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Infection Control

Infection Control In Health Care Facilities — Who's Responsible?

September 19, 2010
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The cleaning industry, especially in health care, has greater anxiety about its role in infection control than ever before.

Question:

With the prevalence of antibiotic-resistant "superbugs," what do you see as the effect of this?

Do you see environmental services, contract services and managed housekeeping departments being blamed for costs associated with hospital-acquired infections or health care-associated infections (HAIs)?

There are so many variables in infection prevention — hand washing, environmental cleanliness, clinician work practices, etc. — that blaming the cleaning staff seems to be difficult.

The Answer

The problem is that blaming the cleaning staff is not difficult. It may not be rational and logical, which is what you meant, but it is all too easy.

Hospital administration is often seriously blinded to the real issues here.

To put things into perspective, we need only to look at the guidelines for health care facilities given by the U.S. Centers for Disease Control and Prevention (CDC) at www.cdc.gov.

For example, to control of spread of Clostridium difficile (C. diff) by hospital staff, which is an example of an HAI, the website recommends that staff "clean their hands with soap and water or an alcohol-based hand sanitizer before and after caring for every patient. This can prevent C. diff and other germs from being passed from one patient to another on their hands."

When a catheter is used, even the patient is told, "Make sure that all doctors and nurses caring for you clean their hands with soap and water or an alcohol-based hand sanitizer before and after caring for you. If you do not see your providers clean their hands, please ask them to do so."

Regarding the spread of methicillin-resistant Staphylococcus aureus (MRSA), it says, "MRSA can be passed on to bed linens, bed rails, bathroom fixtures and medical equipment. It can spread to other people on contaminated equipment and on the hands of doctors, nurses, other health care providers and visitors."

Isolation of the patient from those not infected is recommended and visitors are told to wear protective gowns and wash their hands after leaving the room.

Obviously, catheters and medical equipment that contacts the patient must be sterile. The bed linens and protective gowns should be fresh and not contaminated by previous use. The people touching the patients need to wash frequently and correctly; no five-second rinses.

However, the cleaning crew does not have any of this as an assignment.

They may have to wipe down bed rails, clean the vacated rooms and clean restroom fixtures, but that is actually a small amount of responsibility compared to that of those touching, moving and nursing the patient.

Unless you have patients sleeping on the floor, the mopping quality isn''t of much magnitude.

It is ludicrous to blame the custodial crew for HAIs.

The 2008 CDC Guideline for Disinfection and Sterilization in Healthcare Facilities uses these definitions:

"Cleaning is the removal of visible soil — organic and inorganic material — from objects and surfaces and normally is accomplished manually or mechanically using water with detergents or enzymatic products."

"Thorough cleaning is essential before high-level disinfection and sterilization because inorganic and organic materials that remain on the surfaces of instruments interfere with the effectiveness of these processes."

"Decontamination removes pathogenic microorganisms from objects so they are safe to handle, use or discard."

Seldom is the cleaning staff involved in decontamination — often called hygienic cleaning or microbial reduction cleaning — to the extent the nurses and other medical practitioners at a health care facility are.

The cleaning industry certainly can improve in its care of health-related facilities — and most other buildings — but it should not accept or be blamed for HAIs.

Cutting back on health care facility cleaning to save money is poor management and placing the blame for HAIs on cleaners is misguided management.

When the health care industry gets enough bad publicity and lawsuits for failing to follow the infection control guidelines that they are well aware of, we will see some serious changes.

Until that happens, it would be unwise for the custodial industry to sit back and take the heat.

We aren''t the ones causing the problem or needing disinfection.


The International Custodial Advisors Network Inc. (ICAN) is a non-profit association comprised of industry consultants with a wide range of expertise in building management, indoor environmental and service disciplines. This network provides free janitorial and building maintenance consultation service to the industry through the Cleaning Management Institute®.

Recent Articles by Lynn Krafft, ICAN/ATEX editor

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