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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Page 30 of 36

30 ICT November 2018 Solutions to Floor Contamination Floor cleaning and disinfection is an essential component of a larger, effective environmental hygiene program in the hospital. There are a number of steps that experts suggest to keep fl oors from serving as a vector of potentially infectious micro- organisms. Daily maintenance involves the routine removal of dry soil and damp/wet soil through vacuuming, dust/damp mopping and other bioburden removal processes. A good fl oor-care disinfection program comprises use of effective disinfectants/detergents, tools and procedures. All three elements must be present to be successful in physically and chemically removing soil and microorganisms. Many experts emphasize that so - c alled 'extraordinary' attempts to disinfect floors are usually unnecessary, as the actual physical removal of soil and microorganisms is probably at least as important as the germicidal activity of the disin- fectant used. Low-level, hospital-grade disinfectants are the recom- mended products for fl oor-care disinfec tion in healthcare settings. The Environmental Protection Agency (EPA) regulates and registers all low-level disinfectants. When selecting a disinfectant, fi rst review technical research bulletins provided by vendors. These bulletins will identify the different microorganisms that the disinfectant has been tested against. Then match the tested microorganisms against those most prevalent in your particular environment. In addition to the microorganisms most prevalent, a disinfectant should have a broad range of kill; it should be capable of killing Gram-positive and Gram-negative bacteria, fungi, and viruses. Second, compute the parts per million (PPM) of active disinfectant. This computation simply translates the percentage of active ingredients into parts per million. The resulting number can be used to determine how effective a disinfectant will be as you introduce soil load. As the EVS worker mops a fl oor and immerses the mop into the bucket of disinfectant solution, the solution will degrade. At a certain point, approximately 300 to 350 ppm, a disinfectant will be rendered ineffective. Therefore, it is recommended to change the soiled disinfectant solution on a routine basis, usually every three to four rooms. Exceptions to this rule would include isolation cases, discharges, cleaning in surgery or delivery, and cleaning of blood spills. Jensen (2016) advises, "Using the appro- priate tools and chemicals for each part of the fl oor care process will avoid damage to the fl oor care surface. Using the wrong product will void the fl oor manufacturer's warranty and could mean signifi cant expense to replace any damaged fl ooring. In general, fl oor care maintenance is divided into three frequencies. As the name suggests, daily maintenance is a routine process of removing dry soiling such as dust and dirt through vacuuming, dus t m o pping and damp mopping. By following these simple processes frequently, the hospital can extend the time between more aggressive and costly processes. The fi rst step is to remove the dry dust and soil not removed by the matting. This is most effi ciently accomplished by vacuuming carpeted surfaces and dust mopping, then damp-mopping hard floors. This should be performed daily at a minimum and more often when conditions require. The dirt removed at this point in the process doesn't have to be removed later with more aggressive processes and expense. This daily cleaning should be performed more frequently at all entrances and less frequently farther into the center of the facility. Microfi ber products are effective when used dry or with water because microfiber cleans surfaces mechanically, not chemically, by scraping the surface with microscopic precision. The best chemical for mopping most hard-surface fl oors is a neutral — pH between 6 and 7 — fl oor cleaner that has no strong alkaline ingredients that might remove polish. Outside of surgical and invasive practice areas, fl oors in patient areas are not typically considered sterile environments. If a healthcare institution requires that disinfectants be used on fl oors, a quaternary product should be used, followed by a neutral fl oor cleaner to rinse the fl oor after the disinfectant has dried. ES managers should ensure proper dilutions of all chemicals to prevent excess chemical residue on the dried fl oor." Jensen (2016) continues, "Periodic maintenance consists of more aggressive methods, which incorporate scrubbing, buffi ng and burnishing. Depending on the traffi c volume or location of the particular fl oor, this could require daily maintenance, or it might be performed weekly or semi-weekly. Again, higher-frequency scrubbing is performed in locations closer to facility entrances and in high-traffic areas vs. locations toward the center. When creating floor-cleaning schedules, this methodology should be utilized to ensure that time is spent where needed. All fl oors should be dust mopped prior to using a fl oor-scrubbing process to prevent excess dirt from accumulating on the scrubbing pads and equipment and being sucked into the vacuum motor system or scrubbed into the floor fi nish. After placing safety or caution signs in the area, the fl oor is ready to be cleaned. The fl oor scrubber uses a process of placing water or cleaner on the fl oor, scrubbing with moderately abrasive nonwoven pads, and then removing the water with a vacuum. This is typically done in one continuous process as the machine passes over the fl oor. A pH-neutral fl oor cleaner or similar product can be used in the fl oor scrubber. If there are individuals with respiratory sensitivity in the area, water can be used. The operator should make overlapping passes with the machine in the center of hallways and corridors where most traffi c occurs, and only one pass near the walls where there is less traffi c. If this is performed late in the evenings, nursing can be consulted to see if patient room doors can be closed to limit disturbances." In addition to manual cleaning of fl oors, a few studies have shown some benefi t of adjunct technologies. For example, UV-light is being employed in a number of other devices that are designed to kill and/or inactivate the vast majority of exposed microorganisms, including bacterial and viral pathogens, on the soles of shoes in short amounts of exposure time. By adding a UV-C shoe sole disinfection device to an existing infection control program, the facility could decrease the overall microbial load. These devices are a potential new way to help decrease the aerosolizing, migration or transfer of pathogenic organisms that may lead to higher healthcare-associated infection (HAI) rates. Many of these devices pose virtually no workfl ow interruption or require additional staff or monetary cost to operate. Rashid and Poblete, et al. (2018) sought to demonstrate that shoe soles can be vectors for healthcare-associated infection, and to inves- tigate if a UV-C shoe sole decontamination device would decrease this risk effectively. Staphylococcus aureus, Enterococcus faecalis and Escherichia coli as well as a non-toxigenic strain of Clostridium diffi cile were spiked onto standardized rubber-soled shoe soles and then selected at random for UV-C exposure or no UV-C exposure. Experiments were performed to test the effi cacy of the UV-C device to decontaminate shoe soles and fl ooring. E. faecalis was spiked onto shoes to assess colonization of a simulated healthcare environment and patient. The researchers found that the UV-C device decreased shoe sole contamination signifi cantly for all tested bacterial species, and decreased fl oor Ò All f oors should be dust mopped prior to using a f oor-scrubbing process to prevent excess dirt from accumulating on the scrubbing pads and equipment and being sucked into the vacuum motor system or scrubbed into the f oor f nish.

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