Disinfection in Healthcare

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Objective: Mostly the disinfection procedure varies from hospital to hospital, but there are few points that need to be taken care of by the hospital policy makers. Methodology: In hospitals where the disinfection work is many times handed over to the hospital attendants who are not oriented to the infection control practices, there is increased risk of errors. There are some common errors that need to be recognized and taken care of in the hospital settings.

A special attention need to be placed on the infection control perspective by the person doing disinfection. Result: An effort has been taken to highlight the management role, common errors and mop handling technique during chemical disinfection of hospital surfaces using triple basin method. Conclusion: The regular and systematic review of the procedure related challenges will ensure the better disinfection of the hospital surfaces. The healthcare setting is predisposed to harbor potential pathogens, which in turn can pose a great risk to patients.

Routine cleaning of the patient environment is critical to reduce the risk of hospital-acquired infections HAIs [ 1 ]. Hands are contaminated either from contact with infected or colonized patients, or with their environment [ 2 ].

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Many studies quoted by CDC Guideline for Disinfection and Sterilization in Healthcare Facilities suggested that [ 3 ], Noncritical environmental surfaces frequently touched by hand e. Selection of disinfection materials and the method of disinfection should be given very careful attention. Ayliffe et al. Studies also have shown that, in situations where the cleaning procedure failed to eliminate contamination from the surface and the cloth is used to wipe another surface, the contamination is transferred to that surface and the hands of the person holding the cloth [ 5 , 6 ].

Even though disinfectants generally reduce bacterial colony counts further than detergents, efficacy is dependent on many factors including concentration, contact time with surfaces, types of bacteria or viruses, and care of mops or cloths [ 7 ]. Mops and reusable cleaning cloths are regularly used to achieve low-level disinfection on environmental surfaces. However, they often are not adequately cleaned and disinfected, and if the water-disinfectant mixture is not changed regularly e.

Westwood and Mitchell also found that standard laundering provided acceptable decontamination of heavily contaminated.

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Frequent laundering of mops e. Single-use disposable towels impregnated with a disinfectant also can be used for low-level disinfection when spot-cleaning of noncritical surfaces is needed [ 9 ].

Disinfection and Sterilization

There are some studies on the kind of mop to be used for disinfecting the surfaces. Wren et al. However they suggested further studies 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. Rutala et al. The use of a disinfectant did not improve the microbial elimination demonstrated by the microfiber system. Doll et al. Although there are number of studies which may give us guidance on the type of disinfectant to be chosen for the various surfaces EPA registered hard surface disinfection chart by NH department of education [ 12 ] and regarding the best quality of mop suitable for surface disinfection, very less literature has been noted so far contributing towards the method or exact procedure of disinfection in practical setting keeping in mind the infection control perspective.

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Patient surrounding might work as a source of infection to patient as well as health care workers HCWs. It is therefore very important to disinfect the surroundings regularly using proper technique. Mostly the disinfection procedure varies from hospital to hospital, but there are few points that need to be taken care of by the hospital policy makers. First, all unit heads should make their own list of high, intermediate, and low risk areas in the unit. The high risk areas are high touch areas, e. These areas should be disinfected every two hours.

Intermediate risk areas like nursing counter, shelves, and doors can be disinfected after every six to eight hours. However the low risk areas like store, cupboards can be disinfected once a day. Second, all hospitals have their own funds distribution. There are some hospitals where disinfectant wipes are being used for disinfection.

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These wipes are single time use and can be thrown afterwards which decreases a lot of work on part of hospital attendants or health care workers. However in some less affording hospitals still the mop and basin method is being used. It is very important that the mode of disinfection and quality of articles should be clearly communicated to all the health care workers and the availability of articles required for disinfection should be monitored and ensured.

Third, the unit should have regular classes of hospital attendants and health care workers on the technique of disinfection.

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The hospital attendants should be trained about the high, moderate and low risk areas in the unit. During terminal cleaning, when they have low, intermediate as well as high risk areas for disinfection in one go, they should start from low risk areas and then go towards moderate to high risk areas. Using this sequence they may ensure better disinfection. Several strategies have emerged that may improve the quality of assessment but introduce additional expense and other potential disadvantages.

Shaping Disinfection Programs

One such alternative is to use aerobic colony counts ACCs , which are a culture-based method for assessing environmental contamination. Use of ACCs requires the collection and processing of specimens, which increases costs and room turnaround time.

Another technique is the use of invisible fluorescent markers placed on high-touch room surfaces before cleaning with UV light inspection following cleaning. This approach provides immediate, direct feedback to environmental services personnel, but also increases costs. Bioluminescence-based adenosine triphosphate ATP assays have been developed as another alternative that offers direct, rapid feedback and provides a quantitative measure of cleanliness. However, the detected presence of ATP does not necessarily indicate viable pathogens on the tested surface.

As genomic and polymerase chain reaction PCR -based technologies become less expensive and more widespread, these may also have a role in assessing environmental contamination and effectiveness of disinfection. While routine cleaning strategies may not be expected to result in a completely sterile environment, consensus is needed on the threshold of contamination below which pathogen transmission is minimized and can be considered safe. Monitoring the operational processes associated with environmental cleaning services, and properly training and managing the staff charged with these duties, are additional elements necessary for preventing transmission of HAIs.

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Strategies for assessing compliance may include use of checklists, direct observation open or covert , and surveys of personnel and patients. Process evaluation and improvement should also consider important human factors and logistical concerns that interact with environmental cleaning procedures, including workflow, staffing, staff training and supervision, collaboration between support services and clinical staff, institutional leadership, and patient preferences.

This technical brief will explore these factors and their impact on reducing HAIs. What are the options for cleaning, disinfecting and monitoring the patient-care environment to reduce surface contamination and prevent HAIs? What elements interact with and impact the implementation of cleaning, disinfection and monitoring? The KIs will have expertise in one or more of the following areas: infectious disease and infection control, environmental disinfection, hospital epidemiology, microbiology, and the implementation of environmental services in healthcare settings.

KIs will be queried on the clinical effectiveness of disinfecting agents and modalities, and the processes and barriers associated with implementation and monitoring. They will be asked about the challenges associated with measuring patient-centered outcomes and the optimal use of surrogate measures. KIs will also provide insight into how environmental services can be monitored in healthcare settings, and the potential impact of cleaning strategies on operational factors such as workflow and patient flow.

KI input will be helpful for informing GQ 1, 2 and 4. KI input will also be used to refine the systematic literature search, identify grey literature resources, provide information about ongoing research, confirm evidence limitations, and recommend approaches to help fill these gaps. Table 1 presents potential questions that would be asked to the KIs.

Grey literature will be most helpful for addressing recently emerging technologies, and identifying important contextual factors such as relevant federal regulations, and staff training and management policies. Finally, input from the KIs will be used to identify other grey literature sources.

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Published literature will be used to answer GQ 1 and 3. Searches will cover the literature published from January 1, through This timeframe is likely to include contemporary disinfection technologies and monitoring approaches, while excluding strategies that are no longer in use. Additionally, significant advances in hand hygiene and other infection control protocols have emerged during approximately the past twenty-five years.

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Older studies may not reflect these important improvements in the clinical environment. Search dates may be adjusted based on the quantity and quality of the available literature. Appendix 1 presents a sample search strategy.