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.
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.
Firstly, the basic premise that shopping trolleys are the route of all evil in supermarkets is stretching credibility just a little bit. Yes, any surface can potentially be a source of bacteria but no one could possibly try and suggest that shopping baskets and trolleys should be sterile. Come on think about it, every surface exposed to the outside environment will have a “normal flora”, and this will happen even if you have recently tried to clean it.
Surfaces get touched and bacteria transfer from one surface to another, bacteria and fungi are stirred up into the air by even the slightest breeze and settle onto surfaces, and it would be impossible to clean every basket and trolley between each person who uses them or between every gust of breeze. Having said that they did show a row of shopping trolleys where birds roosting above had been to the toilet all over them over night and that is wrong in lots of ways, but the program didn’t say whether these shopping trolleys were actually in use or whether the store had identified the problem on opening and taken steps to remove them from use and clean them. As long as the imagery is deplorable and illustrates the story it’s allowed, even if it may be slightly misrepresented. Remember: the media are looking to “entertain” therefore embellishment is somewhat allowed!
Secondly, bacteria and fungi are a normal part of life. They are all around us and we are covered in them. There are approximately 15,000 times more bacteria on one person than there are people on the planet… and that’s okay… that’s just fine. That is how nature works and it works well. In the context of a person these normal bacteria help protect us from becoming colonised with abnormal bacteria which might cause a problem.
Thirdly, most of the bacteria that the show were so outraged about are often naturally found in the environment and on surfaces. Bacteria such as Staphylococcus spp. and enterobacteriaceae are common. The only slightly worrying, but not surprising, finding was the presence of a Salmonella spp. in the bottom of a shopping trolley.
This suggests that bacteria from the original animal have been transferred to the bottom of the trolley via contaminated meat or packaging. This is especially true of raw poultry products like chicken or turkey where bacteria such as Salmonella spp. and Campylobacter spp. can be part of the normal flora of these animals. Correct cooking kills these bacteria (poultry’s “normal flora”). It can be expected that if you have something like a trolley or basket which is specifically designed for carrying these products, it is likely to become contaminated at some time.
The item wasn’t all bad though. Kate Thompson, Director of the Chartered Institute of Environmental Health, Wales, was very good. Calm, and measured, she didn’t try and argue that the show was using bad science to scare monger but rather she explained the results in a clear and concise way. She explained that finding bacteria on surfaces is not a surprise and although Salmonella spp. is not what you would normally “want” to find in you shopping trolley, …she went on to explain that… all food should be washed or cooked before it is eaten and so the risk is very low.
All in all, in my opinion, it was not a particularly good piece of journalism, although I guess it was a bit entertaining if only in a slightly cringe worthy way. Watchdog tried to create a major issue but in reality it fell rather flat. However it did get me thinking. If I wanted to show just how grim surfaces can be where would I swab and why? So here are my top 3 choices…
At number 3 - Wrist watches in clinical areas
Healthcare professionals in the UK are meant to be bare below the elbows, that is they are not allowed to wear anything on their forearms, wrists or fingers except for a plain wedding band. Although there is little evidence to support this (I know evidence based medicine la, la, la!!) the premise is that if you have cuffs down to your wrists, a watch or stoned rings then you are not able to adequately wash your hands, if you wash them at all? At times up to 25% do not! Additionally these items (watches and stoned rings) can become colonised with bacteria which could be transferred between patients. I often have to listen to medical staff try and justify why their particular watch is an exception to the rule when they have forgotten to take them off. No excuses; no wrist watches.
I can remember one particular situation from many years ago where a Consultant Surgeon tried to tell me in front of his entire team that his particular brand of expensive flashy watch was made of a metal that was antimicrobial and therefore it was safe to wear. I offered to test this for him by swabbing the watch in a few places to see what would grow. Sure enough a few days later I was able to tell him, again in front of his team, that his watch had grown E. coli, Klebsiella oxytoca, Enterococcus faecalis, Bacteroides fragilis and Meticillin-resistant Staphylococcus aureus amongst other things. I explained that this was a mixture of faecal flora and an antibiotic-resistant pathogen; I went on … “that if he had been sold the watch as being “antimicrobial” then he really ought to get his money back”. I don’t know if he ever did get his money back but I never saw him wearing that watch in a clinical area again…
At number 2 – mobile phones
How many times do you check your phone every day? Some reports say we check our phones over 100 times a day! Where do you keep it, in a pocket by your backside or in your groin? Have you ever used it in the toilet? (Yep I see this on a daily basis, men talking on their phones whilst GOING TO THE TOILET!!!!). Really?!
Mobile phones have become such a pervasive part of life that many of us can’t seem to go for very long without picking them up, stroking them (I mean swiping) and chatting to them, I’ve even seen people fall over at the gym whilst trying to send texts when running on treadmills. We touch them so frequently that they are bound to be covered in bacteria.
For International Hand Hygiene Day one year I swabbed a few mobile phones belonging to nurses and doctors in the hospital and they were covered in faecal flora. Okay, so I don’t like mobile phones at the best of times but to have something that is covered in bowel bacteria which we then hold against our faces to speak to someone just strikes me as grim… yuck!
It never ceases to amaze me how many people don’t wash their hands having been to the toilet. Okay, I can only speak for men but I’m assured by my wife that the same happens in the ladies loos (although perhaps not as badly). From my own “covert” observations (I know I’m weird but then I am a Microbiologist) I would estimate that about 70% of men do not wash their hands after going to the toilet. Why do we not do this? It’s just wrong! Wash them…WITH SOAP!
There was an editorial in the New England Journal of Medicine a few years ago that looked at this apathy to washing hands. The article looked at the difference between a “no blame” culture and a “no responsibility” culture. It argued that if you went to wash your hands and there was no water, or no soap, then you could not be blamed if you didn’t wash your hands. However, if there was water, soap, hand driers or towels etc. and you still didn’t wash your hands then you were responsible for the consequences of your choice to not wash your hands. I found it a powerful argument and I often quote it when teaching about infection control. Most toilets in the UK (and especially in hospitals) have all of the equipment required to wash your hands and yet people still don’t. In my opinion that is wrong and I would love to be able to stand outside the toilets swabbing people’s hands to show them the difference between washed and unwashed hands… (I know I’m weird but as I have already said, I am a Microbiologist!). Just maybe that would encourage a few more people to take the extra few minutes necessary to give ‘em a quick scrub! And please, please, please, don’t answer or take a call on your mobile whilst you’re in the loo… it’s not okay!
So, over to you “the Swab Mob”, what would you swab? What are your personal annoyances around environmental hygiene? Maybe I should start a “Swab Mob” in the hospital? Let me know… or maybe let Watchdog know, I’m sure we would both like to hear from you. :-)