ECJ EUROPEAN Cleaning Journal

Reports of patients contracting conditions such as MRSA and C.difficile during a hospital stay have become particularly prevalent over the past 30 years. Can hospital cleaning and hygiene regimes make any real headway against health threats such as norovirus, MRSA and C.difficile? Or are hygiene teams fighting a losing battle?

Reports of patients contracting conditions such as MRSA and C.difficile during a hospital stay have become particularly prevalent over the past 30 years.

In recent years, too, Norovirus – commonly known as winter vomiting disease – has become more virulent than ever in healthcare settings. A new strain emerged in Australia during 2012 and this has overtaken all other strains to become the most dominant form of the illness. Prompting one tabloid newspaper to coin the headline “Down Chunder”, the Sydney 2012 strain has since emerged in the US, France, New Zealand and Japan.

It seems that healthcare-acquired infections have found a firm foothold in our hospitals despite ever-increasing efforts by infection control teams to curb their development. Medical and cleaning staff have to fight a constant battle to keep such unseen menaces at bay. But are they winning?
According to Rentokil Specialist Hygiene training and product development manager Karl King, the sheer number of areas that need to be kept hygienic in a healthcare setting makes hospital cleaning a highly complex task.

“Problems such as beds being out of action coupled with a high volume of work make it hard for hospitals to maintain high hygiene standards,” he said.

“The risks of cross-contamination from people sharing contact points are huge, and this is compounded by the need to keep disruption to an absolute minimum and have areas ready for use as soon as is practically possible.”

However, he says rigorous cleaning regimes have a definite impact on cross-infections and hospital-acquired infections. “Sanitising should be undertaken at least as soon as a known infection risk is presented by a patient or visitor, and if that person is known to have inhabited a certain area then that area should always be sanitised prior to re-use,” he said.

“We have found the best results are achieved through a combination of high standards of daily cleaning and infection control by the healthcare unit, backed up with regular sanitisation by specialist service providers.”

He adds that good hand hygiene is critical in preventing cross-contamination. “Providing adequate hand washing and hand drying facilities is crucial, as well as providing hand sanitisers for people to use outside the washroom environment,” he said. “And clean beds, curtains and walls are also important since direct contact with any of these points by the patient could lead to contamination. Ideally all these areas should be sanitised regularly.”

Sudden outbreaks

He says that sudden, major outbreaks put the healthcare system under particular pressure. “This has been evident recently where the Norovirus has closed down some hospital wards and led to visiting hours being curtailed to prevent further infections,” he said. “A high number of hospital admissions can also mean that more people are packed closer together, increasing the risk of cross-infection with airborne organisms. This in turn increases the demand placed upon the cleaning company.”

And such situations often lead to service providers being asked to clean the infected areas more often or more quickly, says King. However, he adds that Rentokil is constantly looking at new products and preparations to improve the effectiveness of its Special Disinfection Service.

The company is not alone in seeking fresh weapons in the battle against healthcare-acquired infections. Manufacturers are continually coming up with new products designed to improve hospital hygiene and to target specific bugs. Difficil-S, for example, is a broad-spectrum disinfectant cleaner claimed to be particularly effective against C.difficile and its spores. Made by Clinimax, the product can be used on hospital floors, walls, beds and other hard surfaces as well as soft furnishings and mattresses and is said to kill 99.999 per cent of all pathogens including MRSA and the Norovirus.

According to operations manager Chris Davy, one of the key advantages of the product is the fact that it requires a short contact time to kill the pathogens.

“Around 95 per cent of hospitals today use a weak hypochlorite-based solution for cleaning but this needs to be kept in place for around 15-20 minutes in order to be effective against C.difficile,” he said. “This is impractical because it means that equipment, floors and other surfaces remain out of use for this period. Also, chlorine-based products tend to degrade the equipment and leave behind rough areas where germs can grow.”

Independent tests carried out by the Journal of Hospital Infection found that chlorine dioxide-based Difficil-S required a contact time of only one minute in order to be effective against pathogens, says Davy. However, such specialist products are more expensive than hypochlorite-based alternatives.

“We want to change the thinking of hospital chiefs,” said Davy. “If they invest in more effective products it may increase their costs but it will lower their rate of infections. You often find that the various hospital departments control different budgets and that every decision is cost-led.

“They need to take the blinkers off and look at what they want to achieve. For instance they should work together and consider the implications of having a patient filling a bed for several more nights; the cost of equipment degradation when using hypochlorite-based cleaning systems; extra pharmaceutical costs, etc.”

IPC Gansow has developed a vacuum cleaner specifically designed for hospital use. The patented Ecospital features a housing made from HDS antibacterial plastic plus silver ion technology vacuum and exhaust filters.

“Air is purified through the filter while the antibacterial plastic automatically kills any pathogens,” said IPC Gansow’s UK and Ireland general manager Richard Slater. “With conventional vacuums, bacteria can spawn and develop in the canister as well as in the hose and on the different tools. Independent tests carried out on Ecospital vacuums in laboratories have shown that bacteria is unable to spawn in our machines.”

However he adds that many hospitals are unwilling to make the investment in the current economic climate. “We may be able to win the fight against infections – but only if we can convince hospitals to buy the products that would help them to do so,” said Slater.

Microbial contamination

Hako has developed its own antibacterial scrubber dryer machines for use in healthcare and other sensitive settings. Recovery tanks on Hako-AntiBac machines are made from plastic containing additives said to significantly reduce bacterial and fungal growth. This means that the amount of disinfectants used to clean the tank can be scaled down considerably, says product and marketing manager Klaus Serfezi.

“The recovery tanks are in particular jeopardy of being contaminated with microbial growth over time if the inside of the tank is not 100 per cent cleaned after each use,” he said. “This is a risk to health in sensitive areas such as hospitals and old people’s homes.”

Gojo has come up with a Purell hand rub said to sensitise microbial cells to alcohol. This makes it more effective than other products that contain higher levels of alcohol according to Gojo’s marketing manager Europe Suzanne De Maine.

“If healthcare settings are equipped with easy-to-use products that allow everyone visiting or working there to keep their hands clean and germ-free, this acts both as a preventative hand hygiene measure and a way to help restore normality after an outbreak has occurred,” she said.
The fact that new ‘superbugs’ and mutant strains are emerging all the time does seem to indicate that the battle can never be entirely won. However, experts feel they are certainly making some headway.

According to healthcare environmental hygiene consultant Michael Rollins  the most difficult pathogens to kill are those that can survive on surfaces for long periods. “C.difficile spores can remain viable for months, while Acinetobacter and Klebsiella are very sticky organisms and can be resistant to normal decontamination methods,” he said. “These tend to have a potentially high incidence of infection in high-risk patient areas such as intensive care.

“Norovirus also remains viable in the environment for long periods of time. The infective dose is very low and there is a high level of viral particulate dispersion during episodes of vomiting and diarrhoea. It is an airborne as well as a surface contaminant and you have to clean, clean and clean again to eradicate it.”

He says sudden outbreaks of illness present the biggest challenge for healthcare cleaners since these put a strain on already stretched resources.

“Bed pressure can also be a problem,” he adds. “If patients are waiting to be admitted, the time available to thoroughly clean and decontaminate equipment is short and cleaning quality may be compromised. Also, the bugs are smart and can build up a resistance to traditional decontamination methods and materials. New technology is available for area decontamination - but this costs more than a bucket and mop.”

So, are we fighting a losing battle? The answer is no according to Rollins. “A programme carried out in the UK in 2008 resulted in all NHS hospitals being deep cleaned,” he said. “The rate of MRSA and C.difficile infections reported in the following quarter dropped by over 30 per cent on the previous quarter. Notwithstanding seasonal variance, to record the single largest drop in infection rates following a deep clean programme is significant.”