Contact Cleaning

Health care-associated infections (HAIs) continue to plague facilities in the United States. The Centers for Disease Control and Prevention (CDC) estimate that one out of every 20 patients will become infected with an HAI.

Two of the most troublesome HAIs that health care facilities face include norovirus, a pathogen that causes gastroenteritis and food poisoning, and Clostridium difficile (C. difficile), a spore-forming bacterium that causes symptoms ranging from diarrhea to life-threatening inflammation of the colon. These infections spread rapidly through populations and can cost facilities thousands of additional dollars to contain. However, there are prevention mechanisms and protocols available to help minimize outbreaks.

HAI prevention should be a priority for health care staff working in all types of facilities including hospitals, outpatient, and long-term care facilities. Prevention is not only in the best interest of the patients, but health care staff as well. It is everyone’s responsibility to maintain a safe patient environment. Cleaning staff need to be knowledgeable about proper hand hygiene protocols, personal protective equipment use, disease transmission, and cleaning and disinfection procedures for HAIs. Therefore, training and educating staff on these issues should be a main priority for both the infection prevention and environmental services teams. While protocols can differ between facilities, all personnel should have their roles and responsibilities clearly defined so that their progress can be monitored.

The following tips and recommendations on how to prevent and manage C. difficile and norovirus outbreaks help to serve as a great primer on the importance of infection prevention and environmental surface disinfection in health care facilities. The important thing for health care cleaning staff to remember is that the standard activities of cleaning, selecting appropriate disinfectants, and monitoring practices all contribute to a safer, healthier patient environment.

C. difficile
According to a recent CDC Vital Signs Report, C. difficile infections are at an all-time high and are linked to 14,000 deaths in the United States each year. A stronger germ strain also contributed to a 400 percent increase in C. difficile-related deaths between 2000 and 2007.

C. difficile can infect anyone, but older adults and those on antibiotics are most at risk. C. difficile spores are resilient and can survive on surfaces for months, allowing them to easily spread to others through contact with contaminated surfaces or health care workers’ hands.

To help reduce the spread of C. difficile infections, each facility should have protocols in place that outline cleaning and disinfecting practices, recommended U.S. Environmental Protection Agency (EPA) registered products to use, and assigned roles for personnel. Always use disinfecting products that are EPA-registered to kill C. difficile and follow the label instructions to keep the surface wet for the recommended amount of time.

The CDC also has six key steps to prevention, which are listed below.

CDC’s Six Steps to C. difficile Prevention

  1. Prescribe and use antibiotics carefully. About 50 percent of all antibiotics given are not needed, unnecessarily raising the risk of C. difficile infections.
  2. Test for C. difficile when patients have diarrhea while on antibiotics or within several months of taking them.
  3. Isolate patients with C. difficile immediately.
  4. Wear gloves and gowns when treating patients with C. difficile, even during short visits. Hand sanitizer does not kill C. difficile, and hand washing may not be sufficient.
  5. Clean room surfaces with an approved, spore-killing disinfectant after a patient with C. difficile has been treated there.
  6. When a patient transfers, notify the new facility if the patient has a C. difficile infection.

Norovirus

Recent study statistics from the February 2012 issue of the American Journal of Infection Control show that norovirus is the leading cause of HAI outbreaks. Norovirus is responsible for 18.2 percent of all infection outbreaks and 65 percent of ward closures in United States hospitals.

Like C. difficile, norovirus is highly contagious, causes diarrhea in patients, and is transmitted to others through touching infected surfaces, eating contaminated food, or by having direct contact with a contaminated individual. Norovirus outbreaks are especially difficult to contain and control once a health care facility is contaminated.

Maintaining a proactive disinfecting protocol against norovirus is extremely important for all health care facilities. Cleaning staff should work with their infection control departments to determine appropriate disinfecting and monitoring procedures that are best suited to their facility. Health care cleaning staff should be advised to use the proper protective equipment (gown and gloves), use EPA-registered disinfectants with a label claim to kill norovirus, and clean rooms and high-touch surface areas more frequently during a suspected norovirus outbreak. Follow the product manufacturer’s instructions and pay attention to how long a product needs to remain wet on a surface to kill norovirus.

The CDC also recommends the following procedures for prevention and disinfection against norovirus.

CDC Norovirus Prevention Tips

Patients with suspected norovirus may be placed in private rooms or share rooms with other patients with the same infection.

  • Follow hand-hygiene guidelines and carefully wash hands with soap and water after contact with patients with norovirus infection.
  • Use gowns and gloves when in contact with or caring for patients who are symptomatic with norovirus.
  • Routinely clean and disinfect high-touch patient surfaces and equipment with an EPA-approved product with a label claim for norovirus.
    • Increase the frequency of cleaning and disinfection of patient care areas and frequently touched surfaces during outbreaks of norovirus gastroenteritis (e.g., increase ward/unit level cleaning twice daily to maintain cleanliness, with frequently touched surfaces cleaned and disinfected three times daily using EPA-approved products for health care settings).
    • Frequently touched surfaces include—but are not limited to—commodes, toilets, faucets, hand/bed railing, telephones, door handles, computer equipment, and kitchen preparation surfaces.
  • Remove and wash contaminated clothing or linens.
  • Exclude health care workers who have symptoms consistent with norovirus from work.

Additional Resources

Many educational resources for dealing with C. difficile and norovirus are available from a variety of sources including government and professional organizations and product manufacturers such as the CDC, Association for Professionals in Infection Control and Epidemiology (APIC) and the Association for the Healthcare Environment (AHE). Below are a few great options for further reading:

  • APIC’s 2008 “Guide to the Elimination of Clostridium difficile in Healthcare Settings.”
  • CDC’s 2011 “Guideline for the Prevention and Control of Norovirus Gastroenteritis Outbreaks in Healthcare Settings.”
  • Clorox Healthcare’s C. difficile Prevention Tool Kit.
 
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