"One well-trained, conscientious housekeeper given the right tools and enough time will prevent more disease than a room full of doctors can cure."

The role of the housekeeper or environmental cleaning personnel is critical to the control and prevention of infections in the hospital. It is a team effort to which all hospital workers play a part – doctors, nurses at the bedside, respiratory therapists, pharmacists, physical therapists, surgery technicians in the Operating Rooms, cooks in the kitchen and housekeepers who work throughout the busy hospital to maintain a clean environment.  

Bacteria are able to survive in dust and on bedrails, phones, nurse call buttons, curtains and other surfaces for long periods. Hand hygiene is important for all hospital workers but without a clean environment, hands will quickly become recontaminated. In fact, one U.S. study found that 42 percent of nurse's hands were contaminated with MRSA even though those nurses had no direct contact with a patient's wound or urine.

Antibiotic–resistant bacteria ("super bugs") have also been unleashed in hospitals and they can survive on common touch-points for up to 56 or more days.

Prevention of healthcare associated infections depends on a clean and properly disinfected patient room. In order to reduce the number of infections in the hospital, it is extremely important that housekeepers understand their role, proper cleaning procedures and the soaps or chemical solutions they use for cleaning. 

In this column, my goal is to teach you the essential elements of your job with special attention to the infection prevention and control aspects. 

Definition of Terms

Before we can embark on this journey of preventing or controlling infections through better cleaning practices, we must understand some of the basic terms used by those in the field of cleaning and disinfecting healthcare facilities around the world.

Cide or Cidal
Cide or Cidal means to kill or murder. For instance, a bactericide is an agent that kills bacteria. Virucidal, fungicide, sporicide and tuberculocidal can kill the type of microorganism identified by the prefix.

Cleaning is not the same as disinfecting or sanitizing. It should occur before disinfecting or sanitizing surfaces. Cleaning is the removal of all foreign material from objects by using water and detergents, soaps, enzymes and the mechanical action of washing or scrubbing the object. Disinfection/sterilization cannot be accomplished if cleaning is inadequate.  

Cleaning involves the following ingredients:
• Water-must be clean, potable and kept clean. Once the water becomes visibly soiled, it must be changed for clean water.
• Soap, detergents or enzymes mixed at proper concentrations with water
• Time must be allotted in order to remove all soil from a surface
• Agitation-scrubbing with brushes, abrasive pads, or microfiber cloths is necessary to break through biofilm.

For those in the profession of cleaning, the best way to remember the definition of cleaning is:  NO Dust, NO Spots, NO Smudges, NO Odors=CLEAN

Disinfection describes a process that eliminates many or all pathogenic microorganisms — except bacterial spores — on inanimate (non-living) objects. In healthcare settings, objects usually are disinfected by liquid chemicals called disinfectants.

Factors that affect the efficacy of disinfection include prior cleaning of the object; organic and inorganic soil load present; type and level of microbial contamination; concentration of and exposure time to the germicide; physical nature of the object (e.g., crevices, hinges and lumens); presence of biofilm.

Unlike sterilization, disinfection is not sporicidal. A few disinfectants will kill spores with prolonged exposure times (3–12 hours); these are called chemical sterilants. Low-level disinfectants can kill most vegetative bacteria, some fungi and some viruses in a practical period of time (<10 minutes). Intermediate-level disinfectants might be cidal for mycobacteria, vegetative bacteria, most viruses and most fungi, but do not necessarily kill bacterial spores.

Infection Prevention 
Infection prevention is identifying and reducing the risks of infections from developing or spreading (infection control).  Because of diseases such as cholera, typhoid and Hepatitis B, the risk of acquiring infection in healthcare facilities has increased in recent years for both the patient and the staff.

Hospitals and health centers have special requirements for sanitation as they may have to treat patients who are infected with diseases. Medical staffs caring for these patients are exposed to a higher risk of infection than the general public, as are other patients who may be weak and unable to fight infection.

As a healthcare worker, you must recognize and understand that these threats are a reality and that universal precautions should always be implemented in all patient care.  This is considered one of your biggest job responsibilities.

Sanitizers are a type of antimicrobial that kills or irreversibly inactivates at least 99.9 percent of all bacteria, fungi and viruses (called microbials, microbiologicals, microorganisms) present on a surface. Most sanitizers are based on chlorine, iodine, phenol, or quaternary ammonium compounds, and (unlike some antiseptics) may never be taken internally. Sanitizers are mainly used in food preparation areas such as kitchen counters where food-borne pathogens need to be kept to a safe level.

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