It's been a year since the first cases of the H1N1 (Swine) flu were reported and the Centers for Disease Control and Prevention warned of a global pandemic that could kill hundreds of thousands of people. Today, there are thankfully far fewer reported deaths from H1N1 or the seasonal flu.

Did the flu viruses dwindle of their own accord? Was the vaccination program particularly effective? Or did proper cleaning and hygiene practices play a role in halting their spread?

We may never know the answer, but one thing is clear: cleaning staffs around the country adopted best practices for flu prevention that will likely set a new standard for the future.

Disinfectants Deemed Adequate

While the world was gearing up for potentially the most lethal influenza virus since the 1918 pandemic, the U.S. Department of Health and Human Services released "Interim Guidance on Environmental Management of Pandemic Influenza Virus" for environmental professionals. Its research revealed that Influenza A and B viruses could persist on both nonporous and porous surfaces anywhere from hours to days — which meant the likelihood of secondary transmission by touching infected surfaces was high.

The good news, however, was that influenza viruses were among the least resistant microorganisms to chemical disinfection. Routine cleaning and disinfection products, it was concluded, are adequate to manage the environment during a pandemic.

So while the broad-based disinfectants found in most janitorial closets can kill and eliminate the virus, frequent attention to cleaning touch points is essential to ward off the spread of the disease.

Cleaning: A Team Effort

Schools and day care centers offer some of the greatest challenges during flu season, since children are notorious for sharing cold and flu germs. At Bethany Evangelical Lutheran School in Manitowoc, Wis., Head Custodian Sandy Smith, CEH, switched from a once-a-week rigorous cleaning to a nightly routine at the height of the flu season. She was able to back off to a two to three times a week schedule after the threat passed.

Daily cleaning at Bethany focuses on touch points such as doorknobs, telephones, desks, tables and chairs. Smith keeps a spray bottle in each classroom for the teachers to use throughout the day, while her staff cleans the touch points again each night.

In a school environment, Smith warns, you have to be careful what products you use. "Some kids are sensitive to smells. If I try something new and it bothers them, I'm not going to use it anymore. I use what's effective but doesn't leave a lingering odor," says Smith.

Education Is Key

Bigger kids pose bigger challenges, and that was no exception at the nation's college campuses during flu season. At Richmond, Ind.-based Earlham College, strategies for treating a pandemic were already part of the school's Emergency Preparedness Program, according to recently retired Director of Facilities Alan Bigger.

As former president of APPA, the national association for higher education facilities managers, Bigger had the opportunity to visit Asia to see how facilities there had dealt with the Avian Influenza (also known as Bird Flu or H5N1) outbreak. Learning from this oversees experience, Bigger developed an effective and healthy program at home.

Fifteen percent of Earlham's student population come from oversees, says Bigger, and the rest come from 44 states.

It is important to keep these kids healthy because "if you send [sick] students home, you send the disease all over the country," he notes.

Like Smith, Bigger is concerned about the use of chemicals and antibacterial cleaners in an educational setting.

"There's a great deal of concern in the medical community that overuse may lead to disinfectant-resistant bacteria," he says. "There's also the potential for long-term allergic reaction" after repeated exposure. "Now more than ever, we need to emphasize good cleaning protocol, such as wearing gloves and goggles for both chemical exposure and infection control."

Dealing With A Global Audience

The other extreme from a close-knit educational environment is the large conference center, where hundreds of thousands of strangers mix and mingle over the course of a day. Patrick Jackson is director of building services for all 3.9 million square feet of the Georgia World Congress Center in Atlanta, where touch-free technology has always been part of the infection control strategy.

During the peak of the pandemic and flu season, Jackson had 50 freestanding touch-free sanitizing stations installed in the large concourse area and pump-type sanitizer bottles placed on tables outside each meeting room. Not only does this display an infection control effort by the facility, but it gives visitors control over their own health.

The germicide that Jackson's staff ordinarily uses in the restrooms is now also used at all entry touch points, with a particular emphasis on disinfecting handles and doorknobs. In restrooms, hands-free paper towel dispensers are in use, and touch-less cleaning equipment is used to clean walls and partitions more frequently.

Another major effort at the Georgia facility is staff and patron education. For staff, Jackson offers a series of 100-level courses on infection control, which proved particularly valuable at the height of the flu season. For clients and visitors — up to 40 percent of whom are international — signage is prominent throughout the facility with pictures demonstrating good hand washing techniques and reminders to cover up when coughing and sneezing.

Keeping Viruses Out Of Health Care

In any season, the most challenging infection control environment is a medical setting, but even more so when the flu can cause widespread illness among crucial staff and patients with suppressed immune systems.

Jack Van Reeth, manager of environmental services for Geisinger Medical Center in Danville, Pa., says the use of H1N1 and regular flu vaccines was essential to preventing a widespread outbreak. Everyone involved in patient care was encouraged to get both vaccines. For each vaccine, they received a star to wear on their nametags.

"Anyone not wearing both stars would have to wear a mask to protect the patients and themselves," he says.

The hospital also initiated a massive visitor-screening program. At each entrance with public access, there was a table staffed with screeners who would ask visitors a series of questions about their current health. Visitors were also given information about not spreading germs and the importance of hand washing.

"A large number of additional hand sanitizer bottles, mounted in dispensers, were available in public areas," Van Reeth adds.

All flu or suspected flu patient cases were placed into contact and droplet isolation status, he says. Patient contact employees were required to take special precautions of wearing a gown, gloves and mask when working with the patient.

At discharge, the cleaning staff would take extra measures, including washing walls and changing curtains. The cleaning staff was also reeducated about the importance of daily disinfection of high-frequency touch points.

With the end of the flu season, Geisinger Medical has discontinued the entrance screening process and flu emergency protocols.

"Next year when flu season kicks in, I would imagine that we would reinstitute these practices," Van Reeth says. In the meantime, the new hand sanitizers will remain in all public areas.

From Flu To Allergy Season

With the end of the flu season comes the beginning of the allergy season and the new challenge of keeping dust and dander to a minimum. Atlanta, in particular, gets inundated with pollen.

"From an engineering viewpoint, we go through and change out the filters in the heating, ventilating and air conditioning (HVAC) air intakes to minimize the flow of pollen," says Jackson. "The main thing is to control the air coming into the building."

Doormats that generally catch dirt and provide traction are also effective in trapping pollen. His staff also uses HEPA vacuums to capture the smallest particulates and microfiber on floor surfaces.

In an education environment such as Bethany, the custodial staff has little control over open windows and doors during the school day. Smith and her staff also change out the filters, use dual motor vacuums and wet dust when they clean the classrooms to try and catch as much dust and pollen as possible.

Bigger comments that microfiber and HEPA vacuums are a huge help at Earlham, especially when compared to vacuums of the past that would "blow out more dust than they would pick up."

Whether dealing with infection control or minimizing allergens, Smith recommends keeping up with new products and tactics by problem solving with peers and sharing best practices. "Education and interaction with peers is important to stay on top of infection control," she says.

Maureen Conners Badding is a freelance writer based in Milwaukee, Wis.