Healthcare Hygiene magazine October 2019 | Page 38

environmental hygiene
By J. Darrel Hicks
Cleaning and Disinfection in the 21st Century
A
lthough cleanliness may be next to Godliness, it’s also
very closely related to disinfection. In fact, cleaning may
avert the need to disinfect in some situations because clean
and dry surfaces can’t harbor microbial growth for very long.
In view of the evidence that transmission of many
healthcare-acquired pathogens (HAPs) is related to con-
tamination of near-patient surfaces and equipment, all
hospitals are encouraged to develop programs to optimize
the thoroughness of high-touch surface cleaning as part of
terminal room cleaning at the time of discharge or transfer
of patients.  In view of this fact, isn’t it time to get rid of
Spaulding’s classification of those near patient surfaces
and equipment as “non-critical”?
Numerous studies have demonstrated the role of the
environment as a reservoir and in the transmission of
human pathogens. However, the precise role of environ-
mental cleaning and disinfection in preventing acquisition
of healthcare-acquired infections (HAIs) is uncertain in
part, because of variations in assessment methodology
and lack of randomized control studies. This standard
relies on the available scientific evidence for effective
cleaning and disinfection practices in order to minimize
the risk of pathogen transmission to patients and protect
patient health.
How do we define “clean” or “cleaning,” “disinfection” or
“disinfecting” for the environmental services (ES) technician
to insure a safe, clean and disinfected environment?
Personally, I prefer the definition that Michael Berry, PhD,
promotes for “clean” and “cleaning.” Clean is a condition
free of unwanted matter that has the potential to cause an
adverse or undesirable effect. Cleaning is the fundamental
management process of putting unwanted matter in its
proper place to achieve a clean condition.  Cleaning pro-
fessionals will understand these definitions and be able to
deliver the desired outcomes.
In my professional opinion, along with “Spaulding’s
non-critical” classification for near patient surfaces, we
need to get rid of the term “visibly soiled.” There are more
than enough C. difficile spores in the size of a pinhead to
transmit the pathogen. When the ES technician is given
the instruction to clean “visibly soiled” surfaces, are they
looking for soil the size of a pinhead? No, they don’t have
time...they have eight more patient rooms to clean in the
next two hours before they clock out.
Cleaning and disinfection have shown benefits in infec-
tion prevention and control, and as the research continues
to evolve, more clarity emerges. The challenge to research
in this area is the lack of clinical trials. This is further
compounded by the difficulty in conducting cleaning and
disinfection research clinical trials in healthcare facilities.
The following are the more traditional, time-worn
definitions for consideration:
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Cleaning agent  — a substance, or mixture of
substances, that physically removes foreign material (e.g.,
dust, soil, food) and patient-derived material (e.g., blood,
secretions, excretions, microorganisms) from environmental
surfaces and inanimate objects due to the detergent or
enzymatic properties of the formulation.  See  One-Step
Cleaning Agent Disinfectant, Detergent.
 Cleaning — the physical removal of foreign material
(e.g., dust, soil, food) and patient-derived material (e.g.,
blood, secretions, excretions, microorganisms). Cleaning
physically removes rather than kills microorganisms. It is
accomplished with water, detergents and mechanical action.
 Contamination — the presence of an infectious agent
on hands or on a surface such as clothes, gowns, gloves,
bedding, toys, surgical instruments, patient care equipment,
dressings or other inanimate objects.
 Decontamination — the process of cleaning, by use
of physical and chemical means, to remove, inactivate, or
destroy, followed by the inactivation of pathogenic micro-or-
ganisms, in order to render an object safe for handling.
 Disinfectant — a substance, or mixture of substances,
capable of destroying or irreversibly inactivating pathogenic
(disease-causing) and potentially pathogenic (opportunistic)
microorganisms, but not necessarily bacterial spores, present
on environmental surfaces and inanimate objects due to the
antimicrobial action of the active ingredient(s). A disinfectant
shall have an EPA registration number.
 Disinfection — the inactivation of disease-producing
microorganisms to a level previously specified as being ap-
propriate for a defined purpose on the equipment or surface
after the cleaning process has been properly completed.
Disinfection does not destroy all bacterial spores. Note:
Disinfection typically involves chemicals, heat, ultraviolet
light, ozonated water or self-disinfecting materials.
 Fomites — inanimate objects in the environment that
may become contaminated with microorganisms and serve
as vehicles of transmission.
The fact is, surfaces appearing to be clean might not
necessarily be clean when scientifically quantified or qual-
ified. Remember, what you can’t see, can hurt you. The
ES technician should be educated and trained to strive for
health-based or hygienic cleaning (cleaning for a healthier
environment and not just for appearances). That means
cleaning AND disinfecting.

This article continues online; visit: https://www.
healthcarehygienemagazine.com/surface-hygiene/
J. Darrel Hicks, BA, Master REH, CHESP, Certificate of
Mastery in Infection Prevention, and a Certified Expert
Trainer — is the owner/principal of Darrel Hicks, LLC.
october 2019 • www.healthcarehygienemagazine.com