Infection Control Today

NOV 2018

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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26 ICT November 2018 feature www.infectioncontroltoday.com By Kelly M. Pyrek Editor's note: This is the fi rst in a series on fomites in the healthcare environment that are under the radar but deserve renewed attention. It sounds like the beginnings of a riddle: What do we wear and walk on daily but never truly think about, especially in terms of pathogen transmission? Shoe soles and healthcare facility fl oors are the workhorses of the environment, and yet their capacity for aiding and abetting infectious agents remains unclear. Recent research seems to confirm what common sense already tells us — that items which contact the fl oor are contaminated and could serve as vectors; despite daily cleaning of high-touch surfaces such as fl oors, it has already been shown that bacterial and viral contamination returns rather quickly. In 1967, Ayliffe, et al. observed the obvious: "The fl oors of hospital wards become contaminated with large numbers of bacteria, including Staphylococcus aureus, and are commonly assumed to be important reservoirs of hospital infection." They added, "Efforts are also commonly made to reduce the numbers of bacteria on the fl oors by manual or mechanical scrubbing or disinfection, but the results of such treatment have been disappointingly small. Ayliffe, Collins and Lowbury (1966) found that areas of fl oor protected against recontamination lost about 80 percent of their bacterial fl ora after mopping or mechanical scrubbing, and a signifi cantly larger proportion (about 99 precent) after treatment with certain disinfectants. Since areas which were not protected against recontamination were often as heavily contaminated 1 hour after scrubbing or disinfection as they were before such treatment, there appeared to be little Shoe Sole and Floor Contamination: A New Consideration in A New Consideration in the Environmental Hygiene the Environmental Hygiene Challenge for Hospitals Challenge for Hospitals g g fl or no advantage in cleaning fl oors. On the other hand, frequent scrubbing or the use of disinfectants might be expected to keep the mean level of bacterial contamination lower than that which is present on an uncleaned surface. Even if regular disinfection of fl oors reduces the mean level of contamination, such treatment cannot be considered useful in preventing infection unless pathogens on the fl oor are transferred either by air or by contact to patients in the ward." The researchers continue, "From this study we deduce that at most times daily disinfection contributes little or nothing to the bacteriological cleanliness of ward fl oors. In operating theaters and other areas with less contamination than that which occurs in wards, disinfection or cleaning might be expected to be more effective. The main function of disinfection, however, must be in the removal of sporadic local contamination which occurs when fl oors or walls become contaminated with sputum, pus, urine and other fl uids, or when walls are touched by fi ngers of a heavy carrier of pathogens. Since the occasions when such contamination occurs often pass unnoticed, there is a case for regular disinfection to prevent this sporadic hazard in areas where the risk of contamination is high." Guidance from the Centers for Disease Control and Prevention (CDC) issued in 2003 predates the most recent research; the agency's Guidelines for Environmental Infection Control in Health-Care Facilities proclaimed, "Extraordinary cleaning and decontamination of floors in healthcare settings is unwarranted. Studies have demonstrated that disinfection of floors offers no advantage over regular detergent/ water cleaning and has minimal or no impact on the occurrence of health-care associated infections. Additionally, newly cleaned

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