Infection Control Today

MAR 2019

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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21 March 2019 ICT 2. After cleaning areas with high concentrations of germs, such as restrooms, kitchens 3. When changing the color of the towel you're using (applicable t o c o l o r c o d e d m i c r o f i b e r towel systems) 4. When going from building to building or foor to foor • Avoid contaminating your hands when removing gloves by following CDC guidelines 6 • Wash hands and or use hand sanitizers after janitorial tasks are completed Facilities that require more stringent "janitorial precautions" include day-care centers, hospitals, medical offces, restaurants and assisted living facilities. In these situations, changing gloves after cleaning each room may be indicated. Cleaning Protocols that can Prevent Cross Contamination The total removal of germs from surfaces beyond disinfection, i.e., sterilization, is not practical or necessary to prevent janitor- induced cross contamination. However, sterilization principles can be applied on a relative basis to the performance of janitorial tasks to reduce the likelihood of cross-contamination. Maintaining a "sterile feld" during a surgical operation is based on the following principles: Sterile objects should only touch other sterile objects. Objects should be removed from the sterile feld when they become contaminated. These concepts can be applied on a relative basis when performing janitorial tasks to maintain a "clean feld" whenever possible: • The sequence of cleaning should be from clean to dirty areas • Cleaning should be performed from high to low areas • Use no-touch systems for cleaning and disinfection when possible • Use mopping systems that apply fresh cleaning solution with each pass • Use color coded microfber towel systems • Change towels, gloves, and supplies when they become visibly soiled or contaminated Case Study: Outbreak of Hand, Foot and Mouth Disease in a Preschool Hand, fo ot and mouth dis eas e in pre-schools is not uncommon. When this occurs, thorough cleaning and disinfection of the facility is warranted and should help stop the spread of the disease. Recurrent outbreaks in one preschool prompted the administrators to consult with our company to evaluate the cleaning protocols in use at the time. There were approximately 100 children attending the preschool. The virus was spreading from one classroom to another. The school and administrative offces were in separate buildings. Administrative staff that had no contact with the preschool children were also contracting the virus. There was some concern that the center wasn't being cleaned properly, but nobody suspected that the virus was spreading because of janitor- induced cross-contamination. While the spread of viruses from one child to another by direct contact (i.e., sneezing and coughing) was occurring, the viruses seemed to be spreading by indirect contact also (i.e., touching contaminated surfaces). Cross-con- tamination was a plausible explanation for the adults who were contracting the illness in the administrative building. It was determined that the following practices could have been contributing to cross contamination: • String mops and buckets weren't sanitized properly (mop heads weren't laundered and dried after each use)7 • The cleaning crew was using the same mop head to clean all areas in both buildings. • The crew wasn't following best practices for disinfection: • They were using paper towels to clean and disinfect. • They were using ineffective, store bought cleaning supplies and disinfectants; • The crews weren't changing gloves, towels and other supplies frequently enough (i.e., when they became contaminated). Recommendations to reduce the likelihood of cross-contamination in this case study were: • Replace string mops with a microfber fat mop system for routine foor cleaning. • Clean and disinfect foors daily, as foors in preschool classrooms are considered high-touch surfaces • Change mop heads after each classroom • Use a different mop head to clean the administrative building • Use a color-coded microfber towel system • Change gloves after cleaning each classroom; after cleaning restrooms and kitchen areas; and before entering the administrative building Clean the administrative offces frst (if possible) In conclusion, cleaning and disinfection protocols to prevent cross contamination are a necessary part of any cleaning program. The protocols should focus on the sequence of cleaning as well as the type of equipment and supplies that are used. Standard "janitorial precautions" should be customized for each facility and should include protocols for using gloves to reduce the incidence of cross contamination. Robert Shor, DPM, is the director of environ- mental services for Ace Cleaning Systems in Coral Springs, Fla. Shor was a practicing physician and surgeon for 20 years and has been developing cleaning and disinfection programs for the janitorial industry since 2010. References: 1. Otter J, Yezli, S, Salkeld J, French G. Evidence that contaminated surfaces contribute to the transmission of hospital pathogens and an overview of strategies to address contaminated surfaces in hospital settings. Am J Infect Control. May 2013. 2. Otani S and Fujita K. Contaminated gloves increase risks of cross-transmission of pathogens. American Society for Microbiology. June 2016. 3. Centers for Disease Control and Prevention. Standard Precautions for Patient Care. January 2017. Accessible at: https://www.cdc.gov/infectioncontrol/ basics/standard-precautions.html. 4. World Health Organization. Hand Hygiene: Why, How & When. Accessible at: http://www.who.int/ gpsc/5may/Hand_Hygiene_Why_How_and_When_ Brochure.pdf. 5. Centers for Disease Control and Prevention (CDC). Guidelines for Environmental Infection Control in Health-Care Facilities. Feb. 2017. Accessible at: https://www.cdc.gov/infectioncontrol/pdf/guidelines/ environmental-guidelines.pdf 6. Centers for Disease Control and Prevention (CDC). Guidelines for the Selection and Use of Personal Protective Equipment in Healthcare Settings. October 2016. Accessible at: https://www.cdc.gov/hai/pdfs/ ppe/ppeslides6-29-04.pdf 7. Westwood JC, Mitchell MA and Legacé S. Hospital sanitation: the massive bacterial contamination of the wet mop. Appl Microbiol. 1971 Apr;21(4):693-7.

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