Infection Control: Flushing Away Germs
Every few years, a new communicable disease sparks a flurry of media attention and rouses public alarm. The pandemic du jour is H1N1 (also known as “swine flu”), a contagious virus that has people panicked and facility managers scrambling to ease fears about cleanliness.
“With all the media attention to these diseases, people are very aware and concerned,” says Mike Liscio, vice president of sales for the Clark Products New Jersey Division in Carteret, NJ. “My customers bring it to my attention.”
In fact, problems like avian flu and SARS are a great opportunity for housekeeping departments to re-evaluate and update their policies for dealing with cross-contamination (the spread of bacteria from one person to another). And perhaps the area of greatest concern is the restroom.
“The restroom is a place where germs and bacteria can develop and grow,” Liscio says. “People carry germs on their hands, walk into the restroom touching hotspots and spread those germs to others.”
While there is potential for cross-contamination in any space, the restroom is of particular concern because it is used for bodily functions and it has so many touch points in such a small area.
In just one restroom visit, a patron may need to touch a doorknob, a stall latch, a toilet seat, a toilet-paper dispenser, a toilet handle, a stall door, a faucet, a soap dispenser, a paper-towel dispenser and the exit door. That’s 10 surfaces where a person (including the housekeeper) may pick up germs and then spread them throughout the facility.
With so much potential for cross-contamination, it’s imperative that housekeeping departments develop policies for proper restroom cleaning and then train the staff to follow them properly.
“A key ingredient in any job is giving the cleaner the right products and tools and training them how to use them,” Liscio says. “In our industry, we take it for granted that people know how to properly clean and disinfect a restroom. The majority of the time they don’t.”
Thorough hand washing is the best way to prevent cross-contamination. While janitors cannot force people to wash up, they can offer incentives that increase the likelihood. First, remind patrons of the importance of hand washing with signs, which are often available for free online and from distributors.
“Signage is a quick slap in the face that people should be washing their hands,” Liscio says. “You can get signs online and then customize them to your needs.”
It’s also important to provide hand-washing products that people want to use. Identifying which type of soap and towel your patrons prefer may be a matter of trial and error, but one preference is a matter of fact: Hands-free technology is a hit with patrons.
Adding no-touch paper dispensers is quick and often free thanks to proprietary products offered at no cost by manufacturers. Switching to auto-flush toilets and touch-free faucets, on the other hand, can be a slightly bigger and more costly endeavor.
Even so, people prefer hands-free technology, which means they are more likely to use it. The fixtures have the added benefit of reducing the number of touch points for possible cross-contamination in the restroom.
“I classify adults as large kids,” says Bob Mogge, sales specialist at Allied Eagle Supply in Detroit, Mich. “The more you take out of their hands, the better. It’s less for them to worry about.”
In an ideal world, everyone would wash up after using the restroom, but studies have found 25-35 percent don’t. Newer products can help address this problem. Hand sanitizer wipes or gel dispensers placed near doors can act as a fail-safe.
“You can put all the money you want into auto flushing units and faucets and soap, but if you stop to grab the door handle on the way out, you can still have cross-contamination,” says Joshua Kraft, sales manager and education coordinator for Bruco Inc., in Billings, Mont.
Even with the best hand-washing policies, germs will find their way onto surfaces. Preventing cross-contamination requires regular and thorough cleaning with the proper chemicals and tools. Frequencies should be established based on traffic; cleaning once a day may be enough for a little-used office restroom, while hourly cleanings may be needed for an airport facility.
To avoid spreading germs within a restroom, housekeepers should clean the space from top to bottom and from non-acute to acute areas.
“You can use the same towel to wipe the sink and then go towards a urinal but you never want to go the other way,” Kraft says. “Your procedure in the cleaning process is more important to the cross-contamination issue than the tools you choose.”
One of the most important procedural issues is dwell time. A disinfectant cleaner, which kills germs as well as cleans, is a must-use chemical for a restroom. In fact, some facilities find a multipurpose disinfectant cleaner can handle all the cleaning duties in a restroom. To do its job correctly, the product must sit on the surface for a specific time. Just spraying and wiping doesn’t give the chemical the time it needs to kill 99 percent of bacteria.
“To kill germs, a disinfectant needs to fight the battle for about 10 minutes,” Liscio says. “If a cleaning person only allows the product to sit for 5 minutes, it’s not as effective. Dwell time is key to disinfecting.”
To achieve necessary dwell time, janitors can apply the chemical as they move around the restroom (following the top-to-bottom method). By the time they are finished, they can return to where they started to wipe up the wet chemical. In a smaller restroom, they may need to disinfect the men’s restroom and let it sit while they work on the women’s restroom, and vice versa.
Disinfectants must also be diluted properly and the U.S. Environmental Protection Agency requires special procedures for their handling, use and disposal. That’s why many facilities use chemical dispensing systems that properly dilute the chemical to take away any guesswork. Cleaners should also be instructed to wear personal protective equipment, including gloves and masks, to protect themselves when handling disinfectants.
Cleaning procedures may be paramount in preventing cross-contamination, but certain products can play a strong supporting role.
For example, color coded tools can keep a janitor from tracking germs from the restroom all over a building. By using red tools for toilets and urinals, yellow for sinks and mirrors and blue for windows and dusting, a janitor can avoid accidentally using the same rag in a toilet and on a kitchen counter.
“We highly recommend color coding,” Liscio says. “It’s just a way of simplifying the cleaning procedures. It’s easy for the cleaner to recognize what product to use and where.”
Also helpful in preventing cross-contamination is microfiber technology. These products provide better agitation for chemicals, which can help with the efficacy of kill claims for disinfectants. Microfiber cloths and mops also contain about 95 percent of bacteria on a surface, Liscio says, while traditional products may spread the bacteria around. Plus, microfiber cloths and pads are easier to swap out from room to room, so they are less likely to be used in multiple settings.
“Even though the initial cost is more than a cotton mop, microfiber products are washable 400 to 700 times,” Mogge says. “You aren’t going to get 700 washings out of a regular cotton mop. Microfiber cloths can be used and reused if you simply wash them in a gentle cycle with detergent. That negates any extra cost you would have.”
Housekeeping managers who are particularly concerned about cross-contamination — those in such high-risk facilities as nursing homes and hospitals — may want to invest in disposable products. These one-time-use items are trashed as soon as they’ve served their purpose, so there is no chance of them spreading germs to other areas.
“I recommend them for the restroom if the budget allows,” Kraft says. “When there’s a green focus, disposables won’t fly. But sometimes with the cost and energy aspects of laundry, disposable can be less expensive.”
Buying fancy products and implementing great procedures won’t matter if the housekeeping staff doesn’t understand them. Clearly outline the cross-contamination policies and then educate the staff on them. Make the task even easier by asking a distributor for help.
Suppliers should know the proper procedures for cleaning a restroom to avoid cross-contamination and should be willing to offer on-site training to the staff. They may also be able to provide literature to help custodians remember the correct cleaning methods.
Make sure the training includes information not just on the “what” and “how” of cleaning, but also on the “why.”
Becky Mollenkamp is a freelance writer based near DesMoines, Iowa.