ECJ EUROPEAN Cleaning Journal

To disinfect or not to disinfect? That is the big question. During the Covid-19 pandemic we have all been bombarded with information about the need to disinfect in all areas. But it's not quite that simple, because disinfecting surfaces in the wrong way, or when it's not needed, can be dangerous. Paul Harleman of Vileda Professional, based in the Netherlands, explains why.

An estimated one trillion species of microbes live on earth. Approximately 15,000 different types of micro-organisms live on and in your human body. Most of them are harmless and very useful. We could not live without them. However, a relatively small number of these little creatures can give us serious trouble. So serious that it causes irreversible body damage or even death.

Worldwide more people die because of a hospital acquired infection than by traffic accidents. Micro-organisms are invisible to the eye. Therefore micro-organisms are dirty and frightening to many of us. And so we fight them, specifically the bad ones that can harm us. In a targeted and very organised way, but unfortunately also unfocused and insufficient. Especially in the latter lies a possible danger.

Meet the invisibles

There are many varieties of micro-organisms. Examples you probably have heard of are yeast, fungi, bacteria and viruses. As said before most of them are very useful, but some can make you sick. These are called pathogenic micro-organisms. Pathogenicity varies. The extent to which a micro-organism can cause damage to its host is called virulence. Covid-19 is caused by a virus. Although viruses and bacteria have totally different characteristics they are often mixed up. Learn the differences summed up in the diagram.

SARS-CoV-2

SARS-CoV-2 is the official name of the virus causing the disease called Covid-19. It is a Corona related type of virus, highly contagious and new to mankind. Although scientists are learning every day, there is still a lot unknown about SARS-CoV-2. What we do know by now is that the virus is more harmful than we thought in the beginning.

Ignoring the virus, which some people still do, will possibly make you regret it later. The most important way the virus travels (infection route) is via droplets caused by coughing, sneezing or heavy breathing of a contaminated person. That's why we have to keep a certain distance from one another.

Most likely SARS-CoV-2 can also survive on "dead surfaces" for a certain period (1). That is why we have to clean or disinfect surfaces. And most recently scientists believe that aerosols, which have a much wider coverage than bigger droplets are also a route of contamination. That's why experts advise to be extra careful inside buildings, particularly those with poor ventilation systems.

What has changed since Corona came into our lives?
For sure the code of conduct has changed. Governments introduced new rules which are mandatory and subject to penalties in case of violation. Rules are constantly changing, depending on the level of control we have in the spread of the virus.

Something else that seems to be changed is what I call the move from ‘visible clean' to ‘hygienically safe'. Organisations that host people for a short or longer period have to create trust. A visitor or user of the facility wants to be confident that it is hygienically safe. You can see with your own eyes if an environment is clean, but you need equipment and knowledge to check if it is hygienically safe as well. That is why trust is so important.

Finally our cleaning behaviour changed. We started to clean or disinfect everything all the time. Not always because it makes sense, but in many cases because it reduces our fear. But...as we know, fear can be a bad guide.

Microbes are top defenders

Imagine we are confronted with a highly contagious pathogen micro-organism? Facility managers feel the need to do something and decide to disinfect door handles every three hours. Let's say the pathogenic micro-organism can survive on a door handle for a few days and through that route other persons can be contaminated.

Even then is does not make sense to disinfect the door handles every three hours. Only the first person that touches the handle right after it was disinfected is safe. All the others that touch the handle in the remaining time until the next disinfection takes place, are only safe if no contaminated person has touched the door handle. This anecdote is not made up - during the Mexican flu facility managers did this. And probably now again. A real life example of useless disinfection.

You need targeted and well-considered disinfection procedures. Otherwise there possibly could be a risk that micro-organisms become resistant to disinfection products, a phenomena that is already a big problem with antibiotics. In a worst case scenario people get infected and sick because the disinfection product no longer kills the pathogenic micro-organism.

Once you are sick you can't be cured because the same micro-organism is also resistant to antibiotics. If that happens, we have a really big problem. The Dutch government is worried as well and has asked a committee of scientists if there possibly is a risk of micro-organisms becoming resistant to disinfectants. The answer is, yes is not unthinkable, yes we need to do more research. Read the reports at the Health Council of the Netherlands website. (2)

We have to realise that micro-organisms are smart top defenders. They win over humans easily. Bacteria for example multiply under favourable conditions every 20 minutes. As a result, they can adapt relatively quickly and develop mechanisms that make them resistant to attackers like antibiotics. Humans reproduce much slower. It takes a very long time for the human body to adapt to changed circumstances. In that sense we are far behind micro-organisms.

Human behaviour strengthens the power of micro-organisms
Humans help micro-organisms to get stronger. We frequently and easily travel all over the world. Micro-organisms travel with us. In that sense we help them spreading out to new environments.

The human population is still growing. We need more space to live and grow food. That space is taken from the habitat of wild animals. If a bat cannot sleep in the woods it will sleep in the tree of your back garden. Wild animals and us will not live in separate worlds anymore, we have to share our habitat. Meaning that we will also share the micro-organisms that we are hosting.

In our attempts to fight the threatening micro-organisms we try to reduce or kill them. For instance by cleaning (removing) or disinfecting (killing) processes. However if we disinfect a surface in the wrong way, the weak microbes will die. The strongest survive and multiply which makes the population even stronger.

It is not an exception that a wrong disinfectant is used, the wrong dilution is used, the surface is insufficiently moistened with disinfectant (a disinfectant needs a certain contact time to perform), the surface is not cleaned before disinfection (some disinfectants are partly inactivated by specific dirt and bio-films have to be removed before disinfection), the surface is clean but not yet dry (which is causing a dilution of the disinfectant) or the surface was simply not ‘touched all over'. I have seen it all happening.

Mass attacks with disinfectants stimulate micro-organisms to adapt and develop defence systems. I visited a hospital in Florida, USA where employees were disinfecting everything all day. Just to be sure. But also in the UK I saw nurses ‘cleaning' all day with ready to use, disposable disinfection cloths, unintentionally stimulating bacteria to create defence mechanisms and become stronger.

Time to change

It looks like it is time to change. But do we really have to clean or disinfect entirely differently since Corona stepped into our world? Probably not. In most cases the knowledge is there, we have the protocols and we know how to clean and disinfect. The major thing we have to change, is our behaviour in cleaning and disinfection: do what we have to do, do it consistently and do it according to the instructions.

Ask yourself if this really happens in your organisation. Not because you believe it, but because you checked it. It is possible that over time good intentions devaluate. Because of cost savings, lack of education, less operational guidance by supervisors and architectural obstacles that hinder the cleaning operation.

What to do now?

As previously mentioned, we don't have to change things drastically. But it is advisable to pay attention to certain aspects.

1. Check your cleaning documentation. Up to date? Everyone involved is aware of it? Suggestion: ask an accredited infection prevention expert to validate the cleaning protocols

2. Identify the contamination hotspots and risks of your building. Adapt protocols if needed.

3. Train and check (and repeat) all personnel involved in cleaning.

4. Check cleaning equipment. Is it professional, without defects, and clean?

5. Invest in understanding and motivation. Explain to cleaning operators the importance of infection prevention and the choice of cleaning system. Understanding creates motivation and involvement.

6. Change behaviour if needed.

7. Create trust. Hygienically safe is the new clean.

Disinfecting can be dangerous

Disinfection has saved many lives. Correct hand hygiene, one of the most important ways to prevent cross contamination, is a must. Nobody will deny that. But disinfecting surfaces in a wrong way or when it is not needed can be dangerous. There is a risk we create stronger bacteria and viruses causing illness and death.

The question is, should the cleaning staff and nurses that have cleaning tasks as well ‘clean' with ready to use disinfection wipes all the time? Is a detergent always needed? Or is cleaning with microfibre cloths/mops and only water in many times a better solution.

Dutch and Belgium infection prevention experts say yes, good cleaning is better that unnecessary disinfection. Which means that we have to disinfect only when it is needed, of course it does not mean that we don't have to disinfect anymore at all. That is obvious.

The Covid-19 pandemic should be a wake-up call. SARS-CoV-2 will not be the last unknown microbe that enters our safe and controlled world and disturbs it. There will be more, experts assure us. And they could be even worse than SARS-CoV-2. So let's evaluate and improve. That is what micro-organisms do as well.

www.vileda-professional.com

Notes & links

(1) Careful use of disinfectants_2016_Dutch Health Council https://www.healthcouncil.nl/documents/advisory-reports/2016/12/21/careful-use-of-disinfectants)

(1) Resistance due to disinfectants_2016_Dutch Health Council https://www.healthcouncil.nl/documents/advisory-reports/2016/12/21/resistance-due-to-disinfectants-background-report

(2) Persistence of Corona viruses on inanimate surfaces and their inactivation with biocidal agents_ 2020_Kampf et al https://www.sciencedirect.com/science/article/pii/S0195670120300463
Free information - https://www.nap.edu/catalog/13006/what-you-need-to-know-about-infectious-disease