ECJ EUROPEAN Cleaning Journal

Cross-contamination needs to be avoided in any environment where crowds collect in order to prevent the spread of infections and viruses. So which touch points are the chief culprits for passing on illnesses, and what products do cleaning companies offer to reduce the risk?

Swine flu has returned with a vengeance this year and is adding to the annual misery of winter illnesses. Those of us who have not yet succumbed are desperately trying to dodge the bullet of colds, flu and other ailments. But it is a sobering thought that infections and viruses can be picked up practically anywhere.

It is virtually impossible to avoid airborne bacteria without shunning public places altogether or wearing a face mask at all times. But germs on the hands and surfaces can potentially be avoided through rigorous cleaning and sanitising regimes.

Any environment where crowds of people gather is a potential hazard, particularly where those people are vulnerable to illnesses such as in hospitals and schools. Other places at risk are environments where large numbers of people share equipment such as in an office or college.  So which are the key areas to avoid, and how can the risk of cross-contamination be reduced?

Mike Rollins, research and development manager for Osprey Deepclean’s parent company Proventec, says people are often unaware of the risks that public places pose.

“Everyone knows the cross-contamination risks in, say, a doctor’s surgery at this time of year when everyone is coughing and sneezing,” he said. “But they may not be so aware of the potential hazards in other public facilities such as in cinemas, supermarkets and gyms.”

The infection risk varies depending on the type of facility, the activities carried out in it and the amount of time people spend there, according to Rollins.

“In a cinema, for example, people will be gathered together for several hours,” he said. “Some will be coughing and sneezing and many will be eating – and all will be touching the seating areas. In a sports club, too, people will be sharing equipment such as weights, cross-trainers and exercise bikes and will remain there for lengthy periods of time. Both these environments represent a potentially high risk of infection.”

Other vulnerable areas include the handrails and seats on public transport; supermarket trolleys; lift buttons, and offices where people 'hot-desk'. “Here shared items such as telephones, keyboards, headphones and microphones are a particular risk,” he said.

According to Rollins it makes sense to clean vulnerable surfaces more frequently during the flu season where possible. “There may also be a case for frequent steam cleaning, particularly in public toilets.”

Osprey Deepclean specialises in steam-cleaning equipment for vulnerable areas, particularly in the healthcare sector. “Steam cleaning is a very rapid way of decontaminating surfaces in high-risk areas,” said Rollins. “When used in conjunction with extraction tools it removes any contamination and leaves the surface clean and dry so that it can’t be colonised by micro-organisms.”

Besides more frequent surface cleaning, Rollins stresses the case for good hand hygiene. “Good personal hygiene is the number one consideration,” he said. “If we are washing our hands frequently we are not transferring our infections into the general environment.

Frequent hand washing

“People should be frequently washing their hands with soap and water and keeping their fingers away from their eyes and nose. They should also have ready access to alcohol hand gels where water is not available or where they are unable to leave their desks, such as in a call centre.

“But a lot of infection control advice comes down to common sense. For example, on public transport in winter you could carry an alcohol gel wiper with you and wear gloves while travelling to prevent cross-contamination via the hands. It also makes no sense to eat your croissant while riding the tube.”

According to Deb’s marketing director for Europe Paul Blount a hand sanitiser can help to reduce the risk of cross-contamination. The company offers Deb InstantFOAM hand sanitiser which is claimed to kill 99.999 per cent of many common germs without the use of water.

“Following the ‘Catch it, Kill it, Bin it’ campaign we are all aware that germs are generally spread by sneezing or coughing and then touching contaminated surfaces,” he said. “These include door handles and telephones or when shaking hands.

“It is also known that people interacting closely with one another in enclosed environments are at a higher risk, particularly if they deal with the public, handle money or regularly commute on public transport.”

According to senior hygiene advisor at SCA Rolf Andersson bacteria are particularly prevalent on hand-touch sites in public places such as doorknobs, light switches and keyboards. “However, most microbes can be reduced or removed through ordinary cleaning regimes using detergents and water,” he said.

In hygiene-critical environments such as hospitals and food preparation areas antimicrobial products can be used for cleaning hand-touch sites, says Andersson. “However, antimicrobials can give a false sense of security since no antimicrobial substance is effective against all microbes.”

He claims that the best way to avoid cross-contamination is through hand washing. “You will only become ill if the germs gain access to your body and the primary routes that allow them to do this are via the eyes, nose and mouth,” he said.

“The most effective way of preventing yourself from becoming ill is to wash your hands - especially before preparing food and eating, after coming home from work, when you have visited the washroom and after using public transport.”

SCA manufactures Tork washroom systems including liquid soaps, alcohol hand gels and hand towels. According to Andersson hand drying with paper towels is a crucial part of any hand hygiene regime since it uses the “Catch it, Bin it, Kill it” logic.

“Paper towels have the advantage of trapping the bacteria within the towel which is then thrown away into the bin,” he said.

High-tech cleaning solutions

A range of high-tech cleaning solutions are now available for use in areas where cross-contamination is a risk says Ian McCormack, responsible for technical training and support at ServiceMaster Clean. These solutions include ionisers, chemical treatments and low-grade ozone. “Contained areas can also be treated with fogging products but these should not be used in occupied areas,” he said.

Other solutions include broad-spectrum virucidal, bacterial and fungicidal products, though these should be safe for the user and for anyone else who comes into contact with them, says McCormack. “It is also helpful if they possess some form of residual action that continues to protect.”

ServiceMaster Clean uses Hygienilac products for day-to-day sanitising. These were originally designed for coating hospitals doors and bedside cabinets and they kill pathogens by depriving them of nutrients rather than by poisoning them.  “This means that the viruses, bacteria and fungi cannot become immune to Hygienilac,” said McCormack.

However, killing pathogens is an inexact science because rigorous product testing does not take place with every product nor against every pathogen, he said. “Testing costs many thousands of pounds and for an inexpensive product may not be viable,” he said. “So an assumption is made that if a particular product kills a specific pathogen, it will also kill similar ones.”

According to OCS’s business support director Paul Thrupp, vulnerable areas for cross-contamination include reception desks, seating areas, lift buttons, public computers and public telephones.

“Typically cross-contamination occurs through hands or footwear, although certain contamination can occur through airborne viruses,” he said.

Guidelines to cleaning staff

The company’s core cleaning products are claimed to kill 99.9 per cent of viruses and bacteria, though for more complex viruses - particularly where pandemics such as avian flu are concerned - specialist products such as enzyme-based chemicals tend to be more effective, says Thrupp. And he stresses that the method used to apply cleaning products can make a major difference to the level of clean they achieve.

“Damp rather than dry dusting should be carried out to avoid the generation of dust particles,” said Thrupp. “Surfaces should be cleaned using normal detergents and hot water, and protective gloves should be used when emptying bins and waste paper baskets. Also, the hands should be washed afterwards.”

OCS issues guidelines to its cleaning staff to help them avoid catching or transmitting infections. For example, employees are advised to clean areas at risk of infection at least once a day and pay particular attention to touch points such as handles, horizontal surfaces, doors and washrooms. Hard surface cleaning should be carried out more frequently during the flu season and soft surface cleaning can be reduced to offset this.

“Microfibre materials are used extensively where cleaning needs to be carried out to a clinical sanitisation level such as in healthcare,” he said. “These are proven to be very effective for the removal of pathogens from hard surfaces.”

Fogging systems are also becoming more common for cleaning large areas within the healthcare sector, he said. These are also often used for deep cleaning the air-conditioning systems and cabins of passenger aircraft. “However, the most effective way to control and minimise cross-contamination is to adopt an adequate hand hygiene regime,” he said.

“The importance of hand washing with soap and water - and good personal hygiene - cannot be overemphasised.”