Last month, the following question was posted on the “International Executive Housekeepers Association (IEHA) Unity Question and Answer Board” by Beth Risinger, IEHA’s executive director.
Being that most facilities have some carpeting and cleaning for health is an issue in every facility, I thought the subject of what’s coming out the exhaust of wet vacuums, autoscrubbers and carpet extractors was a relevant subject with which we should all be concerned.
Here’s the question, followed by my answer: “Any suggestions on cleaning carpet that has been contaminated in a nursing home by a resident infected with Clostridium difficile (C. diff)?”
Your question and the posted answers that suggest extracting with a detergent solution or hitting the carpet with dry vapor caught my attention and, considering the potential risks and liability of placing a patient in an inadequately cleaned room has spurred me to comment, even though the question doesn’t provide as much information as I’d like to have before responding.
To begin with the question itself would best be referred to an infection control committee or professional, as they normally have the final say as to what procedures and products are to be used in a health care facility.
The environmental services (ES) manager and staff are expected to follow those procedures, using the approved products when completing their assignments.
If the room is grossly contaminated, my recommendation would be to remove the carpeting, possibly using negative air containment procedures — similar to what is done during mold remediation — and replace it with a seamless vinyl floor, using this room for future cases that require high levels of cleaning and infection control.
Some subfloor remediation may be needed prior to the new flooring or replacement carpeting being installed.
Wrong Place, Wrong Time
I don’t believe that a patient with C. diff or any other highly contagious infection or disease should be placed in a room with carpeting on the floor.
In my opinion, it’s simply the wrong surface for such use because carpeting can’t be adequately disinfected to a level that is safe for reuse after exposure to highly infectious disease-causing microorganisms.
I would have to venture a guess that this is why we don’t see carpeting on the floors of operating suites, laboratory areas or in true cleanrooms of any level.
See the U.S. Centers for Disease Control and Prevention’s (CDC) comments regarding where carpet is not recommended for use.
From a practical standpoint, if the C. diff contamination was a very small area, say less than four inches, and could be cleaned immediately, blotting and extraction with a machine that has a high-efficiency particulate air (HEPA) filter on the exhaust may be acceptable.
However, most carpet cleaning extractors or wet vacuums have little or no filtration on the exhaust, let alone a HEPA filter that is working properly.
The CDC recommends that, to kill C. diff spores on hard surfaces, you need to use a 1:10 solution of bleach with a five to 10 minute dwell time.
If this is required for hard surfaces, I’m having a difficult time understanding how a highly porous surface such as carpeting, it’s backing and possibly a cushion below it — all of which could be contaminated with vomit or fecal matter from watery diarrhea that’s probably been walked on and tracked around the room for period of time — can be returned to a safe condition by extracting with a detergent solution and a carpet spotter.
In my mind, the use of a typical extractor and detergent solution would further contaminate the room, while exposing workers and other patients to infectious airborne particulates.
I would also refer to the American National Standards Institute/Institute of Inspection, Cleaning and Restoration Certification(ANSI/IICRC) Water Damage Restoration Standard (S-500) that states that a Category 3 exposed carpet or cushion — grossly contaminated water damage exposure containing sewage, pathogenic and or toxic materials — cannot be cleaned, but should be replaced and properly disposed of.
Sources that address the issue of dealing with C. diff exposure and cleanup:
Keep it clean out there.