environmental hygiene
By J. Darrel Hicks, MREH, CHESP
10 Commonly Asked Questions Relating to
Environmental Hygiene
1
To what extent does environmental surfaces cleaning
affect contamination levels in hospitals?
The role of the hospital environment as a reservoir of
infection is poorly understood. But this is certain: one well-
trained hygiene specialist (housekeeper or environmental
services professional) can prevent more disease transmission
than a room full of doctors can cure.
2
Is there a way to measure the efficacy of a cleaning
program?
There are four ways to measure the efficacy of a cleaning
program. They are: (A) Visual assessment-not a reliable indica-
tor of surface cleanliness. (B) ATP bioluminescence-measures
organic debris (each unit has own reading scale) will give you
a reading within seconds. (C) Microbiological methods-can be
costly and pathogen specific. (D) Fluorescent marker to ensure
that cleaning processes have been adequately performed.
3
What is the difference between disinfectants
and sanitizers?
Sanitizers can be used in cafeterias, kitchens and food
preparation surfaces to keep certain (short list) microorganisms
at a safe level. But, if you want those same microorganisms
eliminated, you would need to use a disinfectant such as a
quaternary ammonium compound (quat), phenolic, accel-
erated hydrogen peroxide or other the U.S. Environmental
Protection Agency (EPA)-registered disinfectant.
4
Knowing that surfaces nearest the patient harbor
the greatest number of pathogens, what is the best
method to reduce or eliminate those pathogens?
Washing or scrubbing a surface physically removes soil
and organic material such as blood and body fluids and takes
with it the disease-causing pathogens. The guiding principle
is always to remove germs, if possible, rather than kill them,
and then when necessary, use the least amount of the mildest
chemical that will do the job, because stronger often means
more toxic to people.
5
Is microfiber that much better than cotton when it
comes to mops and cloth wipers?
Yes. Microfiber helps physically remove the food and
moisture necessary for microorganisms to survive, but better
grades of microfiber (those with very dense weaving and fiber
configuration) can even remove large quantities of microbes,
including hard-to-kill spores.
6
Is it necessary to disinfect floors in hospitals?
A: Floors aren’t a high-touch surface, but some cleaning
professionals and healthcare experts suggest that they should
be included in disinfection processes. The other school of
38
thought is to simply use a neutral floor cleaner since floors
are quickly re-contaminated as soon as somebody walks on
them or something is dropped on them.
7
How long must a surface, wetted with disinfectant,
remain wet?
This question deals with exposure time or contact time.
Each disinfectant has a label with directions for contact
time. The Centers for Disease Control and Prevention
(CDC) guideline recommends a contact time of 1 minute
at a minimum. If the label states different contact times for
different organisms, the highest contact time listed must
be used because one doesn’t know the contents of the soil
being cleaned.
8 Is it possible to perform ‘green disinfection’?
9 What are “superbugs” and why should we be
concerned about them?
Disinfectants — used properly and wisely — are
designed to protect public health. In many situations—and
especially in healthcare and other critical facilities—there is
no substitute for disinfectant cleaning. That being said, there
are some old technologies (i.e., copper- or silver-impregnated
surfaces, steam vapor devices, spray-and-vac technology)
and some new, emerging technologies that hold great
promise (i.e., UVC (short wave or germicidal light) photons
damage DNA and hydrogen peroxide (HP). Both UVC and
HP technologies are meant to supplement, not replace
routine disinfection.
Some pathogens have gotten the reputation for being “su-
perbugs” because of their ability to survive on environmental
surfaces for up to 56 days after contamination on common
hospital materials. Methicillin-resistant Staphylococcus aureus
(MRSA) and vancomycin-resistant Enterococci (VRE) are
two of the most talked about “superbugs” that have been
implicated in transferring from hospital surfaces to previously
uninfected patients.
10
Is it true that quats (quaternary ammonium disin-
fectants) are inactivated by cotton mops and cloths?
True, once cotton mops or wipers are introduced into
a fresh solution of quat disinfectant, the cotton binds the
available, active ingredients of the disinfectant within minutes.
To avoid this, use a synthetic microfiber cloth or man-made
spun material (no cellulose) in quat disinfectants.
J. Darrel Hicks, BA, MREH, CHESP, is the owner/principal
of Darrel Hicks, LLC and the author of the book Infection
Prevention for Dummies. He is also a board member of the
Healthcare Surfaces Institute.
february 2020 • www.healthcarehygienemagazine.com