Home' Inclean : INCLEAN May-Jun 2017 Contents 24 INCLEAN May/June 2017
Infections are one of the most common
causes of morbidity and mortality in
modern healthcare – any of which are
acquired in hospital or residential care,
hence the term ‘healthcare acquired
infection’ or HAI.
Multiple factors influence HAI rates.
The best known is hand hygiene.
Other factors include isolating infected
patients, implementing antimicrobial
stewardship (which means monitoring
antibiotic usage) and environmental
cleaning and disinfection.
Cleaners remain the last line of defence
against HAIs, and due of the pressures
placed on cleaning staff, it is becoming
more and more important to work
smarter, not harder.
Antimicrobials or antibiotics kill
pathogens in the bloodstream through a
delicate ‘lock and key’ mechanism. If the
pathogen evolves and changes, it can make
it impossible for the antibiotic to attach to
the pathogen. The key won’t fit in the lock.
We call this ‘antimicrobial resistance’.
Disinfectants are far less elegant. They
are more like a sledgehammer to a
watermelon. This means there is minimal
risk that bacteria will become immune
to disinfectants the way they have to
antibiotics. A good disinfectant is the
most effective tool in the cleaner’s toolkit.
Unfortunately, there is no perfect
disinfectant; no silver bullet. Some
disinfectants are very strong but they
damage surfaces; others have a high
safety profile but have poor efficacy
against healthcare pathogens.
There is no evidence that antimicrobial
resistance correlates with the effectiveness
of disinfectants. This is due to
fundamental differences in the mechanism
of killing of micro-organisms by these
agents (antibiotics vs. disinfectants).
Most disinfectants are effective against
vegetative bacteria regardless of the
antimicrobial resistance profile. It is only
when faced with spore-forming bacteria
what is best practice?
Most hospitals focus their efforts only on terminal cleaning of patient rooms
with less emphasis on daily cleaning. However, as Ivan Obreza* from Diversey
Care, Australia points out, this must change in order to achieve better
such as C. difficile that a higher-level
disinfectant with sporicidal properties
should be considered.
In her 2015 study published in the
American Journal of Infection Control,
Michelle Alfa demonstrated that best
practice disinfection requires the right
product, the right process, and proof of
Once the right disinfectant for your
environment has been selected, the right
procedures need to be standardised. There is
a growing body of evidence that the biggest
pathogen loads are found on high-touch
surfaces next to the patient. Thus it makes
sense for cleaners to target the point of care.
If cleaning time is limited, it makes
no sense to disinfect ledges and
window panes when the pathogens are
concentrated on bedside tables, remote
controls and bedrails.
One study showed that the bedrail in
an average surgical unit was touched 256
times per day by different people. Yet it
was disinfected only once. That leaves a
lot of scope for cross-contamination.
Best practice: when
should patient surfaces
To adapt the vernacular of the World
Health Organisation, there are six
moments of surface disinfection which all
relate to the point of care:
• Before placing a food tray on a
• After any procedure involving blood,
vomit, urine or faeces
• After any wound dressing procedure
• After a bed bath
• After assistance with productive cough
• Any time surfaces are visibly soiled
Should floors be
Normal shoes are heavily contaminated
and will deposit germs on the cleanest of
floors. Recent studies have shown that air
currents pull germs from the floor into
the air, where they are carried in currents
behind people as they walk. The germs
are then deposited on high-touch surfaces
elsewhere within 24 hours.
Similarly, patient stockings and shoe
covers pick up floor germs and deposit
them in their bedding. A weekly deep
cleanse by a floor scrubber may be
more effective than a daily wipe with a
disinfectant-soaked mop. Whether or
not you choose a disinfectant for your
floor, the common denominator remains
effective disinfection at the point of care.
Proof of compliance is becoming popular
as hospitals seek validation that cleaning
is being done. There are various models
available, including protein swabbing and
fluorescent ink with UV light.
Most hospitals focus their efforts only
on terminal cleaning of patient rooms
with less emphasis on daily cleaning. This
must change in order to achieve better
More emphasis should be placed on
daily cleaning of high-touch surfaces at
the point of care, with a safe and effective
disinfectant, and a program to ensure
surfaces are being cleaned effectively.
Ivan Obreza is an infection prevention
consultant and the senior clinical advisor
for Diversey Care, Australia.
“Cleaners remain the
last line of defence
against HAIs, and
due of the pressures
placed on cleaning
staff, it is becoming
more and more
important to work
smarter, not harder.”
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