ECJ EUROPEAN Cleaning Journal

Cleaning for patient health and safety - a ‘blueprint’ for enhanced hygiene and infection prevention in healthcare, food and beyond through product development based on science, validation and engagement with the market.

Healthcare-associated infections (HCAI) persist, despite increasing concern and resources allocated to their control. The relative contribution of the environment to HCAI is under increasing scrutiny. It is clear that some if not most pathogens can contaminate and persist in a viable state in the hospital and food processing environments for weeks if not months. Many outbreaks have been attributed to such environmental sources.

The physical forces that determine the relative ability of different types of cleaning methods to remove microbiological, chemical residue and particulate matter from surfaces are complex and not easily defined. Conventional physical forces such as cloths, mops and wipes are not considered always sufficient to completely remove bacteria from surfaces.

Certain microorganisms are known to have effective ‘survival’ characteristics including robust attachment to surfaces and some demonstrating acquired resistance to chemical disinfectant formulations and concentrations in current use. Of increasing concern to clinicians are the studies that indicate genetic information is being transferred between microorganisms and environmental disinfectants, driving resistance to essential front line clinical antibiotics.

The need for agents with disinfectant properties presents its own environmental impact problems, as antimicrobial compounds containing halides, or oxygen releasing compounds (such as peroxides), or quaternary ammonium compounds are harmful to health, degrade the built environment, and are implicated in driving antimicrobial resistance, respectively. Enhanced removal of particulates such as bacteria and spores from surfaces without having to resort to potentially toxic and destructive biocidal agents would therefore be advantageous not only to local ecology, but also in reducing or eliminating damage to the structural surface integrity of clinical and patient equipment and of the building itself.

Equipment such as patient mattresses, commodes, electronic keypads and surfaces made from stainless steel and plastics are all susceptible to premature deterioration as a result of residual chemical action.

Physical removal of dirt and bacteria from the hospital environment usually involves the passage of cloths, wipes or mops, across surfaces.  In recent years a new generation of cleaning textile produced with microfibre has been successfully introduced into healthcare cleaning practice. The microfibre contains positively charged fibres which remove soil and microscopic particles by a combination of static attraction, capillary adsorption and entanglement action.

Microfibres also conform better to surfaces containing small abrasions invisible to the naked eye, and surfaces manufactured with textured or delustered finish in which bacteria might lodge and remain after passage of a conventional fibre cloth or non-woven wipe.

Studies conducted at University College London Hospitals (UCLH) Dept of Microbiology, commissioned by the Department of Health concluded that microfibre materials and steam cleaning have a proven ability to raise levels of both aesthetic and microbiological cleanliness, particularly when combined together as an integrated cleaning programme. This research was published in 2007: An Integrated Approach to Hospital Cleaning: Microfibre and Steam Cleaning Technology.

Two-step process

The initial study commission was based on microfibre alone. However during ward based trials, researchers identified that the aggressive cleaning action of the microfibre cloths and mops revealed that many surfaces carried large residue deposits which were difficult to clean in the initial introduction of microfibre cleaning. The result was the ‘sticking’ of the microfibre to the surface, resulting in excessive effort required by cleaners and complaints of sore muscles and lower back pain.

Concurrent studies of steam cleaning techniques revealed the ‘deep clean’ power of dry steam vapour that would penetrate these same surface residues and reduce the adhesion of the soil to the surface, allowing for rapid and consistent removal.

The conclusion was made that a two-step process of steam vapour cleaning had significant synergistic advantage by restoring the surface to a clean condition which could then be effectively maintained using microfibre and water alone, thus eliminating the need for surfactants or chemical agents.

This method of restoration cleaning was employed broadly in the National Health Service (NHS) Hospital Deep Clean programme directed by the UK government in 2008/9. The NHS studies of microfibre and steam cleaning utilised equipment produced by OspreyDeepclean, a UK manufacturer with a reputation for industrial and food sector cleaning technology. Many of the steam delivery tools were ideal for large scale commercial kitchen environments but not validated for use in healthcare.

This need for validation initiated a two-year development programme of original steam tool design and validation for efficacy, patient safety and productivity in the healthcare setting. Of particular initial concern was the characteristic of a pressure spray of steam vapour and the creation of a harmful dispersion or aerosolisation of contaminants from the treated surface.

European norm standards did not exist for this type of validation so appropriate test protocols were needed and subsequently developed by TNO, The Netherlands Research Centre for Life Sciences in Zeist. This involved two-stage research studies conducted within TNO Clean Room microbiology laboratories followed by ward simulation studies at UCLH in London.

The original design concept of the tools was based on analysis of typical patient environment equipment and high contact hand touch points. Tool prototypes were developed to clean these specific healthcare surfaces. An additional design consideration was the integration of microfibre as an integral component of the tool. This provided for a concept of total removal by emulsification and removal of contaminant in one process. The design objective in the validation of the OspreyDeepclean system was based on proving effective removal of both soil and microorganisms utilising an ergonomic ‘wiping’ technique.

Extensive testing of the tools for aerosolisation and dispersion followed, with the conclusion that no hazard was expected with correct tool selection and correct cleaning technique specified for each cleaning task.

Several critical values were defined within the studies to endorse the safety and performance of the OspreyDeepclean Healthcare Hygiene system. The quality and flow of dry steam vapour particles was a vital factor. With this knowledge, OspreyDeepclean proceeded to design a Healthcare Steam Machine – the ProVap Steam and Vac system. This combined the application of steam and microfibre deep cleaning with steam and vacuum restoration cleaning.

A range of applications followed from this development and is now documented within the Healthcare Cleaning and Decontamination Training Manual containing standard operating procedures for each environmental cleaning task.

In 2009, The Department of Health HCAI Technology Innovation Programme awarded OspreyDeepclean the award for new technology providing greatest contribution to enhancing the cleanliness of the hospital environment. Concurrently Health Facilities Scotland (HFS) launched the OspreyDeepclean technology nationally to include all health boards and ambulance services.

Successful implementation

Following on from the HCAI award the HCAI programme awarded OspreyDeepclean  showcase research funding to validate  practical implementation for successful implementation of Dry Steam Vapour cleaning in UK hospitals. The Durham & Darlington NHS Foundation Trust provided ward study access within elderly care, where challenges of diarrhoea and vomiting, seasonal illness, and Clostridium difficile infections were of particular concern.

The final results from the Department of Health are unpublished at the time of writing, however periodic review of the trial while underway indicated that the microbiology results were consistent with the TNO /UCLH trials and, from an operational perspective, patients, nurses and cleaning staff all approved of the system, offering no objection to the method of daily and deep cleaning.

Similar ward based studies have been successfully conducted in University and Ministry of Health hospitals in France, Germany, India, UAE, Saudi Arabia and Malaysia. Results reported have been consistently successful in both cleaning and terminal decontamination of patient environmental surfaces and equipment tested.

OspreyDeepclean Dry Steam Vapour technology is compatible with standard chemical disinfection practices, effectively neutralising the damaging effects of the chemical following disinfection activity.

To support the delivery of good practice and consistency of optimal results OspreyDeepclean has developed a full training programme, specifying standard operating procedures for each cleaning and decontamination task. This has now been complemented by OspreyFrance with the introduction of web-based E-learning tools.

Current research developments include the introduction of a new Steam and Vac professional machine which has been engineered to reduce its size and weight to accommodate the need for fast response ward based and nursing home applications. The new equipment is compatible with the full Healthcare range of tools.

The latest new microfibre cleaning systems recently introduced by the group have changed the horizon for enhanced cleaning performance, productivity and economic benefit. Lightweight microfibre which reduces washing costs and environmental impact by up to 80 per cent, fully disposable microfibre, a new microfibre system that is fully compatible with current disinfectant standards and a new design in microfibre ‘fluid’ mopping systems that ergonomically incorporate a self-dosing disinfectant through the mop head.

Validated procedures

OspreyDeepclean is also actively engaged in working with numerous original equipment manufacturers of healthcare, clinical and patient equipment. These studies are designed to provide validated standard operating procedures for proprietary equipment together with robust cleaning and decontamination specifications for the training of end users. This collaboration with OEMs has allowed for thorough investigation of the sites of microbial contamination and potential reservoirs influencing the incidence of nosocomial infection.

The company was also a successful bidder in the Department of Health Small Business Research Industry (SBRI) research and development competition for a novel hand hygiene technology. The work has now moved to phase two of the original design of automated hand hygiene systems for healthcare workers with all the scientific validation being completed by Campden BRI, a leading food research centre for Europe, based in Chipping Campden, England.

OspreyDeepclean is one of the Proventec plc group of companies, which also include Frank of Germany, and Contico UK. The shared expertise of the group is forging ahead in new product and performance enhancement technologies for both the healthcare and food manufacturing industries.

Altogether, the Proventec Group of companies is taking health and hygiene protection to a higher level. The future is clean and safe.