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, June 15, 2012

Complexities in cleaning a paediatric hospital environment

Those of us working to prevent infections in paediatric hospitals typically view the environment with a high degree of suspicion.  A bundle of factors predispose infants and young children to acquire infections from organisms present on surfaces.  Their relatively na├»ve immune systems and lack of inhibition for environmental oral interaction, combined with total dependence on others for care and a tendency for us to surround them with toys and other objects for distraction, development and amusement, align the odds strongly in favour of transmission. 
The epidemiology of infections in paediatric hospitals differs from adult hospitals.  Health care associated respiratory and gastrointestinal viral infections are far more common than so called “super bugs”.  These agents are viable from environmental surfaces from hours to weeks.  When you consider how often the side rail of a crib can be inoculated with pathogens in the context of a baby with diarrhea requiring frequent diaper changes, the risk for transmission becomes very clear.  You cannot safely leave the side rail down while removing gloves and cleaning your hands, particularly when you have a heavily loaded diaper to contend with at the same time.  Diapers of sick children need to be weighed and cannot be immediately discarded, resulting in even more opportunities for transmission.     
The recent focus on Clostridium difficile infection (CDI) has reinforced what we think we know about the environment in paediatrics and has highlighted what we don’t know.  The morbidity and mortality of CDI is much lower in children than adults and yet the rate of infection when directly compared (which epidemiologists know we should not do), is generally higher.  We know that a larger proportion of infants and very young children are asymptomatically colonized with C. difficile.  For that reason, it is rare to test infants less than 12 months of age for that agent as a cause of diarrhea.  Recent studies suggest that C. difficile may be a more important pathogen in children than previously appreciated.   Until that is better understood, we need to focus on what we do know; that C. difficile may be present in the stool of more than 60% of infants and that it may easily contaminate the environment putting certain paediatric populations at risk for infection.  That knowledge places even greater importance on having sound cleaning practices in place. 
Achieving optimal cleaning requires an understanding of the complex interplay of chemistry, human factors and behavioural science involved in cleaning processes.  We are attempting to understand that better.  A recent quality improvement project (Matlow, Wray & Richardson, Am J Infect Control, 2012 Apr;40(3):260-2) has contributed to our understanding by highlighting the importance of the attitudes and beliefs of cleaning staff and how their attitudes and beliefs shape both their intent and actual attention to environmental cleaning.  We learned that it was largely their internal desire to do a good job, with underlying thoughts of “what if it were my child in that bed” that drove their practice.  We also learned that they did not always feel appreciated by staff who took for granted the work that they so highly valued.  From a practical perspective, we learned that cleaning staff, professional staff, and infection prevention and control staff had varied opinions regarding which surfaces are frequently handled and therefore require consistent attention.  We also better understand some of the tensions between family centered care and achieving high standards of cleanliness.  Families of patients are integral to the care of their children.  They are nearly always present.  While present, they bring belongings from home, needed for extended lengths of time.  We don’t always have adequate storage space and so personal belongings become clutter and impede cleaning. 
Similar findings arose from our “housekeeper for a day” program (Streitenberger, et al, 2012, poster; 8th Annual Paediatric Patient Safety Symposium) in which assorted hospital staff were partnered with a member of our cleaning staff to learn from and to work with them to clean patient rooms.  One medical leader commented that he felt immediately “invisible” to professional staff but he became more accessible to patients and families who seemed pleased to see him and perhaps more willing to initiate conversation than he was accustomed to in his usual role.  One senior leader became aware of the pride and diligence of the staff member with whom he was partnered.  She was reluctant to let him do the cleaning; not because it was a job beneath his usual position but because he wouldn't do it well enough and she would have to clean up behind him.  All of the participants gained more appreciation for the competing demands and interruptions of the cleaning role and better understood how physically demanding it could be.  Most importantly, staff could all identify simple ways in which they could make cleaning easier and how they could include cleaning staff as team members with a common goal.  At least short term, there was less clutter, better communication, fewer unnecessary interruptions, and a renewed sense of pride among cleaning staff following the program.  We intend to include this program as part of our best practice for optimal cleaning. 
On the surface (no pun intended), cleaning appears to be a straightforward task once you choose the right tools.  The complexity is only revealed when all of the many drivers associated with the practice are taken into account.  It should never surprise us that what seems to be straight forward is rarely that way in the complex environments in which we work.

Rick Wray

Rick Wray has worked at The Hospital for Sick Children (SickKids) for 30 years, the last 16 of which have been in Infection Prevention and Control.  Rick is currently the Director of Quality, Safety and Infection Prevention and Control.   Rick has been an active member in the Canadian Infection Control Community and has been involved with CHICA-Canada both as a board member and president.

Thursday, June 7, 2012

Saying Good-bye to San Antonio and APIC 2012

June is always a busy month for tradeshows.  This week was no exception as my colleagues and I attended APIC 2012 in San Antonio, TX.  I never did find the other delegate who had #0222 on their pin, but with over 2000 people walking around is it any wonder and I sure had fun walking up to people and asking what number are you?

 To say that APIC can be overwhelming is an understatement.  If you so choose, there are sessions from 6am in the morning and evening symposiums that run until 8 or 9pm (the non-educational functions run later if you know what I mean!).  There were 238 exhibitors with booths ranging from mediocre to SPECTACULAR hocking all sorts of infection prevention and control related items…and some not so infection prevention and control items.  The 9 hours of exhibit time over three days made some serious strategizing to ensure you saw what you wanted to!

 The education sessions themselves covered every topic an Infection Preventionist could want and Dr. William Rutala’s talk the opening morning was packed with people standing and sitting on the floor!  Truth be told, if they walked to the far side of the room there were plenty of chairs available!  There were two workshops focusing on disinfection: 2.5 hrs focusing on the role environmental contamination plays in transmission of HAIs and 2.5 hrs on High-Level Disinfection, Sterilization and Antisepsis.  All heady stuff if like me you’re a bit geeky on the topic if disinfection! 

 There were 17 posters is the “Antisepsis/Disinfection/Sterilization” grouping the ones of particular interest were:

• Disinfect To Protect – Developing a System to Enhance Disinfection of Patient Care Equipment.  The researchers after the initial audit found that equipment disinfection occurring only 47% of the time (that’s only slightly better than typical Hand Hygiene rates – no wonder we spread HAIs!) After the intervention the compliance increased to 74.3%, but that still leaves a whack of dirty equipment out there waiting to be used and waiting to spread HAIs!

• Hydrogen Peroxide Patient Privacy Cubical Curtain Cleaning Study.  Privacy curtains have been found to carry high loads of pathogens and as a frequently touched surface between laundering of the curtains the researchers investigated is spraying a 3% H2O2 solution would decrease the bioburden and found that in fact after just 5 mins of dry time the bio-burden significantly decreases.

• Cleaning Practices for Hospital Mattresses in Top US Adult Hospitals. The researchers conducted a survey of the top 113 Hospitals in the US to learn what products and procedures cleaning for mattresses to determine if they met the recommended cleaning practices (clean with soap and water, disinfect the surface and the rinse the surface.  Of the 69 hospitals that participated in the survey, only 6 reported rinsing off the disinfectant while only 16/69 cleaned with a detergent prior to disinfection.  Cleaning recommendations are not followed which may lead to failure in adequate cleaning and disinfection and may also damage the surface of the mattress.

 The Onsite Program with all of the abstracts can be found on the APIC Website:  http://ac2012.site.apic.org/files/2012/06/AC2012_final_onsite.pdf be sure to check them out! 

Bugging Off!