Preparing For Antibiotic-resistant Infections
Our facilities today have a silent enemy stalking for the opportunity to attack building occupants with lethal force: Microorganisms that are resistant to several classes of antibiotics, commonly referred to as "superbugs" and also known as multiple drug-resistant organisms (MDRO).
This is not a scene out of a horror movie; it is a situation that has been occurring for several years — and it is only getting worse.
Many different species of organisms are acquiring antibiotic resistance at an alarming pace.
Several superbugs hang out in hospitals and communities now.
The major players are: Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant Enterrococcus (VRE), resistant Escherichia coli (E. coli), resistant Acinetobacter baumannii, Clostridium difficile (C. diff), resistant Pseudomonas aeruginosa, and resistant Klebsiella pneumoniae.
These superbugs have a high mortality rate, and it has been stated that there are over 100,000 deaths and 2.5 million infections annually worldwide.
These are staggering statistics and, as environmental services managers, project managers, executive housekeepers and the like, we must continue to prepare for a potential infectious incident in our facilities.
How do we ready our facilities for exposure to these superbugs or potential outbreaks; what is necessary so we can be ahead of what could come at us in our offices or health care facilities?
It is imperative that the housekeeping manager or the environmental services manager recognize immediately that they will need the support, advice and assistance of all the managers in a facility.
Whether the tenant coordinator, property manager, nurse, doctor or resident, it must be understood that everybody lives in the environment the cleaning staff maintains.
Whether they like it or not, they are part of the equation to support their immediate staff and associates.
They must support what you are trying to do in preparing for the contingency of a potential event.
Preparation must be a complete buy-in from everyone in the facility.
If not, efforts to control a healthy outcome should an outbreak occur will be in jeopardy.
Collaboration among facility residents is the informational source you will need to rely upon to gather necessary information about illnesses that may happen in the facility.
This information is vital so you can respond immediately and effectively.
The Criticality Of Understanding
First, acknowledge what you are dealing with, if possible, as to the potential infectious outbreak possibilities.
Second, prepare for a possible MDRO event.
Third, analyze the response to the outbreak.
Fourth, train the staff thoroughly on their response.
Finally, establish protocols for the daily cleaning process.
The "what if" analysis must be activated and all scenarios developed and remedies established, not unlike any Operational Plan a military unit would have in place to strategically and tactically respond to a given situational event.
These superbugs lie in wait for an opportunity to move to a host whom they can infect and further spread.
Research has discovered that several of these superbugs can live outside a host on an inanimate surface for several days.
They are waiting for a hand to pick them up from a countertop, a handle or a railing.
Such surfaces are referred to as fomites: Any inanimate object that can carry an infectious organism.
A majority of us understand this as cross-contamination; in a health care environment, it is called a nosocomial or hospital-acquired infection.
Since none of us are scientists, there is a need to approach any situation with an understanding that the pathogen/MDRO is contagious and can cause tremendous injury if contracted.
In health care environments, knowledge as to the type of pathogen/MDRO will be usually known in two to four days; in an office environment, it may not be known until much later.
The management team may only understand that someone on the tenth floor has a staph infection or that a staff member was diagnosed with the influenza virus and they went home sick.
This is where, in an office environment, floor coordinators must be aware and share information with the property management team.
Training And Preparation
It is imperative to prepare for a MDRO.
Primary consideration should be given to the selection of a disinfectant for the facility.
The U.S. Centers for Disease Control and Prevention (CDC) has good selection criteria for choosing a disinfectant.
The effective use of disinfectants, which will vary depending on facility type, is a major part in the strategy for mitigating these pathogens.
A disinfectant for use in a surgical suite may not be needed in an office facility. Select a disinfectant based on probable pathogens you may encounter.
Your local supplier can help with the selection of a good disinfectant for your facility.
It is imperative that you obtain the proper disinfectant for the appropriate situation and that you use the disinfectant as per manufacturer recommendations.
It might be helpful to enlist the help of your vendor, industry associations or colleagues in similar facilities to see what others are doing to combat outbreaks.
After establishing a plan, train the personnel that will be required to respond to a MDRO.
Keep in mind training is not a one-time event, but rather an ongoing process.
There are mandatory annual training requirements in U.S. Occupational Safety and Health Administration (OSHA) codes.
We all hope that an event does not occur, but we all know when you least expect it, "it" will happen.
The process of training should be as real as possible and practical in scope.
The personnel that have been designated to perform the cleaning should understand why they are doing things.
Systematically cover assembling the necessary equipment, putting on personal protective equipment (PPE), detailing the area that needs to be disinfected, etc.
Critical to the training process is understanding the dwell time needed for a disinfectant to work effectively.
By using a microfiber cloth, with vigorous application of the cloth to clean the surfaces then applying the disinfectant as prescribed by the manufacturer, you should successfully defeat the pathogen.
Observe the cleaner performing their tasks and emphasize what is expected of their effort.
Keep the training fresh and updated and ensure cleaners recognize they are being exposed to a serious situation.
Their training is critical for their safety as well as those who are using the area.
Also not to be overlooked during training is how to remove PPE, dispose of the contaminated debris and properly wash hands after completing the process.
It is quite easy to overlook the daily operations of the cleaning staff.
Observing daily activities of the cleaning staff will insure that a certain level of disinfection happens every day.
Seriously look at the performance of the cleaning crew and determine if proper cleaning habits and processes are happening or not.
This must be an objective appraisal of the cleaner in the performance of their assigned duty.
Is how they clean the proper method and with the right equipment; are they washing their hands when needed?
Throughout the day, all cleaners must adhere to a strict discipline of handwashing — something of simplistic criticality.
Look for gaps in their cleaning activities, disinfecting practices and personal hygiene.
Perform a walk-through and look for high touch points.
Are they being cleaned and disinfected daily to remove potential pathogens?
Train employees to remove their deficiencies and to improve their efficiencies.
Some of the points herein may seem like minute aspects of cleaning and disinfecting to prevent and conquer superbugs.
But, remember that the little things can get you.
John Poole, Jr. is a Master Registered Executive Housekeeper (REH) with the International Executive Housekeepers Association (IEHA), a Registered Building Services Manager (RBSM) with the Building Services Contractor Association International (BSCAI) and a Cleaning Industry Management Standard (CIMS) Assessor with ISSA. He is also an Authorized OSHA Outreach Safety Trainer. Poole has experience as a project manager in Class-A office buildings and is the former the superintendent of custodial services for the Georgia Building Authority. Poole is currently available for consulting and training through his business, John M. Poole Company, in Atlanta. He can be contacted at JMPoole_Co@Yahoo.com.