ECJ Hygiene for Health 2015

EC J Hygiene for health A supplement to European Cleaning Journal

SEPTEMBER 2015

CONTENTS

ECJ Hygiene for Health - September 2015 |

ECJ HYGIENE FOR HEALTH 3 A matter of life and death Foreword from Sealed Air Diversey Care president Dr Ilham Kadri

7 No room for complacency A look at why all businesses involved in food must be proactive in hygiene.

11 A hands-on approach Employers and FMs must create a healthy workplace through hand hygiene.

14 Falling ill - at your own leisure Ann Laffeaty on the implications of sickness outbreaks in the leisure sector.

19 Understanding needs What role does floor care play in maintaining high standards of hygiene?

22 Hygiene on the move What are the hygiene issues we should be aware of when travelling abroad?

26 Calling in sick Workplaces are a breeding ground for bacteria and must be kept safe.

28 Training well for well-being Why well-trained and skilled professionals are so vital in proper cleaning.

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30 The sharp end of cleaning The concept of hygiene is never more critical than in the healthcare sector.

31 Legionella - stay vigilant We all need to be more vigilant than ever in the battle against legionella.

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European Cleaning Journal is published six times a year by Criterion Publishing Ltd. Although every effort is made to ensure the accuracy and reliability of material published in European Cleaning, Criterion Publishing Ltd and its agents can accept no responsibility for the veracity of claims made by contributors, manufacturers or advertisers. Copyright for all material published in European Cleaning remains with Criterion Publishing Ltd and its agents.

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FOREWORD

A matter of life and death Fighting infections truly is a matter of life and death. The World Health Organisation (WHO) reports that at any given time, of every 100 hospitalised patients, seven in developed countries and 10 in developing countries will acquire at least one healthcare-associated infection (HAI).1 Tragically that means every year, HAIs kill 16,000,000 patients as documented in Thierry Crouzetís ëClean Hands Save Livesí book.

In the EU alone, approximately 4,100,000 patients per annum acquire a HAI according to the European Centre for Disease Prevention and Control (ECDPC). The number of deaths occurring due to these infections is estimated to be over 37, 000 and HAIs are thought to contribute to an additional 110,000 deaths each year. Approximately 20ñ30 per cent of healthcare-associated infections are considered to be preventable by intensive hygiene and control programmes again according to the ECDPC. Infection prevention and control are therefore now, more than ever, key objectives of healthcare locations and most other types of facilities too.

The healthcare sector, and the building service contractors who clean within them, have long placed huge emphasis upon understanding and mitigating the risk factors that can lead to outbreaks of infectious pathogens. Increasingly, others are following suit ñ from the hospitality sector to food services, retailers to offices ñ and with good reason.

Financial implications An organisationís brand reputation and brand value can be tarnished and diminished ñ perhaps even irreversibly. Who would want to go to a hospital, or eat at a restaurant or school canteen, in which people have fallen ill? Future business may well be affected, and many who have suffered such circumstances know that recovering a brandís good name, once diminished in the eyes of the public, is a long and slow road.

In the meantime, fingers may well be pointed at those responsible for designing and undertaking the (failed) cleaning regime.

But it is not just the infection of patrons which can have serious financial implications. When a facility fails to take adequate precautions against contagions, employees are also risk of becoming ill. Absenteeism will always reduce overall productivity as projects become delayed and deadlines are missed. Ultimately, robust infection prevention practices result in both healthier people, and a healthier bottom line. If you want further validation of this point, I strongly recommend that you look at the Value of Clean Calculator from our friends at ISSA. In recent years, there has been an explosion in the scientific breakthroughs which are driving ñ and changing ñ the future of this area.

For example, in the last 10 years, the volume of scientific literature being produced Continued page 4

Hygiene for Health - September 2015 | ECJ | 3

FOREWORD A matter of life and death (continued)

on environmental microbiology has expanded exponentially. This is in itself one of the most significant breakthroughs affecting infection prevention. It has created a powerful focus on the impact the environment has on infection rates ñ including increased investigation into areas that were previously largely ignored, such as the role of soft surfaces in patient care. In turn this focus has led to the development of technologies that help address the risks inherent in the environment ñ such as those that significantly reduce pathogen load on surfaces ñ and has led to increased efforts to elevate the role of certain highly effective cleaning practices, like good hand hygiene.

There is a wealth of new products on the market designed to help cleaning teams better tackle and reduce the risk of infection. These include hands-free robotic cleaning machines, no-touch disinfectants like fogging or the use of UV lights, and safer, more effective disinfectants such Accelerated Hydrogen Peroxide (AHP) technology ñ a blend of surfactants, chelating agents and low levels of hydrogen peroxide which have been demonstratively proven to reduce infection rates.

Safe and efficient processes With a shift towards more cleaning taking place while patients are present ñ and this means that cleaning processes must be completed safely and efficiently by cleaning staff, so as not to create an unpleasant environment or put patients at risk - AHP formulations are increasingly replacing disinfectants whose formulations include chlorine and/or quat-based ingredients.

There has also been a rise in the use of cleaning validation methodology, which allows facilities to better understand how effective cleaning should be conducted, and therefore whether they need to re-evaluate their current procedures.

There are standards of care, especially related to healthcare facilities, which are fairly well established within the recommendations that come from the CDC and WHO. However, there is sometimes a gap between what these and other such organisations put forward in their guidance, and the specific details needed to effectively manage the environmental risks that contribute to infections. This is where cleaning validation methodology comes in.

For example Diverseyís VeriClean is a comprehensive cleaning validation solution designed for healthcare, which does just this ñ in addition to improving cleaning compliance; it also focuses on the processes of cleaning that are being used to clean a clinical space. New technologies and products play a strong part in infection prevention, but more ëfundamentalí solutions which address the actual methods of cleaning are vital in helping to reduce the risk of environmental contamination, and ultimately reducing infection rates.

The fight for universal adoption of infection prevention best-practices is not one that is going to be won overnight. My view is that it is a multi-year exercise that will ultimately rely not only upon the development of new technologies, but also upon ensuring knowledge levels are raised internationally and on all sides of our industry ñ contractor, distributor, manufacturer and end client. But as science and technology continue to innovate, the future of infection prevention looks very bright ñ and very clean!

1 http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf

Dr Ilham Kadri President, Sealed Air Diversey Care

Dans son avant-propos au supplÈment HygiËne pour la SantÈ, la Dr Ilham Kadri, de Diversity Care, discute de líimportance de la prÈvention et du contrÙle dans des Ètablissements de tous types. Elle souligne aussi le rÙle crucial assurÈ par les prestataires de service de nettoyage et díhygiËne pour notre bien-Ítre.

In ihrem Vorwort zur Beilage ÑHygiene for Healthì (Hygiene f¸r Gesundheit) diskutiert Dr. Ilham Kadri von Diversey Care die Bedeutung der Infektionsverh¸tung und Infektionskontrolle in Einrichtungen aller Arten. Sie betont auch, welche ausschlaggebende Rolle bei der Erhaltung unseres Wohlbefindens diejenigen Personen spielen, die Reinigungs- und Hygieneleistungen vollbringen.

Hygiene for Health - September 2015 | ECJ | 4

Nella sua introduzione al supplemento Hygiene for Health, la Dott.sa Ilham Kadri della Diversey Care discute líimportanza della prevenzione e del controllo delle infezioni in tutti i tipi di strutture. Enfatizza inoltre il ruolo cruciale che hanno i fornitori di servizi di pulizia e di igiene nellíassicurare il nostro benessere.

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KITCHEN HYGIENE

No room for complacency Although the number of cases of foodborne illnesses across the EU has been decreasing steadily in recent years according to latest figures, there is still much work to be done.

All businesses involved in preparing and serving food must have a proactive approach to food safety and hygiene in order to prevent problems before they occur.

Safe kitchen hygiene can only be achieved by a team of people who are all trained in the correct procedures, who know what they are doing and why theyíre doing it.

The European Food Safety Authority and the European Centre for Disease Prevention and Control analysed information submitted by 27 European Union member states on the occurrence of zoonoses and foodborne outbreaks in 2012. Zoonoses are infections and diseases that are naturally transmissible, directly or indirectly - for example via contaminated foodstuffs - between animals and humans.

The most commonly reported zoonosis continues to be Campylobacteriosis, with 214,258 confirmed human cases. There has been a significant decreasing trend in Salmonellosis since 2008, with 2012 rates seeing a decrease of 4.7 per cent over 2011 and 32 per cent compared to 2008 ñ there were 91,034 cases in 2012.

The report notes this postive progress is ìmainly a result of the successful Salmonella control programs in poultry populations. Most Member States met their Salmonella reduction targets for poultry, and Salmonella is declining in these animal populationsî.

On the increase, however is listeriosis at 1,642 cases. While the case rate seems low compared to other pathogens, a high fatality rate (17.8 per cent) was reported among the EU cases. Rates of verocytoxigenic Escherichia coli decreased by a significant 40 per cent over 2011 at 5,671, after increasing since 2008.

While progress is clearly being made, efforts must continue in reducing pathogens in foods in order to reduce the health impact on consumers. The global movement of food and people makes this especially important.

Improper cleaning and sanitisation of food service equipment, surfaces and utensils are a significant factor in the food production process. Microorganisms or allergens are frequently transferred directly onto food or surfaces during the food preparation, serving and storage cycle. Poor hand washing, failure to clean and sanitise a cutting board between uses, or using the same preparation table with

raw and cooked foods are all examples of how easy it is to move bacteria around the kitchen and create dangerous food safety risks.

Marc Hurst of Enviro Health in the UK specialises in helping restaurant and hotel operators to maintain a spotless record in instances of foodborne illness. As an expert consultant in professional kitchen hygiene he has worked for some of the worldís largest hotel chains and tour operators.

Rapid intervention ìBeing proactive is key,î he emphasises. ìPreventing outbreaks before they happen is what every business should be seeking to do. In the past many were not so thorough in inspecting kitchens for cleanliness and hygiene compliance but Iím glad to say that has changed significantly. It just simply does not make sense anymore to react to issues as they occur.î Poor kitchen hygiene in hotels, restaurants, etc has a number of impacts.

First and foremost, the impact on the individual. Here, Hurst says, published statistics are a ìdrop in the oceanî because cases are simply not widely reported. ìIllness is the consequence,î Hurst explains. ìDiarrhoea and vomiting, fever, stomach pains, nausea. And all the implications that brings ñ time off work, inconvenience, suffering, etc. And for the more vulnerable groups in society, such as the very old, the very young and pregnant women, the implications can be much more serious. In the most severe cases, death.î ìSo that means the quicker you can get to the source of an outbreak if one does happen, the better. Because you may be able to prevent further cases.î Then there is the impact on businesses that have food poisoning cases as a result of poor hygiene. ìIf that news makes the national, or even local, media, it can be potentially devastating,î Hurst says. ìIt is possible for the authorities to close Continued page 8

Hygiene for Health - September 2015 | ECJ |7

KITCHEN HYGIENE No room for complacency (continued) restaurants down for hygiene offences and even when they open again, word has spread about the problems and business may never return to normal. ìRestaurant owners can also be banned from ever running a food business again.î The other factor increasingly coming into play is the compensation culture, which is particularly prevalent in the UK. ìIn todayís world so many people try to claim compensation if they think they have contracted food poisoning at a particular restaurant, for example, and that can hit businesses very hard,î Hurst explains.

All these factors combined make it essential for any business serving and preparing food to take a proactive approach towards hygiene, and to ensure their staff are properly trained in the correct procedures.

Varying standards Standards do still vary somewhat around the countries of Europe in Hurstís experience. ìI believe the UK is one of the best in Europe when it comes to food hygiene,î he says, ìbecause the authorities are extremely good at enforcing laws there. ìSpain and Turkey in particular have improved immeasurably in recent years,î he adds. ìOften tourists travelling there in the past would almost expect to contract some kind of stomach bug, now itís increasingly rare.î Hurst is commissioned by companies across the globe to advise and educate

Le respect des normes díhygiËne est vital dans les cuisines díhÙtels et de restaurants, et le seul moyen de prÈvenir les risques díempoisonnement alimentaire est de prendre les devants. ECJ síentretient de ces questions avec Marc Hurst, un consultant et spÈcialiste de líhygiËne des cuisines, qui travaille pour des tour-opÈrateurs et exploitants de restaurants dans le monde entier.

on kitchen hygiene standards. So how does he work when he visits a kitchen? ìThe first thing I do is wash my hands. By doing that I can tell if the staffís hands are being washed ñ if the water runs hot immediately I know the tap has been used recently. ìThen I work through the kitchen looking for signs of any pests, checking the cleaning of floors, cleaning under cookers, equipment, utensils, etc. Cleanliness of the fridge, storage of food, use-by dates on food, ventilation and grease filter cleaning, the state of hand washbasins.î

Kitchen staff Hurst then turns his attention to the kitchen staff. ìI observe their clothing, their behaviour. I ask to see their sanitisers, for example, the ones they use to clean surfaces. I question them about contact times, etc and ask them some more detailed questions about their cleaning procedures, food handling techniques, prevention of crosscontamination etc.î To judge exactly how good the cleaning really is Hurst often goes down on his hands and knees to check underneath appliances in the kitchen. ìWhere I often find shortfalls in cleaning is underneath counter-top equipment such as meat slicers, tin openers, etc,î he says.

Hurst estimates that between 80 and 90 per cent of the kitchens he inspects have some issue with cleaning under large equipment. ìNot only is that unhygienic,î

Die Hygienestandards in Hotel- und Restaurantk¸chen sind besonders wichtig, und ein proaktiver Ansatz ist die einzige Mˆglichkeit, um sicherzustellen, dass es keine F‰lle von Lebensmittelvergiftung gibt. Das ECJ f¸hrt ein Gespr‰ch mit Marc Hurst, einem Berater und Experten f¸r K¸chenhygiene, der f¸r Tourenveranstalter und grofle Restaurantbetreiber auf der ganzen Welt arbeitet.

Hygiene for Health - September 2015 | ECJ | 8

he points out. ìIt can attract pests.î In many cases itís the kitchen porters who are responsible for cleaning. ìThe problem with that is they are under the supervision of the chef, who is often not present when cleaning is being done.î Hurst also often sees the incorrect products being used for cleaning ñ for example a detergent rather than a sanitiser. ìI usually recommend that hot soapy water is probably the best solution for basic cleanliness. When using a sanitiser I often advise my clients to find one with as short a contact time as possible ñ five minutes, for example, is simply not practical in a busy kitchen.î Vital to any hygiene programme, in any application, is hand hygiene and here Hurst finds much work to be done. ìThere is still a real lack of knowledge about the consequences of bad hand hygiene,î he explains. ìStaff really must have proper training in hand washing technique, with soap and water and paper towels. In the kitchen, our hands are our worst enemies.î Safe kitchen hygiene can only be achieved by a team of people who are all trained in the correct procedures, who know what they are doing and why theyíre doing it. ìThere also has to be a supervisory system in place,î Hurst emphasises, ìin order to monitor and check that standards are being maintained.

There is no room for complacency or negligence because the consequences can be extremely serious.î

Gli standard di igiene nelle cucine degli hotel e dei ristoranti sono di vitale importanza e un approccio proattivo Ë líunico modo per assicurarsi che non si verifichino casi di intossicazione alimentare. ECJ intervista Marc Hurst, un consulente ed esperto in igiene delle cucine che lavora per tour operator e operatori di grandi ristoranti in tutto il mondo.

THE IMPORTANCE OF HAND HYGIENE

Can washrooms make you sick?

One out of four refllable bulk soap dispensers are contaminated with illness-causing bacteria.1 Once dispensers become contaminated, they can’t be cleaned, even with bleach. The bacteria re-grows.

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AFTER

Workplacea Elementary Schoolb (FedEx Custom Critical) (with Handwash Program)

Extended Care Facilityc

Acute Care Facilityd

Higher Educatione (University of Colorado Dorm Study)

“Keeping hands clean is one of the best ways to prevent the spread of infection and illness.”2 Centers for Disease Control and Prevention Actual petri dish photos

If you would like to know more about absenteeism and hand hygiene email ‘ECJ’ to infouk@GOJO.com a. FedEx Outcome Study Executive Update: Interim Report, July 27, 2004, (unpublished) GOJO Industries, Inc., 90.3% confdence interval b. M. Guinan M. McGuckin, and Y. Ali. 2002. The effect of a comprehensive handwashing program on absenteeism in elementary schools. American Journal of Infection Control. 30(4):217-220. c. EJ Fendler, Y Ali, BS Hammond, MK Lyons, MB Kelly, NA Vowell; Effects of alcohol hand sanitizer on infection control in an extended care facility.

Am J Infect Control. 2002, 30:226-233. d. J Hilburn, BS Hammond, EJ Fendler and PA Groziak. 2003. “Use of alcohol hand sanitizer as an infection control strategy in an acute care facility.” American Journal of Infection Control 31: 109-116 e. C White, R Kolble, R Carlson, N Lipson, M Dolan, Y Ali, M Cline. 2003. “The effect of hand hyagiene on illness rate among students in university residence halls.” American Journal of Infection Control 31: 364-370 1. 2013 meta-analysis of germ transmission data by Dr. Gerba, University of Arizon 2. http://www.cdc.gov/features/handhygiene

©2015. GOJO Industries-Europe Ltd. All rights reserved.

HAND HYGIENE

A hands-on approach Well-being is crucial to everyone in all walks of life ñ and itís as important in the workplace as it is in our personal lives. Continuity and consistency are key, but the spread of illness can place a strain on resource and operations.

Mike Sullivan, managing director of GOJO Industries Europe, explains how employers and facility managers can gain the upper hand when it comes to creating healthy and hygienic working environments, and show that they care for their employees, customers and service users, by implementing effective hand hygiene programmes.

Someone once memorably said that absence makes the heart grow fonder.

In romantic liaisons this may be true ñ depending on your point of view ñ but it does absolutely nothing in terms of productivity and profitability for any organisation providing services or support.

Factoring out natural disasters and critical incidents such as fires and industrial accidents ñ all of which are thankfully rare ñ the spread of illness through an organisation is perhaps one of the most potent threats any business or service faces. Like throwing a stone into a pond, one personís cough or cold can quickly cause ripples throughout the entire workforce, as more and more people are infected and have to take days off to recover. When you consider the additional strains placed on healthy staff, who have to back-fill for their ill colleagues, itís obvious that keeping your workforce well has to be a priority. ëHealth at Work ñ an independent review of sickness absenceí, a report by

Dame Carol Black and David Frost CBE that was published in the UK in November 2011, states that sickness absence from work can be, ìwasteful and damaging ñ to individuals and their families, employers and our wider societyî.

Europe is also becoming increasingly alert to the problems caused by workplace absence. The European Foundation for the Improvement of Living and Working Conditions published its report ëAbsence from Workí in July 2010. Its aim was to, ìaddress patterns of absenteeism in the 27 EU countries and Norway, the costs involved, policies for dealing with absence and general developments in relation to promoting health and well-being.î While the study revealed that the availability of absence statistics varied greatly from country to country, one of its conclusions was that promoting good health and attendance instead of penalising absence has become a growing policy priority ñ and an area where hand hygiene can play a pivotal role.

Clean hands for health Our 24-7 media, both social and ëtraditionalí, is quick to capitalise on any disruption to delivery of services ñ whether this is the closure of a hospital ward or the early curtailment of a cruise because of a norovirus outbreak, or diners affected by food poisoning at a Michelin-starred restaurant. Readers will easily recognise these examples, and be able to add more of their own ñ many of them caused by the spread of germs and viruses. Faced with the triple whammy of unwelcome publicity, a downturn in productivity and output, and plummeting customer satisfaction, organisations need to take preventative steps to protect both their reputations and their employees ñ and investing in effective hand hygiene solutions will make a huge difference.

The Centers for Disease Control and Prevention (CDC), one of the leading national public health institutes in the USA, says: ìKeeping hands clean is one of the best ways to prevent the spread of

infection and illness.î This is borne out by research from the University of Arizona, which found that almost 80 per cent of all illnesses are transmitted by hands.

Human beings are social animals and everyday life involves countless interactions with our fellow citizens.

From schools, colleges and universities to the workplace, shops, leisure centres, healthcare providers and cinemas we, and more precisely our hands, come into contact with lots of different surfaces ñ where germs lie in wait. Community has perhaps become an overused word in recent years, but it has largely positive associations for us all, with its emphasis on togetherness and working for the common good. One of the very few negatives is the fact that germs love communities ñ because they provide perfect breeding grounds in which to swarm, multiply and spread.

The length of time bacteria and viruses can live outside the body depends on each individual organism and what kind of surface they are on, according to the UKís NHS Choices. Cold viruses can survive on indoor surfaces for more than seven days whereas flu viruses can survive on hard surfaces for less than 24 hours.

Stomach bugs are another huge cause of ill health but whereas salmonella and campylobacter survive for between one and four hours on hard surfaces and fabrics, norovirus and clostridium difficile can last much longer, surviving for up to days, and sometimes weeks.

For someone with no underlying health issues catching a cold or a stomach bug will usually be a short, albeit uncomfortable and unpleasant experience.

However for people with established respiratory conditions, or the very young and very old who may be less able to fight off infection, they can easily develop into something more serious. Education on the benefits of practising good hand hygiene, together with easy access to products and systems that are effective in combating Continued page 12

Hygiene for Health - September 2015 | ECJ |11

HAND HYGIENE A hands-on approach (continued) germs and a pleasure to use, are therefore essential for all public facing organisations and businesses ñ great or small.

The potential for hands to spread bacteria is obvious ñ just think about what yours might do in just one day. We all touch a multitude of surfaces ranging from door handles to escalator rails and shopping trolleys to computer keyboards.

In many doctorsí surgeries weíre now asked to sign in for our appointments using a touch screen monitor ñ which many other people have touched before ourselves! If this is the case at your surgery, perhaps itís time to suggest that they provide hygienic hand rub to be used before and after you tap that screen, if they donít do so already.

The basic principles behind hand hygiene are simple and straightforward ñ if you wash your hands more often you can protect yourself against illness and disease ñ but donít let that simplicity fool you. The bacteria we face are complex and adaptable, but effective hand hygiene regimes do work, and there are independent results to prove it. GOJO has conducted multiple outcome studies to scientifically prove that a programme using hand soaps, hand sanitiser and state-of-the-art dispensing systems will reduce illness and absenteeism across a wide range of everyday settings. The results showed: ï 21 per cent reduction in absenteeism in the workplace ñ conducted at a FedEx facility ï 50 per cent reduction in absenteeism in an educational setting (elementary school) ï 29 per cent reduction in infection rates at an extended care facility ï 36 per cent reduction in infection rates at an acute care facility ï 20 per cent reduction in illness and 43 per cent reduction in absenteeism in a higher education setting (University of Colorado) These results should provide reassurance to managers and business owners that a solution does exist for every situation. Take education as an example.

Teachers who are ill incur significant costs.

As well as the sick pay for the unfortunate employee, extra funds will be needed to pay for supply teachers to cover classes.

If the contagion spreads to students absenteeism will affect their academic

achievement. This could result in less than spectacular exam results, which will reflect badly in league tables ñ not to mention the dissatisfaction of parents, and stress caused to all parties. This scenario could be replayed in any other public service or business setting by just changing some of the words, but it will still achieve the same results ñ namely nose-diving employee morale, customer satisfaction, profits Ö the list goes on.

LíhygiËne des mains joue un rÙle crucial pour la santÈ et le bien-Ítre dans tous les domaines de la vie quotidienne.

Mais si on nÈglige líhygiËne des mains, quelles en seraient les consÈquences et o˘ se situeraient les zones aux risques les plus prononcÈs ? Nos mains abritent et rÈpandent facilement des microbes. Pourquoi ? Et que faire pour nous prÈmunir, ainsi que les autres, contre ce danger ?

Handhygiene spielt eine wichtige Rolle f¸r unsere Gesundheit und unser Wohlbefinden, in allen Bereichen unseres t‰glichen Lebens. Doch was sind die Konsequenzen mangelhafter Handhygiene in Bezug auf die Gesundheit, und welches sind die wichtigsten Risikobereiche? Warum sind unsere H‰nde so wirkungsvoll beim Beherbergen und Verbreiten von Krankheitserregern, und wie kˆnnen wir am besten sicherstellen, dass wir uns selbst und andere nicht in Gefahr bringen?

Help is at hand Hand hygiene systems are easy to incorporate into any work or leisure facility but in order to get people to use them they need to have a number of attributes.

Itís often said that we eat with our eyes, and aesthetics play a crucial role in hand hygiene too. Dispensers that look good, and are easy to operate, will encourage more people to wash theirs hands, and the more they do it, the more it becomes a habit. Futuristic elements such as touchfree technology provide an additional element of attraction. These dispensers intuitively sense the presence of hands and dispense just the right amount of soap every time. Not only does this save money, as less soap is wasted, it is also more hygienic as it negates the needed to press a button or touch another surface.

Soap formulations need to be effective, with claims backed up through independent scientific testing, but they also need to be a pleasure to use, incorporating colours scents and textures that appeal to the senses and will keep hands in good condition ñ not just hygienically clean but moisturised and protected, too. You certainly wouldnít expect soap to make you sick ñ so how you refill your dispensers is another important part of creating a healthy workplace through hand hygiene.

Buying in bulk is often associated with cost savings, but bulk-fill soap dispensers are a false economy because they carry a high risk of bacterial contamination every time they are filled up. The reason for this is simple. A bulk-fill dispenser is refilled by pouring liquid soap from a container into an open reservoir at the top of the unit. Being exposed to the environment, this open reservoir can be infiltrated by bacteria, which forms a biofilm on the inside of the dispenser.

Hygiene for Health - September 2015 | ECJ | 12

Biofilms are groups of bacteria that coat surfaces and are hard to wash off or ëkillí. As the film coats the inside of the reservoir, any soap subsequently poured into it can become contaminated. Simply cleaning the reservoirs may not solve this problem as one study found that despite employing multiple cleaning methods, including bleach-based products, contaminated bulk-fill dispensers became re-contaminated within two weeks of cleaning. The World Health Organisation (WHO) has recognised the bacteria contamination risk of refillable bulk soap dispensers and has issued guidelines against this practice.

GOJO has been at the forefront of hand hygiene innovation for many years, and its SANITARY SEALED refills are a direct response to the problems posed by bulk-fill dispensers. Each refill is sanitary sealed, meaning that the product inside is protected from contamination and each refill comes with a fresh valve. This not only enhances hygiene and health outcomes, it also makes the lives of maintenance staff easier.

Hand sanitisers are useful when access to washing facilities are limited and means that employees are not restricted to the washroom as a place to keep their hands clean. PURELL Advanced Hygienic Hand Rub provides an additional layer of protection thanks to its antimicrobial efficacy. It is available as a gel for use on the hands, through wall-mounted or free-standing dispensers. However, in this era of ëhot deskingí it can also be provided in pump dispenser bottles for table tops, and in travel sized bottles that can easily attach to clothing so that hand hygiene is possible anywhere and everywhere.

The importance of encouraging and maintaining good hand hygiene, whether at work or play, cannot be overemphasised. By investing in the best hand hygiene solutions businesses and services can be protected, while increasing the well-being of employees, customers and clients. Faced with the possible consequences of an outbreak of illness managers and facility owners could be forgiven for going into panic mode, but my advice is simple and I make no apologies for misquoting a popular phrase, ëkeep calm and carry on cleaning your handsí.

Líigiene delle mani ha un ruolo molto importante per la nostra salute e benessere, in tutte le aree della nostra vita di tutti i giorni. Ma quali sono le conseguenze di una scarsa igiene delle mani in termini di salute e quali sono le aree a maggior rischio? PerchË le nostre mani sono veicolo cosÏ efficace di incubazione e diffusione di germi e come possiamo assicurarci al meglio che non mettiamo a rischio noi stessi e gli altri?

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LEISURE

Falling ill - at your own leisure A trip to a hotel or restaurant is often an expensive treat, and should therefore be a pleasurable experience. But your pleasure will quickly turn to outrage if it makes you ill.

Ann Laffeaty looks at the implications of outbreaks in the leisure industry ñ both to the unlucky guest and to the reputation of the venue concerned.

Hygiene in the leisure industry has never been more important. And it is up to the front-line cleaning staff to ensure that high standards are consistently met.

It is irritating when one contracts a cold or a stomach bug at work. But workplace illnesses are hard to avoid since healthy employees have to mingle with their infected co-workers on a daily basis.

However a person who falls ill following a visit to a restaurant or hotel will feel justifiably outraged. Leisure activities are supposed to be enjoyed and savoured and if they make you unwell, you may blame the venue for your illness ñ whether this is deserved or not. And your illness may well affect your decision as to whether or not to return.

The damage to a brandís reputation can be phenomenal following any outbreak.

This spring it was announced that 193 UK diners who contracted the Norovirus planned to sue a restaurant in Exeter where they believed they had contracted the illness.

According to the lawsuit, the first positive test from a patron at the Toby Pub and Carvery came on March 29 but the restaurant remained open for business until April 7. This was despite the fact that many people reported dining at the restaurant and subsequently falling ill with vomiting and diarrhoea.

Meanwhile, more than 20 children in Washington State, US, fell ill this spring with E. coli O157:H7 following a visit to their local Milk Makersí Fest. A petting zoo and animal exhibits formed part of the three-day attraction and 10 of the youngsters were hospitalised following the outbreak.

A family in Scotland recently won an out-of-court settlement from the exclusive Gleneagles Hotel after becoming ill with Norovirus symptoms at the fivestar venue three years ago. The family claimed that the hotel had failed to act in time to deal with the outbreak.

And in May it was announced that two Californian women planned to sue a Los Angeles Mexican restaurant after claiming they were both infected with Salmonella after meeting there for lunch.

Twenty years or so ago these types

Hygiene for Health - September 2015 | ECJ | 14

of reports may have appeared in a local newspaper and then been quickly forgotten, particularly if there were no deaths or other serious repercussions following the incident. Now however, they appear on the internet where they remain indefinitely ñ causing untold harm to the brand in question.

The Mexican restaurant in LA had been a popular venue for 33 years and the womenís salmonella experience could have been overlooked as an isolated case. But several other customers took to Yelp and Twitter to complain of similar symptoms after eating there.

Tweets about the Gleneagles case have been cropping up at intervals over the three years since the event took place, eroding the brandís reputation on a gradual basis. The other two cases also show up on search engines which means potential diners can read these reports and decide to avoid those particular establishments.

So there is no longer any hiding place for leisure facilities where hygiene levels are poor. This can also be seen following the introduction of the UKís Food Hygiene Rating Scheme which was rolled out five years ago by the Food Standards Agency in partnership with local authorities. Every food outlet in the country is now inspected and given a rating from zero to five.

While displaying the rating is only compulsory in Wales, would-be diners are now able to search for a specific food outlet on the FSA website and review its rating. In fact they can even obtain a list of establishments nationwide that have five stars, four stars and so on.

This facility is of little use to the public since there are nearly a quarter of a million five-star rated establishments which means this hardly narrows down the dining choice for the average restaurantgoer. However, this facility to search by star ratings has been a gift to journalists at local, national and trade level. When they are short of a story they now simply need to search for zero-rated restaurants

LEISURE and cafes (1,500 at the time of writing) or one-star establishments (currently 14,000-plus) and then highlight those they find newsworthy. These ëname-andshameí news stories may then stay on the internet long after the next FSA inspection.

So the damage to the brand goes on.

Worse still for low-rated outlets is the fact that todayís smartphone-savvy diners can download an FSA iPhone or android app that allows them to check their chosen restaurantís rating before deciding on whether or not to set foot inside.

Rating schemes are an official way of grading food outlets in terms of hygiene.

But the perception of cleanliness is also important ñ and much more difficult to quantify. Many restaurants have kitchens with viewing windows and if a diner were to spot a chef blowing his or her nose and then immediately going on to dress a plate, that diner may never return. Worse still, he or she might take to Twitter and cause that momentary slip by a chef to become an international incident.

Meanwhile in hotels there has been a recent preoccupation with placing hidden cameras in guest rooms so that the actions of the housekeeping staff can be observed. Practices such as cleaning drinking glasses with a spray cleaner or drying them with the guestís own used washcloth have been observed in international chains and naturally, these videos have been uploaded on to YouTube for all to see.

In the face of todayís social media obsession, there is some comfort in the fact that bad reviews at least enable establishments to respond with an explanation and an apology and to react accordingly. In fact it can sometimes be worse if a diner or hotel guest votes

silently to shun an establishment without the manager ever finding out why.

Hygiene products manufacturer SCA recently carried out a survey into the publicís perceptions of hotel and restaurant washrooms. Of the 8,000 people questioned Europe-wide, more than 80 per cent believed that a dirty restaurant washroom was likely to reflect the standards of the restaurant kitchen. A similar percentage believed that if a hotel washroom was dirty, then rooms would probably be dirty too.

La visite díun hÙtel ou díun restaurant est souvent un plaisir onÈreux et doit donc procurer une expÈrience agrÈable. Mais le plaisir passe rapidement ‡ líindignation síil rend malade. Ann Laffeaty examine les consÈquences de líÈclosion de maladies dans líindustrie des loisirs, tant pour les hÙtes infortunÈs que pour la rÈputation des Ètablissements en cause.

H‰ufig besuchen wir ein Hotel oder ein Restaurant, um eine andere Person oder uns zu verwˆhnen, und ein solcher Besuch kann teurer sein. Daher sollte er eine angenehme Erfahrung sein. Aber das Vergn¸gen wandelt sich schnell zu Empˆrung, wenn Sie dadurch erkranken. Ann Laffeaty betrachtet die Folgen von Krankheitsausbr¸chen in der Freizeitindustrie ñ sowohl f¸r den ungl¸cklichen Gast als auch f¸r den Ruf des betroffenen Orts.

Clean washroom vital Around 90 per cent believed that the washroom had an important part to play in the overall impression of a restaurant or hotel. And more than 75 per cent said they would not return to an establishment where the toilets were unclean, with 25 per cent vowing to walk out if they encountered a dirty washroom in an eating place.

So hotels and restaurants need to be seen to be clean. Establishments with viewing windows on to the kitchens need to ensure that faultless cleaning and hygiene systems are in place and that kitchen staff are never allowed to put a foot wrong.

Most restaurant and hotel guests are there to enjoy themselves and are not usually on the lookout for evidence of poor hygiene. But a diner sitting at a restaurant or hotel table is basically a captive audience for several hours, and during that time they will observe the habits of the waiting staff, the cleanliness of their surroundings and any hygiene slip-ups in the kitchen.

On the other hand, where the surroundings are spotlessly clean and the

staff are seen to be well groomed and practising good personal hygiene, the diner will be impressed and reassured.

When someone falls ill following a visit to a hotel or restaurant, it is often hard to tell whether that venue is actually to blame. If the illness is an isolated case the person in question might have contracted it before or after their hotel or restaurant visit.

But if the victim has perceived any lapses in hygiene on the part of the hotel staff they are much more likely to blame the venue ñ and to bad-mouth that venue to others, whether verbally or via the internet.

Uniformed waiting staff in restaurants who work quickly and efficiently to clean tables will create a good impression.

Similarly, smartly-dressed housekeeping employees with well-ordered trolleys in a hotel will create an impression of professionalism.

Toilets in both restaurants and hotels should be spotless with visible cleaning schedules on display. There should be a number to call for when a cleaning team is required, and an attendant in the washroom will provide further reassurance that cleaning and hygiene is constantly being considered.

There has been a growing preoccupation with hygiene over recent years, with antibacterial wipes and sprays becoming increasingly popular. Todayís insistence on high levels of hygiene ñ coupled with the ease with which images and videos can capture any hygiene lapses ñ means that hygiene in the leisure industry has never been more important. So it is up to the front-line cleaning staff to ensure that high standards are consistently met.

Soggiornare in un hotel o andare al ristorante Ë spesso uno sfizio costoso e dovrebbe perciÚ essere una esperienza piacevole. Ma il piacere si trasforma presto in sdegno se la visita vi fa ammalare. Ann Laffeaty osserva da vicino le implicazioni delle epidemie nel settore dei luoghi di ricreazione e divertimento, sia per gli ospiti sfortunati che per la reputazione delle strutture interessate.

Hygiene for Health - September 2015 | ECJ |15

Sergio Pupkin, Vice President Global Marketing at Diversey Care discusses the role good environmental hygiene plays in fighting healthcare-acquired infections.

penalised if the rate of HAI transmission exceeds set criteria.

While the actual nature of the HAI threat is constantly changing, and we now better understand the nature of that threat through scientific breakthroughs, the incidence of HAIs remains frighteningly high.

In Europe alone, 4.1 million patients acquire a HAI per annum resulting in 37,000 deaths. This is a modern day human tragedy. The threat of HAIs is as real as ever and remains one that we have to urgently and relentlessly focus on.

What is the best strategy for hospitals to adopt in combatting HAIs?

Is the threat to patient safety from HAIs still as great as ever?

Environmental services and infection prevention/control departments continue to face the incessant challenge of preventing the transmission of healthcareacquired infections (HAIs).

Their threat remains very much in the spotlight as incidences of HAIs are often now publicly reported, patients and their loved ones are demanding safer care, and in many countries hospitals or healthcare trusts are financially

A multifaceted approach to preventing infection is critical to reducing the risk for HAIs and should include hand hygiene practices, antimicrobial stewardship, as well as environmental cleaning and disinfecting. The risks associated with a lack of hand hygiene adherence have been well established and rigorous hand hygiene protocols, based around right dosing dispensers, should be an integral part of any healthcare hygiene program. The role of environmental surfaces has been less understood, but recent studies are showing that it is more important than was

previously thought.

Contaminated surfaces are a reservoir for transmission of pathogens directly through patient contact with the environment or indirectly through contamination of health care workers’ hands and gloves. Environmental cleaning is therefore vitally important for reducing microbial contamination of surfaces and the subsequent risk of HAIs. What are your top tips for hospital housekeeping?

Train, train and train again!

Training is the foundation for any successful infection prevention programme. Successful training programs clearly outline expectations, including what to clean, when to clean and how to clean. However, the most successful training programs also communicate why a task or role is so important.

Beyond that, selecting the right disinfectant is vital - consider its effectiveness against the pathogens of concern, its impact on surfaces and assets, its safety profile and having realistic contact times. We believe that once a surface dries, the disinfectant activity stops, so it is important for the disinfectant to have contact times of 5 minutes or less against pathogens of concern.

This helps assure that the disinfectant can kill the pathogens present.

Also you should measure what matters. Unfortunately, pathogens are almost always invisible. It can be very difficult for a supervisor to determine if high-touch surfaces were effectively cleaned based on visual inspection alone.

There are now a number of tools that healthcare organisations can implement to help them measure if high-touch surfaces were effectively cleaned. Instituting a programmatic approach that facilitates objective monitoring of surface cleaning and tracking those results so that gaps can be identified is the first step in a continual improvement process.

Do you see disinfectants playing a bigger role in combatting HAIs in future?

There is compelling evidence that effective, daily cleaning and disinfection of high touch surfaces, plays a critical role in breaking the chain of infection in a healthcare setting.

But there is also a significant shift in the type of disinfectant being used in healthcare settings and those whose formulations include chlorine and/or quatbased formulations are rapidly being replaced by products which incorporate alternative - but equally effective - ingredients such as Accelerated Hydrogen Peroxide (AHP).

One AHP disinfectant is Oxivir which both cleans and kills bacteria, viruses and fungi quickly in one action therefore bringing productivity benefits as well as disinfection reassurance. The safe breakdown of Oxivir after

use means no residual active ingredients are left behind and no sub-lethal doses are available for microorganisms to develop resistance to.

What other product innovations do you see helping in the fight against HAIs? Healthcare facilities must look for innovative ways to maintain cleanliness and combat the increased number of biological threats as well as removing the bio-burden of skin cells/dust, hair, and other contaminants settling on the floor and other surfaces.

The fact is that almost every healthcare facility is operating to limited budgets or even is running to a deficit. This means there is constant pressure to minimise the cost of any line item not immediately related to patient care which in turn means that the size of cleaning teams is kept very lean. Robotic machines such as the TASKI Intellibot range - which allow operators to clean floors at the push of a button and then walk away to concentrate on hot spots or high risk areas where germs reside - are consequently quickly becoming sought-after in the fight against infection. The hands-free machines are to avoid obstacles such as IV poles, trolleys and other expensive equipment and incorporate a unique UV light to kill bacteria as part of its Eco Save water purification system.

Through the use of robotic machines and re-assigning staff to higher level tasks, more cleaning can be done in the same time thereby improving the bottom line – and staff and patient safety.

A recent study “Microbial Contamination of Hospital

Reusable Cleaning Towels� found 93% of laundered towels cleaning hospitals contained bacteria, increasing the risk of the recontamination of surfaces. The new Diversey Care Disposable Dry Wipes System allows cleaning operatives to add cleaner or disinfectant of their choice to the wipe substrate and then dispose of the wipe after use. This offers enhanced health security and increased user safety by reducing the threat of cross contamination and the incidence of chemical spills associated with traditional cleaning methods.

Finally, what did the Ebola outbreak teach us about preparing a hospital for a new or emerging pathogens?

The Ebola outbreak was instructive in how quickly a pathogen in Africa can present a risk for countries globally. This teaches us the importance of having an outbreak response plan that includes identifying what disinfectants will be needed, what level of supplies are needed, what training is needed, how to deal with blood and body fluids - including having spill kits readily available - and what communication materials would be needed. Communicating and training in the appropriate response to a new or evolving pathogen is vital.

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FLOOR CARE

Understanding needs What role does effective floor care play in maintaining high standards of hygiene?

What are the most important considerations when cleaning floors to such high standards, what are the high-risk areas and how should service providers select the most appropriate equipment and chemicals?

Jean-Pierre Lebrun, group product manager, floorcare at Nilfisk, examines the vital role of this aspect of the cleaning operation.

A clear understanding of the needs in terms of hygiene level, cleaning efficiency, productivity, cost control. This is the only way to help logistics teams in hospital to win their daily challenge of cleaning.

Clean large floors areas - this is the daily challenge faced by logistics teams in hospitals. Every day thousands of square metres of floors have to be clean to a high standard of hygiene - this is why the cleaning of healthcare buildings need to be done by professionally qualified operators with the right floor care tools.

Healthcare facilities are by definition designed to receive patients with health problems, so they must have a good level of hotelier capacity coupled with a high level of hygiene.

Healthcare facilities are divided into several areas that require different levels of hygienic cleaning. These areas start with administration offices that require a standard building level of cleaning, going through medical services which require a high level of hygienic cleaning, right up to highly sensitive area like surgical units for instance, where all risks of contamination are forbidden.

For each area a specific cleaning programme must be followed to protect patients and avoid cross-contamination.

Cleaning is the first step of the hygienic chain. The constant challenge in healthcare is to stay permanently at a much higher level of hygiene than required each specific area, while the cleaning situation is deteriorating constantly during the time youíre working there.

How often cleaning is required will be linked to the level of contamination present in the place that has to be clean and the hygienic level required for this specific area.

For instance, daily cleaning will be enough for the administration offices but for the surgical units, where patients are very vulnerable and soil level is very important, an intermediate clean will be done between each surgical operation and a deep hygienic clean will be carried out at the end of each cycle of surgical operations or in case of high potential risk of contamination.

All these cleaning activities require hard work from professionally qualified

operators and it is an important part of the running cost in healthcare activities. Like everywhere cost are under pressure in the health environment and itís fundamental to have a perfect cleaning organisation with the right level of productivity for each activity.

The efficiency of the cleaning of very important, of course but avoiding the proliferation of germs is fundamental.

Trained operators For instance, itís efficient and professional to work with a trolley including buckets and microfibre clothes to clean a patientís room but itís essential to have trained operators who know how to use these tools in the correct way.

Itís also vital to make sure that cleaning operators are following the basic cleaning rules - cleaning from the cleanest to the dirtiest; use correctly the different microfibre cloths with different colours for each hygienic zone (the room needs to be clean first with one/several cloths and the toilet need to be cleaned afterwards with another/several cloths); use the correct chemical detergent on the right surfaces; use disinfectant only when needed on clean surfaces, and so on.

Without good training, the best cleaning tools used in the wrong way can be a vector of contamination, and the hands of cleaning operators are the first tools that must be managed. Good hygienic cleaning needs to be checked frequently in terms of the cleaning result, but also in terms of contamination and corrective actions, should be implemented when necessary.

A good example of cost optimisation in health facilities is to use machines like scrubbers dryers to clean large surfaces such as corridors, instead of manual mopping, Using scrubber dryers brings better cleaning efficiency, a faster job, better safety for the patient (the floor is immediately dry and not slippery), an higher level of hygiene (the microorganisms need humidity to grow) and a better aesthetic.

Continued page 20

Hygiene for Health - September 2015 | ECJ |19

FLOOR CARE Understanding needs (continued) How should cleaning service operators choose the most appropriate equipment and chemicals?

The main points that healthcare facilities managers need to consider when selecting floor care equipment and chemical are cleaning efficiency and productivity, to be sure to reach goal of cleaning and hygiene level specified in the programmes.

But they need also to take into consideration many other factors. For the machines the ergonomics, the low noise levels, the manoeuvrability, the ease of use, the water and energy consumption.

For chemical products, the usersí safety, floors compatibility, the ease of dosing.

They need also to check if equipment and chemical cleaning products can handle the variety of floors found in healthcare buildings, if the equipment fits with the building to clean (door sizes, lifts capacitiesÖ) and the ability to maintain the equipment itself.

Efficient machines A wide range of equipment is available to the healthcare market in the form of scrubber dryers in walk-behind, stand-on and ride-on models. These scrubber dryers use a detergent dispensing system that allows the operator to use the minimal amount of detergent needed for cleaning an area, while providing a burst of power in heavily soiled areas. These machines feature a quiet mode that permits daytime cleaning in sound-sensitive areas. Also, the minimal water used can reduce a facilityís water consumption. Paired with a squeegee design, they leave floors dry in a single pass.

The size of the scrubber dryer required depends on the surfaces to be cleaned: big ride-on scrubber dryers for large corridors and compact models for rooms inside the service areas or in sensitive applications.

Using and keep a scrubber dryer inside the same service area avoids contamination across health facilities.

Other machines can be used for floor care applications in healthcare building.

High or dual speed single disk models are the best tools for dry cleaning solution by spray method - removing tracks or sticky dirt from the floor without water is a good way to prevent microorganisms from growing and keeping the aesthetic on Quel est le rÙle vÈritable de la propretÈ des sols pour le maintien de hautes normes díhygiËne ? Quelles sont les considÈrations principales intervenant dans le nettoyage de sols ‡ de telles normes, quelles sont les zones ‡ risque, et comment les prestataires de services doivent-ils sÈlectionner les Èquipements et produits chimiques appropriÈs ?

soft floors.

Low speed single disk machines allow deep cleaning or floor restoration in narrow spaces. Burnishers increase the shine level for a better aesthetic, especially after scrubber dryer cleaning.

Wet vacuum cleaners can be used to absorb all kind of liquids. Dry vacuum cleaners can be used with HEPA exhaust filter to remove dust everywhere without contamination.

Definition of clean Steam cleaners scan clean and sanitise all kind of furniture, such as beds or operating tables.

All these machines are enabling heavy and laborious floor care activities to be scheduled into the daily cleaning routine for healthcare workers , allowing them to focus on more sensitive cleaning issues closer to the patient.

What have been the most important floor care developments in recent years in terms of more effective and reliable standards of hygiene? The first vector of better standard of hygiene in healthcare was a better definition of cleaning and hygiene programmes and the better training of health cleaning operators.

In term of equipment, the main progress drivers were better management of chemical and water consumption by chemical dosing system on trolleys or by dosing system incorporated directly into cleaning machines, like the Ecoflex from Nilfisk. The optimum level of water and chemical for the right level of cleaning needed brings less cleaning cost, gives microorganisms less water to grow in, and itís better for the environment.

Another clear trend in floorcare in healthcare facilities, is the reduction in the size of the scrubber dryer in order to replace manual mopping by mechanical cleaning. A good example is the Nilfisk SC351 small scrubber dryer, which has high manoeuvrability, a low sound level, and is usable frontwards and backwards to perform fast and deep hygienic cleaning of a patient room.

And the future is now with the new scrubber dryers from Nilfisk SC500 as walk behind and SC2000 as micro ride-on, which were carefully designed to improve productivity and drive down total cleaning Welche Rolle spielt die wirkungsvolle Bodenpflege bei der Aufrechterhaltung hoher Hygienestandards?

Welches sind die wichtigsten Aspekte bei der Bodenreinigung, die solch hohen Standards entspricht, welches sind die risikoreichen Bereiche, und wie sollten die Dienstleister die am besten geeigneten Ger‰te und Reinigungschemikalien ausw‰hlen?

Hygiene for Health - September 2015 | ECJ | 20

costs. These significant benefits are achieved through more ease-of-use and a series of technical features enabling daytime cleaning and the most effective use of water and detergent. Productivity is taken to a new level by the automatic adjustment of the water/detergent solution flow according to the speed of the machine. By using this control, which ensures a consistent cleaning result and an optimised consumption of water and chemicals, the operator can focus on getting the job done. Cleaning costs are reduced due to several features.

Water-only option The sustainable Nilfisk Ecoflex system offers very flexible use of detergent, and also water-only cleaning, just by pushing a button. Also driving down costs is the opportunity to introduce more daytime cleaning due to the remarkably low sound level of the SC500 and SC2000.

A clear understanding of the needs in terms of hygiene level, cleaning efficiency, productivity, cost control. This is the only way to help logistics teams in hospital to win their daily challenge of cleaning.

The only way to win this challenge is a constant communication between machines and chemical providers and the cleaning team in healthcare facilities, and itís the way Nilfisk is working.

ECJ is the only pan-European publication serving the professional cleaning sector. To register for your regular copy visit the website at www. europeancleaning journal.com Che ruolo gioca la cura efficace dei pavimenti nel mantenere degli standard di igiene molto alti? Quali sono le considerazioni pi˘ importanti quando si puliscono i pavimenti secondo standard cosÏ alti, quali sono le aree ad alto rischio e con che criterio i fornitori di servizi devono scegliere le attrezzature e i prodotti chimici pi˘ adatti?

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TRAVEL

Hygiene on the move An increasing number of people travel abroad these days whether on holiday, on business or to visit friends and family. Ann Laffeaty looks at the hygiene issues involved when venturing to other countries and finds out where in the world you are most likely to fall ill - and whether you can do anything to prevent it.

Where high standards of professional cleaning are maintained, travellers will be healthier and tourism to those countries will then ultimately benefit.

A mere 50 years ago it was not unusual for people the world over to live their entire lives in their home country ñ or even in their home town. Travelling was not on most peopleís agendas either because it was too expensive or too difficult or both. Many had little leisure time to spare for a holiday in any case, and those who did would simply head for the nearest beach or country resort.

But when Mediterranean package tours began to take off in the 1960s large numbers of Europeans developed the ëtravel bugí. Before long holidaymakers had begun seeking ever newer destinations to satisfy their wanderlust.

There followed a quiet revolution in travel and tourism. A staggering 1.1 billion tourists travelled abroad during 2014 according to the UNWTO World Tourism Barometer. This was 51 million more than the number travelling worldwide the previous year, representing a 4.7 per cent increase.

Meanwhile, business travel has also been on the rise with growing numbers of companies becoming multinationals.

The expansion of emerging markets such as China, India and Brazil has fuelled this growth and as a result an expected 8.6 per cent increase in global business travel spend is forecast in 2015.

This explosion in travel has led to a number of benefits. People are becoming more enlightened and are developing a greater understanding of other cultures.

We are more open to exotic cuisines than ever before and we also tend to be braver when crossing new frontiers and trying out new experiences.

However it is an unfortunate fact that some of these experiences are making us ill. Our immune systems have not yet evolved to enable us to fight off the diseases and stomach bugs that we routinely meet when we travel.

In some countries the danger is greater than others either because of graver health risks, poorer healthcare provision or both. According to health security risk

Hygiene for Health - September 2015 | ECJ | 22

services company International SOS, the worst destinations to become ill while on holiday in 2015 include North Korea, Sudan, Zimbabwe and Afghanistan. These all fall into the ëextreme riskí category since they combine inadequate healthcare provision with common incidences of serious diseases such as dengue fever, malaria, typhoid and cholera.

These four diseases may also be encountered in Egypt, Sri Lanka, Cambodia and Cuba which are listed as high risk destinations. These countries are said to offer limited emergency care and low access to quality prescription drugs.

South Africa, Thailand, Mexico, Cyprus and Turkey are considered to be medium risk countries since malaria, dengue fever and waterborne diseases may be present. In fact only Western Europe, North America, Canada, Australia and New Zealand fall into the low-risk category.

Luckily the risk of contracting a serious illness on holiday is generally considered to be relatively low. But even a mild illness on holiday such as a stomach bug caused by contaminated water or food poisoning can ruin a much-needed break.

According to a recent UK study around a quarter of Brits have been struck down with food poisoning while on holiday.

Many of the respondents claimed that the illness had wrecked their break, with half adding that their travelling companionsí trip had also been ruined. One in six respondents had had to be admitted to hospital during a holiday.

The study of 2,000 holidaymakers carried out by travel specialists at law firm Slater and Gordon revealed that nearly 40 per cent of British respondents consider the hygiene implications before deciding where to book. For example, more than 20 per cent said they would not risk travelling to India due to health concerns.

The survey showed that British holidaymakers were most likely to fall ill in Spain, Turkey or Egypt.

However with people travelling further afield all the time ñ and the popularity of

TRAVEL different countries constantly rising and waning ñ it is impossible to draw up a definitive list of ëriskiestí countries. Spain may be top of Slater and Gordonís UK list, but this result might be skewed by the fact that Spain is also one of the most popular tourist destinations of the British.

In fact a previous survey carried out by Holiday Which? in the UK put Peru at the top of the list of risky holiday destinations, with two-thirds of British visitors claiming to have become ill there. Nearly half of all travellers to Kenya and around 40 per cent who went to India also reported being unwell, with stomach upsets accounting for nearly 50 per cent of maladies.

Meanwhile, a poll of 3,000 Australians by the Travel Doctor revealed that India, Vietnam and Thailand topped the list of riskiest travel destinations while Spain, Egypt and Turkey did not feature.

Presumably this is partly because Australians are more likely to visit the three relatively close Asian countries than to travel to Western Europe. The Philippines, Indonesia and Myanmar also featured on the Travel Doctor list, backing up this theory.

Of course it could be that each nationality is particularly susceptible to specific bugs and illnesses. As an example, all our studies point to a potential health risk when travelling to India whereas Sweden emerged as one of the safest destinations. But from anecdotal accounts when a team of Indian IT workers recently visited the headquarters of a hygiene company in Gothenburg, the Indian

visitors were observed to quickly catch colds while their Swedish colleagues remained healthy.

So any of us can fall ill anywhere ñ particularly when we are visiting somewhere new.

Since only one in 1,400 of us contract a serious illness overseas according to the Holiday Which? study ñ and most people can handle a holiday cold - the chief dangers to travellers are stomach upsets caused by food poisoning or contaminated water.

According to the Slater and Gordon study, most illnesses caused by food poisoning are fortunately short-lived and can easily be treated. Others ñ such as Salmonella - can be more serious and even have life-changing effects.

But whether a stomach upset overseas is mild or monumental, It makes sense for travellers to be on their guard and make informed eating and drinking choices when travelling to a high-risk country. Tap water in any unfamiliar country ñ even where it is claimed to be safe to drink ñ can still cause upset stomachs to an unseasoned traveller. Bottled water is therefore a sensible option in higher-risk countries and care should be taken to ensure that the bottle is sealed before use, since some unscrupulous restaurateurs have been known to simply refill a used bottle from the tap.

Salads and other foods that may have been washed in tap water plus unpeeled fruit should be avoided. And ice cubes ñ usually made from tap water ñ could

Le nombre de gens voyageant ‡ líÈtranger, que ce soit pour les affaires, les vacances ou les rencontres familiales, ne cesse de croÓtre. Ann Laffeaty examine les aspects hygiÈniques des voyages en dehors du pays de rÈsidence et síinterroge sur les rÈgions du monde o˘ líon risque le plus de tomber malade, ainsi que sur les moyens de le prÈvenir.

Le nombre de Heutzutage fahren immer mehr Menschen ins Ausland, sei es um in Urlaub zu fahren, aus gesch‰ftlichen Gr¸nden oder um Familie und Freunde zu besuchen. Ann Laffeaty betrachtet die Hygieneprobleme, die bei Reisen in andere L‰nder auftreten kˆnnen, und sie findet heraus, wo auf der Welt die Wahrscheinlichkeit am hˆchsten ist, dass Sie erkranken ñ und ob Sie etwas unternehmen kˆnnen, um dies zu verhindern.

represent a risk in countries where the water is not safe to drink.

Good cleaning and hygiene regimes can play an important part in holiday health.

Where high standards of cleanliness are observed and a hand hygiene policy is in place in hotels and restaurants, illnesses are less likely to occur. A supply of antibacterial wipes may seem like overkill, but a quick wipe of hotel surfaces such as the door handles, light switches and the TV remote could prevent any illnesses contracted from the previous occupantís unwashed hands.

Most people will quickly shrug off a mild bout of food poisoning and will not let it ruin their holiday. In fact, only three per cent of the Britons questioned in the Slater and Gordon survey said a bout of food poisoning would deter them from returning to the same country again.

But poor health as a result of poor hygiene standards will still have an adverse effect on tourism. If we take into account the fact that more than 800,000 Britons visit India each year and around 40 per cent of them fall ill ñ and three per cent of that figure would avoid returning ñ that is still 960 visitors a year from Britain alone who will have opted to shun India.

Just consider how that figure will grow when visitors from other countries are factored in.

So where high standards of professional cleaning are maintained and an emphasis is placed on the importance of professional cleaning, travellers will be healthier and tourism to those countries will benefit.

Attualmente un numero sempre maggiore di persone viaggia allíestero sia per vacanze, per lavoro o per trovare amici e famiglia. Ann Laffeaty prende in esame le questioni di igiene relative allíavventurarsi in altre nazioni e scopre dove nel mondo Ë pi˘ facile ammalarsi e se si puÚ fare qualcosa per prevenire questa situazione.

Hygiene for Health - September 2015 | ECJ |23

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WORKPLACE

Calling in sick The workplace is a breeding ground for bacteria and any contagion will quickly spread in a busy office, institution or factory. Ann Laffeaty looks at the implications of an outbreak at work and asks whether employers and staff could be doing anything more to keep their workplace safe.

Anyone who works in an office will recognise the scenario. One person sneezes during a meeting, then another blows their nose. Within a week virtually half the office is incapacitated. Several members of staff will by now have called in sick while the rest of them struggle on, working under par while trying to do the job of several absent colleagues.

Infections and viruses can spread very rapidly in the workplace. Some scientists claim colds are more prevalent in winter because people spend more time huddled together inside. If that is indeed the case, it is no wonder that the unnatural surroundings of workplaces where people remain cooped up together for eight hours at a time are a hotbed for germs.

Many illnesses spread rapidly via communal touch points. Research carried out by a team at the University of Arizona in 2014 revealed that infections and viruses can be spread from a single office door handle to more than half the workforce in just two hours. The research involved researchers planting a harmless bug with similar properties to Norovirus on an office doorknob at the beginning of a working day.

They then sampled other surfaces such as light switches, lift-push buttons, coffee pots, taps and computers at two-hourly intervals. The study revealed that up to 60 per cent of the workforce in the building had been contaminated by the ëbugí in just

two hours.

A previous study carried out by Initial Washroom Hygiene in 2012 revealed the average computer mouse at work harboured three times as many bacteria as a toilet seat. Researchers at Initial, which tested 150 separate items in 40 workstations, attributed the results to workers eating lunch at their desks while using their other hand to surf the web. This was said to effectively turn workstations into germ breeding grounds.

And a third study staged by consumer organisation Which? in 2012 revealed that computer keyboards can harbour more germs than a toilet seat. Keyboards at the London offices of Which? were swabbed for E.coli, coliforms, staphylococcus aureus and enterobacteria. Of the 33 keyboards tested, four were regarded as potential health hazards and one harboured five times as many germs as one of the officeís toilet seats.

The takeaway from these studies is that commonly-touched surfaces in offices can be major contamination points for the spread of disease. Or maybe it is simply that workplace washrooms are surprisingly clean?

Breeding grounds for bacteria Toilets tend to be cleaned more regularly than other areas of the office.

This is because washrooms are generally considered to be breeding grounds for bacteria and it is also important to keep supplies of consumables such as toilet rolls and soap topped up. But not all washroom visitors wash their hands, and anyone who leaves the toilet without having done so will quickly contaminate other parts of the workplace.

Other commonly-touched surfaces such as light switches, telephones, microwave handles, water fountains, keyboards, paper files and door handles tend to be cleaned much less frequently ñ if ever.

This means they may present worryingly high levels of contamination.

So-called ëSick Building Syndromeí may also be a factor in causing people

Hygiene for Health - September 2015 | ECJ | 26

to become ill at work. The term was first coined by the World Health Organisation (WHO) in 1986 after people in the UK and Denmark reported symptoms such as headaches, nausea, dizziness and poor concentration that seemed to be linked to working in modern office buildings.

Flaws in the Sick Building Syndrome theory were revealed in two subsequent Swedish and Danish studies, and the term has become less widely used over recent years. But Sick Building Syndrome is still a recognised concern, certainly with the UKís National Health Service (NHS) which claims poor standards of cleanliness in the working environment and contact with airborne particles such as dust and fungal spores to be two of the potential risk factors.

The implications of failing to curb the spread of illness in the workplace can be dramatic. A recent study by professional services firm PWC revealed that Western European employees take an average of 7.3 days off work each year, with UK staff being the most likely to call in sick.

Employees in the UK take an average of 9.1 days off each year ñ almost double the number of days taken by US workers (4.9 days) and four times as many as their Asia-Pacific counterparts (2.2 days). One theory as to why Europeans take off a relatively high number of sick days could be because more of them receive sick leave than employees in the US and AsiaPacific regions.

Meanwhile, the global population is ageing and people are retiring later. This means older, more vulnerable people are populating our offices and are potentially more likely to be floored by that office bug.

And the cost of this absenteeism is phenomenal. PWC estimates that the cost to businesses in the UK alone is nearly £29 billion (39.7 billion euros) a year.

While the US absenteeism figures may appear admirably low compared with those of their UK counterparts, American employees are not actually avoiding workplace illnesses. In fact ëpresenteeismí

WORKPLACE - or turning up at work while feeling ill and under par ñ is becoming increasingly recognised by companies as a factor contributing to lost productivity.

Current estimates put the total cost of presenteeism to US employers at between $150 and $250 billion a year.

So while employers have a duty of care to keep their staff healthy, it is also very much in their own interests to do so.

From the bacteria studies it becomes clear that regular and thorough cleaning will help to keep office surfaces safe.

Well-trained cleaning contractors will understand the risks posed by surfaces such as keyboards, computer mice, telephones and light switches and will pay these areas particular attention.

Dr Charles Gerbaís study revealed that good hand hygiene coupled with the use of antibacterial wipes reduced the spread of his Norovirus-like bug by between 80 and 99 per cent. So office managers should Le lieu de travail est un terrain fertile pour la multiplication de bactÈries, et la contagion peut vite se propager dans un bureau, une organisation ou une usine plein de monde. Ann Laffeaty Ètudie les cas de maladie survenant sur le lieu de travail, et les perspectives qui síoffrent aux employÈs pour síen prÈmunir et protÈger ce lieu des infections.

do all they can to facilitate good hand hygiene practices in the washroom by providing adequate supplies of soap and hand drying equipment, and perhaps by displaying hand hygiene posters explaining the link between hand washing and illness.

This could deter people from leaving the washroom without washing their hands and going on to contaminate surfaces.

Cross-contamination risk Office cleaners are not always expected to carry out specialist tasks such as cleaning computers or other electronic equipment. Where laptops are used, too, it is the responsibility of the laptop owner to keep their keyboard clean.

However, the Which? study found one in 10 people never clean their keyboard and 20 per cent never clean their computer mouse. This could be a major cause of cross-contamination, particularly with the modern practice of hotdesking where Der Arbeitsplatz ist eine Brutst‰tte f¸r Bakterien, und jede ansteckende Krankheit wird sich in belebten B¸ros, Behˆrden oder Fabriken schnell ausbreiten. Ann Laffeaty betrachtet die Folgen eines Krankheitsausbruchs am Arbeitsplatz und fragt, ob Arbeitgeber und Mitarbeiter mehr tun kˆnnen, um die Sicherheit an ihrem Arbeitsplatz zu verbessern.

staff sit at different workstations. The research by Dr Gerba revealed that the bacteria count at office desks rose steadily throughout the day and typically peaked after lunch ñ unless the desk had been wiped with an antibacterial wipe during the course of the day.

There are currently moves to look into developing systems that reverse the effects of Sick Building Syndrome. At the University of California, for example, scientists are considering the possibility of embedding ëgoodí bacteria into walls, chairs, carpets, and other indoor fixtures.

But such high-tech solutions are a long way off, and in the meantime office managers and staff should be aware of the risks of neglecting their hand hygiene regimes. However at the end of the day it is the efficient and thorough work carried out by the cleaning teams that will often be the determining factor in the wellness ñ or otherwise ñ of the workplace staff.

I posti di lavoro sono terreni di cultura per i batteri e qualsiasi malattia contagiosa si diffonde velocemente in un ufficio molto affollato, istituto o fabbrica. Ann Laffeaty prende in esame le implicazioni di uníepidemia in un luogo di lavoro e indaga per sapere se i datori di lavoro e i dipendenti possono fare qualcosa di pi˘ per mantenere il loro luogo di lavoro sicuro.

Hygiene for Health - September 2015 | ECJ |27

TRAINING

Training well for well-being When cleaning in areas where hygiene is of the utmost importance, the skill of the operative cannot be underestimated. Keith Baker of industry trade association ISSA explains why well-trained, skilled professionale are so crucial in maintaining proper cleaning and hygiene standards.

Cleaning is quite possibly the only industry in the world that touches every other business including retail, food service, hospitality, offices, public buildings and transport terminals for example. Without cleaning industry professionals, these places would simply not be able to operate or exist.

Cleaning, ideally, should be the process of identifying, containing, removing and properly disposing of any unwanted substances from a surface or environment. The longer a building goes without this level of effective housekeeping and maintenance, the more serious the likely impact to health will be for occupants.

The long-term costs to owners and building occupiers also increase without proper cleaning.

However nowhere is the impact of proper cleaning regimes, and the importance of quality standards being adhered to, more critical than in the healthcare sector. Here cleaning operatives are literally on the front line in defending public health and well-being.

It is no overstatement to say that the role of cleaning is vital in breaking the chain of infection, and becoming ever more so, given the new epidemics that are springing up and the speed with which they can be transferred in todayís global environment.

Approximately two million people are in the air on route to a different country while you are reading this supplement.

This generates enormous potential for cross-infection as travellers may well be coming from different parts of the world where hygiene standards may not be so rigorous to those countries where public hygiene is held to be of paramount importance.

I truly wish I could follow this up by claiming that therefore everybody recognises the importance of cleaning but shamefully in the wider world more often than not, cleaning is still only noticed or commented on when it is not done well. Perhaps I should take that as a back-handed compliment but remember cleaning is not only for appearanceís sake, it also has a direct bearing on the facility occupantsí health. Infection control is important in any building, but particularly in hospital, schools and residential care facilities where disease can spread quickly among more naturally vulnerable people.

Front line operatives In our rapidly changing world, if cleaning operatives are to be on the front line, and they are expected to defend public health and well-being, then it follows that arming them with training to do the best possible job is more than desirable. It is entirely practical and highly logical.

Yet all too often the training of front line cleaning operatives continues to be rather random, haphazard and cursory although there are some very honourable exceptions to this disturbing trend I am pleased to report.

The difference between a well-run cleaning operation and a sub-standard one often comes down to the quality of training yet the fact remains that investing in people does not come easily to some while delivering training to a workforce that may be spread over different sites, regions or even countries is difficult, timeconsuming and costly.

When this is combined with the fact that a significant number of cleaners -

Hygiene for Health - September 2015 | ECJ | 28

particularly in the UK, Germany, France, the Netherlands and Scandinavia ñ who do not speak or read the language of that country as their native tongue the problem multiplies. Then factor in the traditionally high staff turnover rates blighting our industry, and we find that even when effective training programmes are in place, in a blink of an eye many of the trained staff have moved on within months of being trained.

The threat to health and well-being is also changing too. A few years back, MRSA was the number one enemy but now however C. diff is arguably a greater threat and the most prevalent germs are those that live on surfaces, such as door handles, beds, worktops, keyboards and telephones. I have seen studies that viruses such as the Ebola virus can remain viable on surfaces for days on end, and other germs such as the ones that cause colds, ear infections, and strep throat.

MERS is also rising up the pandemic threat list with a life-claiming outbreak in Seoul in June that also had severe ramifications for business and travel while there have been outbreaks of Enterovirus D68 (EV-D68), measles and influenza A across Europe in recent times.

According to research have seen, health-related lost productive time amounts to approximately 1,160 euros per annum per employee (Source: Journal of Occupational Environmental Medicine) with major causes of absenteeism being colds, flu, food poisoning and asthma plus other respiratory illnesses caused by poor indoor air quality. Preventing the spread of these infections and surge in these illnesses is therefore not only highly desirable but is very much an area where improved hygiene interventions can make that vital difference.

At its root, many of these infections are still relatively simple to solve though but we have to change the way the world views cleaning. How do we do this? I would say by increasing our professionalism and transforming the way that we go

TRAINING about training our people.

At the most basic level, I would urge that training of cleaning operatives should include the orientation of new workers including training on equipment such as the use of floor machines, no-touch washroom cleaning or backpack vacuums; cleaning hard floors, carpets, the set-up and operation of a colour coded system for use of clothes in different areas of a facility; new technologies for measuring cleanliness; using personal protective equipment and so on. Running training sessions with a knowledgeable distributor on specific topics always works well in my experience but whatever training session you are running take care to ensure that they are truly understandable by taking into consideration the skill level, language and other potential cultural barriers of the cleaning operative being trained.

Increasingly technology can be of great assistance in training cleaning operatives too. Personally, I still believe that face-toface training is unbeatable but I acknowledge that increasingly it can be impractical to organise it too. Technology though can be harnessed to provide short, digestible bursts of training to company-wide audiences through apps, online training modules, webinars, how-to videos, animated infographics and even gamification.

Quand il síagit de nettoyer des espaces dans lesquels líhygiËne joue un rÙle critique, líimportance de disposer díopÈrateurs habiles ne peut Ítre sousestimÈe. Keith Baker, de líassociation professionnelle ISSA, explique pourquoi il est vital de faire appel ‡ des professionnels bien formÈs et habiles pour assurer un nettoyage de qualitÈ et les normes díhygiËne requises.

Bei der Reinigung in Bereichen, in denen Hygiene von ¸berragender Bedeutung ist, ist das Kˆnnen des Personals nicht zu untersch‰tzen. Keith Baker vom Industrieverband ISSA erl‰utert, warum gut geschulte, sachkundige Fachkr‰fte so wichtig sind, um angemessene Reinigungs- und Hygienestandards aufrechtzuerhalten.

Investment worth making The importance of effective, high quality employee training programmes cannot be overstated. Whilst some companies may initially be hesitant to implement a training programme ñ citing initial costs as off-putting ñ such short-term thinking limits the potential for future opportunities to reap significant financial rewards as well

as safeguarding health. Here I am excited to see the industry is getting strongly behind ISSAís Value of Clean campaign and learning how to make the case for the value of proper cleaning as a way to invest in reduced workplace health and safety risks, using the various ISSA Value of Clean tools. We need to move to that point where cleaning is viewed as more than a cost to be minimised ó it is an investment worth making.

In summary, cleaning clearly plays a critical role in protecting human health by preventing the transmission of an ever growing array of harmful, and in some cases, deadly infectious diseases. Quality cleaning and infection control therefore has a big impact on health and hygiene.

Ensuring cleaners are well trained and qualified is therefore an investment in all our futures.

Quando si eseguono operazioni di pulizia in aree dove líigiene Ë della massima importanza, líabilit‡ degli addetti alle pulizie non deve essere sottovalutata.

Keith Baker dellíassociazione di categoria del settore ISSA spiega perchË il personale operativo ben addestrato e molto abile e professionale Ë cosÏ cruciale nel mantenere degli appropriati standard di pulizia e di igiene.

Hygiene for Health - September 2015 | ECJ |29

HEALTHCARE

The sharp end of cleaning The concept of hygiene for health is never more relevant or more critical than in the healthcare sector itself. Hospitals are the most demanding of cleaning contracts, where the highest of hygiene standards must be consistently maintained.

How has this sector progressed in recent years, what lessons have been learned and what are the key challenges to be faced in the future? Kelvin Eyu, chief operating officer at ISS World Services in Singapore, which holds an 80 per cent share in the local healthcare cleaning market, talks to ECJ. Cleaning in hospitals is one of the most demanding and exacting areas of the sector, with expectations in terms of hygiene standards, cost-efficiency and transparency increasing continuously.

What are the most important developments affecting service providers?

According to Eyu, one of the most important factors was the introduction in acute hospitals some years ago of the Joint Commission International (JCI) standards of patient-centred care and safety. ìThis was seen as the ëgoldí standard for operations excellence within the healthcare environment,î he explains. ìThese US-based standards also cover the requirements of outsourced partners including, but not limited to, competency, risk management, cleaning methods, safety, emergency response and infection control etc.î Other trends that have influenced healthcare service provision include the rising cost of labour, labour shortage and ageing population pushing healthcare to spend more ñ while the share of taxpaying citizens is decreasing. ìThis means, healthcare customers are hungry Quelles ont ÈtÈ les amÈliorations des normes díhygiËne dans des contextes hospitaliers ces derniËres annÈes, et quíont fait les responsables de services de propretÈ de ces Ètablissements pour faire face aux risques de maladies, díinfections iatrogÈniques, etc. ? Quels sont les dÈfis les plus importants ‡ relever pour líavenir ? ECJ se penche sur ce dossier avec le concours díISS, le prestataire mondial du facility management.

for productivity initiatives,î continues Eyu. ìSolutions such as mechanisation, automation, e-solutions, job redesign and work process re-engineering are expected as part of our value proposition.î Business Continuity Management (BCM) is defined as a ìholistic management process that identifies potential threats to an organisation and the impacts to business operations those threats, if realised, might cause. It provides a framework for building organisational resilience with the capability of an effective response that safeguards the interests of its key stakeholders, reputation, brand and value-creating activitiesî. This is gaining ground in the healthcare arena, says Eyu, ìin view of the perpetual threat of disease outbreak and environmental threat, eg, flood, fire etc. ìCustomers are particularly interested in alternative sources of manpower support should there be quarantine imposed.î And we are also witnessing increased centralisation of hospitals ñ certainly in parts of Europe ñ to create much larger sites. ìThis sometimes leads to insourcing of cleaning tasks, because it makes sense as far as the hospital is concerned to have its own cleaning team,î Pernille Storm Larsen, Head of Cleaning Excellence at ISS Denmark, explains.

For cleaning service contractors then, the environment has become ever more challenging so how has the sector responded in order to rise to these new demands? One of the greatest investments has been in human resources ñ in the hiring of professionals such as nurses and registered safety officers ñ and in programmes in the fields of training and development, health and safety, and infection control.

Pernille Storm Larsen explains some of the other initiatives ISS has been involved with in order to offer better services to its healthcare clients. ìWe have been working with supplier partners such as Diversey to introduce new disinfection kit focused on containment and fast response in case of biohazard risks. We have also converted Inwieweit haben sich die Hygienestandards im Gesundheitswesen in den letzten Jahren verbessert, und wie haben diejenigen, die f¸r Reinigungsdienste verantwortlich sind, ihr Angebot entwickelt, um auf Herausforderungen, wie Krankheitsausbr¸che, Krankenhausinfektionen usw., zu reagieren. Worin werden k¸nftig die grˆflten Herausforderungen bestehen. Das ECJ untersucht diese Aspekte mit der Hilfe des globalen Geb‰udetechnikunternehmens ISS.

Hygiene for Health - September 2015 | ECJ | 30

manual tracking into automated methods using RFID, PDA or tablets to reduce our reliance on labour to carry out checking and tracking.î ìSometimes unconventional cleaning methods are being used, such as using hydrogen peroxide instead of manpower to disinfect a patient room with contagious disease,î says Kelvin Eyu of ISS Singapore.

And to accommodate the changing nature of the cleaning workforce ISS now favours icon-based communication over text. ìThis is because we have to cater for many different languages and cultural diversity,î explains Eyu. ìAnd the fact we have an increasingly ageing workforce has led us to purchase lighter, cordless or twoin-one machinery.î Large service providers like ISS are even achieving ISO standards on Business Continuity Management and implementing the system in the hospitals where they provide services ñ ensuring they are complying with hygiene standards and putting control systems into place.

In a changing global marketplace facilities service providers in healthcare must adapt to meet the needs of their clients if they are to survive and prosper. ìCustomers are expecting economies of scale, cost-effective solutions, higher and more professional levels of service delivery, traceability, and increased transparency in costing,î Eyu says. ìThey are also testing cleaning employeesí knowledge more and more, questioning them on exactly how much they know about hygiene. In general there is much more quality control (both self-regulation and third party monitoring).î Healthcare clients are also no longer happy with the traditional way of doing things, they expect to see ongoing innovation from their service suppliers. ìFor example they are eager to see us at ISS use the companyís global platform to deliver a measurable differentiation,î Eyu points out.

Finally, there is an increasing trend towards empowering the individual cleaning employee. ìWe aim to ensure they act with competence and responsibility in the actually health/ hygiene/risk situation instead of just ëfollowing the rulesí,î concludes Eyu. Come sono migliorati gli standard di igiene negli ambienti del settore sanitario negli ultimi anni e in quale modo i responsabili dei servizi di pulizia hanno sviluppato dei prodotti adatti a fronteggiare le sfide come lo scoppio di epidemie, infezioni contratte in ambienti ospedalieri, ecc.

Quali sono le sfide principali che il futuro ci riserva? ECJ prende in esame la questione con la collaborazione della fornitrice globale di servizi ISS.

WATER HYGIENE

Legionella - stay vigilant L8 guidance now has less emphasis on precisely when you should carry out some of the procedures that help to control and prevent Legionella. But does that mean we can relax or ease up on legionella prevention? Not at all; we need to be more vigilant than ever, as Gary Nicholls, managing drector of Swiftclean Building Services, explains in this exclusive article for ECJ.

Properties which have shut down periods can be particularly prone to legionella proliferation as water may stay stationary while the building is not in use.

The L8 Approved Code of Practice and guidance on Legionnairesí disease, issued by the Health & Safety Executive (HSE) in the UK, guides duty holders, including employers; those in control of premises; and those with health and safety responsibilities for others to comply with their legal duty to protect building occupants from infection by legionella bacteria. This Approved Code of Practice (ACOP) status makes legionella control an important legal duty. It is essential to prevent outbreaks of Legionnaireís Disease, the flu-like illness which legionella causes, which can be fatal, particularly in the elderly or people suffering from underlying health conditions such as respiratory, lung and heart diseases, impaired immune system, etc.

This is why, if a nominated Responsible Person is deemed negligent in a legionella outbreak they and their organisation can be prosecuted under the Health and Safety at Work Act and COSHH Regulations. Limitless fines can be imposed on the organisation and custodial sentences can also be given to individuals who are deemed negligent, especially if a fatality has occurred.

The recent fourth edition of L8 guidance places greater emphasis on a number of important legionella control issues which now have ACOP status: risk assessment; the specific role of an appointed competent person, known as the Responsible Person; the control scheme; a review of control measures; and duties and responsibilities of those involved in the supply of water systems.

The first step towards L8 compliance is a comprehensive risk assessment, and this requires a thorough investigation into the configuration and condition of all water systems present at a site. Water should flow freely around the system and there should be no areas of the distribution pipework system where water can remain static and potentially stagnate.

At the design stage of any new system,

this should automatically be a prime consideration, but it is also important to ensure that operational systems have not developed ëdead legsí over time which can occur when pipework has been altered for instance during the removal of a shower or sink. If this alteration is not carefully considered with reference to legionella prevention, ëdead endí lengths of pipe in which water can ësití and stagnate can be created. These provide favourable conditions for legionella bacteria proliferation, so any historic dead ends should be identified and removed as fully as possible, to enable water to circulate through every part of the water system, eliminating static areas.

Careful design New water systems should be carefully designed to avoid any static areas and services or outlets which are likely to become infrequently used. Where a water system or outlets have not been in use for a week or longer L8 requires periodic flushing of the water system to be carried out in order to avoid conditions favourable for the proliferation of legionella bacteria.

Cold water storage tanks in buildings are often situated on roof top spaces and installed in enclosures which can capture heat and raise the temperature of the stored water. This can be an issue especially in the warmer summer months when stored cold water can suffer from significant heat gain, and is normally as a result of the tank not receiving adequate demand. This scenario provides a perfect potential breeding ground for legionella.

Therefore it is essential that cold water storage tanks are not oversized, receive good turnover rates and they have adequate insulation installed. Water tanks need to be protected against significant heat gain during the summer, so existing tank installations should be reviewed to see if this is occurring. If necessary they should be retrofitted with shading or insulation to prevent the water temperature being raised by solar gain.

Continued page 32

Hygiene for Health - September 2015 | ECJ |31

WATER HYGIENE Legionella - stay vigilant (continued)

Properties which have shut down periods can be particularly prone to legionella proliferation as water may stay stationary while the building is not in use.

Buildings such as factories and especially schools, colleges and universities, which have long breaks when buildings are not used, are more vulnerable than most. This also applies to buildings such as stadiums which are used seasonally; but any property, either domestic or commercial, which has been unoccupied for some weeks may also be vulnerable.

Since last year private landlords and letting agents must now tackle this important aspect of property management. When letting property to new tenants, it is now just as important to ensure that the water supply is clean and

healthy as it is to ensure that the gas and electricity supplies are safe and that there is an energy performance certificate.

If a commercial property has a wet cooling system or cooling tower, L8 does still stipulate a minimum frequency for testing. Cooling towers and wet cooling systems should be tested at least quarterly for the presence of legionella bacteria; if found present, there should be immediate remedial action taken to eliminate it. If a property has a history of the occurrence of legionella, L8 also requires more stringent measures. Where the control scheme has been found to be ineffective, for instance the temperature control regime cannot be achieved or in systems which have a history of legionella bacteria being detected, regular ongoing testing should be carried out to ensure legionella bacteria has not reoccurred.

Water should also be tested for the presence of legionella if the building has been unoccupied or the water system has not been used for several weeks, as during the long summer break in schools and colleges. Water services also need to be flushed through before use is resumed at the start of the new term. How this is conducted is also important - flushing should be carried out without creating water spray as legionella can be inhaled in fine water particles.

It is important, if possible, to conduct flushing before any cleaning teams enter the building. If this is not done and the cleaning team is the first to run showers and taps etc, they will be very vulnerable to inhaling contaminated spray and contracting Legionnaireís Disease.

To comply with L8, there must be a current legionella risk assessment in place. This needs to be viewed as a living

LíhygiËne des systËmes de distribution díeau dans les immeubles ne peut Ítre nÈgligÈe. De nombreux risques síassocient ‡ la lÈgionelle et díautres pathogËnes hydriques, imposant de rigoureuses pratiques díhygiËne. ECJ examine les principaux domaines ‡ risque ainsi que les mesures ‡ mettre en place. 708

Die Hygiene von Wassersystemen in Geb‰uden kann nicht ¸bersehen werden. Es gibt viele Gefahren, die von Legionellen und anderen durch Wasser ¸bertragene Krankheitserreger ausgehen, sodass strenge Verfahren unverzichtbar sind. Das ECJ betrachtet die wichtigsten Gefahrenbereiche und die Maflnahmen, die getroffen werden sollten.

New cold water tanks should be installed with solar shading or appropriate insulation.

Once an appropriately sized cold water tank is operational the storage temperatures need to be checked during the summer; and it should also be possible to drain the tank completely for cleaning.

If the cold water system is not used for a shutdown period during the summer, this is also the optimum time to clean and disinfect it or to carry out any maintenance or refurbishment required.

Cold water tanks should be checked periodically, at least annually, to make sure that they are free of excessive sediment contamination, fungal growths, insects, and vermin such as pigeons and rats, etc. The structural condition of the tank should be checked for L8 compliance and if its interior is degraded it should be refurbished or replaced as necessary.

Buildings not in use

Hygiene for Health - September 2015 | ECJ | 32

document which requires regular review to ensure that it remains appropriate. It must be updated if any significant changes are made to the systems. It is a legal requirement for a Responsible Person to be appointed, so care should be taken to ensure if roles or personnel change over time, there is still a Responsible Person and a current risk assessment in place.

Annual checks To avoid any possibility of this being overlooked, it is a good idea to implement a robust legionella process of annual checks to ensure that nothing has changed with regard to the management structure or physically to the water system. An equally good idea is to make reviewing of L8 compliance part of an induction process whenever a new property manager or owner takes over.

If there is any aspect of legionella control which the Responsible Person is unsure of, it is wise to seek expert advice. An expert can not only help you to formulate and correctly document a risk assessment, they can also provide training and help establish robust control processes such as routine testing and maintenance. The Responsible Person also needs to ensure that all routine monitoring and maintenance tasks involved in the legionella control regime are accurately documented within a site based logbook, to provide legal protection as well as legionella prevention.

Expert advice should also be sought before designing and installing a new system; starting out with an L8 compliant system and robust prevention processes is the best way to ensure that water stays legionella free in the future. www.swiftclean.co.uk

Líigiene dei sistemi idraulici allíinterno degli edifici non puÚ essere trascurata e sottovalutata, ci sono molti rischi associati alla legionella e ad altri agenti patogeni trasportati dallíacqua quindi delle abitudini rigide sono di vitale importanza. ECJ prende in esame le aree pi˘ importanti del rischio e delle misure che dovrebbero essere adottate.

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