Last week in Part 1 of the Clean Matters PerfectCLEAN podcast, Dealing with Biofilm, host Michelle Dawn Mooney spoke with Dr. Rodney E. Rhode, Professor and Chair, Clinical Laboratory Sciences Program for Texas State University and Mark Hodgson, Vice President, Health Care, UMF PerfectCLEAN. They discussed biofilm – what it is, where it lurks, how it grows and how it can affect individuals in hospitals, nursing homes, schools and homes – anywhere there is a drain.
This week, in Part 2 beginning at [00:20:40] we’ll review best practices for fighting biofilm in your drains and on surfaces. If you don’t have time to hear the podcast in one sitting – you will find timestamps on the transcript below so you can easily follow along, or pick up where you left off.
PART TWO
[00:20:40] Michelle Dawn Mooney
I would think that there’s really kind of a delicate balance here of having things that are strong enough to kill what we want to kill, but at the same time, you know, not being invasive or potentially dangerous to the people that are there, especially with the patients who already have suppressed immune systems. So, Mark, given that we’re dealing with drains, are there chemicals registered by the EPA that tackle biofilm and that are also safe to use in plumbing systems and the environment?
[00:21:14] Mark Hodgson
Certainly. Michelle, we would recommend that you consider sodium dichloroisocyanurate.
[00:21:22] Michelle Dawn Mooney
Say that ten times fast.
[00:21:25] Mark Hodgson
Otherwise known as NaDCC, which can be purchased pre-blended with a surfactant. These are EPA registered products on the US market that are normally sold in the form of a fast dissolving tablet. So you take the tablet, you dissolve it in water, it does an impersonation of a little Alka-Seltzer because it fizzes away, releases the chemical into the water, and now you have your supply of disinfectant ready to be either foamed or if you’re looking at one of those dry surface biofilms that Doctor Rohde was talking about, then apply to a cloth, preferably a high quality microfiber wiper, and wipe the surface with the wiper will help to provide that physical friction and removal of the biofilm. The disinfectant, plus surfactant, will penetrate and kill the biofilm. Because one of the things that Doctor Rohde mentioned was just how quickly a biofilm can reestablish itself. And, you know, we hear stories and there is research that says 40 minutes, if you have not properly killed that biofilm, but you wiped it with an ineffective disinfectant, your dry biofilm just became a wet biofilm. And a wet biofilm is a growing biofilm. So, yes, we need to be sure that we are getting a high-level kill, and we’re getting as much of that material off the surface as we possibly can.
[00:23:03] Michelle Dawn Mooney
Absolutely. So, I feel like the phrase the proof is in the pudding comes to mind. How do these chemicals work? And then how are they best applied to drains?
[00:23:13] Mark Hodgson
So, most of these, in terms of drain lines, the best chemicals are oxidizing disinfectants combined with surfactants. The surfactant breaks down the EPS. The disinfectant then penetrates and oxidizes the bacteria. The EPA test is based on a fully hydrated biofilm. And unfortunately, it only identifies two bacteria, Staphylococcus aureus and Pseudomonas. So those are the only two that we currently have data on. We’re seeing a lot of research data. For instance, Doctor Rohde mentioned earlier, Candida auris is a yeast that’s causing us all kinds of problems on bone marrow transplant units. And the bad news is, it’s a yeast that loves to live and generate its own biofilm. So you need to make sure that your disinfectant is broad spectrum. It kills not just those bacteria. It kills the yeasts, it kills the viruses, and it kills all the other things that are going to be in your biofilm. We have a measuring stick at present, it’s not necessarily perfect, but it’s as good as we’ve got. And if we have that EPA claim, if we can get the product in in the right format, it will work.
[00:24:42] Michelle Dawn Mooney
So we know we have the tools to combat this issue and we can kill these organisms. But, Doctor Rohde, how often should drains be disinfected?
[00:24:52] Dr. Rodney E. Rohde
Yes, it kind of goes without saying that the research is absolutely showing that even with good disinfection done properly, as we’ve been talking about, sometimes that biofilm can reestablish in a drain, especially a drain where it’s, consistently wet within about 48 hours. So it’s pretty quick. And ideally, the drains would be treated about every 2 to 3 days when you’re thinking about that turnover. And again, it just really goes to show you that, the education is so important because, I know Mark agrees with this because he’s out there in the trenches like me talking with people. It reminds me of my parents who are in their 70s and 80s now. And my dad actually deals with MRSA. And it’s why I do the research I do. And years ago, I did a Ted X talk in this area to talk about the problem. And my parents are very similar to many people, Michelle. They’ll often walk into a health care setting, perhaps you’ve walked into your doctor’s office and you can’t see these things. Generally, they’re microscopic. And someone who’s cleaned, may use something that smells nice. You know, it might even, and I know Mark knows this, it might smell really strong.
[00:26:17] Dr. Rodney E. Rohde
And you may think that is a good thing. But that’s kind of old thinking in the world of cleaning and disinfection. It’s not just how it smells. It’s not just how clean a room looks. It’s not the personality of the physician and the health care professional. It’s not how nice you’re treated. It’s about people who are doing the cleaning, the EVS professionals and others who are in those trenches taking care of that health care environment. They are just as important in many ways as the people performing surgery. And you may think that’s a silly statement, but it’s not. These things kill. And sometimes physicians, once they get embedded in a device like they did with my father’s knee, hey deal with these infections for the rest of their life. He’s on antibiotic therapy all the time. It reoccurs, and so, you know, it doesn’t matter who is physician is. He’s dealing with this all the time now. So I’ll just drop that in there along with, you know, it’s a consistent, sustainable process. Now we have the right chemistry, NaDCC chemistry is showing great results, and we need to stay on top of this and continue to educate those out there that don’t know this.
[00:27:31] Michelle Dawn Mooney
And what are the best practices that should be considered Dr Rohde when it comes to preventing biofilms, because we know really prevention is key. If we can avoid even getting to the step of where we need to kill these organisms, or in a much better place.
[00:27:46] Dr. Rodney E. Rohde
Yes, it reminds me. Mark made me giggle when he talked about, you know, pouring stuff down the drain and you remarked about it, I think most people don’t think about that all the time. And as recently as a few months ago, we had to replace our garbage disposal in my home. And we talked to the plumber, and he had a totally different view of this, just kind of on a lighter side, he said, oh, I love them. I love garbage disposals because every time I come to fix one, it’s another $250. And he’s like, you basically, and this is to Mark’s point, he told us in a home, you should never be putting food and organic material and grease and other things down drains, because all you’re doing is think of your arteries. And when you build up with different fats and sugars and it’s the same thing, a drain is the artery of a building. And when you continually pour that stuff down the drain and it congeals and conglomerates, you’re just you’re feeding the bacteria. You’re absolutely feeding the enemy. And so that can help. It’s not the only thing you’ve got to do. You’ve got to treat those places as well. But it certainly would slow down the accumulation, the buildup of EPS availability for bacteria to start amplifying that problem.
[00:29:03] Michelle Dawn Mooney
This podcast is changing everything for me. I’m going to be cleaning for the next six hours my husband is going to be like, what? What’s got into you?
[00:29:09] Dr. Rodney E. Rohde
Every time I teach this subject or talk to the public, I always start by saying, I apologize, but I’m going to ruin everything you know about traveling, about eating, about getting in a hot tub. Yes, everything. Everything is ruined when you know about the invisible world of microbes.
[00:29:27] Michelle Dawn Mooney
Well, Rodney, I’m glad you brought that up, because, Mark, I want to bring you in for this question. Does biofilm, and I think we already know the answer, but maybe it’s more of how, biofilm impacts other types of facilities, such as hotels. I’m scared to say this food service and then schools.
[00:29:45] Mark Hodgson
As I think Doctor Rohde just, stated, anywhere that has a drain, has potential, has biofilm in that drain and has potential for there to be resistant pathogenic organisms in that drain. We tend to focus on hospitals because that’s where the largest immune compromised population is. They’re the most susceptible individuals. But it’s just as true in a hospital as in a hotel, as on a cruise liner and in your home, at school, anywhere else. So it doesn’t matter where the drain line is. Once the bacteria get in there and colonize the P-trap, they will live there, they will grow there. And what’s more, even if the first bacteria that arrive and colonize it are not necessarily resistant organisms. There’s all kinds of wonderful things happening. Biofilm bacteria share these things called plasmids that make them more or less resistant. So they swap all kinds of genetic material. And what might not have started off as a resistant organism becomes a resistant organism. So, the answer is, unfortunately, biofilm is everywhere. We concentrate mostly right now on health care because that’s the single biggest risk. But if you run a hotel. If you are responsible for school buildings, if you are responsible for a dormitory, you have the same issues. Are hopefully not to the same extent, but you have the same problems.
[00:31:36] Michelle Dawn Mooney
Doctor Rohde, I know you mentioned education before in this conversation, but when it comes to dealing with biofilm in drains in general, just how important is training and education for EVS departments, hotel housekeeping departments we heard Mark talk about, and then of course, school custodians working with our children.
[00:31:56] Dr. Rodney E. Rohde
Yes, it is. It’s at the highest rung of the pyramid. I mean, if you don’t know what you’re dealing with, you need to find out. And you need to talk to people that know what they’re dealing with. And Mark, Mark’s becoming a closet microbiologist over there. He’s talking about plasmids and and resistance factors. And I’ll tell you, Michelle, one of the things I do with an audience, you may not know what a plasmid transfer is, but if you think about bacteria being kind of like a oval shaped or square shaped, they can be all sorts of shapes. They have these things on their outer surface called pili. They’re like little hairs, and when those hairs touch, they can literally copy over resistance to an antibiotic, resistance to a disinfectant. So it’s called horizontal transfer because vertical is through a sexual reproduction route. So it would mean if you could reach through your screen right now Michelle, and touch my finger, I could give you gray hair right now. I could literally share that trait. And that’s funny, but it’s not funny with bacteria because, I mean, they don’t even have to, they don’t even have to wait for a mutation to occur. It can be instantaneous. And so that education piece around that danger, that’s the big picture, is that biofilms are absolutely a part of and helping drive the global problem of antimicrobial resistance. And many of us, including myself, have been preaching and screaming this for over a decade or more now.
[00:33:27] Dr. Rodney E. Rohde
It is a slow burning pandemic. It’s been here longer than Covid, antimicrobial resistance. You know, it makes me think back to my grandparents when you had children succumbing to strep throat or a scraped knee or, uh, and it sounds dramatic, but it’s happening. I mean, there are actually organisms now that doctors have no therapy for. Or they’re giving you seven antibiotics to try to knock out that nasty superbug. And you’ve heard of superbugs and things like that. So this is real. Unfortunately, we tend to sometimes only hear it when it happens to famous people or football players. But that hotel, I’ve done the studies, I’ve done the studies for MRSA, especially within prisons, within dormitories, everywhere, everything Mark was telling you, I’m here checking the boxes, rec centers, with health care professionals that carry it in their nasal passages. So they’re colonized but they’re not infected, but they are vectors. They could potentially spread it through their hands in other ways. So, coming back to education, and I’m an educator as well, and this is a passion of mine. It’s why I love and I’m so very thankful for this opportunity to speak with you, because this podcast, papers, conference presentations, word of mouth, all of that’s important. Whether you’re talking to your school custodian or whether you’re talking to the infection preventionist at your hospital, they’re all kind of on the same team with respect to combating biofilm and ultimately, antimicrobial resistance.
[00:35:01] Michelle Dawn Mooney
This has been an eye-opening conversation, to say the least. And I’m sure we could talk for a few more hours about just all of the factors that we’re leaving out of this conversation, only kind of just scratching the surface here. But any final thoughts as we’re wrapping up here?
[00:35:16] Mark Hodgson
Well, I think Doctor Rohde actually said it earlier. If you are not “disinfecting to eliminate biofilm from surfaces, from drain lines, from your facility, you’re not disinfecting”. And we spend an awful lot of money on materials and on manpower to disinfect surfaces to try and eliminate fomites in hospitals. Unfortunately, we’re not getting the result we want. We can still do statistical analysis that will tell you the probability of you being infected with a specific organism is driven entirely by what the prior room occupant was infected by. We’re not disinfecting properly. We’re not disinfecting properly because we’re not addressing biofilm.
[00:36:12] Dr. Rodney E. Rohde
Yes. And I would echo that. And, as a final thought for the audience, it is every bit the responsibility of everyone to think about this. And it is absolutely your right to discuss this when you’re choosing a hospital, when you’re going into a health care unit. It may sound rude to talk about, but it’s okay to ask. When was this room cleaned, and how? I do this with my elderly parents because I obviously know what I’m thinking about here, but I’m usually asking, what are your infection rates and what’s going on in this hospital? And this is not an attack on hospitals. This is an educational process to let people know that you’re an informed consumer. Just like when you pick an airline, just like when you pick a doctor, just like when you do anything else, you buy a car, you kick the tires. And you should absolutely be thinking about this with respect to cleanliness and disinfection. I think I’ll leave it where Mark stated, if you’re not disinfecting for biofilm, you’re not really disinfecting. And we didn’t know that 20 years ago, but we do now. And so we need to get everybody on board and getting on the right
[00:37:30] Michelle Dawn Mooney
Dr. Rodney E. Rohde, professor and chair, clinical laboratory Sciences Program for Texas State University, and Mark Hodgson, vice president, Health Care, UMF PerfectCLEAN. I want to thank both of you, although I feel like I in some ways went to a horror film screening and hearing about what’s going on. But, you know, the key point, and you just said this, Rodney at the end is education. We need to talk about this because it is a problem. It’s not going away. And thankfully we have some solutions. So I want to thank both of you for your time, a very important topic, and, uh, really appreciate you being here today.
[00:38:03] Dr. Rodney E. Rohde
Thank you so much. Okay.
[00:38:05] Mark Hodgson
Thank you, Michelle.
[00:38:06] Michelle Dawn Mooney
And I want to thank all of you for tuning in and listening to Clean Matters, a podcast brought to you by PerfectCLEAN. And of course, you can go to PerfectCLEAN.com for more information there about what we’re talking about and a variety of other topics and offshoots of this conversation. Thank you again for joining us. An important topic nonetheless. But thankfully, once again, there are solutions. I’m your host, Michelle Dawn Mooney. Thanks again for joining us and we hope to see you soon.
To return to Part One of Dealing with Biofilm go HERE
NOTE: PerfectCLEAN’s Klorese is an EPA registered chemistry that can mitigate the risk of biofilm. To learn more about Klorese go HERE
