Buttering Bread is an Infection Control Strategy!

Buttering bread stopped a plague.

In the 16th century, Copernicus (yes, the physician and astronomer) commanded the Allenstein castle in Prussia which was besieged by Teutonic Knights. A “plague” in the castle rendered many soldiers ill, including Copernicus. He divided the people into various diets and noted that the contagion was related to bread intake.

Soldiers atop the castle worked 12 hour shifts and took lunch while on duty (no workers’ rights there!). Copernicus determined that the bread-loaf was contaminated when accidentally dropped on the floor whilst being carried up the narrow steep stairs to the turrets by untrained staff pressed into waitering. The staff put the dropped bread back on the tray but as it was black in colour, the contamination with dirt and pathogens was not noticed.

A friend suggested coating the loaf with a light-coloured spread so they would detect if it had been dropped. They used churned cream and when eaters elected to clean or reject visibly dirtied bread, the epidemic halted. The practice was publicised by Copernicus’ colleague, BUTTENADT, secretary to the Apothecaries and Physicians Guild. The practice of BUTTENADTING later became popular with the people and the shortened form of the word became BUTTERING.

PS (TG). The epidemic would not have been THE plague (Yersinia pestis – spread by flea bites) but likely to have been any one of several diseases transmitted from rat faeces. Must be coincidence that the word “butter” is derived from the Greek Bouturon (“cow-cheese”). And for those whose bread always falls butter-side down – that’s fundamental physics and the height of your table!

Great to have neighbours with wine connections

Vanya Cullen of Cullen Wines??

Wine is another love my wife Jenny and I share.

In our kitchen we have a large poster ranking Australia’s top wines – you can imagine our excitement when our neighbors Christine and Mana popped in to ask could they bring over their guest to share a wine with us – their guest? –  Vanya Cullen of Cullen wines! Cullen’s “Diana Madeline” (named after Vanya’s mother) is on top row of the poster!

Wow! – we were having wine royalty for drinks! What do we serve!? After a wee while in our cellar fondling bottles we chose a ’98 Lakes Folly and decanted and aired it, hoping it would “stand the company”. When Vanya entered carrying a 2005 Diana Madeline we knew we had a contest!

We all agreed the Lakes was smooth, elegant and up with good Bordeaux as Max intended. And the Diana Madeline … we have never sampled a wine so balanced – we thought it would last for years – then Vanya said “I’d like to try this in 30-40 years time! Vanya rattled off at least 6 descriptive adjectives that immediately magnetized our noses to our glass and with many inhalations and memory synapses, we recognized 3-4. What a learning experience it was to have a diva vintner as our tutor! We had to pinch ourselves – we were drinking one of Australia’s top wines – with the woman who made it!

Cullen’s has a homestead in which guests can stay. You can bet what our next visit to Western Australia will entail.

Sharps injury rate may be due to non-use and non-activation of safety devices

Our recent study of Sharps injury (SI) incidence in USA shows there has been little reduction in overall SI incidence in last 10 years. This is puzzling as, under OSHA law, every hospital must use safety engineered devices (SED) wherever commercially available and clinically feasible, review their Exposure Control Plan and new technology annually, and maintain a log of all SI. We also know that every hospital is conscious of their SI incidence and is striving to reduce it. So why hasn’t the national incidence decreased?

In a recent publication to investigate one possible reason for the above, I audited a sample of 18 sharps containers from 5 Florida healthcare facilities. The results were disturbing – over half of the sharps were NOT SED, and of the SED, 22% were NOT activated. It is only a sampling of one region in one state but my experience tells me these results may reflect a national phenomenon.

These results indicate that:

  • less SED are being used than thought (do staff have non-official access to non-SED?), and
  • more SED are non-activated than thought (do staff not see need to always activate?).

Non-use and non-activation of SED may be one explanation for the lack of falling SI incidence in USA.

Are you a healthcare professional?

  • If so, how do we correct this?
  • Under what circumstances do you see HCP:
    • not using SED?
    • not activating SED?

I’d like to hear your feedback and opinions

Survey reveals USA sharps injury prevention is not meeting goals

This is my first blog so please forgive any ineptness – I felt I should quickly get the word out to as many as I could. My recent national survey with my colleague Linda Good estimated that 322,000 US healthcare personnel (HCP) sustain sharps Injuries (SI) each year – but that disturbing news is compounded by the fact that our results show there has been no significant decrease in this figure since 2001. And this is in a developed country that has enacted sharps injury specific laws (NSPA 2001) – think of the plight of HCP in developing countries with scarce resources for safety devices.

Sharps injuries (penetrating injuries of the skin by a cutting/pointy item) among HCP can transmit over 60 different diseases (AJIC 2006) the three most published being HIV/AIDS, Hepatitis B and Hepatitis C. With Hepatitis B, the risk of getting disease from a positive patient is a worrying 1 in 30. This worrying is an important but often neglected facet. HCP often have to wait months for confirmation of “All clear” and have to modify their sexual and maternal practices while waiting, and this takes a huge emotional toll on injured HCP. I know of 4 marriages that have broken under this stress.

Along with many colleagues I am striving to bring this situation to the notice of politicians, healthcare administrators and managers, and the public. We need put zero back on the radar. We need find a new vigor to protect these workers – it may be more intense, repetitive, competency-based education, HCP ownership of their safety, or technology less dependent on human behavior, but a change must occur.