“Clean” is a simple term that means different things in different contexts. In a hospital setting, one can divide cleanliness into four levels:

• Clean, which is the removal of soils from a surface;
• Sanitize, which involves the use of chemical agents to remove bacteria;
• Disinfect, which destroys most microorganisms such as viruses and bacteria;
• Sterilize, which entails the killing and removal of all forms of life and biological agents from an object or surface.

In general terms, the floor of a hospital is cleaned, a food preparation surface is sanitized, anything that’s been in contact with blood gets disinfected, and surgical instruments are sterilized.

“You’re not going to sterilize a room,” says Hicks. After all, sterilization involves either high temperature steam or an ethylene oxide process that takes hours. “You can’t do that for surfaces, and those surfaces aren’t going to be put into someone’s body anyway. We in the sanitation business can’t worry about that ... we have to focus on what we can do.”

EVS departments can make sure dispensers are continually stocked with soap, hand sanitizer and towels to promote proper hand hygiene among hospital staff and visitors. They can also make sure surfaces are clear of bacteria through proper cleaning and disinfecting. 

It sounds simple, but these tasks need to be applied in the right way to be effective — and that doesn’t always happen. That’s one reason even hospitals that are cleaned on a regular basis can harbor HAIs.

Imagine, for example, washing clothes in cold water with laundry detergent for one minute, then draining and drying.

“Time, temperature, chemicals and agitation are all part of the cleaning process for your clothes,” says Hicks. “[If any of these steps are omitted], it would take a long time for those clothes to get clean.”

The same goes for sanitizing and disinfecting surfaces and equipment in hospitals. Custodians need the right chemicals, which must be used properly and given time to work. But time is not on the hospital’s side.

“If it normally takes 60 to 90 minutes to remove a gallbladder, would you trust someone to do it in 10 minutes?” asks Hicks. “But the pressure is on housekeeping to clean that quickly. Multiple studies in hospitals over time have shown that when housekeeping goes in for the terminal cleaning after a patient goes home, greater than 50 percent of the surfaces weren’t cleaned well enough, or at all.”

Adding to the time crunch is the fact that surfaces need to be cleaned before they can be disinfected. Workers are encouraged to clean with micro-denier microfiber cloths and mops, which can remove up to 95 percent of soil from a surface, as well as remove the surface’s protective biofilm, says Hicks. So, if custodians skip the cleaning step, a disinfectant can’t do its job, says Hicks.

When disinfecting, custodians must pay attention to the required dwell time. Ten minutes used to be the industry standard for many chemicals, but newer products in the market have dwell times as short as one minute.

Custodians also need to use the right products, so they should pay attention to the disinfectant’s kill claims to understand what they are protecting against.

For example, Clostridium difficile (C. diff) is a particular harsh bacteria and requires a bleach-based product, says Steve Attman, principal and co-CEO of Acme Paper and Supply, Savage, Maryland. However, departments wouldn’t need to use such a strong disinfectant if battling Influenza A.

In addition to using proper products and processes, a focus on commonly touched objects can reduce the risk of HAIs.

“Ten years ago I met with an epidemiologist and asked him the biggest common transference of infection,” says David Thompson, CEO of the Green Clean Institute, Rolla, Missouri. “He said, ‘If you go to convenient care or urgent care, what’s the first thing they ask you to do? Fill out forms using the same pen handled by lots of other sick people.’ Don’t touch that pen!”

In the waiting room, everyone touches the same chair railings and children play with the same toys, but these waiting areas are less of a focus for cleaning than the patient rooms.

In addition, the surfaces inside a patient room that should receive the most attention may be surprising. In a presentation about infection prevention, Hicks highlighted surfaces commonly contaminated by MRSA in a typical hospital room. These included hospital bed handrails, mobile tables used to hold food trays, armrests on chairs for visitors, window ledges and curtains used to separate beds in a shared room.