The following article is written by Kim LaFreniere, PhD, associate research fellow at Clorox Professional Products Co.
Infection preventionists and environmental services professionals are stationed on the frontlines of the infection prevention battleground and they understand that environmental surface disinfection is a key defense strategy against healthcare-associated infections (HAIs) and multi-drug resistant organisms (MDROs). Yet even seasoned professionals may find it challenging to quickly identify target areas where microorganisms hide and the products needed to help remove them.
Research is constantly conducted in the field to determine better cleaning and disinfecting protocols and to create effective educational materials and product recommendations. Although these recommendations are regularly evaluated, the CDC and the Healthcare Infection Control Practices Advisory Committee's (HICPAC) "Guideline for Disinfection and Sterilization in Healthcare Facilities"[1] serves as a great resource for healthcare professionals to quickly assess how to clean and disinfect environmental surfaces.
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The CDC and HICPAC guideline spells out a few levels of environmental surface disinfection based on the type of microorganism contamination. For example, intermediate-level disinfectants destroy all vegetative bacteria including tubercle bacilli, fungi, lipid and some nonlipid viruses, but do not destroy bacterial spores. Low-level disinfectants are similar to intermediate-level disinfectants except they do not destroy tubercle bacilli, some fungi and bacterial spores.[1]
It is important for professionals to understand the differences between different products and when to apply the correct procedure. The following overview highlights some key healthcare areas requiring disinfection and the appropriate products to use to help prevent the spread of infections.
Intermediate-level disinfection areas
MDROs and HAIs can be found on high-touch surfaces in patient rooms, operating rooms, emergency rooms, isolation rooms and intensive care units. According to CDC and HICPAC, items requiring intermediate-level disinfection are those that either come into contact with intact skin, but not mucous membranes (non-critical items) or broken skin and mucous membranes (semi-critical items). In general, the areas that see the most daily interactions from patients, visitors and staff are the most easily contaminated and require disinfecting on a frequent basis.
High-touch non- and semi-critical items to disinfect include the following:
- IV stands
- BP monitors and cuffs
- Stethoscopes
- Glucometers
- Bedrails and bathroom handrails
- Bedside tables
- Drawer, door, cabinet and toilet seat handles
- Light switches
- TV remotes and nurse call buttons
What products to use
Intermediate-level disinfection requires the use of an EPA-registered hospital disinfectant cleaner such as sodium hypochlorite (bleach). Bleach-based disinfectant wipes or sprays are generally effective against a broad range of microorganisms and have short contact times. In fact, the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA) recommend a 1:10 bleach solution to kill the pathogens which are of most concern to healthcare facilities such as C. difficile.[2]
Low-level disinfection areas
Although it's important to keep every area of a healthcare environment clean, not every surface requires intense disinfection. Less-frequently touched items and surfaces in non-patient areas are considered lower-risk areas for spreading infections throughout the healthcare environment.
Low-risk items to disinfect include the following:
- Wheelchairs
- Crutches
- Computers
- Patient furniture
- Counters
- Carts
- Walls
- Floors
What products to use
For daily cleaning of these types of hard, nonporous surfaces, use an EPA-registered quaternary disinfectant cleaner. Low-level disinfectants such as dilutable quaternary ammonium compounds succeed in killing many deadly healthcare pathogens, but are gentle enough to use daily on common surfaces. Look for products that are registered to kill many pathogens in the shortest amount of time possible. One-step products that do not require a pre-cleaning step can also save staff valuable time.
Important cleaning and disinfecting tips
According to the CDC's "Guidelines for Environmental Infection Control in Health-Care Facilities," healthcare professionals should remember to adhere to the following general guidelines[3]:
- Always select EPA-registered disinfectants, if available
- Follow the manufacturer's instructions for all products, paying particular attention to the recommended dwell times needed to kill specific microorganisms
- Educate healthcare workers to pay close attention to hand-washing procedures and don the appropriate personal protective equipment
Other resources
For more information about how to disinfect different areas of the healthcare environment, visit www.cloroxprofessional.com. There you will find step-by-step procedures for cleaning and disinfecting different areas of the hospital (patient rooms, operating rooms, emergency rooms, etc.), product usage instructions, technical training resources and a variety of free educational materials and kits for infection preventionists and environmental services professionals.
CloroxProfessional.com also offers a C. difficile Prevention Kit which features a protocol and checklist for terminal cleaning of C. difficile isolation rooms, information on bleach efficacy when it comes to fighting C. difficile spores, a calculator estimating the financial impact of C. difficile on acute care facilities and infection prevention training and education videos.
Learn more about Clorox Professional Products Co.
Related Articles on Healthcare-Associated Infections:
Bacteria on Healthcare Workers' Uniforms: Q&A With APIC President Russell Olmsted
Case Study: Reducing C. Diff. at Alabama's Huntsville Hospital
Infection Prevention in ASCs: Looking Ahead
[1] Rutala WA, Weber DJ, Healthcare Infection Control Practices Advisory Committee, (2008). Guideline for Disinfection and Sterilization in Healthcare Facilities. Retrieved from: http://www.cdc.gov/hicpac/pdf/guidelines/Disinfection_Nov_2008.pdf
[2] Stuart H. Cohen , MD, Dale N. Gerding , MD, Stuart Johnson , MD, Ciaran P. Kelly , MD, Vivian G. Loo , MD, L. Clifford McDonald, MD, Jacques Pepin , MD and Mark H. Wilcox , MD (May 2010). Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infection Control and Hospital Epidemiology Vol. 31, No. 5 (May 2010), pp. 431-455. Retrieved from: http://www.cdc.gov/HAI/pdfs/cdiff/Cohen-IDSA-SHEA-CDI-guidelines-2010.pdf
[3] Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC), (2003). CDC - Guideline for Environmental Infection Control in Health-Care Facilities. Retrieved from: http://www.cdc.gov/hicpac/pdf/guidelines/eic_in_HCF_03.pdf