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Thursday, December 22, 2011

Top 10 Disinfectant Offences for 2011

It’s amazing how quickly 2011 flew by, but more amazing to Lee and I was the response we have gotten to the Talk Clean To Me Blog. Since the launch in June there have been over 7000 page views which equates to an average of 1000 people per month reading (or at least looking) at our blog! Thank you to everyone who has read, shared and commented on our blogs and a big Thank You to our 2011 Guest Bloggers!

For our last blog of the year Lee and I wanted to have some fun by creating a spinoff of David’s Letterman’s Top 10, here is The Clean Freak’s Top 10 Offender List for the Misuse and Abuse of disinfectants:

NUMBER 10

The Granola Bunch: The advocates who believe that all chemicals are bad and should be banned regardless of their need from an infection control perspective. Now don’t get me wrong – I believe that we need to use chemicals judiciously. Antibacterial hand soaps are not needed for the general public or at home – just use plain soap and water. Nor do disinfectants need to be used everywhere or on everything. There are, however, areas that require the use of disinfectants and cucumber juice, essential oils or other seemingly benign chemicals that claim to have killing properties do not provide the level of efficacy (protection) that are needed. You can however, chose products that use safer, more environmentally friendly chemistries. In Canada you can find certified green disinfectants through the EcoLogo program and in the US, through the Design for Environment program in the near future there will be certified green alternatives available. The key is to choose a product that provides a balance between its safety (personal and environmental) and efficacy (it can kill what it needs to).

NUMBER 9

The One for All Army: In efforts to streamline our chemical purchases or simplify training programs many managers are looking for the silver bullet – that product that does everything from glass and floor cleaning to hospital grade disinfection and still make the surfaces look shiny! Like different grades of gas or types of flour and sugar, each product has its reason for being and using ONE product for everything can lead to sticky and not so shiny surfaces, but more importantly have us using disinfectants on surfaces that do not need to be disinfected! There is a concern that over use of disinfectants can lead to chemical resistance. In a society where we are losing our ability to cure disease because of antibiotic resistance, we cannot risk the development of chemical resistance. If infection control principles do not mandate the use of a disinfectant, don’t use one!

NUMBER 8

The Shiny Surface Syndicate: If it’s shiny it must be clean (and free of germs)! For some, the Syndicates’ obsession with shiny surfaces leads them to abandon infection control principles in search of the product, Spic & Span and Windex are two of the most commonly use culprits, that leaves the surfaces all sparkly. The upside, is that staff / patients / residents believe the environment is safe because it is so shiny. The downside, is that Windex, Spic & Span or whatever product has been used puts these people at risk for transmitting and acquiring deadly germs.

NUMBER 7

The Glug-Glug Gang: I don’t need to use a dilution system, I know how much to add just be eyeballing! To be fair, the Glug-Glug Gang can be a result of not having access to dilution systems or not having dilution systems in convenient locations. Either way, the end result is improperly diluted product meaning we are not meeting the infection control standards we need to. Even better, they are known to glug more product into the mop bucket after cleaning 6 rooms so it “cleans” better rather than dumping the dirty solution out and getting some fresh stuff!

NUMBER 6

The Top-Off Artists: Have you ever had a situation where you’ve checked your dilution systems, they are working properly, but when you test the bottles of diluted product the concentration is off? Of course, this doesn’t come to light until an important audit and you now have a negative citation you have to investigate and provide a reason for. You may have Top-Off Artists in your midst. This efficient group of staff likes to see their bottles full and not half empty….so they “top up” their bottles during the day and at the end of each shift. The end result is a bottle that does not have the right concentration of disinfectant because new product has been mixed with old.

NUMBER 5

The Scent Seekers: Unfortunately, we live in a society where we believe pretty smells equate to clean and don’t always understand or associate the health risks that come with using highly fragranced products. Most healthcare facilities are becoming fragrance free – no perfumes, no air deodorizers and no pretty smelling cleaning products. The problem is that our cleaning staff likes to smell something to “prove” they have cleaned and secretly add liquid deodorizers to the scent free disinfectants they are using. The result is the room may smell nice, but the deodorizer they added may have neutralized the disinfectant so that it has lost its killing potency or in some cases, where people have added bleach (some people, love the smell!) they may have created some toxic fumes with deadly consequences.

NUMBER 4

The More is Better Bandit: Oh the stories we can share on this! Unlike the Glug-Glug Gang, who think they can dilute correctly without measuring, the More is Better Bandit believes it if works at the right dilution it will work EVEN BETTER if I add more! The More is Better Bandit runs rampant during pandemics and outbreaks (especially if we are dealing with a new bug) believing that even if they have been told the disinfectant works at a specific dilution and contact time that he or she can ensure they annihilate the pesky pathogen by adding more. The result often ends in Occupational Health complaints and/or degradation of surfaces being disinfected by using a product that is too concentrated.

NUMBER 3

The Instruction Ignorers: Most often men (its true! How many men do you know that ask for directions?), the Instruction Ignorers believe that labels are meant for others to read so will use a disinfectant in the way they THINK it should be used and not how it was INTENDED to be used. Examples include trying to dilute ready-to-use products meant for spraying on high touch surfaces into a bucket to clean floors (also known as a Glug-Glug Deviant), using disinfectants meant for disinfecting or chemically sterilizing surgical instruments on surfaces (a subspecies of the One for All Army) and my all time favorite if it’s a wipe, it must be okay to use for personal hygiene or as a diaper wipe! There are reasons labels exist so READ THEM and most importantly follow the directions!

NUMBER 2

The Custodial Chemist: Probably my favorite group. This group believes that their collective years as professional cleaners is far more knowledgeable then formulating chemists who have years of higher education and develop the products the Custodial Chemist use. The Custodial Chemist is someone who mixes products together in the belief they are making a better product (or simplifying their job). Why use a degreaser or glass cleaner followed by a disinfectant when you can mix them together and create a degreaser-disinfectant or the best disinfectant glass cleaner on the market!

AND THE NUMBER 1 OFFENCE!

The Sink or Swim Squad: Whether you call it training, instructing or educating it all comes down to the fact that we CANNOT expect our staff to know how to correctly use the products and tools to do their jobs unless we TEACH them how to use them. In fact, if you go back and re-read the other Top 9 examples of misuse and abuse of disinfectants they all come down to the fact that if we teach everyone the where’s, what’s, why’s and how’s to using disinfectants and cleaning chemicals we won’t have any stories of how we have seen them used and abused.

I hope your top priority for 2012 is to educate your staff, friends and even family on how to correctly use cleaning and disinfectant products.

Happy Holidays to all from Lee and I!

Bugging off!
Nicole

Thursday, December 15, 2011

"I don't want a lot for Christmas, there's just one thing I need..."

I always liked the Mariah Carey Christmas song titled "All I Want for Christmas". But, Michael Buble does a much softer and more romantic version of the song on his new Christmas album that has sold a TON. My wife bought the CD and has nearly worn it out in the week she has owned it.

But, I'm not here to pan music. I want to develop my own list of "Wants" for this Christmas. Here goes:

  1. I want a non-bleach disinfectant with a C-diff spore-kill claim with a contact time of 5 minutes or less. Really, I don't want a lot for Christmas.
  2. I want a sure-fire disinfectant system for use in the terminal cleaning of discharged patient's room. A system that kills the microorganisms left behind by the best disinfectants, the best employees and the best practices. We all know they are there, lurking on the bottom of the bed rail that is touched by every caregiver who raises or lowers the bed rail. The ESKAPE family of organisms that lurk on the bottom side of the lever that raises and lowers the over-bed table. And, yes, C-diff lurks in the privacy curtain that is opened and closed by every physician, respiratory therapist, family member and nurse that comes to check on the patient. Oh yes, those MDRO's also hide in the velcro in the blood pressure cuff. I want this system to work with minimal disruption to the operation of the Environmental Services or Nursing departments (i.e., no taping off of the ventilation system, in/up/done/out in 10 minutes or less). While I am wishing, I wish it wouldn't break the bank (<$50K per unit).
  3. I want a hospital that realizes that the IPC partner from the Environmental Services Department that cleans the patient's room is only in that room for 15-20 minutes on a daily basis. The other 23 hours 40 minutes out of the day, that clean, safe and disinfected environment has to be maintained by every person who enters the room and touches surfaces like bed rails, faucet handles, toilet flush handles, furniture, door knobs, over-bed table lever that raises and lowers the table, etc. Fully engaged healthcare workers realize the importance of proper hand hygiene. But, the BEST staffers know that clean, sanitized hands or gloves are quickly contaminated by soiled surfaces they touch. Then those soiled hands or gloves spread the contamination to an undeserving patient or a previously cleaned surface. I want a hospital full of hygiene specialists who know their role of preventing the transmission of dangerous organisms by maintaining the sanitary conditions in the patient's room 24/7.
  4. And, finally, I want a ZERO HAI rate. That means that EVERYBODY gets a gift! Our patients recuperate from the illness, accident or surgery that caused their admission to the hospital without fear of contracting a MDRO that could cause a life-long dependence on medical care, or, even worse, cause their death. I have heard too many heart-wrenching stories about loved ones lost to a system that was too loose with their infection prevention practices. Our hospital admits over 40,000 patients each year. I can't imagine us putting up a scrolling marquee out on the interstate bragging that only 800 patients left the hospital with something they didn't expect, a life-altering or terminal condition called a HAI. I want to see them live healthy, happy and purposeful lives for many years to come. Families win by having their loved one at Grandma's house enjoying their Christmas season of love and cheer. And, the hospital wins by getting the maximum reimbursement by preventing the "must nevers".
  5. Oh I don't want a lot for Christmas;
    This is all I'm asking for;
    I just want to see my baby
    Standing right outside my door.
    Oh I just want you for my own.
    More than you could ever know;
    Make my wish come true,
    Baby all I want for Christmas is...You (Happy, Healthy You)

Have a Merry Christmas and a Happy, Prosperous 2012!


J. Darrel Hicks, BA, REH, CHESP

Author of “Infection Prevention for Dummies”

Go to: www.darrelhicks.com to order your FREE copy of “Infection Prevention for Dummies” (just pay S&H) or to see other blogs and articles.


Darrel Hicks is the author of Wiley Publishing's "Infection Control For Dummies", and is nationally recognized as one of the top experts in infection control. Darrel is also the immediate Past President of the IEHA and is an active member in ASHES where he holds the designation of CHESP. Darrel started his career in the management of housekeeping services in 1981. He has worked in hospitals ranging in size from 20-500 beds, and knows what it takes to plan, set goals and provide guidance and consultation to the management team and department(s) staff. He has managed as many as 13 departments and 170 F.T.E.’s at one time in a 3-hospital system. In that healthcare system Darrel had to pioneer and discover ways to save money by cross training staff, job sharing, controlling overtime and putting a system of controls in place.

Wednesday, December 7, 2011

Home is where the heart is...and apparently where the germs are too!

Last week Nicole identified some of the germiest public places we should be mindful of as we’re out and about during this holiday season. Let me ask you a question: Have you found yourself thinking twice about what you’ve touched as you complete your Christmas shopping??

Do the bacteria and viruses magically stop at our front doors? No! Our homes are literal breeding grounds for germs. According to a study conducted by NSF International here’s a few surfaces or items to pay extra close attention to as you prepare to host family and friends or find yourself visiting their homes this holiday season.

Kitchen Sponge/Dish Cloth

The item most frequently used to clean dishes and countertops was actually the germiest place found in most homes. Sponges and dish rags can pick up bacteria during the cleaning process, and, if not regularly laundered or properly sanitized, they can be a prime spot for germ growth. Perhaps you can use this as an excuse to get out of helping your host with the dishes??

To Clean: Place wet sponges in the microwave for two minutes once per day and replace often - every two weeks or more as needed. Better options for kitchen cleaning are dishcloths, towels and rags. These items can be sanitized by washing on the clothes washer's hot water cycle with bleach. Replace every 1-2 days.

Kitchen Sink

The second highest concentration of microorganisms was found in the kitchen sink. Chalk up another excuse for not helping with the dishes. Can you tell I really don’t like doing the dishes??

To Clean: Wash and disinfect the sides and bottom of the sink 1-2 times per week with a disinfecting cleaner. Wash kitchen sink strainers in the dishwasher weekly.

Coffee Reservoir

Given the dark, damp location, it's a prime location for bacteria, mold and mildew to grow. Perhaps adding a liqueur to the coffee will help kill-off any of the bacteria swimming in your after dinner coffee??

To Clean: Follow the manufacturer's recommended cleaning instructions. A common recommendation is to clean by adding up to 4 cups undiluted vinegar to the reservoir, letting it stand for 30 minutes, then running the vinegar through the unit. This is followed by running 2-3 cycles of fresh water through the unit until the vinegar odor is gone. Most manufacturers recommend cleaning every 40-80 brew cycles or at least monthly.

Faucet Handles

Faucet handles in both the kitchen and bath contained bacteria as well as yeast and/or mold. These are very frequently touched surfaces in the kitchen during food preparation and not surprisingly can be easily contaminated.

To Clean: Clean daily with disinfecting cleaner or disinfecting wipes.

Pet Toys

Forget the myth that your dog’s mouth is cleaner than yours, pet toys were found to be a significant source of bacteria, yeast and mold in many homes. No doubt we’ve all found ourselves playing with our friend’s pets, or our friends playing with our pet. Simply encourage everyone to wash their hands after playing with the pet and their toys.

To Clean: Hard toys can be gently cleaned with hot soapy water and rinsed with fresh water. Soft toys can be washed with other laundry on the hot water cycle. Wash monthly or more often as needed.

Countertops

Countertops had bacteria present in 30% of the homes tested by NSF. Sources of bacteria can be traced to many food items, including unwashed produce as well as raw meat and poultry. In addition, bacteria can be introduced into a kitchen area through improperly washed hands. So next time you belly-up to the bar or kitchen island, be careful about where you place your hands prior to grabbing another tasty hors d’oeuvre.

To Clean: Countertop surfaces should be washed daily. Once all food prep activities have been completed, wash the surface with hot soapy water, rinse with clean water, then apply a sanitizer approved for food contact surfaces.

So now that we’re equipped with this information, what are we to do? Similar to what Nicole stated last week, there’s no need to panic. We simply need to reinforce some of the best practices we’re already aware of. Regularly wash your hands prior to eating, after using the washroom and prior to and after preparing food. Likewise, clean and disinfect/sanitize those surfaces that are likely to become contaminated and those that are frequently touched to prevent further transmission.

Wishing you a safe and happy holidays!

Lee – The Germinator

Thursday, December 1, 2011

What have you touched today?

Did you know that on average adults can or will touch as many as 30 objects within a minute and that over the course of a year we can encounter about 60,000 different types of germs? I’d like to say that those stats surprise me, but with the number of media articles and new clips in recent months talking about the dirtiest or germiest public places it seems entirely plausible. Like me, some of you may have the “pleasure” of travelling for work and today after reading an article by Dr. Oz that talked among other things about dirty places I spent the day while travelling to and from Ottawa contemplating what surfaces I had touched.


Based on what has been published this year here are my Top 10 picks for the dirtiest and mostly unavoidable public surfaces:



  1. Public Restrooms – while we may automatically think of toilet seats, in actual fact the faucets and door handles are the worst offenders. Several studies have found fecal contamination on faucets which in itself is not surprising, but what do you do when faced with a faucet you have to turn off after you’ve cleaned your hands and there is no paper towel to turn it off with? I say WALK AWAY!! At the very least get yourself some toilet paper. Same goes for opening a bathroom door, palm a spare paper towel after you wash up and use it to grasp the handle. Yes, other patrons may think you're a germ-a-phobe - but you'll never see them again, and you're the one who won't get sick!

  2. Airplane Restrooms – I think it’s safe to say we all gag a bit when faced with the fact that you have to use the airplane restroom. Researchers have found surfaces from faucets to doorknobs to be contaminated with E. coli. It's not surprising, then, that you're 100 times more likely to catch a cold when you're airborne and you’ll never think of turbulence in the same light again – just think of all the spreading around a little shaking can do!

  3. Elevator Buttons and Escalator (or moving sidewalk) Handrails – while these surfaces have a better chance of being cleaned on a daily basis I loath to even consider the number of times those surfaces are touched between the last time it was cleaned. While it will be unlikely that we can avoid touching elevator buttons, I will certainly be limiting my touching of escalator handrails!

  4. Grocery Cart Handles - the handles of almost two-thirds of the shopping carts tested in a 2007 study at the University of Arizona were contaminated with fecal bacteria. In fact, the bacterial counts of the carts exceeded those of the average public restroom. If you don’t have a disinfectant wipe to clean off the handle at the very least while you're wheeling around the supermarket, skip the free food samples to avoid eating someone else’s poop!

  5. Vending Machine Buttons - this introduces a whole new way of looking at too much fast food and vending-machine food being bad for our health! It may not be the food that’s making us sick, but the fact that these machines are rarely cleaned. Next time you grab a bag of chips from a vending machine wash your hands before eating unless of course you’re looking for a little extra protein!

  6. Restaurant Menus – when was the last time (if ever) you actually saw someone clean a menu in a restaurant. If it's a popular restaurant, hundreds of people could be handling the menus and passing their germs on to you. Never let a menu touch your plate or silverware, and be sure to wash your hands after you place your order.

  7. Counter Pens – how many times have you had to sign something at a bank or sign in at a company you are visiting? The next time you have to use a counter pen ask yourself how many people have touched this before me? We may mock people with pocket protectors that carry a wide selection of pens, but frankly I think they have the last laugh. They always have a pen handy!

  8. ATM / Debit Machines – we virtually live in a paperless society when it comes to money. Paying by debit is the norm and based on various articles, ATM or Debit Machines are certainly not cleaned with any frequency. Carrying cash is no better there are germs all over it as well. Unless you intend to wipe down the ATM or Debit machine before you use, be sure to wash your hand after!

  9. Gas Pump Handles – really should not come as a surprise. They’re gross and we know it. Unless you are willing to drive all over town to find a full service kiosk (where you’re still going to pay by debit….) just be sure to wash or sanitizer your hands after filling up.

  10. Buttons on Crosswalks – a new thought twist on keeping our streets clean and safe! It’s a bit much to think that city officials will include cleaning crosswalk buttons on a job description. Like gas pump handles and any other public surface, just wash your hands when you get the office and be sure to wash them before you put any food in your mouth!

Do we need to panic or live in bubbles? No. In truth, only 1%-2% of the germs we come in contact with on these surfaces are potentially dangerous to healthy people with normal immunity. Whether germs are viral, bacterial, or fungal, some can remain active on most surfaces for several days regardless of the type of surface (stainless steel, wood, plastic, or even the paper in a magazine). When you touch that surface, it's transmitted to your hands. Then if you touch your eyes or rub your nose or lips, when you eat, VOILA!, you have infected yourself. When and where you can, clean the surfaces you are in contact with the most daily, but most importantly be diligent with hand-washing! Not only will it keep you healthy, but think of it as your civic duty not to spread your germs in public!




Bugging Off!


Nicole