The International Nosocomial Infection Control Consortium (INICC) led by Dr Victor D. Rosenthal published a study in 2015 about hospital-acquired infections (HAIs) in 40 Indian hospitals located in 20 different cities over a 10-year period, starting in 2004. The study found that the number of reported incidences of HAIs was “markedly” higher in India than in the United States which had has a fairly serious problem with HAIs already.
There were several reasons given for the high incidence rate of HAIs in India. Among them were the following:
• Poor sterilization of medical tools
• Seriously overcrowded hospitals, requiring, in some cases, two patients to share one bed
• Too few nurses
• Doctors and nurses not following proper infection control practices
• Ineffective cleaning and disinfecting of surfaces, ranging from high-touch areas such as doorknobs, ledges, and bed tables to floors touched directly or indirectly and restroom fixtures
To be clear, HAI is a disease that someone contracts only once inside a hospital; no one comes into a hospital with the disease.
And HAIs are serious because they can be very hard to treat. Many people die of HAI infections. According to the Indian Journal of Basic and Applied Medical Research, the mortality rate among people infected with an HAI can range from 35% to as much as 45 per cent, meaning that more than a third to nearly half of the people with an HAI die. HAI is usually caused by viral, bacterial, and fungal pathogens, and treatment often requires a powerful “cocktail” of antibiotics.
HAIs and Hospital Perceptions
However, just recently, a new study has revealed something totally unexpected. It appears that some people acquire an HAI just because they think or perceive the medical facility they are in is poorly cleaned and maintained.
The study was the result of interviews and focus groups with patients acquiring an HAI in US hospitals over a period of one year ending in June 2014. It was conducted and published by Press Ganey Associates, which studies the healthcare industry. The researchers reported a “clear correlation” between patients’ perceptions of cleanliness (by asking them questions such as, “How often were your room and bathroom kept clean?”) to the number of HAIs reported.
What researchers found was that hospitals in which patients reported lower cleanliness scores tended to have higher infection rates. And, conversely, they found that those hospitals that scored in the highest quintile for cleanliness had, on average, the lowest number of reported infections.
One of the most common concerns expressed by those patients who later contracted an HAI was, “If they can’t keep the hospital clean, what other things that I can’t see might also be neglected?” The patients had no proof, scientific or otherwise, that surfaces in the hospital were contaminated with germs and bacteria that could result in an HAI. They just perceived them to be so, and apparently, this perception led to their acquiring the disease.
Addressing Perceptions
We all know that how people evaluate cleanliness can be very subjective. What may appear clean and healthy to one person may not appear so to someone else. For that reason, cleaning professionals involved in cleaning medical facilities should take additional steps to ensure and qualify, scientifically, that surfaces have been effectively cleaned. This should be done to protect the health of not only patients but also doctors, nurses, and anyone else working in or visiting the hospital.
Achieving effective cleaning involves a two-step process:
• First, reevaluate the tools and methods that are used for cleaning to see if they are helping or hindering cleaning effectiveness.
• Second, set up a regular, ongoing program of testing surfaces using ATP monitoring devices.
As to cleaning tools and methods, we need to do away with cleaning cloths, even microfiber, as well as mops and buckets to the extent possible. There are a number of reasons why this is necessary, which are nicely summed up in the following two studies.
The first is a study published in 2004, “Household cleaning and surface disinfection: New insights and strategies,” which investigated the repeated use of cleaning cloths to clean different surfaces. The researchers concluded that, as the cloth becomes contaminated with use, “the contamination is transferred to [new] surfaces.” This means that the cloths used to clean surfaces may actually be spreading disease.
What may be termed even worse findings applies to mops. A 40-year-old study that is as relevant today as it was then and was conducted in a hospital found that germs and bacteria that may cause disease are spread through the mopping process. More specifically, the researchers found that, just like cleaning cloths, as mops become soiled, they spread germs and bacteria that can affect the health of the entire building and its users.
So how do we replace using cleaning cloths and mops?
As to cleaning surfaces, we must minimize the actual touching of surfaces when cleaning. No-touch cleaning systems apply cleaning agents directly to all types of surfaces – floors, tables, fixtures, walls, and so on – and then rinse them clean and vacuum up contaminants. These systems are the most effective way to clean surfaces and do not require the use of cleaning cloths or mops.
As to floors specifically, we must do away with mops, as they have proven to be unhealthy. Floor cleaning systems that replicate the cleaning power of an auto scrubber but at a fraction of the cost are now available to replace the use of mops. Similar to how an auto scrubber works, cleaning solution is applied directly to the floor as the machine is walked over the floor. In the process, a microfiber pad at the back of the machine loosens and removes soils, which are then caught by the squeegee and vacuumed up. No mops or mop buckets are used anywhere in the cleaning process.
Scientific Testing
For cleaning professionals handling the cleaning and maintenance of medical facilities, it is imperative that they begin using ATP monitoring systems to test surfaces for cleanliness. We can no longer visually inspect a surface to determine if it is effectively cleaned.
ATP stands for adenosine triphosphate. Microscopic amounts of bacteria and pathogens found on surfaces may contain hundreds, if not thousands, of ATP molecules. ATP monitoring systems measure the amount of ATP molecules present on surfaces. Although a high presence of ATP on a surface does not necessarily mean it harbors disease-causing pathogens, this should serve as a warning that the surface may need cleaning attention and that contaminants may be present.
A 40-year-old study that is as relevant today as it was then and was conducted in a hospital found that germs and bacteria that may cause disease are spread through the mopping process.
Marc Ferguson
International business development manager, Kaivac
And, taking this a step further, some ATP monitoring systems allow users to transfer the testing results from the device, which looks like an handheld TV remote control, to a computer. It is a wise idea to test surfaces before cleaning and then after cleaning to prove cleaning effectiveness. We should do this on an ongoing basis, and keep these reports on file, to continually ensure the effectiveness of the cleaning methods being used.
Just as doctors and nurses record the health and progress of patients in the hospital, using an ATP monitoring system allows custodial workers to record their progress in keeping the facility healthy. And these ATP reports can also be used to help change patient perceptions by being able to prove, scientifically, that the hospital is being effectively cleaned. This should help eliminate false perceptions of a lack of hospital cleanliness. Improving both hospital cleanliness and patients’ perceptions of it will help reduce the incidence of HAIs.
