NDM1 - Cleaning Up On Super Bugs

NDM-1 is a fast emerging enzyme that turns superbugs into death causing unstoppable monsters. It is easily transferred not only from person to person but from bacteria to bacteria.

There are no known antibiotics that are effective against it and it is going to kill many people worldwide. Wow! We might as well seal off the house and become a recluse until all this is over, right? Wrong. There are plenty of weapons in the fight against this new threat to human existence.

Here’s how this NDM 1 thing works. We have the pathogens (bad bacteria to you and me) like E.Coli 0157, Salmonella, Campylobacter, Staphylococcus and other less common organisms and these infect you through the food and water you consume and by cross contamination between you and someone else infected with them.

These pathogens, under normal circumstances, get into your body and start multiplying in the blood or tissues of the body. They cause damage and release toxins into your system and you get very, very sick. So you have a fever, can’t eat, move or work and are in terrible pain, what do you do? Visit the Doctor or have the Doctor visit you. You are then given antibiotics to kill off the organism that ails you and 5-7 days later you are clear of the infection and on your way to recovery. This is the normal scenario in our nice clean modern medical world.

Now, let’s look at the effect of NDM-1 on the situation. These same bacteria mentioned have a small piece of genetic code inside them that helps them produce an enzyme called NDM-1. NDM-1 stands for New Delhi metallo-beta-lactamase by the way because that’s where this comes from.

This piece of genetic code enables the pathogens to produce this NDM-1 enzyme which protects the bacteria from all known antibiotics. What's more it is easily transferrable between bacteria. It is akin to passing on a super power to all neighbouring organisms just by being in close contact. Once the genetic code has been reproduced and passed on the pathogen is now totally immune to all antibiotics, even the most powerful ones. Result ... for them.

This means that the Doctor, in most cases a general practitioner who thinks she / he is dealing with a general infection will prescribe normal antibiotics and when they don’t work they try something else and after that it’s off to hospital for tests.

Only when in the hospital do they finally find out what’s wrong and by that stage you are weak as sick puppy and may have already infected others with the offending organism. Time to pack up and move to Alaska where these infected people are few and far between.

Back on planet Earth let’s remember that our bodies have been dealing with these threats for millions of years at a biological level, that’s why there are so many humans alive today. Our bodies are designed to react to new threats through our immune system and these new emerging threats are actually good for a species and in the long run as they make our species stronger. Unfortunately a certain portion of the population dies in this process.

Now I hear you say, death is good for us? The immune system needs to be challenged as that is what stimulates it to react. If your immune system is not up to the job you don't make it without medical help. So this is the first point, the immune system of a normal healthy person will normally prevent infection getting out of control in the first place, even for NDM-1 infected bacteria and will respond to these new threats over time by developing a mechanism to deal with it. Nature always finds a way.

In the meantime we need to do what we can to prevent the spread of this problem and basic hygiene measures are the way forward. All bacteria require five basic things to survive and prosper and they are the same things we need. The need air to breathe, water to keep them hydrated, food for energy, a nice warm temperature to grow in and time to reproduce.

Good hygiene practice is all about denying bacteria the things they need. Now in most cases we cannot deny them air, except in the case of vacuum packing or canning food and even then there are some organisms that grow in an absense of oxygen. However we can deny them water and food and in most cases when it comes to food we can control the temperature and remove food by proper cleaning and sanitation.

We all know that hygiene in the kitchen whether at home, a take away, restaurant or hospital is a good way of preventing the food poisoning and infections that may carry NDM-1. This threat makes cleaning and hygiene more critical than ever in our hospitals and in our homes. So here are my top common sense tips for infection control to help you beat not only this organism but any organism.

This is so basic but people lapse on it in an attempt to cut corners or when they are in a rush or when facilities are poor. Hands must be washed with hot soap (preferably bactericidal hand soap) and water in the following cases:

1. After visiting the toilet, E.Coli and other pathogens grow in excrement.
2. After touching your nose, face, cuts, sties and boils. Bacteria such as staphylococcus aureus (the MRSA causing one) live there.
3. After handling waste product, bacteria grow there unabated.
4. Before and after coming into close contact (this means in the same room) with someone who is sick. You can pick organisms up from their hands and anything they have touched.
5. After handling raw foods such as meat, eggs, poultry, fish or shell fish. Salmonella, campylobacter and E.Coli may be present on them.
6. Before handling ready to eat or cooked foods such as cooked meats, salads, bread, etc. So we don’t transfer dangerous bacteria onto food that will not be cooked before consumption.
7. After shaking hands with others who may not have washed their hands in a while, especially in food preparation environments or hospital areas.

Good food hygiene practices include the following:

1. Separate storage and preparation surfaces and utensils for raw and cooked foods. If only one refrigerator is available for storage always store cooked and ready to eat foods above the raw foods to avoid potential cross contamination.
2. Separate staff, clothing and areas for handling and preparation of raw and cooked foods.
3. Chilled foods (raw and cooked) must be stored at <5oC (41oF)
4. Hot foods on display must be stored at a minimum of 65oC (149oF)
5. Raw foods must be cooked to at least a core temperature of 75oC (167oF) for at least 2 minutes.
6. Ready to eat ambient foods such as salads must be covered at all times to protect from contamination.
7. The time between cooking and consumption should me minimised and preferably less than 20 minutes.

Contact surfaces such as light switches, door handles, telephone handsets are common ways for bacteria to be transferred from person to person. Here are my top tips for avoiding picking up bacteria and viruses and staying healthy.

1. In the home, particularly, when someone is sick at home, use a disinfectant wipe to sanitise light switches, door handles and hand contact areas, for example, on fridge doors and food cupboard doors. Don’t forget the telephone handset for your home phone.
2. In public, if you travel on public transport such as a bus, train, boat or plane get a small bottle of alcoholic hand gel sanitizer and take this with you whenever you travel. Use before and after using public transport and try not to touch your nose or face during public travel as this can transfer any organisms to the face, nose or mouth.
3. In a hospital, always use the alcohol hand sanitizer provided or take your own and use before you enter the hospital and after leaving it and after touching hand contact or other surfaces whilst you are there.

In addition to the above eat well, take regular exercise, minimise stress and get plenty of rest. It is important not to develop an Obsessive Compulsive Disorder (OCD) about this but remember that poor hygiene results in hundreds of thousands of deaths each year and almost all of these are preventable. The same basic precautions for all other types of infection will also help in the prevention of infection by NDM-1 harbouring bacteria and if more people practiced the above then this type of organism would never get a foot hold in the first place and cause the widespread alarm and distress that results from its emergence.

James Flynn is a Food Safety Consultant and the author of HACCP Now, a popular means of implementing HACCP (Hazard Analysis Critical Control Points) that has been used in over 1000 food businesses world wide.