Hygiene protocols - getting the facts straight

2nd of October 2020
Hygiene protocols - getting the facts straight

When to clean, when to disinfect, when to fumigate, when to chemical spray? Cleaning professionals are now faced with the enormous responsibility of ensuring buildings are hygienically safe and ready for use by the general public. Thanks to its experience working in clinical areas, Clean Hospitals is
well qualified to offer advice.

What is cleaning, and what is disinfecting? What are the differences, and when should each one be used? It’s these questions that are being asked widely as businesses and public buildings open after lockdown due to the Covid-19 pandemic. More than ever before there is a focus on professional cleaning and hygiene, and the industry as a whole bears an enormous responsibility in helping to restore confidence by guaranteeing the correct hygiene standards are met.

One industry group that has expert knowledge in the protocols around cleaning for health and hygiene is Clean Hospitals. ECJ spoke to them about the key points all cleaning professionals should be aware of when making decisions as to what type of cleaning process to carry out in different environments.

Cleaning versus disinfection

Cleaning is removal of microorganisms. If you clean a surface you can use soap and water, a detergent and physically unstick and remove the soil, including many of the microorganisms. When you clean your hands, you can use soap and water.

Disinfecting means you not only clean (remove the microorganisms) but you also use a product that kills microorganisms on the surface. Disinfecting should only refer to killing microorganisms from a surface or environment. When you use alcohol-based hand rub you kill the microorganisms and at that point you are actually doing hand antisepsis. This is the equivalent of surface disinfection on hands.

Coronavirus and disinfection

There is no need to supplement protocols with additional measures even when talking specifically about Coronavirus. But there should be made a difference between healthcare and non-healthcare facilities.

Disinfection practices are important to reduce the potential for Covid-19 virus contamination in non-healthcare settings such as in the home, office, schools, gyms, publicly accessible buildings, faith-based community centres, markets, transportation and business settings or restaurants.

High-touch surfaces in these non-healthcare settings should be identified for priority disinfection such as door and window handles, kitchen and food preparation areas, countertops, bathroom surfaces, toilets and taps, touchscreen personal devices, personal computer keyboards, and work surfaces.

In non-healthcare settings, sodium hypochlorite (bleach/chlorine) may be used at a recommended concentration of 0.1 per cent or 1,000ppm (one part of five per cent strength household bleach to 49 parts of water). Alcohol at 70-90 per cent can also be used for surface disinfection. Surfaces must be cleaned with water and soap or a detergent first to remove dirt, followed by disinfection.

Cleaning should always start from the least soiled (cleanest) area to the most soiled (dirtiest) area in order to not spread the dirt to areas that are less soiled. All disinfectant solutions should be stored in opaque containers, in a well-ventilated, covered area that is not exposed to direct sunlight and ideally should be freshly prepared every day.

Indoors, routine application of disinfectants to surfaces via spraying is not recommended for Covid-19. If disinfectants are to be applied, this should be via a cloth or wipe soaked in the disinfectant.

In fact, there are some conditions where you should do both cleaning and disinfecting, if something is very fat or greasy you should first use soap or a detergent to clean and then add a disinfectant. This can be on the floor, on a machine, the environment, and so on.

Regarding healthcare facilities, if environmental hygiene protocols are currently being implemented and followed, all the tools necessary are present. The need is much more to focus on education, and implementation of the right protocols by the staff. This is the way to make sure compliance with the protocols is as good as possible.

Disinfection claims

Various manufacturers claim to make products that offer disinfection that lasts for long periods of time. So far Clean Hospitals has found no evidence in the laboratory and no clinical evidence of the real usefulness of these types of approaches. It says surfaces remain protected from virus, bacteria or parasites for a few hours only, especially due to the deposit of physical soil.

Fogging and spraying

Large-scale spraying or fumigation in areas such as streets or open market places for the Covid-19 virus or other pathogens is not recommended. Streets and pavements are not considered as routes of infection. Spraying disinfectants, even outdoors, can be noxious for people’s health and cause eye, respiratory or skin irritation or damage.

This practice will be ineffective since the presence of dirt or rubbish for example, inactivates the disinfectant, and manual cleaning to physically remove all matter is not feasible. This is even less effective on porous surfaces such as pavements and unpaved walkways. Even in the absence of dirt or rubbish, it is unlikely chemical spraying would adequately cover surfaces allowing the required contact time to inactivate pathogens.

Spraying of individuals with disinfectants (such as in a tunnel, cabinet, or chamber) is not recommended under any circumstances. This practice could be physically and psychologically harmful and would not reduce an infected person’s ability to spread the virus through droplets or contact. Even if someone who is infected with Covid-19 goes through a disinfection tunnel or chamber, as soon as they start speaking, coughing or sneezing they can still spread the virus.

In indoor spaces, routine application of disinfectants to environmental surfaces by spraying or fogging (also known as fumigation or misting) is not recommended for Covid-19. One study has shown that spraying as a primary disinfection strategy is ineffective in removing contaminants outside of direct spray zones.

Moreover, spraying disinfectants can result in risks to the eyes, respiratory or skin irritation and the resulting health effects. Spraying or fogging of certain chemicals, such as formaldehyde, chlorine-based agents or quaternary ammonium compounds, is not recommended due to adverse health effects on workers in facilities where these methods have been utilised.

Spraying environmental surfaces in both healthcare and non-healthcare settings such as patient households with disinfectants may not be effective in removing organic material and may miss surfaces shielded by objects, folded fabrics or surfaces with intricate designs.

If disinfectants are to be applied, this should be done with a cloth or wipe that has been soaked in disinfectant. Some countries have approved no-touch technologies for applying chemical disinfectants (eg, vaporised hydrogen peroxide) in healthcare settings such as fogging-type applications.

Furthermore, devices using UV irradiation have been designed for healthcare settings. However, several factors may affect the efficacy of UV irradiation, including distance from the UV device; irradiation dose, wavelength and exposure time; lamp placement; lamp age; and duration of use. Other factors include direct or indirect line of sight from the device; room size and shape; intensity; and reflection.

Notably, these technologies developed for use in healthcare settings are used during terminal cleaning (cleaning a room after a patient has been discharged or transferred), when rooms are unoccupied for the safety of staff and patients. These technologies supplement but do not replace the need for manual cleaning procedures which must be carried out.

Our message is clear: there is no need to supplement protocols with additional measures even when talking specifically about coronavirus.



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