Gastro Bugs

17 09 2012

There is no such thing as “stomach flu,” despite the cavalier use of the phrase in some circles. What’s really going on is usually viral gastroenteritis.

Viral gastroenteritis isn’t caused by just one thing—it can be the result of any one of many different viruses, such as norovirus or rotavirus.

A gastro bug, as I like to call it, can be in the food or water we consume and will most commonly cause diarrhea, nausea and vomiting, and/or abdominal pain or discomfort.

Sometimes, it can also cause you to have a fever or chills, clammy skin, muscle or joint pain, and may put you off your feed. (That’s a “duh,” isn’t it!)

With liquids of various sorts pouring out of you, dehydration is a concern. Here are the signs, symptoms, and potential treatments to consider, as specified by NIH:

Signs and tests

The healthcare provider will look for signs of dehydration, including:

  • Dry or sticky mouth
  • Lethargy or coma (severe dehydration)
  • Low blood pressure
  • Low or no urine output; concentrated urine that looks dark yellow
  • Markedly sunken soft spots (fontanelles) on the top of an infant’s head
  • No tears
  • Sunken eyes

Tests that examine stool samples may be used to identify which virus is causing the sickness. This is usually not needed for viral gastroenteritis. A stool culture may be done to find out whether diarrhea are causing the problem.

Treatment

The goal of treatment is to prevent dehydration by making sure the body has enough water and fluids. Fluids and electrolytes (salt and minerals) that are lost through diarrhea or vomiting must be replaced by drinking extra fluids. Even if you are able to eat, you should still drink extra fluids between meals.

  • Older children and adults can drink sports beverages such as Gatorade, but these should not be used for younger children. Instead, use the electrolyte and fluid replacement solutions or freezer pops available in food and drug stores.
  • Do NOT use fruit juice (including apple juice), sodas or cola (flat or bubbly), Jell-O, or broth. All of these have a lot of sugar, which makes diarrhea worse, and they don’t replace lost minerals.
  • Drink small amounts of fluid (2-4 oz.) every 30-60 minutes. Do not try to force large amounts of fluid at one time, which can cause vomiting. Use a teaspoon or syringe for an infant or small child.
  • Breast milk or formula can be continued along with extra fluids. You do NOT need to switch to a soy formula.

Food may be offered often in small amounts. Suggested foods include:

  • Cereals, bread, potatoes, lean meats
  • Plain yogurt, bananas, fresh apples
  • Vegetables

People with diarrhea who are unable to drink fluids because of nausea may need intravenous (directly into a vein) fluids. This is especially true in small children.

Antibiotics do not work for viruses.

Drugs to slow down the amount of diarrhea (anti-diarrheal medications) should not be given without first talking with your healthcare provider. DO NOT give these anti-diarrheal medications to children unless directed to do so by a healthcare provider.

People taking water pills (diuretics) who develop diarrhea may be told by their healthcare provider to stop taking the diuretic during the acute episode. However, DO NOT stop taking any prescription medicine without first talking to your healthcare provider.

The risk of dehydration is greatest in infants and young children, so parents should closely monitor the number of wet diapers changed per day when their child is sick.

You can buy medicines at the drugstore that can help stop or slow diarrhea.

  • Do not use these medicines without talking to your healthcare provider if you have bloody diarrhea, a fever, or if the diarrhea is severe.
  • Do not give these medicines to children.

Viral gastroenteritis can become a serious illness, so watch for the symptoms and alert your healthcare provider if symptoms worsen.

Washing hands is the best prevention, along with vaccination when available (babies can be vaccinated against rotavirus).

Visit these websites for more information on gastro bugs

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001298/
http://www.cdc.gov/ncidod/dvrd/revb/gastro/faq.htm
By Trish Parnell (really by the NIH with a few asides from me)

Image courtesy of Examiner





Germs (and kids) Go Back To School!

27 08 2012

Kids are headed back to school, and all their germs are going with them. This means that germ-swapping is about to take place. Are you ready? Is your child?

Share these three concepts with your kids and their school year is likely to be healthier than years past.

Clean your hands

Use soap and water if possible and if not, use an alcohol-based hand sanitizer with at least 60% alcohol. Clean hands before leaving the house, after you get to school, before you eat, after using the restroom, and anytime your hands are dirty. Important: keep your hands off of your eyes, nose, and mouth, and don’t touch any scrapes or breaks on your skin unless your hands have just been cleaned.

Get immunized

Parents, this one is up to you. Most kids aren’t going to remind you that they need to be vaccinated, so please put it on your schedule to get it done. We don’t have vaccines against every disease, but in combination with clean hands and standard precautions, they’re effective shields against infections.

Practice standard precautions in daily living

Practicing standard precautions means assuming that every person’s blood or body fluid is infected with HIV, HBV, or other bloodborne germs, and then acting accordingly to prevent infection. Since most people who are infected are unaware of their infection status, it’s safest to assume everyone is infected with something and to keep barriers between yourself and another person’s blood or body fluid. This means that you never use your bare hands to touch someone’s blood (or body fluid). You get a towel, or put gloves on, or find something to put between you and the fluid. Kids should simply tell an adult if they see someone who is hurt and know not to touch anything leaking from another person.

If you repeat the messages often enough, the kids will adopt the habit of prevention.

By Trish Parnell
Image courtesy of Johnny Ancich





Orange Nose Day is 5 October 2012!

20 08 2012

Orange Nose Day is just around the corner!

One day a year (October 5th), health educators don an orange nose and start talking. And here’s why . . .
 
Most days of the year, educators get out there and talk the talk, saying the same things repeatedly: wash your hands, get immunized, floss, eat fruits and veggies, and so on.
 
When we hear these messages often enough, they become white noise.
 
But, somebody puts on an orange nose and turns to us with the same messages, we start smiling and we’re all ears. That’s the spark that created Orange Nose Day.
 
If you have a health message to share, visit www.orangenoseday.org, get an orange nose on your photo, and use that photo on your social media sites come 5 October. Also, join the collaborative by sending in your organization’s logo and become a partner on the website!
 
The Orange Nose Day collaborative identifies five steps to good health and encourages you to add your own. The day isn’t about any particular message, but about sharing whatever health message you want your patients or public to hear.
 
There are lots of downloadables, including posters, web banners, and stickers, that are available free of charge on the site.
 
Hey, there are plenty of reasons to not kid around when we’re talking about health, but occasionally bringing a little levity to the message is a good thing.
 
Come, join the fun.





Hepatitis A, B, C, D, and E

10 05 2012

The month of May is well-used. Mother’s Day is in here. May Day too, of course, along with graduations galore and, not insignificant for us, a date with the IRS that nonprofits shouldn’t miss.

It’s also Hepatitis Awareness month, although World Hepatitis Day is in July. We can’t explain why.

The important part is that we can use this month to remind moms and dads that hepatitis is around and some of it can be prevented by vaccination.

Hepatitis C is a bloodborne virus that attacks the liver. It is not vaccine-preventable. If babies are infected it’s usually from their hepatitis C+ mothers or, and this is unlikely these days, from a blood transfusion. It’s unlikely because the screening process of donated blood is pretty darn thorough. But, germs have slipped through that screening process.

Teens and young adults may become infected, primarily through sharing of needles, sex with an HCV+ person, or sharing personal items such as razors or toothbrushes that may be contaminated with HCV.

There are effective treatments that work on a good portion of hepatitis C-infected children. But not on all infected children. Work is ongoing in this area.

Hepatitis C is frequently a chronic infection, meaning that if treatment is not effective, you will be infected for your lifetime.

Hepatitis A is vaccine-preventable. Normally, it’s passed person-to-person through the fecal-oral route, which is when something you eat or drink has been contaminated with hepatitis A+ poop. If you haven’t been vaccinated, chances are you will become infected.

This virus makes you feel lousy and can, rarely, do serious damage to the body. It does not become a chronic infection. It infects you and then goes away, like a cold virus.

Hepatitis B is vaccine-preventable. It’s transmitted in a lot of ways—mom to newborn, sharing needles or personal items, sex with an infected person, even household (nonsexual) contact. If a mom is aware of her infection prior to giving birth, shots can be given to the baby within 12 hours of birth that are effective at stopping tranmission of the virus from mom to baby. However, when babies are infected, almost half of them in the US will become chronically infected. In developing countries, that figure shoots up to 90 percent.

Today, despite the vaccine, approximately 1,000 babies become chronically infected with hepatitis B each year in the US. Many of the moms-to-be who are infected are unaware of their infection. Every pregnant woman should be tested for hepatitis B so that action can be taken at birth to prevent infection of the newborn.

Hepatitis D is an odd virus. You have to be infected with hepatitis B before you can get hepatitis D. It’s vaccine-preventable in that, if you get immunized against hepatitis B, you won’t be able to get hepatitis D.

Hepatitis E is similar to hepatitis A in the way it is transmitted—the fecal-oral route. It’s rarely a chronic infection. For most people, they get it, get sick, and get over it. It can however be dangerous for pregnant women, with a 10% – 30% fatality rate for this group. It’s not often found in the US but can be easily picked up in some other parts of the world.

That’s about it for hepatitis in the US. To prevent a hepatitis infection (and lots of other infections), wash your hands throughout the day, put barriers between yourself and another person’s blood or body fluid, and use the available vaccines. The trick is to do these things with everyone. It’s impossible to tell who is infected with what, most of the time, so the safest course of action is to assume everyone is infected with something and then act accordingly.

Got any tips? Hope you share them will us in the comments.

By Trish Parnell

Image courtesy of Johns Hopkins





Here’s to Clean Hands

15 03 2012

It’s no secret that clean hands are one of our most effective weapons against infections. At PKIDs, we’re big on handwashing. One of our first projects as an organization was the development of a handwashing video for young kids. It still gets used today:

Several years later, PKIDs and students from the Art Institute of Portland developed a handwashing cartoon that’s perfect for middle school or high school students. It’s a flash program and can be played from a computer.

We also have a handwashing poster that can be downloaded from our site. There are two versions—one with PKIDs’ brand on it and one that’s unbranded, should you want to put your own contact info on it.

Yep, we think clean hands are a big deal in the fight against infections. If you know of any resources health educators can use, just put them in the comments section. Thanks!





Holiday Poisoning (oops) Cooking

7 11 2011

Do you cook? Most people do, and some people cook every day. I know of only one person who doesn’t cook—ever. The rest of us crank the oven on or prepare salads or treats at some point during the year, even if it’s just for the holidays.

We also manage to poison each other when we handle food with unclean hands, undercook the bird, or let hot foods get cool and cold foods get warm.

CDC says that “each year roughly one out of six Americans (or 48 million people) get sick, 128,000 are hospitalized, and 3,000 die from foodborne diseases.”

Hence this rather long (but we hope useful) post on how not to poison Grandma this year.

Foodsafety.gov says to follow these four steps (edited a little for length):

CLEAN hands and surfaces often—wash your hands for 20 seconds with soap and running water. Here’s a visual that shows how.

And when to do it:

  • Before eating food.
  • Before, during, and after preparing food.
  • Before and after treating a cut or wound.
  • Before and after caring for someone who is sick.
  • After handling uncooked eggs, or raw meat, poultry, seafood, or their juices.
  • After blowing your nose, coughing, or sneezing.
  • After touching an animal or animal waste.
  • After touching garbage.
  • After using the toilet.

Wash surfaces and utensils after each use:

  • Use paper towels or clean cloths to wipe up kitchen surfaces or spills, then toss or wash.
  • Wash cutting boards, dishes, utensils, and counter tops with hot, soapy water after preparing each food item and before you go on to the next item.
  • As an extra precaution, you can use a solution of 1 tablespoon of unscented, liquid chlorine bleach in 1 gallon of water to sanitize washed surfaces and utensils.

Wash fruits and veggies:

  1. Cut away any damaged or bruised areas.
  2. Rinse produce under running water. Don’t use soap, detergent, bleach, or commercial produce washes.
  3. Scrub firm produce—like melons or cucumbers—with a clean produce brush.
  4. Dry produce with a paper towel or clean cloth towel and you’re done.
  5. Bagged produce marked “pre-washed” is safe to use without further washing.

Don’t wash meat, poultry, and eggs. Washing raw meat and poultry can actually help bacteria spread, because their juices may splash onto (and contaminate!) your sink and countertops. All commercial eggs are washed before sale. Any extra handling of the eggs, such as washing, may actually increase the risk of cross-contamination, especially if the shell becomes cracked.

SEPARATE Don’t cross-contaminate

Even after you’ve cleaned hands and surfaces, raw meat, poultry, seafood, and eggs can still spread illness-causing bacteria to ready-to-eat foods—unless you keep them separate. Use separate cutting boards and plates for produce and for meat, poultry, seafood, and eggs.

  • Use one cutting board for fresh produce, and one for raw meat, poultry, or seafood.
  • Use separate plates and utensils for cooked and raw foods.
  • Before using them again, thoroughly wash plates, utensils, and cutting boards that held raw meat, poultry, seafood, or eggs.
  • Once a cutting board gets excessively worn or develops hard-to-clean grooves, consider replacing it.

Keep meat, poultry, seafood, and eggs separate from all other foods at the grocery.

  • Separate raw meat, poultry, seafood, and eggs from other foods in your shopping cart.
  • At the checkout, place raw meat, poultry, and seafood in plastic bags to keep their juices from dripping on other foods.

Keep meat, poultry, seafood, and eggs separate from all other foods in the fridge.

  • Place raw meat, poultry, and seafood in containers or sealed plastic bags to prevent their juices from dripping or leaking onto other foods. If you’re not planning to use these foods within a few days, freeze them instead.
  • Keep eggs in their original carton and store them in the main compartment of the refrigerator—not in the door.

COOK

Did you know that the bacteria that cause food poisoning multiply quickest in the “Danger Zone” between 40˚ and 140˚ Fahrenheit? Cooked food is safe only after it’s been heated to a high enough temperature to kill harmful bacteria. Color and texture alone won’t tell you whether your food is done. Instead, use a food thermometer to be sure.

  • If you don’t already have one, consider buying a food thermometer.
  • When you think your food is done, place the food thermometer in the thickest part of the food, making sure not to touch bone, fat, or gristle.
  • Wait the amount of time recommended for your type of thermometer.
  • Compare your thermometer reading to our Minimum Cooking Temperatures Chart to be sure it’s reached a safe temperature.
  • Some foods need 3 minutes of rest time after cooking to make sure that harmful germs are killed. Check the Minimum Cooking Temperatures Chart for details.
  • Clean your food thermometer with hot, soapy water after each use.

Keep food hot after cooking (at 140 ˚F or above). The possibility of bacterial growth actually increases as food cools after cooking because the drop in temperature allows bacteria to thrive. But you can keep your food above the safe temperature of 140˚F by using a heat source like a chafing dish, warming tray, or slow cooker.

Microwave food thoroughly (to 165 ˚F). To make sure harmful bacteria have been killed in your foods, it’s important to microwave them to 165˚ or higher. Here’s how:

  • When you microwave, stir your food in the middle of heating.
  • If the food label says, “Let stand for x minutes after cooking,” don’t skimp on the standing time. Letting your microwaved food sit for a few minutes actually helps your food cook more completely by allowing colder areas of food time to absorb heat from hotter areas of food. That extra minute or two could mean the difference between a delicious meal and food poisoning.
  • After waiting a few minutes, check the food with a food thermometer to make sure it is 165˚F or above.

CHILL

Did you know that illness-causing bacteria can grow in perishable foods within two hours unless you refrigerate them? (And if the temperature is 90 ˚F or higher during the summer, cut that time down to one hour!) But by refrigerating foods promptly and properly, you can help keep your family safe from food poisoning at home.

Cold temperatures slow the growth of illness-causing bacteria. So it’s important to chill food promptly and properly. Here’s how:

  • Make sure your fridge and freezer are cooled to the right temperature. Your fridge should be between 40 ˚F and 32 ˚F, and your freezer should be 0 ˚F or below.
  • Pack your refrigerator with care. To properly chill food (and slow bacteria growth), cold air must be allowed to circulate in your fridge. For this reason, it’s important not to over-stuff your fridge.
  • Get perishable foods into the fridge or freezer within two hours. In the summer months, cut this time down to one hour.
  • Remember to store leftovers within two hours as well. By dividing leftovers into several clean, shallow containers, you’ll allow them to chill faster.

Never thaw or marinate foods on the counter. Many people are surprised at this tip. But since bacteria can multiply rapidly at room temperature, thawing or marinating foods on the counter is one of the riskiest things you can do when preparing food for your family. To thaw food safely, choose one of these options:

  • Thaw in the refrigerator. This is the safest way to thaw meat, poultry, and seafood. Simply take the food out of the freezer and place it on a plate or pan that can catch any juices that may leak. Normally, it should be ready to use the next day.
  • Thaw in cold water. For faster thawing, you can put the frozen package in a watertight plastic bag and submerge it in cold water. Be sure to change the water every 30 minutes. Note: If you thaw this way, be sure to cook the food immediately.
  • Thaw in the microwave. Faster thawing can also be accomplished in the microwave. Simply follow instructions in your owner’s manual for thawing. As with thawing in cold water, food thawed in the microwave should be cooked immediately.
  • Cook without thawing. If you don’t have enough time to thaw food, just remember, it is safe to cook foods from a frozen state—but your cooking time will be approximately 50% longer than fully thawed meat or poultry.

To marinate food safely, always marinate it in the refrigerator.

Know when to throw food out. You can’t tell just by looking or smelling whether harmful bacteria has started growing in your leftovers or refrigerated foods. Be sure you throw food out before harmful bacteria grow by checking our Safe Storage Times chart.

And finally, CDC has some reminders for Turkey Day:

Food safety is especially important as you prepare a holiday meal. Within the last couple of years, CDC has investigated outbreaks of foodborne illness that were caused by bacteria in jalapeños, spinach, peanut butter, frozen pizza, frozen pot pies, and frozen beef patties. Many consumers are now more aware of the ongoing importance of food safety.

CDC is a food safety partner with the United States Department of Agriculture (USDA), Food Safety and Inspection Service (FSIS), which is responsible for the safety of meat and poultry. The FSIS has assembled preparation tips intended to serve as safety reminders to those who are already familiar with meat and poultry preparation safety and as guidelines for the first-time chef.

Turkey Basics: Safely Thaw, Prepare, Stuff, and Cook

When preparing a turkey, be aware of the four main safety issues: thawing, preparing, stuffing, and cooking to adequate temperature.

Safe Thawing
Thawing turkeys must be kept at a safe temperature. The “danger zone” is between 40 and 140°F — the temperature range where foodborne bacteria multiply rapidly. While frozen, a turkey is safe indefinitely, but as soon as it begins to thaw, bacteria that may have been present before freezing can begin to grow again, if it is in the “danger zone.”
There are three safe ways to thaw food: in the refrigerator, in cold water, and in a microwave oven. Instructions are also available in Spanish .

Safe Preparation
Bacteria present on raw poultry can contaminate your hands, utensils, and work surfaces as you prepare the turkey. If these areas are not cleaned thoroughly before working with other foods, bacteria from the raw poultry can then be transferred to other foods. After working with raw poultry, always wash your hands, utensils, and work surfaces before they touch other foods.

Safe Stuffing
For optimal safety and uniform doneness, cook the stuffing outside the turkey in a casserole dish. However, if you place stuffing inside the turkey, do so just before cooking, and use a food thermometer. Make sure the center of the stuffing reaches a safe minimum internal temperature of 165°F. Bacteria can survive in stuffing that has not reached 165°F, possibly resulting in foodborne illness. Follow the FSIS’ steps to safely prepare, cook, remove, and refrigerate stuffing. Spanish language instructions  are available.

Safe Cooking
Set the oven temperature no lower than 325°F and be sure the turkey is completely thawed. Place turkey breast-side up on a flat wire rack in a shallow roasting pan 2 to 2-1/2 inches deep. Check the internal temperature at the center of the stuffing and meaty portion of the breast, thigh, and wing joint using a food thermometer. Cooking times will vary. The food thermometer must reach a safe minimum internal temperature of 165°F. Let the turkey stand 20 minutes before removing all stuffing from the cavity and carving the meat. For more information on safe internal temperatures, visit FoodSafety.gov’s Safe Minimum Cooking Temperatures.

By CDC, mostly!





Cleanup!

9 06 2011

One of the most important steps in reducing the number of germs, and therefore the spread of disease, is the thorough cleaning of surfaces that you work or prepare food on, or that come into frequent contact with children, such as toys that children put in their mouths, crib rails or diaper-changing areas.

Routine cleaning with soap and water is the most useful method for removing germs from surfaces.  Good mechanical cleaning (scrubbing with soap and water) physically reduces the numbers of germs from the surface, just as handwashing reduces the numbers of germs from the hands.  Removing germs is especially important for soiled surfaces that cannot be treated with chemical disinfectants, such as some upholstery fabrics.

However, some items and surfaces should receive an additional step—disinfection—to kill germs after cleaning with soap and rinsing with clear water.  Items that can be washed in a dishwasher or hot cycle of a washing machine do not have to be disinfected because these machines use water that is hot enough for a long enough period of time to kill most germs.

The disinfection process uses chemicals that are stronger than soap and water.

Disinfection also usually requires soaking or drenching the item for several minutes to give the chemical time to kill the remaining germs.  Commercial products that meet the Environmental Protection Agency’s (EPA’s) standards for “hospital grade” germicides (solutions that kill germs) may be used for this purpose.

One of the most commonly used chemicals for disinfection in childcare settings, for example, is a homemade solution of household bleach and water.

Bleach is cheap and easy to get.  The solution of bleach and water is easy to mix, safe if handled properly and kills most infectious agents.

To create the solution, all you do is add bleach to the water.  A solution of bleach and water loses its strength very quickly and easily.  It is weakened by organic material, evaporation, heat and sunlight.

Therefore, bleach solution should be mixed fresh each day to make sure it is effective. Any leftover solution should be discarded at the end of the day.

NEVER mix bleach with anything but fresh tap water!  Other chemicals may react with bleach and create and release a toxic chlorine gas.

Keep the bleach solution you mix each day in a cool place out of direct sunlight and out of the reach of children.  Please keep all chemicals away from children.

If you use a commercial disinfectant, read the label and always follow the manufacturer’s instructions exactly.

Recipe for Bleach Disinfecting Solution

(For use in bathrooms, diapering areas, etc.)

  • 1/4 cup bleach
  • 1 gallon of cool water

OR

  • 1 tablespoon bleach
  • 1 quart cool water
  • Add the household bleach (5.25% sodium hypochlorite) to the water

Recipe for Weaker Bleach Disinfecting Solution

(For use on toys, eating utensils, etc.)

  • 1 tablespoon bleach
  • 1 gallon cool water

Cleaning Up Blood and Body Fluids

Spills of body fluids, including blood, feces, nasal and eye discharges, saliva, urine, and vomit should be cleaned up immediately.

Wear gloves or protective material such as plastic sandwich baggies when cleaning up blood or body fluids.  Be careful not to get any of the fluid you are cleaning in your eyes, nose, mouth or any open sores you may have.

Clean and disinfect any surfaces, such as countertops and floors, on which body fluids have been spilled.  Discard fluid-contaminated material in a plastic bag that has been securely sealed.

Mops used to clean up body fluids should be (1) cleaned, (2) rinsed with a disinfecting solution, (3) wrung as dry as possible, and (4) hung to dry completely.  Be sure to wash your hands after cleaning up any spill.

Washing and Disinfecting Diaper Changing Areas

Diaper changing areas should:

  • Only be used for changing diapers
  • Be smooth and nonporous, such as formica ( NOT wood)
  • Have a raised edge or low “fence” around the area to prevent a child from falling off
  • Be next to a sink with running water
  • Not be used to prepare food, mix formula or rinse pacifiers
  • Be easily accessible to providers
  • Be out of reach of children

Diaper changing areas should be cleaned and disinfected after each diaper change as follows:

  • Clean the surface with soap and water and rinse with clear water
  • Dry the surface with a paper towel
  • Thoroughly wet the surface with the recommended bleach solution
  • Air dry – do not wipe

Thanks to CDC for the info! This is one in a series of excerpts from PKIDs’ Infectious Disease Workshop. We hope you find the materials useful – the instructor’s text and activities are all free downloads.








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