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Wednesday, August 10, 2011

Scuff Off!!!

I am constantly amazed by society’s obsession with floors. “Look how shiny that floor is!” “It’s so clean you could eat off of it!” “OMG did you see the scuff marks?!” I was once dragged into a store with a sales rep I was working with – I think it was a Canadian Tire store, but feel free to envision Wal-Mart, Target or any other large box store....and without a word of a lie there were no less than 5 grown men standing in a circle around 2 scuff marks no more than 3 inches long. Picture it: 5 men, 2 scuff marks and 1 highly type A female blocking an isle talking about the best way to remove these pesky little floor blemishes. Suffice it to say the conversation lasted far longer than necessary.

As Lee stated last week, we have been brainwashed to believe that clean is the smell of lemon or pine. I would like to add that we have also been brainwashed to believe that a clean floor free of scuffs equates a safe and risk free hospital environment. There are far better indicators for determining if the healthcare facility you or a loved one is about to be admitted to. Here are a few things I look for: did the nurse/doctor wash their hands before coming into my room and touching me? If I happen to come in through the ER, did the nurse on triage clean the blood pressure cuff and thermometer before slapping it on me and sticking the thermometer in my mouth? Lastly do the high touch surfaces I am most likely to stick my hands on and then inadvertently rub my eye or pop that piece of gum into my mouth after touching look clean? Let’s be realistic, at home we may follow the 5 second rule for eating something off the floor, but would you EVER eat something that has fallen onto a hospital floor? If you answered yes...you are by far, braver than I.

So here’s the truth, bacteria on hospital floors predominantly consist of skin organisms such as coagulase-negative staphylococci, or Bacillus spp.; S. aureus, Acinetobacter spp. and Clostridium spp. can also be cultured. However, the infection risk from contaminated floors is small. Gram-negative bacteria are rarely found on dry floors, but may be present after cleaning or a spill. Nevertheless, these organisms tend to disappear as the surface dries. In general, pathogenic microorganisms do not readily adhere to minimal hand contact surfaces such as floors, walls or ceilings unless the surface becomes moist, sticky, or damaged.

Numerous studies conducted over the years have proven that disinfection of floors offers NO advantage over cleaning with straight detergent with respect to improvement of a facility’s hospital acquired infection rate. A study conducted at a tertiary care hospital comparing multiple units found that the infection rates between units did not differ between those with floors cleaned with a disinfectant and those cleaned with a detergent. In fact, the one unit that did show any appreciable difference was actually one cleaned with detergent! Additionally, no differences were observed in the level of floor contamination.

Makes sense to me! Anyone in infection control should know that microorganism counts on floors reach their pre-disinfection levels within 1 to 2 hrs. This in part is probably the reasoning for infection control guidelines stating that extraordinary cleaning and decontamination of floors is unwarranted.

The next time you see a scuff on the floor I hope you’ll think twice about any association with infection control and instead ask “Hey nurse – did you wash your hands?”

Bugging (or scuffing) Off!


  1. An article I received today may make you think twice regarding survivability of pathogens on surfaces. How long do nosocomial pathogens persist on inanimate surfaces?
    A systematic review
    Axel Kramer*1, Ingeborg Schwebke2 and Günter Kampf1,3

    Results: Most gram-positive bacteria, such as Enterococcus spp. (including VRE), Staphylococcus
    aureus (including MRSA), or Streptococcus pyogenes, survive for months on dry surfaces. Many gramnegative
    species, such as Acinetobacter spp., Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa,
    Serratia marcescens, or Shigella spp., can also survive for months. A few others, such as Bordetella
    pertussis, Haemophilus influenzae, Proteus vulgaris, or Vibrio cholerae, however, persist only for days.
    Mycobacteria, including Mycobacterium tuberculosis, and spore-forming bacteria, including Clostridium
    difficile, can also survive for months on surfaces. Candida albicans as the most important nosocomial
    fungal pathogen can survive up to 4 months on surfaces. Persistence of other yeasts, such as
    Torulopsis glabrata, was described to be similar (5 months) or shorter (Candida parapsilosis, 14 days).
    Most viruses from the respiratory tract, such as corona, coxsackie, influenza, SARS or rhino virus, can
    persist on surfaces for a few days. Viruses from the gastrointestinal tract, such as astrovirus, HAV,
    polio- or rota virus, persist for approximately 2 months. Blood-borne viruses, such as HBV or HIV,
    can persist for more than one week. Herpes viruses, such as CMV or HSV type 1 and 2, have been
    shown to persist from only a few hours up to 7 days.
    Conclusion: The most common nosocomial pathogens may well survive or persist on surfaces for
    months and can thereby be a continuous source of transmission if no regular preventive surface
    disinfection is performed.

  2. The Kramer et al study is certainly one among many that discuss the ability of pathogens to survive on environmental surfaces and certainly one of the many reasons more researchers are focusing on the importance of effective environmental cleaning and disinfection to minimize the spread of HAIs. In June of last year, AJIC published a Supplemental edition (2010;38:S1 - S50) solely focusing on the role of the environment in infection transmission.

    There is no dispute on the importance of cleaning and disinfection of environmental surfaces especially high touch or hand contact surfaces. The intention behind the "Scuff Off" blog was to highlight our obsession with shiny floors, when in fact numerous studies have concluded that floors do not contribute significantly to the transmission of HAIs. This is also supported by infection control guidelines worldwide. With budget and human resource limitations, our focus needs to be placed on those surfaces that contribute to the spread of HAIs - the high touch / hand contact surfaces. Floors are certainly not in this category. In the absence of knowing if the surfaces in a room have been cleaned - as a patient or family member of a patient then our best recourse is to ask the healthcare provider to wash their hands.

    Thanks for the comment and we hope you will continue to follow our blogs.