Warning: this blog mite make you itch!
 
The Oncology Registrar sat in the Multidisciplinary Team meeting looking thoroughly miserable. They looked like they hadn’t slept for ages, and whilst this can often be the case for junior doctors, the Microbiologist knew the registrar had only just returned from annual leave.
 
Whilst trying to pay attention to the patient discussions the Microbiologist watched as the poor Registrar kept scratching at his hands and arms.
 
As the meeting drew to a close, the Microbiologist wandered over…they can’t help but meddle!!!
 
“You look like your suffering” he said sympathetically, when in fact he was “itching” to make a shrewd diagnosis!!!
 
“Yeah. My hands and arms are really itchy, and it was worse in that room as it was so hot. I think I’m allergic to something”.
 
The Microbiologist wasn’t so sure.
 
“Show me your hands” he said.
 
The Registrar helpfully held out his hands which looked red and inflamed.
 
Looking closely whilst not touching (oooh, all those germs!!! He’d seen the Infection Control hand plates in the past!!!) the Microbiologist soon realised the likely cause of the problem.

The Microbiologist was slowly meandering through the daily authorisation, trying to stay awake and not authorise something important without seeing it first… honestly we do really pay attention but it can be a little dull authorising out more than a hundred urine results a day!
 
Suddenly something caught their eye. A wound swab was growing Candida auris. The Microbiologist sat up straight in his chair (I am notorious for slouching at the duty desk!) and picked up the phone to find out more.

It was a hot and dozy afternoon in the microbiology lab. The air-conditioning system was on the blink again and a nice large lunch of sausages, chips and beans had made the Microbiologist particularly sleepy. The telephone rang.

​​“My patient has plague!” screamed the excited junior doctor.

​I’ve had the dubious pleasure of dealing with various incidents and outbreaks over the years. They can be very stressful experiences for everyone concerned, but a clear methodical approach can go a long way to alleviating the levels of stress both in both you and your colleagues.
 
Imagine the scenario:
It’s 9am and the Senior Biomedical Scientist knocks on your door “ummm the laboratory has inadvertently processed a tissue sample containing Brucella melitensis on the open bench!”

The patient was admitted 3 days after arriving in the UK from Nigeria. He had felt unwell with a fever and generalise aches and pains the day before he travelled. On the morning of admission he had noticed a rash on his left leg as well as tender enlarged lymph nodes in his groin.
 
The admitting Consultant Physician spoke to infection control before the patient arrived and it was decided to admit the patient directly to a negative pressure side-room in the infectious diseases unit without bringing the patient into the main hospital in case this might be a viral haemorrhagic fever. The patient met a diagnosis of low possibility of viral haemorrhagic fever; temperature ≥ 37.5 oC PLUS been in endemic area within 21 days of onset of illness.

Between 2000 and 2003 a large outbreak of Clostridium difficile occurred in Montreal, Quebec, Canada. There are differing reports as to the extent of the outbreak, but some estimate that in 8 hospitals there were 7,000 cases and 600 deaths in 2003. This is at least a 5 fold higher incidence and mortality than considered “normal” by the Canadian public health officials. The strain of bacterium was identified as the now notorious O27 strain, but it was soon realised that this “outbreak” was in fact going on all over the World, not just in Quebec. Apparently Clostridium difficile means the “obstinate spindle” bacterium… and I think all Microbiologists would agree with the term, though some of us might be less polite in our language!

Okay, so I’m not one to watch much TV but I happened to have it on the other night and saw the program “Watchdog”. For our friends outside of the UK who may not know this program it’s a consumer rights program where companies are held to account by the media for their poor customer service or down-right dodgy dealing. Even a threat of writing to Watchdog has been known to solve many consumer issues.

The thing that caught my attention this week was an item called the “Swab Mob”. In this section members of the public are encouraged to write in suggesting places where the show could look for bacteria in order to see if there was a risk to public health. This week the area people wanted to swab was supermarket shopping trolleys and baskets.
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Off went the presenters to different supermarkets and there were lots of shots of people rubbing bacteriology swabs on different types of shopping baskets and trolleys; many of the baskets were propped up on the floor. The swabs were sent to a laboratory which cultured bacteria; armed with the results the show then tried to get an authoritative representative to agree that bacteria on shopping baskets was a national scandal.

It’s that time of year again, in UK hospitals healthcare staff are walking the wards with a slightly sore left arm sucking on a boiled sweet lollipop… yep, it’s flu vaccine season!
 
Every year the NHS tries to vaccinate as many of the frontline healthcare staff as possible in order to prevent outbreaks of influenza in our hospitals. In addition GPs are busy coaxing as many of the over 65 year olds as possible to get vaccinated before “flu season” starts. This is in addition to the routine flu vaccination of 2-3 year old children in reception classes and Years 1-4 at school (age 4-8 years).

Having recently just returned from a holiday where the main focus was relaxation and yoga I then saw this story about how filthy is your yoga mat on the Internet… crikey!

So the BBC news story is about what you can potentially catch from dirty gym equipment and gym mats due to the unhygienic practices of some gym members. And I have to agree, some people are particularly revolting in that they sweat and drip all over equipment then just wander off leaving someone else to either clean up after them or lie in the wet patches!
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This got me thinking, what can you catch from a yoga mat? What it comes down to is almost any bacteria, virus, fungi or parasite which can be part of the human microbial flora is potentially transferable between people, if the microorganism can survive on the surface acting as the vector e.g. the mat or equipment. These transferred microorganisms colonise the equipment and then “hop onto” and colonise the next person to use that equipment. Actually…do I really want to know all of this as I’m about to go to the gym?!

Gosh what a controversy (Public Health England) PHE and the International Association of Athletics Federations (IAAF) have got themselves into over the outbreak of Norovirus at the London 2017 World Athletic Championships. The spokesperson from PHE, Dr Deborah Turbitt, said “PHE has been notified of a confirmed outbreak of Norovirus among people associated with the World Athletics Championships”.

​It is reported in the media that around 30 athletes and associated people, all staying at the Tower Hotel near Tower Bridge, have been taken ill over the last few days. Several nationalities are involved including Irish, German, Canadian, Puerto Rican and Botswanan. But it is the Botswanan 200m and 400m gold medal hopeful, Isaac Makwala, who has caused the most controversy, not helped by the videoed eviction at the stadium door which has been played over and over on TV and the subsequent live debate on BBC Sport.