BCIT Environmental Public Health Journal
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The evaluation of factors affecting the pre-swim shower behaviors of pool patrons
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Background: The hygiene practices of pool patrons are important in maintaining water quality as well as patron health and safety. Poor practices, such as not taking a pre-swim shower, can introduce additional contaminants, which will then react with the free available chlorine to form disinfection by products (DBPs). Not only will excess contaminants decrease the free available chlorine but it will also cause a copious amount of DBPs to be formed. DBPs are known to cause eye and skin irritation, an unpleasant odor, and may cause additional respiratory issues. Therefore, in the interest of public health the number of contaminants introduced into the water should be minimized, which can be done through improving the hygiene practices of patrons. This study investigated factors that may affect pre-swim shower frequencies among aquatic facility patrons. Methods: Data from 78 respondents to a self-administered electronic survey were used in this study. The survey evaluated respondents’ knowledge of pool related illnesses, knowledge of proper aquatic facility hygiene practices and their attitudes toward these practices. Results were analyzed using one-way ANOVA, chi squared test and independent samples t-test. Results: The only statistically significant relationship found was an association between the how often an individual used aquatic facilities and their pre-swim shower frequency; frequent aquatic facility users were found to rarely/never take a pre-swim shower (p = 0.049). As well, factors such as knowledge of pool related illnesses, knowledge of proper hygiene practices, age, and if an individual had read the pool rules were not found to be related to pre-swim shower frequency. Conclusion: The results indicate that educational campaigns aimed at increasing the public knowledge of pool related illnesses and proper pool hygiene practices may not increase pre-swim shower frequencies. Results from this study also indicate that if the showers were cleaner, warmer, and or more private, pre-swim shower frequencies may increase. As well, 79.5% of respondents knew that taking a pre-swim shower is required and 52.6% of participants indicated that they would improve their hygiene practices if consequences were implemented. Taken together, this may suggest that the physical layout of the showering facilities within a swimming pool complex may influence showering behaviour, and greater enforcement of pool rules may be needed in order to increase pre-swim shower frequency.
 
Assessing the exposure to formaldehyde of flooring installers during the installation of laminated flooring products
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Background: Formaldehyde is a volatile organic compound (VOC) present in resins that bind the wood fibre core of laminated flooring products. Installation of laminate flooring involves performing certain procedures that increase the chance of formaldehyde volatilizing into the atmosphere. Exposure to formaldehyde can lead to acute health effects such as watery eyes, nausea, skin irritation, wheezing, and even death. Formaldehyde is also classified as a probable carcinogen and long-term exposure, even at lower doses, may lead to the development of cancers such as leukemia and sinus cancer. Method: GASTEC formaldehyde 91D passive dositubes were used to quantify the concentrations of formaldehyde present at laminate flooring installation job-sites. The dositubes were worn by two installers who each completed 5 flooring installations over a 15-day period. Between the two installers, there were 3 jobs using Chinese-made laminate, 3 jobs using German-made laminate, and 4 jobs using Canadian-made laminate. A fresh dositube was attached to the belt or collar of each installer at the beginning of the work day and worn while the installer was present at the job-site. In total, 30 samples were collected to which conversion factors were applied to change the units from ppm-hours to an 8-hour time-weighted average TWA. Comparisons were made between Chinese-made, Canadian-made, and German-made laminates and the mean of all 30 readings was compared to the Operational Safety and Health Administration (OSHA) 8-hour TWA standard of 0.75 ppm. Results: A one-sample T-test indicated that the mean concentration of formaldehyde that the test subjects were exposed did not exceed the 0.75 ppm TWA standard (p=0.000). Further analysis via ANOVA revealed that there was no statistical difference when comparing TWAs stemming from installation of Chinese-made, German-made, and Canadian-made laminate flooring (p = 0.200). Conclusion: Based on the results, it was concluded that flooring installers working for the Laminate Warehouse in Maple Ridge, BC, are not at risk of developing acute health effects from installing laminate flooring. However, the installers are still exposed to formaldehyde on a daily basis and chronic exposure could increase the risk of developing cancer. In addition, there was no observed relationship between origin of laminate flooring and levels of formaldehyde exposure.
 
Biological hazards associated with microblading and evaluation of its infection control procedures and wound care
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Background: Microblading is emerging as one of the fastest growing beauty trends, appearing in tattoo shops, hair salons, and even in private home studios. The procedure uses a tool with single blade to penetrate the upper layer of the dermis and deposit semi-permanent pigments to mimic hair-like strokes. This study compares the risks of microblading to those in tattooing and analyzes the similarities in order to determine the biological hazards associated with microblading. Currently, there is a lack of knowledge on microblading practices specifically, and the purpose of this study was to evaluate the level of infection control knowledge and practices in place, as well as the attitudes towards regulations in British Columbia. Method: Self-administered electronic surveys created on Google Forms were distributed to microblading establishments in B.C. through email. The survey assessed the knowledge, attitudes, and practices of microbladers in B.C. through a series of questions regarding demographics, infection control, and wound care. A list of 130 microblading establishments were contacted and asked to participate in the online survey. Results: Among the 130 microblading establishments contacted, 41 agreed to participate. The majority of microbladers had a college certificate or diploma, 1-5 years of experience, and have taken a bloodborne pathogen course. Over 31% of the participants operated both in microblading as well as permanent makeup, 27% operated solely as microbladers, and 22% of the participants had both microblading and spa operations. The most prevalent form of training was a microblading course that lasted a week or longer, and 78% of the participants felt that there should be more training required for becoming a microblader. There was no association between the years of experience and level of pathogen knowledge according to the Chi square test (p=0.78), and no association between the attitude towards regulations regarding microblading and the number of infection control measures in place (p=0.38). However, there was a statistically significant association between taking a bloodborne pathogen course and knowing the correct bloodborne pathogens of concern. Conclusion: Microbladers in British Columbia are fairly new and thus only have 1-5 years of experience, and minimal training of week-long microblading courses. A majority of them feel that more training or certification should be required and that there should be more regulations regarding microblading. The results indicated that education and training provide the most knowledge rather than years of experience. This suggests that health authorities should focus on providing more access to education for microblading, such as offering a TattooSafe program for tattooing microblading, and permanent makeup, similar to FoodSafe, and developing more material to inform microblading fact sheets.
 
Aerobic colony count assessment on projector remote controls at BCIT major classrooms
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Classroom equipment has been linked to different outbreaks. Surfaces such as tables, chairs, keyboards can harbour pathogens such as Noro virus, Methicillin-resistant Staphylococcus Aureus (MRSA), Influenza A virus and Vancomycin-resistant Enterococci (VRE). Bacteria and viruses can then be transferred to another individual by the mode of touch and leading to potential infections when the individual touches their mouth, nose, eyes or open wound. Institutions usually have their own cleaning and sanitation schedule that covers most of the items in a classroom. However, some common items have been overlooked. Take the project remote controls at the British Columbia Institute of Technology (BCIT) for example. They are often found in filthy condition due to the amount of usage. It is unclear how many sicknesses have been the result of neglecting this device out of their daily cleaning and sanitization schedule. This paper examined the sanitation status of projector remote controls at BCIT. The focus has been placed on major classrooms and laboratories at building SW 1, SW 3 and SE 12 in BCIT. By utilizing the Aerobic Plate Count method, projector remote controls were swabbed using the wet swabbing technique. Swabs were then incubated and results in colony forming units per area in center meter square (CFU/cm2) were collected. A wide range of CFU/cm2 values were observed from projector remote controls. The maximum CFU/cm2 value obtained was 177 and the minimum value was 0. Inferential statistics was performed comparing the mean CFU/cm2 to a stand value of 5 CFU/cm2. Result showed that the mean CFU/cm2 of remote controls in SW 1, SW 3 and SE 12 at BCIT are statistically significantly more than the standard value of 5 CFU/cm2. This suggest that most of the remote controls at BCIT are not in sanitary conditions and BCIT should start to include remote controls into their daily cleaning and sanitization program to prevent students from contracting potential bacteriological infections.
 
Bacterial growth in personal stainless steel water bottles: how often should you clean your bottle?
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Background: There is a general understanding and knowledge among reusable personal water bottle users that there are hazards, such as bacterial growth, associated with poor water bottle hygiene practices. Currently, there is no information associated with outbreaks or cases of illness stemming from poor hygiene on personal water bottles. This may be due to lack of awareness that users have become ill from their own water bottle and have failed to report it. Results from previous studies on personal water bottles have indicated that there is a relationship between higher microbiological counts and the interval between cleaning times; the longer water bottles are left unclean, the higher the microbial count. Methods: 29 randomly sampled stainless steel personal water bottles were swabbed at the mouth piece and 1 brand new personal stainless steel bottle was used as a control. Personal water bottle users were provided with an in-person electronic survey at the time of sample collection. The swabs were plated following the 3M Aerobic Plate Count method and incubated for a total of 72 hours. Plates were counted after 24 hours and 72 hours. Results: There was no statistically significant difference between the aerobic bacterial levels (CFU) of personal stainless steel water bottles that were cleaned within one day and those cleaned within a month but more than one day based on the Independent Sample T-test. There was also no statistically significance difference between the aerobic bacterial levels (CFU) of bottles that were rinsed with tap water and those cleaned with soap and water based on the Independent Sample T-test. Conclusion: Based on the results, stainless steel water bottles are not required to be cleaned frequently. It also appears that there is no difference between cleaning with soap and water and just rinsing the bottles with tap water. Despite results showing no statistical difference to support more frequent cleaning and more thorough cleaning practices, these behaviours should be encouraged to prevent and minimize the risk of potential exposure to harmful pathogens.
 
Impact of overcrowding sous vide water baths on the thermal process of pork loins
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Background: In the culinary industry, sous vide is a popular cooking method in which lower temperatures are used to cook food to retain more desirable organoleptic characteristics. However, this technique may compromise food safety as the temperature may not be sufficient enough to eliminate pathogens that may be present. The BCCDC’s Guidelines for Restaurant Sous Vide Cooking Safety in British Columbia advises when too many food items are placed in the sous vide water bath, inadequate water circulation may occur with the result that process lethality, measured by calculation of log10 reductions, may not be achieved. The purpose of this study was to determine how overcrowding a sous vide water bath would impact the thermal process of pork loins. Methods: Each pork loin sample had a SmartButton inserted and was vacuum sealed in a plastic bag. The water bath was preheated to 60˚C by an immersion circulator. Under normal conditions, six pork loin samples were held in the water bath for 1 hour and the process was repeated four more times. Under overcrowded conditions, two runs were conducted for 1.5 to 2 hours, each consisting of 15 samples stacked in three layers. SmartButton temperature values were used to calculate whether a 6.5 log10 reduction for Salmonella spp. was achieved, using the American Meat Institute’s formula. Results: Using a 31-minute cook time, pork loins in normal conditions reached an average log reduction of 8.85 (range: 0.51 to 21.07), which was significantly higher than the 6.5 log10 reduction objective (p = 0.006). Conversely, pork loins in overcrowded conditions reached an average log reduction of 1.76 (range: 0.05 to 7.93), which was significantly lower than the 6.5 log10 reduction objective (p = 0.000). Furthermore, cooking lethality between the two conditions, pork loins in crowded and overcrowded conditions, were found to be significantly different from each other (p = 0.000). No differences were found in the mean log10 reductions between the pork loins placed in each of the three layers in an overcrowded water bath at 31 minutes (p = 0.094). Conclusion: Overcrowding sous vide water baths does impact on the thermal process of pork loins. Food products cooked under overcrowded conditions require a longer cook time, (approximately 30 minutes longer) to achieve at least 6.5 log10 reductions. Therefore, it is advised that food handlers using sous vide techniques should avoid overcrowding sous vide water baths. Further research using more samples is recommended to determine potential cold spot patterns in overcrowded water baths due to inadequate water circulation.
 
Mean difference of coliform counts in relation to sanitation frequencies at the Simon Fraser University Childcare Society
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Background: Young children in child care facilities are more likely to contract communicable diseases than if they are cared for at home. The relationship between pathogen presence and frequency of toy sanitation at these facilities is not well studied. Thus, the discrepancies currently seen in the hygiene guidelines between health authorities in British Columbia, Canada. Most childcare facility studies in the current literature focus on gastrointestinal outbreak situations or the sanitation of multiple surfaces. The focus of this project is on toys only. Toys made out of wood were selected because research shows that this material is more susceptible to harboring bacteria on it. Microbiological swabbing was performed to measure the effectiveness of the sanitation schedule of a child care facility in Burnaby. Method: Twenty-four wooden blocks were randomly selected for surface sampling. The 3M™ Quick Swabs were used to collect the bacterial coliforms before and after sanitizing the blocks, whereas, the 3M™ Petrifilm™ E. coli/Coliform Count Plates were used to enumerate the bacteria. The last time the facility had cleaned the blocks was 1.5 weeks prior to sampling. Results: There were 0 CFU/cm2 for before and after sanitizing the blocks, therefore, the mean difference was also 0 CFU/cm2. Inferential statistics could not be conducted. Conclusion: The results can be interpreted several ways. One interpretation is that the current toy sanitation frequency at the facility is good. It could also mean that, the methodology used was not able to detect any coliforms. In combination with the conclusions from the different studies discussed in the evidence review, the development of a prescriptive toy sanitation schedule for child care facilities would not be a high priority for health authorities.
 
Presence of nicotine in marketed nicotine-free e-liquids for electronic cigarettes
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Background and Purpose: Ever since the electronic cigarette made its debut in the market, it has been garnering great popularity due to public perception of it being a safer alternative to conventional cigarette. As a result, aside from being utilized in tobacco cessation programs, susceptible populations such as teenagers are slowly adopting this new trend of recreational E-cigarette smoking or “vaping”. The literature review conducted suggests that not only do different E-cigarette models exhibit different delivery efficiencies regarding percentage nicotine vapourization, there are discrepancies between what is labelled by the manufacturer and the actual nicotine content in the electronic cigarette liquids. This has serious public health implications because nicotine is the active chemical component in inducing addiction in cigarettes. As a result, recreational electronic cigarette users such as teenagers, may unknowingly become exposed to improper levels of nicotine, leading to a higher probability of nicotine dependence or switching to conventional smoking. The purpose of this study was to determine whether presence of nicotine can be detected in marketed nicotine-free electronic cigarette liquids. Methods: The nicotine content in electronic cigarette liquids was isolated and determined using Gas Chromatography Mass Spectrometry. Descriptive and inferential statistics was conducted using NCSS11 to see if there was a statistically significant difference between the labelled concentration of 0 mg in marketed “nicotine-free” electronic cigarettes from two popular brands, VapeWild and Mt Baker Vapour, to determine whether one brand has better quality control for nicotine content in nicotine-free E-liquids compared to the other brand. Results: Based on the analyzed E-liquid samples from the two brands, no nicotine was detected. Conclusion: E-cigarettes can be putatively considered as a safer alternative to conventional cigarettes because nicotine levels can be pre-determined and limited with a high degree of confidence.
 
Quantification of temperature fluctuations in restaurant coolers and modelled Listeria monocytogenes growth
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Background: Coolers in food service establishments should ideally operate at 4°C or less. However in restaurant environments cooler doors are continually being opened and closed as food workers gather and store items. These actions may lead to temperature fluctuations in coolers which may pose a health risk towards the storage of potentially hazardous foods. This study measured and analyzed temperature fluctuations in coolers and quantified the risk they presented by modelling Listeria monocytogenes growth in response to these temperatures. Method: ACR Systems Inc. Smart Buttons were placed near the opening of restaurant coolers and recorded temperatures over a 1-week span. Food Spoilage and Safety Predictor (FSSP) was used to model L. monocytogenes growth in response to the collected cooler temperatures. Results: Coolers spend significantly less than 50% of the time above 4°C. The magnitude of temperature fluctuations during open business hours was found to be insignificant in comparison to fluctuations during closed business hours. However, fluctuations were significantly greater in reach-in coolers than in walk-in coolers. With respect to modeled L. monocytogenes growth, it was inconclusive on whether growth would be more or less than Health Canada’s 100cfu/g policy in smoked salmon. However growth was significantly less than this limit in ready-to-eat ham. Conclusions: More restaurant coolers need to be analyzed to confirm whether the defrost cycles of coolers have a greater impact on temperature fluctuations above 4°C than the daily activities of staff members. In addition, more coolers need to be analyzed to determine whether L. monocytogenes growth in smoked salmon stored in coolers for a week grow significantly more than 100cfu/g. However, it can be concluded L. monocytogenes growth will be significantly less than 100cfu/g in ready-to-eat ham and will pose a lower risk for listeriosis than smoked salmon.
 
Methods for cleaning & sanitizing food contact surfaces (countertops) to prevent cross contamination in restaurant kitchens
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Background: Cross contamination can occur in restaurant kitchens when food contact surfaces such as countertops are inadequately cleaned between preparation of raw and ready to eat foods. Previous research has demonstrated that washing with detergent and water, rinsing, then applying a sanitizer solution is the most effective cleaning method. The second most effective cleaning method is to use detergent and water alone. In practice, the author has observed kitchen staff using sanitizer alone to clean kitchen countertops. This study surveyed British Columbia restaurant kitchen staff on current practices and makes recommendations to improve cleaning and sanitization practices for the purpose of preventing cross contamination. Methods: A survey was prepared using SurveyMonkey and distributed through Facebook to the author’s contacts in the restaurant industry. The Facebook post included a request for anyone to share the survey link with their contacts who work in BC restaurant kitchens. The survey was shared 21 times by 14 different people. The survey asked questions about restaurant type and position, Foodsafe level, and about cleaning practices such as frequency and cleaning compounds used. Results: When asked what cleaning compounds are most often used to clean work surfaces (countertops) in their restaurant, 56.5% of respondents reported sanitizer solution only, 30.4% of respondents reported soap & water followed by sanitizer solution, and 13.0% reported soap and water only. When asked why sanitizer solution only was used to clean countertops, 46.2% of respondents said it was company policy, 23.1% of respondents said time savings, and 15.4% of respondents indicated that an Environmental Health Officer had recommended sanitizer use and that is what lead to sanitizer alone being used to clean countertops. Conclusions: In practice, some restaurant staff do not use sanitizer effectively and may believe it is a substitute for detergent. Using sanitizer alone is not as effective as using detergent alone. Detergent alone can provide a 2-3 log bacterial reduction. If staff are busy and are only going to use one cleaning step, detergent alone is the best method. Environmental Health Officers should review sanitation plans and talk with operators to determine current cleaning practices in food service establishments. Operators and staff should be re-educated on the importance of the three-step method. It may be beneficial to recommend that sanitizer use be decreased overall to encourage the use of soap and water. It may only be necessary to use sanitizer after high-risk jobs such as preparing raw meat or at the end of the day.