In the field of professional sport, coaches and athletes spend a large amount of time studying their opponents. Weeks before a game, they watch videos for hours to analyse the opponent’s tactics. Each player’s move is carefully recorded and plays are crafted to capitalise on the opponent’s weaknesses. External factors such as pitch and weather conditions are also taken into consideration. When the whistle blows, each team is well prepared with a strong plan for victory.

The same principles can be applied to infection prevention. To effectively combat viruses and bacteria, you must fully understand them. You need to know their composition, how they behave and certain external factors at play before deciding which tactic or infection prevention protocol to use. This knowledge will help you prevent infection and limit your facility’s loss from a potential outbreak.

Train the team: teaching key infection control principles

To properly prepare your infection prevention program, you must first educate your team. Provide ongoing staff training on fomites or high-touch surfaces such as door handles, rails and light switches. Staff must understand that high-touch equals high-risk, so proper disinfection of these areas is a fundamental component of preventing the spread of infection.

In addition to identifying which surfaces to disinfect, cleaning staff should be trained on proper disinfection techniques. One of the most important things to consider is dwell time. If disinfectants are not given the required dwell time to work, they will not be effective. Many traditional disinfectants require a 10-minute dwell time. In this period, surfaces must remain wet to be effective. Most initial disinfectant applications dry after a four-minute period, requiring reapplication. As a result, many cleaning programs are switching to newer disinfectant technology that requires shorter dwell time.

Your opponent: virus types and classifications

The next step in the battle against infection is to understand the key organisms you want to destroy. In order to do so it is helpful to understand the origin and composition of viruses.

The first ever virus, known as the 'tobacco mosaic virus', was identified by a Russian scientist in 1898. Since then more than 5,000 different viruses have been discovered. Present in almost every ecosystem, viruses can affect all types of organisms and are transmitted through a variety of modes.

The two basic virus types that can be potentially harmful to humans and exist within a building are enveloped and non-enveloped viruses. 'Enveloped' viruses, also known as medium viruses, include HIV, HBV, H1N1, herpes and hantavirus. These viruses get their name because they hide in the 'envelope' of the membrane of the infected host cell.

Examples of 'non-enveloped' or small viruses include poliovirus, norovirus, rhinovirus or coxsackievirus. Unlike their counterparts, non-enveloped viruses are more difficult to kill with hard surface disinfectants. Always review the product label to verify what organisms a hard surface disinfectant can kill.   

In 1939 Dr Earle Spaulding of Temple University originally presented the Spaulding classification scale to the medical community in a paper that discussed the disinfection of surgical instruments in a chemical solution. Due to his extensive study of disinfection and sterilisation of medical instruments, Spaulding further refined his classification of appropriate treatment of medical devices based upon how a device is used. Substances in the Spaulding Classification scale were classified as low-level, intermediate-level or high-level disinfectants.

To develop an effective prevention strategy, you must use the best disinfectant based upon your facility’s needs. To do this first determine the appropriate level of disinfection for high-touch, off-the-floor surfaces. Establish which types of bacteria or viruses are likely to be present and assess whether or not they are potentially communicable through environmental surface contact.

Pitch conditions: factors to consider in infection prevention

The next step in developing an effective infection prevention strategy is to identify factors that may impact your program. Budget, training programs, time constraints and administration may all play a role in the effectiveness of your efforts.

For instance in many healthcare facilities there is a focus on increasing throughput so more patients can be tended to and cared for. As a result, the contracted cleaning staff are under pressure to turn rooms over more quickly, which may cause them to overlook certain tasks like disinfecting the tops of cabinets or other hard-to-reach places. This can result in an environment favourable to cross contamination or infection.

Budgets may also play a factor in your infection prevention program. Reductions in labour and funding will limit resources and force cleaning staff to accomplish more with less. In many situations this also results in training cutbacks so the cleaning staff are  not able to review policies and procedures or stay current on the latest protocol for infection prevention.

To help secure buy-in for your infection prevention program, find avenues to educate administrators about the important role cleaning plays in making buildings safe and healthy for occupants and staff. By participating in safety and wellness committees, you can provide information on different virus types and how potential outbreaks can be limited with an effective infection prevention program. This will create proponents for your program, increase opportunities for funding and improve your odds of success in preventing infection.

The focus on using 'green' or 'sustainable' products in facilities is another variable to consider when reviewing your infection prevention efforts. In an effort to reduce the amount of potentially harmful chemicals used, some cleaning departments have switched out traditional intermediate-level disinfectants for less caustic low-level disinfectant. Low-level disinfectants will not kill small non-enveloped viruses such as H1N1 and Norovirus, so make sure you are using newer intermediate-level disinfectant technology that has an improved sustainability profile over traditional disinfectants.

Strategic decision: selecting your disinfectant

You have the team in place. You have studied your opponent. You know the pitch conditions. Now it’s time to make a strategic decision. What tools or disinfectants should you use to prevent infection?

First identify what viruses might be present. Because there is a possibility that you might face small, non-enveloped viruses, you need a broad-spectrum disinfectant that kills viruses spread through environmental surface contact. Recognising that tuberculosis (TB) cannot be transmitted via hand-to-surface contact, there is a growing point of view that TB should not be the determining factor when selecting a hard surface disinfectant. Therefore you should work with your distributor to find an intermediate-level disinfectant that targets small, non-enveloped viruses - not necessarily TB.

Next consider the disinfectants available. Before committing to a traditional disinfectant look at its dwell time. Many traditional disinfectants require a 10-minute dwell time in order to be effective. In this time, the surface must stay wet. For cleaning staff who are under pressure to clean rooms and areas more quickly and efficiently, traditional disinfectants requiring a 10-minute dwell time might not be the best option.

Consider the impact of your disinfection selection on your team or staff. Many intermediate-level disinfectants, such as phenolics, have significant issues related to their use - ranging from the need for proper personal protective equipment (PPE) to protect EVS staff from health effects, such as bleaching of the skin to strong odours and toxicity. Select a disinfectant that has a good safety profile to reduce any potential impact on your staff. If all else fails, consult public information resources like www.outbreakcontrol.com for more details on the appropriate disinfectants to use.

Cleaning professionals who train, take the time to understand their opponent, consider external factors and make a disinfection selection that best meets the needs of their facility will be most successful in the battle against infection. Preventing your facility from shutting down for just one day from common infectious outbreaks can result in thousands of euros in savings. By following these key strategies, you can become an Olympian in infection prevention.

For more information on infection prevention practices go to www.johnsondiversey.com or www.ahptechnology.com