Hygiene in healthcare - a touching bedside scenario

29th of March 2019
Hygiene in healthcare - a touching bedside scenario

Which healthcare surfaces pose the highest risk of spreading infections and viruses around a hospital, asks Ann Laffeaty? And how can this risk be minimised?

A healthcare facility is the place where people go to be cured. But when sick people are kept together in close confinement, the risk of catching a new illness becomes huge. Most viruses and infections are spread via the air or by touching a contaminated surface. It is difficult to avoid breathing the same air as an infected person, but it is slightly more within our control to avoid coming into hand contact with pathogens on surfaces.

The risks of picking up a bug may be reduced if we practise good hand hygiene and if all potentially contaminated surfaces are frequently cleaned. But how difficult is it to keep healthcare surfaces clean and bug-free? Whose job is it to keep them that way, and which surfaces present the most risk to patients?

The answer is, all of them according to Filmop’s export area manager Paolo Scapinello. “Viruses and bacteria are everywhere and respect no territorial limits,” he said. “So all healthcare surfaces areas require well-defined cleaning procedures to help prevent dangerous bacteria
from spreading.”

He adds that common areas such as entrances and waiting rooms pose a particular risk since these accommodate a constant stream of visitors, operators and nursing staff. “Dirt is more present in these high traffic areas which means they will require a targeted action.”

Healthcare surfaces should be cleaned and sanitised every day, says Scapinello, with additional cleaning to be factored in when the need arises. “Even the cleaning equipment itself may become a source of bacterial diffusion so it is essential to use the right equipment to help prevent infections,” he adds.

Components of Filmop’s A-B Plus system – which includes the Alpha A-B Plus trolley - comprise antibacterial additives while the Alpha A-B Plus trolley also offers separate washing, storage and collection compartments. Filmop also offers the Uniko mop holder which can be used with a range of antibacterial microfibre cloths.

Patient rooms, out-patient clinics, washrooms and emergency rooms all present a particularly high risk according to IPC communications manager Gabriella Bianco. “Families with children, doctors and other hospital staff members will be walking around these rooms and the surrounding hallways,” she said. “Dangerous pathogens can therefore easily be transmitted from person to person through the air or via surfaces without anyone realising it is happening.”

High risk surfaces

She says patient rooms contain many surfaces that pose a high risk. “Bed rails, chairs, bedside tables, doors, windows, telephones, call bells, light switches and the edges of privacy curtains may all potentially become contaminated via the hands,” she said. “And in the patient bathrooms, fixtures such as the toilet seat, flush button and taps are also examples of high-touch surfaces.”

Some healthcare areas are often overlooked according to Bianco. “These include the lockers where cleaners store their equipment, and the changing rooms where healthcare staff leave their outdoor clothes before starting work,” she said.

Products in the IPC Healthcare Program include the Brix PT System, a combined floor cleaning and sanitisation protocol that uses pre-treated microfibre mops. The company’s Shark mop has a microfibre textile weave construction which is said to make it capable of effectively absorbing liquids and organic residues.

A two-year study looking at ways of improving hygiene in patient surroundings was recently conducted by Essity, says healthcare marketing director Thomas Bergin. During the multi-partner study the company analysed the presence of bacteria in healthcare facilities and assessed them as potential sources of healthcare-associated infections. “Surfaces we tested included textiles, bed guardrails and the floors in patient wards,” said Bergin. “These were all found to harbour a variety of bacteria, some of which could be potential pathogens.

“And we discovered that soft surfaces such as curtains, bed covers, chairs and couches were often overlooked as potential reservoirs for cross-contamination.”

According to Bergin, some micro-organisms remain viable for weeks or even months. “Minimising contamination is a fundamental aspect of hospital cleaning and needs to be carried out regularly - but also on demand, such as when there is an outbreak of C.difficile or similar,” he said.

“Frequent cleaning is of utmost importance to remove dust, dirt and the chemical residues upon which microorganism can feed and grow. Other important considerations are how you clean, what products are used, how they are being used, the routines involved and how well they are followed.”

He claims that a regular follow-up with ATP measurements and visual inspections are both crucial in order to minimise cross-contamination and maintain control.

Essity offers hand hygiene products, hand sanitisers and couch rolls for the healthcare sector. All Tork dispensers have rounded edges to make them easy to clean, while touch-free and one-at-the time dispensing options are said to minimise the risk of cross-contamination.

Responsibility for cleaning varies from facility to facility, says Bergin. “It is generally a team effort with care staff being responsible for the bedside equipment while cleaners are tasked with cleaning all the other surfaces,” he said. “However, this system may result in some areas being overlooked with items such as curtains and seat cushions often falling into this grey area.”

He believes strict protocols can help to ensure patient safety and optimise cleaning results. “Other important factors are  well-trained cleaning staff and the use of quality products and equipment,” he said.

Greenspeed marketing manager Floor Loos singles out door handles, bed rails and light switches as surfaces that present a particularly high risk. “These are all potentially touched by patients, nurses and visitors,” she said.

Don’t disinfect too often

“Cleaning on a daily basis will minimise the risk of an outbreak, while those places where the risk is particularly high also need to be disinfected. But it is worth keeping in mind that some studies warn against disinfecting too often, since this could help give rise to resistant bacteria.”

Areas that are not directly in line of sight are often typically overlooked, says Loos. “For example, it may be obvious that areas such as washrooms, floors and bed rails need to be cleaned, but it is also important to clean the cupboards, wardrobes, light switches - and the cleaning trolley itself,” she said.

Designed for use in healthcare is the Click’M C flat mop which can be opened with the foot to avoid any contact with the operator’s hands. This can be used with various microfibre mops depending on soil levels and floor type.

Pathogens can hide and breed in the most unlikely of places - and this is also true of healthcare settings according to GOJO European marketing and product development vice-president Chris Wakefield.

“Curtains, lift buttons, computer keyboards and even mobile telephones all have one thing in common – different hands touch them frequently,” he said. “This makes them a potential hotbed for germs if proper hand hygiene protocols are not followed.

“In healthcare it is also a problem to determine who cleans what, when and how. Nurses play their part in ensuring the cleanliness and hygiene of a healthcare facility, but cleaning is a skill that requires training, equipment and resources and it should be undertaken by professional operatives. And patients and visitors also have a responsibility to ensure they do not contaminate their surroundings.”

He says improving hand hygiene is one of the most effective ways of lowering the risk of cross contamination in clinical and healthcare settings. “However, despite being simple, low-cost and highly effective, this method of infection prevention relies on compliance and behavioural change to be successful,” he said.

Gojo offers Purell hand rubs which are formulated with 70 per cent ethyl-alcohol and are claimed to kill germs within seconds. Purell dispensers are said to be easy to use and can be wall-mounted, free-standing, push-activated or touch-free.

Surfaces closest to the patient pose a particular cross-contamination risk according to Diversey’s European healthcare marketing leader Jolanta Stasiewicz. “These include bed rails, over-bed tables and bedside tables,” she said. “Recent studies have also shown that patients frequently cross-contaminate their own bedding with pathogens present on the floor. So in other words, all surfaces in the patient room may potentially be affected and visitors need to play their own role in preventing infections.”

She says viruses can remain active on surfaces for hours or days while infection-causing bacteria can survive for weeks or even months. “If these pathogens are not addressed through hand and surface hygiene, they will present a risk for long periods of time - certainly long enough for cross-transmission to occur,” she said.

Previous occupants

According to Stasiewicz there is mounting evidence that patients could pick up an infection lingering behind from a previous occupant of their hospital bed. “Patients could therefore be forgiven for wanting to know who was in the bed before them and what infections they suffered.”

One of the chief challenges in healthcare cleaning is the clear assignment of responsibility, she says. “Often a contract cleaner is employed to clean part of the patient area while other tasks are left to the nursing staff,” she said. “During discharge cleaning, for example, it is common for the housekeeping department to clean the toilet and some areas of the patient room while a nursing assistant may be responsible for the bed and other surfaces.

“Often these two workers are not in the room at the same time, making it more likely confusion may arise over who cleans what.” This means areas such as bed rails are often overlooked, she says, since each party will believe the other to be responsible for cleaning it. “When you consider that bed rails may be touched more than 250 times a day, the idea that they are not being cleaned is alarming,” she said.

Products such as disposable pre-wetted disinfectant wipes will reduce the amount of time it takes to clean while also making the task easier and more convenient, she says. Diversey’s Oxivir AHP disposable wipes are effective against key pathogens and can be used for a range of healthcare cleaning tasks.

So with all these challenges facing healthcare workers, what is the key advice in terms of minimising the cross-contamination risk? “Detailed cleaning instructions with suggested frequencies are vital, and UVC devices should be used to provide an additional barrier to help overcome any lapses in cleaning procedures,” said Stasiewicz. “There should also be a robust auditing programme focused on identifying the risk areas.”

Correctly cleaning and sanitising every area is the only way to minimise the risk of cross-contamination, says Filmop’s Paolo Scapinello. “It is also essential to use equipment suitable for this task,” he said.

Greenspeed’s Floor Loos adds every room and surface should be cleaned with a new cloth or mop to minimise the risks. “The user’s hands and the mop handle should also be disinfected and the operator should clean from the top down and work from clean to dirty areas,” she adds.

Specialist workers following strict cleaning schedules and operating within specific protocols need to clean daily, says IPC’s Gabriella Bianco. “Healthcare staff should also wear gloves, safety glasses and masks and they should follow good hygiene practices, such as always washing their hands with soap and water.”

Essity’s Thomas Bergin also considers hand hygiene routines to be pivotal. “Ensuring proper hygiene compliance among staff and patients is critical in maintaining a healthy, clean and low-risk environment.”


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