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Infection Control

Wash Away Cross-contamination

September 19, 2010
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Most building service contractors (BSCs) and in-house cleaning professionals, who are outside of a health care setting, are rarely confronted with methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant enterococci (VRE), or Clostridium difficile (C. diff) outbreaks.

However, for many years, health care cleaning staffs have looked to learn more about eradicate MRSA, VRE and C. diff.

“Hospital-acquired infections (HAIs) have been around for a while, so it is not like it’s anything drastically new in health care,” says Chris Kosobud, health care marketing manager for Kimberly-Clark Professional.

However, as these threats spread to the community, especially MRSA, experts say every cleaner at any type of facility should at least have a refresher course.

We spoke with several experts in the JanSan field for more information on MRSA, VRE, and C. diff as well as what to look for and how to eradicate risks.

MRSA: The more you know
Today, MRSA is the most recognized and talked-about villain of the trio.

MRSA is a form of Staphylococcus aureus, which can cause staph infections.

According to Jason Welch, a microbiologist at Spartan Chemical Company Inc., Staphylococcus aureus is a gram positive bacterium that is carried in the nose and on the skin of healthy people.

“It can be found most anywhere in the environment and most of the time this bacterium can live on the skin of healthy individuals without causing any problems,” says Welch.

When a mild infection occurs as a result of Staphylococcus aureus, symptoms include pimples or boils and the area can become red, swollen, painful, or have pus or other drainage.

More serious infections may cause pneumonia, bloodstream infections, or surgical wound infections.

MRSA is difficult to treat because it carries a gene which codes for an enzyme that breaks down methicillin, which is the most common drug for treating staph infections.

Today, MRSA is a leading nosocomial or hospital-acquired pathogen.

In recent years, however, there have been reports of MRSA infections outside of health care.

These cases are classified as community-associated methicillin-resistant Staphy-lococcus aureus (CA-MRSA).

“All areas where populations have opportunity for direct contact with body fluids are prime areas for CA-MRSA,” says Bill Smith, vice president of marketing for National Chemical Laboratories. “This includes fitness clubs, public restrooms, health care-related clinics, school locker areas, and correctional institutions.”

MRSA and CA-MRSA are transmitted through direct person-to-person skin contact or contact with an open wound.
Education and other “community” facility managers can take steps to prevent a MRSA outbreak.

“A broad spectrum of quaternary disinfectant cleaners — both RTU and dilutable — have an efficacy claim for MRSA,” says Smith.

In addition to using the right disinfectant, cleaners should carefully read the manufacturer’s product literature and be properly trained.

The cleaning staff should target hot spots in the facility, such as patient beds and light switches, and remove urine, blood, sweat, and other bodily fluids on surfaces and equipment as needed.

Injured students, staff, and building occupants who have open cuts should seek medical help quickly and properly bandage all wounds.

Cleaners should utilize personal protection equipment (PPE) in high risk areas.

Color-coded tools should be used to prevent spreading contamination.

Many JanSan manufacturers and distributors can provide literature on MRSA and CA-MRSA; post this information around your facility(ies) to increase awareness.

Urge building occupants to not share personal items, such as towels and razors.

“Driving the right type of behaviors can prevent an outbreak from happening in the first place,” says Valerie Williamson, Kimberly-Clark Professional’s KIMTECH category manager.

Vancomycin-resistant enterococci
Similar to MRSA, VRE, first discovered in 1985, has mutated to become resistant to the drug that was designed to kill it.

Enterococci are bacteria that are normally present in human intestines and in the female genital tract and are often found in the environment, according to the Centers for Disease Control and Prevention (CDC).

Vancomycin is an antibiotic that is often used to treat infections caused by enterococci.

In some cases, enterococci have become resistant to vancomycin, and are known as VRE.
Professional cleaners, especially in health care settings, should remain mindful of VRE and follow similar MRSA protocol.

For practical infection control, Welch offers the following tips:
  • Cleaning a surface should be the no. 1 priority.
  • Workers should change buckets of cleaning solutions often, especially when the water becomes visibly soiled.
  • If a disinfectant is being used, all label instructions must be followed; this means paying attention to solution contact times.
  • It is also important to use the proper applicators for the products chosen. Some rags and microfiber cloths may be incompatible to a product’s chemistry and could negatively impact the product’s disinfectant activity.
See the difference in C. diff
Unlike MRSA and VRE, C. diff is a spore-forming organism.

“There are a lot of common chemicals on the market today that will kill things like MRSA, VRE and HIV,” says Kosobud. “But, there is nothing on the market that will kill a spore, that’s why C. diff is the hot topic today in health care.”

Cases of C. diff infections and outbreaks in health care are on the rise.

Although C. diff is a concern mostly for health care facilities, managers and cleaners in all environments should be aware and know proper procedure.

C. diff, as a spore-forming organism, has two states — a vegetative state (active state) and a spore state (dormant state).

C. diff will form spores when the environmental conditions become unfavorable to it, says Welch.

“Infection is usually associated with antibiotic use,” notes Welch. “The antibiotics, which are being used to treat another condition, disrupt the balance of the normal flora.”

When this balance is disturbed, the Clostridium bacterium can grow out of control and cause severe gastrointestinal problems and diarrhea.

“Traditional cleaners and disinfectants are not effective in destroying bacterial spores. If a disinfectant or cleaner is sprayed on the surface where C. diff is present, it is possible that the disinfectant could cause this organism to go into the spore state and not actually kill it,” says Welch.

Cleaners can minimize a C. diff threat only by removing the source.

Low-level disinfectants can create uncomfortable environments for spore-forming organisms and, as an effective cleaner, can aid in removal.

For practical, green infection control and for more information on safe procedure, “follow the guidelines set forth in the Green Seal standard for Cleaning Services (GS-42) as it pertains to green cleaning procedures,” advises Smith. “Green cleaning procedures will normally account for the proper use of EPA-registered disinfectants in areas where cross-contamination of bacteria is likely. A product of this nature should have a neutral pH, be free of dyes and added fragrances, and contain no nonylphenol ethoxylates.”

Most importantly, experts advise all building occupants to practice proper hand-washing.
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