Caroline
Haggerty
addressed
accountability
in cleaning
during her
presentation
at the annual
meeting.
that meets the needs of healthcare
professionals. The gap of knowledge
and understanding is one of the areas
we are working on. We want to build
a bridge between these stakeholders
and help communicate about design,
testing and real-world use.”
Healthcare is a complex and dynamic
arena. In her presentation, Lybert shared
a photo of a patient-room headwall that showed more than
60 surfaces and connection points. “We must examine what
is not being cleaned – the hot zone area must be evaluated
and surfaces cleaned and disinfected regularly. A focus on
high-touch surfaces leaves the highly touched surfaces
contaminated,” Lybert says. “The other challenge comes
when healthcare professionals try to follow instructions for
use (IFUs). In one room there can be as many as 40 different
IFUs. When environmental services professionals are given
20 minutes to turn over a room, following the IFUs becomes
impossible.”
Lybert says it is critical for healthcare professionals to
evaluate and validate IFUs prior to purchase of any products
used within the healthcare environment.
“We must look at items as assemblies,” Lybert says,
meaning that the materials that go into the manufacture of a
patient-care environment or medical devices and equipment
are as critical as the total assembly of the various components.
“We must be cognizant that multiple materials are often used
in the composition of one object that need to be cleaned,
disinfected and sterilized. Manufacturers must test the
material performance and then test the surface or piece of
equipment as an assembly to validate that it can be cleaned
the way it needs to be in the healthcare environment. There
must be consistency with test methods; in a comprehensive
literature review undertaken by the Healthcare Surfaces
Institute, we found significant disparities between the test
methods and the microbes being tested. There currently
are no standards or requirements for testing and that must
change. There also is a lot of confusion among the many
standards bodies and professional organizations about what
what testing should be done and the test methods used to
provide scientific validation that a surface and a product
can be efficiently and effectively cleaned and disinfected.”
Lybert continues, “Our literature review also revealed that
there is confusion around the definitions for cleaning and
disinfection. An evaluation of 31 organizations provided 31
different definitions for cleaning and disinfection. It is true
there were similarities, but the confusion comes in for the
front-line workers who are actually doing the cleaning and
disinfection; the Institute is working on standard definitions
for what we mean by cleaning, disinfecting and sterilizing.
Two material scientists provided insight into the variety of
surface materials and how topography and disinfectants
damage surfaces creating opportunities for microbial
proliferation and cross contaimination. The challenge is
understanding the wide range of materials.”
During HSI’s annual meeting, attendees broke out into
hands-on workshops where representatives from the clinical,
manufacturing and regulatory worlds discussed current
challenges and took first steps on initiatives to address
www.healthcarehygienemagazine.com • april 2020
The annual meeting was held March 3-4, 2020.
those challenges. For example, the Healthcare Surfaces
Institute is developing the first certification and standards
program for surface manufacturers. This program will support
manufacturers as they develop products and empower
healthcare professionals to identify products that can be
effectively cleaned, disinfected and sterilized to reduce the
spread of HAIs. The Institute will Include the development
of surface testing standards, educational programs, and
resources as well as a certification process that will provide
manufacturers with a certificate of validation from HSI. This
program will work with selected laboratories to develop
consistent test methods that includes compatibility testing
of all categories of EPA-registered disinfectants, as well as
no-touch disinfection.
Additionally, the certification program will identify the top
microbes for all testing with option for additional microbial
testing, with the goal of having consistent measurable data
and information.
The certification program also will evaluate surface mate-
rials and products as assemblies. The program will evaluate
surfaces at a micro-level because damage is often unseen,
creating microbial reservoirs that support the growth and
proliferation of microbes. IFUs will be evaluated to ensure
they clearly outline what EPA-registered, hospital-grade
disinfectants can be used and evaluate the scientific testing
data to validate these claims. Further evaluation will review
how IFU’s support current infection prevention processes
and protocols.
“There is a focus on creating healing environments;
however, if we can’t effectively and efficiently clean and
disinfect surfaces, environments aren’t healing,” Lybert says.
“To mitigate the spread of pathogens within healthcare we
must focus on the foundational issue of surfaces to insure
they can be effectively and efficiently cleaned, disinfected and
sterilized without damage before using them for products
or the environment.”
“Critical to understanding the role that healthcare surfaces
play in illness and infection are considerations of risk to
healthcare personnel,” says Amber Mitchell, a board member
of the Healthcare Surfaces Institute. “This would include
not only exposures to pathogens, but also to potentially
harsh detergents, disinfectants, and sterilants. We need to
think holistically about not just patient safety, but worker
safety and the overall safety of the communities in which
they live and work.”
“Infectious agents have been around for a lot longer
than human beings,” says researcher Syed Sattar, PhD,
also a board member of the Healthcare Surfaces Institute.
“They will also be there well into the future with ‘new’ and
devastating ones periodically appearing on the scene. It is
unlikely that we will ever have enough safe and effective
vaccines and antimicrobial drugs to counter such emerging
threats. Infection prevention and control, on the other hand,
are generic, universal and time-honored approaches against
infectious agents.”
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