Curiously enough, it was a nurse by the name of Florence Nightingale who brought to light the clear contribution that surface hygiene plays in reducing the spread of disease-causing pathogens. Yet today as the most technologically advanced country in the world, our acute care hospitals, and even more so our ambulatory treatment centers, represent high risk environments and are the source of countless illnesses and related deaths due, in no small part, to improper surface and hand hygiene protocols. Growing population, increased mobility, new treatment-resistant organisms have all increased the risk factors in all areas of our lives, but to the greatest degree in our healthcare facilities. Recent outbreaks of Influenza A – specifically the H1N1 and ongoing deaths related to MRSA and C-Diff – reveal the depth of real issues we have with the role played by poor cleaning and lack of hygiene in our environments of care.

While data exists detailing infections acquired in acute care centers, recent studies have exposed the very real health threats that exist in our outpatient and ambulatory care centers across the country, especially as these facilities become the line of first defense in treating patients during flu or infectious disease outbreaks. Science is clear that most infectious diseases are transmitted by direct contact with an infected person. Yet, just as clear is that disease-causing pathogens can also be passed along by indirect contact such as touching surfaces contaminated with infectious disease contaminants. Thus, waiting rooms, treatment tables and restrooms in these facilities all present breeding grounds and points of dissemination.

Healthcare facilities currently take intensive preventive steps to control environmental infection to ensure the health and safety of patients and employees – including disinfecting and sterilizing instruments; using personal protective equipment such as gloves, masks, gowns and goggles; and administering appropriate plans for medical waste disposal and management. Additional measures include influenza immunization for healthcare workers and implementation of respiratory etiquette programs, as recommended by the Centers for Disease Control and Prevention (CDC), to limit the spread of common respiratory pathogens. These etiquette programs include posting visual alerts so that patients inform healthcare workers when they have symptoms of respiratory infections, providing tissues and no-touch receptacles for tissue disposal, providing dispensers of alcohol-based hand rubs, ensuring supplies for hand washing are always available, and providing masks or procedures to separate persons with infectious disease symptoms.

During periods of outbreak we have a unique opportunity to draw attention to the need for effective surface cleaning and disinfection and the part it plays in helping break the cycle of infection. Hand washing and proper use of alcohol-based hand sanitizers represent the greatest defense any of us can personally take against most organisms that would seek to create disease in our bodies. While proper hand hygiene provides the largest impact, reducing microbial risks on surfaces plays a large part in the reduction of the overall risk profile in a particular indoor environment as well.

Properly trained Environmental Service professionals can play a vital role in the proper disinfecting of healthcare facility surfaces, where millions of potentially harmful germs exist. Exposure to many of these bacteria can result in healthcare-acquired infections (HAIs). The CDC estimates that HAI infections affect more than two million people each year; resulting in 90,000 deaths. Yet, one-third of these infections are considered preventable. While those statistics are staggering on their own, it is suspected that the real number of infections including those obtained in our outpatient and long-term care centers are much, much higher. Environmental service professionals can assist in reducing the risks of infectious disease transmission through the use of EPA-registered, hospital grade disinfectants, together with ongoing training for their cleaning staffs on their proper and efficacious use.

In addition to basic training in disinfectant chemistry, on-site cleaning teams should receive continuing education in safety and infection control that includes training for Occupation Safety and Health Administration (OSHA) guidelines, the National Safety Council Bloodborne Pathogen Program, and the American Red Cross HIV/AIDS Programs: Preventing Disease and Transmission and Bloodborne Pathogen Compliance.

Microfiber cloths are another effective defense in the battle against the spread of infectious diseases in healthcare facilities. Microfiber technology in all cleaning cloths and mopping programs can effectively increase soil and matter containment and removal. Microfiber attracts dirt, grease and contaminants with its small angled edges along the fibers that pull in and attract dirt leaving surfaces truly clean. New microfiber cleaning technology has been shown to be 99% more effective at capturing and removing bacteria and soils than traditional cleaning methods. Strict color-coding methodology in all microfiber cleaning implements is essential to obtain best results in reducing cross contamination. With a color-coded system, cleaning professionals use several different cloths, each for use in a specific room or area. This method of cleaning ensures that soil and matter from one area is contained in that area and is not spread to other areas in the facility.

However, effective risk reduction must be multi-faceted and ongoing. Effective cleaning of all surfaces daily with the use of proper disinfectants and soil removal systems followed by periodic cleaning of high-touch points throughout the day with disinfectant wipes combined with an aggressive hand hygiene program represents the most effective strategy. High-touch transmission points, or hot zones, include items that patients, medical staff and visitors touch most often such as treatment tables, call buttons, hand and bed rails, faucets, light switches and door knobs.

In periods of known outbreak or contamination, the daily cleaning can elevate even to terminal protocol in order to contain or effectively reduce the risk of a particular organism that exists within a facility. Terminal cleaning methods can vary, but usually include removing all detachable objects in a room or facility, then disinfecting lighting, air duct surfaces and room surfaces such as flooring. Items removed from the room or facility must be disinfected before being returned to use.

Regardless of how in-depth decontamination cleaning procedures are, once a surface is cleaned and disinfected it will only stay that way until someone touches it or it becomes contaminated with airborne organisms settling onto surfaces. Because surface areas can quickly become re-contaminated, focusing on high-touch or critical control points that represent the highest areas of dissemination is the key to effectively reducing risk levels in our healthcare environments, along with effective hand hygiene for microbial risk reduction. This two-fold protocol should be adopted not just when concern over an outbreak is looming, but as a continuous and ongoing program to maintain an effective defense against pathogenic organisms seeking to make us ill.

Reference

1. Guidelines for Environmental Infection Control in Health-Care Facilities, Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC), U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC) 2003.