Floor Disinfection: Creating a Healthier Environment
by Joe Saunders and Lynda Mathiesen
Housekeeping surfaces include floors, walls, counters, and furniture and are considered non-critical items that require low-level disinfection. Cleanliness and infection control of these surfaces can be ensured by removal of soil on a routine basis.
The primary function of the housekeeping department in a healthcare facility is to create a clean, safe, and healthy environment for patients or residents, staff, and visitors. Included in this function is the disinfection of all environmental surfaces, which comprises floors, walls, counters, furniture, etc.
Establishing and adhering to a sound program is the key to effective cleaning and disinfecting of environmental surfaces throughout a healthcare facility. This article focuses on floor disinfection and provides guidelines for a good floor care disinfection program.
Many environmental surfaces, including floors in a medical facility, can harbor disease-causing germs. Although not directly involved in disease transmission, environmental surfaces may indirectly contribute to secondary cross-contamination by the hands of healthcare workers or by contact with medical instruments that will subsequently come into contact with patients/residents. Martin Favero and Walter Bond expanded Dr. E.H. Spaulding's original classification of medically related surfaces to define more clearly the relative risks of disease transmission. This expansion included dividing the classification of environmental surfaces into two sub-groups: medical equipment surfaces and housekeeping surfaces. Housekeeping surfaces, of course, include floors, walls, counters, and furniture and are considered non-critical items that require low-level disinfection. Cleanliness and infection control of these surfaces can be ensured by removal of soil on a routine basis. This can be accomplished using water and a detergent or a low-level, EPA-registered, nontuberculocidal, hospital-grade disinfectant designed for general housekeeping procedures.
A Floor Care Disinfection Program
A good floor care disinfection program comprises three key elements: 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. Extraordinary attempts to disinfect floors are usually unnecessary. The actual physical removal of soil and microorganisms is probably at least as important as the germicidal activity of the disinfectant used.
Effective Disinfectant Detergents
Low-level, hospital-grade disinfectants are the recommended products for floor care disinfection in healthcare settings. The Environmental Protection Agency (EPA) regulates and registers all low-level disinfectants. To be considered a hospital grade disinfectant, manufacturers must test their germicidal products against three microorganisms: Staphylococcus aureus, Salmonella choleraesuis, and Pseudomonas aeruginosa. Usually products are tested against a variety of other microorganisms, especially in today's age of antibiotic resistance (MRSA and VRE) and concern with bloodborne viruses. To obtain a one-step cleaner disinfectant claim, testing of these products is usually done in the presence of organic serum (at least five percent) and hard water (at least 400 ppm). This testing is always done at the manufacturer's recommended dilution rate; therefore, it is important for the user to mix a disinfectant according to the manufacturer's label.
The "cleaner" part of the product acts as a penetrating agent through soil loads and allows the disinfectant part of the product to penetrate the cell wall of the microorganism so that the killing action can take place. A one-step claim is very important in today's cost-conscious healthcare environment because it reduces labor and product costs. In laboratory testing, microorganisms must come into contact with the disinfectant for 10 minutes; however, actual kill time might be less than 10 minutes. In real world applications, floors usually do not stay wet from damp mopping procedures for 10 minutes. A few minutes can be expected, which should give most disinfectants adequate time to kill. Physical removal with a mop or autoscrubber in itself will remove a significant share of microorganisms present. If a mop is used, it will be immersed in a solution of disinfectant upon completion of the mopping procedure. If an autoscrubber is used, any solution applied to the floor will be picked up by the machine and will be held in a recovery tank until emptied. A related corollary to contact time is residual activity. Disinfectants in a dry state do not have a residual activity. Disinfectant action can only take place when moisture is present.
Selecting a Disinfectant
When selecting a disinfectant, first 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. This computation is:
% of active ingredients X 10,000
The resulting number can be used to determine how effective a disinfectant will be as you introduce soil load. As the employee mops a floor 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.
A disinfectant should be noncorrosive, nonirritating, effective in hard water, able to dilute in hot or cold water (preferably cold water), and as close to neutral pH as possible so as not to affect floor finishes. Neutralization of the product due to soil load should not occur. Finally, a disinfectant should be economical to use. To determine how economical it is, focus on the end use cost not the price per gallon. To calculate and use cost, simply divide the cost per gallon by the dilution rate per gallon.
Tools and Procedures
As important as the disinfectant-detergent is in the floor care disinfection program, the tools and procedures used are as equally as important. Appropriate selection, use, and care of dust mops, wet/dry vacuums, and wet mops are critical to the success of the program.
Proper dust removal is critical. Bertha and Warren Litsky demonstrated in 1968 that effective dust removal before wet mopping or scrubbing of floors proved to be an important part of the cleaning and disinfecting process. Dust removal prior to scrubbing or mopping will collect a large portion of debris, dirt, and dust that, if uncollected will affect the disinfecting capability of the disinfectant-detergent. Litsky recommends the following order for dust removal effectiveness:
- A wet/dry vacuum or vacuum with a filtration system is a superior dust-removal tool. This tool is recommended for areas like the operating room, delivery room, and nursery.
- A chemically treated disposable dust mop head.
- A freshly machine laundered dry dust mop head.
Sweeping floors with a broom is not recommended because particles become airborne and can be transferred throughout the facility. Since microorganisms are attracted to dust and dirt for a food source, any chance of creating an airborne situation is not advised. To eliminate this concern in areas like the operating or delivery room and where a wet/dry vacuum is not available, a broom dipped into disinfectant can be used. Dipping the broom into the disinfectant will eliminate any dust particles from becoming airborne, thus negating a potentially hazardous situation.
Proper care of all dust removal tools should be taken to maintain the life of the equipment as well as to eliminate cross contamination. Wet/dry vacuums should be cleaned internally and externally daily with a disinfectant and after each use when contaminated with blood or body fluids that visibly contain blood. Disposable dust mops should be discarded when thoroughly soiled. Laundered dust mops should be laundered daily.
With proper dust removal, the wet mopping or scrubbing process is much more effective. Litsky recommends the use of sterile wet mops or freshly machine laundered wet mops for the wet mopping process. Mops should be replaced after each isolation room cleaning, discharge cleaning, clean up of blood spills, and cleaning in surgery and delivery suites. A routine of changing mops after a certain number of rooms should also be adopted. It is not unusual for wet mops to become contaminated even after dust removal, so it is important to adopt a routine of changing disinfectant solutions and mops frequently. Dirty mops immersed in a bucket of disinfectant, can become a medium for growth of live microorganisms. Solutions should be changed after every 3-4 rooms if using a single bucket method or 6-8 rooms if using a two-bucket (both buckets contain disinfectant solution), two mop system.
In large open areas like hallways or lobbies, wet mopping of floors is not necessarily the most productive and cost effective process. In these instances, use of an automatic scrubber is appropriate. An automatic scrubber applies the disinfectant-detergent to the floor, scrubs the floor with pads or brushes, and then vacuums the floor dry. It is a very productive tool for large areas and very effective in the soil removal process. When using an automatic scrubber to clean and disinfect a floor, double scrubbing is recommended. Double scrubbing is the process of applying the disinfectant-detergent on the floor and scrubbing twice prior to vacuuming the solution. Double scrubbing will allow the disinfectant more contact time with a microorganism, thus creating a better killing situation. Automatic scrubbers should be cleaned daily by running a solution of disinfectant through the machine. Pads or brushes should also be cleaned in disinfectant for 10 minutes and allowed to air dry.
General Disinfectant Problems and Solutions
Three major problems can occur when cleaning and disinfecting floors:
Problem 1: Film on floor from use of germicides.
Solution 1: Dust mop with untreated dust mop prior to damp mopping with disinfectant.
Solution 2: Change disinfectant at recommended times--approximately every three to four rooms.
Problem 2: Tacky floors caused by change from a "quat" to a
Solution 1: Scrub floor with a neutral cleaner before using a germicide with a different active ingredient. If floor is still tacky, mop floor with alcohol.
Solution 2: Check dilution of the disinfectant. Use chemical dispensing systems for best accuracy.
Problem 3: Discolored floor tile caused by too strong a solution.
Solution 1: Rinse the floor periodically with clean, clear water.
Solution 2: Use disinfectant at proper dilution as a stripping solution to strip the discolored area.
Despite the fact that floors do not play a major role in the transmission of disease, it is appropriate to clean and disinfect floors in a healthcare facility on a regularly scheduled basis. This is especially true in all patient care areas. Use of disinfectants in this process control the spread of bacteria from room to room as long as proper procedures are followed and proper tools are used. Use of disinfectants is also as cost effective as neutral or general-purpose cleaners when comparing end-use costs.
Joe Saunders is Health Care Market Manager and Lynda Mathiesen is Health Care Specialist for Pioneer/Eclipse Corporation (Sparta, NC). John Hilgren, a principal technical affairs specialist for the professional products division of Ecolab Inc. (St. Paul, MN), edited this article.
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