Infection Control Today - 06/2003: Environmental Services

Evaluating and Selecting Germicides

By John Roark

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

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

He continues, "With germicides, we would look for broad-spectrum kill ofbacteria, fungi and viruses. Other criteria would be that a product is notaffected by water hardness, organic matter or soap detergent residue, but isstill 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 ORsuite, so it's got to be an effective product to use on all surfaces,"Solomon adds.

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

A Material Safety Data Sheet (MSDS) is designed to provide healthcare workerswith the proper procedures for handling a particular substance. An MSDS includesinformation 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 lessrisky from an MSDS standpoint, but from a greening standpoint they may be veryhot," says Solomon. "There are some products we use that we're lookingat changing because they pose great risk to the employee." Examples of therisks: some products are carcinogenic, some are hormone modifiers, and some mayhave chemicals that are endocrine inhibitors. "The goal is to go beyond theMSDS sheet and look at products from an environmental standpoint that are goingto pose less risk to the employee within the building because of closed-buildingsyndrome, and also to the environment, because you're dumping these things downa drain."

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

Solomon advocates initial training and monitoring usage to ensure chemicalsare being used correctly. "Based on the number of employees you have, whichareas they're cleaning and the square footage, you should be using a certainamount of chemical per day or per week, or per month or per year," he says,recommending supervision through observation, by monitoring bottles, checkinglabels, and by asking employees. "I've been on quality audits where I'vewalked up to an employee and asked, 'What do you have in your mop bucket?' I askhow much water they have and how much germicide. You validate that they'refollowing directions by questioning them, observing them, and by repeatedtraining."

In addition to initial training, many housekeeping and environmental servicesdepartments have ongoing monthly training, where chemical use, cleaningtechniques, equipment care and maintenance are reinforced.

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

It is important that environmental services personnel realize the importanceof 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 exactdilution for it to work and to be effective, or it's not going to work againstthe bacteria that it's meant to kill." he says. "For this reason, alot of hospitals and contract companies have created control centers whicheliminate the guesswork. The employee simply turns the dial to the product theywant, 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 providethe employees with the appropriate personal protective equipment like masks,gloves and goggles when mixing," says Solomon. "And with disposal, youwant to be careful when you dump it out, so it doesn't splash back in yourface."

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

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

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

"With this new system, when you start your shift, you take as manymicrofiber 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 startsweeping and mopping your floor. When you've finished with that room, you putthe mop head in a bag on your cart, and move on to the next room. You're using aclean mop and clean solution in every room. And instead of having to change thatgermicide every three rooms, you have one bucket of germicide that lasts thewhole day. You're using less chemical, you have less chemical exposure, lesschemical going down the drain, less risk of splash-back into the employee'sface. It's proven to be tremendously effective."

The use of environmentally friendly sterilants and disinfectants should be apriority for all healthcare administrators. "For routine daily cleaning, wewant the employees to use products that are going to be safe for them, for thepeople in their environment, and for the environment itself," says Solomon."During the past 10 years, these products have been reformulated to keepthem environmentally friendly, but to make them effective and price-competitiveas well."

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

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