FLOOR DISINFECTION INHEALTH CARE

Dr.T.V.Rao MD @ Hospital care 1

FLOOR DISINFECTION INHEALTH CAREfacts concerns and solutions

Dr.T.V.Rao MD

Importance of Disinfection of Floors in the Hospitals

• The floor and the surface areas of the Hospital form the largest area in a Hospital, yet there are no unified opinions on how we disinfect these areas, However there are solutions with existing literature how to take care of the matters suiting to the prevailing conditions in Hospitals, I have studied the matters in at least 4 Hospitals people practice in different ways. The program is created with vision to improve the matters overcoming many myths wasting unnecessary use of chemical solutions, The Aim of the program is to create a vison for optimal use of resources with lesser use of chemicals

Dr.T.V.Rao MD Freelance

Clinical Microbiologist



Hospital floor get contaminated with

•Hospital floors become contaminated by settlement of airborne bacteria, by contact with shoes, trolley wheels, and other solid objects, and occasionally by the spilling of urine, pus, sputum, and other fluids


What are the Microbes on the Hospital Floors

• Pathogens commonly present on the floor include Staphylococcus aureus dispersed by patients and staff, and (in much smaller numbers) Gram-negative rods, such as Pseudomonas aeruginosa. Spores of Clostridium tetani and gas-gangrene bacilli are also present on floors, probably deposited in larger numbers from shoes and trolley wheels than by deposition from the air. Some of the bacteria lie loosely in dust, while others are ingrained into the surface and between cracks.

All aspects of cleaning health care areas begin with

simple solutions • Physical removal with a mop

or auto scrubber in itself will remove a significant share of microorganisms present. If a mop is used, it will be immersed in a solution of disinfectant upon completion of the mopping procedure.



The removal of this reservoir is one of the normal aims in the control of

hospital infection.• Dispersal of bacteria into the air has been greatly reduced through the replacement of brooms by vacuum cleaners in wards (Rogers, 1951


Differing opinions • Scrubbing and disinfection

might be expected to have a larger effect, and useful results of disinfection are reported on the other hand, have reported no significant difference in the reduction of bacterial counts on floors washed with detergents or with disinfectants


Major and Peer reviewed Study reported Hospital Floors-

Aylilfe et al. • Soap and water caused a mean

reduction of 80% and disinfectants caused a mean reduction of 93-99% in bacterial counts on areas protected from recontamination. These effects were highly significant, as were the differences between detergent washing and disinfection


Environmental surfaces harbor

infectious agents

•Many environmental surfaces, including floors in a medical facility, can harbor disease-causing germs. Although not directly involved in disease transmission,


Surfaces which can harbor

Microbes and can be harmful • Housekeeping surfaces include

floors, walls, counters, and furniture and are considered non-critical items that require low-level disinfection. Cleanliness and infection control of these surfaces can be ensured by removal of soil on a routine basis.


Environmental surfaces indirectly

contribute the infections

• Environmental surfaces may indirectly contribute to secondary cross-contamination by the hands of healthcare workers or by contact with medical instruments that will subsequently come into contact with patients/residents


Definition of Environmental surfaces

•Martin Favero and Walter Bond expanded Dr. E.H. Spaulding's original classification of medically related surfaces to define more clearly the relative risks of disease transmission. This expansion included dividing the classification of environmental surfaces into two sub-groups: medical equipment surfaces and housekeeping surfaces


HOUSE KEEPING

SURFACES • Housekeeping

surfaces, of course, include floors, walls, counters, and furniture and are considered non-critical items that require low-level disinfection.


Cleanliness and Hygiene

are Important •Cleanliness and

infection control of these surfaces can be ensured by removal of soil on a routine basis.


HOUSE KEEPING PLAYS A GREAT ROLE IN SAFTEY OF THE HOSPITALS


Proper dust removal is critical•Bertha and Warren Litsky demonstrated in 1968 that

effective dust removal before wet mopping or scrubbing of floors proved to be an important part of the cleaning and disinfecting process. Dust removal prior to scrubbing or mopping will collect a large portion of debris, dirt, and dust that, if uncollected will affect the disinfecting capability of the disinfectant-detergent


What are Ideal for dust cleaning

• A wet/dry vacuum or vacuum with a filtration system is a superior dust-removal tool. This tool is recommended for areas like the operating room, delivery room, and nursery.• Modern hospitals prefer A

chemically treated disposable dust mop head.• A freshly machine laundered dry

dust mop head.


Sweeping floors with Brooms prohibited

• Sweeping floors with a broom is not recommended because particles become airborne and can be transferred throughout the facility. Since microorganisms are attracted to dust and dirt for a food source, any chance of creating an airborne situation is not advised.

Circumstances we use Brooms

• To eliminate this concern in areas like the operating or delivery room and where a wet/dry vacuum is not available, a broom dipped into disinfectant can be used. Dipping the broom into the disinfectant will eliminate any dust particles from becoming airborne, thus negating a potentially hazardous situation.


How to Take care of the Mops

•With proper dust removal, the wet mopping or scrubbing process is much more effective. Litsky recommends the use of sterile wet mops or freshly machine laundered wet mops for the wet mopping process. Mops should be replaced after each isolation room cleaning, discharge cleaning, clean up of blood spills, and cleaning in surgery and delivery suites.



Ways of Cleaning Floors are Changing

Frequent change of the Mops is highly recommended

• A routine of changing mops after a certain number of rooms should also be adopted. It is not unusual for wet mops to become contaminated even after dust removal, so it is important to adopt a routine of changing disinfectant solutions and mops frequently.


Dirty Mops Are Source of Infection

•Dirty mops immersed in a bucket of disinfectant, can become a medium for growth of live microorganisms


Frequent Changing of Disinfecting solution

is warranted • Solutions should be changed

after every 3-4 rooms if using a single bucket method or 6-8 rooms if using a two-bucket (both buckets contain disinfectant solution), two mop system


Open and non critical areas of hospitals cleaned with

• In large open areas like hallways or lobbies, wet mopping of floors is not necessarily the most productive and cost effective process. In these instances, use of an automatic scrubber is appropriate. An automatic scrubber applies the disinfectant-detergent to the floor, scrubs the floor with pads or brushes, and then vacuums the floor dry. It is a very productive tool for large areas and very effective in the soil removal process.



What is to be used for general house keeping

cleaning purpose • This can be accomplished

using water and a detergent or a low-level, EPA-registered, nontuberculocidal, hospital-grade disinfectant designed for general housekeeping procedures

Can the Bleach a all purpose solution YES OR NO No

• Bleach is not an all-purpose cleaner.• Bleach might get rid of germs and

stains on white t-shirts, but as far as cleaning grime and dirt from surfaces in your home, it is not a very good choice. Bleach does not contain any surfactants, and therefore will not lift and remove dirt and grime.

• Even if you’re using bleach to sanitize, it has to be used on a clean surface or else it isn’t



A Floor Care Disinfection Program• A good floor care disinfection

program comprises three key elements: use of effective disinfectants--detergents, tools, and procedures. All three elements must be present to be successful in physically and chemically removing soil and microorganisms.

WHEN WE USE AUTOSCRUBBER

• If an auto scrubber is used, any solution applied to the floor will be picked up by the machine and will be held in a recovery tank until emptied. A related corollary to contact time is residual activity. Disinfectants in a dry state do not have a residual activity. Disinfectant action can only take place when moisture is present.



Selecting a Disinfectant• When selecting a disinfectant, first review technical research

bulletins provided by vendors. These bulletins will identify the different microorganisms that the disinfectant has been tested against. Then match the tested microorganisms against those most prevalent in your particular environment. In addition to the microorganisms most prevalent, a disinfectant should have a broad range of kill; it should be capable of killing Gram positive and Gram negative bacteria, fungi, and viruses. Second, compute the parts per million (PPM) of active disinfectant. This computation simply translates the percentage of active ingredients into parts per million

Using the Auto Scrubber entering into all modern hospitals

• If an auto scrubber is used, any solution applied to the floor will be picked up by the machine and will be held in a recovery tank until emptied. A related corollary to contact time is residual activity. Disinfectants in a dry state do not have a residual activity. Disinfectant action can only take place when moisture is present.


Effective Disinfectant Detergents

• Low-level, hospital-grade disinfectants are the recommended products for floor care disinfection in healthcare settings. The Environmental Protection Agency (EPA) regulates and registers all low-level disinfectants.


Hospital Disinfectants should fulfill the following criteria

• To be considered a hospital grade disinfectant, manufacturers must test their germicidal products against three microorganisms: Staphylococcus aureus, Salmonella choleraesuis, and Pseudomonas aeruginosa.


Major and Peer reviewed Study reported Hospital Floors-Aylilfe et al.

• Soap and water caused a mean reduction of 80% and disinfectants caused a mean reduction of 93-99% in bacterial counts on areas protected from recontamination. These effects were highly significant, as were the differences between detergent washing and disinfection



Time Tested and credited AntisepticsCleaning and Disinfection of Hospital

FloorsG. A. J. AYLIFFE,*

• A selection of agents commonly recommended for surface disinfection was investigated. The concentration chosen was 1/100 of concentrate or 1 % w/v for most of the disinfectants. Aqueous solutions of the following compounds were studied: . 1Phenolic compounds: Sudol 1/100, Hycolin 1/100, Izal 1/100 and 1/160.


Time Tested and credited Antiseptics

• 2. Chloroxylenol: Dettol 1/100 and 1/40. 3. Quaternary ammonium compounds: Benzalkonium chloride (Roccal) 0.1%, Cetrimide B.P. 0.1%. 4. Ampholytic compound: Tego M.H.G. 1/100. 5. Combination of tri-n-butyltin, a quaternary ammonium compound (alkyl dimethylchlorobenzyl ammonium chloride) and isopropyl alcohol: Micro Gard with Trimicrotin 1/100. 6. A mixture containing a non-ionic detergent and a quaternary ammonium compound (alkyl dimethylbenzyl ammonium chloride): Shield 1/40.

Time Tested and credited Antiseptics

• 7. Chlorhexidine (Hibitane) 1/500 and 1/5,000. 8. Iodophors: Idokyl and Wescodyne 1/100 and 1/160. 9. Chlorine compounds: Domestos 1/100 and 1/160; chlorine cleaning powders, Diversol BX 1% and Septonite 1%. 10. Ethyl alcohol 70%. Used mainly for instruments in operation theaters and critical care areas


Quality control Aspects of Disinfectants

• Usually products are tested against a variety of other microorganisms, especially in today's age of antibiotic resistance (MRSA and VRE) and concern with bloodborne viruses. To obtain a one-step cleaner disinfectant claim, testing of these products is usually done in the presence of organic serum (at least five percent) and hard water (at least 400 ppm)


Health Care Workers to follow the Instructions

• This testing is always done at the manufacturer's recommended dilution rate; therefore, it is important for the user to mix a disinfectant according to the manufacturer's label.



One Step Disinfection methods are need of the Modern Hospitals • A one-step claim is very important in today's cost-

conscious healthcare environment because it reduces labor and product costs. In laboratory testing, microorganisms must come into contact with the disinfectant for 10 minutes; however, actual kill time might be less than 10 minutes. In real world applications, floors usually do not stay wet from damp mopping procedures for 10 minutes. A few minutes can be expected, which should give most disinfectants adequate time to kill


Extraordinary care is unnecessary

why • Extraordinary attempts to disinfect

floors are usually unnecessary. The actual physical removal of soil and microorganisms is probably at least as important as the germicidal activity of the disinfectant used.


Effective Disinfectant Detergents

• Low-level, hospital-grade disinfectants are the recommended products for floor care disinfection in healthcare settings. The Environmental Protection Agency (EPA) regulates and registers all low-level disinfectants.

What is a Hospital Grade Disinfectant

•To be considered a hospital grade disinfectant, manufacturers must test their germicidal products against three microorganisms: Staphylococcus aureus, Salmonella choleraesuis, and Pseudomonas aeruginosa.



General Disinfectant Problems and Solutions

• Problem 1: Film on floor from use of germicides.• Solution 1: Dust mop with

untreated dust mop prior to damp mopping with disinfectant.• Solution 2: Change disinfectant

at recommended times--approximately every three to four rooms.


• Problem 2: Tacky floors caused by change from a "quat" to a phenolic.

• Solution 1: Scrub floor with a neutral cleaner before using a germicide with a different active ingredient. If floor is still tacky, mop floor with alcohol.• Solution 2: Check dilution of the

disinfectant. Use chemical dispensing systems for best accuracy.



•Problem 3: Discolored floor tile caused by too

strong a solution.• Solution 1: Rinse the floor

periodically with clean, clear water.• Solution 2: Use

disinfectant at proper dilution as a stripping solution to strip the discolored area.



A great Question Hunts many when we use Disinfectants


Never obsessed with too much cleaning

• Despite the fact that floors do not play a major role in the transmission of disease, it is appropriate to clean and disinfect floors in a healthcare facility on a regularly scheduled basis. This is especially true in all patient care areas


Never obsessed with too much cleaning

• Use of disinfectants in this process control the spread of bacteria from room to room as long as proper procedures are followed and proper tools are used. Use of disinfectants is also as cost effective as neutral or general-purpose cleaners when comparing end-use costs.


FLOORS NEVER REAMIN ASEPTIC

• Since the benefits of disinfection are frustrated by recontamination, it is necessary also to reduce the access of bacteria by air and by contact if floors are to be kept bacteriologically clean.

The Markets are flooded

with • Today the markets are

flooded with Good, bad, and spurious disinfectants, many choices however choosing on creditability with scientific acceptance is a great challenge and a priority



Major references • 1 Cleaning and Disinfection of Hospital Floors. A. J. AYLIFFE,* M.D.,

M.C.PATH.; B. J. COLLINS,* A.I.M.L.T.; E. J. L. LOWBURY,* D.M., F.C.PATH.Brit. med. J., 1966, 2, 442-445• 2 Floor Disinfection: Creating a Healthier Environment by Joe

Saunders and Lynda Mathiesen Infection control today June 2000 Floor Disinfection: Creating a Healthier Environment


•Program created by Dr.T.V.Rao MD for benefit of Health care workers

for the Global education on Hygiene and safe health practices

•Email•[email protected]

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FLOOR DISINFECTION INHEALTH CARE