Home' Inclean : INCLEAN May-Jun 2015 Contents 20 INCLEAN May/June 2015
By Robert Kravitz*
What was termed a ‘modern’ North
American hospital was very concerned about
the cleanliness of its facility. There was
an uneasy concern that ‘dirt’, as hospital
administrators called it, may in some way
be connected to an increase in infection
rates among staff and nosocomial (hospital
acquired) infections in patients. However
there was no way to prove this.
With no data available, an investigation** was undertaken to find
the culprit: specifically, to see if the contract cleaning company hired
to clean the facility was doing an effective job at removing ‘dirt’.
If so, recommendations would be made to the current cleaning
contractor, which would also become ground rules for maintaining
the hospital facility in the future. One of its key concerns was how
the floors in the hospital were cleaned and maintained. According to
the investigators, the hospital depended on a wet-mopping program
using a two-bucket system.
To conduct their investigation, researchers cleaned metal buckets
with a properly diluted disinfectant and cleaning solution, and then
rinsed the buckets thoroughly. A properly diluted disinfectant was
then poured into the mop buckets along with six ‘clean’ but previously
used pure cotton mop heads and left there for 30 minutes (Note:
contamination levels on the test mop heads were performed before
and after all experiments). This experiment was designed to see how
much contamination was on the six mops before and how much was
killed by the disinfectant after the 30 minute time period.
What the researchers found is that while the disinfectant did
kill a considerable amount of contaminants, it did not kill all. “It
is evident that chemical disinfection is not capable of adequate
decontamination even at uneconomical concentrations of
disinfectant,” stated the researchers.
This experiment is important because very often cleaning professionals
and facility managers assume that if a mop bucket is filled with a
disinfectant, any bacteria, ger ms, and other contaminants in the mop
bucket or on the mop head will be killed. Apparently this is not true.
While another experiment found that laundering the mops in a
standard washer was effective, hospital administrators and cleaning
professionals agreed that the mop heads are not laundered regularly
in the hospital. Instead, they are typically rinsed at the end of use and
left to air dry. But rinsing and air drying does little to kill contaminants
on the mop. Another experiment found that bacteria counts on the
mops actually increased with this standard procedure.
Build-up of contamination during floor cleaning
The results of this first experiment indicate that very often cleaning
professionals, at least in this hospital, begin their floor cleaning tasks
using already contaminated mop heads. The next experiment, which
deals with contamination build-up during the actual mopping process,
finds that in regards to contamination build-up, things essentially go
from bad to worse.
To conduct this phase of the study, clean mop heads were issued to
cleaning staff on three consecutive days. They were used for up to 60
minutes; while a properly diluted disinfectant was placed in both the
wash and rinse water but not changed. What the researchers found
was that there was a “substantial increase in contamination” in the
cleaning solution and on the mop heads “despite the presence of
disinfectant in both the wash and rinse waters”.
This test was carried out for five days and on the sixth day, the
researchers conducted spot checks on several floors in the hospital
where the investigation had been carried out. What they found was
nothing less than “massive contamination spread by this cleaning
procedure,” stated the researches.
They concluded that in order to keep contamination to acceptable
levels, a new or freshly laundered mop would have to be used every
day because “even as early as the second day of use, bacterial counts
in the millions” were detected. Further, the study suggests that mop
heads be changed frequently during the course of the workday.
The researchers also recommended that using a mop head on a
second day be forbidden; a disinfectant always be used in the cleaning
solution (along with appropriate detergents); both wash and rinse
water in a two-bucket system be changed “not longer than every 60
minutes”; along with machine washing mops each day, they must also
be thoroughly machine dried, not air dried; finally that these (and other)
requirements be part of every cleaning program for hospital floors no
matter if handled by an outside contractor or by in-house staff.
Consideration: then and now
It is important that we note that this study was conducted in the
early 1970s. However, this study is still referenced here and in other
articles on floor cleaning for a very simple reason: the ways floors were
cleaned in the 70s are still, in many facilities, exactly the same ways
they are being cleaned today – using a mop, a bucket, with cleaning
detergents, and very often disinfectants.
We should also note that 40 years ago, hospital administrators and
the researcher had few options when it came to cleaning floors but
to use mops and buckets. Today, they most likely would recommend
alternatives. For instance, they would suggest that the hospital cleaning
contractor switch to a no-touch cleaning system, often referred to by
ISSA, the worldwide cleaning association, as a ‘spray-and-vac’ system
or another option, a dispense-and-vac system.
The reason is simple. With these systems, no mops or buckets
are ever used. The no-touch system applies chemicals to floors and
surfaces, rinses, and then vacuum dries these areas. The second
option (dispense-and-vac) uses a trolley bucket to dispense solution
directly to the floor; a deck brush, which is never inserted into
the cleaning solution, can be used to loosen soils which are then
vacuumed up. In both cases not only are mops eliminated but
fresh solution is always applied to the floor, eliminating both of our
contamination culprits: mops and buckets.
Finally, the researchers had to determine if the old floor cleaning
method was contributing to the increased infection rate in the
hospital. While they concluded that “it is not possible to determine
with certainty the role of mop-spread contamination in the
production of nosocomial infection”, they did find that more than
half of the infections treated in the hospital over a three-month period
were caused by many of the same types of organisms and pathogens
found on the floors. While a direct correlation could not be stated,
evidence then – and still today, where floor mopping procedures are
used – points to a possible indirect correlation.
*Robert Kravitz is a frequent writer for the professional cleaning, healthcare, and
building industries, www.alturasolutions.com
**The study was titled Hospital Sanitation: The Massive Bacterial
Contamination of the Wet Mop, published in Applied Microbiology, April 1971.
Guilty verdict: mops
and buckets are
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