SPRING 2014Vol. 6 l No. 2

AddressingContaminatedSurfaces inHospital Settings

Page 2 Page 5

Is it Safe forChildren to UseHand Sanitizers?

Whether you’re a small busi-ness just getting off theground or a multi-milliondollar company, trade shows

are a great resource for connecting with yourmarket and showcasing your product in amore intimate setting.

In today’s competitive market, adver-tising and social media can only do so muchin terms of product understanding. Theadvantages of being able to physically see

7 Reasons Why TradeShows are Good For Business

and feel the product or service, as well asbeing able to engage with the people be-hind it, are unsurpassed by traditionalforms of advertising.

“One of the most useful aspects ofexhibiting in a trade show is being able tospeak with consumers one-on-one,” saidHeather MacRae, manager of LandscapeOntario’s expo and congress trade shows.“Trade shows allow exhibitors to show-case their product or service in person,

rather than trying to convey it through anad. The personable interaction at tradeshows is far more helpful because you arephysically there to display and discuss thetrade and your product’s usefulness to it.”

Following are some reasons why beinga trade show exhibitor can be beneficial:

• Meet prospective clients. This is a greatway to connect with people that are alreadyinterested in your trade. Give them advice,show your expertise and hand them a busi-ness card or brochure with more informa-tion.

• Be the trendsetter. Being an exhibitorat a trade show is a good opportunity toshow everyone what your business is madeof – get creative, inventive and let yourdisplay help demonstrate how you are get-ting ahead of the curve.

• Enjoy the opportunity to be featuredin major media publications. Trade showsaggressively pursue media coverage. Withan interesting booth, you may catch theeye of a reporter who may want to speakwith you about your product or service.Prepare yourself and be ready for potentialmedia coverage that brings additional value.

• Great way to advertise. The fee ofpurchasing a booth is a good investmentconsidering the amount of exposure yourbusiness will get from the media andguests attending the show. Remember, themore attractive and original your displayis, the more views it will receive form guests

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Mark your calen-dars for Wed.,Sep. 10, whenthe Canadian

Sanitation Supply Associa-tion’s (CSSA)Atlantic Chap-ter presents the Clean Atlantic2014 trade show and educa-tion conference. The show

egates with information on the mostpertinent issues affecting the indus-try today – infection prevention, greencleaning, sustainability and improvingbusiness practices.

For more information, contact CSSA at(905) 665-8001, Toll Free: (866) 684-8273or visit the association’s web site atwww.cssa.com.

Clean Atlantic 2014

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will be held at The Cunard Centre, 961Marginal Rd., in Halifax, NS.

If you are a decision maker or end-user of janitorial supplies, Clean At-lantic 2014 is where you want to be.In addition to viewing and testingthe latest technologies available onthe trade show floor, an outstandingline-up of speakers will provide del-

2 Clean Atlantic Canada – Spring 2014

at the trade show and media.• Meet experts in the field. A trade

show is an opportunity to network withother professionals in your field. Lookat them as partners instead of compe-tition, and use the opportunity of thetrade show to extend your contracts,attract business leads, exchange tasksand complete joint projects.

• Start building sales. Going to tradeshows isn’t all about looking pretty;trade shows are good for building brandawareness and, hopefully, generating

7 Reasons Why Trade Showsare Good For BusinessContinued From Page 1

The transmission routes ofpathogens are complicatedand difficult to investigate, sostudies focused on the role of

surfaces in transmission have been rareuntil relatively recently. The role played bycontaminated environmental surfaces inthe transmission of nosocomial patho-gens was recently addressed in an Ameri-can Journal of Infection Control article(2013 May; 41) that presented the latestdata evaluating the role of contaminatedsurfaces in transmission and discusses thevarious strategies available to address en-vironment contamination in hospitals.This article is excerpted from that review.

Data suggesting that contaminated sur-faces play a role in transmission come from:studies modeling transmission; microbio-logic studies in vitro and in situ; observa-tional epidemiologic studies; interventionstudies aimed at improving the efficacy ofcleaning and disinfection; and outbreak re-ports.

Modeling transmission routes canprovide “proof of principle” that contami-nated surfaces are involved in transmission:for example, monitoring the spread ofnon-microbial markers, the use of animal

Addressing ContaminatedSurfaces in Hospital Settings

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The recent discovery of biofilms on dryhospital surfaces may provide a mechanismthrough which vegetative bacteria couldsurvive on dry surfaces for such extendedperiods without a nutrient source. Severalin vitro microbiologic studies have inves-tigated the transfer of pathogens fromsurfaces to the hands or gloves of healthcare personnel in the absence of direct pa-tient contact. Contact with an environmen-tal surface carries approximately the samerisk of acquiring MRSA, VRE and C. difficilehand or glove contamination as touchingan infected or colonized patient.

sales. Make sure you stock up withmarketing materials, brochures andbusiness cards to give to prospectiveclients, but also find a way to get theircontact information to keep them up-dated with new developments.

• Displays in addition to portfolio.Sometimes portfolios just don’t cap-ture the essence of your work, whereasa display is more physical and tangible.Potential clients will be able to see andfeel your product, which is always bet-ter than a photo or video.

Carefully performed observationalepidemiologic studies have establishedthat contaminated surfaces are involved inthe transmission of certain pathogens. Forexample, one study concluded that at leastthree of 26 patients acquired MRSA di-rectly from contaminated environmentalsurfaces. It is somewhat difficult to deter-mine the independent role of contami-nated surfaces in these studies.

Intervention studies, including the useof a black-light marker or a specific changein cleaning methodology, are often usedto evaluate the impact of improved clean-ing and disinfection. Several prospectivestudies have demonstrated that interven-tions aimed at reducing surface contami-nation also reduces the transmission ofhospital pathogens. These can be broadlydivided into studies of a change in disin-fection agent, or educational improvementsusing existing agents.

Outbreak reports, and the findingthereof, are often limited by lack of con-trols, multiple interventions and the po-tential for regression to the mean. How-ever, many outbreak reports implicate con-taminated surfaces in the transmission ofC. difficile, MRSA, VRE, MDR gram-nega-tive rods and noroviruses.

Despite the limitation of the evidencebase, more needs to be done to addressenvironmental contamination in hospitals

models and math-ematical modeling.

Microbiologicstudies have estab-lished that certainhospital pathogenscan survive on dryhospital surfaces forextended periods.VRE in particularseems to have re-markable survivalproperties, with a re-cent study showingthat VRE can remainviable on dry surfacesfor almost four years.

Continued On Page 4

By LEE NESBITT,Virox Technologies Inc.

Clean Atlantic Canada – Spring 2014 3

The Canadian SanitationSupply Association(CSSA) has launched a newon-line source guide direc

tory, available in English and French,designed to showcase and promote theproducts and services of its member-ship.

The Membership Products Promo-tion Platform (M3P) is a specialized serv-ice resulting from a partnership betweenCloud Search Portal, a leading providerof cloud based search technology serv-ices, and the CSSA. M3P is specificallydesigned to meet the needs of CSSAmember companies that are looking foran online “Source Guide” solution forpromoting their brands, products andservices. In addition to providing aneeded promotional service for itsmembers, CSSA also offers a uniqueadvertising platform for those who areparticularly interested in reaching deci-

CSSA Launches InnovativeOn-line Source Guide Directory

Promoting Members’ Products and Services toEnd-Users of Janitorial Supplies and Services

sion-makers and active participantswithin the industry.

“CSSA is always trying to find newways to provide valuable services to ourmembership,” said Mike Nosko, execu-tive director of CSSA. “This on-line di-rectory presents us with an opportunityto proudly showcase and promote thebrands, products and services of ourmembership to the vast end-user mar-ket, not only in Canada, but worldwide.It also offers networking and connection

opportunities between manufacturers,distributors, retailers and service provid-ers within the industry. With M3P, CSSAwill actually help members increase sales,visibility and market presence.”

M3P works by using Cloud SearchPortal technology to automatically in-dex the web sites of all CSSA membercompanies. As website content is up-dated with new information, the CSSAsource directory will automatically re-fresh its search index to always presentfresh and current member website in-formation.

The CSSA is a non-profit Cana-dian trade association representingthe leading companies engaged inthe manufacture, distribution andsale of sanitary maintenance prod-ucts and services.

Please visit the CSSA web site atwww.cssa.com to see the Source Guide servicein action.

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Cold weather, which contin-ues to grip most of NorthAmerica, usually means coldand flu season will stick

around for a little while longer.Many cleaning professionals may be

asked to use disinfectants more frequentlythan at other times. While disinfectants canbe helpful because of their ability to killgerms and bacteria, they can also pose arisk to cleaning workers, building users andthe environment.

Because of this, Charlotte Products /Enviro-Solutions, a manufacturer of tra-

Using Disinfectants WiselyThe Contract Between the Manufacturer and the User

ditional and Green cleaning products, of-fers the following tips on how to use dis-infectants wisely:

• Only use disinfectants that have beenregistered by the Environmental Protec-tion Agency (EPA) – the EPA registrationwill be clearly printed on the label.

• Look for and take note of signalwords such as poison, danger, warning andcaution – the warnings are there first andforemost to protect cleaning workers.

• Note the dwell time. The EPA re-quires that surface dwell time be printedon the label – this is the length of time the

product must remain wet on a surface toeffectively kill germs.

• Wear personal protective equipment,such as gloves and goggles.

• Read the directions before use – thisshould provide a clear, step-by-step guidefor the safe usage of the product, as well asinformation on safe storage and disposal.

• Create a list of all disinfectants usedin the facility. This includes the names ofthe products as well as emergency contactinformation. Keep this information handy.

• Select the type of disinfectant needed

C

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4 Clean Atlantic Canada – Spring 2014

to deliver the safest possible health-care.Strategies to address environmentalcontamination can be divided into re-ducing and containing the shedding ofpathogens, and improved cleaning anddisinfection.

IMPROVED CLEANINGAND DISINFECTION

Effective cleaning and disinfectionrelies on the operator to repeatedly en-sure adequate selection, formulation,distribution and contact time of theagents used. Educational improve-ments designed to modify human be-haviour can be attempted with the sup-port of various tools including fluo-rescent markers or adenosine triphos-phate assays, and monitoring and feed-back can improve the frequency of sur-face cleaning, reduce the level of envi-ronmental contamination and reducethe acquisition of pathogens. However,no studies have evaluated the sustain-ability of such systematic improve-ments. Indeed, recent evidence indicatesthat altering the location of fluorescentdye spots reduced the proportion ofobjects that were cleaned from 90- toapproximately 60 per cent.

Improvements in hospital designand materials, novel disinfectants andcleaning/disinfection technologiesshould be evaluated to determine theireffectiveness in improving cleaning dis-infection. For example, there has been

recent discussion on “no-touch” auto-mated room disinfection (NTD) sys-tems, which remove or reduce the reli-ance on the operator to achieve adequatedistribution and contact time of theactive agents. HPV, aerosolized hydro-gen peroxide, ultraviolet C, and pulsed-xenon ultraviolet radiation NTD sys-tems have all shown promise and im-proved efficacy when compared withconventional methods. HPV has beenassociated with reductions in patient ac-quisition and evaluations of otherNTD systems with a clinical outcomeare eagerly awaited. NTD systems areonly appropriate for certain applicationsand should be introduced in parallelwith an educational campaign to im-prove conventional methods.

The finding that admission to aroom previously occupied by a patientwith a hospital pathogen increases therisk of acquiring that pathogen, com-bined with intervention studies show-ing that this increased risk can be miti-gated by improved environmental de-contamination, provides the mostpowerful evidence that contaminatedsurfaces contribute to transmission andthat more needs to be done to improvesurface decontamination. The mostappropriate strategies to address sur-face contamination will depend on thesetting and on local epidemiology.

Reprinted from the Fall 2013 issue ofVirox Technologies’ Solutions newsletter.

Addressing Contaminated Surfacesin Hospital SettingsContinued From Page 2

for a particular cleaning task. Many disin-fectants are designed to kill specific viruses– such as hepatitis.

“As mentioned, using disinfectantswisely involves reading the product’s labelcarefully,” said Jennifer Meek, marketingdirector for Charlotte Products / Enviro-Solutions. “View this as a contract betweenthe manufacturer and the user. The manu-facturer suggests how to use the productsafely and effectively, and expects the userto follow these instructions.”

Using DisinfectantsWisely Continued From Page 3

The Canadian Green Sustain-ability Program (CGSP) avail-able through the CanadianSanitation Supply Association

is a nationally recognized program com-plete with an independent, third party cer-tification and auditing system.

The CGSP was designed by Canadians

for Canadians, and was launched threeyears ago to provide equal opportunity,security, support, national representa-tion, audit privileges and more. It’s aprogram that brings manufacturers, dis-tributors and end-users, regardless ofsize, together to work and support oneanother.

Building owners, facility managers andindividuals wishing to achieve Green Build-ing Status will benefit through the new-est module in the program – CertifiedGreen Sustainability Manager. Certifica-tion in the program will lead to cleanerfacilities, improved indoor air qualityand a healthier building, not to men-tion a complete understanding of what ittakes to maintain the level of cleanlinessthat is expected. Learn more by attendingClean Atlantic on Wed. Sep. 10, 2014 atThe Cunard Centre in Halifax, NS.

Conventional cleaning has given way toskill, knowledge and communication. Ad-ditionally, exposure to harmful chemicalsover a career span has proven to be detri-mental.

With the Canadian Green Sustainabil-ity Program and the Certified Green Sus-tainability Contractor (CGSC) program,building service contractors (BSCs) and in-

Green Certification Through CSSA’sCanadian Green Sustainability ProgramT

Continued On Page 6

Clean Atlantic Canada – Spring 2014 5

The following article is posted onthe Deb Group Hand Hygiene,Infection Prevention and FoodSafety Blog – http://info.debgroup.com/blog.

In 2013 more than 600 comments wereposted to the Deb Canada hand hygieneblog – http://info.debgroup.com/blog –and its diligent team of experts tried torespond to everyone as part of the ‘Ask theExperts’ series.

Kayon Abrams, who teaches hand hy-giene workshops to children asked, ‘Is itsafe for children to use hand sanitizers as thereseems to be many different viewpoints.’

Barry Michaels, a regular blog contribu-tor, microbiologist and expert in infectiousdisease provided the following response:

This is a very good question and has beenthe subject of much toxicology research. Sincethe question is about children, I will try topresent a trail of information that is avail-able from scientific literature to help an-swer this aspect of hand sanitizer use.

With normal adult usage, ethanol hasfound to have stimulatory effect on skinkeratinocytes (most common skin cell re-sponsible for high-strength protein kera-tin) and even some improvement ofwound healing has been found. Damaged,abraded or lacerated skin increases risks oftransdermal absorption allowing alcoholand anything carried by alcohol to enterthe blood stream and potentially cause sys-temic effects. In adults with a normal, in-tact skin surface, the rapid evaporation alsolimits time that alcohol has to enter theblood stream. Net/net for normal, healthyadults the preponderance of evidenceshows there is no evidence of any toxico-logical endpoint indicating alcoholsanitizers should not be used.

The best evidence in favour of their useis the skin damage from hand washingnecessary to match the repeated germ fight-ing efficacy of hand sanitizers. Measure-ment of transdermal absorption with ex-posure many times above that experiencedin normal use shows only miniscule quan-tities entering the blood stream represent-

Is it Safe for Childrento Use Hand Sanitizer?T

ing perhaps 100safety margins. Po-tential damagefrom frequent handwashing men-tioned earlier is whyselection of theright soap is so im-portant and thefoundation of anyhand hygiene pro-gram.

While extremelylow sanitizer toxic-ity is true forhealthy adults,there is a subset ofthe adult popula-tion with an alde-hyde dehydroge-nase (ALDH) defi-ciency (higher in Asians) who will experi-ence skin irritation and sensitization to al-cohol hand sanitizers. Having a non-func-tional ALDH gene causes oxidative me-tabolism of alcohol compounds to be pre-vented with evidence of toxicity. Childrenwithout full functional metabolism aregoing to fall in with these individuals butwe need to look further into the story.

So, in otherwise healthy individualswith good skin barrier function of the stra-tum corneum, alcohol penetration is pre-vented. Destroy or take away the stratumcorneum and penetration is assured. Clean-ing up an accident victim with hand sani-tizer can even have legal implication asblood alcohol level can be impacted. And,this is where we have to consider youngchildren.

It is generally considered that childrenunder two years of age do not have skinwith a fully-developed barrier function andthis is the clear cut-off point in terms oftoxicology. Experiments performed onchildren from seven- to nine-years of agewith legs wrapped in alcohol soaked cot-ton and rubber sheeting for four- to nine-hours failed to show measurable bloodalcohol levels.

Alcohol and alcohol-free hand sanitizershave been used in a variety of elementaryschool settings with significant (30 to 50per cent) reduction of infectious diseaserates. Alcohol hand sanitizers have alsobeen used in daycare centres by staff andby children under strict direction from staff,again providing significant infection ratereductions. These are studies conducted inthe United States, Finland and Sweden. Thelatter two countries are known for advancedthinking in terms of dermal compatibilityissues and precautionary thinking when itcomes to child development.

We definitely have an age where alcoholuse in topically applied skin productsshould not occur (under two years of age).International infection control investiga-tors, whom prior to trials no doubt stud-ied the toxicology, seem to be pointing today care age as acceptable for use by chil-dren as long as it is under careful direction.By elementary school, barrier function isso well established that normal use five to10 times a day seems to be well acceptedwith no toxic effects demonstrated. As analternative, there are also alcohol-free or lowalcohol quaternary ammonium hand

Continued On Page 6

6 Clean Atlantic Canada – Spring 2014

Green Certification Through CSSA’sCanadian Green Sustainability Programhouse service providers can achieve inde-pendent, third-party certification. CGSC’swill be equipped with the knowledge toalso achieve “Green Building Status” at noadded cost to the building owner or facil-ity manager.

BSCs can visit the CSSA web site(www.cssa.com), locate a certified ExpertSustainability Professional (ESP) for con-sultation, and arrange for training.

“Since its’ launch, building service con-tractors have benefitted enormously,” saidJames Barkman, CGSP facilitator.

For example, the BSC directory was re-cently added to the CSSA website. Thishelps to validate a BSC’s commitment tothe program for those property managersand building owners seeking their serv-ices, or requiring advice on tenders or re-questing RFP’s.

According to Barkman, “ I won’t gointo the nuts and bolts of the program, Iwill leave that up to the ESP’s ( ExpertSustainability Professionals), but I will say

the CSSA has done a tremendous serviceby providing the BSC industry a Canadianprogram in which they can trust and de-pend on.”

The cost of the program is also afford-able to companies of any size.

The CSSA will be offering a three-and-one-half-hour Certified Green Sustainabil-ity Contractor certification program atClean Atlantic on Wed. Sep. 10, 2014 at theCunard Centre in Halifax, NS.

To register or obtain more information, con-tact James Barkman at (613) 503-0086 or e-mail: james.barkman@yahoo.ca.

Continued From Page 4

sanitizers that have been used in elemen-tary school settings that would also bebetter tolerated by individuals withALDH deficiency.

For adults and children over twoyears of age (under adult supervision)and not suffering from ALDH it isrelatively as per caveats above. Forchildren under two years, it is clearlynot appropriate due to their underdeveloped skin barrier function. Atthe border line, there is a grey area,where adults supervising childrenneed to be aware of the risks and takeinto account skin science presentedhere to manage risks not just due toskin issues, but also potential patho-gen exposures (e.g. petting zoos,etc.).

Indications are that for healthy adultsthere are no safety issues with these

exact science with a great deal of indi-vidual variability having been identifiedin how we respond to various types oftoxic exposure (e.g. even water can betoxic). Therefore, in this borderline re-gion, individual child health constitu-tion must be weighed with respect toskin barrier function, type and extentof potential pathogen exposure, andif there is time to get to a water sourceto wash hands before that little handmakes it into the child’s mouth.

products withnormal andeven exagger-ated use. Allbets are off ifskin is damagedfor adults andchildren. Toxi-cology is not an

Is it Safe for Childrento Use Hand Sanitizer? Continued From Page 5

CANADIAN SANITATIONSUPPLY ASSOCIATION910 Dundas St. W.,P.O. Box 10009Whitby, ON L1P 1P7Tel: (905) 665-8001Toll Free: 1 (866) 684-8273Fax: (905) 430-6418E-mail: mike@cssa.comWebsite: www.cssa.com

Clean Atlantic is edited for people whomaintain high standards of sanitary cleaningin commercial, institutional, residential andindustrial facilities (including hospitals,nursing homes and long-term care facilities,schools, food processing plants, hotels,motels, recreational centres, shoppingmalls, government facilities, restaurants,building owners, maintenance contractors,sanitary maintenance distributors and carpetcleaners).

The editorial objective of Clean Atlantic isto provide news and views about newcleaning technologies, new sanitary cleaningmethods, cleaning regulations and standards(where applicable), educational opportunities,industry trends, and information on peoplewithin the industry.