John Parker, director for marketing of Alphaclean, explains how keeping floors clean in hospitals and other healthcare environments can help reduce the spread of infections.
Controlling the spread of infections or viruses is vitally important in many different locations and settings, but it is even more crucial for healthcare providers. People visiting or receiving treatment in these environments are already vulnerable to the spread of infection, so making sure that effective cleaning regimes are in place for waiting rooms, corridors, reception areas and wards is key. A clean and welcoming environment is also important from an aesthetic point of view, engendering feelings of well-being and trust in people who are anxious or unwell.
In its Healthcare Associated Infections Action Guide, the Australian Commission on Safety and Quality in Healthcare states that: ‘Healthcare associated infections (HAIs) are one of the most common, significant and preventable patient safety issues today. Each year in Australia, 180,000 patients suffer healthcare associated infections that prolong hospital stay and consume two million hospital bed days.’ It goes on to say that HAIs generate a considerable health and economic burden for both the individual and the health system, citing the example of one Australian state that found the excess costs associated with only 126 surgical site infections ran to over $5 million.
The importance of infection prevention
Standard 3: Preventing and Controlling Healthcare Associated Infections (HAIs) forms part of the Australian Commission on Safety and Quality in Healthcare’s Improvement Guide, which was published in October 2012. It defines healthcare associated infections (HAIs) as: ‘Infections acquired in healthcare facilities (nosocomial infections) and infections that occur as a result of healthcare interventions (iatrogenic infections), and which may manifest after people leave the healthcare facility.’
Cleaning, disinfection and sterilisation is one of the key criteria in the standard because, the guide explains, ‘there is increasing evidence of a link between a clean, hygienic healthcare environment and reduced risk of infection transmission to patients’. It goes on to state that policies, procedures or protocols for environmental cleaning that address the principles of infection prevention and control should include:
- Maintenance of building facilities
- Cleaning resources and services
- Risk assessments for cleaning and disinfection based on transmission-based precautions and the infectious agent involved
- Waste management within the clinical environment
- Laundry and linen transportation, cleaning and storage
Keeping a healthcare environment clean is a constant battle, as there are so many opportunities for contamination and transmission. Hands, surfaces and airborne pathogens, mean that cleaning needs to be constant and meticulous. Infectious micro-organisms can enter the air by a variety of routes including sneezing, coughing, skin shedding, patient treatment, and activities such as bed-making. Organisms such as MRSA (Methicillin-resistant Staphylococcus aureus), Colstridium difficile spores, VRE (Vancomycin-resistant enterococci) and Acinetobacter can remain viable in the environment for months, and can have severe implications for patient safety. However, a number of studies* have shown that improved cleaning and disinfection of environmental surfaces can reduce the transmission of such pathogens.
Guarding against cross contamination
Infection control teams are increasingly requesting that neutral detergents and taurine-based products are used to clean safety flooring – but these need to be applied by a machine to be truly effective. Operatives using conventional mops can’t put enough pressure on the floor to ensure total efficacy. Neutral detergents will only work effectively in a machine as they need the thoroughness provided by brush agitation.
Brushes should be colour-coded to prevent cross contamination, and those made from materials such as poly-propylene don’t harbour bacteria like natural fibres, and are easy to disinfect. These are all crucial points to consider when selecting cleaning equipment, as are the speed and pressure at which brushes operate. Too much friction can cause burn marks to floors, so this aspect should be thoroughly researched before any purchasing decisions are made.
As well as ensuring all operatives are fully trained and equipped with the right equipment or machinery to clean each specific location, there are other ways they can contribute to preventing cross contamination, once cleaning has been completed. Micro-organisms thrive in warm, moist environments, and dust can enable them to become airborne, so the following steps should be followed with floor cleaning machines:
- After use, ensure all water tanks, both clean and dirty, are emptied
- Clean and rinse through both water tanks
- Clean and rinse squeegee assembly and blades
- Clean and rinse all hoses
- Leave all tanks open to air dry
- Wipe clean all outer surfaces
Choosing the correct floor cleaning equipment
High traffic, high risk areas such as A&E and operating theatres need to be cleaned rigorously at least once, sometimes several times per day. The amount of traffic in other areas, such as wards, out-patient clinics and bathrooms will influence how frequently they are cleaned.
Given the physical size of most healthcare settings, and the fact that many operate on a 24-7 basis, floor cleaning machines need to be compact and manoeuvrable to reach into tight corners and fit into smaller areas. They must also be as quiet as possible, especially where cleaning has to be carried out near patients, and safe, both for the machine operator and for other staff and patients. Above all, they have to be capable of doing tasks that are particularly important, like being able to clean under beds and furniture.
For carpeted areas, vacuum cleaners that also feature HEPA filtration to trap spores and organisms will help with infection control. When it comes to tiled floors, healthcare providers need to look for machines that scrub deeply – always ask the supplier the depth to which a scrubber dryer scrubs. Deep scrubbing uses less water and a smaller quantity of chemicals than shallow scrubbing to remove grit and soil. Machines with cylindrical brushes exert greater pressure on floors and can dig more deeply into tile and grout areas. Less use of chemicals means lower costs; deeper scrubbing means cleaner, more sustainable results.
Infection control is undoubtedly crucial in healthcare environments, and the correct cleaning and maintenance methods play an invaluable role in helping to reduce the occurrence of HAIs.
Kaatz GW, Gitlin SD, Schaberg DR, Wilson K, Kauffman CA, Seo SM and Fekety R. Acquisition of Clostridium difficile from the hospital environment. Am J Epidemiol 1988; 127:1289
Mayfield JL, Leet T, Miller J, Mundy LM. Environmental control to reduce the transmission of Clostridium difficile. Clin Infect. Dis 2000; 31:995
Hayden MK, Bonten MJ, Blom DW, Lyle EA, van de Vijver DA, Weinstein RA. Reduction in acquisition of vancomycin-resistant enterococcus after enforcement of routine environmental cleaning measures. Clin Infect Dis 2006; 42:1552
Boyce JM, Havill NL, Otter JA, et al. Impact of hydrogen peroxide vapour room decontamination on Clostridium difficile environmental contamination and transmission in a healthcare setting. Infect Control Hosp Epidemiol 2008; 29:723
Dancer SJ. Importance of the environment in meticillin-resistant Staphylococcus aureus acquisition: the case for hospital cleaning. Lancet Infect Dis 2008 Feb; 8(2):101-13. Epub 2007 Oct 31