At the end of August 2011, the fantastic news was revealed that the number of MRSA Super Bug fatalities in the United Kingdom was at an all-time low.  Alongside this, it was reported that the number of people dying with CDF, had also dramatically fallen since the last count.  The new, stricter cleaning and hygiene systems in place in these hospitals have evidentially been a success.

MRSA, otherwise known as Methicillin-resistant Staphylococcus aureus is one of the most well-known, and most feared, infections transmitted within hospitals.  The MRSA bacteria creates a number of different infections if it enters your system, and is therefore particularly dangerous to vulnerable people already at risk in hospitals.  People with open wounds, and already weakened immune systems, can be exposed to the MRSA bacteria through contact with contaminated surfaces or hands.  MRSA can be extremely challenging to treat, as it is unaffected by a number of the most common antibiotics; making it an even greater threat to patients.

CDF, or Clostridium difficile bacteria, is also extremely dangerous to those who are already unwell, and have weakened immune systems.  It causes a number of problems in the patient’s intestine, including severe diarrhoea; dangerous to those who are already ill, as it can drastically dehydrate them.

In the constant battle against hospital-transmitted infections, hygiene and cleaning standards need to be impeccable.  The bacteria can spread through a hospital extremely quickly, through person to person contact and by the touch of surfaces that have been contaminated.  It is therefore a testament to the changes that have been made within the hospitals, that the infections have decreased so dramatically.

The Office for National Statistics made the discovery that the number of deaths caused by MRSA in England and Wales has dropped, by looking at how many death certificates mentioned MRSA.  Their research concluded that in 2010, the number of deaths caused by the Super Bug was four times fewer than in 2006.  In 2006, the number of deaths caused by MRSA was at its highest, with 1,652 individuals dying from it, and in 2010 this number had fallen to 485.  In addition to this, the number of people dying from CDF infection has also fallen; there were 2,704 in 2010, from the 8,324 recorded in 2007.

Hospitals have tackled the problem by preventing the patients being infected, and from any existing infections spreading.  The hospital staff, who encounter several patients a day, are extremely diligent with their hygiene; preventing the bacteria spreading from one patient to another.  There are particular hand washing techniques in place, which must be undertaken before they treat a patient, and after their work is complete.  This hand washing procedure must be followed after other activities, such as preparing food or using equipment; ensuring that at all times any bacteria is removed from their hands.  They use hot water and soap where available, or an alcohol gel or rub.
If hospital staff are tending to patients who have open wounds or handling needles, they wear gloves at all times.

If MRSA is found in the hospital, patients who have the infection are isolated to prevent them from infecting others, and all patients are only transferred around the hospital if absolutely necessary

Consistent and correct hand washing is also extremely important for the patients themselves to undertake, as well as using their own soap and wipes, and keeping their bed areas clean and tidy.  Their visitors must also follow similar stringent hand washing routines; there are regular dispensers which contain alcoholic gel which kills bacteria on their hands.  They have also been stopped from sitting on patients’ beds.

The cleanliness of the hospital itself, has also contributed to the decrease of the MRSA and CDF virus.  Every surface that can come in to contact with human touch, including beds, floors and toilets, is constantly cleaned, to particular and exacting standards.  These areas need to be washed, disinfected, and dried to ensure that these infections and bacteria are killed.

If these cleaning and hygiene measures continue to be followed and improved, MRSA and CDF infections will continue to fall.  To find out more about specialist hospital cleaning service, visit http://www.newlifecleaning.com/services/specialist-services/medical-clinical/hospitals/

Sources:
http://www.bbc.co.uk/news/health-14636224
http://www.nhs.uk/conditions/MRSA/Pages/Introduction.aspx

• At least 5,000 patients die of complications due to infections they acquired  in hospitals each year.
• 9% of patients in UK hospitals pick up an infection that they did not have before they arrived.
• A hand contaminated with Influenza A virus will contaminate the next 7 surfaces it touches.

These terrifying facts summarise the prolific danger that hospital-acquired infections pose to the NHS and to their patients.  Every year, the NHS spends roughly one billion pounds in an attempt to clean hospitals, in order to defeat these infections and lower the mortality rate they cause.  Many of these hospital-spread infections have become household names, including MRSA, E. coli, klebsiella pneumoniae which causes pneumonia and clostridium difficile which causes tetanus.  In more recent years, bird flu and swine flu have also threatened to infect British hospitals.

In recent years, evidence has been found that offers some hope; hospitals can stop the spread of these germs and infections through the use of  copper.

Roughly 80% of all infectious diseases are spread by touch; the contact of one surface with another.   In hospitals, certain surfaces are touched hundreds of times a day; push plates, door handles, bed rails, light switches, table tops and counters, dressing trolleys and soap, alcohol and paper towel dispensers are all heavily responsible for the spread of infection.  Research has proven that if these surfaces are replaced by copper, or high-copper alloys like brass, the spread of infectious germs in hospitals can be dramatically reduced.

Why it works
Copper prevents the spread of infectious germs because it is a natural antimicrobial; something which can kill or deactivate microbes.  The microbes that make up the harmful bacteria present on many hospital surfaces can stay alive and active for hours, days or even months if untreated.  If this surface is then touched, the active bacteria can spread, creating the potential for infection.  The antimicrobial quality of copper means that when the same dangerous bacteria lands on its surface, it cannot survive; a copper surfaces kills more than 99.9% of the bacteria that lands on it within two hours, and kills over 99% after repeated contamination.  Copper is proven to deactivate microbes which cause the most dangerous hospital-acquired infections, listed earlier, which once done will reduce their spread throughout the hospital.

Tried and tested
Using copper to fight against the spread of infection was first tested in laboratory research at the University of Southampton, where they tested MRSA’s survival rate on different surfaces.  The results showed that after just 90 minutes on copper, the MRSA bacteria was deactivated; a stark contrast to stainless steel, used in many hospitals, where the bacteria was unaffected.  A  clinical trial then followed in Selly Oak Hospital in Birmingham, which discovered that replacing hospital surfaces that get touched every day with copper could reduce hospital-acquired infections by 90-100%.

The tried and tested concept has now started to work its way into hospitals.  St Francis Private Hospital in  County Westmeath in Ireland pioneered the idea, and was the first hospital in the world to change frequently-touched surfaces to copper-based substances.  The concept soon spread and in January 2011, French care home Centre Inter Générationnel Multi Accueil became the first in France to use copper in this way.

There is every argument for hospitals and care homes to replace regularly-touched surfaces with copper and high-copper alloys, as a preventative measure against the spread of disease.  Once installed, the copper fixtures will  quickly and endlessly kill dangerous bacteria, which will without a doubt reduce the spread of infection.  The cost of replacing he surfaces with copper may seem off-putting, but when the battle against hospital-spread infections is costing the NHS a billion pounds each year, this one-off payment is something worth investing in.

Joe Grundy of The Archers was 88 years old this year and for as long as I’ve listened to that melodic dum,di-dum,di-dum,di-da tune, (it’s actually a Maypole dance called Barwick Green) he has moaned and groaned about his Farmers Lung usually through fits of chesty coughing.

Joe may use Farmer’s Lung for the sympathy angle with Clarrie and the rest of the folk in Borsetshire but extrinsic allergic alveolitis as the medical condition is known can strike the susceptible at home work and play.

Just look at its common names: Bird-fancier’s lung, Hot tub lung, Mushroom worker’s lung, Chemical worker’s lung and Malt worker’s lung.

It strikes the air sacks and passageways of the lungs which become inflamed when sensitised by repeatedly breathing in organic antigens (protein molecules) in a carrier such as dust or steam usually associated with a process. This is the common denominator in all those colloquial names, the process source, – dairy or grain dust, animal dander (think of it as animal dandruff) and water reservoir vapours. And it’s not just an adult disease; pigeon-fanciers lung is occasionally present in children.

It shows itself in many forms. In its acute state symptoms can start within hours of exposure and can be recognised by headaches, chills, flu like feelings with aches and pains. Usually the symptoms, depending on the length of exposure, diminish within the day but can lead to respiratory distress and a high fever.

Its intermittent form can be present as recurring pneumonia with repeated acute attacks (Joe Grundy’s version). With the chronic form even removing the source of the antigens by, and this is an extreme example, giving up work, there may only be partial improvement of the symptoms and permanent lung damage can occur leading to pulmonary hypertension and ultimately even a heart attack.

As always prevention is better than cure. Safety procedures are simple to adopt in themselves. The main difficulty arises in the education and raising awareness of the potential dangers with staff and clients. They simply do not realise the dangers inherent in carrying out certain apparently simple cleaning tasks such as guano removal, water tower cleaning, mill high level works, swimming pools and sites with air conditioning equipment.

Prevention techniques include:

H&S measures at work, including wearing appropriate PPE and adequate air filters and ventilation.

Choosing your hobby carefully and if you are going to keep birds and suchlike consider the use of filtered facemasks whenever handling livestock.

Proper care and maintenance programmes for swimming pools, hot tubs, humidifiers and air-conditioning equipment.

Many people especially older ones susceptible to flu and other winter ailments have got into the habit of having a seasonal flu jab as we enter autumn.

Millions of people are regularly vaccinated including the long term sick, people in susceptible job roles and even pregnant women.

This year’s campaign is now under way with a tripartite action against the major virus strains identified as being the most threat this year.

Last years potential swine flu pandemic led to the production of tens of millions of H1N1 doses of vaccines. Whilst most stocks were not used in this country many millions were administered worldwide without any major reported safety issues.

Some patients though refused the H1N1 vaccine last year following concerns about its speed of production as the government geared up for a full scale pandemic and also it’s perceived lack of extensive testing.

This year’s seasonal flu jab contains the vaccine against swine flu as it is one of the three flu strains being targeted. This does not mean that there is the same level of concern about a pandemic of swine flu but simply that major flu viruses often develop into seasonal strains in the years following major outbreaks.

The concern though is that those people who refused the single dose swine flu vaccine last year, for whatever perceived concerns, will now be vaccinated with it unknowingly. That is unless their doctor takes valuable surgery time to help them make an informed decision.

The unexpected death of Andy Holmes the double Olympic gold medallist from Weil’s at the early age of 51 brings this age old disease under the spot light.

Here in Northern Europe we tend not to worry about it thinking of it as a ‘rat-catchers’ disease or something that only happens in Third World countries. But as a bacterial infection it can affect anyone of any age who comes into contact with urine or other bodily fluids from an infected animal.

While rare, the ease of contact through broken skin, the eyes or mucous membranes means that leptospirosis can be easily caught at home, work or play.

The bacteria must physically enter the bloodstream to cause infection but in the cleaning industry the use of pressure washing equipment increases the risk of bacteria inhalation via water atomisation.

This risk must be fully addressed in the job specific risk assessments you prepare for your work crews. N.B. infection is only caused by the transfer of bacteria directly from water absorbing it via cuts or via food. It is NOT airborne and cannot be passed by normal human contact.

The most important factor in saving lives is to recognise the risks. Accordingly if you suspect you or your staff have been exposed to contamination, seek help immediately. The incubation period is at least three days so now is not the time to put sniffles and aches down to ‘fighting off a cold’ or ‘Man-Flu’

Symptoms to watch out for include severe headaches, redness in the eyes, muscle pains, fatigue and sometimes, similar to meningitis there is a red, non-blanching, pin-prick rash.

Antibiotics are very effective if given early in the infection but time is of the essence. To ensure your doctor, who may not have much experience in identifying the infection, treats you seriously and ensures you receive the appropriate blood tests make sure you tell him exactly what your fears are, why and all the circumstances.

Finally to put a hoary chestnut to bed: Do not believe or open spam mail with headlines such as “ Disease Caught From Coke Can” The basic gist of the e-mail is about some unknown person who is supposed to have caught leptospirosis by drinking from a soft drink can that rats had urinated on. This is a total fallacy as the bacteria cannot survive without the medium of the wet urine. As the official www.leptospirosis.org website plainly states ‘ you are more at risk of being hit by lightening while riding a camel than contracting Weil’s disease from a commercial drinks container’

Additional information for the professional practitioner is available from www.leptospirosis.org

Columbus Dixon October 2010

Dirty toilets and slapdash cleaning standards are responsible for the rapid spread of novovirus on cruise ships – and the hand sanitisers designed to reduce germs are powerless to prevent contamination, says US medical researchers.

In an attempt to stem the rise in outbreaks, cruise lines now routinely station hand sanitiser gels at restaurant entrances, but this simply does not work says a new study.

“It’s a tough virus,” said lead researcher Dr Philip Carling, pointing out that the pathogen can live on surfaces at room temperature for weeks “ It isn’t killed by alcohol hand rubs. Chlorine bleach is the only thing that works.”

For the study, the researchers tested public lavatories on 56 of the world’s largest cruise ships. Using a solution visible only under ultraviolet light, they marked the doors, toilet seats, flush buttons, hand holds and baby-changing tables in 273 facilities, then monitored them for five to seven days to see if the solution got cleared off.

The results were alarming, showing that only 37% of the public toilets tested were thoroughly cleaned every day, and in 18% of cases they remained uncleaned for more than 24 hours. On three of the ships, the baby changing tables were not cleaned at all during the monitoring period.

Leading cruise line Royal Caribbean International said it takes “numerous proactive steps to prevent, control and eradicate novovirus”, including “special cleaning of all ‘high-touch’ areas on the ship”.

“Those affected by the short lived illness generally respond well to treatment provided on board, and the illness itself usually resolves itself in 24 – 48 hours” said the cruise line.

Fred Olsen, which operates the twice-stricken Balmoral, said its public toilets were cleaned with chlorine based disinfectant on an hourly basis. In addition, it said, “every passenger must use the antimicrobial and cleansing foam sanitiser on entry to any restaurant or eating area”

Chris Haslam Times 22nd November 2009

A new electric filter has been designed to reduce the spread of viruses and provide enhanced norovirus  and swine flu protection. The filter is specifically designed to be fitted onboard commercial aircraft in an effort to reduce the international spread of these highly contagious viruses.

According to the systems designers it is able to destroy around 99.9 per cent of known infectious diseases onboard an aircraft. The swine flu filtering system has been designed and constructed by the aerospace giant BAE Systems, alongside a smaller firm, Quest International.

The swine flu protection system is know as “AirManager” and relies upon an electrical field to destroy germs and other pollutant particles circulating in the air. This is quite unlike a conventional air filtration system which seeks solely to remove the particles from the air.

Alongside its ability to destroy swine flu and the norovirus the system is also proven to reduce the spread of dreaded “superbugs” like MRSA and C.difficile. Due to this it is also being considered for use by the NHS in an attempt to reduce the spread of these killer “superbugs” and enhance the current standards of hospital cleaning.

The swine flu filter is especially effective onboard aircraft as the air inside the cabin can be recirculated up to 30 times in a single hour. This could lead to passengers being exposed to infected air numerous times on a flight. Introduction of the swine flu filters may also put an end to the practice of pre-take off disinfectant spraying on long haul flights.

The swine flu filtration system was recently tested onboard numerous aircraft including a Boeing 757. After these successful tests one airline has already placed a firm order. One downside to the filters is their price tag. At £10,000 the price tag may not seem that steep when compared to the operating costs of an aircraft, however a large aircraft would require up to eight swine flu air filtration systems to deal with the volume of air inside the cabin. Regardless of this it is clear that these swine flu protection filters are a break through in the battle against infectious diseases.

By Mark Warner on behalf of ISSA

It seems we can’t go a day without more press coverage of methicillin-resistant staphylococcus aureus (MRSA), or the superbug.  Infectious disease control has long been the concern of infection control departments in hospitals and nursing homes but rarely has it been the focus of cleaning staff in schools, colleges, day care centres offices, government buildings or large industrial plants. Now, because of recent deaths, we know that many more pathogenic bacteria have become more deadly than ever – and are cropping up in more places than ever. In fact, beyond MRSA, there are other more horrific diseases on the horizon, things like multi-drug resistant Acinetobacter and others that you may hear about in the future.

The cleaning industry has been fighting the MRSA superbug for years. Stories about MRSA and other “flesh-eating bacteria” appeared in many of the broadsheets 15 years ago. To deal with MRSA and other superbugs, it is extremely important we understand what the threat level is so we can adjust our cleaning programme accordingly. What we need to do and when are totally dependent on the environmental degree of danger and on having a complete understanding of the different types of contagious pathogens that we need to confront.

The Degree of Danger

To assess the environmental degree of danger, we have to understand how to identify the degree of threat levels and adjust the procedures, chemistries and tools to fit the situation. To better explain this philosophy; let’s use the DEFCON ranking system

DEFCON 1: No Threat

Normal, everyday cleaning procedures can best be described as a DEFCON 1 threat level-no threat. Although there are minor adjustments that can be made, most of these adjustments are related to the facility’s appearance. One can assume that the existing cleaning programme is adequate if the facility looks and smells clean. Regular neutral floor cleaners or half ounce per gallon disinfectant cleaners are usually preferred to keep end use costs minimised. The biggest concern is not to allow any used cleaning solution to sit in a mop bucket or the recovery tank of a machine. Bacteria can thrive and multiply around moisture on ex[posed bucket or recovery tank surfaces. If the used solution is a disinfectant solution yet is highly soiled, it’s disinfections capabilities can be severely compromised, allowing a massive explosion of the growth of bacteria in the used solution itself!

• Everyday housekeeping procedures may not need to change, assuming that all the proper procedures are already in place.

DEFCON 2 Threat in the Community

The most important time to ramp up the game is when there is a threat in our community (DEFCON 2). At this point, normal procedures need to be more aggressive. Basic chemical disinfectants need to be replaced with hospital grade disinfectants that are specific to the pathogenic threat. It is generally preferred to use a disinfectant cleaner concentrate with a rich mixture ratio such as 2 ounces per gallon to increase the cleaning efficacy of the disinfectant. Hard floor cleaning procedures need to be exemplary. Traditional mop buckets need to be monitored in regard to frequent and consistent solution changes. Disinfectant solutions lose their killing efficacy, as they are loaded with bacteria and soil picked up from the floors. Even solution that looks clean can be overloaded with bacteria. There are several answers to this dilemma, including the use of auto scrubber driers and pressurised self-contained flat mop systems. Both focus on the use of clean, fresh solution being applied to the floor, without the danger of used solution being introduced to the clean solution.. In addition different chemistries are needed for soft, porous surfaces such as carpeting and upholstery. Because carpets and upholstery are porous they can’t be disinfected like hard non-porous surfaces, but using a carpet sanitiser can help. Try to use low moisture systems. The goal is to have the carpets or fabrics dry within two hours to greatly minimise the chances of the formation of bacteria colonies or mould or mildew.. Tools and equipment may need to be upgraded, but more importantly, all the tools and equipment need to be disinfected on a daily basis. Also supply carts, storage areas and the housekeeping offices need to be completely cleaned and disinfected, since they are at the hub of activities that reach into all areas of the facility.

• Speciality disinfectants, disinfected cleaning equipment, and more aggressive procedures need to be implemented.

DEFCON 3 Threat in The Facility

When there is an outbreak in the facility (DEFCON 3), we need to use the strongest disinfectants possible, preferably a tuberculocidal-rated disinfectant. It is critical to use the appropriate procedure for different types of contamination. We may be facing contaminated blood or body fluids, as well as contaminated surfaces and substrate.

Since few people are trained to properly identify body fluids, cleaning personnel should assume that all fluids are potentially infectious and treat them accordingly. To clean up blood or bodily fluid it is recommended that the fluid be saturated with disinfectant cleaner to re-emulsify any dried material and to reduce the viscosity of any thickened fluid. This procedure creates a safer environment for the cleaning person, as well as reducing the possibility of surface-to-surface cross contamination on the soles of the cleaner’s shoes. After absorbing the material, and putting it into a yellow biohazard bag disinfect the surface and allow the disinfectant 10 minutes dwell time.

For general surface disinfection, it is critically important to focus on all the largest environmental reservoirs of bacteria. Obviously, most people are preoccupied with touch points. Although they are important to disinfect, the largest reservoirs of bacteria tend to be the largest horizontal surfaces in a facility: floors, desks and countertops.

In addition, the use of bio-remediation technology can eliminate disease causing bacteria or viruses in the air and inside floor grout lines, concrete and wood floors, under carpeting or vinyl tile or inside the walls. These bacteriological and bio-enzymatic products consume the food sources that the pathogenic bacteria need to survive. In this way, the pathogenic bacteria are displaced with safe, non-pathogenic bacteria that die when the food source is completely gone.

For the air in contaminated buildings, a popular and effective tool is the use of wall mounted or floor standing lamp units that produce UVA or UVC light in a protected vent chamber or tube. These units will sterilise all the air passing through them. Over time they will greatly reduce the airborne bacteria counts to levels less likely to cause infection, literally sanitising the air. Ozone is an effective way to treat the air during times when a room isn’t occupied. It oxidises organic molecules and bacteria in the air by corroding them.

• A three-dimensional approach needs to be used so that the surface, sub-surface and air borne bacteria are addressed effectively, as well as strict adherence to proper procedures for blood and body fluid cleanup.

DEFCON 4: Weapons grade Pathogens in a Facility

The most extreme level is DEFCON 4. There may be a time when we need to completely decontaminate a facility exposed to bio-terrorism or weapons grade pathogens. Keep in mind, any contagious pathogen that has been determined to be lethal to 85% or more of its hosts needs to be handled at this level and there have been naturally occurring diseases that meet this criterion. A good example of this was the Ebola outbreak in Zaire in 1998, with a 90% kill rate.

This decontamination operation is performed on an unoccupied (or evacuated) building. The most common approach for this operation is the use of radiation with Alpha or Beta particle sources or the use of gases and free-radical technology. These technologies are very dangerous and some are explosive, so knowledge and experience are critical.

• This level of decontamination requires special protective equipment, tools and training. It should only be performed by professionals who are experienced in this kind of procedure.

In summary, the most important message is that we need the proper chemistries, the proper tools and the procedural knowledge to have any chance of being successful. Also, we need to have some way to verify or validate that we have accomplished what we wanted to accomplish – the elimination of the disease-causing bacteria or viruses. Equipment like ATP- hygiene monitoring devices and swab cultures may be necessary.

Keep in mind, when the threat is high and the cost of failure is high, we need to clean everything! The enemy in this case is invisible, so we need to assume that what looks clean may not be actually clean. In this day and age, we really can’t be too vigilant. Fore-warned is forearmed.

This article, re-produced with kind permission, is written by Max Warner, international director of disinfection and decontamination certification for Airx Laboratories and appeared in www.ISSA.com

Most sectors of the cleaning industry have been rather scathing about the government’s ‘quick fix’ of throwing £50,000,000+ at the current hygiene problems within the NHS.

Equally vocal have been the usual trades union demands that the funds be spent on introducing more in-house cleaning staff and ‘good old fashioned Matrons’ instead of the work going to the dreaded private sector.

Against this backdrop, every cleaning trade magazine is bursting with articles about the latest gizmos, chemicals or Heath Robinson contraptions, which will save patient’s lives by eradicating every bug and virus known to man.

Where is the voice of reason and common sense amongst all this discordant background noise? New Labour has pumped more money into the NHS over the last 10 years than it’s founder Bevin could possibly ever imagine. Why does it appear to have gone so horribly wrong?

Newlife’s experiences’ travelling around the country carrying out hospital deep cleans for primary care trusts have been shocking and horrifying. Basic standards of day-to-day cleanliness vary dramatically from site to site. Each authority has a different interpretation of the work specification they want achieved to obtain the results they desire under the same Deep Clean programme. In some cases the ultimate cleaning objective appears to have morphed from decontamination to having “clean shiny floors” or simple wall washing with no attention being paid to soft furnishings, fixtures and fittings.

Is this simply Trusts trying to get extra cleaning works completed under the guise of decontaminating their premises or is it a simple fundamental lack of cleaning knowledge?

Surely common Best Practice methods could be adopted by following the methodology of our European neighbours who already have proven lower levels of infection.

Simple screening of incoming patients, staff and other workers would identify carriers and allow isolation and specialist cleaning to be directed more cost effectively straight to where it is most needed.

Further education of patients would allow them to gently dissuade their own casual visitors and empower them to remonstrate with hospital staff and visitors that are not adhering to basic personal hygiene standards.

We believe that seemingly simple steps such as these would reduce bacterial infections to an acceptable level leaving “one-off” deep cleaning budgets free to be focussed on emergency requirements as they arise.

Columbus Dixon