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Keeping hospitals healthy

September 19, 2010
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Cleaning medical facilities is a specialized service.

However, except for in certain areas of a hospital — such as operating and emergency rooms, which usually require special cleaning chemicals and procedures — there are few widely practiced and recommended janitorial procedures for cleaning medical facilities.

Over the years, healthcare facilities and hospitals have developed what are termed “recommended,” or “best practices” to address certain tasks and procedures, including cleaning-specific tasks.

These tasks involve cleaning and sterilizing, disinfecting, or sanitizing such things as surgical tools, hospital equipment, clothing and attire, and even the scrub pads and brushes doctors and nurses use before operating on patients.

Although these recommended or best practices have been recognized for cleaning highly infectious or critical care areas of a medical facility, or for handling hazardous waste, for example, there are no universally established cleaning and maintenance procedures for other medical facility areas.

Without the appropriate products, procedures, frequencies, equipment, and custodial hardware, as well as the proper frequency of washing hands and/or changing gloves — all of which may differ by area, contact points, and surfaces in a medical facility — the cleaning may not be as effective or efficient as it should be.

The lack of universally established best practices for general medical facility areas is surprising because the number of people inflicted with hospital-acquired illnesses continues to grow.

These illnesses, in addition to causing pain, suffering, and many unnecessary deaths, cost hospitals, medical facilities, and taxpayers hundreds of millions of dollars each year.

It appears the time is long overdue for medical facilities to re-evaluate the ways in which all of their areas are cleaned and set goals for creating a standard or recommended best practice that all healthcare facilities can incorporate.

Indeed, the problem is so acute in England that almost 1,000 of the country’s hospitals have started an annual Think Clean Day to find ways they can improve hospital cleaning and develop a universal system. However, medical facilities need much more than one day a year to “think clean.”

These facilities need to be kept clean every day, and it is likely that cleaning professionals will be the ones called upon to implement recommended standards and cleaning procedures that will deliver real improvement.

And because many hospital and medical facilities now contract out their cleaning needs, JanSan distributors and building service contractors may be directly involved in developing these standards.

Steps to establishing a medical cleaning standard
Creating a recommended or best practices cleaning program for medical facilities starts with the major facility stakeholders: Facility managers, staff, custodial crews, and JanSan distributors.

Together, they must evaluate current cleaning programs, procedures, tasks, and frequencies, as well as products, dilution rates, and bucket cleaning solution frequency rates to determine which are working successfully.

Forming this team is important. Studies in some hospitals and medical facilities have shown that when these groups work together to improve the cleaning and health of a medical facility, a better program is developed and a sense of ownership for the program evolves, ensuring its continued success.

The team must establish the cleaning quality standards for the facility. These standards provide a benchmark to gauge cleaning performance and include a regularly monitored cleaning program to ensure quality is consistently maintained in all areas of the facility.

The auditing process is not intended to be punitive; instead, it should report regularly and encourage quality improvements.

Medical facilities are often many facilities in one: Offices, operating rooms, patient care areas, lounges, etc. The cleaning standards developed must reflect this and acknowledge that certain areas of a medical facility will likely require more attention and cleaning frequencies than others.

This is best accomplished by determining which areas and specific contact points (toilet seats, door push plates or bars, elevator buttons, public telephones, railings, etc.) of the medical facility are:
  • Very high risk for transmittable infection
  • High risk
  • Significant risk
  • Low risk.
Identifying risk categories
Very high-risk areas of a medical facility include operating theaters; critical, intensive and infant care areas; emergency rooms; and patient bathrooms.

These areas may need to be cleaned several times per day using high-quality cleaners and hospital-grade disinfectants. And they may require weekly auditing to maintain cleaning levels.

Bleach and water is typically not the best solution to use on these areas because of its impact on surfaces, the environment, the cleaning staff, and others who are exposed to the residue left behind.

In addition to the high-volume contact points previously mentioned, other high-risk areas in a medical facility include common areas, hospital wards, public restrooms, high-contact points such as elevator buttons, railings, push bars and plates, and staff areas.

These areas also may require high-quality cleaners, disinfectant cleaners, and possibly the use of a sanitizer sprayed on the surface and allowed to air dry.

Plus, these areas should be cleaned daily, as well as “spot cleaned” several times during the course of the day.

Cleaning audits should be performed at least monthly, and more frequently in a busy facility.

Areas deemed as a significant risk are cleaned as much for aesthetic reasons as for good hygiene.

These areas may include outpatient departments, patient waiting rooms, and general offices used by staff and patients.

Cleaning with a high-quality or disinfectant cleaner is acceptable, and the areas should be audited every three months.

The low-risk areas of a medical facility or hospital include administrative offices used by facility personnel, record storage areas, and non-sterile supply areas.

Some facilities can adequately maintain these areas by cleaning just three to four times per week, usually with a high-quality all-purpose cleaner.

Auditing twice per year will likely suffice.

Using cleaning chemicals correctly
When it comes to cleaning medical facilities, cleaning workers must have a clear understanding of the differences between cleaning, sanitizing, and disinfecting surfaces.

Using a disinfectant incorrectly will not deliver the stated “kill claims.” And in an infectious, very high-risk area of a medical facility, this can have serious health consequences for the cleaning workers, patients, and medical staff.

Cleaning and disinfecting/sanitizing a medical facility is actually a two-step process in which surfaces are first thoroughly cleaned to eliminate any soil that prevents the sanitizer or disinfectant from working properly.

In other words, cleaning is the removal and washing away of soils — including some bacteria, and other contaminants — on surfaces.

Killing and/or reducing bacterial contaminants on the surface involves the disinfecting, or sanitizing step.

Sanitizing requires heat, chemicals, or both to be effective. When using a chemical sanitizer, the application on a pre-cleaned surface can air dry and usually only requires 30 to 60 seconds to meet the stated label kill claims.

According to the U.S. Environmental Protection Agency (EPA), a sanitizer reduces, but does not necessarily eliminate, all the microorganisms on a treated surface.

To be a registered sanitizer, the product must show a reduction of at least 99.999 percent in the number of stated pathogens.

A disinfectant is more powerful than a sanitizer. Although it may not kill all known viruses, microbes, germs, bacteria, or fungi, a disinfectant has a much wider kill rate.

Be sure to check the label for the kill claims as different disinfectants have varying claims and levels.

A disinfectant typically requires a dwell time of 5 to 10 minutes and must stay “wet,” or is not allowed to dry.

If this dwell time is not met, the kill claims may not apply.

Disinfectants typically kill more pathogens and kill 99.99999 percent of the stated pathogens (versus 99.999 percent of the stated pathogens for a sanitizer).

As with sanitizing, areas must first be cleaned when disinfecting.

The disinfectant is then applied as the second step. Often cleaning workers in medical facilities simply spray disinfectants on surfaces and then wipe them clean in virtually one step.

The disinfectant may not work with the soil load still present and given the inadequate dwell time.

To further compound the problem, the user may be using a “neutral” disinfectant (as opposed to a neutral disinfectant cleaner), which may not suffice.

Therefore, the user may not be disinfecting or cleaning effectively.

Another common error is that the cleaning solution may not be changed as often as is required to maintain the parts per million (ppm).

It is imperative that workers adhere to the required pre-clean dilution rates, ensure the required ppm, and allow the proper dwell time as per the label instructions. Only in this way will the disinfectant or sanitizer meet best practices.

Typically, sanitizers are significantly less expensive and safer for people and the environment.

Therefore, if a disinfectant is not required because of its risk, use a sanitizer, or simply an effective cleaner that removes the soils.

Best practices require training
The procedures mentioned here — forming a team; evaluating current cleaning products, dilution rates, dwell times, and procedures; establishing cleaning standards; and monitoring systems — are all the first steps in developing a recommended or best practices system for cleaning medical facilities.

Knowing what chemicals to use, at what dilutions, and at what frequencies for particular surface areas, etc., are all essential parts of these standards as well.

And the importance of ongoing training and education cannot be emphasized enough, especially when it comes to cleaning medical facilities.

Inefficient or unsatisfactory cleaning procedures and frequencies have a nasty habit of resurfacing when retraining and education are not provided to cleaning professionals on a regular basis.

This — along with the lack of recommended or best practices — may result in customer complaints in schools or offices. But when it comes to cleaning medical facilities, the repercussions can be much more serious.


Mike Sawchuk is vice president and general manager of Enviro-Solutions, a manufacturers of green cleaning chemicals and products. He may be reached by email at Sawchuk@Enviro-Solution.com.

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