Practicing thorough hand hygiene is key to avoiding the virus Floorcare The link between floors and superbugs Stepping up healthcare hygiene from the floor up

The link between floors and superbugs

The problem with floors is gravity. You walk on floors and everything that falls to the earth also lands on the

floor and is walked upon. Then the dirt and soils are stuck to the bottom of your shoes, and as you walk, you are

tracking that dirt everywhere. When looking at cleaning in most buildings, removing dirt from the floor is just a

part of the challenges of a cleaner’s life. However, in hospitals, the problems can become much more complex

and dangerous, according to Dr Greg S. Whiteley, chairman of Whiteley Corporation.

Before we open that little can of worms, let’s review some of the latest news on the so-called ‘superbugs’. And by ‘superbug’ we mean the multi-drug-resistant microbes that don’t respond to antibiotics. These superbugs are also referred to as antimicrobial-resistant (AMR) superbugs, and they are deadly.

The US Centers for Disease Control and Prevention (CDC) in Atlanta, has released an updated report (2019) on AMR/superbugs. The CDC advised that the number of superbugs has increased from 18 (in 2013) to 21 (in 2019). The highest level of concern at the top section of the list has expanded from three to five superbugs. People with infections from these bad bugs often end up in a hospital and many of those people die.

Healthcare settings

In hospital or healthcare facility cleaning settings, we must clean in such a way to combat the normal soiling that drops from everyone, every day. For example, each and every day, everybody sheds around 50 million skin cells. That soil load is in addition to the normal dirt that gets tracked into a hospital. Cleaning away all of this human debris is a constant challenge for any cleaning process.

However, when a patient has contracted a superbug it will be present on the person’s skin cells, which is very concerning. This is because the skin cells fall off and the superbugs with them, where they can circulate throughout the hospital. Bugs from a sick person resting in a hospital bed may be spread – ending up to 11 metres from the bed in just one day!

Now for many years it was thought that if the bad bugs (superbugs) are on the floor – with all of the other many, many bugs and dirt – then what’s the big worry? It’s not as if the patient gets lifted out of the bed and rolled around on the floor.

Colonisation issues

The concern is that the superbugs on the floor can end up in a bed with another patient, where they can transfer onto that patient’s skin and spread. This is commonly referred to as patient ‘colonisation’. Terrifyingly, when a patient is colonised with a superbug, it is a silent and ominous event, and nobody rings a warning bell. It just happens silently, and many people who get colonised are completely unaware of the problem.

Being colonised with a superbug poses an elevated risk of infection, but infection doesn’t always happen, and there is a very low risk of death from skin colonisation in and of itself. But colonised patients shed the superbugs just as much as an infected patient with the same superbug. And because the colonisation is silent, the shedding of skin cells with superbugs included is a silent risk inside the hospital.

However, it gets truly horrific for any patient, if the superbug moves from the patient’s skin into a wound, a catheter, a cannula, or a respiratory device. That is when the bug has moved from colonisation into an infection state. With many of the superbugs, the risk of death arising from a superbug infection can often be as high as 50 percent (from within 90 days of the onset of infection).

How do the bugs jump from the floor and onto the patient? A recent study from the team led by Dr Curtis J Donskey (Case Western Reserve University) observed two critical issues. The first is that 41 percent of occupied hospital rooms had an item that touched the floor at some point. These items were then returned to the patient level without any cleaning or disinfecting action. These included articles of clothing, the TV remote, the call buzzer, and other commonly used items. The second significant finding from the study was the frequency of C. diff spores, MRSA, and VRE contaminating the hospital floors.

Dr Donskey was able to show that superbugs on the floor could grab onto the dropped items and then be lifted up to the bed level to make contact with the patient. The bad bugs get a free ride from the floor up to the patient level, where a new victim awaits.

But wait, there’s more… two other studies have shown the danger of non-slip bed socks which are handed out to patients within hospitals. A study in England showed that from 54 pairs of non-slip bed socks collected from patients in a hospital, there were 46 pairs (85%) that had gathered up at least one superbug.

A separate study from Australia demonstrated that in just five minutes of walking around on a hospital floor, non-slip socks were very efficient at picking up the superbugs from the floor and then transferring these onto hospital sheets.

In hospital or healthcare facility cleaning settings, we must clean in such a way to combat the normal soiling that drops from everyone, every day. For example, each and every day, everybody sheds around 50 million skin cells. That soil load is in addition to the normal dirt that gets tracked into a hospital. Cleaning away all of this human debris is a constant challenge for any cleaning process.

Please note that the socks collected the superbugs from the floor, and then they were transferred via the socks into the bed with the patient. Could it be that they all lived happily ever after? Unfortunately, no, because those bad bugs, the superbugs, simply found someone else on which they could live. And once they are on the skin, these same superbugs have an extraordinary capacity to move around, and into places that are normally moist and covered such as the underarms, genitals, and groin.

A recent medical commentary has noted: “Rectal colonisation with ESBL

producing Enterobacteriaceae (these bad bugs are in the top five of the CDC superbugs lists) is associated with increased risk of hospital-acquired pneumonia, bacteraemia, and urinary tract infection with the same organism.” (Stewart et al, Microbiol Aust 2019.) So the superbugs can move to the bottom, to the top, and back again.

Therefore, it’s extremely important to keep the superbugs far away from the patients. And it turns out that the floor is a critical concern and must be maintained, clean and free from superbugs. If the superbugs are allowed to get onto the patient at bed level, and then onto the patient’s skin, there is a heightened risk of infection which can put the patient’s life in jeopardy.

Importance of cleaning

Cleaning suddenly comes into focus as a critical, lifesaving intervention. But there is one proviso, which is that the cleaning process (materials and method together) must be proven to be effective. This is a difficult challenge in hospital cleaning.

Another study by Dr Donskey’s group, published in 2013, demonstrated that improperly used wipes could easily spread C. diff spores from place to place via the wipe itself. The misused wipe becomes the mechanism of transfer for a life-threatening superbug. We could go into another bunch of published studies of events where the cleaning process simply moved the bugs from one place to another and never removed or killed the superbugs, but we have run out of space for this first article.

The only logical conclusion is that we need better quality control of cleaning. This quality-control challenge affects both the materials used (equipment and chemicals) and the methods used to achieve the cleaning process. This is a quality challenge, and while productionrates-based methods will assist with cost control, they are useless when it comes to quality control.

Cleaning in healthcare is, without a doubt, the most important cleaning challenge facing our sector. So, make sure those floors get properly cleaned because patients’ lives depend on it!

Whiteley Corporation is committed to worldleading research and innovative product development in the field of hygiene, cleaning and infection control products. Dr Whiteley is the chairman of Australian-based Whiteley Corporation. For more information visit: www.whiteley.com.au

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Stepping up healthcare hygiene from the floor up

Gordon McVean

The challenges in delivering consistently hygienic cleaning in the healthcare sector are considerable. Budgets are tight, while there is a growing demand for services. Gordon McVean, International Sales and Marketing Director of Truvox International, offers advice on how to achieve both hygiene and high efficiency in healthcare floor cleaning.

Hygiene-control procedures often focus on hand washing and common touchpoints. But floors accumulate and spread toxins too. Routine cleaning must deliver consistently reliable standards of cleanliness day in, day out, to prevent soils underfoot being tracked through the building with the risk of eventual cross-contamination of hands, equipment and other surfaces.

In our experience, that usually involves a mix of scrubber-dryers and rotary machines. Yet it’s still surprisingly common to see hand mops in use, not just in toilets and wet rooms, but other areas as well.

Even with microfibre mop heads, standards of cleanliness are compromised as soiled solutions in buckets are recirculated and inadequate pressure fails to dislodge embedded dirt – in the grout lines of tiled floors, for example. This labour-intensive method compounds the false economy of using cheap tools. Even cramped spaces and cubicles are no justification for a mop when compact scrubber-dryers offer a more efficient and effective alternative.

Versatile machines

It is the scrubber-dryer’s versatility that is so often crucial to cost-effective hygienic cleaning in a busy environment where there is a constant battle against infections.

A powerful, cordless, batterypowered scrubber-dryer that cleans nearly every type of floor, creates a practical floor-care solution. A good option is a model that can wash, mop, scrub and dry hard and soft floor coverings in a single pass, like the multi-purpose scrubber-dryers in our Multiwash range. Machines that enable you to easily change and colour code the brushes for different areas will prevent cross-contamination while providing outstanding cleaning results.

Machines should apply clean solution to the floor, and remove soils and used solution, leaving a surface that’s dry and safe to walk on in minutes. The rotating cylindrical brushes of a scrubber-dryer are particularly effective when it comes to cleaning deep into grout lines where bacteria can easily multiply. An optional side brush enables cleaning to skirting-board level, which is especially important with safety flooring, which tends to curve up the wall before it finishes, and in places like wet rooms.

Ergonomically designed, the machine should be easy and comfortable to operate, even on long shifts. The smallest model in our range, the Multiwash II 240 is ideal for confined spaces, while the cordless, batterypowered Multiwash II 340 Pump/ Battery works even more quietly and adaptably.

A bonus is that the modern scrubberdryer can economise on the use of water and solutions, aiding efficiency further.

Polishers and burnishers

Faced with large areas of hard flooring, another option that healthcare teams often rely on are rotary machines. Operating at speeds of around 1500 rpm, high-speed rotaries will burnish large areas rapidly to a high sheen.

But when traffic can lead to heavy soiling and impacted dirt, low-speed rotary machines come into their own. They offer a more versatile and effective choice when it comes to taking on a range of tasks, from scrubbing to stripping floors, for spray cleaning or even sanding wooden surfaces. They can also serve to buff floors to remove scuff marks and dirt, or for producing a quick shine with some polish.

Hourly outputs up to 475 m 2 can be achieved at speeds of 200–400 rpm, with single-disc machines that combine exceptional handling with low vibration levels, so operators maintain high productivity even on long shifts. A high pad/brush pressure and optional solution tank for wet scrubbing ensures effective cleaning in all situations – as well as intensive maintenance duties.

Putting health and safety first

Health and safety practices are key both for cleaning operatives and the people in the premises while they are being cleaned. Whichever machines you use, quietness is an issue that must be addressed. This is an important issue in hospitals or care homes where noise can be an unwelcome and distracting intrusion, as well as a health hazard.

Cordless battery-powered machines with no trailing leads will be less likely to cause trips or falls, and they must also leave floors clean, dry and ready to walk on in a matter of minutes. Cleaning operatives also appreciate the freedom of working without the stop-start of plugging and unplugging machines and finding the nearest electrical wall socket.

Lighter machines are also vital to occupational health, especially where they have to be transported in lifts to other floors. Machines must be well balanced and easy to handle, combined with simple and easy to use controls, making them comfortable to operate and manoeuvre. This means that more equipment can be carried in smaller vans at a lower cost.

Ergonomic design and adjustable handles, combined with built-in safety features, make machines versatile and easy to use with powerful low-level motors that allow ease of access in busy areas and under furniture.

For more information on Truvox’s comprehensive range of floor-cleaning machines visit: www.truvox.com