Home' Inclean : INCLEAN May-Jun 2016 Contents 12 INCLEAN May/June 2016
By Robert Kravitz*
There are about
200,000 cases of
HAIs each year in
Australia and while
the bulk of them
are contracted in
hospitals, they can
also be acquired in long-term living or
senior care facilities, walk-in clinics, even
in doctors' and dentists' offices. Many
hospital patients have compromised
immune systems, making them less able
to fight off infections caused by these
easily spread pathogens. While it is
possible to acquire nosocomial infections
by interacting with other patients, most
encounter bacteria, fungi, parasites, or
viruses in one way or another just by being
in the hospital environment.
As a result, of the 200,000 Australians that
contract an HAI disease each year, five to 10
percent of them die as a result of the disease.
In many parts of the world, hospitals or
medical centres are blamed for HAI disease.
By this we mean the patient's insurance
provider, whether private, such as an
insurance company, or public, such as the
U.S. medicare program for older adults, will
not reimburse a hospital for costs related to
Insurance providers have made this
decision because they believe that most
HAIs are preventable and that it is the
medical facility's responsibility to prevent
or at least minimize their occurrence.
The Australian government has issued
a number of guidelines to help prevent
HAI, most of which are similar to those
in other areas such as North America,
Europe, and Asia. However, as we shall
discuss further, it appears that the value of
one preventive measure medical facilities
should incorporate may have been
underestimated by hospitals in all corners
of the world.
The Australian government's key
suggestions for preventing the spread of
HAI recommend that hospital staff take the
• Use proper hand washing and hygiene
practices, before touching the patient or
starting a procedure; after touching a
patient, after completing a procedure, or
after leaving a patients environment.
• Use the proper hand washing soaps and
products; hands should be dried using
• Wear gloves and gowns on a regular basis
and before entering a patient care area.
• Wear sterile gloves before any invasive
procedure or contact with sterile sites
(such as in an operatory room); after
exposure to blood, body substances,
secretions, and excretions.
• Properly clean shared medical tools
• Decontaminate sites after spills of blood
or other potentially hazardous materials
• Wear properly fitted respirators to prevent
• Place patients with highly infectious
diseases in separate areas and in areas
where air from that room does not
circulate with air delivered to other rooms.
The cleaning component
The government's guidelines address
significant concerns yet one preventive
measure appears to have been overlooked.
When it comes to halting the spread of
HAI, the Australian government may have
underestimated the value and importance of
effective cleaning. For instance, all that is
recommended in their preventive guidelines
when it comes to cleaning are the following:
• Clean frequently touched surfaces with
detergent solution at least daily, and
when visibly soiled and after every
• Clean general surfaces and fittings when
visibly soiled and immediately after spillage.
This differs, for instance, from standards
set by the Centre for Disease Control
and Prevention (CDC) in the U.S, which
places considerably more emphasis on
proper and effective cleaning to help
prevent the spread of HAI. They suggest
far more time cleaning "high-touch" areas
throughout the medical facility as well as
Do Australia's HAI guidelines
really address the problem?
As is true in many parts of the world, Australia has serious concerns when
it comes to hospital-acquired infections, typically referred to as HAIs,
healthcare-associated disease, or more traditionally, nosocomial infections.
These are illnesses that patients acquire due to being in a hospital... but
what role does cleaning play in the battle against HAIs?
requiring medical locations to "include
appropriate monitoring of housekeeping
activities to ensure that hospitals maintain
a sanitary environment."
To ensure consistent care, the CDC also
requires that medical facilities:
• Maintain adequate [housekeeping] staffing
to prevent HAI infections.
• Develop a facility cleaning standard that
helps prevent HAI.
• Require that housekeepers spend as much
as 30 minutes detail cleaning a room
occupied by a former patient.
We should note that in Australia, as in
many other areas of the world, disinfectants
are required to be used in specific areas
of a medical centre. However, hospitals,
in an attempt to be more environmentally
responsible and reduce costs, are often
looking for ways to minimise the use of
disinfectants, using them only in those areas
where they are legally required.
But germs and bacteria that can cause
HAIs can find their way on to many other
surfaces where a disinfectant is not legally
required. As a result, to prevent the spread
of HAI a hospital has three choices:
1. Use disinfectants everywhere, ignoring
their potential negative impact on the
user and the environment.
2. Ignore the additional costs.
3. Seek an effective cleaning alternative.
One alternative that is proving effective in
many medical facilities is the use of aqueous
ozone cleaning systems.
Ozone, which is found naturally in the
atmosphere, can be mechanically created
through the interaction of electricity and
oxygen. It is then infused into water to
create aqueous ozone.
The researchers applied E. coli and
Listeria bacteria on stainless steel and
ceramic surfaces and measured the bacteria
by counting the number of colony-forming
units (CFUs). For control purposes,
some surfaces were cleaned using sterile
water, others were cleaned using peracetic
acid (PAA), a powerful, hospital-grade
disinfectant, and the rest cleaned using an
aqueous ozone cleaning system developed
by CleanCore Technologies.
"The study found that there was a significant
decrease in bacteria in the areas treated with
the aqueous ozone machine," according to
Matt Montag of CleanCore Technologies.
When it comes to the prevention of HAIs,
it looks like many medical facilities and even
government bodies must become re-educated
about the value of effective cleaning.
*Robert Kravitz is a writer for the professional
cleaning, building, and safety industries.
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