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Microbiologic evaluation of microfiber mops for surface disinfection
Abstract
Recently, health care facilities have started to use a microfiber mopping technique rather than a conventional, cotton string mop to clean floors.
The effectiveness of microfiber mops to reduce microbial levels on floors was investigated. We compared the efficacy of microfiber mops with that of conventional, cotton string mops in 3 test conditions (cotton mop and standard wringer bucket, microfiber mop and standard wringer bucket, microfiber system). Twenty-four rooms were evaluated for each test condition. RODAC plates containing D/E Neutralizing Agar were used to assess "precleaning" and "postcleaning" microbial levels.
The microfiber system demonstrated superior microbial removal compared with cotton string mops when used with a detergent cleaner (95% vs 68%, respectively). The use of a disinfectant did not improve the microbial elimination demonstrated by the microfiber system (95% vs 95%, respectively). However, use of disinfectant did significantly improve microbial removal when a cotton string mop was used (95% vs 68%, respectively).
The microfiber system demonstrated superior microbial removal compared with cotton string mops when used with a detergent cleaner. The use of a disinfectant did not improve the microbial elimination demonstrated by the microfiber system.
... More recently, microfiber has been introduced as an alternative for better cleaning in health care facilities. 11 The structure of microfiber cloths is different from that of cotton because the microfiber has a larger surface area per centimeter. 12 Microfiber has been shown to be an innovative tool to remove and retain dust, particles, and fluids from surfaces 13 more efficiently than cotton wipes. ...
... 12 Microfiber has been shown to be an innovative tool to remove and retain dust, particles, and fluids from surfaces 13 more efficiently than cotton wipes. 11 The role of microfiber cloths in environmental cleaning within the health care setting has been reviewed in a Provincial Infectious Diseases Advisory Committee document. 13 They point out the need to ensure the chemicals used for cleaning and disinfection are compatible with the microfiber cloths used and that reprocessing of microfiber cloths does eventually reduce their efficacy. ...
... 10,11,14e16 As such, a new microfiber cloth should be used in each room to prevent the transmission of microorganisms between different patient care areas. 11 To prevent microbe transfer, it may also be necessary to change cloths between different areas within the same room or use a folding technique as described by Bergen et al. 16 To reduce the risk of microbial spread, the current Canadian guidelines 13 recommend using a disinfectant agent for patient care areas. One of the greatest challenges in terms of environmental cleaning is the presence of Clostridium difficile spores. ...
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.
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.
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)).
The use of microfiber cloths may reduce the risk of C difficile spore transfer during surface cleaning.
Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
... The method of application of any disinfectant including QACs is important to ensure the proper dosage. For example, the effective dose of the QAC can be compromised by combination with cotton mops and cleaning towels (19,20). QAC concentrations can be reduced by 50 to 83% by cotton and microfiber cloths (20,21). ...
... For example, the effective dose of the QAC can be compromised by combination with cotton mops and cleaning towels (19,20). QAC concentrations can be reduced by 50 to 83% by cotton and microfiber cloths (20,21). Thus, it is important that proper concentrations, as indicated on product labels, be used and monitored. ...
... While it is often implied that their continued use will result in the development of resistance, this is not the case. The nonspecific action of QACs makes the development of resistance unlikely (22), and several recent reviews support this conclusion (20,(23)(24)(25). The multitarget nature of QACs means that mutation within a single target is unlikely to result in a treatment failure. ...
Quaternary ammonium compounds (QACs) are among the most commonly used disinfectants. There has been concern that there widespread use will lead to the development of resistant organisms and 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 in bacteria 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 are available on the efficacy of QACs relatively few studies have been conducted to assess efficacy in practice. Development of better standardized tests for assessing and defining the differences between increases in tolerance vs. resistance are needed. The ecological dynamics of microbial communities where QACs are a main line of defense against exposure to pathogens needs to be better understood in terms of sub-lethal doses and antibiotic resistance.
... Les microfibres sont des filaments extrêmement fins de titre inférieur ou égal à 1 denier (c'est-à-dire qu'un filament de 9 000 mètres ne pèse pas plus d'un gramme). La structure particulière des microfibres, leur diamètre micrométrique et leurs propriétés électrostatiques confèrent aux tissus qui en sont composés la capacité de piéger la poussière et les microbes plus efficacement que les chiffons ou balais à franges en coton traditionnels; cela est probablement attribuable à la grande surface développée et à la grande capillarité des tissus en microfibres 94,95 . Leur capacité d'absorption d'eau, leur perméabilité, leur résistance aux tâches et leur autodéfroissabilité peuvent varier selon le tissage et la composition des fibres. ...
... Les fibres ne se sont pas avérées microbicides par elles-mêmes, mais elles ont fait preuve d'une efficacité de nettoyage considérable en éliminant physiquement les microbes et débris organiques des surfaces [95][96][97] ...
... Bien que les chiffons en microfibres soient plus coûteux que ceux en coton, une étude de cas de l'Agence de protection de l'environnement des États-Unis montre que l'emploi de balais à franges en microfibres plutôt que de balais à franges traditionnels par les services de nettoyage hospitaliers permet d'économiser du travail, de l'eau, des produits chimiques et de l'électricité 99 . Cependant, les microfibres peuvent subir des dommages réduisant leur efficacité, notamment sous l'effet de la chaleur (hautes températures de traitement des machines à laver industrielles), de certains désinfectants (comme l'eau de Javel) et des assouplissants 95 ...
... Due to the unique structure of the fibres, micrometre diameters, and electrostatic properties, the fabrics made from microfibres have an ability to trap dust and microbes more effectively than conventional cotton cloths or mops; this is likely attributed to the high surface area and capillary effect of microfibre fabrics. 94,95 Depending on the weave and composition of the fibres, properties of water absorption, permeability, stain-resistance, and wrinkle-resistance can vary. ...
... The fibres themselves have not been shown to be microbicidal, but have been shown to demonstrate considerable cleaning efficacy, by physical removal of microbes and organic debris from surfaces. [95][96][97] For example, microfibre cloths (with water) have been documented to reduce S. aureus, E. coli, and Clostridium difficile spores on hard surfaces, by an average of 1 to 3 logs. 97,98 However, it is difficult to make general statements regarding efficacy due to the lack of standardized testing methods and manufacturing parameters for microfibre cloths. ...
... 99 However, the cleaning efficacy of microfibre is reduced through damage that can be caused by high heat (e.g., process temperatures of industrial washing machines), some disinfectants (e.g., bleach), and fabric softeners. 95,98,99 In addition, studies have emphasized that the lack of antimicrobial properties allows for the potential for cross-contamination or recontamination of subsequently cleaned surfaces if used with water alone (i.e., transmission of diseases in institutional and food processing settings). 88,96,100,101 Evidence Gaps ...
... For example, microfiber mops and cloths have been shown as effective and safe alternatives to traditional rag mops, decreasing the use of harsh chemical cleaners, and potentially reducing back pain and injury from water buckets and mops. 7,[21][22][23][24] An entire building and its operational design needs to be considered for environmentally friendlier cleaning strategies. This may range from choosing surface materials that are easy to maintain and clean with the greenest product available to minimizing patient and worker exposure to cleaning and disinfecting products. ...
... 103 Rutala and colleagues showed that microfiber mops with a regular detergent cleaner demonstrated superior microbial removal compared with cotton string mops (95% vs 68%, respectively). 24 In general, it is difficult to find comprehensive examples of green cleaning efforts in healthcare facilities (see Appendix B). ...
... Microfiber mops demonstrated superior microbial removal compared with cotton string mops (95% vs 68%, respectively). 24 The microfiber mop is lightweight, compact, and offers ergonomic, infection prevention and control, as well as inventory management benefits compared to a conventional mop and bucket system. In microfiber mopping, a fresh cleaning pad soaked in cleaning solution is used for each room. ...
... Microfibre products have been shown to give good performance under practical conditions in a number of studies with and without the use of biocides (Rutala et al, 2007;Hamilton et al, 2010;Wilson et al, 2011). In a 24-room study based in a general surgery ward (Rutala et al, 2007) MF mops demonstrated superior microbial removal (27% improvement) efficiency to cotton string mops when used in conjunction with a detergent. ...
... Microfibre products have been shown to give good performance under practical conditions in a number of studies with and without the use of biocides (Rutala et al, 2007;Hamilton et al, 2010;Wilson et al, 2011). In a 24-room study based in a general surgery ward (Rutala et al, 2007) MF mops demonstrated superior microbial removal (27% improvement) efficiency to cotton string mops when used in conjunction with a detergent. The observed difference was not evident when both types of mop were used with a QAT based detergent (Rutala et al, 2007). ...
... In a 24-room study based in a general surgery ward (Rutala et al, 2007) MF mops demonstrated superior microbial removal (27% improvement) efficiency to cotton string mops when used in conjunction with a detergent. The observed difference was not evident when both types of mop were used with a QAT based detergent (Rutala et al, 2007). A seven-week, four-ward, crossover trial (Hamilton et al, 2010) demonstrated that moistened MF cloths were able to generate a significant reduction of total viable (bacterial) counts (TVC) in the region of 30%, and in conjunction with a Evaluation of the cleaning efficiency of microfibre cloths processed via an ozonated laundry system PN Humphreys 1* , J Hook 2 , S Rout 1 1. ...
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.
... On this basis, three different microfibre cloths and a disposable cloth were selected for the present study. According to some other studies, the effectiveness of microfibre cloths in removing microbial soil from surfaces is better than the cleaning efficiency of cotton or non-woven cloths (Nielsen et al., 2002;Rutala et al., 2007;Toiviainen-Laine et al., 2009). Bergen et al. (2008) demonstrated that the removal of different bacteria from the surface to microfibre cloths varied greatly. ...
... Bergen et al. (2008) demonstrated that the removal of different bacteria from the surface to microfibre cloths varied greatly. According to Rutala et al. (2007), effective laundering is essential to mitigate the contamination risk from reusable microfibre cloths, because micro-organisms are entrapped (but not inactivated) within the microfibre weave. In the study by Rutala et al. (2007), the use of a disinfectant did not improve the microbial elimination from surfaces demonstrated by the microfibre system, but it improved the elimination achieved when a conventional string mop was used. ...
... According to Rutala et al. (2007), effective laundering is essential to mitigate the contamination risk from reusable microfibre cloths, because micro-organisms are entrapped (but not inactivated) within the microfibre weave. In the study by Rutala et al. (2007), the use of a disinfectant did not improve the microbial elimination from surfaces demonstrated by the microfibre system, but it improved the elimination achieved when a conventional string mop was used. The International Scientific Forum on Home Hygiene (IFH) is an organization which gives recommendations dealing hygiene in the domestic environment. ...
Abstract The objective of this laboratory study was to obtain general background information concerning professional cleaning in private domestic homes. The specific aim was to examine the effect of storage and washing of dirty cloths on their hygienic status. The effect of storage on the number of Staphylococcus aureus bacteria in cleaning cloths was examined using current or potential materials for professional cleaning in private homes. The bacterial content increased in microfibre cloths in some cases during a normal working day (8 h storage), and more clearly after 16 h or 48 h of storage. Disposable fibre cloths did not promote the growth of microbes as well as microfibre cloths. The effect of detergents on the hygienic status of cleaning cloths was unclear: some cleaning agents appeared to enhance the growth of bacteria, while others did not. In many cases, organic substances, i.e. protein added to the cloths, enhanced the growth of microbes. Washing of microfibre cloths at 60°C reduced the numbers of bacteria on the cloths but did not remove them entirely. Storage of dirty cloths before washing will probably cause difficulties in the proper washing of the cloths, and thus negatively affect their capacity for hygienic results in cleaning surfaces, as well as presenting a risk to the safety of the worker. Cleaning cloths should be washed as soon as possible after use: washing after each working day, at the latest, is recommended. Furthermore, cleaning cloths should be selected for professional use to allow washing at hot temperatures. The findings of this study could be used for training in professional home cleaning. They also provide valuable information for other branches of cleaning, including consumer use in households.
... It is well established that effective hand hygiene practice reduces the spread of bacteria that cause HAIs in hospitals, and the beneficial role of cleaning is also now becoming clear (Dancer, 2009). Effective removal of bacteria from the environment using classical cloth/mop-based cleaning requires disinfectants if pathogens are to be consistently and effectively removed and/or neutralised (Rutala et al, 2007;White et al, 2007). ...
... Microfibre (MF) materials make a significant difference to the effectiveness of surface cleaning (Moore and Griffith, 2006;Nilsen et al, 2002;Wren et al, 2008), and MF mops have been shown to be more effective at microbial removal from surfaces in hospital wards than string mops (Rutala et al, 2007). However, MF cloths and mops become contaminated during cleaning and this can lead to the spread of viable bacteria (Bergen et al, 2009). ...
... Taking the entire study into consideration, the pre-clean median RLUs with UMF + water/CuWB50 were equivalent to those post-clean with standard cleaning. Several groups have reported that MF and UMF products are very effective at removing dirt or soil from surfaces (Moore and Griffith, 2006;Rutala et al, 2007;Wren et al, 2008), and the present study confirms this view. ...
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.
... The method of application of any disinfectant including QACs is important to ensure the proper dosage. For example, the effective dose of the QAC can be compromised by combination with cotton mops and cleaning towels (19,20). QAC concentrations can be reduced by 50 to 83% by cotton and microfiber cloths (20,21). ...
... For example, the effective dose of the QAC can be compromised by combination with cotton mops and cleaning towels (19,20). QAC concentrations can be reduced by 50 to 83% by cotton and microfiber cloths (20,21). Thus, it is important that proper concentrations, as indicated on product labels, be used and monitored. ...
... While it is often implied that their continued use will result in the development of resistance, this is not the case. The nonspecific action of QACs makes the development of resistance unlikely (22), and several recent reviews support this conclusion (20,(23)(24)(25). The multitarget nature of QACs means that mutation within a single target is unlikely to result in a treatment failure. ...
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.
... The cleaning results with the microfibre cloths were the same when plain water or cleaning agents were used. These results are consistent with earlier studies (Nielsen et al., 2002;Rutala et al., 2007). In the study by Nielsen et al. (2002), the properties of 14 micro-fibre cloths were studied and compared with ordinary fibre (viscose) cloths. ...
... The microfibre cloths tested had as good a cleaning effect without detergent as the ordinary cloth with detergent. Rutala et al. (2007) compared the ability of a microfibre and a conventional cotton string mop to remove microorganisms from an environmental surface. In their study, the use of disinfectant did not improve the microbial elimination obtained with the microfiber system. ...
... According to Barker et al. (2004), detergent-based cleaning without adequate disinfection carries the risk of increasing rather than reducing the risk of infection transmission. This is not supported by the results of the microfibre cloth study by Rutala et al. (2007). A study by De Wit et al. (1979) showed that hygiene was achieved in 16 of 26 kitchens after detergent-based cleaning following domestic preparation of chickens artificially contaminated with Escherichia coli, but in 10 kitchens, E. coli was found after washing up. ...
In many countries, changes in the pattern of working lives and ageing of the population increases the need for professional cleaning in private domestic homes. The objective of this study was to obtain basic knowledge concerning professional home cleaning. The study consisted of two parts. First, cleanability of surfaces contaminated with microbiological and organic soils was examined in the laboratory using cleaning cloths, detergents and rapid detection methods with potential for use in conjunction with professional cleaning in private homes. Second, hygienic conditions in three households were screened using the same rapid detection methods as in the laboratory experiments. According to the laboratory study, the cleaning efficiency of the non-woven cloth was clearly poorer than that of the cleaning cloths containing microfibers. There were differences between the efficacy of the cleaning agents in removal of protein and microbiological soils. Despite the differences between surface topography observed with scanning electron microscopy, differences between the cleanability of the three examined surface materials (steel and two plastic surfaces) were small. In hygiene monitoring, the highest levels of total aerobic bacterial counts were detected in the plughole of the sink, on the eating table in kitchens and along the edge of the toilet washbowl and the cover of toilet seats. Low amounts of Enterobacteriaceae indicating faecal contamination were detected in the toilet and bathroom after cleaning. Moulds were not detected in any of the three households, and the amounts of yeasts were low. Detection methods, microbiological dipslides and the protein test, were well suited to the laboratory study. Furthermore, they complemented each other in the hygiene monitoring. The information obtained will be used for development of better practices in professional home cleaning. Good quality management in professional home cleaning and the cleanliness of surfaces in homes are important factors affecting comfort and safety.
... A maioria dos hospitais prefere panos e mops de algodão, considerando que estes podem ser lavados repetidamente e que suportam altas temperaturas (>90°C). Entretanto, recentemente foram introduzidos no mercado os panos e esfregões de microfibra e ultramicrofibra (Rutala et al., 2007;Dancer, 2014). ...
... Alguns estudos demostram maior eficácia de limpeza de panos de microfibra ou ultramicrofibra do que os de algodão padrão (Rutala et al., 2007;Trajtman et al., 2015), inclusive com erradicação completa ou parcial de bactérias cultiváveis, bem como, de esporos de C. difficile das superfícies testadas (Wren et al., 2008). Entretanto, outro estudo demonstrou pequena superioridade da microfibra na remoção de poeira e microrganismos do que panos de algodão na presença de matéria orgânica (Mafu et al., 2013). ...
... Microfiber cloths or mops and ultramicrofiber cloths are among the relatively newer methods for applying liquid disinfectants to surfaces [50][51][52][53][54]. Some studies have shown increased cleaning efficacy of microfiber or ultramicrofiber cloths compared to standard cotton cloth or mops [51,55]. ...
... Microfiber cloths or mops and ultramicrofiber cloths are among the relatively newer methods for applying liquid disinfectants to surfaces [50][51][52][53][54]. Some studies have shown increased cleaning efficacy of microfiber or ultramicrofiber cloths compared to standard cotton cloth or mops [51,55]. However, it appears that all microfiber wipes are not equally effective [50]. ...
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.
... Custodial work, regardless of the type of cleaning products used, can be physically demanding, requiring static muscle loads, and repetitive movements of arms and hands [Kumar and Kumar, 2008]. Some new cleaning technologies such as microfiber [Rutala et al., 2007;Gillespie et al., 2015] that are being developed for the custodial field may help to reduce physical load for custodians, but other ergonomic solutions are needed in conjunction with changes to cleaning products to reduce musculoskeletal symptoms among custodians. ...
... New equipment has the potential to reduce cleaning product exposure. For instance, microfiber and steam technologies, which do not use any chemicals, may be effective for cleaning and disinfecting [Rutala et al., 2007;Gillespie et al., 2015]. It is possible that as the technology and chemical formulations continue to evolve the health hazards associated with environmentally preferable cleaning products will be reduced even further. ...
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.ResultsWe 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. Am. J. Ind. Med. © 2015 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals, Inc.
... Researchers observed and reported a variation in the efficiency of removal of bacteria from a surface with microfiber cloths that are new and those that have gone through reprocessing, cycles of washing and drying. [47][48][49][50] In our work, only new microfiber and cotton cloths were used. This could explain why our results indicate that microfiber cloth is slightly more effective in comparison to the cotton. ...
... Similar results were obtained in the microbiological evaluation of microfiber and conventional cotton cloths for surface disinfection. [50][51] These observations corroborate with the results of this study since no significant differences were observed. This is even more evident when the cleaning of the surfaces was done in presence of organic matters. ...
In health care facilities, the inanimate surface environment can become contaminated with nosocomial pathogen agents. Cleaning has already been accepted as an important factor for controlling the contaminants. For instant, cotton cloths and microfiber may help in the removal of soils and attached bacterial cells. It is also important to know if the nature of the surface can affect the cleaning when we use both microfiber and cotton cloths. In this work, the role of physicochemical factors on bacterial adhesion to stainless steel, melamine and Formica laminate was investigated by assessing the contact angle. In addition, the attachment capability of methicillin-resistant Staphylococcus aureus (MRSA) to the surfaces was studied using scanning electron microscopy technique. The results revealed that, with the exception of Formica laminate, MRSA cells could attach to stainless steel and melamine surfaces after short contact time of 24 h. The outcome also indicated that the microfiber cloths are, slightly, more efficient for removal of soil and microbial cells compared to the cotton cloths. For the surfaces without soils, no significant difference was found when cotton cloths or microfiber cloths were used. It was also appeared, regardless of the type of cloth and presence of soil, the melamine surfaces are the most difficult one to clean.
... Custodial work, regardless of the type of cleaning products used, can be physically demanding, requiring static muscle loads, and repetitive movements of arms and hands [Kumar and Kumar, 2008]. Some new cleaning technologies such as microfiber [Rutala et al., 2007;Gillespie et al., 2015] that are being developed for the custodial field may help to reduce physical load for custodians, but other ergonomic solutions are needed in conjunction with changes to cleaning products to reduce musculoskeletal symptoms among custodians. ...
... New equipment has the potential to reduce cleaning product exposure. For instance, microfiber and steam technologies, which do not use any chemicals, may be effective for cleaning and disinfecting [Rutala et al., 2007;Gillespie et al., 2015]. It is possible that as the technology and chemical formulations continue to evolve the health hazards associated with environmentally preferable cleaning products will be reduced even further. ...
Objectives: We sought to investigate the relationships between cleaning chemicals and respiratory, dermatological and musculoskeletal symptoms among custodians transitioning from traditional to green cleaners.
Methods: University-employed custodians completed a questionnaire to assess cleaning chemical use and health symptoms. An exposure index was developed to quantify custodians’ relative intensity of exposure to cleaning chemicals in total, and to traditional or environmentally preferable or ‘green’ chemicals. Associations between health outcomes and total, traditional, and green-cleaning chemical intensity were investigated in separate models using logistic regression controlling for age, gender, and smoking status.
Results: A total of 329 custodians from three universities and one university health center completed questionnaires. Health symptoms within the last month included dermatitis (26% of respondents), lower respiratory complaints (30%), upper respiratory complaints (43%), pain or discomfort in back (32%) and pain or discomfort in neck, shoulders or arms (44%). Increased total exposure was associated with increased odds of pain or discomfort in the neck, shoulder, arms, or hands (p=0.03). Increased traditional-chemical exposure was associated with increased odds of upper respiratory symptoms (p=0.03) and neck, shoulder, arms, or hand pain (p<0.01). There was no association between increasing green-cleaning chemical exposure and health symptoms.
Conclusion: Custodian musculoskeletal symptoms follow a dose-related pattern with increasing risk for symptoms related to increased total cleaning-chemical exposure. Custodian upper respiratory symptoms were associated with traditional cleaning chemical use only.
... The other important factor in the method of QAC application is to ensure the proper dosage. For example, the effective dose of the QACs can be compromised when combined with cotton mops and cleaning towels, because QAC concentrations can be reduced by 50% to 83% by cotton and microfiber cloths [68,69]. Moreover, the contact times for products containing alcohol plus other active agents vary considerably based on their content. ...
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.
... Disinfection is the process of eliminating pathogenic microorganisms (bacteria, fungi, and virus), from inanimate objects or surfaces [7] and the agents used for this process are called disinfectants. The disinfectants are the first line of defensive agents against the spread of pathogen infection [8]. ...
... This is likely related to both the role of patient and HCP foot traffic in addition to the physical action of mopping which may spread body fluids containing viral RNA within the patient's room. Our findings match previous description of high probability of floor contamination relative to other surfaces, but the role of mops in the spread of viral RNA has not been previously described 18,22 . In contrast to floors, walls had significantly lower probability of contamination. ...
Background
The spatial and temporal extent of 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% CrI 36.3 to 131); high-touch elevated OR 7.39 (95% CrI 4.31 to 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 to 2.53)). The probability of elevated surface contamination decayed with prolonged hospitalization, but the probability of floor detection increased with duration of the local pandemic wave.
Conclusions
Distance from 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.
... Accordingly, most hospital facilities using traditional string mops have switched from cotton to microfibre to increase the efficiency in cleaning and reduce I.-J. Kim the costs of replacement [77][78][79]. However, one of the major changes is a trend towards the utilization of non-wax floors in hospital facilities. ...
Fall incidents are a leading safety apprehension 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 were mainly comprised by 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.
... [46] When examining reusable materials, several studies found that microfiber cloths and microfiber mops were more effective at microbial removal when compared to cotton cloths or cotton mops. [47,48] However, microfiber cloths were not as effective as cotton cloths after multiple uses. [10] Contrasting information exists when comparing microfiber cloths. ...
Background: Healthcare associated infections are a leading cause of illness and death in the United States and across the world. Environmental surfaces are considered non-critical, although recent evidence suggests that the built environment may contribute to the transmission of pathogens. Ineffective cleaning and disinfecting of environmental non-critical surfaces may increase risk of transmitting nosocomial pathogens leading to hospital acquired infections among hospital patients.Objective: This systematic review identifies elements of cleaning and disinfecting protocols, synthesizing the evidence to evaluate cleaning protocols that effectively reduce surface contamination and minimize risk of hospital acquired illness.Methods: A systematic literature review was conducted with a clearly formulated research question and systematic approach to identify publications, select relevant studies, critically appraise the research through analysis of reported data, and reported the results according to the Cochrane methodology.Results: In total, 245 studies were initially identified with 19 studies meeting inclusion criteria. Emerging categories include chemical application methods, chemical application time, cleaning type and frequency, and interventions for training and monitoring.Conclusions: Establishing adequate cleaning protocols for hospital environments is a complex process which requires consideration of multiple components including mechanical action, chemical application materials, types of cleaning, chemical contact times, education and training of EVS staff, cleaning monitoring and feedback, no-contact cleaning methods, and self-disinfecting surfaces. Recommendations for protocol development based on the study results are provided.
... Cotton-based cloths and mop heads may be more attractive from a cost perspective as they can be washed multiple times at high temperatures. It has been found that ultra-microfiber cloths and other microfiber products have the potential of enhanced cleaning [15], although study results are discordant, and their use is still controversial. These products and disinfectants are often used either alone or in combination, along with educational interventions, increased volume of disinfectants, increased surveillance and other techniques to terminate outbreaks or simply improve the bioburden. ...
... A common practice to control and reduce disease transmission in healthcare facilities and public spaces is to disinfect contaminated surfaces with a bleach and wipe with a cloth. In recent years, reusable microfiber wipes and mops have been widely adopted by these facilities, which are able to adsorb dusts, particles, and microbes effectively because of their large surface areas [7][8][9][10][11][12]. Meanwhile, chlorine bleach is still an economical disinfectant, commonly used in hospitals and food processing facilities [7]. ...
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.
... For this reason, it is very effective even in the disinfection of the surfaces of premises, such as hospitals, where the issue of air contamination must be tackled. It also appears to be effective even after several cycles of reconditioning [16,17]. ...
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.
... Non-disposable mops were not more effective than disposable mops. In practice, disposable mops are preferred to non-disposable mops because they present a higher cleaning efficacy and they are discarded once they are used to avoid cross-contamination during washing [5]. ...
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.
... Together with disinfectants, novel materials for liquid application such as microfiber cloths or mops and ultramicrofiber cloths are under development. When used according to manufacturers' instructions, an increased cleaning efficacy is to be expected as compared to standard cotton cloths or mops [84]. ...
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.
... Many reports have demonstrated their efficacy in clinical settings. [22][23][24] The main limitation of our study was that we could not evaluate the individual impact of each measure included in the bundle. This was a common limitation among previous studies, and it may reflect ethical dilemmas in performing randomized studies in epidemic situations or in populations with high endemicities. ...
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.
... Microfibers that were used in the experiment appear to have similar knitting pattern as terry towel; however the loops were smaller and denser than terry towel. Microfiber is made of polyester 70% and polyamide 30% fiber that is 1/100 size of a human hair and 40 times more surface area compared to cotton fiber ( Rutala, Gergen, & Weber, 2007). Due to highly compact composition, microfiber absorbs liquid more effectively to remove food residue and microorganism. ...
Food-contact surfaces are highly contaminated with microorganism and great sources for transmission of foodborne pathogens. It is important to eliminate bacteria using appropriate sanitizing approaches to minimize cross-contamination during food preparation and/or consumption and reduce the risk of foodborne diseases. The objective of this study was to compare the removal efficiency of bacteria on food-contact surfaces by different cleaning cloths. Commercially available blended cellulose/cotton cloth, microfiber, scouring cloth, nonwoven fabric and terry towel were used. Stainless steel and Formica laminate surfaces were inoculated with Listeria monocytogenes in ready-to-eat turkey slurry and the surface was wiped with different cloths. The remaining bacteria on the food-contact surfaces and bacteria immersed in each cloth were enumerated. Overall significant reductions were observed on stainless steel and Formica laminate surfaces by 0.92–2.62 and 2.21–3.44 log CFU/cm2 reduction, respectively (P < 0.05). Among all cloths, blended cellulose/cotton cloths showed the highest removal efficiency by 2.53–2.62 (stainless steel) and 3.16–3.44 (Formica) log CFU/cm2 reduction. Bacteria captured by each cloth did not show significant differences with the range of 5.40–5.69 log CFU/cm2 (stainless steel) and 2.78–3.62 log CFU/cm2 (Formica). ATP bioluminescence assay result was significantly reduced by cleaning cloths (P < 0.05) while the relative luminescence unit (RLU) value was higher on stainless steel by 2547–6073 RLU than on Formica by 208–503 RLU. These results indicate that the performance of cleaning cloths varied for the removal of bacteria and food debris depending on the fabric material and processing pattern.
... There are many potential benefi cial strategies and interventions which could ultimately reduce the risk of HAI, such as hand rubs ( Stout et al, 2007 ) and enhanced cleaning ( Dancer, 2009 ). One of the most promising innovations in recent years has been the introduction of microfi bre (MF) and ultramicrofi bre (UMF) cleaning ( Nilsen et al, 2002 ;Rutala et al, 2007 ;Wren et al, 2008 ). However, the benefi ts of MF/UMF cleaning can be lost for several reasons including inadequate training and supervision, laundering and logistics. ...
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.
... Compared to conventional cotton string mops, the microfiber (MF) mops have been shown to be more effective in disinfecting hospital surfaces. 104 The UMFs are finer than MF and remove particles by the combination of static attraction and capillary action. The UMF mops have been designed to be used with low volumes of water without adding detergent or biocide solutions. ...
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.
... As for performance, a report published in the American Journal of Infection Control reported that microfiber mops outperformed conventional cotton mops in microbial removal, 95% and 65% respectively [15]. This superior performance, combined with the 95 percent decrease in water and cleaning chemical usage seen by the UCDMC, makes a strong case for the adoption of microfiber mops for hard floor cleaning in business, government, and school buildings, as well as in hospitals. ...
The purpose of this study was to get more objective information on the relative costs of environmentally preferable ("green") cleaning products relative to conventional cleaning products. Existing literature on the subject showed institutional-grade green cleaning products as cost competitive or slightly more expensive than their conventional counterparts. The literature shows that green cleaning practices offer opportunities for cost savings, for example, through reduced use of water and chemicals use, safer work environments, and reduced need to lift heavy buckets. In 2009, we surveyed the prices of 373 cleaning products from 26 manufacturer across 8 product categories. The prices of green products were not significantly different from those of equivalent conventional products, with the exception of floor strippers, where conventional products were more expensive. In general, green products averaged somewhat cheaper than conventional, with the exception of glass cleaners. As expected, products sold as aerosols or as ready-to-use (RTU) products were significantly more expensive than the equivalent concentrates; RTU products averaged 15 times more expensive and aerosols averaged 27 times more expensive. Because most third-party certified green products are sold as institutional-grade concentrates, businesses currently using consumer-grade products should consider switching to green institutional products to both save money and improve their environmental profile.
... It is essential that cleaning be thorough and consistent and that all surfaces are wiped. Surface decontamination quality is dependent upon good practice (Rutler and Webber, 2001; Rutala et al, 2007). The findings of the remaining two commodes are as follows. ...
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.
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.
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.
All invasive procedures involve contact by a medical device or surgical instrument with a patient's sterile tissue or mucous membranes. The level of disinfection is dependent on the intended use of the object: critical, semicritical, or noncritical. New issues and practices can affect the risk of infection associated with devices and surfaces. Endoscopes continue to represent a nosocomial hazard. The contaminated surface environment in hospital rooms is important in the transmission of health care-associated pathogens. Thoroughness of cleaning must be monitored and no-touch room decontamination technology should be. In general, emerging pathogens are susceptible to currently available disinfectants.
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.
The control of hospital-acquired infection (HAI) in the future will be challenging. As hospitals across the United Kingdom face increasing financial restrictions healthcare staff have to cope with a rising workload, fewer staff, higher throughput of patients, and high ward occupancy rates. Clinicians are beginning to make smarter choices based on the availability of up-to-date guidance that enables them to make risk assessment-based decisions at the local level. Healthcare professionals make choices in what disinfectants are used to control environmental microorganisms, and testing is required to allow them to make informed decisions on effective antimicrobial agents. Antimicrobial surfaces and nontouch gaseous decontamination technologies may have a role to play in decontamination of the built environment but the fundamentals of cleaning must not be forgotten if these technologies are really to make significant reductions in HAI. Decontamination guidance for surgical instruments has recently been updated and reverts to a Health Technical Memorandum. The decontamination of prions has driven improvements in central sterile services departments in the reprocessing of surgical instruments and endoscopes and healthcare professionals must be vigilant to prevent the potential for patient to patient transmission. Research is fundamental to the future of disinfection and decontamination in hospitals and both industry and research institutions must continue to development novel strategies.
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 drag and transfer 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.
Janitorial cleaning activities and the use of cleaning products are ubiquitous in buildings. To reduce exposures associated with cleaning, it is important to conduct quantitative assessments of airborne exposures and develop science-based best cleaning practice guidelines accordingly. This paper presents a study on a quantitative inhalation exposure assessment for floor mopping - one of the most basic janitorial cleaning activities. Two floor mopping methods, 1) a cotton string mop with a bucket and 2) a flat microfiber mop head with a reservoir on the mop handle, were evaluated using simulated-use full-scale chamber tests. At least five repeat tests were conducted for each procedure. Quantitative exposure assessments were made for both TVOC using real-time monitors and for individual VOCs using integrated sorbent tube samples. Reasonably good test repeatability was achieved, suggesting the testing methodology and measurement methods proposed in this study were effective for assessing airborne exposures due to different cleaning methods. The study found that the bucket and string mop method appeared to result in higher air contaminant concentrations (therefore risk of higher airborne exposure) than the flat microfiber mop head and handle with reservoir. The study also showed that the exposures can be significant for bystander workers and other occupants present after cleaning as well as for those who conduct cleaning.
Mechanical wound debridement (article in German)
Wound cleansing is an essential factor in wound bed preparation, and an adequate cleansing result is considered a prerequisite for the start of physiological wound healing processes.
Different techniques are available for debridement, with a new method of mechanical wound cleansing using a microfibre wound cleansing pad showing good clinical results with ease of use as well as high treatment comfort.
The use of this technology improves the result of the treatment, makes debridement easier and more widely usable and can also be implemented in the outpatient routine or special knowledge and technical equipment.
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.
Clostridium difficile spores can survive in the environment for months or years, and contaminated environmental surfaces are important sources of nosocomial C. difficile transmission.
To compare the clinical and cost effectiveness of eight C. difficile environmental disinfection methods for the terminal cleaning of hospital rooms contaminated with C. difficile spores.
This was a novel randomized prospective study undertaken in three phases. Each empty hospital room was disinfected, then contaminated with C. difficile spores and disinfected with one of eight disinfection products: hydrogen peroxide vapour (HPV; Bioquell Q10) 350-700 parts per million (ppm); dry ozone at 25 ppm (Meditrox); 1000 ppm chlorine-releasing agent (Actichlor Plus); microfibre cloths (Vermop) used in combination with and without a chlorine-releasing agent; high temperature over heated dry atomized steam cleaning (Polti steam) in combination with a sanitizing solution (HPMed); steam cleaning (Osprey steam); and peracetic acid wipes (Clinell). Swabs were inoculated on to C. difficile-selective agar and colony counts were performed pre and post disinfection for each method. A cost-effectiveness analysis was also undertaken comparing all methods to the current method of 1000 ppm chlorine-releasing agent (Actichlor Plus).
Products were ranked according to the log(10) reduction in colony count from contamination phase to disinfection. The three statistically significant most effective products were hydrogen peroxide (2.303); 1000 ppm chlorine-releasing agent (2.223) and peracetic acid wipes (2.134).
The cheaper traditional method of using a chlorine-releasing agent for disinfection was as effective as modern methods.
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.
Debridement is a basic necessity to induce the functional process of tissue repair, especially in chronic wounds. In this pilot study the authors used a new debrider technology with specific monofilament fibres in a unique texture to evaluate its efficacy, safety and tolerability. In eleven patients, exhibiting all types of wound-associated debris (biofilms, slough, necrotic crusts and hyperkeratotic plaques), the debrider, wetted with physiological solution, was wiped without specific force over the wound for about 2-4 minutes. This led to removal of almost all debris leaving healthy granulation tissue intact, including small epithelialized islands of vital tissue. The procedure was without pain and adverse events. Scanning electron microscopic analyses identified the majority of the removed debris tightly packed within the monofilament texture. A surgeon who blindly assessed pictures taken before and after the debridement categorized all except one wound without the need for surgical debridement and ranked all the debridement results with the new debrider as 'very good' (best category). This formulates the basic concept that the new debrider-based technology is easy, fast, highly efficient, well tolerated and cost effective.
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.
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.
Microfiber cloths showed the best results when being used in new condition. However, after multiple reprocessing, cotton cloth showed the best overall efficacy.
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.
Although the environment serves as a reservoir for a variety of microorganisms, it is rarely implicated in
disease transmission except in the immunocompromised population. Inadvertent exposures to
environmental opportunistic pathogens (e.g., Aspergillus spp. and Legionella spp.) or airborne
pathogens (e.g., Mycobacterium tuberculosis and varicella-zoster virus) may result in infections with
significant morbidity and/or mortality. Lack of adherence to established standards and guidance (e.g.,
water quality in dialysis, proper ventilation for specialized care areas such as operating rooms, and
proper use of disinfectants) can result in adverse patient outcomes in health-care facilities.
Impression plates from initially clean horizontal surfaces and floor areas in surgical wards showed a rapid accumulation of bacteria, mainly micrococci, which reached a fluctuating equilibrium after about 24 h. A later increase in bacterial contamination (mainly with aerobic sporing bacilli) to a higher equilibrium level after about 14 days occurred on uncleaned areas. Walls, even if left unwashed, acquired very few bacteria, but many were deposited locally when the wall was touched by a subject whose skin carried large numbers of staphylococci; moist exposed plaster was also heavily contaminated.
Regular use of a disinfectant (‘Sudol’ 1 in 100) in cleaning a ward floor did not reduce the equilibrium level of bacteria on the floor.
The transfer of staphylococci from contaminated to clean areas on the soles of shoes was demonstrated; the use of tacky and disinfectant mats did not appreciably reduce the transfer of bacteria by this route.
Staphylococci deposited on a wall by a disperser were shown to be transferred from the contaminated area of wall to the hands of another subject who did not previously carry the organism; this subject was shown to transfer the staphylo-coccus to a wall which he touched.
Attempts to redisperse by air movement Staph. aureus which had been shed by a disperser or by a contaminated blanket on to the floor surfaces had little effect; neither blowing with a hair dryer nor brisk exercise appeared to lift any of the staphylococci from a vinyl surface, and only small numbers were lifted by these measures from a terrazzo surface.
The hazards of infection from the inanimate environment are discussed.
To determine the susceptibilities of vancomycin-resistant and -sensitive enterococci (VRE and VSE) to various concentrations of commonly used, commercial, hospital-grade disinfectants.
A microbial suspension test using inocula of 10(8) cells per mL in a disinfectant test dilution was used to determine inactivation kinetics of the test strains. In each test, 1-mL aliquots were removed from the cell-disinfectant mixtures at 15 and 30 seconds and then at 1-minute intervals for 5 minutes and neutralized. Appropriate serial dilutions were plated on agar medium for enumeration of survivors.
VRE and VSE challenge inocula (in the absence of any additional protein or serum challenge) were below the limit of detection (5 colony-forming units/mL) after 15 seconds' exposure to the manufacturers' suggested use-dilutions of quaternary ammonium, phenolic, or iodophor germicidal detergents. In subsequent tests, when the disinfectants were diluted far beyond-the recommended use-dilutions (extended dilution), no differences were demonstrated between the susceptibilities of VRE and VSE.
VRE and VSE are sensitive to a spectrum of commonly used environmental disinfectants and have parallel inactivation rates when challenged with extended dilutions of these products. Our findings did not demonstrate a relationship between antibiotic and germicide resistance. Routine disinfection and housekeeping protocols presently used in hospitals need not be altered due to concerns about the potential for environmentally mediated transmission of antibiotic-resistant microorganisms.
To evaluate whether hospital strains of antibiotic-resistant bacteria exhibited altered susceptibility to disinfectants.
Antibiotic-susceptible bacteria were obtained from American Type Culture Collection: Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Klebsiella pneumoniae, Salmonella choleraesuis, and Pseudomonas aeruginosa. Hospital strains of antibiotic-resistant bacteria were obtained from clinical isolates, including: S aureus, S epidermidis, E coli, Enterococcus species, K pneumoniae, and P aeruginosa. The Association of Official Analytical Chemist's use-dilution method was used to test these 12 strains of 7 bacterial pathogens for their susceptibility to a phenol and a quaternary ammonium compound. For five pathogens, we tested a susceptible and a more resistant strain in 20 comparative trials (5 pathogens, 2 disinfectants, 2 dilutions per disinfectant).
In our 20 comparative trials, the antibiotic-resistant strains exhibited an increased resistance to the disinfectant in only a single instance.
Our data demonstrate that the development of antibiotic resistance does not appear to be correlated to increased resistance to disinfectants.
The health-care facility environment is rarely implicated in disease transmission, except among patients who are immunocompromised. Nonetheless, inadvertent exposures to environmental pathogens (e.g., Aspergillus spp. and Legionella spp.) or airborne pathogens (e.g., Mycobacterium tuberculosis and varicella-zoster virus) can result in adverse patient outcomes and cause illness among health-care workers. Environmental infection-control strategies and engineering controls can effectively prevent these infections. The incidence of health-care--associated infections and pseudo-outbreaks can be minimized by 1) appropriate use of cleaners and disinfectants; 2) appropriate maintenance of medical equipment (e.g., automated endoscope reprocessors or hydrotherapy equipment); 3) adherence to water-quality standards for hemodialysis, and to ventilation standards for specialized care environments (e.g., airborne infection isolation rooms, protective environments, or operating rooms); and 4) prompt management of water intrusion into the facility. Routine environmental sampling is not usually advised, except for water quality determinations in hemodialysis settings and other situations where sampling is directed by epidemiologic principles, and results can be applied directly to infection-control decisions. This report reviews previous guidelines and strategies for preventing environment-associated infections in health-care facilities and offers recommendations. These include 1) evidence-based recommendations supported by studies; 2) requirements of federal agencies (e.g., Food and Drug Administration, U.S. Environmental Protection Agency, U.S. Department of Labor, Occupational Safety and Health Administration, and U.S. Department of Justice); 3) guidelines and standards from building and equipment professional organizations (e.g., American Institute of Architects, Association for the Advancement of Medical Instrumentation, and American Society of Heating, Refrigeration, and Air-Conditioning Engineers); 4) recommendations derived from scientific theory or rationale; and 5) experienced opinions based upon infection-control and engineering practices. The report also suggests a series of performance measurements as a means to evaluate infection-control efforts.
Healthcare Infection Control Practices Advi-sory Committee. Guideline for disinfection and sterilization in health-care facilities: recommendations of CDC
- Rutala Wa Weber
- Dj
Rutala WA, Weber DJ, Healthcare Infection Control Practices Advi-sory Committee. Guideline for disinfection and sterilization in health-care facilities: recommendations of CDC. MMWR. In Press.
Old mops die hard: should you microfiber for infection control sake?
- Polonsky
Polonsky D, Roill JD. Old mops die hard: should you microfiber for infection control sake? Infect Control Today 2004;July:24-8.
Susceptibility of vancomycin-resistant enterococci to environmental disinfectants
- Anderson
Susceptibility of antibiotic-susceptible and antibiotic-resistant hospital bacteria to disinfectants
- Rutala