Preventing Cross Contamination: A Prescription for Clean
Hospitals and other healthcare facilities are the first places we turn to when something compromises our health, so the need for cleanliness is inherent to protecting patients, staff and visitors.
While other types of facilities, such as offices and schools, don’t demand a completely sterile environment, there are things that housekeepers in facilities other than healthcare can learn from their standards.
Cross contamination is one of the biggest concerns in hospitals because the spread of viruses and bacteria from room to room or person to person can quickly balloon from a minor problem to full blown disease outbreak. While cross contamination can lead to devastating circumstances when people with compromised immune systems are exposed, cross contamination is also a threat to anyone who crosses the facility’s threshold.
Our world is full of germs. The general population would probably be shocked to find out just how unsanitary many facilities are. In day care centers, for example, the flu virus can be found on between 40 and 50 percent of surfaces, says Dr. Charles Gerba, a microbiologist with the University of Arizona. “It’s pretty important to interrupt the spread of disease, particularly the norovirus, which spreads very rapidly through institutions,” says Gerba.
About 80 percent of infections are transmitted through our environment — through the air we breathe, the water we drink and the surfaces we touch, he says. “Most colds, the flu and diarrhea are caused by touching surfaces and getting something on your hands and then bringing your fingers to your nose, mouth and eyes.
Knowing that there are very few “safe places” is important in fighting cross contamination, says John Bartello, director of facilities management for Skiff Medical Center, Newton, Iowa. He and others who hold similar positions in healthcare will go to hotels and offices to see just how contaminated those facilities are and how they may be contributing to the spread of disease.
“We’re sitting there just cringing because [these facilities] don’t follow most of the same procedures [as healthcare facilities], some of which are almost common sense to prevent infection in both the staff and anyone else who goes into that office or those rooms. It’s kind of interesting to take a look at cleaning procedures across the board.”
Inhabitants of everyday facilities don’t have to leave their health to chance, however, as those in charge of cleaning programs in the healthcare industry are more than willing to share their knowledge and expertise on maintaining sterile environments.
Perhaps the most important tool needed to clean a hospital is a hospital-grade disinfectant cleaner. Other useful items that are becoming more common in healthcare settings are microfiber cloths and gel-based hand sanitizers. While chemical dispensing systems are not new, they are still high on the lists of hospital housekeepers.
In Gerba’s experience, disinfectant cleaners top housekeepers’ lists of must-have items.
“In our studies, we’ve looked at restrooms that aren’t cleaned at all, those where cleaners use soap and water only and others that use disinfectants,” Gerba says.
The use of disinfectant cleaners is preferred by far, and using just soap and water is often the worst option. In most cases, bacteria are simply being spread around with just soap and water, he says. “It’s better not to clean the darn restroom at all because you don’t spread the germs all around like you do with soap and water,” says Gerba.
Larry Lawton, vice president of sales and marketing for Lawton Bros., a jan/san distribution company in Orlando, Fla., says hospital-grade disinfectants are the most important chemical tool in fighting cross contamination, but they need to be used correctly. “You have to apply it properly and give it adequate time to dwell, and in a lot of facilities, they don’t give it the time to allow the disinfectant to kill bacteria,” Lawton explains.
Distributors and those in charge of cleaning staffs at hospitals say a good dispensing system is worth its weight in gold when it comes to mixing disinfectants properly.
As a training tool, Bartello fills three bottles — one with a proper amount of chemical mixture and two that are improperly mixed — and has staff members try to guess which one is in correct proportion. “Everyone invariably picks the wrong one because it looks right,” says Bartello.
Metering out the correct amount of chemical for a cleaning solution serves many purposes, he says. It eliminates the potential of any staff getting injured in mixing a concentrate, prevents overuse of chemicals for a short-term costs savings and reduces the damage that using too much chemical may have on surfaces, saving facilities money in the long-term.
Microfiber cleaning technology is one of the cleaning industry’s newest and most exciting offerings, providing a new cleaning option that has been embraced in many healthcare facilities.
There is a buzz surrounding microfiber and its ability to help fight cross contamination, says Jon Scoles, managing director of Scoles Floorshine, Farmingdale, N.J. While he is still in the process of researching microfiber’s benefits for his customers, he does acknowledge the technology offers some advantages.
“There’s no question that microfiber is a big advancement in helping in the cross-contamination problem, not only in hospitals, but in any cleaning environment,” said Scoles.
Microfiber does a better job of hanging onto germs, Scoles says, and when using a color-coded system, cleaners don’t have to change cloths after every room — as long as a disinfectant and a specific color of microfiber are used to clean certain areas in a room such as mirrors, sinks and toilet fixtures.
Using microfibers in mop systems is a boon to cleaning systems because after every room, the cloth is removed from the mop head for cleaning and replaced with a clean cloth before moving to the next room.
“This precludes [cleaners from] having to change the water every three rooms, which is required with the use of disinfectant, so productivity increases greatly because they don’t have to take the time to stop, change the water, and go back to their operation,” said Scoles.
Implementation of a microfiber mop system in Kent Miller’s facility two years ago has saved the facility chemical dollars because less of the chemical and water mixture is needed; and it has created an even cleaner environment because mop heads are replaced before cleaning each room. Miller is the director of environmental and linen services for Mercy Medical Center in Cedar Rapids, Iowa.
“We are over and above what the standard is because of the microfiber system,” Miller says.
While Lawton says microfibers do clean better, he reiterates that disinfectant needs to be allowed to sit for 10 minutes on a surface in order to be effective.
“The problem with microfiber flat mops is in the hands of the housekeeper,” says Scoles. “If that microfiber is not wet enough when you use it to mop the floor, then the disinfectant doesn’t sit wet for 10 minutes.”
Hand It To Them
One of the fastest ways to spread germs is via hand-to-hand, hand-to-surface or hand-to-mouth contact. That’s why hand sanitizers, virtually unknown even five years ago, are among the favorite items in fighting cross contamination.
Gerba says alcohol-gel sanitizers are one of the better new innovations because they are more effective in killing germs than soap and water hand washing.
In facilities such as nursing homes, alcohol gel use can reduce illnesses by 300 to 350 percent, Gerba notes. Ease of use is one of the biggest reasons for gel sanitizers’ success.
“Most people will use [hand sanitizer] because they don’t like washing their hands because it takes time, and if you don’t like doing something, you won’t do it,” said Gerba. “This is a quick and effective alternative.”
Sanitizing wipes can also be used for hands, in addition to light cleaning by all members of a hospital staff. For example, Bartello says that while the housekeeping staff cleans all patient rooms by stripping a room of its contents and thoroughly cleaning, desks in offices are often ignored by cleaning staff to reduce potential accidents with paperwork or computer files. Instead, many facilities now place disinfectant wipes at each desk for office staff to use to clean their own desks.
Using the Tools
Having the necessary tools to disinfect an environment is crucial, but so is making sure they are used properly. Working with housekeeping staff is a good practice for any facility and distributors can help in training.
Bartello frequently reminds his staff that “clean” and “disinfected” are two different things.
“The perception is, when someone walks into a hospital, that if it looks clean, it is infection-free and they’re going to get good quality care and so forth,” says Bartello. “That’s not necessarily true.”
An adherence to strict regulations in cleaning are one of the primary differences between healthcare and other facilities, Miller says.
Miller reminds staff that they are integral to keeping the facility in operation and informs them of the tough industry controls in place. “I always tell my staff that we are the second most heavily regulated industry in the country today behind nuclear energy,” says Miller.
Even though industries such as education or industrial aren’t as highly regulated, Miller believes housekeepers in those industries should simply watch the news — especially in light of the resurgence of Avian Flu — to see that fighting cross contamination should be a priority.
“If you’re not controlling how you are wiping things down like door handles, handrails and other high-contact areas that people are constantly touching, you are promoting infection,” says Miller.
As a distributor, the biggest problem Lawton sees in helping achieve and maintain a sanitary environment is improper workloading. “Sometimes there are too many rooms for a housekeeper to clean on a shift. Other times there is improper or inadequate training for the housekeeper to properly disinfect a room, and still other times, there is inadequate supervision to ensure what is supposed to be getting done is getting done,” says Lawton.
Bartello says managers of healthcare housekeeping departments keep in touch with each other and frequently use organizations as mouthpieces for passing on information about what procedures and products are working for them. “The networking thing has always been good and we try to promote that as much as possible,” says Bartello.
In much the same way, distributors who provide the products and equipment to customers that are interested in sanitizing a facility to the high standards exacted by hospitals can also serve as an important link in disseminating information on what cleaning systems work and which don’t.