A good infection control protocol for restroom cleaning requires a combination of time-tested strategies and cutting-edge technology, according to several leading building service contractors. That formula includes: communication, cooperation, retrofitting restrooms, the right tools, improved cleaning products and properly trained staff.

Partnerships Matter

A business relationship that fosters clear communication and a willingness by both parties to effectively fight infection is very important. This includes creating infection control programs to fit the needs of individual customers, buildings and occupants.

"A partnership is what gives us the strongest hygienic barrier against disease transmission," says Peter Sheldon, vice president of operations and development for Coverall Health Based Cleaning Systems in Boca Raton, Fla.

"We can't eliminate infection risk completely, but through education we can reduce that risk," he adds.

GCA Services Group of Greensboro, N.C., begins each new job with an occupancy study.

"We look at how many building occupants use the restroom," says Director of Training and Sustainability Jason Lee, "including how often and at what times of the day, to determine the frequency of cleaning."

Often, clients agree to complete a customer survey to help GCA determine the best schedule. Taking a proactive stance differentiates a BSC and lets building managers know that they are working as advocates for occupants' good health.

Studies have shown that most people don't correctly wash their hands, and that — moreso than inadequate cleaning — is responsible for spreading bacteria and infections in schools, offices and any building that is accessible to the general public.

Coverall, along with many other BSCs, provides educational hygiene messages to a variety of building occupants, including child-based messaging about proper hand washing for daycare centers.

In addition to communicating the message that proper hand washing by occupants is key to infection control, BSCs should provide the right products and fixtures to encourage that behavior.

Those include antibacterial soaps, which come in a variety of dispensation options, including foam and liquid, as well as touch-free dispensers. By cutting down or eliminating restroom touch points, the risk of contracting and spreading illness is greatly reduced.

Touch-free soap dispensers are just part of a touch-free restroom system, which includes faucets, towel dispensers, hand dryers and door handles.

"We're reaching the point where you can do everything you need to do without touching anything that someone else has touched," says Larry Snider, managing director of Building Professionals of Texas Janitorial Service in Houston.

Travis Ryan, general manager of EnviroTech Building Services in St. Cloud, Minn., has seen many clients making the transition to touch-free fixtures.

"It just makes sense from a health, environmental and economic standpoint," he says

Snider has seen an upswing in the installation of infrared water spigots, paper towel dispensers and hand drying machines.

The Right Tools, Chemicals

While microfiber has been the new industry standard for a few years, it's hard to overstate its value at mechanically removing microbes.

In restrooms where there's a higher risk of infection, many BSCs use a no-touch spray-and-vac or spray-and-squeegee cleaning system.

"They apply disinfectant all over the surface with low pressure, then apply a high-pressure rinse," Sheldon says.

The solution and microbes are then recovered from floor surfaces with a wet vacuum contained in the same unit or squeegeed into a floor drain.

Depending on the facility, GCA employees use anywhere from three to five microfiber cloths or mops per restroom visit to avoid recontamination. GCA Services also uses a touchless cleaning machine system, sometimes as often as a daily basis, according to Lee.

Spray-and-squeegee systems — which remove cleaning solution, water and debris from floors rather than absorbing liquid like mops or leave floors to air dry — have been shown to clean restroom tile and grout with great efficiency. A recent study found the systems to have 99.9 percent efficiency on tile and 98.1 percent efficiency on grout.

Building Professionals of Texas normally use side-to-side scrubbers "with a brush that goes down into the grout lines, vs. a pad that skims on top of the tiles," says Snider. His staff uses a disinfectant nightly, but scrubs the grout on a regular basis to avoid build-up of microbes and odor.

Obviously, the kinds of cleaners and disinfectants used are integral weapons used to fight infection.

While the type of chemicals preferred may vary from one BSC to the next, two themes emerge regarding chemical use: BSCs are using greener, safer chemicals and strictly adhering to label directions for dwell time.

Snider is enthusiastic about using hydrogen peroxide based cleaners.

"We have more customers requesting nonvolatile chemicals," he says. "Hydrogen products are environmentally friendly, safer on surfaces and safer for the human body all around."

Another popular and practical trend in cleaning chemistry is the use of foam disinfectants, which offer a more even distribution and cling to surfaces longer for a better dwell time. They also require less work to remove than liquids.

During the H1N1 flu outbreak in 2009, Rembrandt Commercial Cleaning in Waukesha, Wis., invested in disinfectant bombs, which are set off after cleaning has finished.

"It will take care of every surface you couldn't get over several hundred square feet," reports Emilie Talady, operations manager.

Measuring Effectiveness

When clients are concerned about cleanliness and infection control, ATP (adenosine triphosphate) measurement technology can bring peace of mind.

ATP, which is present in all animal, vegetable, bacteria, yeast and mold cells, can be an indicator of contamination. Today's ATP testing kits can give real-time microbial load results, indicating how effective cleaning methods are.

"We use ATP measurements to prove every element of our proprietary cleaning program," says Sheldon.

Unlike traditional methods that merely move germs around, ATP testing allows Coverall to focus on a regimen that kills, captures and removes germs.

GCA uses ATP testing on a random basis to check the level of contaminants and help them determine the frequency of cleaning required in a restroom.

"We use the data we collect to drive when the restroom is serviced," says Lee. "It's a great communications tool for the customer from a quality perspective."

Restroom infection control requires the partnering of many factors — but none of them can come together correctly without trained janitors that properly clean, disinfect and maintain fixtures.

Ongoing training about protocol and critical touch points are essential to limiting the spread of infection.

"Our industry and product manufacturers need to do a better job of relaying this information from the top down, through labeling, training and stressing the importance of knowing the proper way to clean and disinfect," says Ryan.

EnviroTech's training also covers the importance of wearing the proper personal protective equipment, such as gloves, while cleaning to avoid cross-contamination.

Maureen Badding is a freelance writer based out of Wauwatosa, Wis.

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