Surface disinfection in healthcare facilities

“Knowing is not enough; we must apply. Willing is not enough; we must do.”

J.W. von Goethe

Disinfection is a procedure aimed at reducing the number of microorganisms on disinfected objects, surfaces and skin. As a result of disinfection, the level (number) of pathogenic and potentially pathogenic microorganisms should be reduced to a safe level for human health.

Disinfection in health care facilities (PSZ) is an extremely important element in preventing nosocomial infections. However, it requires the cleaning staff and personnel to acquire a certain amount of knowledge and skills in order for the service offered to benefit both the customer and the cleaning company in the form of clean (also microbiological) surfaces.

In the case of outsourcing of cleaning services, the cleaning company’s crew becomes, in a way, the “external” link in the broadly understood prevention of nosocomial infections. This prophylaxis includes subsequent surface cleaning processes as well as their disinfection. Then the typical industry knowledge is supplemented by issues from the field of epidemiology, microbiology, chemistry. Only conscious and trained personnel are able to perform the service without losing sight of the primary objective of preventing the spread of infections.

Legal guidelines

The personnel of the cleaning company are exposed to the same risks as the middle and senior medical personnel. Both the Regulation of the Minister of Health and the Directive 2000/54/EC list all biological agents that pose a risk and exposure to health. The same pronunciation is given by Article 226, 222 and 237 of the Labour Code, emphasizing the responsibility of the employer to ensure that the employee is protected against risk factors at work. The third, but not the last, regulating element is the Regulation of the Minister of Labour and Social Policy on general regulations of safety and hygiene at work. This list is closed by the State Sanitary Inspectorate for the supervision of the proper working conditions in the establishments on the one hand and the hygienic and sanitary conditions to be met by medical personnel, equipment and rooms where health services are provided.

Infection transmission routes

Before we move on to the principles of use and application of disinfectants, I would like to draw attention to basic issues related to the ways of transmission of infections.

Normally the transmission of the infectious agent, i. e. its pathway requires 3 elements: the source (reservoir) of infectious agents (e. g. sick person), a sensitive host with open gates sensitive to the infectious agent (here it may be a healthy cleaner or a patient) and a transmission agent (way of arrival, movement).

The victim of the infection may be a patient, medical personnel or other people in contact with the former’s environment. They may have an active infection without clinical signs and/or be in the incubation period of an infectious disease. They can also be colonized by microorganisms that are potentially pathogenic, particularly in the respiratory or digestive tract. The endogenous (physiological – normally human) flora of these people can also be the cause and source of infection. An infection is the result of creating a specific relationship between a potential source and an infectious agent. Most of the factors influencing the symptoms of the disease and its severity depend on the sensitivity of the host, although the dose, place and route of exposure of the infectious agent certainly have a large impact on virulence and reactionality.

The fact that some people do not develop any symptoms and some people get sick or even die is still unknown. Some of them are temporarily or permanently colonized. This is known to be influenced by the condition of the immune system. Older people with chronic diseases (diabetes), immune disorders (HIV), after transplantation or during treatment may be more susceptible to infections.

Various microorganisms may be the agents of infection. Let’s list: bacteria (B) including mycobacteria (Tbc), fungi (F), viruses (V) and prions. The routes of their transmission are different and depend on the type of germ. They may be different for one type of microorganism. And so, for example. Herpex simplex, staphylococcus aureus can be transferred simultaneously by direct and indirect routes. Others by droplet (influenza, pertussis – B. pertussis) or by air (TB – M. tuberculosis). Other infectious agents such as blood-borne viruses (hepatitis B,C – HBV, HCV) are transmitted through the mucous membranes or interrupted skin continuity.

It is very important that the route of infection will not always be direct contact between a person and a person. We can talk about three possibilities here. Infection through indirect (especially bacterial flora transmitted on staff or instruments) or direct contact (blood, saliva, clothes, caps, aprons, masks and equipment may be contaminated by potential pathogens of the colonised or infected patient) and the drip and airway.

Airborne infections occur when the infectious agent or a small particle of the droplet containing it remains active for a long time and distance and can be ingested by a sensitive person who is not in direct contact with the patient. The prevention of such infections consists in protecting the respiratory system of staff and patients and the ventilation system of the rooms. This is a typical route for the transmission of M. tuberculosis and Varicella virus (smallpox).

Choosing the right preparation

Preparations for surface or skin disinfection must meet certain requirements in order to be used safely. Currently, from a regulatory point of view, they should meet the following criteria:

  1. Have a declaration of conformity issued, which in practice means qualification to the group of Medical Devices (II a) and is signed by placing the CE mark on the packaging together with a numerical code, marking the notifying authority. Most of them are preparations for disinfecting instruments and equipment, but there can also be products for disinfecting skin and surfaces.
  2. Have information on the listing of biocidal preparations, most of which are surface disinfection products.
  3. Preparations for skin and mucous membranes entry in the list of medicinal products.

In addition, a safety data sheet is required for each of these groups. Please note that it is the supplier’s responsibility to provide these documents and he is also responsible for placing the product on the market. It is your responsibility to ask for such documents on the occasion of delivery.

Meeting these requirements allows you to use a product which, in accordance with Polish regulations, is approved for marketing. In practice, this means that the inspection bodies cannot accuse you of using the products illegally. This does not, however, release you from your responsibility to select the correct product according to the risks in your establishment.

In practice, healthcare facilities often specify which products are to be used for daily floor disinfection. They thus take responsibility in the event of actions by patients or medical personnel. However, it is worth having elementary knowledge of this subject in order to be able to select products in an optimal way, taking into account all aspects related to this subject.

Having a selection of a surface disinfectant in front of us, we have to divide them according to the size of the area to be disinfected into: small, hard to reach (bedside table, handle) and large so called  “washable” (floors, lamps). Already at this stage we choose from completely different product groups. Alcohol-based preparations are used for small, hard to reach surfaces. This is because the properties of alcohols work perfectly well in this type of treatments. Quick time of action and drying, relatively wide cidal spectrum cause that most often these types of surfaces are used in the form of aerosol or wipes. Assuming that aerosols are formed during the treatment and procedures, it can be assumed that the patient’s immediate environment is loaded with protein substances. This is why there is a need to select preparations that provide the widest possible spectrum of action, or at least include blood-borne viruses (HIV, HBV). Due to its specificity, it is also recommended to act on Tbc (in Anglo-Saxon countries, this criterion is paramount for the division of preparations). For your convenience, I would like to remind you that the mention on the label or in the product leaflet of the effect on one of the listed species of mycobacteria is a reliable proof of such effect: M. tuberculosis or M. avium or M. terrae. For the time being, such information, which may serve as an indication to the user of the performance of the preparation under protein load conditions, is the presentation by the manufacturer of tests or a declaration that the preparation has been tested in phase 2 step 2 (simulated use conditions) and can also be used in the presence of biological contamination (this can be annotated on the packaging or there is an entry with ‘*’ or ‘z’). Biological contamination is defined as visible contamination caused by the patient’s body fluids (blood, saliva, secretions and excretions). In hospital conditions, we always strive to use the product with the shortest possible duration and the widest spectrum. Today you can already successfully find on the market preparations operating for less than 1 minute. in the full spectrum (i. e. B, Tbc, F, HIV and HBV) under protein load (phase 2, step 2).

Despite the widespread use of alcohol-based products, there is a risk of material intolerance, e. g. with armchair upholstery or other materials used to make a dental unit. It is also worth noting that most of the lamps are made of acrylic glass, which becomes dull after a long period of use.

In the case of chemicals used for large area disinfection, the range of chemicals and their groups is much more extensive. Halogens are used here because of their wide spectrum of action and their ability to be used in the presence of biological contamination. They are inexpensive and effective, but the reduction is due to the nuisance of smell when used in the presence of patients and high toxicity. Currently, the broadest group of products are amines and their derivatives. Their relatively low cost, good cleaning properties, wide spectrum and low nuisance make them very popular.

Regardless of the group of chemical compounds used in the disinfection preparations, it is important that it reaches a minimum of the spectrum or B,F in no more than 15 minutes.

Of course, a shorter action time is welcome, especially in the case of aerosol formulations. A common mistake is a misinterpretation of the operating spectrum assigned to different concentrations and exposure times.

Necessary equipment and rules for surface disinfection

It is important to mention here that when using washing and disinfecting preparations, to perform the washing and cleaning process properly you should use double bucket carts and start washing from the farthest and dirtiest parts of the room heading to the exit. Change the mop after each room. If the floor is dirty by blood, secretions or excretions, the dirty place should be flooded (sprinkled in the case of powder) or applied with gauze or lignin soaked in the disinfectant and wait 15 minutes. After this time, you can proceed with further cleaning and disinfection of the floor.

In conclusion, it is worth noting once again that in the case of disinfection processes carried out by the cleaning company’s staff, it is the employer – the cleaning company is responsible both for patients and medical staff, but also to its own employees performing the cleaning service

Other from: Disinfection

Zaloguj się do Strefy Wiedzy. Uzyskaj darmowy dostęp.
Unia europejska