Home' Inclean NZ : INCLEAN NZ Aug 2017 Contents 18 INCLEANNZ August 2017
Infections are one of the most common
causes of morbidity and mortality in modern
healthcare -- any of which are acquired in
hospital or residential care, hence the term
'healthcare acquired infection' or HAI.
Multiple factors infuence HAI rates.
The best-known is hand hygiene. Other
factors include isolating infected patients,
implementing antimicrobial stewardship
(which means monitoring antibiotic usage)
and environmental cleaning and disinfection.
Cleaners remain the last line of defence
against HAIs, and due of the pressures placed
on cleaning staff, it is becoming more and
more important to work smarter, not harder.
Antimicrobials or antibiotics kill pathogens
in the bloodstream through a delicate 'lock
and key' mechanism. If the pathogen evolves
and changes, it can make it impossible for
the antibiotic to attach to the pathogen.
The key won’t ft in the lock. We call this
Disinfectants are far less elegant. They are
more like a sledgehammer to a watermelon.
This means there is minimal risk that
bacteria will become immune to disinfectants
the way they have to antibiotics. A good
disinfectant is the most effective tool in the
Unfortunately, there is no perfect disinfectant;
no silver bullet. Some disinfectants are very
strong but they damage surfaces; others have
a high safety profle but have poor effcacy
against healthcare pathogens.
There is no evidence that antimicrobial
resistance correlates with the effectiveness
of disinfectants. This is due to fundamental
differences in the mechanism of killing of
micro-organisms by these agents (antibiotics
Most disinfectants are effective against
Healthcare cleaning and disinfection:
what is best practice?
focus their efforts
only on terminal
cleaning of patient
rooms with less
emphasis on daily
as Diversey Care Australia's Ivan
Obreza* points out, this must
change in order to achieve better
vegetative bacteria regardless of the
antimicrobial resistance profle. It is only when
faced with spore-forming bacteria such as C.
diffcile that a higher-level disinfectant with
sporicidal properties should be considered.
In her 2015 study published in the
American Journal of Infection Control,
Michelle Alfa demonstrated that best
practice disinfection requires the right
product, the right process, and proof of
Once the right disinfectant for your
environment has been selected, the right
procedures need to be standardised. There
is a growing body of evidence that the
biggest pathogen loads are found on high-
touch surfaces next to the patient. Thus it
makes sense for cleaners to target the point
If cleaning time is limited, it makes no
sense to disinfect ledges and window panes
when the pathogens are concentrated on
bedside tables, remote controls and bedrails.
One study showed that the bedrail in an
average surgical unit was touched 256
times per day by different people. Yet it was
disinfected only once. That leaves a lot of
scope for cross-contamination.
Best practice: when
should patient surfaces be
To adapt the vernacular of the World Health
Organisation, there are six moments of
surface disinfection which all relate to the
point of care:
• Before placing a food tray on a bedside table
• After any procedure involving blood, vomit,
urine or faeces
• After any wound dressing procedure
• After a bed bath
• After assistance with productive cough
• Any time surfaces are visibly soiled.
Should floors be disinfected?
Normal shoes are heavily contaminated
and will deposit germs on the cleanest of
foors. Recent studies have shown that air
currents pull germs from the foor into
the air, where they are carried in currents
behind people as they walk. The germs
are then deposited on high-touch surfaces
elsewhere within 24 hours.
A weekly deep cleanse by a foor scrubber
may be more effective than a daily wipe
with a disinfectant-soaked mop. Whether or
not you choose a disinfectant for your foor,
the common denominator remains effective
disinfection at the point of care.
Proof of compliance is becoming popular
as hospitals seek validation that cleaning
is being done. There are various models
available, including protein swabbing and
fuorescent ink with UV light.
Most hospitals focus their efforts only
on terminal cleaning of patient rooms
with less emphasis on daily cleaning. This
must change in order to achieve better
More emphasis should be placed on daily
cleaning of high-touch surfaces at the point
of care, with a safe and effective disinfectant,
and a program to ensure surfaces are being
*Ivan Obreza is an infection prevention
consultant and the senior clinical advisor for
Diversey Care, Australia.
Links Archive INCLEAN NZ May 2017 INCLEAN NZ Nov 2017 Navigation Previous Page Next Page