Fighting Bacteria, Fungi and Viruses

[Music] Welcome to Process This, a podcast for the Steril Processing Community. The Healthcare Steril Processing Association, HSPA, invites you to log on, listen and learn. Now it's time to process this with your host, clinical educator, Casey Zarnowski. [Music] Hello and welcome to the Process This Podcast. My name is Casey Zarnowski and I would like to start with a big thank you to all of our long-time listeners and a big welcome to our new friends. We have a ton of intriguing and informative guests lined up in the coming months, so be sure to keep a lookout for our regular guest line-up announcements. All of our podcasts are available on demand on your favorite platform. When you are ready for us, we will be there for you. [Music] [Music] In the Steril Processing Department, we work hard to protect our patients from harmful microorganisms. It's like we are the last line of defense against an alien invasion. But what weapons do we have in our arsenal to protect the inhabitants of our home planet from bugs, fungi and viruses? Today we are talking with Larry Talapa of Soventum about those microorganisms and there are a lot of them that invade our surgical instruments and what we use to make the planet safer for our patients. Larry, welcome. Thank you, Casey. I really appreciate being here today. I am excited about this topic that you put together. So a little bit about myself and why I am excited about this topic. I am educated as a microbiologist, so I got my degree in microbiology from the University of Minnesota. I remember the day very clearly when I decided I wanted to go into microbiology. I was so pumped excited. It was such a clear moment in my life. I even called my parents and said, "I know what I want to do." So I was very excited about that. I went to being an educator as a microbiologist. During that time I was working in an environmental sterilization laboratory at the University of Minnesota. That's why I started my career in sterilization. From there I went to Medtronic as a sterilization engineer. And then after that I went to 3M, which is now spun off to be Soventum. And during that entire time I have worked with our biological indicators, our chemical indicators, and steril processing departments on education, on sterilization, and disinfection. So to talk about bacteria and fungi and virus, it's just like the root of my education and I am excited to do this today. I love it and if our listeners, I know that they can't see us, but if our listeners could see Larry's face right now, they know that this is going to turn out to be a great discussion. So Larry, let's begin with bacteria. What are bacteria? Bacteria are single-celled living organisms. They are found almost everywhere on our planet. We could say soil, water, surfaces, on and inside human bodies and other animals. Many bacteria are harmless and many of them, like the ones we have in our gut are beneficial to us. So healthy bacteria in our digestive system helps us digest food. And I just was researching recently we have bacteria in our stomach that can actually regulate our appetite. Wow. Fascinating. Yes. Now you can get a virulent form of that bacteria, which think disrupt a lot of other activity in your digestive system. And I mentioned that because my wife is a health assistant at the local high school and she had two students recently diagnosed with this. So we both looked it up and it was quite interesting. So of course we know bacteria can cause disease. This disease causing is their ability to reproduce a rapidly. So under the right conditions, bacterial populations can go very quickly. And some bacteria as we know produce bacterial spores. And so when a family of bacteria, this specific species, if it detects its environment around it, has become fortress or the environment is no longer able to support them, they will say, I'm out. Peace out. I'm out of here. I got to go because I cannot survive here anymore. So I'm going to put all my genetic information into a spore, very resistant. And then I'm going to move off to another location. Oh. And then the same spores is what we were using in our biological indicators for monitoring sterilization processes. And we use those because we know they're the most resistant to our sterilization process. So hold on there. I always thought a bacterial spore was just a bacteria like curling itself up like a little armadillo or something and resisting. But it's actually something other outside of the body that bacteria are really. Yes. Absolutely. Absolutely. So it's very interesting. I actually did a presentation recently on this actual topic. But what happens is your vegetative, what we call them vegetative bacteria that can replicate and make a colony, a family together where they're just living. Again, if they detect, they cannot survive here. The conditions have become too harsh. They then take all their genetic information, wrap it up into a tight ball and everything else around it's dispersed or digested or however you want to call it. So they're taking all their information into what now is a spore or like a nut or a seed that it can either stay in the location or move off to somewhere else until that spore senses the environment is safe to reproduce again. So it's a different whole different entity of Michael organism. Wow. You know, I talked in the intro about an alien invasion that totally sounds like something from a science fiction movie. I love your alien invasion because what I have talked about this in the past is in the microbial world. The world we can't see with our naked eyes, but where these microbes were talking today. They're badly themselves. They are under warfare. They are under warfare for resources and space to live food and water. We'll talk about fungi, but penicillin, if you think of penicillin as what we're using as an antibiotic, it's from a fungus. And so the fungus is producing that so bacteria won't invade its space so it can live. They're actually battling each other with their abilities to reproduce in our environment. So I call that microbial warfare because they are competing with each other. Unreal. All right. So bacteria, what types do we encounter in the soil processing department typically and what diseases do these bacteria that we encounter cause? Yes. In cell processing department in a hospital, we can run into some dangerous bacteria. And they can be contaminated in our devices and our instruments in common health care associated bacteria is staphococcus orius. Or we could also get MRSA, which stands for mepilline resistant, staphococcus, orius. A C-diff is another one. A C-diff is a bacteria that can also create a spore. So we call it a spore forming. A coli as well. A coli found in our gut that can be very detrimental to someone who's compromised. Pseudomonas are genosis. So pseudomonas is typically in moist environments of water. And then also, which I have just learned in preparing for this case is Michael bacterium tuberculosis. So tuberculosis is one of the microorganisms globally that's compromising or killing people that are already compromised. So globally tuberculosis is a bacteria that's been highly recognized as one that we have to get better control of. Okay. And pseudomonas, that's something that our friends with the plant ops think of when they think of legionaire diseases, right? In the maintenance department, that's what they're watching out for. Yes. So, not a world expert on this, but the legionaire disease because of this water. If you've got sitting water somewhere and if this my memory serves me correctly, it's coming from air conditioning events originally where pseudomonas was living. And you can find it in your shower. You can get the pink stuff in your shower that could most likely could be pseudomonas. Not my shower. I said, I'm not sure. I've got a third of shower. No, but what that happens. And so the legionaire and you said mechanical, if you got sitting water in your mechanical vents in your air things where you could maybe disperse it, that's a potential site where you could have that problem. Okay, fascinating. So how do we kill bacteria? What exact part of our of our process It takes care of bacteria. Maybe there's more than one. Maybe it's multiple We have we have several several methods for killing bacteria So I want to start off with because I think it's fascinating in the CDC guidelines that you can find on the website CDC website It's free on sterilization and disinfection Figure one towards the back. It has a great diagram or figure. It's a called figure one where it looks at the resistance and so when I say resistance It's the ability of that microorganism not to be healed And so it looks at the resistance of microorganisms from bacterial spores to virus to fungi and the ability to withstand specific items we have in our arsenal of our SPD So it goes from cryon reprocessing all the way down to low level disinfection so you can take a broad scope on okay How do I kill these microorganisms? What is that generality of Method that we can use to to destroy these microbes and we can look at this To help us understand. Okay, what tools are we using in the SPD to eradicate them? So it's a good reference and resource But I was a remiss to say the first thing what we have to do and we always talk about this in the SPD is cleaning It is so critical important for cleaning of the devices cleaning of contact surfaces surfaces that we touch so we don't want to spread it cleaning of storage areas cleaning of air ducts The cleaning is important because we don't want a reservoir or a location where the bacteria Itself can harbor and be protected so on a device we talk about mucus bodily fluids and blood. We don't want it protected because Generally these microorganisms are easy to kill bacteria are relatively easy to kill when they're outside of the body so I mentioned figure one that shows about look high level disinfection Little intermediate log will take care of the majority of these pathogens that we are concerned about But I was remiss to not mention cleaning first because if they're protected by something outside of themselves It makes them harder to kill and it potentially could make that sterilization process But for bacteria cleaning and then disinfection of course low-level intermediate high-level disinfectants are effective against a majority of bacteria and of course we use Intermediate low or high-level depending on the device that we're disinfecting on that spalline's classification What I do want to mention and I think it's important when I was researching just last night again preparing for this today Is there are different disinfectants and you need to use them at different concentrations and contact times and Michael organisms can be more resistant than others to specific disinfectants Okay, important important to have a disinfectant that's EPA approved that EPA approval requires stringent testing on specific types of bacteria that you're going to find in your department so Following the IFU Following the instructions for use I know we say it all the time, but it's important because we got a lot of science behind those I am used to assure that they're killing the bacteria and so our disinfectants would reduce it the majority of those bacteria that we're gonna find And then of course sterilization Steam sterilization is going to take care of that highest resistant. We know those bacteria spores That's why we're using biological indicators and then could be steam could be ethyenoxide or vaporized hydrogen peroxide Okay, so that's how we're using and rid of these bacteria in the SPD Perfect that's great stuff and we will put the link to that CDC guide which I've used lots of times before We'll put the link for that into the description of the podcast so that people can look at that figure one or the whole thing The whole thing is just great. It's a little bit older, but it still has some really great information on it So thanks for bringing that up. We'll get the link into the into the description. All right, let's move on to fungi. What are they? Okay, fungi are living organisms as well and they can be found almost everywhere in the environment But they are different than plants. They're different than animals and they are different than bacteria and I'll try to Describe why they are different some are harmless and some are even useful as we know yeast is a fungus Yeast that we're using to make bread rise or Yeast that we use to brew beer I did a lot of beer brewing at one time until my wife said you are stinkin up this house So I had to stop it. She goes do it in the garage. I said well, I live in Wisconsin. I can't do it in the garage Eight months out of the year but Casey I tell you you sparked me to want to do it again I'm like I'm going back to brewing because I love this and there's a specific yeast Which is a fungi that you would use to brew beer But however some fungi can cause infections in humans And to me just seems like something I would just never want to experience as an infection by a fungi that you cannot get rid of Now fungi they grow best in warm and dark and moist environments and They reproduce the majority of them by Spores as well. So releasing spores out into the environment where they can go and relocate and find an environment where they can then also reproduce and grow bigger There's several types of fungi There are mushrooms and these are visible reproductive fruit and fruiting type of bodies which sprout from a vast underground web like roots in the ground Now we also have molds and yeast and molds and yeast are the type of fungi that we'll most likely find in our health care facilities in our S.P.D. Department Our molds are Filamentists so they're filamentists that form fuzzy Multicelular colonies and these molds are ones you're most likely going to find on your food that's starting to decay So that's a very common one to find and I mentioned yeast So yeast or single-celled fungi that reproduce by budding rather than spores So you got a single cell and it kind of buds out another one and That's the three categories of fungi and What they are and the differences of them Okay, and what types do we typically encounter in spd and what diseases do they cause? So in the stair processing departments you may we may encounter fungi Of course on surgical instruments or on flexible endoscopes I mentioned before with bacteria we can find them in storage areas You mentioned legionnaires with bacteria you could also find fungi in air handling systems and then also Hon pack surfaces so if you've got it a patient that's infected with a fungi contact surfaces of the patient rooms or Equipment that they're using you can find them two of the most common and can be very deadly fungi and healthcare is handed in and that's a yeast those infections I've reading more of that last night these infections are horrible for patients and and that Candidate yeast can spread very easily on contact surfaces and then aspergillus That is a mold that's a mold that can be airborne and found in dust and air and soil Okay, so patients with a weak and immune systems these fungi can be detrimental all right Alright, so they're really bad when they get into the patient. How do we prevent that? How do we kill them in spd so that that doesn't happen? Yes, so as I had mentioned before very similar to bacteria in regards to cleaning so cleaning of our devices extremely important we don't want them having a place they can harbor and be protected on our devices but also cleaning of our department and of our storage areas where dust and other areas can collect so and aspergillus or this fungi that can Flow through the air so that cleaning is so also critically important So we got to do that first step because of cleaning so then our disinfectant so again We can look at the figure one in the CDC guidelines and look at okay What fungi are more resistant or less resistant to our disinfectants and I believe when I was looking at it before we need to have some high level disinfectants or at least an immediate disinfectant for some of our fungi that I just mentioned, Aspergillus and Canada, it because they are both mentioned in figure one in the CDC guidelines. So our intermediate to high level disinfection is critical for these locations and surfaces. And then of course, after that, for our sterilization, it's important for theme. And then of course hydrogen peroxide and then or ethnoxide for that final sterilization. Okay. But again, we could go into all the different chemical disinfections like hydrogen peroxide, paracetic acid or bleach solutions. I don't want to emphasize one is better than the other. I just definitely follow your manufacturers, IFU for that disinfectant solution that you are using in your department. Okay. Perfect. When we were discussing this podcast, you mentioned a particular fungus out in the world. That's the largest organism that we know of. Can you talk a little about that? - I love to talk about this. So it's called a honey fungus. Honey fungus, I have to be very hard to explain to get the name, but I'm going to try to get it. Armorella Oceolo. It's, I can't pronounce it very well, but it's located in Oregon and it's roughly 3.5 square miles. So it's 1600 football fields, and the majority of the fungus is underground. And it's spreading out 3.5 square miles. And within those 3.5 square miles, it's communicating amongst itself. And it's doing this with mycelium. And this is what the technical term of them being able to communicate with itself. They're, Hasey, they're predicting it's thousands of years old that this organism is living. Now it's not dangerous to us, but it's dangerous to the forest and the trees with root rot, because that's what it's going to use. And decay on. Again, the majority of it is underground. We're only going to see it when it mushrooms out and wants to then spread its spores to grow. Cool. So then it's awesome. That's awesome. fungus. Yeah, fungus scares me now. I don't know what it is. It's something that I find so creepy. Well, if we think that's creepy, I think we move on to the most alien like of our microorganisms in my mind. And that is the virus. So tell us what is a virus? - Viruses, I think, probably got me into microbiology, and I've stirred the passion inside of me. So viruses themselves are much smaller than bacteria or fungus. So let's look at the size. They're going to be much smaller. And I'll explain why that is. Unlike fungi and bacteria, viruses are not considered fully living organisms because they can't reproduce on the room. - Oh, all right. - When I was in school 35 years ago, it was still a debate. We would love to have this debate, is it alive? Is it not alive? Is it a living organism? Just because it can't reproduce on its own, is it alive? I was always on the side of, it's alive. It's alive. It can do things. It can find its way to reproduce. And so that would be my opinion. But because it can't reproduce on its own, it needs to get into a host. It needs to get into a cell. And so what it does, once it gets into a host and a very specific cell, these viruses are very specific on the cells that they can get into. The specificity is important because what it does, this virus, very small, finds the cell that it knows it can get into, it gets into it. And then it says, "Hey, cell, you're no longer gonna do what you're supposed to do. You're gonna make me. - Wow. - You are going to reproduce me. I am taking over your mechanics. You no longer do for the body that you're supposed to do. You make me." And then at some point, the cell will make so much of that virus, the cell lysis. It explodes and the virus then go out inside that host and find more cells. And so you're getting this massive burst of these viruses. They get to other cells. They reproduce for a while. And then they get to other cells. And they reproduce for a while. So they're not a bacteria. They're not fungi. They are parasitic in a fashion where they need to take over and be reproduced and tell a cell to do that. What I also find fascinating about them, they're not just human cells. They're in plant cells. They are in animal cell. They have viruses for animals. And then there's also viruses for bacteria. - Wow. - So there's viruses that specifically attack and get replicated by bacteria. - Yeah, they're animals. - So they're ubiquitous. They're everywhere, depending on it. Now one other item, maybe I'm getting a little verbose, they're sorry, what I was always taught in microbiology, they are so specific, these viruses, on the host cell that they actually can get into and take over, that it's very rare that they cross over. You hear sometimes, you hear crossover, avian bird flu. It's a virus that affects a bird. How does it cross over into a human? Because it has to be very specific. And so when COVID-19 happened, I was very confused. And very confused on how can that virus affect so many different organs in the body? Still don't understand it, not an expert on it, but I was perfect by it when we hear the reports of all the different organs this virus was able to infect in the human body when I was always taught that it's very specific. Because if you think of the mechanism, it can get inside a cell without destroying it and then tell that cell reproduce me so that I can go and affect other cells. - Excellent. - But yeah, viruses are fascinating. Alien, they like what you said, they learn. - Nice. - We are going to pause our conversation here just for a moment. Are you looking to receive continuing education credit for this podcast? To receive credit, log into your MyHSPA account, register for this podcast and use the code Aliens. Here's that code again, Aliens. You need that code and it only works for this episode specific to our discussion today. If you don't have a MyHSPA account, no worries. You can create one for free and it will help you keep track of your CE's all in one place. Now, let's get back to our conversation. So Larry, what types of viruses do we typically encounter in the Stereo Processing Department? - Good question. And there are a variety that we could encounter. And those viruses, the ones that are related to blood contaminated instruments, of course, respiratory droplets from infecting patients or potentially infected co-workers or we could get them from bodily fluids and of course contaminated surfaces and touch points and facilities. And these viruses include ones that cause hepatitis B or HBB, hepatitis C, HCV, of course HIV, the virus that causes AIDS, flu virus, very calmness. Of course, I mentioned a little bit COVID-19 and then also neurovirus, the stomach bug it would just be horrible to have as well in my feeling. And so all of these types of viruses and we could go down to other lists of course that you could potentially encounter in a healthcare facility. I feel if you can encounter it in the healthcare facility, why would you not encounter it in a Stereo Processing Department? It would find its way, some way, a down there in my opinion. - Right on, right on. Our viruses really that hard to kill. I know that when COVID came up, the Stereo Processing Department was asked, how do we deal with this? How do we kill this thing? Not in the body, but when it's on surfaces, when it's on our instruments, what is our answer to that? That is a great question. And again, not in the body, 'cause you know in a body, very difficult, the viruses inside one of your own cells. How do you do that? But we got a really great scientists out there to know how to hunt that down. But outside the body, they're very susceptible to disinfection. But of course, I gotta emphasize the cleaning. The cleaning is important, but also, I do wanna mention viruses aren't as stable outside of their host. So their ability to remain viable, outside of a host is minimal as compared to like a fungus or a bacteria that could be on a surface in a hospital. So that is minimal in a generality, but important to clean because if it is harmered in bodily fluids or blood or mucus, so it can stay a little bit longer. But in general, once we can get to them, you just basically need intermediate to low level disinfection to be able to inactivate them. Of course, higher level disinfection is always going to be helpful as well. I mean, you can look at alcohol solutions, bleach, hydrogen peroxide, quats. All of these are effective against viruses, of course, outside of the body. Again, I want to impress using these disinfectants, or me just mentioning, "Oh, alcohol works on viruses. Gotta follow that IFU, ensuring the concentration and contact time is followed." Now, in regards to sterilization, no problem. If that device is presented in sterilization, to be able to contact all the sterilized surfaces, hydrogen peroxide, ethylene oxide, or steam, it's going to have no problem in activating those viruses. All right. You know, if you want to mention a little bit more in regards to SVD and healthcare facility, came across a lot in this research for this podcast in viruses, and it seems common, but very important. Now, you're talking about how do we get rid of those in our healthcare facility and SPD? Also, is just prevention. Prevention using hand washing. Just hand washing. So critical, you know, and then our PPEs. You see the PPEs that they're using in patient rooms? They're preventing that spread. We can prevent that spread. We can reduce the number of patients that have it, or reduce that reservoir of it transferring around the healthcare department. All of that is critical as well, just prevention of it, and then vaccination as well. Again, having the PPE hand washing, so we're not the reservoir that's bringing it into the healthcare facility, potentially bringing it to a patient that's already compromised. Wow. That's really great to remember that that we really have to protect ourselves in order to protect our patients. I love that. And this podcast, we've got some extra baddies on our planet that are for one reason or another resistant to our defenses. The World Health Organization publishes something called the bacterial priority pathogens list, and you can look this up at www.who.int. And to quote from an article about it in the Lancet, the emergence and spread of anti-microbial resistance threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses, and fungi. Larry, can you tell us a little bit about this aspect of the fight and how we in-stay our processing can contribute? Casey, thanks for bringing this to my attention, the item that I had found through WHO is infection control practices. And that's where the SPD comes in. Infection control practices to prevent the spread and infection of these microorganisms. Patients not become infected, then we're going to have to have less use of the tools to eradicate them. Sterilization and disinfection. Disinfecting our work surfaces, cleaning our work surfaces, when I say cleaning, it's also cleaning and disinfecting helps it control it. That's really important. If you're in your SPD department, again, these microorganisms are going to find their way down there, keeping your work spaces clean and disinfected, critical. We're not just saying it because that's what the auditor's looking for. It provides a practical purpose. And then of course, hand hygiene. So critical. I'm not in patient care areas that often. And that is by design. I don't want to be in the patient care area. I'm in the SPD because I want to help out our colleagues in our profession, but in patient care. But when I am in patient care areas, that hand washing, I love to see those nurses. They know right away. Hand wash, walk in and out, hand wash, walk in and out. They're doing it all the time. So critical to prevent that spread, not just from human human, but on contact points where another human could touch it. And then the other item in regards to this is also surveillance and monitoring. And I think the WHO who does a really good job surveillance, monitoring and communication to professions like ours, when there has been a change or a shift or potentially something more that we can do for something that could be emerging out there. Wow. Wow. Well, thank you for listening. And thank you to Larry Toulapa for your expertise and for your tireless traveling all around the planet to bring that expertise to our sterile processing professionals everywhere. And as you go about your work today, please remember that every patient is someone's most special person. Thank you. [BLANK_AUDIO]