ECJ EUROPEAN Cleaning Journal

What are the latest cleaning and hygiene technologies in the healthcare sector? Ann Laffeaty looks at steam cleaning, ultrasonic tanks, silver ion systems plus some innovative ideas for the future such as patient tracking technology and 'intelligent' hand washing systems.

The healthcare sector is coming under increasing pressure to reduce HCAI levels and provide a clean, hygienic environment in which patients can recover. In order to do this a number of high-tech cleaning solutions have been developed. While the mop-and-bucket approach has by no means died out, the use of sophisticated steam cleaning methods and ultrasonic tanks has become more prevalent.

At the same time, state-of-the-art testing systems have been introduced to check that healthcare surfaces have not been compromised. But how vital are these in improving standards of cleanliness and hygiene in our hospitals?

Opinion on this is divided. Osprey Deepclean specialises in steam-cleaning equipment but the company’s consultant Mike Rollins said: “There is a school of thought that says good hygiene takes care of 90 per cent of the job, and that is quite true. But the conventional mop and bucket system also has certain failures.”

One issue concerns the increasing use of plastics in hospitals in place of materials such as stainless steel, he said. “Some plastics have a rippled surface and there is a tendency to skim the surface and leave a residue behind in the crevices when cleaning.”

Steam cleaning tools

Osprey Deepclean has developed a range of purpose-designed steam cleaning tools for use in hospitals. Steam destroys the biofilm inhabited by bacteria on curtains, bed frames and mattresses. The tools are designed to avoid any dispersal of the bacteria back into the atmosphere.

One obvious limitation of the system, which is now in widespread use across Europe, concerns cleaning the areas close to the patient. “You can’t clean with steam while the patient is in the bed, but you can demonstrate effective technology around the chair, table and bed once the patient has been discharged,” said Rollins.

Another high-tech solution being increasingly used in healthcare is the ultrasonic tank. One of the companies offering this system is the CK Group. According to managing director Ian Pether the technology itself is by no means new. ”Ultrasonic tanks were first developed for cleaning the atom bomb and are now widely used in the food and car industries,” he said. “It was CK Group that brought the technology into healthcare.”

Items such as wheelchairs, drip stands and commodes are dipped into 400 litre stainless steel tanks for a period of several minutes and then wiped down with microfibre cloths. “Ultrasonic tank cleaning works better than conventional cleaning methods and ensures a consistent result,” said Pether.

Thunderstorm gas

Meanwhile laundry company JLA claims to be destroying superbugs using a gas created by thunderstorms. The company’s Otex system uses cold water in conjunction with ozone, a natural disinfectant that acts 3,200 times faster than chlorine bleach.

Ozone is created when oxygen molecules are broken down by lightning during a thunderstorm. When used in concentrated form inside a washing machine it is said to destroy organic matter including bacteria. The system, which is already in place in several UK hospitals, is said to be effective against MRSA and C.difficile.

IPC Gansow has come up with its own high-tech cleaning system in the form of a vacuum cleaner specifically designed for hospital use. The 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. “The Ecospital was launched in the UK in June and is already selling well in France, Italy and Germany.”

Another high-tech solution that is increasingly used in hospitals is the ATP hygiene monitoring test. ATP – or adenosine triphosphate - is a molecule found in living cells that measures the level of biological concentration on a surface. ATP is quantified by measuring the light produced through its reaction with a naturally-occurring enzyme using a luminometer. A swab is taken of the surface to be tested and then programmed into the hand-held testing device, which provides an ATP reading.

One company that produces ATP systems globally is Hygiena. According to general manager Martin Easter the company’s SystemSURE products have been widely used in the food industry for some years but are only now taking off in the healthcare sector.

“Hospital managers had not seen the need for ATP systems before, but it is very important to provide a direct, objective test to cleanliness,” he said. “Most cleanliness assessments have been visual up to now, but ATP takes away the guesswork and gives you an instant result.”

Also designed to make the healthcare environment safer is Purazone system from Signature Aromas. This is designed to purify hospital air and remove pathogens from the atmosphere while neutralising odours.

The system comprises a stainless steel box with a 'killing chamber' through which air is drawn. “High-tech air care systems can have important benefits in the healthcare sector,” said Signature Aromas managing director Brian Chappell. “Our Purazone system kills more than 99 per cent of germs and other pathogens including swine flu and C.difficile.”

High-tech methods of cleaning in healthcare are constantly being developed according to Paul Cryer, one of the speakers at the Association of Healthcare Cleaning Professionals 35th annual national conference in June. Cryer is a consultant and former manager for the UK Department of Health’s  HCAI Technology Innovation Programme.

Showcase hospitals

The programme involves carrying out trials of high-tech cleaning solutions at eight showcase hospitals throughout the UK. New technologies being piloted include a hand hygiene system featuring a chip in a camera that 'knows' how medical operatives are washing their hands. “It registers the various stages of hand washing and once the member of staff has completed all the stages, a green light appears,” said Cryer.

Another system being trialled involves the acoustic tracking of patients. “This allows us to know where every patient has been and every interaction they make,” said Cryer. “This is important for monitoring the spread of infections and ensures that a patient is not admitted to a bed unless it has been signed off as being clean.”

Also under discussion is the development of a mattress incorporating a dye that shows up if the mattress has been compromised. And another possible breakthrough for the future is an electronic badge worn by all healthcare workers that glows red when the worker’s hands have been contaminated and green once they have been washed.

But some of these high-tech breakthroughs have their downsides, it seems. Head of patient environment at the UK’s Department of Health Dr Liz Jones told the AHCP conference that ATP technology would not figure in the forthcoming new UK national hospital cleaning specifications.
“ATP is fantastic for training and research, but not very good as a means of mass measuring where the micro-organisms are,” she said. “The new standards will only cover visual assessments since everyone can apply these consistently.”

Mike Rollins also pointed out problems that can arise when a new cleaning or hygiene initiative is developed in isolation, and quoted as an example the increasing use of alcohol gels. “These contain a high level of emollient,” he explained. “Once the alcohol disappears the emollient adheres to surfaces - such as hand rails - and allows microbes to colonise.

Hand hygiene strategy

“The World Health Organisation developed a strategy for hand hygiene, but the problem is that nobody ever studied the knock-on effects of bringing that volume of alcohol gels into the hospital environment.”

And Dr Stephanie Dancer - consultant microbiologist at NHS Lanarkshire – has issues with several of the new cleaning technologies around today. “I love microfibre products, but they pick up spores of C.difficle and won’t let them go even when washed repeatedly,” she claims.

“Steam methods are great for cleaning the toilets, but cannot be used on hand-touch sites or items such as cardiac monitor buttons without being a risk to the patient.”

So, are increasingly high-tech methods the answer to improving healthcare hygiene? Dancer referred to a Glasgow study in which an extra cleaner was brought in to clean hand touch sites - resulting in a 27 per cent reduction in new MRSA infections.

“In another UK study where MRSA was an issue they tried improving hand hygiene and introducing screens, but MRSA did not go away until they doubled the number of cleaning hours,” she said.

“It seems that it is a combination of extra cleaning and improved hand hygiene that gets the best results.”