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How to Clean for Health in Healthcare

September 19, 2010
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In healthcare, cleaning is critical. A spotless space is essential for patient and occupant comfort, as it implies a safe, healthy and well-run environment. But a clean surface can also be misleading, as infection dangers and health risks often exist just beyond the visible realm. So how can a healthcare maintenance crew work to clean not only for appearance, but also for health? Importantly, how can they do it efficiently, effectively and on budget every time? We''ll take a look at the recent studies on the science of cleaning to learn the ins and outs—and dos and don''ts—of cleaning hospitals, assisted living centers and other mainstay environments of the healthcare world.

Chemical overload

Unfortunately, recent studies suggest that cleaning is often an environmental hazard rather than a help. An April 2009 report by the Healthcare Research Collaborative, Cleaning in Healthcare Facilities: Reducing human health effects and environmental impacts, found that "conventional cleaning products and disinfectants bring a host of other health hazards despite their capacity to fight against multi-drug resistant organisms."

Standard cleaning chemicals contain a complex cocktail of chemical ingredients that are known or suspected to be associated with asthma and other respiratory disorders. Cleaning crews and patients with compromised immune systems often receive the brunt of the chemical blow. According to the Healthcare Research Collaborative, several population-based studies confirm that healthcare workers who are exposed to cleaning products have high rates of asthma and other respiratory symptoms, including illness severe enough to result in lost time from work.

In the face of easily-spread, hard-to-combat bacteria and microbes, cleaning chemicals are a necessary evil right? Not so fast. The Practice Greenhealth Guide states that more is not better with disinfection. In fact, excess product use increases occupational and environmental risks without improving infection prevention and control effectiveness.

So what can be done?

"Improving cleaning is not just about transitioning to more benign chemicals," notes the Healthcare Research Collaborative report, "But also about broadly examining the purpose cleaning serves and systematically considering alternative, and sometimes very different, strategies for minimizing unintended consequences while achieving the desired outcome."

Systems cleaning

Cleaning thoroughness often varies widely. A 2008 study of randomly selected patient rooms and bathroom areas of 23 acute care hospitals found that high-touch areas, like toilet handholds, bedpan cleaners, light switches, doorknobs, patient phones, nurse call devices, and bedside rails, were poorly cleaned.

Standardizing a cleaning program for infection control can be extremely effective. The most well-known systematic cleaning program is Team Cleaning (, a process that relies on a trained and precisely managed team of cleaning workers and two main tools: micro-fiber cloth and high-filtration backpack vacuums.

When used in a cleaning system, backpack vacuums cover up to 10,000 square feet an hour, cleaning both hard floor surfaces and commercial-grade carpeting. This increases productivity over upright vacuums and dust mops by three times or more, allowing cleaning workers to use the recovered time to focus on high-touch areas on a daily basis.

Dust and allergen capture is also greatly improved. According to the American Lung Association, indoor air quality can be up to 10 times more polluted than the air outdoors. Dust mops and upright vacuums often disperse fine particulate matter back into the air. Quality backpack vacuums rely on a high-powered motor that creates advanced suction, extracting and removing even deep-seated particles, cleaning and dust. The most common backpack used in Team Cleaning is made by a company partnered with the American Lung Association to educate the public on the importance of indoor air quality on occupant health. Those backpacks feature standard Four Level Filtration systems that trap and eliminate 99.9 percent of harmful pollutants like dust mites, mold, bacteria, cleaning chemical residue and other allergens down to 1 micron in size. HEPA filtration models extend that capture rate even further, down to .3 microns.

For cleaning staff, the ergonomic fit and ease of movement of the backpack reduces the risk of repetitive stress injuries, which are a common, debilitating problem in this line of work. Hard to reach areas, like under patient beds, are easily cleaned with a rotating, swiveling head that minimizes the need to bend over or move heavy furniture. An on-belt attachment kit allows a maintenance worker to also do detail work, like blinds, ceiling fans and other areas, with far less strain, in far less time. The backpack vacuum also operates at a lower decibel than many commercial upright vacuums, so cleaning near occupants and staff becomes less of a nuisance.

Microfiber mops and cloths can also greatly improve overall health and reduce expenses. The University of California Davis Medical Center replaced conventional mops with microfiber mops, and saw a 60 percent cost savings, a 95 percent reduction in chemical costs associated with mopping tasks, and 20 percent labor savings a day.

Team Cleaning programs have been used in schools to great effect, reducing student and teacher absenteeism due to lung health issues. Deep cleaning is rotated into the schedule on a regular basis, and detailed records are kept. Importantly, the standardized system creates structure and accountability for the cleaning worker, the maintenance supervisor and the healthcare facility.

Case study: Cleaning senior living centers

Emeritus Senior Living owns and operates 309 retirement centers in 39 states. Many feature memory care neighborhoods for Alzheimer and dementia patients. A facility typically spans 25,000 to 125,000 square feet. Two full-time housekeepers and a part-time housekeeper cover a typical 100-unit building, with average cleaning times of 30 to 35 minutes per room. They also spend an average of two to four hours a day on common areas, like dining rooms, activity centers and other spaces. Most Emeritus facilities have carpet in dining rooms, common areas and private rooms, with hard surface flooring in the dining area and some private rooms of memory care neighborhoods.

"If you walk into one of our buildings, you''ll find them cleaner than most," says Steve Wolley, Corporate Property Manager at Emeritus. "Most of the people who work in this industry really care deeply about the elderly. Our job is to make sure that the quality of life while they''re with us is excellent, and cleanliness is a part of that. It''s a basic fact. It has to be done first before anything else. We strive for excellent care of our residents and the highest cleanliness standard we can achieve."

All of Wolley''s suppliers are working on cleaning green, and Emeritus is now taking steps to clean for health. Staff at each center dust and wipe down common areas, clean bathrooms and hard floors, and rotate cleaning of other areas daily.

Emeritus primarily utilizes the ProForce upright from ProTeam who popularized the use of backpack vacuums. Similar to ProTeam''s backpack vacuums, these uprights feature Four Level Filtration with HEPA media exhaust filters to capture microscopic dust mites, pollen, cleaning chemical residue, viruses and bacteria. A dual-motor system dedicates one motor to suction and one to the powerhead, so extraction never diminishes, even when the brush roll is hard at work. Similar to the backpack models, an on-board tool dock makes quick work of detail cleaning and hard to reach areas.

"We''ve always had some commercial grade vacuums on site, but the quality of our vacuuming has changed since we switched," says Wolley. "Dust has diminished. We cut down on some of the hours it takes to vacuum, and the wand allows us to do the window blinds, corners and crevices."

Emeritus is proud of its cleanliness standard, and the results of the process they currently use.

"From that standpoint, we try to make all our buildings clean all the time," Wolley notes. "It benefits our residents and families, and even helps our sales and marketing."

The future of healthcare cleaning

Many factors are motivating the healthcare sector to develop and implement sustainable, healthy and green initiatives, including green cleaning programs. Colorado, Connecticut, New Jersey, New York and Wisconsin have issued Executive Orders for greener cleaning practices. One of the most visible and influential factors is the impending launch of the new Leadership in Energy and Environmental Design (LEED) for Healthcare certification program by the US Green Building Council (USGBC) that is tailored to healthcare facilities. The USGBC-LEED EB (existing buildings) standard awards one point of the necessary 32 to facilities that have an effective, high-performing matting system in place. Another effective tool that complements and reduces chemical cleaning is the use of vacuum cleaners with HEPA filtration, a move that also offers LEED points.

With increased concern for occupant health and the spread of infectious diseases, the landscape of cleaning in healthcare is changing rapidly, but the new tools and standards of the trade are helping cleaning workers and hospital patients breathe a little easier.

Jessica Holmes is a freelance writer based in Boise, Idaho, and a PR consultant for ProTeam, the company that innovated the lightweight backpack vacuum over 20 years ago and transformed the efficiency of cleaning. Learn more at

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