Cleaning Formula Efficacy

Raymond B. Otero, Ph.D.
Consultant

1. Purpose of environmental cleaning

The elimination of body fluids from fomites (inaminate objects such as floors, walls, etc.) is an important responsibility of all health care workers. It is important that all healthcare personnel communicate with one another to make certain that body fluids do not remain on objects for prolonged periods of time because of the possibility of contamination of patients/residents, visitors or other healthcare workers. There are a very few cases where the environment has been responsible for direct patient/resident infections. Most hospital infections are acquired from staff members not performing good hygienic practices such as handwashing or barrier controls (gloves). However, gross contamination of the environment can lead to the contamination of the hands, foods or objects that may come in contact with patients.

Good environmental cleaning can contribute to the following:

1. the healthcare facility is clean and without odor;

2. lessens the opportunity of contamination of healthcare workers or objects that may come in contact with the patient;

3. promotes self esteem among the workers.

It is important that housekeepers understand the proper procedures in preparing disinfectants, uses, limitations of chemicals and interpret MSDS forms that accompany each chemical. A procedure manual should be written for housekeepers and updated on a yearly basis.

2. Common terms

The following terms are given to make it easier to understand disinfection practices:

Antiseptic - a chemical used primarily on skin and mucous membranes (e.g., alcohol);

Bacteriocide - killing of bacteria;

Bacteriostatic - inhibiting the growth of bacteria;

Communicable - transferable;

Contamination - presence of organisms on objects;

Debilitated - a state of weakness such as a bone marrow patient;

Deodorizer - a chemical used to reduce odor (e.g., Lysol^R);

Disinfectant - a non-selective chemical agent that is ordinarily applied to inanimate surfaces (fomites);

Dissemination - to spread;

Endospore - a specialized structure produced by certain bacteria that enhances the organism’s ability to withstand high temperatures and disinfectants;

Fomites - nonliving material such as linens;

Germicide - a chemical agent that kills germs (disease-producing organisms);

Infection - a state where living hosts harbors microorganisms that have entered, survived and multiplied in tissue(s); results may or may not be clinically apparent;

Sanitizer - a chemical used on inanimate surfaces to reduce the number of bacteria to a safe level;

Pathogenic - disease producing;

Use-dilution - recommendations by the manufacturer on how to prepare disinfectants (e.g., 1:256);

3. Factors influencing the disinfection process

Figure 1 shows the vulnerable areas of a bacterium that are susceptible to chemical activity.

The following factors can reduce the efficacy of any disinfectant regardless of where they are used:

1. water - hard water can precipitate out the active ingredient of some disinfectants (e.g., phenolics);

2. soil - can affect disinfectants in three ways:

1. soil can combine with the chemical and form a precipitate that is no longer capable of inhibiting or killing the organism;

2. soil can precipitate out the active components of the disinfectant thereby reducing their effectiveness;

3. soil can coat the organism thus physically preventing the chemical from coming in contact with the organism, as seen in Figure 2.

4. Proper selection procedures

The following criteria should be used in choosing a disinfectant for housekeeping practices:

1. common organism to be removed in the general area of cleaning;

2. corrosive powers that the disinfectant has on susceptible metals;

3. types of soils commonly present;

4. solubility of the disinfectant in the water used for dilution;

5. toxic activities of the disinfectant towards those using it;

6. how fast the disinfectant works in decontamination;

7. does it have bactericidal or bacteriostatic characteristics;

8. stability in diluted state.

5. Levels of disinfectants

• There are three levels of disinfectants based on the types of activity against certain group of organisms. Table 1 summaries these activities.

• Table 2 summarizes a variety of chemicals and antiseptics commonly used in healthcare according to their active chemical compounds, advantages, disadvantages and uses.

6. Common misconceptions concerning disinfectants

1. Applying disinfectants in a light manner on floors in order to dry quickly so that visitors or staff members will not slip on a wet surface. Disinfectants must be applied in sufficient quantity in order to allow contact time to be optimal.

2. Not changing the disinfectants in the buckets after schedule times even though the water/disinfectant is cloudy thinking that the chemical still has activity. Soil can diminish a disinfectant’s mode of action very quickly.

3. Making the use-dilution more concentrated thinking that it will last longer in use. Too much disinfectant (over concentrated) will not improve the killing effect and may damage the surface’s texture or diminish drying whereby increases the possibility of slipping.

4. Disinfectants do not have the surfactants that cleaners possess so that dirt is not easily removed making it difficult to be picked up from the surface.

It is important that proper training is given to each individual whose responsibility is to clean. A checklist should be developed in order to ensure quality of work. The supervisor must constantly remind their employees of their responsibilities.

 

Questions:

1. Good environmental cleaning can contribute to:

1. self esteem in among workers
2. lessens the opportunity for cross contamination
3. decreases odor
4. all of the above

2. Bacteriostatic is defined as the killing of bacteria:

1. true
2. false

3. A sanitizer can be used on human tissues:

1. true
2. false

4. The following factors can reduce the efficiency of disinfectants:

1. organic soil
2. water
3. time of exposure
4. improper use-dilutions
5. all of the above

5. An intermediate level disinfectant has no activity against the tuberculosis organism:

1. true
2. false

6. All quaternary ammonium compounds do not affect the hepatitis B virus:

1. true
2. false

7. Iodophors are used to clean environmental surfaces:

1. true
2. false

8. One good characteristic of alcohol is that it has good residual activity:

1. true
2. false

9. Hydrogen peroxide can be used to clean wounds:

1. true
2. false

10. One misconception that housekeepers may have about using disinfectants is that the higher the concentration the more effective it will be:

1. true
2. false

Answers:

1. d
2. b
3. b
4. e
5. b
6. b
7. b
8. b
9. b
10. a