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Infection Control

Cleanliness In U.S. Hospitals

September 19, 2010
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Editor’s note:
The following letter to the editor is in response to a previous letter published in the November issue of CM/Cleaning & Maintenance Management®.

In the letter, the author discussed his feelings about the level of cleanliness in U.S. hospitals and areas that cleaners should focus on to maintain safe environments.

Below is a response from Barbara A. Behrens.


Letter to the editor:
The November 2007 issue carried a letter which appeared to point to environmental surfaces as the cause of nosocomial infections in hospitals.

The writer stated: “And, although doctors, nurses, and other medical staff have long followed standard precautions to deal with a variety of health care issues, this does not necessarily apply to how a hospital is cleaned and maintained.”

Floors, walls, and furnishings are rarely implicated in disease transmission.

Drug-resistant bacteria evolved from excessive and improper use of antibiotics.

For decades, antibiotics were prescribed freely, and patients often failed to complete the entire course of treatment.

Incomplete treatment gave us drug-resistant TB after patients were no longer confined in sanitariums and required to take all their medications.

It is no surprise to infection control practitioners that we also have other MDRO (multi-drug resistant organisms).

OSHA mandates health care facility staff, including Environmental Services and Maintenance, be trained in Standard Precautions.

However, infection control studies show direct care staff is not always compliant with hand-washing protocols.

This is how most germs spread from one patient to another.

Medical providers, nurses, and aides are overworked and hurried.

Do they always wash their hands before gloving?

After removing the gloves?

Do they always change gloves between patients?

The answer is a definite “maybe.”

Caregivers are people too — no one is perfect.

Since disinfectants can only kill up to 99.9 percent of germs, and germs grow exponentially, testing surfaces for germs is guaranteed to find — you guessed it — germs.

If a facility has adequate cleaning personnel, who are well-trained, appropriately supplied, and supervised, the facility will be clean and sanitary.

Since Environmental Services is not a revenue-generating department, it is commonly a target for cutbacks.

Such limited thinking may result in shortcuts and unsanitary surfaces.

Under such circumstances, if rooms are checked by both E.S. and nursing staffs, errors can be corrected promptly, assuring a clean environment for patients.

However, if caregivers do not wash their hands and use gloves correctly, their patients will have infections — infections that would spread even if the environment could be sterile.

Barbara A. Behrens, R.E.H.
Environmental services manager,
Posada del Sol Health Care Center
Tucson, AZ
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