The ugly truth is despite our best efforts hospital associated infections (HAIs) continue to occur. Thanks to improved efficacy testing methods, Chemical manufacturers have certainly done their part in developing disinfectants that can kill virtually any pathogen known to man. Environmental Services has worked diligently to implement these products, train their staff and ensure through the use of cleaning validation tools that we are in fact cleaning the surfaces. As we know that contaminated hands are still likely the largest contributor to transmission, Infection Prevention and Control has put a strong focus on Hand Hygiene in order to improve compliance rates.
Why then are we still seeing transmission?
Aside from the fact that Hand Hygiene rates are still dismal, I think the unfortunate truth is we still are not cleaning (aka killing bugs) effectively. By this, I am not meaning that our Environmental Services team is doing a poor job of cleaning. Regardless of country or region, what do we all have in common? I think we can agree that would be limited or dwindling budgets. We are all asked to do more with less. BUT, when it comes to effective cleaning and disinfection we need both the appropriate amount of time and the right number of people to do it. Cutting back on time and people forces staff to cut corners and cutting corners in the healthcare world leads to adverse patient events (e.g. HAIs).
Now go and read the article published in AJIC by Schmidt et al (AJIC 2012;40:907-912). This research team investigated the bacterial burden associated with bed rails and how disinfection helps to minimize the bacterial burden thereby reducing the chance for transmission. Makes perfect sense doesn’t it? We know that cleaning and disinfection reduces pathogens on environmental surfaces which has a direct impact on hand contamination... etc, etc... As expected, the results showed that after cleaning and disinfection the microbial burden found on the bed rails was reduced by at least 95%. That’s pretty darn good!
However, they also looked at what happens to the bacterial burden after disinfection took place. Within 6.5 hrs after cleaning, the bacterial burden had rebounded back by 30 – 40%. In fact, when using a standard of 250 CFU/100 cm as the level of contamination considered “safe”, within 2hrs after cleaning the contamination on the bed rails exceeded that arbitrary number. The overall contamination rate was still lower than before the bed rails were cleaned but over the course of 6.5hrs there was a whole whack of reproducing going on!
Another interesting tidbit is that the researchers compared the results of a standard Quat with a 10-minute contact time to a Quat-Alcohol with a 3-min contact time. And yes, it is true, the faster the contact time the better the kill will be, but in the end bacteria reign supreme!
Let me ask you this. What is the definition of INSANITY? According to Albert Einstein it is doing the same thing over and over again and expecting different results. If our cleaning schedule allows only for Environmental Services to clean patient rooms once per day and while we know this will reduce the environmental bioburden but we also know by the time we get back to clean that same room the next day we are basically back to square one are we insane? Perhaps the answer to solving HAIs is in fact increasing the frequency of cleaning. The more we clean, the more we remove the environmental bioburden which will have a direct impact on hand contamination and HAI transmission. If we follow the data presented in the study, the optimal frequency between cleaning would be every 3 hrs. That may be a bit hard to get buy in for, but, I do know of one facility that has increased their EVS budget to allow for their cleaning staff to clean ALL high touch surfaces twice, yes TWICE, per day. I’ll be sure to let you know what impact they are seeing to their HAI rates.
In the meantime, who’s brave enough to go ask for more money in order to hire more cleaning staff and increase the frequency of cleaning?