Welcome to Professional and Technical Services (PTS) – experts in chemical disinfection for infection prevention. Our goal is to educate and provide you the latest resources related to cleaning and disinfection of environmental surfaces, medical devices and hands. As specialists in disinfectant chemistries, microbiology, environmental cleaning and disinfection, facility assessments and policy and procedure creation we are dedicated to helping any person or facility who uses chemical disinfectants.

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Friday, February 24, 2017

Do disinfectants pose health risks?

Whether we’re talking politics, religious beliefs, vaccination, science or the use of disinfectants as part of an infection prevention program, there will always be differing opinions and there will always be that polarizing personality that you either love or hate.  As a wise woman (or man) once said “there are two sides to every story and the truth lies somewhere in the middle”.

A great example of this is the use of disinfectants and their role in occupational or worked-related asthma.  According to sources I have read, more than 300 workplace substances have been identified as possible causes of occupational asthma.  These substances can be broken down into the following categories: animal substances, chemicals, enzymes, metals, plant substances and respiratory irritants.  If you’re luckier than me, I hope you’ve never experienced an asthma attack.  If you’re not familiar with asthma, symptoms start when your lungs become irritated which leads to inflammation.   This inflammation causes a restriction of the airways which makes breathing difficult.  With occupational asthma, lung inflammation may be triggered by either an allergic response to a substance or irritation of the lungs caused by an inhalation of a substance, such as chlorine.

Enter the differing opinions.  A study published in May 2016 in AJIC titled “Occupational healthrisks associated with the use of germicides in health care” concluded that the data reviewed in the study demonstrate that occupational asthma as a result of chemical exposures, including low-level disinfectants, are exceedingly rare.  However, unprotected exposures to high-level disinfectants may cause respiratory symptoms. 

On the other side of the story, a study by Rosenman et alreported that a cleaning product was at least 1 of the 3 suspected agents identified in 12% of confirmed work related asthma cases that they reviewed.  The fact that bleach was the most frequently identified product should not be all that surprising considering that bleach was recently designated an asthma-causing agent by the Association of Occupational and Environmental Clinics (Sastre 2011).   Furthermore, Quaternary ammonium compounds (Quats or QACs) also tend to be frequently identified as potential asthma causing agents due to their prevalence in numerous cleaning and disinfectant products.  Michigan’s SENSOR program published a detailed report on the link between asthma and Quats in their 2008-2009 newsletter.  The newsletter includes several case reports and a review of several peer reviewed studies completed on the subject. 

This leads me to try to figure out what the “truth” is.  I think there is enough evidence to support the fact that the use of some chemicals (including some disinfectants) can lead to occupational asthma particularly with our increased reliance on disinfectants as part of our infection prevention program.  However, I also believe that we cannot with broad strokes state that all disinfectants will cause occupational asthma.  I think there are products available on the market that meet the criteria of non-asthma inducing agents that can be used safety and effectively.

As a person with asthma, I know I can state categorically that some disinfectant actives irritate my airways more than others.  I can also state without a doubt that the method of application can also dramatically increase or decrease the level of irritation.  Perhaps the next investigation should be to look at the method of application – spray and wipe versus wiping with a cloth or pre-moistened wipe to see which method reduces the likelihood of inducing respiratory irritation.  Not to say I already know the answer, but I do know which method bugs me the least!  Wiping!  I also happen to believe that wiping is the best method of application for disinfectants to ensure even distribution of the disinfectant solution and physical friction to help lift and remove soils and bugs from the surface you are wiping.  But, I’ll let you decide for yourself!


Bugging Off!


Nicole

Friday, February 17, 2017

Do engineering and cleaning have anything in common?

Regardless of the fact that we are into the second month of 2017, for some the concept of cleaning has not progressed much past Florence Nightingale’s introduction to the concept of hygienic needs during the Crimean war in 1854.  For others however, we are looking past the mop and bucket, the cotton versus microfiber cloths, or the difference between disinfectant chemistries. Instead, we are considering change management and implementation science as ways to improve our cleaning and disinfecting practices.

Being someone who actively seeks to learn and develop processes or behaviors to improve our cleaning practices and perhaps more importantly ways that we can elevate the importance of the environmental services department from the CEO downward, I was most excited to read an article from Health Facilities Management about a new three year study that has just begun.  I am dismayed of course that I will have to wait three years to learn of the outcomes, but the fact that the study is using human factors engineering as a way to improve and optimize cleaning and disinfection practices is extremely exciting to me!

The study is aimed at using a human factors engineering approach to measure and improve patient room cleaning and disinfection processes. The study will explore work systems, tools and technologies that environmental services staff use as they go about their day.  However, the study will go beyond just the methods and process of how the work is done, it will also look at training, education and how environmental staff are valued within the hospitals organization.

After auditing 7 environmental staff clean a total of 70 rooms, the researchers noted that many surfaces were only cleaned about half of the time (or less).  They were quick to point out that missing these surfaces was not an issue of the staff being inattentive or careless, but in many cases the missed items were in use during the time they were cleaning the room and/or staff would be asked to vacate the room before they had completed their work.

While it is still in the early days of the study, it’s exciting to see that unlike the focus of many studies where the assumption is that housekeeping staff are simply not doing their jobs, this study is looking at why the job is not getting done and realizing that that there are extenuating circumstances that makes achieving 100% compliance virtually impossible…..at least by today’s methods and by today’s organization standards.  The focus on the need to have multidisciplinary collaboration at a unit level is also exciting.  If we think of the adage “it takes a village to raise a child” perhaps at the end of the three years we will realize that “it takes everyone on a unit working together” to keep the area clean.

It reminds me of my favorite definition of insanity – doing the same thing over and over and expecting different results.  Perhaps through this out-of-the-box approach to investigating the processes, tools or materials used, the training and the collaboration between disciplines working on a unit will finally get us to nirvana…..or at least a place where cleaning and disinfection can happen 100% of the time.


Bugging Off!


Nicole

Friday, February 10, 2017

Short Staff, Short Cuts

According to the National and State Healthcare-Associated Infections Progress Report released in May 2016, on any given day, about 1 in 25 hospital patients have at least one healthcare-associated infection. While the number of HAIs has decreased overall, we certainly have a long way to go.  The stats currently spewed in so many studies or reports estimate that there are 722,000 HAIs in US hospitals each year, with 75,000 patients dying during their hospitalization as a result of an HAI.  The attributed cost for these HAIs according to a 2013 study is an estimated $96-147 billion annually.


I think we can all agree there has been a significant focus on trying to reduce HAIs.  I’m sure we can all agree that there is not one single magic bullet.  Reducing HAIs is a bundled approach where we need to ensure environmental surfaces and medical devices are cleaned and disinfected, everyone cleans their hands, and antibiotic stewardship programs are put into place.   Unfortunately, we also know that hospitals need to balance their budgets.   HAIs and outbreaks are expensive.  There are times when a hospital is forced to rob Peter to pay Paul.  The ugly truth is that Environmental Services staff are often on the chopping block when it comes to having to make cut backs.

I realized it may seem logical when you are just looking at numbers on a piece of paper, but let’s think about the unintended consequences of such an action.  Does the size of the facility change?  No.  Can you cut back on cleaning and disinfection?  No, there is a plethora of data linking the fact that effective cleaning and disinfection can reduce HAIs.  What then is the reality of cutting back on the number of staff when the workload has not been reduced?  Corners get cut.  Short cuts are taken.  The result is a potential increase in HAIs.

According to a survey conducted in 2016, understaffing in environmental services is getting worse, with reports of layoffs and cuts occurring regularly.  Concerns are growing among environmental service workers that hospitals do not have the capacity and enough cleaning staff to keep key surfaces like bedrails, mattresses, taps, door handles and chairs clean.  The survey revealed a disturbing pattern of having to speed through the cleaning, being short staffed due to vacations or sick days, employees admitting to having high levels of stress and injuries occurring at work.  In fact, a large majority reported that more duties have been added to their already heavy workloads. Over half of the respondents believe the situation is unsafe.

A study from 2014 noted that cleanliness in hospitals can be characterized as less than optimal. Nearly 40% of respondents did not judge their hospital to be sufficiently clean for infection prevention and control purposes.  If we admit the truth, we know there is reams of data to support the fact that infection rates would decline and fewer people would die if we just cleaned.  The problem is determining how to apply the science and the data generated into mathematical models that can calculate the return on investment (ROI) and define what the value proposition is for supporting a fully staffed Environmental Services department.

We know that cleaning works.  We know that cleaning is time and labour intensive.  We know that having adequate staff will impact the budget.  Are we willing to risk the lives of patients when we know the harm that can be prevented by improving our cleaning and disinfection programs?  I’m hoping the answer is no.


Bugging Off!


Nicole


Friday, February 3, 2017

What does your nose tell you?

Regardless of whether you’re male or female, at some point in your childhood you likely read the book or watched the movie Cinderella.  Cinderella was overworked and forced to clean, cook and sew by her nasty step-mother and her step-sisters.  Luckily, as with all fairy tales, the story has a happy ending with Cinderella falling in love and living happily ever after, but prior to that did you ever consider what those cleaning chemicals could have been doing to Cinderella and her animal friends? 

I’ll admit, I hadn’t.  Truthfully, I don’t really think it had mattered in the movie either.  Really, my intent of using Cinderella and her friends was to ease into my dirty little secret. While I know quite a bit on the topic of cleaning and disinfection and have certainly conducted my fair share of in-service training to teach people how to clean and disinfect, I am too lazy to do it myself.  I have a housekeeper; however, unlike Cinderella’s nasty step-mother, I do not force anyone to work.  In fact, I recently had to change housekeepers as my previous one retired.  So what does this have to do with anything?

How many of you have ever reacted negatively to the smell of chemicals – too pungent, too lemony, too anything.  Have you ever had a reaction that caused respiratory irritation or any other form of distress?  While many of us know that animals have an acute sense of smell, researchers have concluded that our noses are in fact exquisitely sensitive instruments that guide our everyday life. They have found that even very subtle smells can change your mood, your behaviour or the choices you make without you even realising it. In fact, a study out of the University of Utrecht found that the hint of aroma wafting out of a hidden bucket of citrus-scented cleaner was enough to persuade students to clean up after themselves even though most had not even registered the smell.  I may have to try that with my son!

Completely opposite to making you want to clean, there is also research to show that when there has been a change in a cleaning product, regardless of how small, some people will pick up on this immediately.  Depending on the circumstance, this change in odor profile may simply require a period of adjustment to get used to the new product.  However, it is possible that some will experience chemosensory irritation (a sensation of burning in the nose, eyes, mouth or respiratory pathways) associated with the change in odor profile of a disinfectant.  The reason being is that as people become accustomed to the smell or odor profile of a product, any change in odor profile regardless of how slight a change can result in perceived irritation. Studies investigating chemosensory irritation resulting from both agreeable and disagreeable odors have found that people often report health symptoms associated with the use of a chemical at concentrations well below the concentration that is actually capable of eliciting upper respiratory tract irritation.  Because odor properties can often be detected at much lower concentrations than those capable of eliciting upper respiratory tract irritation, confusion between odor and irritation can create an obstacle during the transition to a new product. Researchers believe that the perception of a malodor elicits a stress-induced reaction and raises the concern for adverse health effects from exposure.

How many of you have chosen to change cleaning and disinfecting products in your facility only to have a rash of complaints about the odor or respiratory irritation?  People do not like change.  Even if the product you are moving to is safer for them to use, this serves as a reminder that “the nose knows” and if you want a smooth transition, we need to be thoughtful in our introduction of a new product.

You may be wondering why I even brought up my housekeeper.  I did because I have experienced the reaction to a change in products first hand.  I have gone from coming home to my house smelling clean – meaning there was no smell at all.  To a house that smells like harsh chemicals.  Sure, my place looks great, but man do my eyes and nose burn when I walk in the door and I’m pretty sure my cat loses all sense of smell for a couple of days.  I now know the next time I provide an in-service for a facility conversion, I’ll spend more time prepping the staff on the odor they can expect with their new product and I hope you will too!


Bugging Off!


Nicole