Microbiologic evaluation of microfiber mops for surface disinfection

Inactivation and/or physical removal of Candida auris from floors by detergent cleaner, disinfectants, microfiber, and ultraviolet C light (UV-C)

Contaminated surfaces may be a source of transmission for the globally emerging pathogen, Candida auris. Because floors may be a source of C. auris contamination on hands, strategies for inactivating or removing C. auris from floors were investigated. A sporicidal disinfectant and UV-C were most effective in inactivating C. auris on floors.

Update on potential interventions to reduce the risk for transmission of health care-associated pathogens from floors and sinks

Health care facility floors and sink drains and other wastewater drainage sites are universally contaminated with potential pathogens and there are plausible mechanisms by which organisms can be disseminated from these sites. However, floors and sink drains are not addressed as potential sources of pathogen transmission in most health care facilities. One factor that has hindered progress in addressing floors and sinks has been the lack of practical and effective measures to reduce the risk for dissemination of organisms from these sites. This article provides an update on some of the potential interventions being used to reduce the risk for transmission of health care-associated pathogens from floors and sinks. Practical approaches to address these sites of contamination are emphasized.

Disinfection, sterilization and antisepsis: An overview

BACKGROUND

Each year in the United States there are approximately 100,000,000 outpatient/inpatient surgical procedures. Each of these procedures involves contact by a medical device or surgical instrument with a patient's sterile tissue and/or mucous membrane. A major risk of all such procedures is the introduction of infection.

METHODS

We searched published literature for articles on the use and effectiveness of disinfectants, sterilization methods and antiseptics.

RESULTS

The level of disinfection is dependent on the intended use of the object: critical (items that contact sterile tissue such as surgical instruments), semicritical (items that contact mucous membrane such as endoscopes), and noncritical (devices that contact only intact skin such as stethoscopes) items require sterilization, high-level disinfection and low-level disinfection, respectively. Cleaning must always precede high-level disinfection and sterilization. Antiseptics are essential to infection prevention as part of a hand hygiene program as well as other uses such as surgical hand antisepsis and pre-operative patient skin preparation.

CONCLUSIONS

When properly used, disinfection and sterilization can ensure the safe use of invasive and non-invasive medical devices. Cleaning should always precede high-level disinfection and sterilization. Strict adherence to current disinfection and sterilization guidelines is essential to prevent patient infections and exposures to infectious agents.

Spatial and temporal effects on severe acute respiratory coronavirus virus 2 (SARS-CoV-2) contamination of the healthcare environment

BACKGROUND

The spatial and temporal extent of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) environmental contamination has not been precisely defined. We sought to elucidate contamination of different surface types and how contamination changes over time.

METHODS

We sampled surfaces longitudinally within COVID-19 patient rooms, performed quantitative RT-PCR for the detection of SARS-CoV-2 RNA, and modeled distance, time, and severity of illness on the probability of detecting SARS-CoV-2 using a mixed-effects binomial model.

RESULTS

The probability of detecting SARS-CoV-2 RNA in a patient room did not vary with distance. However, we found that surface type predicted probability of detection, with floors and high-touch surfaces having the highest probability of detection: floors (odds ratio [OR], 67.8; 95% credible interval [CrI], 36.3-131) and high-touch elevated surfaces (OR, 7.39; 95% CrI, 4.31-13.1). Increased surface contamination was observed in room where patients required high-flow oxygen, positive airway pressure, or mechanical ventilation (OR, 1.6; 95% CrI, 1.03-2.53). The probability of elevated surface contamination decayed with prolonged hospitalization, but the probability of floor detection increased with the duration of the local pandemic wave.

CONCLUSIONS

Distance from a patient's bed did not predict SARS-CoV-2 RNA deposition in patient rooms, but surface type, severity of illness, and time from local pandemic wave predicted surface deposition.

Comparison of Floor Cleaning and Disinfection Processes in a Research Animal Facility

Floor cleaning and disinfection are essential components of maintaining animal health status and meeting regulatory requirements in research vivaria. However, best practices for method, frequency, and evaluation techniques have not been established. Reuse of cotton string mop and bucket systems has been implicated in spreading contamination in the human hospital setting. We evaluated 4 different combinations of disinfectant and mop systems commonly used in rodent vivaria. Eight housing rooms were mopped a total of 4 times using one of the following methods: quaternary ammonium compound (QUAT) and cotton string mop (QC), QUAT and microfiber mop (QM), hydrogen peroxide disinfectant (HPD) and cotton string mop (HC), or HPD and microfiber mop (HM). ATP and RODAC samples of the floor were taken before and after mopping. The time to mop each room, floor drying time, and the amount of disinfectant used were recorded. The QC method was associated with significantly more bacterial contamination while all other methods significantly reduced bacterial contamination. The QC method performed significantly worse in reducing bacterial contamination as compared with all other methods when cotton mop heads were reused. All methods except QC significantly reduced ATP levels, with the HC and HM methods being significantly more effective at reducing ATP levels than the QC and QM methods. Costs were similar for the QC, QM, and HM methods. The results of this study indicate that reuse of cotton string mop heads with QUAT increases floor contamination while HPD is effective for up to 3 reuses. Single use microfiber mops were effective with both QUAT and HPD but did not result in more effective cleaning or disinfection than cotton string mops.

Comparing the microbial removal efficacy of new and reprocessed microfiber on health care surfaces

The Centers for Disease Control and Prevention (CDC) suggests that microfiber is preferred for environmental cleaning and disinfection given its enhanced microbial removal. There has been controversy surrounding the sustained efficacy of reprocessed microfiber, though existing literature on the topic lacks standardized laundering parameters. The present study demonstrates that reprocessed microfiber cloths and pads, laundered according to CDC laundry parameters, achieve microbial removal from healthcare surfaces that is substantially equivalent to that of new microfiber.

Disinfectants against SARS-CoV-2: A Review

The pandemic due to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has emerged as a serious global public health issue. Besides the high transmission rate from individual to individual, indirect transmission from inanimate objects or surfaces poses a more significant threat. Since the start of the outbreak, the importance of respiratory protection, social distancing, and chemical disinfection to prevent the spread of the virus has been the prime focus for infection control. Health regulatory organizations have produced guidelines for the formulation and application of chemical disinfectants to manufacturing industries and the public. On the other hand, extensive literature on the virucidal efficacy testing of microbicides for SARS-CoV-2 has been published over the past year and a half. This review summarizes the studies on the most common chemical disinfectants and their virucidal efficacy against SARS-CoV-2, including the type and concentration of the chemical disinfectant, the formulation, the presence of excipients, the exposure time, and other critical factors that determine the effectiveness of chemical disinfectants. In this review, we also critically appraise these disinfectants and conduct a discussion on the role they can play in the COVID-19 pandemic.

Hospital flooring safety and health: knowledge gaps and suggestions

Fall incidents are a leading safety concern in the hospital industry. Whereas roughening the floor surface can reduce fall risks, there remains unanswered controversies between achieving and maintaining hygienic cleaning efficiencies and adequately addressing conditions of flooring safety. Thus, the current study critically overviews the status of research and accepted practices on hospital flooring safety and healthy controls. Salient literature was identified by searching keywords and phrases within the databases of PubMed, Web of Science, MEDLINE, Scopus and ScienceDirect to find answers for the major questions on hospital floorings. A comprehensive review analysis identified that underlying causes of hospital fall incidents and flooring-attributable infectious illnesses mainly comprised floor types and materials, cleaning chemicals, materials and methods, maintenance and slip-resistance properties. Findings from this study suggest several major actions to advance hospital flooring safety and health research and practice.

Best practices for disinfection of noncritical environmental surfaces and equipment in health care facilities: A bundle approach

Over the past decade, there is excellent evidence in the scientific literature that contaminated environmental surfaces and noncritical patient care items play an important role in the transmission of several key health care-associated pathogens including methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Acinetobacter, norovirus, and Clostridium difficile. Thus, surface disinfection of noncritical environmental surfaces and medical devices is one of the infection prevention strategies to prevent pathogen transmission. This article will discuss a bundle approach to facilitate effective surface cleaning and disinfection in health care facilities. A bundle is a set of evidence-based practices, generally 3-5, that when performed collectively and reliably have been proven to improve patient outcomes. This bundle has 5 components and the science associated with each component will be addressed. These components are: creating evidence-based policies and procedures; selection of appropriate cleaning and disinfecting products; educating staff to include environmental services, patient equipment, and nursing; monitoring compliance (eg, thoroughness of cleaning, product use) with feedback (ie, just in time coaching); and implementing a "no touch" room decontamination technology and to ensure compliance for patients on contact and enteric precautions. This article will also discuss new technologies (eg, continuous room decontamination technology) that may enhance our infection prevention strategies in the future.

Disinfectant Performance of a Chlorine Regenerable Antibacterial Microfiber Fabric as a Reusable Wiper

Rechargeable disinfectant performance of a microfiber fabric grafted with a halamine precursor, 3-allyl-5,5-dimethylhydantoin (ADMH), was tested in an actual use situation in a university student dining hall. The precursor was successfully incorporated onto the surfaces of polyester fibers by using a radical graft polymerization process through a commercial finishing facility. The N⁻H bonds of ADMH moieties on the fibers can be converted to biocidal N⁻Cl bonds, when the fabrics are washed in a diluted chlorine bleach containing 3000 ppm available chlorine, providing a refreshable disinfectant function. By wiping the surfaces of 30 tables (equivalent to 18 m²) with wet chlorinated fabrics, both Staphylococcus aureus and Escherichia coli in concentrations of 10⁵ CFU/mL were totally killed in a contact time of 3 min. The disinfectant properties of the fabrics were still superior after 10 times successive machine washes (equivalent to fifty household machine washes), and rechargeable after wiping 30 tables before each recharge. Recharging conditions, such as temperature, time, active chlorine concentration and pH value of sodium hypochlorite solution, as well as the addition of a detergent, were studied. The product has the potential to improve public safety against biological contaminations and the transmission of diseases.

Evaluation of the Cleaning Procedure Efficacy in Prevention of Nosocomial Infections in Healthcare Facilities Using Cultural Method Associated with High Sensitivity Luminometer for ATP Detection

In healthcare facilities, environmental surfaces may be a reservoir of infectious agents even though cleaning and disinfection practices play a role in the control of healthcare-associated infections. In this study, the effectiveness of cleaning/disinfection procedures has been evaluated in two hospital areas, which have different risk category classifications. According to the contract with the cleaning service, after the daily ambulatory activities, the housekeeping staff apply an alcohol-based detergent followed by a chlorine-based disinfectant (2% Antisapril, Angelini; 540 mg/L active chlorine), properly diluted and sprayed. The contract provides for the use of disposable microfiber wipes which must be replaced with new ones in each health out-patient department. Surface contamination was analyzed using cultural methods and ATP detection, performed with a high-sensitivity luminometer. The values 100 CFU/cm² and 40 RLU/cm² were considered as the threshold values for medium-risk category areas, while 250 CFU/cm² and 50 RLU/cm² were defined for the low-risk category ones. Air quality was evaluated using active and passive sampling microbiological methods and particle count (0.3 μm⁻10 μm) detection. The cleaning/disinfection procedure reduced the medium bacterial counts from 32 ± 56 CFU/cm² to 2 ± 3 CFU/cm² in the low-risk area and from 25 ± 40 CFU/cm² to 7 ± 11 CFU/cm² in the medium-risk one. Sample numbers exceeding the threshold values decreased from 3% and 13% to 1% and 5%, respectively. RLU values also showed a reduction in the samples above the thresholds from 76% to 13% in the low-risk area. From the air samples collected using the active method, we observed a reduction of 60% in wound care and 53% in an ambulatory care visit. From the air samples collected using the passive method, we highlighted a 71.4% and 50% reduction in microbial contamination in the medium-risk area and in the low-risk one, respectively. The 10 μm size particle counts decreased by 52.7% in wound care and by 63% in the ambulatory care visit. Correct surface sanitation proved crucial for the reduction of microbial contamination in healthcare settings, and plays an important role in ensuring air quality in hospital settings.

Pilot Study Evaluating the Efficacy of Four Cleaning Solutions and Two Types of Mops in Delimited Areas of a Floor Contaminated with Cyclophosphamide

Background

Hazardous drugs (HD) traces are measured in most hospitals that perform environmental surveillance. Uncertainties exist regarding the cleaning agents and procedures needed to completely remove HD contamination The objective was to evaluate the efficacy of four cleaning solutions and two types of mops in reducing contamination on a floor contaminated with a predetermined amount of cyclophosphamide (CP).

Methods

This pilot study was divided into three steps: 1) the voluntary contamination of a pre-delimited area on the floor (3600cm

Results

The average decontamination efficacy of the four cleaning products used was: 99.53%±0.41 % for the detergent, 99.74%±0.15 % for quaternary ammonium, 99.86%±0.11 % for sodium hypochlorite, 99.75%±0.15 %, for hydrogen peroxide. The average decontamination efficacy for disposable mops was 99.58%±0.28 % and 99.86%±0.09 % for non-disposable mops.

Conclusion

Sodium hypochlorite, hydrogen peroxide, quaternary ammonium and a detergent applied with a disposable or a non-disposable mop were efficient to reduce the CP concentration on the floor contaminated with a predetermined quantity of CP. However, no cleaning scenarios was able to remove 100 % of CP after one cleaning session. Further studies are required to identify an optimal strategy.

High-touch surfaces: microbial neighbours at hand

Despite considerable efforts, healthcare-associated infections (HAIs) continue to be globally responsible for serious morbidity, increased costs and prolonged length of stay. Among potentially preventable sources of microbial pathogens causing HAIs, patient care items and environmental surfaces frequently touched play an important role in the chain of transmission. Microorganisms contaminating such high-touch surfaces include Gram-positive and Gram-negative bacteria, viruses, yeasts and parasites, with improved cleaning and disinfection effectively decreasing the rate of HAIs. Manual and automated surface cleaning strategies used in the control of infectious outbreaks are discussed and current trends concerning the prevention of contamination by the use of antimicrobial surfaces are taken into consideration in this manuscript.

Surface Disinfectants for Burn Units Evaluated by a New Double Method, Using Microorganisms Recently Isolated From Patients, on a Surface Germ-Carrier Model

Assessment methods of surface disinfection based on international standards (Environmental Protection Agency, European Norms, etc) do not correspond to hospital reality. New evaluation methods of surfaces disinfection are proposed to choose the most suitable disinfectant to act against clinically relevant microorganisms detected on the surfaces of burn units. 1) "Immediate effect": 6 products were compared using a glass germ-carrier and 20 recently isolated microorganisms from different patients in the intensive care units. Disinfectants were applied with microfiber cloths. Log10 reductions were calculated for colony forming units produced after 15 minutes of disinfectant application. 2) "Residual effect": the glass germ-carriers were previously impregnated with one of the studied disinfectants. After a 30-minute wait period, they were then contaminated with 1 microorganism (from the 20 above-mentioned). After 15 minutes, the disinfectant was inhibited and the log10 reduction of colony forming units was assessed. The immediate effect (disinfection and microorganism dragging and transferring from the surface to the cloth) produced complete elimination of the inoculums for all products used except one (a diluted quaternary ammonium). The average residual effect found on the 20 microorganisms was moderate: 2 to 3 log10 colony forming unit reduction with chlorine dioxide or 0.5% chlorhexidine (and lower with the other products), obtaining surfaces refractory to recontamination, at least, during 30 minutes. Two tests should be performed before advising surface disinfectant: 1) direct effect and 2) residual efficacy. These characteristics should be considered when a new surface disinfectant is chosen. Chlorine dioxide has a similar or better direct effect than sodium hypochlorite and a similar residual effect than chlorhexidine.

Control of endemic extensively drug-resistant Acinetobacter baumannii with a cohorting policy and cleaning procedures based on the 1 room, 1 wipe approach

BACKGROUND

Our institution experienced an endemic situation with extensively drug-resistant (XDR) Acinetobacter baumannii in the intensive care units (ICUs). Here, we describe the long-term results of the implementation of a screening and cohorting policy and new cleaning techniques based on a procedure that we call the 1 room, 1 wipe approach.

METHODS

We conducted a 4-year quasi-experimental study in the ICUs of an 800-bed teaching hospital. The main actions implemented were active surveillance of XDR A baumannii and cohorting of carriers and introducing new cleaning techniques intended to avoid sharing wipes between rooms.

RESULTS

XDR A baumannii significantly decreased from 132 cases in 2011 to 8 cases in 2014 and from 10.78 cases per 1,000 patient days in 2011 to 0.69 cases per 1,000 patient days in 2014. Segmented regression analysis showed that after implementing the measures, the monthly rates presented a sustained negative slope, with a significant change of -0.623 (P = .002).

CONCLUSIONS

The prompt identification and isolation of patients and adequate environmental cleaning are effective measures for reducing XDR A baumannii in ICUs. The 1 wipe, 1 room approach should be considered a standard measure for cleaning hospital facilities to avoid cross-transmission as a result of reusable cleaning wipes.

Modern technologies for improving cleaning and disinfection of environmental surfaces in hospitals

Experts agree that careful cleaning and disinfection of environmental surfaces are essential elements of effective infection prevention programs. However, traditional manual cleaning and disinfection practices in hospitals are often suboptimal. This is often due in part to a variety of personnel issues that many Environmental Services departments encounter. Failure to follow manufacturer’s recommendations for disinfectant use and lack of antimicrobial activity of some disinfectants against healthcare-associated pathogens may also affect the efficacy of disinfection practices.

Improved hydrogen peroxide-based liquid surface disinfectants and a combination product containing peracetic acid and hydrogen peroxide are effective alternatives to disinfectants currently in widespread use, and electrolyzed water (hypochlorous acid) and cold atmospheric pressure plasma show potential for use in hospitals. Creating “self-disinfecting” surfaces by coating medical equipment with metals such as copper or silver, or applying liquid compounds that have persistent antimicrobial activity surfaces are additional strategies that require further investigation.

Newer “no-touch” (automated) decontamination technologies include aerosol and vaporized hydrogen peroxide, mobile devices that emit continuous ultraviolet (UV-C) light, a pulsed-xenon UV light system, and use of high-intensity narrow-spectrum (405 nm) light. These “no-touch” technologies have been shown to reduce bacterial contamination of surfaces. A micro-condensation hydrogen peroxide system has been associated in multiple studies with reductions in healthcare-associated colonization or infection, while there is more limited evidence of infection reduction by the pulsed-xenon system. A recently completed prospective, randomized controlled trial of continuous UV-C light should help determine the extent to which this technology can reduce healthcare-associated colonization and infections.

In conclusion, continued efforts to improve traditional manual disinfection of surfaces are needed. In addition, Environmental Services departments should consider the use of newer disinfectants and no-touch decontamination technologies to improve disinfection of surfaces in healthcare.

Traditional and environmentally preferable cleaning product exposure and health symptoms in custodians

BACKGROUND

We investigated the associations between traditional and environmentally preferable cleaning product exposure and dermal, respiratory, and musculoskeletal symptoms in a population of custodians.

METHODS

We analyzed associations between symptoms and exposure to traditional and environmentally preferable cleaning product exposure among 329 custodians.

RESULTS

We observed increased odds of dermal (P < 0.01), upper (P = 0.01) and lower respiratory (P = 0.01), and upper extremity (P < 0.01), back (P < 0.01), and lower extremity (P = 0.01) musculoskeletal symptoms associated with increased typical traditional cleaning product exposure. We observed significant trends for increased odds of dermal (P = 0.03) and back (P = 0.04) and lower (P = 0.02) extremity musculoskeletal symptoms associated with increased typical environmentally preferable cleaning product exposure.

CONCLUSIONS

Fewer positive associations and reduced odds of health symptoms associated with environmentally preferable cleaning product exposure suggest that these products may represent a safer alternative to traditional cleaning products.

Microfiber cloths reduce the transfer of Clostridium difficile spores to environmental surfaces compared with cotton cloths

BACKGROUND

Environmental surfaces in health care facilities contaminated with Clostridium difficile spores can be a reservoir that contribute to transmission of hospital-acquired infections. Microfiber cleaning cloths may improve the effectiveness of surface cleaning. The objective of this study was to assess the removal and transfer of C difficile spores on surfaces cleaned by microfiber compared with cotton cloths.

METHODS

C difficile spores (approximately 4.2 log(10)/site) were applied to ceramic surfaces. Microfiber or cotton cloths were used to wipe the surfaces that were sprayed with either buffer or a nonsporicidal cleaning agent. To ensure reproducible pressure and surface contact time, a drill apparatus was used. The pressure was 1.5-1.77 N, and the total number of rotations was 10. Viable counts were used to assess the efficiency of microfiber and cotton cloths in removing and transferring spores.

RESULTS

Of 4.4 log(10)C difficile spores inoculated on a ceramic surface, microfiber and cotton cloths removed 2.4 and 1.7 log(10), respectively. Microfiber cloths containing 4.2 log(10)C difficile spores transferred 1.7 log(10) C difficile spores when used to wipe a ceramic surface compared with cotton cloths that transferred 2.4 log(10). Similarly microfiber wipes transferred fewer spores on consecutive surfaces wiped compared with cotton cloths (0.8 log(10) vs 1.80 log(10)).

CONCLUSION

The use of microfiber cloths may reduce the risk of C difficile spore transfer during surface cleaning.

Quaternary ammonium biocides: efficacy in application

Quaternary ammonium compounds (QACs) are among the most commonly used disinfectants. There has been concern that their widespread use will lead to the development of resistant organisms, and it has been suggested that limits should be place on their use. While increases in tolerance to QACs have been observed, there is no clear evidence to support the development of resistance to QACs. Since efflux pumps are believe to account for at least some of the increased tolerance found in bacteria, there has been concern that this will enhance the resistance of bacteria to certain antibiotics. QACs are membrane-active agents interacting with the cytoplasmic membrane of bacteria and lipids of viruses. The wide variety of chemical structures possible has seen an evolution in their effectiveness and expansion of applications over the last century, including non-lipid-containing viruses (i.e., noroviruses). Selection of formulations and methods of application have been shown to affect the efficacy of QACs. While numerous laboratory studies on the efficacy of QACs are available, relatively few studies have been conducted to assess their efficacy in practice. Better standardized tests for assessing and defining the differences between increases in tolerance versus resistance are needed. The ecological dynamics of microbial communities where QACs are a main line of defense against exposure to pathogens need to be better understood in terms of sublethal doses and antibiotic resistance.

Evaluation of two organosilane products for sustained antimicrobial activity on high-touch surfaces in patient rooms

A controlled trial of applying 2 organosilane-based products with antimicrobial properties to high-touch surfaces was conducted in 9 patient rooms. Cultures of surfaces obtained before daily cleaning with a quaternary ammonium disinfectant showed no significant residual antimicrobial activity of the organosilane products, although a modest reduction could not be excluded.

Decreased activity of commercially available disinfectants containing quaternary ammonium compounds when exposed to cotton towels

BACKGROUND

Health care-associated infections (HAIs) are a significant problem in hospitals, and environmental surfaces have been implicated as a source of HAIs in the hospital environment. Furthermore, Gram-negative and Gram-positive bacteria can persist on dry environmental surfaces for as long as several months. Poorly cleaned surfaces may serve as vehicles for microbes, which may then be transferred to patients.

METHODS

Cotton and microfiber towels were both tested for their abilities to bind quaternary ammonium compounds (QACs). The towels were exposed to 3 commercially available disinfectants for 0.5, 30, and 180 minutes. Germicidal spray tests (GSTs) were performed for all towel eluates in accordance with the AOAC International method 961.02. Cotton towel eluates were analyzed for QAC concentration using high-performance liquid chromatography.

RESULTS

QAC concentrations were reduced by up to 85.3% after exposure to cotton towels, resulting in failure of the disinfectants exposed to cotton towels in 96% of the GSTs.

CONCLUSION

The use of cotton towels with QAC-based cleansers should be reconsidered, particularly in hospitals where effective cleaning of the patient environment is needed to reduce the risk of HAIs.

Modern trends in infection control practices in intensive care units

Hospital-acquired infections (HAIs) are common in intensive care unit (ICU) patients and are associated with increased morbidity and mortality. There has been an increasing effort to prevent HAIs, and infection control practices are paramount in avoiding these complications. In the last several years, numerous developments have been seen in the infection prevention strategies in various health care settings. This article reviews the modern trends in infection control practices to prevent HAIs in ICUs with a focus on methods for monitoring hand hygiene, updates in isolation precautions, new methods for environmental cleaning, antimicrobial bathing, prevention of ventilator-associated pneumonia, central line-associated bloodstream infections, catheter-associated urinary tract infections, and Clostridium difficile infection.

Evaluation of the cleaning efficiency of microfibre cloths processed via an ozonated laundry system

The use of microfibre cloths for environmental cleaning has become ubiquitous in healthcare environments. However, there are issues with the re-use of microfibre cloths associated with their sterilisation and continued cleaning performance. Ozone-based laundry systems potentially provide an efficient route for the recycling of microfibre cloths; however it is necessary to demonstrate that this technology does not degrade their cleaning efficiency. The impact of an ozone-based laundry system on the cleaning efficiency of microfibre cloths was evaluated using a simulated wiping protocol. Two different types of microfibre cloth were investigated with no significant difference ( p>0.05) in the cleaning efficiency of either type being found over one, 150 and 350 wash cycles. The cleaning performance of ozone treated cloths was also not significantly different from that of conventionally laundered (250 cycles) cloths.

A hospital cleaning study using microfibre and a novel copper biocide. I. Microbiological studies

We compared the performance of Vermop ultramicrofibre cloths/mops (UMF) with water (UMF + water) or impregnated with a novel copper-based biocide (UMF + CuWB50; 300 mg/L) with standard cleaning using cotton mops/cloths with Hospec detergent. Six sites were sampled with contact plates to enumerate total viable (bacterial) counts (TVCs) and with the 3M Clean-Trace ATP assay to assess cleaning efficacy. Statistical analysis revealed that one hour post-cleaning TVC levels were lower when using UMF + CuWB50 (75% reduction) compared with standard cleaning or UMF + water (45% and 35% reductions, respectively). There was a small overall residual effect when cleaning with UMF + CuWB50 (11.7% reduction in TVCs, p = 0.209). ATP levels were reduced more with UMF + CuWB50 than with standard cleaning or UMF + water. UMF( ± CuWB50) cleaning was more effective than standard cleaning (~78% vs. 61% reduction of ATP levels, respectively). This hospital implementation study demonstrates overall superior cleaning performance of UMF, which is enhanced with CuWB50, compared with standard cleaning.

A UK district general hospital cleaning study: a comparison of the performance of ultramicrofibre technology with or without addition of a novel copper-based biocide with standard hypochlorite-based cleaning

We compared the performance of an ultramicrofibre (UMF)-based system with or without a novel copper-based biocide (CuWB50) with standard cleaning using Actichlor Plus in four hospital wards in a crossover study design, and analysed our results using univariate and multivariate statistics. We measured total viable counts (TVCs) and ATP levels in 10 near-patient sites three times weekly, one hour before and after cleaning. Standard cleaning reduced TVCs further than UMF cleaning with water, but UMF cleaning with CuWB50 produced equivalent TVC reduction. Furthermore we identified a ‘residual effect’ with UMF + CuWB50, conferring TVC suppression for up to a week after application. ATP results did not correlate with TVCs. We conclude that UMF-based cleaning with CuWB50 results in TVC reductions equivalent to hypochlorite-based standard cleaning, with the added advantages of a residual effect that keeps TVCs lower between cleaning rounds.

Promises and pitfalls of recent advances in chemical means of preventing the spread of nosocomial infections by environmental surfaces

Hard, nonporous environmental surfaces in health care settings are now receiving due recognition for their role in the spread of several types of nosocomial pathogens. The corresponding increase in the means to decontaminate such surfaces to interrupt the spread of infections is leading to the marketing of a plethora of products and procedures, including the "green" variety, with varying claims of microbicidal activity, human and environmental safety, and materials compatibility. Limitations of the existing methods to assess environmental surface disinfectants and the regulations that govern their premarket registration make objective evaluations difficult. Label claims of many such products also do not reflect the realities of field use along with a strong tendency to focus on the "bug de jour." Furthermore, whereas wiping is often an integral part of environmental surface decontamination, products meant for the purpose are rarely assessed with the physical effect of wiping incorporated. Many "green" products possess neither the spectrum of microbicidal activity nor the speed of action essential for use in health care settings. In general, "self-sanitizing" surfaces being marketed actively these days require greater scrutiny for field-relevant microbicidal activity as well as the potential to enhance microbicide resistance. The widening use of environmental surface disinfectants is also raising concerns on their human and environmental safety at many levels along with the realization that routine surface disinfection procedures in health care settings are frequently inadequate and possibly counterproductive. All this points to an urgent review of the basic procedures for assessing existing and new environmental surface disinfectants for their microbicidal activity, label claims, registration requirements, overall safety, and routine practices of environmental surface decontamination.

Lifting the lid: a clinical audit on commode cleaning

Many healthcare-associated infections (HCAIs) are preventable by infection control procedures designed to interrupt the transmission of organisms from a source. Commodes are in use constantly throughout healthcare facilities. Therefore commode surfaces are constantly handled, and any pathogens present have the potential to be transferred to not only other surfaces but also, more importantly, to patients, thus compromising patient safety. In order to examine the effectiveness and thoroughness of cleaning commodes an audit was undertaken to assess compliance with evidence-based practice. This audit demonstrates a cycle which includes defining best practice, implementing best practice, monitoring best practice and taking action to improve practice. The audit results confirmed an issue that the authors had long suspected. That is, that commodes allocated to individual patients are not always cleaned after every use. Using adenosine triphosphate (ATP) bioluminescence as an indicator of organic soiling also demonstrated that commodes that were considered clean were not always cleaned to a high standard. Implementing the audit recommendations improves staff knowledge through education, standardises cleaning procedures and ultimately improves patient safety.

Evaluation of the decontamination efficacy of new and reprocessed microfiber cleaning cloth compared with other commonly used cleaning cloths in the hospital

BACKGROUND

The aim of this study was to investigate the decontamination capacity of 4 different types of cleaning cloths (microfiber cleaning cloth, cotton cloth, sponge cloth, and disposable paper towels) commonly used in hospital in their ability to reduce microbial loads from a surface used dry or wet in new condition. All of the cloths except disposable paper towels were also compared after 10 and 20 times of reprocessing, respectively, at 90 degrees C for 5 minutes in a washing machine.

METHODS

Staphylococcus aureus (ATCC 6538) and Escherichia coli (ATCC 8739) were used as test organisms. Test organisms were then added to a test soil (6% bovine serum albumin and 0.6% sheep erythrocytes) resulting in a controlled concentration of 5 x 10(7) colony-forming units per milliliter in the final test suspension. Standardized tiles measuring 5 x 5 cm were used as test surface.

RESULTS

Microfiber cloths showed the best results when being used in new condition. However, after multiple reprocessing, cotton cloth showed the best overall efficacy.

CONCLUSION

We therefore suggest that the choice of the cleaning utilities should be based on their decontamination efficacy after several reprocessings and recommend the establishment of strict and well-defined cleaning and disinfection protocols.

Performance of ultramicrofibre cleaning technology with or without addition of a novel copper-based biocide

This study compared the bacterial removal performance of ultramicrofibre cloths and mops (UMF) moistened with water (UMF+water), with those moistened with a novel copper-based biocide (UMF+CuWB50, 300ppm) in several working hospital environments, specifically accident and emergency (A&E) and three other wards. A total of 13 defined sampling sites (10 sites per ward) were sampled in order to retrieve, culture, and enumerate total viable (bacterial) counts (TVC) for each site. We sampled 1h before, and 1 and 4h after, cleaning three times per week. The trial ran for 7 weeks. Two wards were cleaned with UMF+water for 3 weeks, and UMF+CuWB50 for 4 weeks. The reverse applied to the other two wards in a cross-over design fashion, to eliminate ward- and time-specific bias. Multivariate statistical analyses were used to establish extent and significance of any perceived differences, and to eliminate the effects of potential confounders. Cleaning with UMF+water reduced TVC on the test surfaces by 30%, whereas cleaning with TVC+CuWB50 reduced TVC by 56%. CuWB50 had two separate effects; a direct antibacterial effect (evident shortly after cleaning), and a residual antibacterial effect that lasted approximately 2 weeks. The residual effect requires regular application of CuWB50 if it is to persist. This 'real life' hospital implementation study demonstrates encouraging microbiological cleaning performance for UMF, which is further enhanced with CuWB50.

Removing bacteria from hospital surfaces: a laboratory comparison of ultramicrofibre and standard cloths

We compared the ability of ultramicrofibre-woven cloths with conventional cloths moistened with water only, for their ability to remove several types of organisms relevant to hospital-acquired infections from a variety of surfaces in hospitals. We showed that ultramicrofibre cloths consistently outperformed conventional cloths in their decontamination ability, across all surfaces, and irrespective of whether the bacteria were coated on to the surfaces with phosphate-buffered saline (PBS) or PBS containing horse serum to simulate real-life soiling. The ability of the cloths to remove bacteria from surfaces was assessed by contact plating and colony formation, and by swabbing and measurement of ATP bioluminescence. The results suggest potential for use of ultramicrofibre in healthcare environments. Further studies are required, however, to define accurately how these cloths, which are designed to be used without detergent or biocides, might be capable of safe and effective deployment and recycling in the healthcare environment.