Best Practices in Reducing Microorganisms on Surfaces
- • Develop a housekeeping program that meets the needs of the particular area to reduce all visible dirt and dust on floors, walls, windowsills, ventilation systems including grills, door ledges and frames, tops of cabinets and bedside tables, equipment, bathrooms, etc., while enhancing the physical environment of the institution.
- • Focus cleaning and disinfection especially on high-touch surfaces, especially those that come in contact with the skin or bodily fluids including all bathroom surfaces, bed rails, tray tables, IV poles and pumps, all controls, call boxes, telephones, chairs, sinks, door handles, etc.
- • Immediately clean up all spills of fluids of human origin and any other sources of bacteriological contamination and then disinfect with either a phenolic compound or a chlorine compound. Keep all floors, walls, and other surfaces free of blood and other bodily fluids.
- • Do not use alcohol to disinfect surfaces. While it is effective on skin, it does not work well on a variety of surfaces.
- • Train appropriate housekeeping staff in specific cleaning techniques to be used in areas where isolation and reverse isolation (protecting the patient from the environment and people) is required.
- • Immediately clean up all chemical spills to prevent hazardous conditions for patients, employees, and others.
- • Utilize a housekeeping evaluation form such as that found in the Handbook of Environmental Health—Biological, Chemical, and Physical Agents of Environmentally Related Disease, Fourth edition, Volume 1, pages 528-529 (see endnote 62), to do self-inspections of all areas to determine if the areas are being properly cleaned to remove all visible soil and potentially large quantities of microorganisms which may cause healthcare-associated infections.
- • Develop a specific training program for housekeeping supervisors and managers including classroom topics and practical work experiences. This should include some elementary knowledge of the spread of microorganisms and potential means of control, potential hazards from cleaning products and personal protective equipment to be used, use of appropriate cleaning products for the project to be completed, use and care of cleaning equipment, techniques of cleaning and disinfecting, and use and evaluation of the results of the self-inspection program.
- • Develop and enforce a hand-washing program specific to the jobs performed by housekeeping personnel.
- • Develop a specific training program for housekeeping supervisors and managers including classroom topics and practical work experiences on supervision and management of people including discussions on leadership, planning and organizing work assignments, employee selection, people management, understanding human behavior, how to be firm but fair, the significance of good morale, how to teach adults to carry out assignments accurately and in a timely manner, and how to properly communicate with all levels of individuals.
- • Develop a specific training program for new employees in job orientation and various cleaning techniques. Provide immediate close supervision to all new employees.
- • Develop short training sessions for existing employees to reinforce skills of cleaning in various situations and introduce new techniques and products as needed.
- • Evaluate the work of individuals on a weekly basis and make necessary corrections.
- • Use the appropriate detergent and disinfectant, quantities of chemicals needed, and amount of time used in cleaning for the potential microbiological load from potential contamination and the types of surfaces to be cleaned, recognizing that detergents are surface-active chemicals that emulsify soil and then need to be removed from the surfaces by proper rinsing techniques before disinfecting. There are some chemicals which are both detergents and disinfectants to which the above does not apply.
- • Make sure that all detergents and disinfectants being used are compatible, that adequate contact time periods are being utilized and water is changed very frequently.
- • Do not use the same mop water in areas of potentially high contamination and other areas. Change water and clean equipment or use new equipment when mopping each different isolation or reverse isolation room.
- • Recognize that floor finishes and floor strippers are chemical agents that can be hazardous to individuals if inhaled and then take necessary preventive actions.
- • Recognize the limitations of disinfectants on certain surfaces and the potential hazards associated with them to people.
- • Clean up immediately all spills of blood and other bodily fluids and substances and then disinfect with a chlorine solution.
- • Where carpeting is used, vacuum areas with special equipment that contains HEPA filters.
- • Privacy curtains in areas where there are large numbers of patients may be contaminated rapidly and therefore should be cleaned appropriately in a timely manner.
- • Use swab cultures only to determine if microorganisms are present on a given surface to see how a disease might be potentially spread by contact or become airborne. The results of the swab sample can be used as a teaching tool. A sample size must be so large to get an accurate determination of the reduction of microorganisms by any given type of cleaning procedure, that it is not cost-effective and also very time-consuming to acquire for the potential benefits realized.
(See Chapter 13, “Water Systems [Drinking Water Quality]”)
Treated water from a public water supply enters the healthcare facility through water mains and is then distributed through a series of pipes throughout the institution. The pipes may be of iron, copper, or polyvinyl chloride. Hot water is produced in boilers and may become chemically or physically contaminated by the contents of the boiler. Water becomes stagnant when it stays in the lines for a period of time without forward motion out of a fixture.
Chlorine content may be reduced below acceptable levels and even to zero because of the retention of the water in the hot water tank.
Because of the size of the institution and the different needs of the staff and patients, the temperature and pressure of the water will vary considerably. Too high a temperature will cause burns especially in older people in nursing care facilities. Depending on the nature of the equipment being used, the temperature of the water may differ substantially and there may need to be booster heaters within given areas, especially in food service and laundry facilities.
When water systems are being worked on because of a water failure, it is necessary to make sure that there will not be any back siphonage into the public water supply. The vacuum breakers may not be working effectively and compound the problem.
Waterborne infections can occur from direct contact in various forms of hydrotherapy, baths, potable water which has become contaminated during dialysis, laboratory solutions, and ice, or through the ingestion of drinking water which has been sitting around and is contaminated. Also equipment used for preparing distilled water needs to be evaluated regularly in case of breaks in lines or improper back flows. Sterile water if exposed to air or physical contact after use may become contaminated.
Legionella bacteria have been found in healthcare facilities in aerosols generated by cooling towers, showers, faucets, respiratory therapy equipment, heated potable water systems, and distilled water systems. The vast number of plumbing fixtures within the institution can also harbor a variety of bacteria. Most of the organisms including fungi may accumulate around the various openings of the fixtures being used. A variety of decorative fountains and waterfalls and other uses of water if not maintained properly can create aerosols containing microorganisms that can potentially lead to healthcare-associated infections.
Other Gram-negative bacteria may be found in the potable water and may cause healthcare- associated infections. These include various species of Pseudomonas, Acinetobacter, Enterobacter, etc. These organisms can grow in distilled water, contaminated solutions and disinfectants, dialysis equipment, nebulizers, water baths, contaminated mouthwash, contaminated respiratory therapy solutions, contaminated disinfectants and antiseptics, and a variety of medical equipment that requires a source of moisture for operation.