Q 1: To what extent does the environmental surfaces cleaning affect contamination levels in hospitals?
A. The role of the hospital environment as a reservoir of infection is poorly understood. But this is certain; one well-trained Hygiene Specialist (Housekeeper) can prevent more disease transmission than a room full of doctors can cure.
Q 2: Is there a way to measure the efficacy of a cleaning program?
A.There are actually four ways to measure the efficacy of a cleaning program. They are: (A) Visual assessment-not a reliable indicator of surface cleanliness. (B) ATP bioluminescence-measures organic debris (each unit has own reading scale) will give you a reading within seconds. (C) Microbiological methods-can be costly and pathogen specific. (D) Fluorescent marker to insure that cleaning processes have been adequately performed.
Q 3: What is the difference between disinfectants and sanitizers?
A: Sanitizers can be used in cafeterias, kitchens and food preparation surfaces to keep certain (short list) microorganisms at a safe level. But, if you want those same microorganisms ELIMINATED, you would need to use a disinfectant such as a quaternary ammonium compound (quat), phenolic, accelerated hydrogen peroxide or other the U.S. Environmental Protection Agency (EPA)-registered disinfectant.
Q 4: Knowing that surfaces nearest the patient harbor the greatest number of pathogens, what is the best method to reduce or eliminate those pathogens?
A: Washing or scrubbing a surface physically removes soil and organic material such as blood and body fluids, and takes with it the disease-causing pathogens. The guiding principle is always to remove germs if possible rather than kill them, and then when necessary, use the least amount of the mildest chemical that will do the job, because stronger often means more toxic to people.
Q 5: Is microfiber that much better than cotton when it comes to mops and cloth wipers?
A: Yes. Microfiber helps physically remove the food and moisture necessary for microorganisms to survive, but better grades of microfiber (those with very dense weaving and fiber configuration) can even remove large quantities of microbes, including hard-to-kill spores.
Q 6: Is it necessary to disinfect floors in hospitals?
A: Floors aren’t a high-touch surface, but some cleaning professionals and healthcare experts suggest that they should be included in disinfection processes. The other school of thought is to simply use a neutral floor cleaner since floors are quickly re-contaminated as soon as somebody walks on them or something is dropped on them.
Q 7: How long must a surface, wetted with disinfectant, remain wet?
A: This question deals with exposure time or contact time. Each disinfectant has a label with directions for contact time. The U.S. Centers for Disease Control (CDC) guideline recommends a contact time of 1 minute at a minimum. If the label states different contact times for different organisms, the highest contact time listed must be used because one doesn’t know the contents of the soil being cleaned.
Q 8: Is it possible to perform ‘green disinfection’?
A: Disinfectants, used properly and wisely, are designed to protect public health. In many situations—and especially in healthcare and other critical facilities—there is no substitute for disinfectant cleaning. That being said, there are some old technologies (i.e., copper or silver impregnated surfaces, steam vapor devices, spray-and-vac technology) and some new, emerging technologies that hold great promise (i.e., UVC (short wave or germicidal light) photons damage DNA and Hydrogen Peroxide (HP). Both UVC and HP technologies are meant to supplement, not replace routine disinfection.
Q 9: What are “super bugs” and why should we be concerned about them?
A: Some pathogens have gotten the reputation for being “super bugs” because of their ability to survive on environmental surfaces for up to 56 days after contamination on common hospital materials. MRSA (Methicillin-resistant Staphylococcus aureus) and VRE (Vancomycin Resistant Enterococci) are two of the most talked about “super bugs” have been implicated in transferring from hospital surfaces to previously uninfected patients.
Q 10: Is it true that quats (quaternary ammonium disinfectants) are inactivated by cotton mops and cloths?
A: True, once cotton mops or wipers are introduced into a fresh solution of quat disinfectant, the cotton binds the available, active ingredients of the disinfectant within minutes. To avoid this, use a synthetic microfiber cloth or man-made spun material (no cellulose) in quat disinfectants.
About the Author
J. Darrel Hicks, BA, REH, CHESP, is the director of environmental services at a 500-bed, award-winning hospital in the United States. Darrel started his career in the management of housekeeping services in 1981. He has worked in hospitals ranging in size from 120-650 beds and knows what it takes to plan, set goals and provide guidance and consultation to the management team and department staff. He has managed as many as 13 departments and 170 FTE’s at one time in a 3-hospital system. In that healthcare system Darrel had to pioneer and discover ways to save money by cross-training staff, job sharing, controlling overtime and putting a system of controls in place.
Hicks is nationally recognized as one of the industry experts in infection prevention and control as it relates to cleaning. He has written and published numerous articles in professional and healthcare related journals as part of his commitment to providing a cleaner, safer and healthier indoor environment.
In 2010, Hicks authored “Infection Prevention for Dummies”, a 43-page, pocket-size book with topics such as: Use cleaning techniques to keep infection at bay; Match the disinfectant to the situation; Understand disinfectant label claims; Keep your environment healthy.
