community 'eagerly .. -, StreptococeRs pn_nmoniae (andother a haemolytic Strepsawaiting _ourobjective opinions and solutions, various terms Neisseria species "

-will be thrown at you to test your credibility, Itiglikely that you *Haemophllus influenzae (and other species)will be familiar with the words but slightly rusty, on tlleir ,Oropharynx:meaning. To help refresh the memory and bring out oi storage_ - a haemolytic Streptococci.their meaning, the following,terms are used frequently in a - Neisseria specieshospital and institutional facility and include: : Corynebacterium species (diphtheroids). ,bacteriostatic, bactericidal, germicide, isolation, endemic, -Staphylococcus epldermidisasymptomatic, sensitivity, asepsis, antiseptic, endogenous -occasionally other'such as: -_ .infection, flora,, sterilization, nosocomial infection and Streptococcus pneumonlaenon-nosocomial infections. The later two terms will be defined. *Staphylococcus aureusNosocomlal Infection - Greek origin, Nosos: disease: Komeo: - *Haemophilus influenzae (and other species)take care of. *Nelsserla meningitidis• An infection arising within the hospital, thatis, an infection *Corynebaeterlum dlphtherlae

which occurs in a hospitalized patient in whom it was not -*Isolation of these may indicate a carrier state and notpresent norincubating atthe time of admission, or an infection necessarily a pathogenic state.acquired in the hospital but appearing after discharge. Also f Pathogens:includes infections the staff acquire while working-in the - Streptocoeeus,pyogenes. Strep throathospital. , - Corynebacterlum dlphtherlae- diphtheriaNon-Nosocomlal Infection - Streptococcus pneumoniae

A community acquired injection clin ically apparent in the - Staphylococcus aureus ]': _' incubation s_age or present in the carrier state at the time of - Candid albicans

admission to the hospital. , - ViruSes - cause of most acute URT infections in adults -- : " " Microbiology Refresher adenoviruses and others

The following brief outline illustrates the variation of _ LOWER RESPIRATORYTRACT:NOrmal Flora:organisms which the/]uman body may,harbour and.consider - None

either part of the normal flora or are pathogens. - This area-is normally a sterile site in health_ individuals.SKIN: Normal Flora: Specimens from this are (example. sputum) however. Often-Staphyiococcusepidermidis (albus) contain normal flora organisms from the mouth and throat.

. - Micrococcus species t Pathogens: (most causing a type of pneumoma)- Propionlbacterlum acnes _ - Streptococcus pneumonlae, lobar pneumonia- Corynebacterium species (diphtheroids) - _ - Haemophilus lnfluenzae

- occasionally others such as: Staphylococcus aureus -- Streptococcus pyogenes a_d other beta haemolyticPathogens: . Streptococci- Staphylococcus aureus

- Staphylococcus aureus¢- boils, carbuncles, impetigo - Kiebsiella pneumoniae - Friedlander's pneumonia- Stroptococeus pyogenes- impetigo, secondary infections • - Myeoplasma pneumoniae . Primary a typical pneumonia- Bacillus anthraeis - malignant pustules A variety of other bacteria may also cause pneumonia or can-Dermathophytes.(fungi). ringworm, athletes foot be secondary pathogens in :this area as a Icomlication of" p

- Viral-diseases - herpes simplex, herpes zoster another disease (example: Pseudomonas aeruginusa]- small pox_ chicken pox -- - Bordetella pertussls - whooping cough- warts ' - MYcobaeterlum tuberculosUs- tuberculosis

-" - measles,-rubella . - other "'atypical" Mycobacteria- tuberculosis-like infectionsMOUTH: Normal Flora: - Yersinia pestis pneumonic plague

" "staphylococcus epldermldls . - Fungi e.g.: Aspergillus species (fumigatus, niger)"' - .a haemolytic Streptococci (viridans group) /' Coccidioides immitis . " "

- neisseria species and Veillonell a Blastomyees dermatldltis-"Lactobacillus• - a few parasites• Haem'ophllus influenzae - Viruses: Influenza- occasionally otherysuch as: Candida species (yeast), AdenovirusStaphylococcus aureus, many anaerobic organisms. Others

: Pathogens:. EYES: Normal Flora:- Vincent's organisms [Treponema vincenti and Fusobacter. Ynoneium nueleatum] --- -. - some organisms may be present (normal flora of skin)• Candlda alblcans (yeast) - thrush e.g, Staphylococcus epldermldis

"_ -:Viral disease- herpes (cold sores) Pathogens:.";'-" UPPERRESPIRATORYTRACT: - Moraxeila lacunata •"

Normal Flora: Nose and Nasopharynx: "Haemophilus aegyptius - pink eye ,- *Staphylococcus=aureus - Pseudomonas aeruginosa ,.• Staphylococcus epidermidis - Streptococcus pneumoniae

Please turn to page 15

ONTARIOBRANCHNEWS/FALLP6.

Microbiology refresher

Continued from page 14 - many of the anerobic cocciand gram negative bacilli normallyStaphylocoeens anreus (and occasionally Staph. epidermidis) found in gastrointestinal tract and on skirl (especially lower

- Nelsserla gonorrhoeae - ophthalmia neonatorum ' regions of genital area, which contains more bacteria as normal- Certain viruses - e.g. herpes virus _ flora than the higher regions, 'such as the cervix).EARS: Normal Flora: . Male: - normal flora of skin and gastrointestinal tract may be- outer ear - similar to normal flora of skin isolated- middle and inner ears -none - site should be sterile Pathogens:Pathogens: - Treponema pallldum - syphilis- Streptococcus pneumoniae - Nelsseria gonorrhoeae - GC- Staphylococcus aureus, Streptococcus pyogenes . Candida alblcans - Candidiasis- Haemophllus influenzae - Trichomonas vaglnalis - a parasite- Pseudomonas aeruginosa - Viruses- Proteus species and other gram negative enteric bacilli - Normal flora organisms - in complications such as those- Aspergillus (fungus): Candida albicans [yeast] following abortion may lead to severe infections. Example -GASTROINTESTINALTRACT [GIT]: Normal Flora; fatal sepsis may result from contamination of damaged tissue

i.. Especially of lower partof the tract• Upper portion contains _ by Clostridlum perfringens.- fewer organisms and stomach - due to extremely low pH of 2-3 - BODYFLUIDS:

is usually sterile• Example: CSF, Pleural Fluid, Blood, Urine ,- a great mixture of organisms including: These contain_nonormal flora and are normally sterile. Any/ Anaerobes such as Bacteroides species organism isolatdd could be a pathogen.

Fusobacterium species Exceptions: Urine:Anaaerobic cocci Trans_ientorganisms may be present in lower femal urinary

. Eseheriehia eoli and other enteric gram negative bacilli tract, but the kidneys, ureters and bladder are bacteria free,- Streptococcus faecalls Contaminationof female tract by organisms of anal and genital- Clostridium pedringens region is not uncommon. With males, however, contamination-Staphylococcus aureus occurs less frequently.- Candida alblcans _ , Organisms most commonly found in "Normal" urines include:

- Staphylococcus epidermidlsPathogens: - Lactobacillus species- Salmonella typhl - typhoid fever - Diphtheroids isolated inlow numbers,- Other Salmonella species - Salmonellosis - Gramnegative bacilli not usually indlcativeof- Shigella species - bacillary dysentery -Others infection- Enteropathogenic Escheriehla coil - infants *Common UrinaryPathogens Include:- StaphylOcoccus aureus - Escherichia coil- Yersinia entercolitiea//Campylobacter jejuni/eoli - Other enteric gram negative bacilli- Vibrio cholera - cholera . Pseudomonas aeruglnosa- Candida alblcans - usually secondary pathogens . Streptococcus faeealis

Various parasites causing amoebic dysentry and other *Significance of these depend upon:disorders a) method of taking the specimen (e.g. MSC, catheter,- Various viruses suprapubic aspiration)GENITAL TRACT: Normal Flora: b) numbers presentFemale: - Loctobacillus acidophilus (Doderlein's bacillus) ' c) handling of specimen after taking.

Infection control committeeBYKLAUSSEEGER can be an effective member of the Infection Control

Before a hospital can become accredited, various standards Committee. In many cases the P.H.I. represents the MOH onmust be met which are required by the Ont. Hosp..Assoc. the committee. Since the P.H.I, is usually the only memberThe process of accreditationS'includes the formation of an wh6 does not work in a hospital, his/her prevention orientedInfection Control Committee• An accredited hospital must training can provide the objective observations which fnayshow proof that the ICCmeets duringthe year and records the spark the discussion to the needed solutions to the incidence ofnosocomial infections that occur in that hospital. The the re-occuring nosocomial infections in the hospital.effectiveness of a particular hospital's ICCdepends largqly on Purposewhat importance the Administrationand Medical staff give the The purpose of the Infection Control Committee is to havecommittee. If the ]CC's role is strictly to collect statistics and the patient discharged fromthe hospital less sick than wheh hehave meetings in,orderto fulfil the accreditation requirements entered. Nosocomial infections occur in 6% of all patientsthen the committee's effectiveness will be little. However, if admittedto hospital, of which 3% are post operative and 3%everyone concerned places a high l_riorityon the ICC's role are from other areas.in"the hospital and take the committee's recommendation to All'St_pervisors who have control of departments where anheart, then the prevention of nosocomial infections will be infectious organism may be spread or cause to be spreadreduced and effectively controlled.

Depending on health unitpolicy, the Public Health Inspector Please turn to page 16

PG. 16"ONTARIOBRANCH NEWSIFALL 1982

• • , Infection control committeeC0ntinued*from page 15 the results of antimicrobial therapy, sterilization and

- _ .... disinfection conformto the claims of a particular supplier. Theshould be members of the InfectiOnControl Committee. Since . : periodicevaluation will ensure that the initial effectiveness ofthe Scope of each department varies, each pers0n_iopinion can the chem!cals, procedures, policies are maintained.provide different perspectives on whether a particular .policy Role of the Public Health Inspectorchange' or change in procedure will. have the desired effect. Ofthe various members of the Infection Control CommitteeCommunication• channels::,:also .remain open to ensure :, only the Infection'Control Practitioner and the Public Healthconsistency from one department to another..Membership -. Inspector can objectively •evaluate the performance andshould'include: Infection.' Control• Practitioner (usually an _ " procedures of the various departments. Since the otherR,N,); medical 'Staffmember (usually an interested surgeon); members are the Heads of their respective departments, their

" Microbi0i0gist, ifalfull Sei:vicelabis located in the hospital; the objectivity is restricted since they are the eyes and voices

Nursingdirector; a Public Health Inspector, representing, or _".. *r'i*representing their,area of expertise as Well as the I.C.C. iin addition to,the Medical 'Officer of Health; Head of the 'The Infection ControlPractitioner is the objective eye of the 1holiSekeeping staff; head of the Dietary Staff; and head of the committee on medical procedurds and.techniques. Observat-,Lg.undry*staff. :." " " - ions in the other department areas, can also be made but the

• The I.C_C,shouM meet monthly and for smaller .hospitals Public Health Inspector can be an important a!ly in evaluatingbi-monthly_.I ' " ':' ...... the housekeeping, dietary, and laundry handling areas. The

"" Responsibilities ' ' P.H.1. can p.r0vide the liason between the Infection ControlInitially the I.C.(_. must determine and review .personnel Praqtifioner(I.C.P,) and the medical staff. Onmany occasions

policy on tests and immunization. Most hospitals use the the P.H.I. has provided in-service programmes for the dietaryfollowing policy: , • housekeeping, and laundry staff, while the 1.C.P. usually

1L. Pre-employment tests; foodhandlers screened with conducts the in-service programmes for the. medical staffWIDAL arL_ stool samples for pathogenic bacteria _and (mostly RN's, RNA's, Orderlies, etc.). Therefore, when the

" parasiteS; other staff who willbe in contactwith patients and P,H.I. and I.C.P..work together, the communication lines willutensil equipment should also submit stool samples, remain open between department, and the efficiency of the

2. Stool specimen is submittedif staffmember has an enteric I.C.C.-operationwill be_increased.disease or if.away for more than one week, including holidays. Two groups of hospital employees have continuous contactNOTE: It must be emphasized that any one negative stool with the patient and his environment. One group is the nursingsample does not Create'immunityto pathogenic organisms. A staffand the second is the housekeeping staff. The nurses have

, negative result only, means that the feces sample was free of direct contact with the patient and it is importantto ensure thatpathogens atthetimeofsamPling. Exposure to any pathogens" " all nursing staff understand and have reinforced theand failure to wash hands and use hygenic practices may result techniques and practices of infection control. An infectionin becoming an asymptomatic carrier if symptoms are not -control programme to be effective must be understood"evident. It is therefore important that a false sense of security thoroughly by all staff and carriedtfirough in every detail. Careis'avoided, of equipment after use .must be thorough, accomplished with

3. Rubella serology for child bearing staff, full knowledge of the disease that may be transmitted from"4. Hepatitis screening for l'abpersonnel, patient to patient. Anunderstanding of the methods that have

5. Vacinnation for diptheria, tetanus, flu, polio, to be used in sterilizating equipment before returning for6. Policy must be determined on procedures used when staff storage must also be complete.

are exposed to •needle picks, hepatitis .and other injuries. Twoareas of potential hazard are respirators and suctioning• OtherFimetlons equipment, 'which if a proven system of cleaning and

Oncethehospitalcommunity'shealth has beenestablished disinfection techniques are not used can easily transferand regularily monit0red, the I,C.C. can turn their attention tO .. " pathogenic bacteria. Frequent cultures of all parts of this typethe various programmes and procedures that are performed on _ of equipment must be taken to guard against•carelessness and

.,a day to day basis. If the monthly statistics indicate that a false security. It must also be emphasized that equipment mustparticular "type of infection consistently occurs following a be disinfected or sterilized immediately after use. on allcertain procedure, or in a specific area of the hospital, the infectious cases as a safeguardtoother patients and personnel.I.C.C. mustcriticallyanalyze all facets of the events leadin'g up For smaller hospitals who do not have.a complete laboratory• L

to that nosocomial infection. . - Service on site, the P.H.1. can offer his services by swabbingThe investigation. Should include an evaluation of "the the equipment and sending samples foranalysis to the regional

)r0cedures and dressifig techniques used prior to infection laboratory. The use of Rodaes'can also be utilized on some ofonset.•Perhaps the housekeeping routine or the sterilization Of the larger equipment. .

• certain equipment used'was n0t_c0nsistent with the policy and Rodac touch plates mayb_ used to evaluate some of thestandards as first determined and demonstrated. On most Claimsofchemical suppliers aridthe products' effectiveness asoccasions the: .human) element plays a large role in the well as providing earlier detection of contaminated supplies'.prevention 0f nosocomial infections. / The consistency and effectiveness of the routines that the

. housekeeping staff use 'in patients rooms is extremelyOn a. regulal", basis (minimum. of once per _year) all important since they have daily contact with his environment.

' departments ifithe hospital should be constructively_ critized Again Rodacs may bc used to prov!de an indication, of staffand appraised::to' determine" whether the policies and consistency and early detection of habit changes.procedures as originaliy set'aremaintained. Ifa large variation The P.H.I. use of Rodacs .in :the ,hospital can be veryis found _mdthe nosocomial infections have als0 increased then beneficial when the I.C.C. evaluates the various programmes. -steps can be taken to redtice their incidence by returning to Many hospitals' reluctance in using Rodacs and environmentalPolicy pr0cedu_es. The .appraisal should include: isolation surveys is dueto the'product!on costand the misunderstandingtechfiiques;*.dressing. techniques; housekeeping routines; _that the results _re not for•statistical purp0ses only. The P.H.I.laundry hahdling pr_ictices;wardr0utines admission poli_ies; can•providethe supply of Rodacs from the regional laboratory atpharmaceutical used; and critically appraise the claims of the no cost to the hospital. This is also an effective method ofChemical _ompany _upplierof the hospital, It is important that Please turn to page 17

• . ., ..

i

/ ONTjARIOBRANCH NEwsIFALL 1982PG. 17

J' Infection control•€ommitt eContinuedfrom page 16 disinfectiontechniquesor contaminatedsupplies.

observingahospital'svariousprogrammesandproceduresto There are many other areas not discussedin this articleprovideobjectivecommentsof observationsduringthe LC.C. whichthe PublicHealth Inspector'sexpertisecanbe usedtomeetings.The Rodacresultsbe usedas part of the overall help 'reduce the incidence of nosocomialinfections in thepicture in evaluating, disinfection supplies, and cleaning hospital 'environment,and through'time exceptanceof theroutines, and not for statistic gathering and finger pointing at P.H.I. role will likely be utilized. : :potential carelessness. Results over aperiod of time can also A patient discharged from a hospital less:sick than when heprovide answers to why a nosocomial infection occured in one. entered, provides less chance that this person, will.be theparticular area at certain times if the cause was related to source of a communicable disease outbreak in thecommUnity.

i Strategy for the in cestigation and control of outbreaksEdRor's Note: As part of-his lecture Frank White 'M.D. 2) verify the diagnosis - review available clinical and

_resented a 'Strategy for the investigation and control of laboratory evidence, consider reliability of clinical andNosocomial disease outbreaks.' Dr. White's lecture was made laboratory sources, establish case definition.at a 1978 conference sponsored by the Canadian Hospital " 3) Establish existence of an epidemic : establish normaFInfection Control Association (CHICA)held in Jasper Alberta. expectancy, review previous records, - compare currentDr. White at that timewas the Director, Commufiicable situation. "' " ?Disease Control and Epidemiology, Albei'ta Social Services 4) Environmental inspection, _ ..and 'Community Health. Following is the outline of the 5. Relate the epidemic to time, place, person " (When?investigation strategy, Where? Who?) - epidemic curve, spot maps' (floor plan, city

* ** * ****** maps, etc.), age, .sex, occupation, admitting diagnosis,Epidemiology: The study of the distribution and determin- treatment, denominators, attack rates. •

ants of disease in populations with a view of prevention and .6) Provisional hypothesis (Hoib?'Why?) - type of outbreak;control. Epidemiology is more'than the sum of its established common sourcp (single exposure, continued exposur.e);facts; it is their orderly arrangements into' chains of propagated (person toperson;vector).interference which go beyond the bounds of direct observation. 7) Immediate control measures: prevent spread.

Epidemic: The occurence of disease in apopulation in excess 8) Detailed analysis: attack rate table, clinical analysis,of normal expectancy, laboratory confirmation, tracer techniques (typing, antibio-

Epidemic Investigations - Basic Requirements: a) Kttow- grams, etc.), environmental studies..ledge, b) Energy, c) Honesty, d) Accuracy, e) Logic, f) 9)-Re-evaluate alternative hypotheses in light o_ .moreAuthority. ' complete findings. _. "- .

Epidemic Investigations - Basic Procedures: 10) Conclusions.1) Immediate control measures: care for the .sick; prevent ' l l)Long term control measures- technical, administrative,

spread. \ legal., .r

Nosocomial Infections .....

Micro-organisms Causing nosocomial infections.. . .o

....Ian B. Duncan M.D. was one of the lecturers _it a 1979 Nose - staph.aureus .Introductory course on Infection control and spoke on Pharynx - strep_pyogenes, colonizing.gram negative rods'Nosocomial Infections.' Dr. Duncan is the Department Head Vagina - bacteroides, anaerobic strep, candidaof Microbiology at the Sunnybrook Medical Centre, Toronto. .Cellular- cytomegalovirus (latent virus), E.B. virus (infectiousFollowing is an excerpt, from a summary made from Dr. , mon0)Duncan's lecture. Thanks goes to Joan Chesney R.N. Infection Exogenous, nosocomicai pathogens .Control Practitioner for providing the information. " Major 3 - staph aureus .

. • pseudom0nas aeruginosa .

Nosocomial infections categorized: urinary - 40%,respirat- klebsiella .ory- 25%,woundsand absesses- 25%,other- 10% ' LessFrequent serratia ._providencia ,- ,Factors influencing nos0comiai infections: _" . .°..,- indole positive'proteus ,•- hospitals are reservoirs of pathogens. Newborn nmmery Infections.- surgical and medical procedures allow ,these pathogens ': "access to the body Group B streptococcus is seen the most,, staphl0c0ccus aureus

has been removed by the use of hexachloropese.- sick people have compromised defences. . Others seen are: Ecoli, pseudomonas, klebsiella, bacteroides,Nosocomial pathogens are classified as: ...............- endogenous or a source'within the patient ' anaerobic cocci ........Viral gastroenterites caused by rotovirus , .- exogenous or a source outside the patient Group B strep has a vaginal carrierrare of 15%that is sensitiveEndogenous .....

Gastro- intestinal tract contains -'E coli, Klebsiella, to penicillin...pseudomonas, bacteriodes, and candida • ' ' _ . Please turn to page 18

_PG. 18 ONTARIO BRANCH NEWSIFALL 1982

Micr-organisms causing nosocomial infections

Continued frompage.17 ' end0tracheal _:atheters, newborn incubators, ventilators,

!nh_iom In Surgery " aerosol mist units, urine 'bottles and measures, multidoseIf/_wound is infected it was either present on admission or pharmaceuticals.

nosocomial " Statistics show a Nosocomial pseudomonas aeroginosa infections are usually20% infection rate,in bowel surgery, sporadic _common source outbreaks, in hyperendemicNo_¢omlal urinary Infections situations.

Spontaneous-and Nosocomial urinary infections _Klebsleila ,Oqimflsms Spontaneous Nosoeomlal - found in food and waterEcoli 68% 10% - 30% hospital staff carriersKlebsiella 10% 21% - contaminated kitchen utensils'and food

Enterococcus 8% 30% - cold.and uncooked items of food j' Proteusmirabilis 5% 14% =development of bowel colonization I

Other Proteus 1% 3% As with pseudomonas, a Klebsiella outbreak often isPseudomonas 3% 12% sporatic with a common source, and a hyperendemic situationProvidencia 0% 7% such as a urinary tract infection. Antibiotics interfere withSerratia 0% _ 2% normal flora, thus often causing,infections, therefore use of

antibiotics prophylactically just increases the colonization of

" Catheter Infections caused by: " " gram-negative rods.• patient to patient- tranferred by the hands of staff

\- bacteria are often antibiotic resistant, commonly klebsiella, :pseudomonas, proteus. _ -Faeto_ predisposing to opportuulstie infections: _ '

- primary diseases such as leukemia, malignamies ° A w ri tt e n pi¢ture of- instruments and pr0stethesis "- antibiotics modify the microbial flora- other .drugs Suchas ster_0ids,immunosuppressives

a hospital needed- people are the main source, and carriers are frequentNasal carrier- 35-40% of population and they are either • , . . .constant or intermittant carriers. -_Whenthe Pubhc Health Inspector makes an Inspection of anSkin carrier - 5-10% and is usually sec0ndary to nasal carrier, institution like a hospital, a room by room, department byNasal carriers are categQrized into: department analysis is made. "Recordingthe deficiencies and

:i.T['rue - these are constant or intermittant observations in each department proyides the Administrator2. Eueatlal Non curriers -these rarely isolate the organism and department heads a picture and status of the hospital. To" , be an effective member of the Infection Control' Committeeand are never positive with the organism. (ICC).the PHI should have a clear understandifig and picture

Nasal swabs should be moistened,lnserted in both nostrils of the facilities, programmes, and staff available at eachand repeats taken in 5 days, e.g. Mon., Fri., Wed._, etc. hospital. Therefore. an inventory of depa_rtmems, facilities,

Staph aureu_survives drying and may.persist forlong period programmes, and l_rocedures should be made. Following is ain aninanimate" environment.brief summary of the items required in completing thepictureDessemination of staph', few from the mouth or nose.

Skin carriers- skin-.clothing- movement- shedding_ of the hospital, helping you to be more effective whenThese "'dispersers" shed heavily into the environment, analyzingthe potential solutions to'infection problems, during

These people, if working in O.R. etc. should shower the discussions with other ICC,members.

evenintz before work tOreduce shedding. What should _ou knowaboutyour hospital:EPIDEMIC OF NOSOCOMIALSTAPH Bed Capacity:Period of prevalence Phage Type Antibiotic i,eslstant No. of surgical beds;late 1950- early to mid 1960 80/81 multi resistant No. of private, semi-private'and publicbeds,early 1960: mid1970 84/85 multi resistam No. of Isolation rooms, and set priorities for Isolation;mid 1970todate 94/96 penicillin only No. of pediatric beds; ,

No of bassinettes;If Staph methocillin resistant ISOLATI_ No. of psychiatric beds; / , .

Factors underlying increased resistance No. ofdouble occupancy psychiatric beds: r

- people survive to greater age No. of premature isolettes and bassinettes;future"construction;prosthetic surgery Set plans for _ _ "

- steroid therapy ' Staffing patterns, how personnel are utilized.- immunosuppressive drugs _ No of obstetric beds.- cancer therapy Ventilation and Handwashing facilities:Pseudomonas- aereginosa " Handwashing:This the commonest, most troublesome and resistant to most What is the number and location of sinks;antibiotics. _ Type of soap - liquid, powder, and brand name;Sources of h_pital pseudomonas ' Type of dispenser used ,for soap; _:-fecal carriers- 25% Type of hand drying system - hot air blower, towels and- infected patients disposable paper towels, or re-usable towels.- sinkg, drains, mops, soap, food, water

contaminated equipment, such as: newborn,, aspirators, / Please turn to page 19

ONTARIO BRANCH NEWSIFALL 1982 PG. i9

, Hospital pictureContinued from page 18 . Number of discharges per month;

Ventilation: ' Type of precautions;What areas . use non recycled air? Are proeoedures In writing? ..Air Filters and how changed and by whom? _ When were they updated; , 'How many air exchanges per hour? Are they practiced;Use of laminar flow hoods, ultraviolet lights, where, what LaundryTechnique: I

purpose? , Written proceedure;Estimate of CrowdIng in multiple bed rooms; Is the laundry wrapped;

This is for rooms with three or more beds. How distributed; •Less than three' feet apart between beds is considered, How is Isolation linen handled;

overcrowded. : ,. Storage and handling of clean and soiled linen_Also consider the size of the room; Analyse _potential of cross contamination in laundry

! Are patients placed in the hall? handling.

t Are solariums opened for patient use? Kitchen Practices:What reconstruction plans are coming up? Observepersonnel hygiene practices and note discrepencies

• and discuss at in-service education programme.High Risk Areas: •Procedurefor Isolation food and dishes;

Estimate of patient flow in intensive care areas; Where is left over food kept, and where disposed, timeFacilities for Isolation in the ICU's., interval for it being kept; '

How many patients are acute; chronic, transient? Incidence of illness among kitchen workers;How many patients and staff are AHApositive? Review last 12 months inspections.What is the cleaning procedure: Employee Health Programme:

Disinfectants in use: Is there a programme;'List brand names? . Are their-employee records?Where each product is kept, used and for what? Is it mandatory?List ingredients and classifications? Who and how are follow ups done?Consider: right kind of product for the job; how and who What type of tests are done and at what intervals?

dilutes antiseptics; criteria for selection of products. Laboratory Facilities:,Record suppliers names, addresses. What types of testing made?

Pblleles imd Procedures: Observe techniques and discuss potential cross-contaminat-A) Isolation, ion, sanitation and disinfecting practices.B) Housekeeping, Are disinfectants used in hospital cleaning tested forC) Bed capacity, contamination? Frequency?D) Surgical Dressing, Environmental Sampling: 'E) Erethral catheterization, What, where, when, and how often done;'F) Intravenous catheter, Types of sampling made (i.e. rodacs, swabs, etc.);G) Tracheotomy care, How are results interpreted and utilized to improveH) Anaethesia and Respiratory equipment, ,. proceedures?I Physiotherapy, ' Is Public Health Inspector utilized?J) Which equipment is disp'osable and which is reused, Autoclave Testing: :how clean, how often; Whois responsible for cleaning - routine Type used, gas, steam, flash;and infected equipment; How tested;Burn Unit: Brand name of testing product;

Number of beds; Expiration date and how recalled if necessary.Number of discharges; Hospital Infection/Control Committee: \Treatment description of burns. Members (list departments, agencies); "

Isolation Units: ' Where does itfit in the structure of the hospital; who is theVentilation of rooms; Chairman; whom does it report to; can all the members vote;Selection of patients; are minutes kept; are its functions clear and written; type of

, Cardiac surgery; reporting; frequency of meetings.How many beds; Are committees recommendations accepted and followed by 'How many proceedure s. hospital staff?. - ' _ ....

Transplants: Type done; , How often is effectiveness of Infection Control Committee. Amount done; .reviewed?

Precautions if,any used.Operating Room;

No. of rooms;No. of special rooms;No. of routine rooms; WEILER'SLAW-How rooms are cleaned; Noth_g is Impossible for the man who doesn't have to do ItList products used for cleaning; himself. ,Is there a special O.R. clean up monthly, weekly, yearly? PUTT'SLAW:How many dirty cases are handled; , Technology is domInated by two types of people: Those whoHow are O.R.s classified, dirty, clean, clean contaminated , understand what thgydo not manage. Those who maMge what

etc,? _theydo not understand.Ontology Unit: , '

.. Type of patient;, " _ "

PG. 20 ONTARIO BRANCH NEWSIFALL 1982 ""

• recta d" ..... Disin nts an uses

.,. , ".... BYKLAUSSEEGER CHEMICALDISINFECTANTSAND ANTISEPTICSDISINFECTANTS-USES.ANDEFFECTIVENESS _Selectivetoxicity differentiates between an antiseptic and a

,Most Public Health Inspectors one time or another have .disinfectant. Both act by combining with and altering proteins"told an operator to use.a disinfectant to properly sanitize and nucleic acids of'cells. In general both disinfectants andutensils or aparticular surface. Brand names are usually not antiseptics have a broad c0mbining/dematuring action onmentioned for the obvi0us, reasons, and 'any chlorine proteins as opposed tothe limited/specific combining action ofcompound' is usually the answer given when asked Whatto chemotherapeutic agents on cell enzymes.use. _ There are many types of disinfectants each of which_has

,However, in a hospital orother institutional environment the advantages and disadvantages for use in particularsituations.choice is not easy. Thereare different types of chemicals on the The more common are listed:-

=..marketmade by an equal number of companies. Each type of 1..Acridines e.g. Aminacrine hydrochloride, proflavine,chemical disinfectant is specifically formulated for different acriflavine. -conditions and microorganisms/that are found in a hospital • These are non staining yellow dyes which are used at,environment. ,Each part .of the hospital, whether it is the ,0.1-0.2% in water, alcohol, creams or vaseline gauze. They actoperating room.or the :emergency ward, produce different well against Gram positive bacteria, less well against some'types of organisms. For some situations a fast acting Gramnegative bacteria and have no action againstbactericidal product is needed, while other situations require Pseudomonads, tubercle bacilli, bacterial spores or viruses.the product to havebacteriostatic properties in high dilutions, ,They are not absorbed by cotton or inactivated by serum and

When a product is chosen by Ahospital,it is first s_utinized work best at a slightly alkaline pH. Their activity is sustainedby the InfectionControlCommittee, even pi-oducts used by the rather than rapid "andis bacteriostatic.housekeeping staff. The criteriafor selecting a disinfectant or 2. Alcohols e.g. methyl, ethyl or isopropyl.antiseptic productinclude: It should act on all microbes in high These act well against all vegetative bacteria includingdilutions and preferably within a short time; They should have tubercle bacilli and against some viruses. Spores are resistant.a high degree of germicidal potency; the cost of the product The inactivity necessitates the presence of water and they aremust reflect its efficiency and effectiveness;. ,it should be used in the range 50-70% alcoh01/water mixture. The

_ compatible with soaps and organic matter encountered in the inactivity is rapid and is complete'when they have evaporatedmaterial to be disinfected and must be chemically, stable. The Off.Forskin cleansing 70% alcohol requires about 2 minutestoquality control of the product must be such that no,shipment is be effective is is bacteriocidal.

_contaminated prior to arrival at the hospital. Di._infectants 3. Quaternary Ammonlm Compounds [QUATS] e.g.contaminated priorto use causing nosocomial infections rather < Cetyltrimethyl ammonium bromide, (cetrimide, cetavlon),than preventing them has been documented many times in the Benzaikonium chloride (Roccal, Zephiran), Cetyl pyridiniumlast't_enty yea_, (see references for further readingL It is chloride (CepacolLtherefore imperative that the disinfectants a hospital uses is These-surface active agents concentrate on all types ofperiodically/checked for contamination and whether it meets surfaces and in high concentration alter cell permeability andthe claims on the label. • " cause bacteria to lyse. Although they are bactericidal in high,. Thechoice of disinfectants for materials andinstruments is concentration they are usually used at a_high dilution asbased on the riskof infection. Critical Items are those which are bacteriostatic agents. They act,rapidly but their activity is veryintroduced beneath,the surface of the body or attached to s ort heed. They are partmlly inactivated by serum_and byanother object which is so introduced, e.g. transfer forceps, gauze and chemically destroyedby soaps and phospholipids.

• scalpel blades,cardiac catheters and plastic components of the They act well agsinst Grampositive bacteria, less well againstheart lung oxygenator. Critical items must be sterile when some Gram negative bacteria and acid fast bacilli, bacterialused. Semlerltieai Items are,thosepieces of equipment that spores or most viruses.

• make _direct contact with mucous membrances, e.g. 4. Phenols .- endotracheal and aspirator tubes, thermometers and telesc6p- Including cresols, xylenols, chlorphenols and chlorxylenols,

ic instruments. Semleritleal Items need not be sterile when arylphenols and bisphenols are all bactericidal and are more.-:used (sterility: is desirable) but must be free of y_ggetative active at an acid pH and except for bisphenols are less active

micro-orgamsms, tubercle vacil_nl and viruses. Noncritical when diluted. They denature cell proteins slowly"but have abadllland items include equipmen t that has indirect patient long sustained activity even when dried on to a surface. Mos.tcontact, e.g. face masks, humidifiers, rebreathing bags. are too toxic for human use but are excellent disinfectants.

, accessory medical and surgical equipment, furniture. Here They are active against Gram postive and Gram negativevegetative bacteria such as staphylococcus arid pseudomonas vegetative bacteria but are in'active against bacterial spores.species must be destroyed. The leveler degree of disinfection Most are inactive against tubercle bacilli. There isrequired isrelated to the relative risk of infection, considerable variability in the speed _f their action against

"A good. bactericidal, disinfectant with long lasting Gram negative,bacteria and the end result varies with the_,bacteriostatic properties must be used on most inanimate formulationof these disinfectants clear soluable phenolics e.g.environmental surfaces.'-- Lysol and Sud01have a high soap contentand act well against• .,Following is a description of the various chemical tubercle bacilli and some viruses. Phenolic disinfectants are

• disinfectants that are commonly Used. Some of the 'less affected by "Soil" than most. They gradually build up a,- descriptions areaclapted froman inservice program where Dr. brownstain on surfaces which contributes to their ability to kill

Leslie Hatch made _ presentation to the Southwestern over extende_d periods of time. The bisphenols e.g.Infection Control Practitioners. Dr. Hatch is the Director Of Hexachlorophane, are very active against Gram postive cocciMicrobiology at St,"JOseph's Hospital, London. ' Please turn.to page 21

!

ONTARIO BRANCH NEWS/FALL 1982PG. 21

DisinfectantsContinued from page 20 humidity control and time - usually 12to 24 hours. It is seldom

bt_t have little action at "therapeutic dilution against other used today outside hdspital laboratories. Theaction coagulatesorganisms. They penetrate the keratinised layers of the skin or "fixes',' protein. Because of this i_enetration is slow andand give a sustained "kill" if they are used regularly., It is uncertain.. It is a common cause of Skin.sensitisation. It isimportant to realize that all phenolics are absorbed via the skin biocidal against all bacteria, spores and viruses eventually.and that prolonged or unnecessary exposure by this route can Gluteraldehyde is adialdehyde derived from glycerol,and isbe harmful. Most of them are caustic even at the recommended active against all bacteria, spores and viruses eventually. It isdilution and none should be used in connection with food used at an alkaline pH and like formaldehyde does not affectstuffs, glass, plastics, rubber or metals. Its activity, is slow at room

5. Clorhexidine , temperature - about 6 hours, but this speeds up if theThis aromatic compound hasan activity with some similarity temperature of action is increased. It is irritant to skin, mucous

to the phenols. It is alomost non toxic at recommended membrances andthe conjuctivabut less so than formaldehyde.dilutions and is probably one of the best multi purpose Aqueous solutions are used. Alcohol doesnot help its effect.antiseptics available .especially for disififeeting the skin. It is • Both aldehydes are extremely effective against fungi.bactericidal and becomes bacteriostatic at high dilution. It is 8. Dyeslong lasting on surfaces and skin and lasts about six hours. It is Mainly triphenylmethanes e.g. crystal violet, brillian green,not affected by. soap traces, protein or dressings and is malchite green and others. These have bacteriostatic actionseffective ih high soil situations. It is v'ery effective against against gram positive cocci and gram' negative bacilli, EachGram positive and Gram negative bacteria at the recommend- individual dye has a spectrum Of activity, .usually differented dilutions but it has no action against tubercle bacilli, from other dyes. Hence theyareoftenusedincombinatione.g.bacterial spores or viruses. It is inactivated by Bark Corkand , "Triple Dye" for skin or mucous. membra'nce antisepsis.this had led to several recorded outbreaks. Bacteriostatic (Crystal violet, Brilliant green and Proflavine.) •dilutions must be prepared aseptically and the containers 9. Miscellaneousnever topped up because some organisms e.g. pseudomonas . (a) Mercurycompounds e.g.. inorganic compounds mercuriccepacia and alcaligenes species can adapt to and grow in them chloride, mercuric Oxycyanide .or organic compounds orunder these circumstances. Chlorhexidine has been success- mercurochrome. These are slow,' variable and unreliablefully combined with cetrimide for antisepsis and the gluconate disinfectants that precipitate protein and act mainly, on gramsalt makes an exce!lent sudsing hand antiseptic with few skin positive cocci and fungi. Their unpredictability has "lessenedreactions if it is used 'properly at S ml per wash, each wash their use although they have been shown to be highly effectiveperformed at 4 hourly intervals i.e. twice per shift. Between against some organisms under some conditions. Other heavysuch washes, water or soap and water rinsing is adequate, metals assert similarastringent effects. Of these silve nitrateisbecause the chlorhexidine has a continuous action on and in the by far the most useful, not only in Crede's precedure but alsoskin. for treating burns, and chronic ulcers. Many strains of

6. Halogen Disinfectants pseudomonas in superficial lesions respond well ,to silver6.Halogen Disinfectants-are all oxidixing disinfectants, nitrate solution. ,

They are a}lrapid acting but the)_are all easily destroyed by (b) Tego compounds - amphoteric combinations of anionic• protein. Many have irritantproperties and all are destroyed by and cationic detergents.which are less effective than the more

alkali. Their activity is biocidal by virtue of forming halogen popular QUATS and are seldom used.compounds with cell proteins. They are all effective against (c) Boric acid isa weak biostatic disinfectant that has be(;nGram positive and Gram negative vegetative bacteria and abandoned becauseoftoxicity from ingestion and absorption.tubercle bacilli. They all have activity against bacterial spores (d) Conde's fluid-potassiumpermanganate-a slow oxidis-and most viruses but this is proportional to time of exposure" ing disinfectant that is biocidal but which stains and is slow. Itsand rate of destruction of the Halogen. activity is similarto that of the halogens and_itsremaining uses

_- would appear'to be foot soaks and for adding as a colour(a) Chlorine Compounds: chloramine, hypochlorites: indicator to hypochlorite solutions.Very fast acting. Very quickly destroyed. Have limited use in (e) Metallic copper, as powder or sheet is used to prevent

patient care and this is mostly a physical ability to dissolve hard microbial erosion of concrete and to prevent algae growth inprotein sloughs and crusts. Though irritant, they are virtually water vessels.non toxic at dilutions used. May be used in conjunction with (f) 8-Hydroxyquinaline (oxine) or its copper salt is used infood-stuffs. Sodium bromides often used to potentiate the paints and textiles as a fungicide. It is'also bactericidal and hasaction been used in ointments for treatment of superficial fungus

(b) Iodine Compounds infections and coccal infections. Its activity ,is entirely2.5% iodine in alcohol is one of the best skin disinfectants, dependent upon the presence of divalent metals. It has no

1% iodine in 50% isopropyl alcohol is less irritant and useful action on vii'us, spores or gram negative bacteria.for both skin and some mucous membranes. Lugol's solution (g) Beta-propriolactone a potent eidal vesicant 7 se!dqmwith 5% iodine in water is also used, is slower and less irritant, used today because it is potentially carcinogenic.Allthese iodine preparations contain potassium iodine which is (h) Sodium bicarbonate. Although 'it is frequelitly .,used tonecessary to dissolve the iodine crystals. .. dissolve mucous in the mouth, nose and eye, it has little or no

lodophors are also popular and effective. They are actiOnon microorganisms. Its pH of 8.6 however.discouragescompounds of iodine with organic surface active agents e.g. bacterial growth hence its use as a ready to ha_ndremedy,forpolyvinylpyrrolidonc-iodine(povidone-iodine), polyethoxyeth- burns etc. " "" "anol-iodine (Wescodyne), The'y are non staining, virtually non (i) Acetic Acid-vinegar. Although an ii'ritantits solution hasirritant and are effective as long as the yellow-red c01our a pH of about 2 and at concentrations of i.5°76it is'biocidalremains. Their action •is much slower than the alcoholic against m_anybacteria' and many viruses, It is p'articularlyiodines, effective against Pseudomonas aeruginosa' sloughs. A similar

7. Reducing Compounds - Aldehydes •effect Can be obtained with citric acid and a substance _:alled

The older formaldehyde is highly efficient but is obnoxious' phenxetoi. However bacterial resistance .rapidly• emergesand very slow. Its action requires temperature control, Please turn co page 22

PG. 22 ONTARIO BRANCH NEWSIFALL 1982

• Disinfectants: , Continued from page 21 . Lancet 1:375-377, 1971. .

against these last two but is less frequently seen with acetic 5. Ogden AE, Rathnell. TK: Infections and benzalkoniumacid. " • solutions. JAMA 193:978, 1965.

6. Plotkin SA, Austrian R: Bactcremia' caused by

FACTORSAFFECI_INGTHEEFFECTIVENESS Pseudononas sp. following the use of materials stored in.' OFDISINFECTANTS:'ASUMMARY solutions of cationic surface-active agent. Amer J Med Sci

1. Temperature: the use of hot Wateris better than-cold 235:621, 1958.Sanford JP: Disinfectants that don't. Ann Intern Medwhen diluting chemicals. Some of the chemicals work more '" • •effect!vely when used with hot water than with cold. The PH 72:282-283, 1970.ofthewatercanalsohaveaneffectonachemicai'_properties. _8. Schaffner, W, Frank M: Contaminated Aqueous

2..The dilutionof the disinfectant will sometimes determine Benzalkonium Chloride; JAMA Nov. 22, Vol 236 No. 21 1976.-o 9. Wishart M, Riley T: Infection with Pseudomonas

whether the chemical is effective as a bactericidal or long term maltophilia, hospital outbreak due to contaminated disinfec-bacteriostatic product. • •3. Thespeelesofmlero-organisms present on the surface or tint. Med J. Australia 1976, 2:710-712.

•piece of equipment to be disinfected will determine whether t• the, product being used will do the job.

4. The nnmber of organisms present and the. requiredcontact time-a product needs to be effective must be

CampylobacterS. The previous item Will determine whether a chemicalwith bactericidal or bacteriostatic properties will be used. It is _importantto.know whether the' product will control fungi and

viruses Also'whether it will remain effective when organic in "ragsmatter is present.• 6. When changing products it is important to: know its • 1

intended purpose; what areas and which staff members will Campylobaeter jejuni is a Ctlrved or spiral gram negativeuse it. Ensurethat all staff understand its purpose etc.: place bacterium which has been known since 1909to cause abortion inon trial in one area for a month and compare with current cattle and sheep. It was first isolated in 1947 from a human

, product; follow directions to the letter, septicemic patient. In 1957 it was recognized that these .To determine a p_oducts effectiveness and whether the staff organisims, then referred to as "related vibrios", caused acute

'are using consistent methods, an environmental survey on diarrheal disease inhumans. During the late 1950s a researcher"areas where the product is used should be made on a by thenameofButzlerwasabletoisolatetheorganismfrom, the

Spot-checkbasis. The use of Rodacs and swabs for instruments feces of children by using a filtration techniq,ue. Two workers inand equipment should be used andspecific organism isolation 1963 argued that the term "vibrio" was not applicable andshould be requested. , suggested that the organism be renamed Campyiobacter on the

Other areas of microbiologic surveillance include: Infant basis of its microscopicappearance as acurv,ed rod. This genericformulas, that are Prepared in the hospital should be checked name. however, was not officially recognized until 1973 whenonce aweekto see that no Salmonella, Shigeila,Campylobacer Veron and Chateiain devised a scheme to speciate the group.or other pathogens are present: Endoscopes and respiratory Even today there exists much controversy Over the,nomenc!a-therapy equipment that are processed by high-level ture used for designating specie s and subspecies.disinfection should be cultured by a swab or rinse method Campylobacter is now recognized as a common entericperiodically. Humidifier breathing apparatus'liquids should be pathogen ranking second only to SalmOnella, and somesampledand sent for analysis. This would be more important . investigators predict that, with advances " in "detecti0niQsmaller hospitals where some of the equipment in is not used " techniques, it will surpass Salmonella iri incidence'.

' _romone week to another. Other equipment which a hospital's EpIDEMIOLOGY.lab usually checks include: Steam sterilizers, Ethylene oxide Considerable interest has been gener.'ated regarding the(gas) sterilizers; Dry heat sterilizers; and water used for to epidemiology Of the organism. A_ian species are knownprepare dialysis fluid, reservoirs. In studies of mammalian hosts Campylobacter has

From the Public Health Inspector's prevention point of view, been isolated from healthy swine, cattle, sheep, horses, goats,spot-check environmental surveys throughout the hospital, rodents and monkeys. Infe'ctionwith Campylobaeter may causecan be more effective in preventing infections rather than diarrheal disease in calves, lambs, dogs, cats and monkeys.

'using anenvironmental survey only as part of an investigation ' Commercial pork, lamb and beef carcasses may be contami-." of a nosocomial infection outbreak. " hated with the organism. Household dogs and cats, especially

" * * * * * * * * _ yoimg ones, are commonly infected'. The organism has also beenBIBLIOGRAPHYAND FURTHERREADING " recovered from environmental sources, inqluding fresh and salt

1.. Center for Disease Control: National Noscomial Infec- water, and from raw milk.fions Study QuarterlyReport, ThirdQuarter 1971, Issued May,' WHATCAMPYLOBACTERMEANS TODOG OWNERS!972; An epidemic of nosocomial EO-1. infection in a ., There have been many recorded familial outbreaks of

. community hospital. Campylobaeter enteritis in which Campylobaeter was also2, Food and Drug Administrationwarning -- co'ntaminated isolated from family pets. Blaser reported five cases of enteritis

detergent solution. Morbidity and Mortality Weekly Report, in which all patients had been in contactwith young dogs which18:366, 1969. - had diarrhea. Campylobacter was isolated from these dogs and• 3. Malizia W.F. Gangarosa EJ, Goley AF: Benzalkomium their litter mates. It is somewhat reassuring to see reported that

,chloride as a source of infection. New Eng J Med 263:800, dogs from the same litter, which were stool positive for1960. • .. Campylobacter, but symptomless, caused no human illness in

4. Phillips I, Eykyn S, Curtis MA, et ai: Pseudomonas their adoptive families. Transmission ofCampylobacterappears

cepacia (multivorans) septicimia in an intensive-care unit. Please turn to page 23

• .. !\

,' 3

ONTARIO BRANCH NEWS/FALL 1982 PG. 23

Campylobacter in .dogsContinued from page 23 WORLD WIDE INCIDENCE

to occur by the fecal-oral route through contaminated food and Many surveys have been conducted in various part's ot'the .water or by direct contact with fecal material from infected world in order to establish the incidence of Campylobaeteranimals or persons. Therefore, the practice of good personal ;_ among dogs. In a survey of 179 dogs conducted in Perth,hygience, including frequent washing of hands after handling England, Campbylobacter was isolated from 10.4%, which werepets, should prove quite effective in preventing transmission, diarrheic, and 11.1% or normal dogs. A similar study in Rio de

Ifthere is some concern about the transmission of the disease Janier0 showed 5.5% recovery of Campylobaeter from 90from domestic pets to humans, it is only fair to recall_the case of diarrheic dogs and none from 25 normal dogs. Forty-nine (49)

"the dog it was that died". In one incident two sisters ate pork oercent of dogs oresent in the RSPCA (Royal Society forluncheon meat, one actually having\eaten the.meat and the . Prevention of Cruelty to Animals) premises in Hereford,other disliking the taste having fed the remainder to her dog. England, were positive for Campylobacter. Samples collectedThe sister who ate tl_e meat became ill and was diagnosed as by veterinarians in the same area were postive forhaving Campylobacter infection. The other sister remained Campylobacter in 38.5% of dogs studied. The incidence inwell, but four days later her dog became ill and died within 36 . normal and diarrheic dogs were comparable in this study. In

t hours of the onset of symptoms. An autopsy on the dog revealed . Guelph, only 0.5% of healthy dogs and no diarrheic dogs weresevere enteritis and Campylobaeter was isolated from autopsy positive. The Atlanta Metro Animal Control facility and a'specimens, , (_olorado kennel reported isolation rates of 30% and '40%

ATTEMPTS TO INFECTDOGS . respectively. In Sweden, 5% of predominantly non,diarrheic•There have been more purposeful attempts to transmit dogs were positiye.

Campylobacter enteritis to dogs and cats. A joint project LOCALINCIDENCEbetween Dr. Karmali from the Hospital for Sick Children, _In'a study, consisting of 144 dogs from the Toronto HumaneToronto, and Dr. Prescott from the Ontario Veterinary College, Society, an isolation rate of 8.3% was observed. Sixty of the(OVC), Guelph, studied the effect of orally administering a large dogs sampled were puppies aged four months old or less. Six (6) -number ofCampyiobaeterorganismsto'puppies and kittens. At _ercent of normal dogs and 11.7% of diarrheic dogs werethe OVC the feces of 3 puppies a_d 3 kittens who had been positive. An additional 38 samples were obtained from dogsinfected were cultured daily to recover Campylobacter. All previously-examined by veterinarians in Scarborough .andanimals shed Campylobacter for 2-3 days a_er inoculation, but Malton; however, none of these specimens were positive foronly one dog showed transient evidence of diarrhea on the tenth Campylobaeter.day, at which point no Campyl0bacter was isolated. Dr. YOUANDYOURDOGPrescott, however, did become iil during the experiment and It is recognized that dogs are a potentially important reservoirCampylobacter was recovered fron_ his feces. At the Hospital for of compylobacteriosis. It is important, therefore, that a familySick Children, three more dogs wer_ infected; however, none of which adopts a dog as a pet sl_ould be aware these animals,the animals developed symptoms. The accidental infection of especially puppies with diarrhea, may pose a threat to a fami|y' soneresearchedledthemtotheconclusionthatdogs_ndcatsare, health and that adequate precautions be taken to prevent • _far less susceptible, infection.

•., . .

" To obtain ,

Licencing and 1

Registratl"onWe need more members

!

IT IS UP TO YOU TOSIGN UP PHI'S

THAT ARE NOT MEMBERSi

• , • .. .

/

PG. 24 ONTARIO BRANCH NEWSIFALL 1982

Give this application form to a fellow PHI APPLICATION FORMand ask him to join today. _

CANADIAN INSTITUTE OF PUBLIC HEALTH INSPECTORS_ • Incorporated

Send application to: _ or C.I.P.H.I.

PATRICKO'DONNELL,SECRETARY-TREASURER g BRIANHATTON

575 SUMMERHILLCRES. 1975CARIBOUCOURTSUDBURY, ONTARIO SUDBURY, ONTARIO

P3A 41'3 P3A 4W6

-- I hereby make application for Active,Membership ( ), Student Membership ( ) in the Canadian Institute ofPublic Health Inspectors. This application implies that membership is to continue until resignation is tendered, or untilmembership is discontinued" under the conditions contained in the By-laws of the Institute.

Name .............. , ................................ _............................................................. "................................... _"....Surname Printnamein full Christiannames

Address ......................... ................. -............ .......................................................................(for correspondence)

Date of Application ............. : ...... ':..._......................... Date of Birth ............................. :........... .................

Positions Held • t . ...... _.................................

...................................................... •...... ; ...................................... ..•.; ......................... , .........

Present employing agency .......................................... Present Position ........................................................

Qualifications (Education, Diplomas and Certificates Held, etc.) (Give Dates and Certificate Numbers)

C.P.H.I. (C.) Certificate Number J Date ............................

.............. •"....................................... _ ....................... ? ............ ".................... ; ................................... ° .........

q

I enclose $40.00 in payment of one year's Regular membership fees.• []I encloseS5.00 in payment of one year's STUDENT membership, fees, []

I enclose $3•00 in payment of onc ycar's RETIRED membership fees. []•I enclose $45.00 in payment of one year's fees as a new member. * _ '

Date of_Application ............................................... Signature ..........................................................

•New Memb'er - one who has never been a regular'member.

For Branch Use, ,(

I recommend that the above applicant be accepted lor membership in the Institute•¢

Date ........ '.............................. Branch ..................... " ...... Signature.. _....................................................(BranchOfficer)

k

' For National UseJ

Date ot_Acceptance for Membership .......................................... Signature. ................................................... :President

Canadian Institute of PublicHealthInspectors.

ICertiticate andLapel Button Mailed to ............................................. ?.................... .............................. •.........

Record card filed Date ........................................................... /•

1982 Baseball _ -

Tournament CHAMPIONS

N

OTTAWA-CARLETON H.U.

From Left to Right: Front Row: BILL COULTER, FRANK ARMSTRONG, AL RAVEN,. RON MACINTOSH, BRADPRIVOST, WAYNE DESORMEAUX, [AN ROSE, BOBBY CLARK, Back Row: COACHES, STEVEN HANSON, DENNISTHOMSON, Second Row: TERRY MULLIGAN, *BILL BELLINGER.

Consolation WINNERS

PEEL REGIONAL H.U. RALPH STANLEY, AKBAR ALl, PAUL PROCTOR, PAUL

From left to right: front row: CARLOSCATARINO, AL CALLANAN, DAVE DORMAN. Third Row: CARL ARM-DUKE, ROSE PONG, RON MARCHAND S_eo0nd Row: STRONG, RICK RYAN, WOLF SAXLER.

,o

CANADIAN INSTITUTE OF PUBLIC :_ -"HEALTH INSPECTORS

• _- L'INSTITUT CANADIEN DES INSPECTEURSEN HYGIENE PUBLIQUE

" THE "INSTITUTE".---WHAT IS IT?Nationally: ...... . .... .. ,

The Institute is the only professional association for-Public Health Inspectors in Canada. It continuallyworks to protect the health of all Canadians-, advance the sanitary sciences and enhance the field of publichealth inspection by: _

1. Providing for ihe training and certification of P.H.I.'s across Canada, plus.those coming from foreign coun-.tries, through the operation and administration of the "Board of Certification."

2. Producing and distributing to the membership and others a professional and tech_nical journal; the Environ-mental Health Review.

3.. Orgamzing with the Branches a National Educational .Conference held annually in a different, centre acrossCanada.

4. Providing the members the right to vote, and the opportunity to hold office and take a leadership role in thefield of environmental health in Canada.

5. Developing standards in the health field through participation on the National Sanitation Foundation (NSF),an agency which sets internationally acceptedvoluntary sanitation standards.

6. Acting as a special resource in Canada for the maintenance and _mprovement of personal and communityhealth through the; " "

(a) initiation, encouragement and participation in health research _

(b) observation and anticipation of health needs such as manpower, resources, legislation and new environ-mental health programs, : " " ,_

(c) development and expression of viewpoints and statements of 'concern on a national basis'regarding- important'health issues. . .• ?

(d) advancement of knowledge, and exchange.of inforrfiation between hen th inspectors, those in other dis-clplines, industry, and the public, -- "

7. Promoting fellowship'an(_ dialoguewith colleagues throughout Canada.

8. Encouraging participation of as many mem_)ers as possible through the operation of the 7 Branches acrossCanada.

• 9. ,.Distribution of,information from various sources.Provincially: ' "

The Branches carry on the National wo_-k4'0fthe Institute at a 'provincial and local level.. Further, through .":- ..vari°us committees and appointments they. address concerns specifi_ to the region by: : ,. . . .- ._,

"; 1. Providing a vehicle through meetings, seminars and workshops" for discussions regardingprofessional _';educational and employment related matters.

2. " Developing briefs for submission to appr0pMateagencies on health related issues siJch as-corltrol and " :, : transport:of _hazardous wastes, noise,-air and w'ater pollution etc_i .- . ' ., .,

..: 3. Endeavour ng to initiate new legislation,ror_bring about changes and improvements to exist ngacts, regu a. "• tions,standards etc. . _ : . '_ " - . . ._. -

4. Providing and encourag ng bursaries, scholarships and awards for deserving persons .entering Or practising• in the field, including recognition for its members by way of re'commendations for Honorary& L fe Member-

sifiipsin the Institute. - • . ' ,, ..- _. ,. ,.. .... _ .. . :.o

5. Developing community,service projects in,the I_eath fie'ld f0rthe benef t of the citizens, the Branch & ns- -titutein general.' - . ' , , " .. - ..... .. ... • • . ,

• Arranging social eVents for members and their famil es "such as,bonspelsl go f_tournaments, clances, ban- '" "• quets and pic-nics. ' - • •. • - .. . . _ .. . _ . :

" 7... Producing and distribu.ting information_to • t he'.Branch 'members tl_rough minutes, flyers land' newsletters as_welt as contributing material to the Environmental Heait•h Review."' "• , " _ -. , . , • ':

.8. Working 'to raise the.status ahd standards oi P.H', 's'th_0ugh inservice and continuing education, .pro_es- :sional development, plusparticipation in tl_e field.tra n'ng, examinat on and certification process'for pros-

- " pe(_tive P.H.I.'s. . .. !: . " . . . . . . . /"'g. Providing a form of solidarity for themembersas thbyjointly ende'avour to meet andsei new'standards for' • the profession . . " . " , ,