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Infection Control

Competing Against Infection

September 19, 2010
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In professional sports, coaches and athletes spend extensive time studying their opponents.

Weeks before a game, they watch hours of video to analyze the opponent''s plays and signals.

Each player''s moves are carefully recorded and plays are crafted to capitalize on the opponent''s weaknesses. External factors, such as field and weather conditions, are also taken into consideration.

When the whistle blows, each team is well-prepared with a strong plan for victory.

The same principles can be applied to infection prevention. To effectively combat viruses and bacteria, you must fully understand them.

You need to know their composition, how they behave and certain external factors at play before deciding which play or infection prevention protocol to use.

This knowledge will help you prevent infection and limit your facility''s loss from a potential outbreak.

Train The Team

To properly prepare your infection prevention program, you must first educate your team.

Provide ongoing staff training on fomites or high-touch surfaces, such as door handles, rails and light switches.

Staff must understand that high-touch equals high-risk, so proper disinfection of these areas is a fundamental component of preventing the spread of infection.

In addition to identifying which surfaces to disinfect, cleaning staff should be trained on proper disinfection techniques.

One of the most important things to consider is dwell time. If disinfectants are not given the required dwell time to work, they will not be effective.

Many traditional disinfectants require a 10-minute dwell time. In this period, surfaces must remain wet to be effective.

Most initial disinfectant applications dry after a four-minute period, requiring reapplication.

As a result, many cleaning programs are switching to newer disinfectant technology that requires a shorter dwell time.

Your Opponent: Virus Types And Classifications

The next step in the battle against infection is to understand the key organisms you want to destroy.

In order to do so, it is helpful to understand the origin and composition of viruses.

The first-ever virus, known as the "tobacco mosaic virus," was identified by a Russian scientist in 1898. Since then, more than 5,000 different viruses have been discovered.

Present in almost every ecosystem, viruses can affect all types of organisms and are transmitted through a variety of modes.

The two basic virus types that can be potentially harmful to humans and exist within a building are enveloped and non-enveloped viruses.

"Enveloped" viruses, also known as medium viruses, include human immunodeficiency virus (HIV), Hepatitus B virus (HBV), herpes and hantavirus. These viruses get their name because they hide in the "envelope" of the membrane of the infected host cell.

Examples of "non-enveloped" or small viruses include poliovirus, norovirus, rhinovirus or coxsackievirus. Unlike their counterparts, non-enveloped viruses either attach to the host cell or penetrate the membrane entirely.

In 1939, Dr. Earle Spaulding of Temple University originally presented the Spaulding Classification scale to the medical community in a paper that discussed the disinfection of surgical instruments in a chemical solution.

Due to his extensive study of disinfection and sterilization of medical instruments, Spaulding further refined his classification of appropriate treatment of medical devices based upon how a device is used.

Substances in the Spaulding Classification scale were classified as low-level, intermediate-level or high-level disinfectants.

To develop an effective prevention strategy, you must use the best disinfectant based upon your facility''s needs. To do this, first determine the appropriate level of disinfection for high-touch, off-the-floor surfaces.

Establish which types of bacteria or viruses are likely to be present and assess whether or not they are potentially communicable through environmental surface contact.

Factors To Consider In Infection Prevention

The next step in developing an effective infection prevention strategy is to identify factors that may affect your program.

Budget, training programs, time constraints and administration may all play a role in the effectiveness of your infection prevention efforts.

For instance, in many health care facilities, there is a focus on increasing turnover so more patients can be tended to and cared for.

As a result, the environmental services staff is under pressure to turn rooms over more quickly, which may cause them to overlook certain tasks like disinfecting the tops of cabinets or other hard-to-reach places.

This can result in an environment favorable to cross contamination or infection.

Budgets may also play a factor in your infection prevention program. Reductions in labor and funding will limit resources and force cleaning staff to accomplish more with less.

In many situations, this also results in training cutbacks so the cleaning staff is not able to review policies and procedures or stay current on the latest protocol for infection prevention.

To help secure buy-in for your infection prevention program, find avenues to educate administrators about the important role cleaning plays in making buildings safe and healthy for occupants and staff.

By participating in safety and wellness committees, you can provide information on different virus types and how potential outbreaks can be limited with an effective infection prevention program.

This will create proponents for your program, increase opportunities for funding and improve your odds of success in preventing infections.

The focus on using green or sustainable products in facilities is another variable to consider when reviewing your infection prevention efforts.

In an effort to reduce the amount of potentially harmful chemicals used, some cleaning departments have switched out traditional, intermediate-level disinfectants for less caustic, low-level disinfectants.

Low-level disinfectants will not kill small, non-enveloped viruses such as norovirus, so make sure you are using newer, intermediate-level disinfectant technology that has an improved sustainability profile over traditional disinfectants.

Calling The Play: Selecting Your Disinfectant

You have the team in place, you have studied your opponent and you know the field conditions.

Now, it''s time to draw up the play. What tools or disinfectants should you use to prevent infection?

First, identify what viruses might be present. Because there is a possibility that you might face small, non-enveloped viruses, you need a broad-spectrum disinfectant that kills viruses spread through environmental surface contact.

Recognizing that tuberculosis (Tb) cannot be transmitted via hand-to-surface contact, there is a growing point of view that Tb should not be the determining factor when selecting a hard surface disinfectant.

Therefore, you should work with your distributor to find an intermediate-level disinfectant that targets small, non-enveloped viruses — not necessarily Tb.

Next, consider the disinfectants available. Before committing to a traditional disinfectant, look at its dwell time.

Many traditional disinfectants require a 10-minute dwell time in order to be effective; in this time, the surface must stay wet.

For cleaning staff that are under pressure to clean rooms and areas more quickly and efficiently, traditional disinfectants requiring a 10-minute dwell time might not be the best option.

Consider the impact of your disinfection selection on your team or staff.

Many intermediate-level disinfectants, such as phenolics, have significant issues related to their use — ranging from the need for proper personal protective equipment (PPE) to protect staff from health effects, such as bleaching of the skin, to strong odors and toxicity.

Select a disinfectant that has a good safety profile to reduce any potential impact on your staff.

Cleaning professionals who train, take the time to understand their opponent, consider external factors and make a disinfection selection that best meets the needs of their facility will be most successful in the battle against infection.

Preventing your facility from shutting down for just one day from common infectious outbreaks can result in thousands of dollars of savings.

By following these key strategies, you can become an Olympian in infection prevention.

Dr. Dale Grinstead is an infection prevention fellow for JohnsonDiversey Inc. For more information on infection prevention practices for your facility, visit or

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