ECJ EUROPEAN Cleaning Journal

Cleaners play an important role in reducing the bacterial loading in hospitals. But are they actually part of the cross-contamination problem when moving from area to area, asks Ann Laffeaty?

The role of cleaners in our hospitals is crucial. They move unobtrusively between wards and corridors, cleaning up as they go and ensuring that all floors and surfaces are spotless.
Cross-contamination is a major issue in healthcare institutions, many of which face an ongoing struggle against healthcare-acquired infections.

So, how do cleaners avoid spreading bacteria between vulnerable patients via their shoes and their trolleys? Does their very presence represent a health risk – and are they aware of the potential dangers that cleaning in such a sensitive setting represents?

Avoiding cross-contamination in hospitals should be a top priority according to TTS Cleaning’s export sales manager Alessandro Costantini. “Operators’ hands are the main vehicle of contamination so it is of fundamental importance to avoid any direct contact with dirt,” he said.

The use of hygienic systems that allow for the disposal of dirty mops without touching them helps to prevent the spread of bacteria, according to Costantini. “Wearing gloves is also very helpful when they are changed regularly,” he said. “It is also pivotal to use a clean, new mop for each area to avoid spreading germs.”

High-risk areas need to be governed by set disinfection procedures to prevent the transmission of pathogenic bacteria, he said. “Medium to high-risk areas have to be properly disinfected to avoid any risk of cross-contamination, while low-risk areas require standard cleaning procedures,” he said.

ccording to Costantini, patients’ health can be safeguarded via a combination of effective cleaning and high-performing equipment. But conversely, a lack of procedure will often cause infections to spread. “Staff need to be trained to develop an awareness of healthcare-associated infections, while setting up supervisory systems is pivotal in order to ensure that cleaning practices are implemented correctly,” he said.

TTS provides training on cleaning procedures and recommends the use of microfibre mops in healthcare environments. “Microfibre removes up to 99 per cent of bacteria and reduces the need to use aggressive detergents and disinfectants,” he said. “This helps to lower the risks of creating disinfectant-resistant bacteria.”

Good hand hygiene is essential if cleaners are to avoid spreading bacteria in the healthcare sector, says Greenspeed marketing manager Floor Loos. “It is important they have no hand contact with their used cloths or mops while removing them from the frame,” she said.

Greenspeed’s Instruction Cloths use a folding technique designed to avoid the risk of cleaners’ hands coming into contact with dirt or bacteria. And the company’s Click’M C magnetic mopping system averts the need for the cleaner to touch the mop head since the used mop is released by pressing a button with the foot.

“To avoid spreading bacteria around, cleaners use one mop per room – or even better, one per patient,” she said.

The risk of patients becoming contaminated by a cleaner or his or her equipment is minimal in most areas of the hospital, according to Loos.

“We always advise staff to disinfect their trolleys and mop handles and to grip them with disinfectant on their hands,” she said. And the ‘rules of cleaning’ must be respected: for example: staff should clean from the top down, working from clean to dirty surfaces.”

All employees are trained in the correct use of cleaning materials as well as being taught how to avoid spreading germs, she said. “To simplify the learning process and to prevent incorrect techniques we offer training cloths so that cleaners can learn to fold them using the instructions on the cloth,” she said.

When correctly folded, Greenspeed’s training cloths produce 16 different sides. “This enables staff members to clean 16 surfaces with an unused side each time - and the cloths can be washed at least 600 times without losing their original shape,” said Loos.

Greenspeed also offers colour-coded cloths plus products that incorporate coloured ribbons. “These allow cleaners to predetermine another colour for other areas of the hospital,” she said. The company’s C-Shuttle trolleys are said to have enclosed wheels that can be easily disinfected and prevent the accumulation of dirt.

Cross-contamination threat

Bacteria and dangerous pathogens from personal contact represent a real cross-contamination threat in hospitals according to IPC’s communications director Gabriella Bianco. “Patient rooms, outpatient clinics, washrooms, operating theatres and emergency rooms represent the highest risk because these will all be attended by families and children walking in and out of rooms and crossing hallways,” she said. “Those areas will also be frequented by doctors and other members of staff tasked with patient care.

“And even trolleys and other tools designed for cleaning could be a medium for transmitting bacteria from ward to ward.”

Bacteria can easily be spread from high-touch sites such as bed rails, chairs, bedside tables, doors, windows, telephones, call bells, light switches, edges of privacy curtains and sanitaryware, she says.
All healthcare staff should follow good hygiene practices such as washing their hands with soap and water and wearing gloves, according to Bianco. “Cleaning staff should also follow strict schedules to minimise bacteria counts on all surfaces while using the most appropriate products,” she said.

Hygienic mop systems, gloves and antibacterial trolleys all help to reduce the risks, she says. The company’s IPC Healthcare Program has been specifically designed for the healthcare environment and incorporates products such as the Brix PT System, a combined cleaning and sanitisation station; and the Shark mop made from a special microfibre textile weave. This is said to enable it to absorb liquids and dirt quickly and to collect grease and organic residues. The company also offers a range of microfibre mops designed to be hygienic and easy to wash.

It is certainly possible in principle for micro-organisms to be spread by cleaning trolleys, says Kärcher trainer Klaas Matti Nolte. “However, trolleys are not taken into the rooms but must be left outside in order to prevent pathogens and other micro-organisms from being carried in,” he said.

“Of course, the presence of the cleaning staff itself poses a risk of infection - particularly for patients with a weakened immune system. For this reason when the rooms of patients suffering from an infection are cleaned, appropriate protective clothing must be worn and then disposed of properly after the cleaning task has been completed.”

In the event of an outbreak of MRSA or a similar hospital-acquired infection, this protective clothing will help to prevent pathogens from being carried to the next patient while also protecting the cleaning staff, he says.

Colour coding

Cleaning protocols in healthcare are designed to prevent the risk of cross-contamination, according to Nolte. “As a rule, prepared mop covers and cleaning cloths are used and these will have ideally already been pre-soaked with cleaning solution in the washing machine after the chemothermal disinfection wash programme,” he said. “These mop covers and cloths are then usually left for up to 24 hours and kept in sealed boxes on the cleaning trolleys.

“One mop cover should be used per sickroom in order to prevent the spread of germs. Gloves should also be changed in each room and the hands should be sanitised.”

The colour-coding of mop covers and cloths will help prevent the spread of germs, he says. “I also recommend the use of overshoes because if, for example, a patient’s pillow falls off the bed the micro-organisms from that pillow might be transferred from the patient on to the floor,” he said. “And evidence suggests that disinfection using a floor cleaning machine is effective provided that the machines themselves are properly maintained and cleaned.”

Detergent-resistant gloves, face masks and hair nets also help reduce the risk of cross-contamination on the part of the cleaner, according to Nolte. Kärcher offers a range of detergents and floor cleaning machines for the healthcare sector.

The risk of infections is reduced in those European countries where patients are screened on arrival to determine whether or not they are at risk, he says. “Fortunately this procedure is becoming more common and may help to get the situation under control,” he adds. “However, it is important that staff implement all the recommended hygiene measures since this is still a common cause of concern.”

So, have there been any recent breakthroughs in terms of reducing the spread of infections in hospitals? Or is cross-contamination avoided simply by implementing a thorough and methodical clean?

Effective cleaning

Probiotic cleaning products could be a way forward, according to Greenspeed’s Floor Loos. “Researchers in Italy have carried out a study that shows the positive effects they can have,” she said. “In one study probiotic cleaning products reduced the number of nosocomial infections by more than a half.”

Mop covers, trolleys and other accessories coated with silver ions are another relatively recent innovation that will help to achieve an antimicrobial effect, adds IPC’s Gabriella Bianco. “Technology is also coming to the rescue in the shape of the bio-luminometer,” she says. “This is an important tool for revealing whether or not there are any microorganisms growing on a specified surface, allowing teams to measure the efficiency of cleaning and the effectiveness of their cleaning protocols.”