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