Train to improve processes

24th of June 2022
Train to improve processes

Cleaning and disinfection processes have become enhanced significantly during the pandemic and education around that must be targeted in order to improve processes and safety. Rich Prinz of EvaClean - specialist in sustainable disinfection solutions - writes exclusively for ECJ.

PRIOR TO THE PANDEMIC, cleaning went on behind the scenes with little or no call for enhanced disinfection. Today, both have become central to protecting the health and safety of everyone in every industry around the globe.

Cleaning and disinfection processes have been dramatically enhanced and become much more complex than traditional methods. They require an understanding of the biological contaminants that pose health risks, as well as the chemicals, technologies, and protocols necessary to mitigate them. There are also application considerations, safety hazards, and environmental concerns that contribute to the science of enhanced hygiene.

Generally speaking, most cleaning professionals didn’t need this depth of knowledge before. Now, job descriptions that already spanned a range of responsibilities include accountabilities beyond the norm. This article will address the increased importance of effective environmental cleaning procedures and initiatives for safety and process improvement through targeted education.

Key drivers

Historically, infection control wasn’t high on the list of priorities. Now, facilities must be capable of identifying bacteria, viruses, and fungi, while prioritising and developing enhanced infection prevention measures to shield occupants from exposure. Many microorganisms and
contaminants pose hazards to wellbeing, from the common cold and influenza to MRSA and food-borne pathogens, such as E.coli and salmonella.

Currently, the highest biological agent risk group is SARS-CoV-2 (Covid-19) and its associated strains, which are classified as serious or lethal human diseases. Though Covid is transmitted primarily through exposure to respiratory droplets, it may also occur indirectly through contact with surfaces (fomites) contaminated by respiratory secretions from infected individuals. However, the risks for infectious disease transmission are not only limited to Covid-19 but, include other dangerous pathogens as well.

Even with social distancing, facial covering, and proper hand hygiene practices in place, the risk of contracting infections from contaminated surfaces remains high. Moreover, if cleaning and disinfection processes are not carried out correctly, they may inadvertently exacerbate risks. Thus, it is vitally important that team members be educated on best practices for more effective cleaning processes to mitigate the spread of contagions.

Enhancement of processes

In simplified terms, there are three main phases in routine cleaning processes: General cleaning/sanitising, disinfecting, and rinsing/drying. The first phase involves removing dirt and debris from surfaces in preparation for the disinfection phase, which eliminates bacteria and other microorganisms.

NHS guidance for effective cleaning recommends working top to bottom, from the cleanest to the dirtiest areas, or from the back of the room toward the door to minimise further contamination. The final phase varies depending on the disinfectant and dwell times. Some disinfectants do not need to be rinsed after application however, requiring adequate time to dry (contact time) in order to kill target contaminants.

Routine housekeeping, also referred to as standard level cleaning, is no longer enough and must be enhanced by a more robust phase incorporating infection control practices that emphasise high-touch surfaces. Commonly touched surfaces or objects present one of the highest risks for exposure to contagious viruses, including handles, handrails, furniture, keyboards, bathroom fixtures, and many other places throughout a facility. Enhanced processes may also require increasing the frequency of cleaning schedules to elevate effectiveness.

Mid-level cleaning, or deep cleaning, involves disinfecting the majority of surfaces from ceiling to floor. This includes lights, vents, doors and framing, as well as all patient contact equipment in healthcare settings. The highest level of cleaning is usually reserved for healthcare environments, such as terminal cleans of patient rooms after discharge and operating rooms/surgical suites.

Cleaning levels are determined by risks. Consequently, conducting regular risk assessments to identify gaps, inefficiencies, and hazards in existing protocols is imperative to improving infection prevention standards. The data obtained from these assessments will help with decisions and plans for preventing viral transmission. However, a successful implementation that results in process and safety improvements is contingent on one key ingredient - perennial training of frontline cleaning staff to raise competency.

Critical cleaning competencies

Training is essential to process improvement for existing staff as well as new team members. Turnover among custodial workers always presents challenges to maintaining efforts. Therefore, training on new technologies and enhanced disinfection protocols should be part of workplace induction.

Programmes should also be tailored to a facility’s environment, be regularly updated based on risk assessments, and align with current guidelines. Training modules should address the three main areas that impact cleaning process outcomes: efficiency, efficacy, and safety.

Raising cleaning competency levels begins with having a strong grasp of a facility’s unique environmental characteristics and demonstrating proficiency in executing specific processes. For example:

• Clear understanding of basic cleaning and disinfection concepts
• Accurate chemical dilution to correct concentration for intended purposes
• Dwell times for disinfecting surfaces and floors
• Cleaner and disinfectant solution preparation for dry wipes or microfibre cloths
• Proper mop bucket assembly, floor cleaning and disinfection practices
• Use of appropriate washroom cleaning procedures
• Maintenance and storage of equipment and chemicals.

Cleaning plans and schedules, product labels and safety data sheets should be readily available to staff members. Critical instructions should be reinforced by supplementary materials, such as usage guides, online videos, infection outbreak control guidelines, wall charts, and other on-site signage.

Educating for safety and efficacy

Ensuring improvements in process outcomes means having a 360-degree view of potential transmission threats, as well as all associated mitigation risks.

In addition to pathogen risks, staff and occupants must be protected from exposure to cleaning chemical hazards. Reducing exposure risks involves using less toxic chemicals and educating staff members on safer cleaning and disinfecting processes.

The Occupational Safety and Health Administration (OSHA) and The National Institute for Occupational Safety and Health (NIOSH) in the US continue to highlight the need for safer sanitisers and disinfectants and stress the importance of using Safety Data Sheets (SDS) to ensure ingredients will not pose health risks. When reviewing SDS, look for indicators of safer solutions, including a 0/0/0 HMIS, neutral pH, and the lowest EPA toxicity rating possible.

Targeted education that supports the safer implementation of cleaning and disinfection processes should cover:

• Following manufacturer recommendations for safe handling and application
• Wearing appropriate personal protective equipment (PPE) for each chemical
• Use of cleaning tools and equipment for safe chemical application
• Chemical stability and longevity in use solution and concentrate.

Nonetheless, for chemistries to be truly safe, they must also deliver efficacy without sacrificing safety. An ideal chemical profile has the highest level 2C Emerging Pathogen Claim and a one to four minute contact time against a wide breadth of bacteria, viruses, and fungi, including C. diff, norovirus, Covid-19, and other pathogens.

Education purposefully designed to develop cleaning expertise, while also increasing safety and efficacy, should also encompass knowledge of the following areas:

• Pathogen training
• Chemical differentiators, master labels, and efficacies
• Best practices for mitigating cross-contamination.

Outside of healthcare, most facilities are not aware that cross-contamination risks exist even though they are a primary contributor to the spread of infections. Surfaces that appear clean can harbour invisible viral droplets from a sick individual or be contaminated by an infected cleaning cloth.

Process improvement is dependent on mitigating the re-contamination cycle. Specialised training on cleaning techniques such as single-use wiping, single area mopping, and dedicated mop head cleaning can help prevent contaminants from being transferred to other surfaces and areas within a facility.

Decontamination plans may also leverage newer cleaning technologies like touchless electrostatic sprayers, which enable efficient and complete surface disinfection without risk of cross-contamination. If using these technologies to enhance disinfection processes, teams must be trained on all aspects of the equipment to ensure safety and deliver optimum results.

In healthcare environments, best practices for preventing cross-contamination suggest pre-treating patient rooms and care areas with an electrostatic sprayer and a sporicidal disinfectant. For most pathogens, the appropriate dwell time is four minutes in compliance with the Joint Commission standards for hospital accreditation.

At the end of the day, improving processes is about putting safety first, while learning to implement procedures more efficiently and effectively.

Sustainable process improvement

Typically, facilities use between seven and 10 different chemicals to accomplish various cleaning tasks, including high-touch surfaces, floors, windows, washrooms, etc - each with a separate set of instructions. This creates significant risks for error at every stage of the process.

A recent trend toward chemical standardisation is rapidly gaining ground among the cleaning industry. Narrowing the scope of products by substituting broad-spectrum chemistries that serve many cleaning, sanitising and disinfecting purposes can dramatically improve processes and reduce failure points.

Moreover, replacing hazardous chemicals with safer, more effective solutions alleviates the majority of health concerns.

As a result of standardisation, organisations are experiencing further benefits with higher productivity and significant cost reduction. However, one additional benefit of this approach is that it also facilitates long-term sustainability by reducing chemical consumption and waste. Safer processes naturally align with the use of more sustainable cleaning products that are healthier for the environment as well.

Once expanded education strategies are formalised and become standard practice, they will establish the foundation for sustaining safety and continuous process improvement. Ultimately, these strategies will help protect facilities from the pathogens of today, as well as those that may emerge tomorrow.


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