624: Pandemic Nursing Home Disaster Left Our Vulnerable Behind! Dr. Buffy Lloyd-Krejci

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Welcome to the Holistic Survival show with Jason Hartman. The economic storm brewing around the world is set to spill into all aspects of our lives. Are you prepared? Where are you going to turn for the critical life skills necessary to survive and prosper? The Holistic Survival show is your family's insurance for a better life. Jason will teach you to think independently, to understand threats and how to create the ultimate action plan. Sudden change or worst case scenario, you'll be ready. Welcome to Holistic Survival, your key resource for protecting the people, places and profits you care about in uncertain times. Ladies and gentlemen, your host, Jason Hartman.

It is my pleasure to welcome Dr. Dr. Buffy Lloyd Kreche. She is the author of how the Global Pandemic Uncovered, A Nursing Home System in Need of Repair and the Heroic Staff Fighting for Change. She is known as Dr. Buffy the Germ Slayer. So we're gonna talk about some practical tips of how you can stay well and avoid germs. Or maybe you shouldn't be avoiding germs because some of them are good for you. So we'll talk about that. And we're also gonna talk about the healthcare system and more spec the nursing home system. We are all aging, but we have aging parents and so forth, or grandparents. So this is an important topic on so many levels, personal and for loved ones. Dr. Buffy, welcome. How are you?

Thanks, Jason. I'm good. Thanks for having me. Appreciate being here.

It's good to have you. Just out of curiosity, where are you located?

Well, I'm in Phoenix, Arizona right now for the moment. I pretty much travel all over the country, but I'm in Phoenix right now.

Yeah, good stuff. This is a really interesting topic and you have been very active in this issue and it's a complex, multi layered issue. Maybe we'll start a little bit with your medical background if you could share that with us.

Well, I'm an epidemiologist and infection prevention and control expert. I work primarily in the long term care, post acute care healthcare setting, primarily because they are so underserved. That's really what drew me there. But I have a background in applied mathematics and epidemiology, biomedical informatics. I am very data driven when it comes to evaluating how infections spread in populations and health care. I've been doing this work, my epidemiology work for over 12 years right now. But I've worked in health care since I was 17, so over 30 years now. In different capacities.

So. So you are definitely a very well qualified person to be talking about this. Just give us the basic idea of infections and germ theory and, and how they spread. I mean, coughing, sneezing, handshakes, breathing on each other. Obviously sexual transmission is a whole nother category, but what happens in these institutional settings, maybe especially IVs and so forth, you know, just take us through all of that.

Yeah, well, I like to say the hardest part about my job is we cannot see the germs. We cannot see viruses, bacteria. We see the effect, so we see the outcomes of it. And so that's the hardest job. And so you have bacteria, they're microorganisms, so we can't see them with the naked eye. And they can transfer. Most commonly, they transfer by our hands. We shaking hands, touching surfaces, then we're face touchers. So we may touch a surface and then touch our face. This can then spread the virus or the bacteria. There's different modes of transmission. There could be small particles, droplets that come out of our mouths when we speak or out of our nose when we sneeze. And so there's different, these different modes of transmission, again, we can't see them. So that makes it the challenging part in our hospitals, our healthcare settings, and really, anywhere we've got the surfaces, we've got intravenous IVs, we've got catheters, surgeries, all of these different opportunities for bacteria or viruses to get inside of our bodies from maybe not good sterilization practices, disinfecting practices, cleaning practices. And again, the number one way still to this day in health care is we transfer infections with our hands. So the basics of hand hygiene is still very, very real and important in preventing the spread of infections.

You know, long before I ever heard of COVID I remember one week I was very sick with the flu maybe 10 years ago. I mean, it really knocked me down for about a week, which is about the worst I ever had. And I remember saying on my podcast after I recovered that we've got to stop shaking hands. And, you know, it just seems like an old fashioned custom that was developed, I guess, and became a custom to show that you didn't have a weapon in your right hand. You know, I don't think we need to worry too much about that in modern life, hopefully. But is the handshake a big culprit?

I think there's many different.

I would rather hug someone than shake their hand, to tell you the truth.

Well, that depends too, because how close are you breathing on Them too. Or, you know, that could potentially the droplets, you know, so this is the challenging part for us. It's like in public health too. It's like, how do we live a normal life, not be germaphobes and yet take care of what we need to take care of ourselves. So, for example, right now we're in a very unique situation with COVID It is not seasonal. It happens. It's all year long. So we see it increase when we are indoors more. So for example, I'm in Phoenix right now. Temperatures are very hot. More people are indoors, the air conditioning. So the risk of transmission is much higher. I have two daughters right now that are in their 20s that have Covid. That's why I'm not with them.

Question for you about being inside. So did they have or determine is Covid aerosolized or is it droplets now? And maybe you want to just take on and explain the difference. I would hope people would know by now, but maybe not. Did someone figure that out yet?

Well, we are saying it's all. That's. That's what we have determined and, and I absolutely know for certain it is aerosolized because especially in. I'm just from my own experience in nursing homes. Once we identify somebody has it runs through the buildings like wildfire.

And that is the H Vac and.

That is a T typical aerosolized virus. It's smaller, it's suspended in the air. The droplets are larger, they land on surfaces. You know, that's what we think about droplets. It's dropping on the surface. The aerosolize. It's in the air and it just lasts. It lasts longer in the air, suspended in the air. And that you're infectious, you're able to get infected a lot easier.

That's bad news. That's the worst kind. We'd rather have it be droplets because my theory at first, and you know, I live in Florida and one of the reasons it wasn't as bad here is because we have this humid air. Right. And so my theory, and I just came up with this myself, I have no idea if there's any science behind it, but is that those droplets in the humid, heavy air drop. They do, you know, and in thin air they don't drop so easily. Right. And they. They project farther. Is that theory legit, by the way?

Well, I actually haven't looked it up, but I think I believe so.

And what's my own theory?

I believe so. So if we. If, and I believe there is evidence behind this. But what we do know is when you're outside. And that goes along with this. When you're outside, the spread is much, much, much less. It is.

Oh, of course. Yeah.

And that I do believe that has to do with the air. I mean, I was. We just know the rates go down when we're outside, more so in different areas. Now, in Phoenix, we'll have lower rates in the winter because we're outdoors more. Right. Than where you are on the east coast and you're inside. So it definitely does make a difference. And so one thing that I always recommend, even in the summer, is keep a window open, try to create some circulation in the air, and that will definitely help, too.

Same with the cars. I never heard this word before, COVID but fomites, when we shake someone's hand and we touch our phone or we touch a surface, how long these germs last on surfaces? Have we determined that yet?

It varies by what organism you're talking about. So, for example, an organism that I study quite frequently is clostridioides difficile, which is a spore that will last on a surface up to five months. People may know this as C. Diff in the hospitals. It's a. It's a common infection that can occur after taking a lot of antibiotics. It's very, very harmful. It's what I did my dissertation on for my doctorate, when I learned that these particles, this organism, these spores, can live on a surface up to five months. That speaks to the importance of. Especially in our health care, of our proper cleaning and disinfecting practices. Jason, guess who gets the least amount of training in infection prevention cleaners is our environmental services. I am incredibly passionate about every building I go into. I spend time with the housekeepers. I work beside them, I train them, because they are our frontline defense against these organisms that live on the surfaces.

Just to speak to that, because this show is about economics and investing money largely. And, you know, something is wrong with our world. You really had to realize that during the harshest part of COVID when all of these frontline people get paid the least, Right. And we realized how important they were and how much less important Jeff Bezos was. Right. You know, these people should be on their way to being trillionaires. Right. Versus these people that are getting, you know, $10 an hour or whatever, it's just not right. But it is what it is. So fomites, for the one that I can't pronounce the name. Five months on a surface.

Yeah. And then some new research is coming out saying that they. It can live indefinitely on a surface.

Okay, now what, what? So, so disinfectant, obviously, and the right kinds of disinfectant. Feel free to speak to that. What about UV light, black light, does that work? Does that kill everything?

There are specific UV lights that can definitely kill. It doesn't kill everything, but it definitely kills a wide range of microorganisms.

We have to realize, though, about UV light is it only can kill something if it actually is exposed directly to it. And that's where people make a lot of mistakes. You know, it's like if I wash my face, if the soap doesn't go on, a certain part of my face, it didn't get clean. Okay. You know, same thing with black light. It doesn't just. You don't just turn on the light in the room. It has to. Literally, if there's a shadow, that's where the germ could be. And it doesn't kill it.

Right. So in our hospitals, many hospitals are fortunate enough to have budgets where they'll have like a UV robot. So after rescue or after a patient leaves, they'll empty out a room and it'll sanitize, basically clean the entire room. So those are great, but those are high budget. Not everybody can afford those, especially in our nursing homes. I mean, I'm seeing some, but it's very, very, very, very rare to have.

You can put them into the H vac system though, and at least the air, when it comes through that return will be sanitized air. The surfaces still have the germs though, right?

Yep. So that there, there's many different technologies that we have today which are amazing, and I don't know them all. I'm really focused on boots on the ground and helping teach the staff, which we have to do. And because the budget is not there for, especially our post acute care. So we're doing the basics. So I mean, if we can get funding to be able to bring in these technologies, then that would really help boost and help the infrastructure. You know, you talk about, you know, the budgeting. I was just in a facility in Minnesota last week, and the housekeeping, the EVS supervisor was so frustrated because he had to cut 10% of his budget and he was already, you know, he already couldn't, you know, so it's just like we're cutting in the wrong places. We need to be helping and adding.

This is kind of like the debate between spending money on education and economic opportunity or prison.

Right.

You're either going to treat the issue in advance or you're going to treat it afterwards when it's much more expensive. My grandmother, my late grandmother used to always say, a stitch in time saves nine, you know, and that's. That's the thing here. I just gotta ask you though, what about other fomites? How long do they live? What about COVID What about the flu? Colds, you know, five months for the one you studied that I can't pronounce. But what about the other ones?

Well, Covid, originally it looked like it was, you know, up to three days it could live on surfaces. So I think. I think now that's been downgraded to like, less than that, like 24 hours. It can live on a surface.

But it depends on a lot of things, right? It depends on the temperature, it depends on the humidity. Like it depends where it is, right? And maybe what type of surface, if it's metal or wood or plastic, does that's got a suppose.

So I think the takeaway. What I would encourage that. I'm not a germaphobe. I don't, you know, I travel a lot. But you can't live your life in this. In this constant state of fear and. Oh my gosh, I'm going to tell. I mean, even when Covid hit, people were disappointed, you know, leaving their groceries out in the garage and paper, you know what I mean? Like, we were doing all sorts of things, you know, to try. But I think, you know, if we can even do basic things, you know, using a disinfectant on our surfaces. I don't think you have to overdo anything. Good hand washing is important too. I carry with me a bottle of hand sanitizer that I travel with. And, you know, I'm just. I'm just aware, you know, like yesterday I went through the airport after touching things and the, you know, the security. I hand sanitize afterwards, you know what I mean? So, I mean, we can't keep track of how long things stay on the surfaces.

Of course not.

I think having an awareness that they do. But then how do we infect ourselves, right, with our hands. So thinking about hand hygiene and maybe improving upon that in different situations, you know, if you go to a restaurant, you know, maybe first thing you do is wash your hands or, you know, just different things like that too.

Yeah. Okay, good. It's all really a matter of risk, mitigation and odds. You just do things. You have protocols in your normal life, if you just. For a person, you need protocols, right? And, you know, it's like your parents said, wash your hands before you eat dinner. Right. And so it's the same idea. You just really reduce the risk when you do that. And when people do that collectively, they massively reduce the risk because the transmission is, you know, person to person.

Of course.

Okay, good.

I do want to say though, that we can't, especially if we are going into a health care setting. You know, if you're in a hospital or even in a long term care, you can make sure that the staff caring for you or your loved one are foaming in and foaming out, that they are using hand sanitizer when they come in the room. That way you, you know, they have clean hands when they're coming to see you. And when they leave, I mean, we can, we can advocate for ourselves in that situation to help us not become infected with something when we go into a healthcare setting.

Okay, I just got to ask you. And we got to get. I got to want to talk about some of the things in your book here, but I got to ask you one more thing because a lot of people have said it. There's a huge debate over hand sanitizer and they say that the germs are becoming immune to it, so you shouldn't use it. Like, you know, what's the thing on hand sanitizer?

Well, we are going to live in a world of. We've always lived in a world of bacteria and viruses and we always will. So we are protecting ourselves from works. Alcohol based hand rub kills 99.999% of all of the bacteria. And we need to use this so it will protect you. But microorganisms are always going to evolve and expand and mutate and change. And so it's, you know, that's part of it. They always have and they always will.

Got it? Got it? Yeah. Yeah. Okay, good. So in Fighting a War Without Armor, which is one of the chapter titles, you're probably talking about what we already discussed, right, where they're cutting budgets and the prevention is more of an issue, is that correct?

Well, within the nursing home setting, we were really the last health care setting to get ppe. So we really started. We talked about the virus Covid. It was first identified as airborne and then it was downgraded to droplet contact. Including droplet contact. But we didn't have ppe. I was helping nursing homes that were duct taping garbage bags together that couldn't get their hands on ppe. And unless they were part of a bigger hospital system, many went without for a long time. I really describe that in the book and describing. We've got to start prioritizing our long term care settings to provide them what they need and even prepare them for the next emergent virus that may come. We've got to invest in this process and we cannot leave our vulnerable populations, such as our long term care behind. And that's exactly what happened.

So what other specifics do you want to share with people about care facilities? Maybe it's healthcare in general or specifically nursing home type facilities. What do people need to know about the care? The problems? We talked about some of them, but I'm sure there's a lot more.

Yeah, we could talk all day about it, Jason. But definitely, you know, I'm an advocate for the long term care industry. I'm an advocate for the workers to improve upon wages, to improve upon having more staff in our facilities. I mean if you, if you are the best nurse like you are the very, very best and you have 20 patients to care for, you can't provide good care. There is not humanly possible really advocating for improved conditions really. And that's going to, that takes a lot of changes to occur. But we really need to start investing in our long term care. With the baby boomer generation, it's only going to continue to grow, but it's just not acceptable. The conditions. I cry with the staff almost every time I go on sight because they're just like it's it. The system is not working, we are not set up to succeed and we need more support within this healthcare setting to help.

And you're saying this in the midst of a huge labor shortage issue where the government has paid people not to work. So it's incentivized, you know, the wrong behavior obviously. Is there any relief that's coming, Buffy, from automation? I mean robotics, whatever. Is there anything coming in that way in your world that is going to solve a lot of these problems or is it just going to be really dependent on more human caregivers?

I mean in long term care, I haven't seen any robotics or any automation as far as that's helping. You know, some, some of it may be with data, data collecting and that kind of thing. We can do some automation, but. But when it comes to providing that intimate care, this is the hardest healthcare setting we have. I mean if you think about, you talked about your parents or your grandparents. My grandparents, my grandparents lived out their days in a nursing home and they just could not stay home anymore. And so you think about add 30 or 60 or 100 of these vulnerable residents that, that need that intimate care staffing was a huge issue before the pandemic within this industry because staff get so burned out based on staffing ratios and based on what the expectation is for one person. It's just near. It's been. It's just an unrealistic expectation that's been that way for years. And so we really need to look at that. And I would say we are. The industry itself is taking a hard look at that in many cases right now, which is good. So I feel we are really looking at and seeing what we can do to create these changes.

You know, many states have enacted laws in public schools for the student to teacher ratio. Right. Are there laws like that in your world from state to state?

Well, there are different states have different laws, but pretty much people follow kind of the federal rules for this, which is not really like black and white. So there is actually right now from the federal government asking and I don't. It's not become a final rule yet, but requesting more realistic staffing to resident ratio. So there is some debate about this right now creating a mandate for it because we can't get the staff in the building because of the staffing shortages. So it's like this is a good thing and we need this, but we need programs that, we need training programs we need other. We need to be able to pay a better wage to be able to attract the workforce to work in this industry as well. But this is something that is currently going on right now. It's a big debate at the federal level and creating these changes to have a better staffing ratio. We just need that. We really do.

It seems like this is a 15 to 20 year challenge ahead in terms of. I look at demographics a lot and this next 15 to 20 years in this field is going to be difficult, I think with the staffing issues and the size of the aging population. Right.

Oh, I mean, people ask me all the time, why are you fighting so hard? Because this is never going to change. And I'm like, well, we got to keep at it. So I would agree with you that this is not an overnight task. It does require us to continue to advocate and work in it. It is going to take time. Yes. But as long as we're still moving forward and making progress, then, you know, that's. Then that's all we can do right now. But I do agree, yeah, it's going to take time, but I do believe it's possible.

Well, good stuff. Give out your website. The book is available in all the usual places, of course. The title again is Broken. That's the name of the book. And anything else you want to share with people just to wrap it up.

Yeah, well they can find me on ipcwell.com that's my website. Like I said, I'm an advocate supporting long term care and I would encourage the viewers to get involved. If you have a loved one in a long term care setting or even a hospital setting, we need to be our own advocates and we need to advocate for our loved ones as well as it's absolutely critical. So if you have a loved one in long term care, get involved with the patient family council meeting, attend the care plan meetings. There is a lot that we can do even if we're not healthcare providers. So that's what I would encourage the public to do.

Good stuff. Thank you so much, Dr. Buffy the Germslayer. We appreciate having you on.

Thank you so much for having me.

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