Surfaces harbor multidrug-resistant organisms (MDRO) such as MRSA (methicillin-resistant Staphylococcus aureus), VRE (vancomycin-resistant enterococci) and other potentially lethal pathogens such as C-diff (Clostridium difficle), all of which are on the increase and pose serious problems to health care.  These “bad bugs” can live on surfaces for several months and are quickly reactivated with moisture.

In addition to an infection threat, not providing a safe, clean environment can result in millions of dollars lost. A court once awarded $13.5 million to the family of a patient who died of flesh-eating bacteria that was contracted during chemotherapy treatment in a facility. In a separate case, a patient was awarded $2.58 million after contracting MRSA in a hospital.

Although cleaning and hygiene issues may not always be the subject of such dramatic litigation, there is little doubt that poorly cleaned facilities are contributing to serious disease transmission.

Improving Clean and Health

For too long, clean has been a subjective term — determined by a simple visual assessment. But two people inspecting the same room or the same object might have a different opinion about whether or not it passes the test.

The fact is, surfaces appearing to be clean might not necessarily be clean when scientifically quantified or qualified. Remember, what can’t be seen can be harmful.

According to recent studies from Healthcare Environmental Hygiene Study Group, although they looked clean, only 25 to 45 percent of touch-points nearest the patient met requirements. Interventions raised the rate of clean to 75 percent and improving processes and integrating measurement of touch-points reduced the risk of cross-contamination by 50 to 75 percent.

Departments should strive for health-based or hygienic cleaning. In other words, clean for healthier environments and not just for appearances.

In 1993, Dr. Michael Berry wrote “Protecting the Built Environment, Cleaning for Health.” In this book, Dr. Berry lists three elements to cleaning:
1. Cleaning is an activity (when workers clean, they do something)
2. Cleaning is a process (top to bottom, clockwise around the room, from the cleanest area to the dirtiest area)
3. Cleaning is a special form of management (green cleaning, understanding the principles of the transmission of disease, etc.)

The first guiding principle for cleaning for health is to remove germs rather than kill them. In other words, workers are performing an activity and a process of removing harmful pollutants and putting them in their proper place so that humans and valuable materials will not be exposed.

The second principle for cleaning for health is to understand some basic microbiology. John Walker’s book, “Microbiology for Cleaning Workers Simplified,” outlines some elementary truths about the importance of the cleaning function in eliminating dangerous or “bad bugs” from the indoor environment.

It addresses: the elements of microbiology and disinfection; the reproduction of bacteria (how a single bacteria reproduces itself every 15 to 30 minutes and that in five hours one bacterium turns into over a million bacteria); how bacteria move; routes of transmission; and the basics of getting rid of bacteria (don’t feed them, don’t move them, just remove or kill them).

Walker also asks and answers the question, “Why should cleaners disinfect?” There are two reasons for using a disinfectant: first, disinfect when there is a possibility or probability that a disease-causing organism is present on the surface being cleaned; and second, disinfect when a governmental or institutional agency says to do so.

The third principle of cleaning for health is this: According to the U.S. Centers for Disease Control and Prevention, friction (or, good old-fashioned “elbow grease”) is as important to removing bacteria and microorganisms as disinfectants. Although “bad bugs” may contaminate surfaces such as tables, chairs, floors or counter tops, it is questionable whether departments need to disinfect these inanimate surfaces.

The CDC further explains that although microorganisms are a normal contaminant of walls, floors and other surfaces, these are rarely associated with transmission of infections to patients or personnel. Therefore, extraordinary attempts to disinfect or sterilize these surfaces are rarely indicated.

However, routine cleaning and removal of soil are recommended. Any hospital-grade disinfectant-detergent formulation registered by the U.S. Environmental Protection Agency can be useful for surface cleaning, but the actual physical removal of microorganisms by scrubbing is probably as important, if not more so, than the antimicrobial effect of the cleaning agent.

The fourth principle of cleaning for health is, not all disinfectants are created equal. There are differences between products of the same type. One phenolic disinfectant is not necessarily as good as another — even with rigid governmental standards, there are still differences.

As vanguards in the battle against hospital-acquired infections (as related to contaminated environmental surfaces) workers need to be well-equipped, well-trained and supported with proper funding for the fight. Hygiene professionals might very well be the only thing that will break the chain of infection now, or in the future.

Darrel Hicks is the author of "Infection Control for Dummies" and is recognized as one of the top experts on infection control issues.