Cross-Contamination: Cleaning Targets Germ Hot Spots
Industry headlines proclaim that cleaners should be on the lookout for “superbugs” that might contaminate buildings. But the truth is, antibiotic-resistant pathogens such as Methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile (C. diff) and others already lurk in the places cleaning crews work. From hospitals to day cares to schools, restaurants and hotels, dangerous infectious agents lie in wait, and without proper cleaning practices they can make building occupants and those who clean these contaminated areas very, very sick.
A fear among cleaning professionals is that instead of eliminating germs, the cleaning staff may play a part in spreading them. And Mark Warner, a cleaning expert from AirX Labs in Folcroft, Pa., and presenter of disinfection and decontamination seminars, says they may be right.
Warner carries a microbial monitoring ATP (adenosine triphosphate) meter with him everywhere. This device, which detects the presence of bacteria, helps him pinpoint the bacteriological source and establish how it’s spreading. Quite often, he says, he discovers flawed cleaning methods are to blame.
While cleaners “do the best they know how,” Jeannie Murphy, president of Murphy Sanitary Supply, a distributor in Tulsa, Okla., admits she sometimes encounters custodial operations lacking written cross-contamination procedures or failing to enforce these processes as they should. Multiply that with understaffing and turnover issues and it quickly becomes more complicated. “Sometimes people are cleaning 20 patient rooms when they don’t even have time for 10,” she says. “That’s a serious thing.”
When facing colossal workloads, corners may be cut. Custodians may be taught to change out mop water every three rooms, but instead mop eight to 10 rooms with the same water to save time, says Jerry Plount, president of Sani-Chem Cleaning Supply Inc., a distributor in Clearwater, Fla.
“How can you not cross-contaminate if you’re not changing your mop water and disinfectant?” he asks. “A disinfectant can only handle a certain amount of soil, before you’re just spreading germs around.”
Cleaning plays a significant role in reducing the spread of minor afflictions, such as cold and flu, and major diseases, such as those caused by superbugs. Plount calls top-notch cleaning practices a prescription for good health.
“You are never going to totally eliminate cross-contamination but we can reduce germ transfer from room to room,” he says. “It goes back to choosing the right products and using them correctly.”
Avoiding cross-contamination begins with an understanding of where germs hide. Consumers are lead to believe that touch points (door knobs, faucets, toilet levers or hand railings) embody the primary source of infectious microorganisms, but Warner says these areas actually hold the third spot. When people cough, spit or sneeze, the germs released into the air first land on the largest horizontal surface in the room — the floor. Next they come to rest on desktops and countertops — the next largest horizontal plane — and finally they make their way to touch points. These microbes can then hitchhike to a person’s hands and eventually to an available portal in the body.
The idea that floors house the bulk of a facility’s bacteria flys in the face of common cleaning practices where crews work from the top down, cleaning surfaces above the floor first. Here a custodian’s feet pick up these portals of disease and transport them everywhere they go.
And when facilities ban custodians from cleaning cluttered desktops, Warner points out that the second largest germ reservoir isn’t even touched.
“Without cleaning these surfaces, we’re essentially spitting in the wind when trying to shut down a microbial spread,” Warner points out. When risk exists, he recommends custodial managers issue a memo to building occupants advising them to clear their desks to allow custodians to clean. The practice doesn’t need to go on forever but experts recommend that it must continue until the threat is gone.
Better ‘Germ’ Traps
Manufacturers continually strive to create better one-step disinfectants and other tools to prevent the spread of disease. These new products include hospital-grade disinfectants designed to kill pathogens, microfiber cleaning technology, wet-vac systems and more.
Perhaps most influential in preventing cross-contamination is microfiber. This micro-miracle does a better job of holding onto germs, and when used in a mopping system allows cleaners to replace the mop head in every room. Not only that but users can wash and reuse each mop head more than 300 times before tossing. Some systems even spray disinfectant on each head individually, providing new and uncontaminated disinfectant in every room.
“It takes a housekeeping department some seed money,” Plount admits. “They have to spend money upfront to buy microfiber heads and frames, and train.” But he notes clients who have made the switch save money in the long run. “Schools we’ve set up with microfiber report spending less money over the course of a school year,” he says. “But finding the funds to make the switch can be tough.”
Nothing Without Training
To fully prevent cross-contamination, Plount says the top tools of the trade must be used properly.
“The best product or chemical in the world when used incorrectly will not provide good results,” he says. “In the recent MRSA outbreaks we’ve learned people were not taking care of certain surfaces the way they should. Instituting thorough cleaning practices would solve a lot of problems.”
Unfortunately that’s where many cleaning operations fall short, says Bob Serfas, president of R.S. Quality Products, a distributor in Allentown, Pa. He emphasizes there is no substitute for thorough training.
“The most common reason for cross-contamination is the human element. It results from inadequate training or improperly written and executed sanitation plans,” he says. “It’s critical to develop a basic sanitation plan, train workers in its implementation and supervise the work they perform.” He urges soliciting input from custodians when developing these plans and incorporating their ideas in the final documents.
Sanitation plans should address what to do when outbreaks occur. In high-risk situations, Warner recommends enforcing a two-step cleaning process. For example, if a nursing home is experiencing infection spikes among its residents, cleaners should mop the floor first, which adds to their own safety because they are not cleaning above a contaminated surface. Workers can then proceed with a top-down cleaning, performing a pre-clean of every surface and following it with disinfectant. Finally, they should mop the floor again with disinfectant.
“If you follow that up with an ATP meter check, you’ll find you’ve been very effective in removing the threat,” he says.
Murphy recommends training and retraining, a minimum of quarterly, and keeping education records in every employee’s file. While it can be expensive and time consuming to assemble the entire staff for education, she stresses “it’s nothing in relation to a lawsuit if someone gets sick.”
“If housekeepers have been trained and perform every procedure in the spirit of that procedure, they can prevent cross-contamination,” she stresses. “It’s a matter of touching every surface with disinfectant to make sure it’s germ-free.”
Leigh Hunt is a freelance writer located near the Milwaukee area.
“Facility managers often say to me, ‘We understand what to do in a contagious environment, but when should we ramp up our game? Do we adjust our procedures forever? If not, how do we decide when it’s safe to go back?’ ” says Mark Warner, a cleaning expert from AirX Labs in Folcroft, Pa.
To fully address disease threats and avoid cross-contamination, experts advise teaching custodians to identify risk levels and adjust procedures, chemistries and tools to the menace at hand. The DEFCON ranking system employed by the U.S. Department of Defense can help crews assess risk.
There are four DEFCON levels. In DEFCON 1, no dangerous pathogen threat exists. At this level, experts recommend cleaning for smell and look. DEFCON 2 means infectious microbes lie in wait and custodians must double their efforts to eliminate fertile pathogen breeding grounds. This may involve switching from a neutral floor cleaner to a lean disinfectant solution to kill off bacteria colonies. When a dangerous pathogen, such as MRSA, exists, cleaners should switch to DEFCON 3 and attack the facility three-dimensionally. Besides disinfecting the primary reservoirs, crews should cleanse floor grout, deep clean carpets and disinfect other substrates. Ultra-violet (UV) lights and air cleaners can be utilized to clean the air. DEFCON 4 denotes the presence of a dangerous biohazard. This situation calls for experts trained in hazardous agent removal.
It is important to train custodians to address questions that may arise from building occupants when outbreaks occur. If someone asks what is being done to prevent MRSA from spreading, every custodian should be equipped to explain that they have upgraded their efforts to DEFCON 3 and will address primary threat reservoirs and substrates until the bacteria is gone.
“People in housekeeping don’t have to — and shouldn’t — apologize for the level of service they’ve been providing,” Warner says. “They’ve provided adequate service levels for a DEFCON 1 environment. But they need to demonstrate that they recognize the threat and are doing everything possible to eliminate it.”
— Leigh Hunt
For additional information regarding cross-contamination and specific cleaning methods, visit www.cleanhound.com and enter the following search terms: cross-contamination, cleaning for health, healthy clean, green and green cleaning.
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