Proper cleaning and disinfection to arrive at hospital hygiene

Sanitization

Sanitizers are used in the hospital for the purpose of hand hygiene. They are known as hand rubs and are an alternative to soap and water. Hand rubs that can be used include alcohol based rubs and those containing povidone-iodine, benzalkonium chloride or triclosan. Alcohol-based hand sanitizers need to have a minimal concentration of 60 per cent and are effective against multiple common disease agents (e.g., shiga toxin-producing E. coli, Salmonella, and Campylobacter). However, they are ineffective against certain organisms (e.g., bacterial spores, Cryptosporidium and certain viruses). However, if the hands are visibly soiled, then it is always better to use an antimicrobial soap and water as hand sanitizers are ineffective in these situations.

Measures to control disinfection

Hygiene is those conditions and practices which are conducive to health or the science for the establishment and maintenance of health. This indicates broadly as what hygiene is but does not quite tell us what hygiene implies for different areas in hospitals. A towel in a washroom and mops used by housekeeping staff can be a potential source of microbes in a hospital despite the fact that housekeeping department is claiming of using the best disinfectant and sanitizer. Cleaning items need to be cleaned regularly as a dirty cleaning tool can spoil the facility. Machinery being used in a hospital or the way tissue dispensers are put also has a bearing on the hygiene.

Occupants of the hospital – patients, doctors, nurses, technicians, paramedical staff, kitchen staff, HK staff – have a dual role in hospital infections. One as a recipient of good hygiene and at the same time as also responsible for the poor hygiene in one way or the other. In general, it is the impact of the patient population, the movement of people across wards from the interior to the exterior, from the exterior to the interior and from one service area to another, which causes the possibility of infection. Personal hygiene is not only applicable to patients but also to other healthcare providers. Workload is another important determinant. There are people who work in air conditioned operation theatres, out-patient departments and clinics whereas housekeeping, engineering and the kitchen staff have to work in hot humid environments and travel through dusty cellars and basements to carry out work. They also have to visit patient care areas in the hospital. Tables, curtains, floors and walls also form the entire gamut of factors when work environment and hygiene are taken into consideration.

Infection control practices

There are standard protocols for surgical sterilization and disinfection of surgical/medical equipment. Pest Control is a problem because there is no omnibus solution for all pests. Each pest requires a different solution. Some solutions are as hazardous to the human beings as they are to the pests themselves. Antibiotic abuse is causing lot of drug resistant micro-organisms which are responsible for Hospital Acquired Infections (HAI). To control HAI, hospital hygiene and cleanliness is very important. Cleanliness of a hospital is a major Quality Indicator. There should be a proper hospital infection programme in each and every hospital. Unfortunately, it has taken a backseat in India. Centers for Disease Control and Prevention (CDC), Atlanta had started the hospital infection control programmes and management of bio medical waste in 1960s. They started the programme/guideline for the use of appropriate disinfectants and antiseptics, cleaning agents and sterilizing methods.

Challenge and Solution

Challenges which infection control personnel face are identification of a single disinfectant which can be used in most of the hospital areas and educating healthcare personnel about the proper use of disinfectants and monitoring their use in the hospital. Microbiologists need to be aware of various disinfection guidelines and protocols to ensure minimal rates of hospital infections.

Administrators generally have the tendency to go for the lowest quoted disinfectant and sanitizer, which may not always work. Hygiene gets compromised due to the strict costing measures in order to run a hospital. An integrated model of cleaning solutions needs to be set up in supplementing proper infection control practices to achieve the desired results. Kitchen and Laundry in a hospital set up should also be considered when following proper infection control practices.

In MBBS course, there is no topic of hospital infection control programme. House surgeons therefore are not knowledgeable about sterile precautions, surgical side wound dressing, hospital hygiene and cleanliness. Infection control also includes waste segregation and management. Waste has to be segregated at the source of generation, which many hospitals fail to follow. About 85% of the hospital waste is non-hazardous and non infectious which should not be allowed to mix with the general waste. Infection control policy and procedures need to be strictly followed. There should be a Clinical Microbiologist and Infection Control Nurse for a minimum 250 bed hospital who can monitors hygienic practices and develop monitoring tools in consultation with Infection Control Doctor.