by Dr. Greg S. Whiteley — Originally published in the May/June 2020 issue of ISSA
In my last article, I had highlighted the connection between the contaminants on the floor and the superbug risks for patients in hospitals. In this article, you might wonder why we have joined schools and our seniors together.
Well, there are two good reasons. First, both cleaning contexts involve people who are at an elevated risk of serious health complications from infectious diseases and common microbial pathogens, such as the influenza virus.
Children are at risk because their immune systems are still developing. For this reason, they can be more vulnerable to serious complications with germs that would pose little threat to a normal adult.
The older members of our communities, particularly the frail and infirm, often have many other existing health conditions. These other health difficulties can add up and leave the elderly with a lower immune response to fight off germs that in the past may have caused them no more than a passing cold or flu. This is also the case with the risks associated with the COVID-19 pandemic involving the SARS-CoV-2 virus (the latest designated name for this novel coronavirus), particularly for the elderly, and especially when they are living in close proximity to each other.
The second reason to link schools and senior care is cleaning. In both the school and senior living facilities, the standards of cleaning are often poor, and cleaning is conducted without meaningful quality control. The cleaning processes, when performed badly, will simply move the germs around rather than remove them altogether. The purpose of cleaning is “to remove germs and soils,” says industry expert Dr. Mike Berry, and where cleaning simply moves the germs from one place to another, this amounts to cleaning failure, and probably negligent conduct.
The common feature in both schools and senior living facilities is the close proximity of people to each other. Also, there is the abundant frequency of commonly touched surfaces. So, if one person gets an infectious germ, then the closer proximity increases the likelihood of person to person spread, or person to surface to person spread.
Remember this simple principle: “What gets touched gets contaminated.”
So, what are the items that get touched most frequently in schools and senior living facilities? In no particular order, every surface, tap, knob, door, and object in a bathroom, everything around where people eat, most doorknobs, and all corridor and staircase railings. In schools, you can include school desks, cafeteria tables, and racking for cafeteria trays. In senior living facilities you can also include bed railings, bed trays, call buttons, and walking aids.
There is a relatively new term used in health care settings to indicate high touch objects and surfaces. That term is HTO (high touch objects and surfaces). Focusing cleaning efficacy around HTO is the best way to minimize the spread of infectious organisms via hand touch. Contaminated surfaces and contaminated hands are inevitably connected via the act of touching something. So, to clean an HTO, the key concern should always be to remove the germs and soils, as well as achieve a clean looking object or surface.
There are two key points to consider in the cleaning process. First, what is “thorough cleaning” and how can it be measured? And second, given wiping is the most fundamental activity in any cleaning process, what does “effective wiping” really mean, and can it be measured?
Remembering what Dr. Mike Berry says, that cleaning is “…the removal of unwanted germs and soils,” thorough cleaning must, therefore, include and reflect the removal of germs and soils. In the context of schools and senior living facilities, this means the removal of the germs and soils that frequent those locations, particularly on the HTO. Measuring the cleaning process involves using a fluorescent marker (FM).
Pricing drives the cleaning tendering process rather than the quality of cleanliness outcome. Where no valid scientifically based measurements are taken to assess the quality outcome, germs and superbugs can exploit the failure with both survival and infectious intent. Too often the scale of cleanliness is assessed using only a visual or sensory method (e.g. visual dust or malodorous smell), and so germs (which cannot be seen with normal eyesight), survive in biofilms or layers of soil that is left behind after the cleaning staff have passed by.
Measuring the cleanliness outcome should involve microbiology, (FM) fluorescent marker, or ATP (adenosine triphosphate) measurement. Studies have demonstrated that where the cleanliness outcome is improved, the risk of disease transmission is lowered. This applies equally to schools and senior living facilities. For schools, there is an additional benefit because both the health and educational outcomes for students are improved through better cleaning outcomes. The ISSA has an excellent existing guide for quantitative monitoring of cleaning and cleanliness in schools.
You can download the ISSA Clean Standard: K-12 Schools by visiting www.issa.com.
So, what should we do? Focus on cleaning quality in schools and senior living facilities to reduce the risk of disease transmission in these community settings. This will by necessity involve improved monitoring of the quality of the cleanliness as an objective outcome. As responsible and professional members of the cleaning community, with superbug threats on one side, and the new COVID-19 disease risk on the other (all are spread via droplet and surface contact), we need to be vigilant to ensure that what gets touched gets decontaminated.