Sins of Suboptimal Disinfection and How to Avoid Them

The headline reads, "In-Use Disinfectant Bucket Identified as Source of Contamination in Hospital." As a veteran environmental services in hospitals for over 35 years, the headline lured me into the story only to be disappointed.

The article lead reads, "Failure to adhere to recommended disinfection protocols and manufacturer’s instructions for use of a hospital-grade disinfectant led to the contamination of high-touch surfaces according to a recent?study?published in?American Journal of Infection Control?(AJIC) by John M. Boyce, MD, and Nancy L. Havill, MT, MHA." Now, I'm curious, what was the FAILURE; how could it have been PREVENTED? How many lives were placed in harm's way by this rule-breaking "disinfectant bucket"?

The story goes on to place blame on the cleaning professional who "rarely cleans patient rooms". “As a result of the investigation, the responsible housekeeper received re-education of the need to follow manufacturer’s recommended instructions for use, and the need for buckets to be cleaned at appropriate intervals and allowed to dry before new disinfectant is added,”

Let me say this. There are more than enough C-diff spores in the size of a pinhead to transmit the pathogen. When the Environmental Services technician is given the instruction to clean "visibly soiled" surfaces, are they looking for soil the size of a pinhead? No, they don't have time...they have eight more patient rooms to clean in the next two hours before they clock out. Does she have time to clean her bucket at appropriate intervals (whatever that means) and allowing it to dry before new disinfectant is added???

Services associates (I dislike and won't use the term "Housekeeper") are often relatively untrained, unmotivated, under-paid, and under-appreciated by other professional staff in the hospital.

When these issues are coupled with the severe labor shortage phenomenon happening in 2021-22, Environmental Service leaders struggle with a situation that creates an undesirable situation regarding patients and healthcare worker safety.

Blame the bucket? Blame the employee? Blame the ES leadership?

None of the above. I want to switch from blaming anybody to eliminating the environment where the chain of infection goes UNBROKEN.

If I wrote the headline for this article it might read, "Sins of Suboptimal Disinfecting and How to Avoid Them."

• Pick the right products. Make sure the products employees are using are fast, effective, responsible and sustainable. Disinfectants should have a broad spectrum of kill claims that are appropriate to healthcare pathogens. They should also have fast kill times as well as be safe to use around patients, easy to use and economical.
• Use products that are safe and pleasant. Products should be safe and not have an offensive odor that would discourage workers from using them. Hospitals should also make sure the staff understands the products being used are safe to ensure proper use.
• Validate effectiveness. A key component to any disinfection program is following up with its efficacy. Hospitals should use fluorescent marking gel with UV lights or other products to ensure disinfection efficacy and should audit housekeeping services and hospital staff to ensure compliance with the product's instructions and established processes.
• The key components of effective disinfection are a balance of the right product, evidence-based practices, educating the frontline service associates and measuring outcomes.

One of the most salient arguments for better, more thorough cleaning and disinfection is, “One well-trained, conscientious cleaning professional given the right tools and enough time to perform her job to a standard will prevent more disease than a room full of doctors can cure.” Prevention trumps a cure every time.