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Tuesday, September 17, 2013

Cleaning and Disinfection Works!

The fall tradeshow and conference season is in full swing.  As I write this blog I am waiting for the opening ceremonies of Exchange 2013 (Association for the Healthcare Environment's (AHE) annual conference).  Could there be a better place to learn about cleaning and disinfection than a convention with delegates whose day to day responsibility is environmental hygiene?

I am not certain what I find more concerning at tradeshows; delegates running from booth to booth in search of a knight in shining armour (aka the next silver bullet) or the noise permeating from vendors as to why their product is the answer to every facilities  problems.  I wonder sometimes if in today's society where we see technological advancements as the answer to everything if we forget that sometimes getting back to basics can in fact improve outcomes as much (OR BETTER) than trying to implement some new fangled gizmo.

For that I would like to applaud Curtis Donskey and his research team for the study they published in ICHE titled "An Environmental Disinfection Odyssey: Evaluation of Sequential Interventions to Improve Disinfection of Clostridium difficile Isolation Rooms".

The research team conducted a prospective study that included three interventions: 1) the use of fluorescent markers applied to high-touch surfaces in patient rooms to provide monitoring and feedback on thoroughness of cleaning; 2) utilization of an automated ultraviolet (UV) radiation device as a complementary disinfection strategy used after cleaning; and 3) an enhanced disinfection process composed of a dedicated daily disinfection team and a process requiring supervisory assessment and clearance of terminally-cleaned C. difficile infected rooms. The study was designed in such a fashion that each strategy built on the previous one. 

In order to determine the effectiveness of the interventions, environmental cultures were obtained from rooms contaminated with C. difficile after cleaning and disinfection.  The first intervention using  fluorescent markers saw modest improvement in the disinfection of high-touch surfaces over traditional cleaning practices (57 percent versus 67 percent).  When UV devices were introduced in the second intervention there was a further reduction in the percentage of positive cultures, but C. difficile still was present in 35 percent of rooms.  However, the impact from implementing an enhanced cleaning and disinfection team dramatically improved the outcome by reducing positive cultures to 7 percent!

What?!  Did I just read that improving cleaning worked better than implementing a new fangled gizmo that we were hoping would be the answer to all of our environmental hygiene problems? 

Yup!  As the study concluded "Ultimately, disinfection was dramatically improved through formation of a dedicated daily disinfection team and implementation of a standardized process for clearing CDI rooms."

I still look forward to walking the AHE Exhibitor hall and picking up the materials on all of the latest and greatest products, but I will certainly make sure I take the time to wade through the noise of what I heard from the sales reps to make my own informed decision on what I think is the latest and greatest advancement to environmental hygiene.   I hope for those of you reading this blog, you'll go back and take a look at what your environmental services team is doing.  Perhaps you already have your knight in shining armour, he may need some polishing but perhaps you've had the answer to your environmental hygiene problems under your roof the entire time.   Let's go back to basics and remember that cleaning and disinfection does and can work.  We just need to support our environmental services staff and promote them for the heroes they really are!


Bugging Off!

Nicole


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