8 Facts About Cleaning and Hospital Acquired Infections
With hospital acquired infections on the rise, the importance of proper hospital cleaning is greater than ever. According to the CDC, on any given day approximately 1 in 25 patients has at least one hospital acquired infection (HAI). These infections cost hospitals around $147 billion, annually. In this blog, we examine the link between proper cleaning and reducing hospital acquired infections. Further details behind all the examples listed below can be found in the article Controlling Hospital-Acquired Infection: Focus on the Role of the Environment and New Technologies for Decontamination by Stephanie J. Dancer and published by the National Center for Biotechnology Information.
1. More Cleaning Reduces MRSA
Methicillin-resistant Staphylococcus aureus (MRSA) is a staph bacterium that is resistant to most ordinary antibiotics. MRSA is common in hospitals, where patients with healing wounds and compromised immune systems are at greater risk of contracting a MRSA infection. Hygienic cleaning can help reduce MRSA incidence or exposure in healthcare facilities.
After a yearlong MRSA outbreak, one hospital doubled the number of cleaning hours and saw an immediate reduction in new cases. The reduced number of infections led to an estimated cost savings of $45,000.
2. VRE is Tough to Kill
Another infection, caused by vancomycin-resistant enterococci (VRE), can survive long term in a hospital. It takes extra care to fully remove this pathogen. VRE can linger on bed-rails, doorknobs and other surfaces if there is inadequate disinfectant dwell time or if the surface is sprayed and wiped rather than actively scrubbed.
One facility tried several cleaning methods but failed to remove VRE from a sampling of surfaces, in spite of using powerful disinfectants. Only by targeting cleaning efficacy and testing over a period of time, did they get VRE under control.
3. Addressing C. difficile Takes Time and Training
C. difficile is a bacterium that targets the intestines and causes cramping and diarrhea. Chlorine-releasing disinfectants do a good job of reducing C. difficile, provided the staff are well trained and allow for the proper cleaning process followed by chemical dwell time. In one hospital, the presence of C. difficile spores fell by 48% and infection rates fell significantly after they began wiping down all surfaces with a diluted bleach solution.
4. When Areas are Missed, Outbreaks of Hospital Acquired Infections Can Occur
With so many surfaces and so many pathogens spreading around a hospital, having a well trained cleaning staff and a cleaning plan in place is of utmost importance to ensure nothing is missed. When areas are missed, outbreaks of hospital acquired infections can occur with dire consequences for those affected.
A pediatric facility installed computers in patient rooms but did not add the computers to the cleaning tasks for each room. Later, an outbreak of Acinetobacter infection was traced back to the computer keyboards. Adding regular cleaning of the computers and keyboards to the list of cleaning tasks helped resolve the outbreak.
5. Norovirus Can Persist in the Environment
Several cases have shown the tendency of Norovirus to spread infection long after initial exposure. In many outbreaks, individuals develop symptoms 5-6 days after exposure. In hospitals, Norovirus reservoirs have been found not only in obvious places such as toilets and showers, but also on equipment, thermometers, and even soap pumps. To fully remove the virus from the environment, it is important to follow a two-step process of cleaning then disinfecting and to allow for appropriate chemical dwell time.
6. All Cleaning Procedures Must Be Specified
In order to develop an effective infection prevention program, all cleaning specifications should be written down including a delineation of high-touch and low-touch surfaces. Custodial workers should be regularly trained in proper protocol for cleaning and disinfecting different surfaces. Additionally, cleaning and infection control supervisors as well as hospital management should regularly revisit cleaning specifications. Below are some examples of critical and noncritical surfaces.
- clinical equipment
- bed controls
- computer keyboards
7. Clean to Reduce Cross-Contamination
Some cross-contamination is unavoidable. It is impossible to stop a sick patient from touching doorknobs, railings and other surfaces. However, housekeepers can avoid cross-contamination when cleaning. Mops are excellent at spreading bacteria from one room to another, as mops and mop water becomes instantly contaminated once used. But mops are not the only tools that can spread disease. One study found that staff wiping multiple surfaces with the same antimicrobial wipe was spreading MRSA from surface to surface.
8. Measure to Prove Cleanliness
Because the pathogens that cause hospital acquired infections are smaller than the eye can see, a surface that looks clean may not necessarily be clean. An important final step in preventing HAIs is measuring to prove cleanliness. An ATP meter uses bioluminescent technology to detect Adenosine Triphosphate (ATP), the universal energy molecule found in all animal, plant, bacterial, yeast, and mold cells. Residual ATP on a surface generally indicates contamination and/or improper cleaning. Measuring cleanliness with an ATP monitor provides housekeeping staff with immediate feedback about an area that has just been cleaned, allowing them to react quickly if a surface needs to be re-cleaned.
Infection Prevention is a Team Effort
Patient health is the priority for all hospital staff, from doctors to cleaning professionals. When all staff members are following proper cleaning protocol and taking active steps to reduce transmission of hospital acquired infections, patients can get well and get home sooner.
For a more in-depth exploration of cleaning and HAI’s, check out this article from the National Center for Biotechnology Information.
*While floors are considered a low-touch surface, recent studies have shown contact with contaminated floors can spread infection.