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Between the trifecta of departments responsible for infection prevention—EVS, nursing and infection prevention—it’s every individual’s responsibility to ensure surface cleaning and disinfecting are done quickly and effectively.
Surface disinfection is key to containing viral outbreaks and has never been more important than it is right now. Fundamentally, the concept and importance of surface disinfection hasn't changed. However, the impact of the COVID-19 pandemic on today’s world makes it imperative to change how the health care community conducts proper surface cleaning and disinfection. It starts with mindset – because health care and lives depend on it.
Recent studies have shown that only 32% of the 110,000 objects in inpatient and outpatient health care facilities are thoroughly cleaned.1
At iClean 2020, an evidence-based cleaning health care leadership conference, Didier Pittet, MD, MS, CBE, called for "urgent reform in our approach to cleaning and disinfection in hospitals and aged-care homes."2
How cleaning is actually done today is based on time, the volume of room equipment, Environmental Services (EVS) staffing levels, experience and training, and the types of cleaning supplies available.
To mitigate the spread of potential pathogens that cause health care-associated infections (HAIs), infection prevention practices must evolve. Everyone practicing should know the following:
Ruth Carrico, Ph.D., DNP, APRN stated at iClean 2020, "Reforming hospital and aged-care disinfection systems can not only help to continue to manage COVID-19 but also reduce the incidence of other hospital and aged-care facility-acquired infections."2
So, what does success look like today, and how is it achieved? Here are 5 tips for getting cleaning and disinfecting right.
Tip 1: Know who is responsible
Between the trifecta of departments responsible for infection prevention—EVS, nursing and infection prevention—it’s every individual’s responsibility to ensure surface cleaning and disinfecting are done quickly and effectively to prevent potential pathogen transmission successfully. It all comes down to good teamwork and relationships with other IP experts, communication, accountability and unwavering protocol. Everyone must be on the same page.
Tip 2: Know the guidelines and practices
Cleaning is a science. That means every element of the process matters, every single time—from quality cleaning with mechanical scrubbing to contact time to following CDC recommendations.
Protocols for individual patient care areas, including frequency, method and process, should be based on the risk of pathogen transmission. The probability of contamination is based on the patient’s care area, the vulnerability of the patient to infection (immunocompromised versus general patient), and the potential for pathogen exposure, ranging from high-touch to low-touch surfaces. For example, patient toilet areas should be cleaned last in the process because of their patient exposure, frequent contamination and higher risk of pathogen transmission.
The CDC recommends the following core practices for environmental cleaning and disinfection3:
Tip 3: Pay attention to detail, provide coaching along the way and articulate success
Share these tips with your team so they can measure and evaluate cleaning quality5:
Tip 4: Empower health care professionals
Armed with the right tools, products and knowledge, everyone involved in health care facility cleaning and disinfection is empowered to play a vital role in the lives of all who set foot inside—which is just as crucial of a role as patient care. Involving every team member in the surface disinfectant conversation helps solidify their buy-in.
Standards can also help empower professionals. The CDC recommends these core components for a successful environmental cleaning and disinfection program6:
Tip 5: Instill awareness and adherence of turnaround time
In the approximately 40-to-45-minute turnaround time window7 for room cleaning, every moment counts. Team members have to work together quickly and effectively within their allotted timeframe without cutting corners to achieve successful pathogen eradication.
For example, in a typical terminal discharge, nurses need time to clean equipment properly before rolling it out of the room and into the hallway, paving the way for EVS to clean and disinfect the room. The equipment moved to the hallway has to be wiped down again and returned to its place in the room. Having to do all of this in a limited timeframe makes it crucial to follow standardized guidelines that everyone can follow and for IPs to monitor.
Tip 6: Know what to value in cleaning and disinfecting products
When it comes to surface disinfection, success is priceless. However, it's no secret that cost is a consideration for a facility’s financial decision-makers. When weighed against product efficacy and contact time, however, the best tools for the job will be those that can be relied on to get infection prevention right the first time.
For example, choosing a disinfectant product with a U.S. Environmental Protection Agency (EPA) Emerging Viral Pathogen claim for all virus types (enveloped, large and small non-enveloped viruses) is a wise investment to help protect patients and health care workers. According to the National Institute of Allergy and Infectious Diseases, emerging viral pathogens like SARS-CoV-2 are those “that have newly appeared in a population or have existed but are rapidly increasing in incidence or geographic range.”8
To qualify for the EVP claim, a disinfectant must be an EPA-registered surface disinfectant and kill at least two different types of small non-enveloped viruses—those that are difficult to kill. The EPA created this claim to establish parameters for disinfectant products to carry specific off-label efficacy claims for new and harder-to-kill viruses during a pandemic. When you use disinfectants with an EVP claim, you are using products formulated to meet current and future infection prevention needs, thus anticipating unpredictable public health crises.
Decision-makers should also look for a surface disinfectant on the EPA's List N–a list of products that the EPA recognizes to be able to effectively kill SARS-CoV-2 when used according to label directions.9
Recognizing the importance of proper surface disinfection to help eradicate emerging viral pathogens is the first step in making this life-saving change. Taking responsibility, paying attention to detail, empowering staff, adhering to best practices and knowing what to value—which ultimately saves lives—are crucial factors for success.
Sharon Ward-Fore, MS, MT(ASCP), CIC, serves as Metrex’s Infection Prevention Advisor. Sharon is also an independent infection prevention consultant and is a member of the editorial advisory board of Infection Control Today®.