Infection Control Today - 06/2003: Environmental Services

Evaluating and Selecting Germicides

By John Roark

With a seemingly unlimited selection of germicides, sterilants and disinfectants on the market, what is the best means of evaluation and selection for healthcare facilities?

"In the past, you had individual environmental services managers making their own decisions on which products to use, with some input from infection control about the efficacy of a chemical, especially hand soaps and germicides," says Carl Solomon, senior maintenance operations consultant with Kaiser National Facilities Services. Solomon has worked in the environmental services industry for 24 years, has served as Kaiser's environmental services director for the past 14 years, and is a national consultant. "Much of the time it was seat-of-the-pants type judgment. For the past six years, Kaiser has had a national team that includes environmental services managers, infection control, a safety expert, resource conservation, and in some cases we include legal because there may be some legal ramifications around some chemicals. With the team, we develop a request for proposal, and within that request there are criteria requirements."

He continues, "With germicides, we would look for broad-spectrum kill of bacteria, fungi and viruses. Other criteria would be that a product is not affected by water hardness, organic matter or soap detergent residue, but is still effective even if there is dirt or debris left on the floor.

"It should be usable as a multiple-surface cleaner; with disinfectants, we use it everywhere from a patient room, exam room, public restroom to the OR suite, so it's got to be an effective product to use on all surfaces," Solomon adds.

Environmental services personnel should establish certain criteria when looking for a germicide that poses the least risk or hazard to the employee and the environment. "You may have some cleaners which are riskier than others, but that goes for any chemical from floor finish and carpet cleaner, to bowl cleaners," says Solomon. "There are some out there that are really hot that you don't want to expose your employees to."

A Material Safety Data Sheet (MSDS) is designed to provide healthcare workers with the proper procedures for handling a particular substance. An MSDS includes information such as physical data (melting point, boiling point, flash point, etc.), toxicity, health effects, first aid, reactivity, storage, disposal, protective equipment and spill/leak procedures.

"Ironically, a lot of the chemicals out there right now may be less risky from an MSDS standpoint, but from a greening standpoint they may be very hot," says Solomon. "There are some products we use that we're looking at changing because they pose great risk to the employee." Examples of the risks: some products are carcinogenic, some are hormone modifiers, and some may have chemicals that are endocrine inhibitors. "The goal is to go beyond the MSDS sheet and look at products from an environmental standpoint that are going to pose less risk to the employee within the building because of closed-building syndrome, and also to the environment, because you're dumping these things down a drain."

Improper use can render disinfectants and sterilants ineffective and a hazard to the environmental services personnel who use them. Ensuring that these employees are armed with the knowledge and skills necessary to use these products correctly and effectively begins with education.

Solomon advocates initial training and monitoring usage to ensure chemicals are being used correctly. "Based on the number of employees you have, which areas they're cleaning and the square footage, you should be using a certain amount of chemical per day or per week, or per month or per year," he says, recommending supervision through observation, by monitoring bottles, checking labels, and by asking employees. "I've been on quality audits where I've walked up to an employee and asked, 'What do you have in your mop bucket?' I ask how much water they have and how much germicide. You validate that they're following directions by questioning them, observing them, and by repeated training."

In addition to initial training, many housekeeping and environmental services departments have ongoing monthly training, where chemical use, cleaning techniques, equipment care and maintenance are reinforced.

"This should be standard, but a lot of times what will happen is when you have an inspection by the joint commission or with your state health department, everybody goes into a panic mode," says Solomon. "Maybe they just panic when they see an inspector walk up. What I did as a department director was put the key information -- the dilution of chemicals, the types of chemicals you use -- on index cards, a little cheat sheet on the carts. That way if an inspector asked about your cleaning solution, if you don't know the answer, there's no problem for you to get your card out and find the information. The important thing is that you have the information, not necessarily that you've memorized it."

It is important that environmental services personnel realize the importance of correct mixing ratios when working with sterilants and disinfectants. "With germicides, it's been proven that if you have the wrong dilution, it's not effective at all," says Solomon. "It's got to be at the exact dilution for it to work and to be effective, or it's not going to work against the bacteria that it's meant to kill." he says. "For this reason, a lot of hospitals and contract companies have created control centers which eliminate the guesswork. The employee simply turns the dial to the product they want, and fills up their mop bucket or spray bottle."

User safety is an issue best addressed with precaution and common sense. "The main thing is to follow the instructions on the label and to provide the employees with the appropriate personal protective equipment like masks, gloves and goggles when mixing," says Solomon. "And with disposal, you want to be careful when you dump it out, so it doesn't splash back in your face."

Kaiser has created a board comprised of regulators, vendors and customers to explore ways to improve safety in the environment and in the products and techniques used for cleaning. One example of how Kaiser has taken a pro-active approach to more effective cleaning, bottom line savings and user safety, is by adopting the use of the microfiber mop.

"When using a regular mop, you should change the germicide in your mop bucket after every three rooms, because the germicide becomes soiled and ineffective," says Solomon. "In order to do that, you have to go all the way back to the housekeeping closet, lift up the bucket and dump it, rinse it out, put new water and germicide in and get a new mop. Then you come all the way back and start the process again."

For a custodial employee cleaning 20 to 25 patient rooms per day or 40 rooms per day for exam rooms, that adds up.

"With this new system, when you start your shift, you take as many microfiber mops as you'll need for the day, roll them up into a little bundle, and put them in a bucket on your cart. Then you fill the bucket with germicide. When you get to the patient room, with your gloved hand, you take out one mop, squeeze it out gently, drop it on the floor, attach the handle, then start sweeping and mopping your floor. When you've finished with that room, you put the mop head in a bag on your cart, and move on to the next room. You're using a clean mop and clean solution in every room. And instead of having to change that germicide every three rooms, you have one bucket of germicide that lasts the whole day. You're using less chemical, you have less chemical exposure, less chemical going down the drain, less risk of splash-back into the employee's face. It's proven to be tremendously effective."

The use of environmentally friendly sterilants and disinfectants should be a priority for all healthcare administrators. "For routine daily cleaning, we want the employees to use products that are going to be safe for them, for the people in their environment, and for the environment itself," says Solomon. "During the past 10 years, these products have been reformulated to keep them environmentally friendly, but to make them effective and price-competitive as well."

One exception would be germicides. "For what it's got to do and what it's got to kill, it's going to be kind of hard to be completely environmentally friendly," says Solomon. "With products like glass cleaner, wall wash, bowl cleaner, carpet cleaner and floor care products, it is possible to get environmentally-friendly products. Another thing to keep in mind is that in a hospital, clinic or nursing home, you clean the same items every single day, so you don't have a lot of buildup and debris that you have to scrub off. Sometimes we do an overkill with these chemicals."

"The key to environmentally friendly products is to get a champion within the organization," reasons Solomon. "If your leadership supports what you're doing, if your labor union supports what you're doing and you're involving them, you're going to have more chances of success."

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