The current situation facing healthcare environmental services in controlling healthcare acquired infections (HAI’s) is strikingly familiar to that facing the food processing industry in the 1980s and ‘90s. At that time, food processors began to fully realize that there was a direct and significant financial benefit from the implementation of science-based control actions that impacted food safety.


The dairy industry had long understood this connection between food safety and microbiological control. In fact, the development of pasteurization in 1862 can be considered one of the earliest examples of a science or evidenced based practice being implemented for food safety and public health. However, the non-dairy related food-processing industry was slow to accept the true nature of this relationship, especially in the area of food plant sanitation.


As with healthcare today, up until the 1970s, food processors relied on visual inspections, many conducted by government regulators such as the U.S. Department of Agriculture (USDA) and U.S. Food and Drug Administration (FDA), to determine the cleanliness of their facilities. If it looked clean, then it was assessed as being clean. So, too, in today’s healthcare facilities. If the patient room passes visual inspection then the room is good to go. Unfortunately, it is generally accepted that only 50 percent of the surfaces are actually being cleaned during a terminal cleaning of a patient room.


As food-processing plants grew larger and increasing complex, traditional inspection based quality systems were no longer able to adequately manage quality nor protect public health. Food processors were forced to apply science-based principles to their quality control programs to address the food safety issues raised by these high volume production units. The same process can be applied today to cleaning and disinfecting healthcare facilities.


Similarities with the food industry

The methodology developed by the food industry to achieve these quality and safety goals is a comprehensive initiative now known as Hazard Analysis & Critical Control Points or HACCP for short. For the food industry, HACCP programs are federally regulated under the FDA. HACCP programs can address all threats to food quality and safety including metal contamination, improper processing or product tampering with the control of microbiological threats from food borne illnesses remaining a primary focus. As a result, although noteworthy outbreaks of food borne illnesses have and will continue to occur, Americans continue to enjoy one of the safest, abundant and most economical food supplies in the world.


The comparison to current the healthcare environment is simple. Healthcare facilities are rapidly expanding. These facilities are designed to provide highly complex care to the greatest number of patients in the shortest period of time. Also, a growing number of their healthcare consumers are typically at higher risk to infection and illness due to their immunocompromised state as a result of ongoing medical treatment. And as with the food industry, reliance on visual inspection is no longer adequate to ensure the safety of the healthcare consumer or the healthcare process.


Using a HAACP approach to environmental hygiene, cleaning professionals in a healthcare facility will be able to identify, evaluate and control HAI hazards by following the seven HACCP principles:


Principle 1:         Conduct a hazard analysis

Principle 2:         Determine the critical control points (CCP’s)

Principle 3:         Establish critical limits

Principle 4:         Establish monitoring procedures

Principle 5:         Establish corrective actions

Principle 6:         Establish verification procedures

Principle 7:         Establish record keeping and documentation procedures


Developing a plan

In many ways, the healthcare industry has already addressed, or is in the process of addressing, the science behind the first principle — a hazard analysis. Epidemiological studies prove that the surrounding environment plays a role in the transmission of disease.


This leads to Principle 2 and shows that one of the key CCP’s in controlling the transmission of infections is adequately cleaning and disinfecting the environmental surfaces that patients and staff come into routine contact – known as high-touch surfaces. The U.S. Centers for Disease Control and Prevention (CDC) recently identified 17 commonly-touched healthcare surfaces that warrant targeting, including bed rails, bedside and tray tables, patient chairs, IV poles and more. In addition to these surfaces, an effective HAACP program will require that each facility evaluate their own patient areas and determine their individual, and possibly unique, list of high-touch surfaces.


Other factors impacting this cleaning and disinfection CCP are the products and procedures themselves and whether or not they are appropriate to the effort to eliminate the organisms of concern. In particular the selection of the disinfectant cleaner and cleaning tools will in the end determine the overall effectiveness of the cleaning and disinfecting process.


For HACCP principles 3 to 5, which address the issues of control limits, monitoring and corrective actions the previously referenced CDC guidance establishes the basic framework for implementing an effective program. It is noted that microbiological monitoring methods are one approach to collecting valid data on cleanliness and as such were available to food processors and have useful and practical application. However, for environmental surface monitoring purposes, microbiological testing is expensive, can produce difficult to interpret results and is always after the fact when evaluating the environment. This proved just as true for the food processor as it does for the cleaning professional.


Therefore, of central importance is the implementation of a monitoring program that replaces visual inspection as an indicator of surface hygiene. For food processors, ATP measurements provided the objective and real-time information needed to assess the cleanliness of environmental surfaces. ATP measurements can provide the data needed to establish the critical limits necessary for developing the corrective actions that will ultimately be required to determine if the program is in compliance and allow for process improvement. An example of this could be the identification of high-touch surfaces that pose greater threats for cross-contamination or the objective evaluation of cleaning procedures or products.


This leads to the final principles of verification and record-keeping, principles 6 and 7. With the data provided by ATP measurements and HAI statistics, cleaning professionals can work together to identify and refine the CCP’s of concern and thereby develop the appropriate action plans. In the end, this process of continuous improvement is necessary to insure that the environmental hygiene program is achieving the overall goal of reducing or eliminating HAI’s and improving patient safety.


Implementing effective HACCP programs in the food industry required top management commitment to invest in the needed systems and to provide employees with a sense of the importance of food safety. Likewise, building service contractors can use the concepts of HACCP to convince customers of the importance of investing in evidenced based practices to improve their environmental hygiene program as it is evident that a commitment to patient safety already exists.


John Thomas is the sales manager and HealthRite specialist for the Philip Rosenau Co., Warminster, Pa. John is also CIMS ISSA Certification Expert (ICE). He can be reached at


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Disinfecting and ATP-Monitoring Commonly Touched Surfaces In Healthcare Facilities