ECJ EUROPEAN Cleaning Journal

Hygiene, efficacy, safety, cost-effectiveness  - what should be the chief requirements of a healthcare cleaning system? Ann Laffeaty considers the main priorities of any healthcare cleaning regime and asks providers about the types of products and systems they offer that can successfully fulfill them.

CLEANING A HEALTHCARE FACILITY can involve a juggling act on the part of the janitorial staff. Cleaning teams need to be able to balance various conflicting priorities when deciding how to tackle a specific task. For example, the elimination of germs and viruses obviously needs to be close to the top of the list in any healthcare facility in order to reduce the risk of cross-infection.

But personal safety is also important, which means harsh, germ-busting cleaning products that emit strong fumes should preferably be avoided because these could pose health risk for patients, staff and cleaners.

State-of-the-art machinery sometimes needs to be deployed in healthcare facilities in order to blitz the aforesaid germs. But any machines need to be sufficiently quiet in operation so as to avoid disturbing the patients. And of course, keeping down costs must always be a consideration in a state-run healthcare facility.

So, how do cleaning solutions manufacturers come up with products and systems that successfully balance all these priorities?

Kärcher trainer Klaas-Matti Nolte confirms that several problems converge in the healthcare sector. “Firstly there are many people occupying a relatively small space in a hospital, most of whom are likely to be ill – and this of course means they are likely to spread pathogens,” he said. “At the same time, their immune systems will potentially be weakened.”

Quiet, unobtrusive cleaning systems that will not disturb the patients are a definite priority in any hospital, he says. “Patients will recover much more quickly and easily when they feel appropriately comfortable, so it is important to use quiet devices and cleaning methods – ideally ones that won’t compromise on efficacy,” he said.

“Quiet devices also have the advantage of extending the cleaning window since they can be used at night as well as during the day.”

According to Nolte, powerful cleaning agents and disinfectants should only be used in the recommended doses. “There are legal guidelines that prescribe which surfaces need to be disinfected and how, and when it comes to strong detergents and disinfectants the principle that applies should be: ‘as much as necessary’ and ‘as little as possible’,” he adds.

While minimising costs is important in any state-run facility, he believes that health preservation should be the ultimate goal. “In any case a hospital will certainly not benefit from an increase in nosocomial infections, so the priority should always be to prevent the spread of microorganisms as far as possible in the first place,” he said.

Cleaning should achieve the desired effect within a good cost-benefit ratio, adds Nolte. “Sometimes a simple procedure will be sufficient,” he says. “However, cleaning processes will inevitably be more complex and time-consuming in areas such as operating theatres.

Simple procedures

“Since these spaces need to be made quickly available for the next patient, all cleaning procedures should be kept as simple as possible. Features such as tank-rinsing systems and machines that offer easy accessibility for cleaning the tanks are important here. But it can be difficult to strike a balance between all the different requirements.”

Kärcher offers a range of machines and equipment designed to meet the demands of healthcare facilities including quiet scrubber driers in various sizes and that incorporate configurable equipment.
Germ-busting power is crucial – but it is not the only consideration to bear in mind when it comes to hand hygiene, according to GOJO’s managing director Chris Wakefield. “Formulations should also be kind to skin due to the high frequency with which healthcare workers need to clean their hands,” he said,

Skin irritation is a growing problem in healthcare settings, he says, as well as being one of the biggest barriers to hand hygiene. “Besides being painful, damaged skin also poses a significant infection risk because the sufferer will be more likely to pick up an infection,” he said. “And this will then be more easily spread to surfaces and to other people because it becomes harder to remove germs from all the cracks and flakes in the skin.”

GOJO offers Purell Advanced Hygienic Hand Rub which incorporates moisturising agents to reduce skin discomfort.

According to Wakefield factors such as healthcare-associated infections, the growing threat of antimicrobial resistance and the emergence of so-called ‘superbugs’ are a perennial worry.  “And of course the added risk of Covid-19 needs to be taken into account, so it is clear that good surface and hand hygiene practices are vital,” he said.

All soaps and sanitisers need to be powerful enough to kill germs while also being fit for purpose in healthcare settings, says Wakefield. “Hospitals should seek out products that conform to the EN 1500, EN 14476 and EN 12791 hospital norms because these will provide assurance that they are safe for use in healthcare settings,” he said. “It is also important to check contact times, since a shorter contact time will allow users to benefit from the full germ-killing power of
the product.”

And he adds that another priority to consider is all hand hygiene products should be made readily available and be easy to use. “According to guidelines, point-of-care products should be within arm’s reach of where patient care or treatment is taking place and should not involve the healthcare worker having to leave the area,” he said.

Delicate balance

Effective hand hygiene and cleaning solutions in healthcare facilities are critical to improving the quality and safety of care, according to Essity’s communications director Renée Remijnse. And while efficacy is key, she says it is important to balance effective hygiene practices against the potential overuse of powerful chemicals.

“Microfibre cloths are an ideal surface-cleaning solution for healthcare environments as these may be used with water alone, providing an efficient solution whilst helping to avoid the use of harsh chemicals,” she said. Essity’s Tork Microfibre Reusable Cleaning Cloth and Tork Microfibre Disposable Cleaning Cloths can be used either dry or in conjunction with cleaning solutions, sanitisers or disinfectants, while according to Remijnse they can remove 99.9 per cent of microorganisms from surfaces including Covid-19 and C.difficile.

As far as hand hygiene is concerned, she believes the use of extra mild products can help to build hand hygiene compliance among healthcare workers. “If the product is pleasant to use as well as being effective it will be adopted more widely,” she said. “Harsh soaps and detergents on the other hand could harm the health of the skin, leading to skin issues such as dermatitis – which in turn could result in staff absenteeism.”

She adds that in her view, good healthcare begins with good cleaning and hygiene regimes. “Quiet hand hygiene dispensers in patient wards will help to support patient well-being, and all cleaning staff should be equipped with the right tools for the task,” she said. “In fact, the use of the correct cleaning techniques coupled with an understanding of how these contribute to patient safety has become a more important topic than ever before.”

Essity offers Tork Interactive Clean Hospital Training in multiple languages to support hospital cleaning regimes. According to Remijnse, it is important to maximise all available resources in any healthcare environment. “For example, data-driven cleaning can improve the effectiveness of existing resources,” she said. The company’s Tork Vision Cleaning is claimed to be able to reduce dispenser checks by up to 91 per cent and cut the number of cleaning hours required by 20 per cent.

Key objectives

So what is the top priority in terms of healthcare cleaning? The views of all commentators are aligned.

“The elimination of any microorganisms along with the prevention of the spread of germs should be primary objectives in any healthcare cleaning and hygiene regime,” said Kärcher’s Klaas-Matti Nolte.

Essity’s Renée Remijnse agrees, adding that reducing the risk of healthcare associated infections should be a key priority in hospitals. “HAIs lead to longer hospital stays, lower bed availability, higher costs and an increase in mortality,” she said.

And GOJO’s Chris Wakefield concurs that preventing the spread of germs is undoubtedly the highest priority when cleaning in hospitals. “Healthcare facilities require the highest levels of hygiene and cleanliness in order to protect all sick and vulnerable patients along with visitors and healthcare staff,” he said.

• The Healthcare Cleaning Forum, a one-day conference on environmental cleaning and hygiene
in hospitals and long-term care institutions, takes place during Interclean Amsterdam on May 12. For information on how to reserve your place visit www.intercleanshow.com/healthcare-cleaning-forum