shield against infections

Training workers to clean and disinfect is essential — as is allotting them adequate time in which to do their work. Unfortunately, this is an area where many hospitals fall short, say industry experts.

“One of the biggest challenges in the industry is time,” says Solomon. “Often EVS staff is being pushed to clean and disinfect quicker, but unfortunately, there is a time factor involved with cleaning and disinfecting a room. So [facility cleaning managers] need to put value on EVS and allow them the time needed to clean and disinfect properly.”

Similarly, the onus is on EVS staff to recognize and adhere to appropriate dwell times when applying disinfectant.

“No matter what the disinfectant is, they all have a specified dwell time that has to be respected,” says Bill Fellows, president of Fellows Custodial Consulting LLC, Nashville, Tennessee. “The reality is people are more concerned with how long it takes to do something, and the dwell time is not always factored in. As a result, the requirement to keep moving supersedes the requirement to disinfect, so you get a false sense of security.”

This is especially true in emergency areas and operating rooms where turnover is high and staff is pressured to get the job done, Fellows adds. He also emphasizes the importance of training staff to choose the right disinfectant for the type of microorganism they’re trying to kill.

With the renewed focus on education, Solomon sees competency testing emerging as a priority to ensure staff understands and retains information. EVS managers should also test the cleanliness of disinfected surfaces regularly.

“We’re seeing a lot of facilities incorporating auditing and validation into their cleaning programs,” notes Solomon. “Technologies like ATP meters and florescent marking gel are valuable not only to document and provide recordkeeping for compliance, but to provide feedback for supervisors to identify areas that may need more comprehensive cleaning and disinfection.”

A Two-Step Approach

According to the U.S. Centers for Disease Control and Prevention (CDC), every year in the United States at least 2 million people get an antibiotic-resistant infection, and of those, at least 23,000 people die.

Although tougher strains of bacteria are a growing threat to healthcare environments, the process for disinfecting surfaces remains unchanged: clean first; disinfect second. Nevertheless time-strapped EVS workers may be tempted to skip cleaning before applying disinfectant, especially if there is no visible soil.

“Both the CDC and the Environmental Protection Agency (EPA) say that disinfectant should be applied to pre-cleaned surfaces,” says Hicks. “It’s a two-step process, but very few people are doing that. They’re using one-step disinfectants, which aren’t good enough for the bioburden in these rooms.”

Fellows agrees: “Let’s say you have feces on the floor. Too many cleaners use the disinfectant to clean up the mess, but it can’t disinfect the surface because it’s working on the feces,” he explains. “You need to make sure a surface is clean before it’s disinfected, otherwise the disinfectant can’t do its job.”

According to Hicks, some facilities only pre-clean if soiling is visible, but some microorganisms may not be visible until multitudes of them exist on the surface. For instance, a speck of fecal matter the size of a pinhead might contain a multitude of C. diff spores, and that minuscule speck may or may not be visible to the person responsible for cleaning the room.

“We need to get rid of the term ‘visibly soiled,’” notes Hicks. “Disinfectants are only tested to a 5 percent soil load, and 5 percent is not even visible. Also, what is visible to one person may not be visible to another.”

A good rule of thumb: Pre-clean all surfaces prior to disinfection, regardless of soil load, because what you can’t see can hurt you.

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