Healthcare Hygiene magazine August 2020 | Page 35

Barring no-touch technologies, chemical decontamination of high-touch environmental surfaces invariably incorporates wiping, but current and widely accepted methods to assess environmental surface disinfectants do not incorporate that physical action (Sattar 2010) so critical for dislodging and removing dried contamination to allow better access to and action by the disinfectant. In view of this, test data from ‘static’ (without any wiping action) test protocols, and label claims based on them, only show the microbiocidal potential of a given formulation without indicating its ability to perform under actual field use. There is, therefore, a need to generate test data on such formulations via a ‘dynamic’ (combining physical action of wiping with chemical disinfection process) test protocol reflecting field use of the process. Such information would better inform disinfectant manufacturers, government regulators as well as infection preventionists. It is with this example in mind that EvSOP© tested most commercially available wipes and mops for evidence-based outcomes to be shared in the future series on science-based cleaning. In her research paper, How do we assess hospital cleaning? A proposal for microbiological standards for surface hygiene in hospitals (Journal of Hospital Infection (2004) 56, 10–15), Dancer stated, “Cleaning in general has two main functions: first: non-microbiological, to improve or restore appearance, and prevent deterioration. Second, microbiological, to reduce the numbers of microbes present, together with any substances that support their growth or interfere with disinfection.” You can clean without disinfecting, but you cannot disinfect without cleaning” — Dr. Earle Spaulding Cleaning • The removal of material like dust, soil, blood, and bodily fluid. • Physically removes rather than kills microorganisms. Accomplished with water, detergents, and mechanical action. • Is always essential prior to disinfection or sterilization. • A surface that has not been cleaned effectively cannot be properly disinfected or sterilized. Disinfecting • The inactivation of pathogens. • Usually involves chemicals, heat, or ultraviolet light. • Sterilization destroys microbial life including bacteria, viruses, spores, and fungi and is not performed by surgical cleaning or environmental services staff. • The most common disinfectants used are quaternary ammonium compond products, hydrogen peroxide-based products, and sodium hypochlorite (bleach). These are the two basic functions we need to look at for EPA-registered, hospital-grade disinfectants to have full efficacy, and to remove potential sources of infection. Notice the importance of the physical removal in the CDC Guidelines for Environmental Infection Control in Health-Care Facilities, section 2b: Disinfectant/detergent formulations registered by EPA are used for environmental surface cleaning, but the actual physical removal of microorganisms and soil by wiping or scrubbing is probably as important, if not more so, than any antimicrobial effect of the cleaning agent used. So, evaluation of a cleaning tool -- albeit wiper or mop -- must include how it performs in both the cleaning and disinfection process. It must trap, capture, and remove bacteria, virions, spores, dirt, dust, soil, blood, and body fluid, while absorbing and eluting the disinfectant to achieve the desired wet contact time per the manufacturer’s label. At the outset of the EvSOP© series, readers were introduced to a set of criteria upon which each product should be tested. Due to the COVID-19 pandemic, most people know the importance of cleaning and disinfecting the environment to ensure a hygienic environment. What appears to be clean and assumed to be hygienic can contaminate the environment and cause a healthcare acquired infection. With the conventional methods, the method of reporting a result from a test is by colony forming units (CFU) per unit of testing (typically CFU per mL or per 100mL). A CFU does not necessarily equate with a number of microorganisms present in the sample but it does provide an indicator of the bioburden load. This is because a CFU is an View Evaluation Criteria estimate of one or more microbial cells which, on the introduction of microbial growth media, can form macro-colonies under the conditions of the test. One colony forming unit is expressed as 1 CFU. In relation to pharmaceutical processing, bioburden testing is implemented in order to assess the quality of the starting materials and to track process hygiene as the product is being manufactured. Healthcare-Grade Ultra Microfiber (H-GUM) used in healthcare facilities is not expected to be sterile, only hygienic. Bioburden assessment is not a requirement of the final product. To expect non-sterile products used in a non-sterile environment to produce a sterile environment or surface is non-sensical, unrealistic, and beyond the realm of the necessary. It should be expected that infection prevention textiles used by EVS in a non-sterile environment may contain a level of bioburden, and bioburden is not another name for pathogens. H-GUM is effective at providing a log-10 5 reduction of surface bacteria in and of itself and, with the proper disinfectant and use, a log-10 7 is attainable. When laundered according to CDC guidelines, H-GUM releases bacteria, spores, and other biomaterial sufficiently to render the product hygienic and effective at removing bioburden from surfaces sufficient to rendering them hygienic. What to remember from all of this? Quite simply, EVS teams must be equipped with knowledge, proper cleaning tools including H-GUM, EPA-registered and hospital-grade disinfectants, and sufficient time to incorporate them. When all four of these essential factors are in place, the microbial jungle is not so frightening; that is, at least until someone with unwashed hands touches a surface. Paul J. Pearce, PhD, has more than 40 years of medical and environmental laboratory testing and teaching experience. Pearce’s training and work in microbiology, chemistry, human physiology and medicine have enabled him to help thousands of people as they strive to improve their lives. John Scherberger, FAHE, is the owner of Healthcare Risk Mitigation in Spartanburg, S.C. He is a subject matter expert in healthcare environmental services, healthcare linen and laundry operations, and infection prevention. www.healthcarehygienemagazine.com • august 2020 35