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Key healthcare cleaning challenges9th of March 2012
Care homes, hospital wards, intensive care rooms, doctors’ surgeries, A&E units - which environments present the biggest cleaning challenges as far as hygiene is concerned? We ask companies and healthcare experts their views.
Healthcare facilities clearly present a major challenge for cleaning teams. Any environment that houses a significant number of people who have an infection, a virus or an open wound is bound to require more frequent and thorough cleaning than, say, an office or home.
The fact that pathogens are invisible to the naked eye further complicates things, since it can be hard to identify those areas in a hospital, surgery or care home that require the most rigorous cleaning. Meanwhile, the need for stringent cleaning regimes in healthcare environments has been highlighted in recent years with the increasing publicity surrounding HCAIs. Reporting data on hospital-acquired infections is now mandatory both in the UK and the US, and this has revealed that around one in 10 patients apparently acquires an infection after admission.
But in which types of healthcare environment are we at most risk of catching an infection? And which of these is the most difficult to clean?
According to corporate account manager at SitexOrbis Kate Rawlinson the risk is highest in intensive care units where potential pathogens are plentiful and can easily gain entry to a susceptible host. “Care homes are also high-risk environments because basic hygiene measures are often not followed, especially given that residents sometimes have dementia,” she said. “GP surgeries, on the other hand, present a much lower risk.”
She says there are several reasons why healthcare settings are particularly vulnerable. “People tend to pick up infections if their defence mechanisms are compromised by factors that have landed them in the healthcare environment in the first place,” she said.
“They might be receiving chemotherapy or be on steroids; they might have a disease, or they might be attached to devices that bypass the body’s normal defences such as intravenous lines or urinary catheters.
“The same applies to premature babies and the very elderly, people with surgical wounds or burns and so on. The infected people then come into contact with other patients, health workers, medical equipment, food, water, air and surfaces that act as transmitters of the infection. This is then passed on to other patients with weakened defence mechanisms, perpetuating the cycle.”
According to Rawlinson transmission via the hands of healthcare workers is the most common cause of cross-infection. “This is why any equipment such as touch screens, seats, keyboards, phones, etc that is frequently touched represents a high contamination risk.”
She adds that perception has a key part to play in the issue of infection control and cleanliness in healthcare. “The perception of a dirty doctor's surgery, care home or hospital for example would be almost as damaging as the breakout of a clinical infection in an intensive care ward,” she claims. “So whatever the healthcare environment, it is essential to keep that environment both clean and hygienic. This requires routine environmental cleaning, ideally by a specialist provider.”
SitexOrbis offers a 24/7 infection control vaporisation service using DuoMax - a specialised disinfecting agent. The vaporisation machine produces a fine mist of DuoMax which is claimed to achieve a 99.9999 per cent reduction of pathogens in every part of the room from floor to ceiling.
“Most commonly-used disinfectants tend to denature only the external membrane and do not kill pathogens, which means they only reduce germs by 99 per cent,” said Rawlinson. “This means that in time, pathogens will regenerate and build up resistance.”
Most difficult to clean
According to Rawlinson, mobile blood donation units are among the most difficult healthcare environments to clean. “Keeping a mobile fleet of vehicles spotless and sterile is challenging, partly because they are packed with such a wide range of equipment including chairs and fridges,” she said. The fact that Duomax is non-toxic means the vehicles can resume their duties fairly quickly after treatment using the agent, she claims.
Rawlinson adds that hand hygiene is one of the most important procedures in the prevention of cross contamination or infection. “Hand washing must be performed frequently during a healthcare worker’s shift including at the beginning and end of each shift, before or after any patient contact, before and after donning and removing gloves and on many other occasions,” she said.
Managing director of PHS Washrooms Ian Osborne feels that patients in hospitals, care homes and GP surgeries are all at a heightened risk of infection. “Many of these will already be vulnerable to the spread of infection, but even seemingly healthy people with no apparent underlying health problems can also be at risk,” he said. “Making sure that preventative methods are in place is crucial.”
He adds that healthcare staff should be educated in healthy hygiene practices and have effective and easy-to-use products close to hand at all times. “Well-equipped washrooms and products such as hand sanitisers at key locations – such as at the entrance to hospital wards – can all reduce the risk of cross contamination.”
PHS Washrooms offers an alcohol-free hand sanitiser – No-Germs – which is said to kill 99.9 per cent of germs while avoiding the issue of skin irritation that can arise with alcohol-based products.
Healthcare environmental hygiene consultant Mike Rollins agrees with Rawlinson that care homes and geriatric wards are among the most challenging healthcare environments to clean, mainly because of the frailty of the people involved and their susceptibility to infections. “Equipment such as chairs, walkers and zimmerframes in such environments are a risk factor,” he said. “These tend to be allocated to one patient at a time - but that doesn’t stop other people from touching them.”
Like Rawlinson he feels that GP surgeries present a much lower risk of cross-infection. “While it is true that a high number of infected people will be confined to a relatively small space here, there is a lower risk of serious cross contamination since most infectious patients will only be suffering from colds and coughs,” he says. “However, in other countries – such as the Middle East, where tuberculosis is recurring – a doctor’s surgery may pose a greater risk since infected people may be coughing into the environment and creating viral particulates which may become an airborne challenge.”
He said A&E units also posed cross contamination risks of their own. “You never quite know what you are dealing with in emergency units since the doors are open to all comers,” he said. “This can be a particular challenge on the weekends when A&E basically becomes a war zone.”
Besides the problem of cleaning up blood spills, however, he feels the risk of any serious cross infection here is minimal. “Basically the people in A&E will probably be in reasonable health and not as vulnerable as, say, those in an ICU unit,” he explained.
Surfaces requiring thorough cleaning in a hospital include keyboards and computer mice which are increasingly being used for writing up patient notes in place of the traditional pen and paper, says Rollins. Another potential cross contamination point is the touch screen in a GP surgery that may used for patients to sign in. “Often there will be no alcohol gels provided to use before and after touching the screen,” he said.
Better cleaning routines
Rollins recently co-ordinated a cleaning study led by consultant microbiologist at University College London Hospital Dr Peter Wilson. The study looked at the benefits of improved cleaning regimes using microfibre products, but also considered the cleanability of the modern hospital environment.
“Modern medical equipment, materials and environmental surfaces pose cleaning challenges associated with surface texture, porosity and accessibility to allow effective manual cleaning,” said Rollins. “So several technologies have emerged and are now widely adopted as solutions to provide more reliable efficacious methods of cleaning, disinfection and area decontamination.”
For example, he says modern bed rails present particular challenges since they are more likely to be made from complex plastic composites with a surface texture that makes them more difficult to clean than traditional materials such as stainless steel or chromium-plated metal. And he adds that any healthcare environment – whether it is a care home, ICU ward, GP surgery of A&E unit – needs to be risk-assessed before a cleaning regime can be developed.
“You need to understand the environment,” he said. “Cleaning regimes used to be devised according to the size of the area and the cost per square metre rather than on the risk factors involved.
“But there has been a change in culture and cleaning is now perceived as a much more important discipline than in the past. It is only in recent years that a number of good studies have been carried out and we have identified that there are certain environmental contributors to infection. As a result, cleaning teams are increasingly being considered to be front-line staff.”