It is difficult for me to believe there are MDs in the epidemiology field who still don’t have “enough evidence” to make them believe that environmental hygiene is key to preventing hospital-acquired infections. I say to them, “It’s all about the cleaning!” I am not talking about the “shiny floor syndrome”, I’m talking about soil removal and proper disinfection of high touch surfaces and patient care equipment.
I am grateful that many in the arena of healthcare epidemiology realize that better, more thorough cleaning and disinfection of fomites will break the chain of infection. Dr. Stephanie Dancer is one of those I applaud. Dr. Dancer gave a rousing presentation at the Spring SHEA Conference in 2013. Dancer believes, as do I, that better manual cleaning and disinfection verified by monitors such as fluorescent markers and/or ATP will provide an opportunity to educate and train environmental services workers.
We must start with the realization that the environmental surfaces of a patient’s room will never be free of disease causing pathogens; although the manufacturers of UV or HPV room disinfection systems make claims to the contrary. The fact is, those methods of terminally disinfecting an empty, discharged patient’s room are only one piece of the total picture. The other 85-90% of the time, that patient’s room is occupied by one or more patients and those room disinfection systems that you paid 10’s of thousands of dollars for can’t be used where humans are present. So, how do we solve the problem of improper daily environmental hygiene?
It’s the daily cleaning and disinfection of occupied patient’s room that I want to focus on. Although I love it when MD’s and PhD’s do those analytical studies that prove what many of us in the profession of cleaning hospitals have known for years, the studies only diagnose the problem without proposing a viable cure. In Dr. Dancer’s presentation she states empirically, “…for modern cleaning, what works best is detergent over disinfectants, used in targeted ways, and done frequently.”
The reason that general purpose cleaning chemicals applied with high quality microfiber works “over disinfectants” is, 95-98% of the soil or bio-burden is removed from the high touch surface. When that high quality microfiber catches, but does not release, the soil back to another surface, all the “Bad Guys” (i.e., pathogens) are removed, leaving the surface sanitized.
I would like to explore Dr. Dancer’s statement a bit further. Disinfectants are designed for a specific purpose and are to be used in a certain manner. Therefore, users SHOULD read the label carefully to ensure the correct product is selected for the intended use and applied correctly. US Federal law requires all applicable label instructions on EPA-registered products be followed (e.g., use-dilution, shelf life, storage, material compatibility, safe use and disposal).
I assure you, that if you were to give a disinfectant salesperson a shot of sodium pentothal (truth serum), he or she would tell you that a surface should be pre-cleaned before it is disinfected. That is because, if a “one-step” disinfectant is applied to a visibly soiled surface, the disinfectant becomes so challenged by the soil that it can’t effectively poison or otherwise destroy the pathogen’s cellular makeup. The obstacle to pre-cleaning surfaces before applying a disinfectant is, TIME. There is no allowance for twice cleaning a room’s surfaces by the housekeeper. He or she is tasked with cleaning 6,000-8,000 sq. ft. of occupied patient’s room, utility rooms, exam rooms, nurses station, public and staff rest rooms and performing 5-10 terminal cleanings of discharged or transferred patient’s room. Where will the time come from to pre-clean surfaces before disinfecting them?
Another challenge to those who clean the patient’s environment is the contact time, or, the time the product’s label says a surface must remain wet in order for the disinfectant to kill the pathogenic load on the surface. No matter whether it is 3 minutes, 5 minutes or 10 minutes, the housekeeper can’t watch that surface dry and then reapply the disinfectant another 2-4 times. Instead, they have to move on to the next surface or next room leaving us to wonder, did the surface remain wet for the requisite amount of time?