Welcome back to the EvaClean Q & A Column, where interviews with industry thought leaders provide insights on important infection prevention issues. This month, we begin a multi-part Q & A series with J. Darrel Hicks, BA, MESRE, CHESP, CMIP on the topic of environmental surfaces. Hicks is past President of the IEHA and the Healthcare Surfaces Institute (HSI), and a current member of the HSI Surface Certification Program. He is a nationally recognized subject matter expert on infection prevention, environmental cleaning and disinfecting. Hicks has written and published numerous articles in professional and healthcare journals, and is the author of “Infection Prevention for Dummies.”
EC: Why do surfaces matter and what role do they play in the chain of infection?
DH: The risks and financial burdens of healthcare-associated infections (HAIs) are not trivial. In fact, on a larger scale, it has been estimated that HAIs in U.S. acute care hospitals cost America as much as $147 billion annually. Additionally, in long term care facilities, between 1 and 3 million residents acquire an HAI and up to 380,000 succumb to those infections.
Despite the use of traditional cleaning and disinfection methods, several studies have demonstrated the persistent contamination of housekeeping surfaces. There is now enough evidence to demonstrate that maintaining the hygiene of hospital surfaces helps prevent infections.
This has led to widespread acceptance of the need to address traditional cleaning processes as well as advanced disinfectant technologies. Furthermore, the education and training of environmental hygiene personnel is at the core of creating a global initiative. Hospitals and key stakeholders must work together to change how we maintain the hospital environment to better protect patients and staff.
EC: Which viral pathogens are considered the most urgent threats today?
DH: For the past 18 months, healthcare facilities have been focused on cleaning to eliminate SARS-CoV2 from surfaces, while “Super-Bugs” like Candia auris (C. auris), Clostridium difficile (C. diff) and Methicillin-resistant Staphylococcus aureus (MRSA) have likely become more resistant to disinfectants.
Let’s talk about C. diff for a moment. When a hospital patient is treated with antibiotics, it affects the balance of bacteria in the gastro-intestinal system and C. diff may take over. C. diff causes severe diarrhea and, due to its out-of-control nature, spreads fast in a hospital. Patients pick up C. diff spores from contaminated bed rails, overbed tables, and virtually any surface they touch, which are then carried to their mouths.
If not properly disinfected, C. diff spores live on surfaces for months. A recent article makes the case that hospital beds and mattresses are inadequately disinfected and placing a patient in a bed previously occupied by a C. diff patient can be a fatal mistake.
EC: Are some disinfectants more hazardous to health than others and why?
DH: I recently visited a hospital and stopped to chat with the Housekeeper. I asked her the name of the disinfectant she was using and she replied, “I don’t know.” This is a violation of OSHA's Hazard Communication Standard (HCS), which states – employees have both a need and a right to know the hazards and identities of the chemicals they are exposed to when working. They also need to know what protective measures are available to prevent adverse effects from occurring.
Six disinfectants commonly used in hospitals are rated as causing asthma by the Association of Occupational and Environmental Clinics. Multi-state surveillance continues to document the contribution of cleaning and disinfectant products to work-related asthma (WRA). In a Michigan surveillance of work-related pesticide poisoning, disinfectants were the cause of over half the confirmed cases. In North Carolina, 7.8% of adults (estimated 592,279 persons) currently have asthma from their work with or near bleach, quats, ammonia, hydrogen peroxide, and so forth.
In closing, Environmental Services managers and their team members are guardians of the health of people and the environment. They must be educated and vigilant in the pursuit of safe and environmentally responsible cleaning and disinfecting methods.