Chemical Free Cleaning the way of the future

Moorabbin Operating TheatresDiane Treagus – ANUM UrologyAnnie James – ANUM Inventory, OH&S RepRonela Osan – Clinical Support NurseLisa Mason – ANUM Orthopaedics

Overview

• Who are we?

• Background

• What is chemical free cleaning?

• Why chemical free cleaning?

• Our journey• Implementation process• Barriers• Outcome

Who are we?

• One of Monash Health Network hospitals: Moorabbin Hospital

• Moorabbin Operating Suite comprises:• Six operating theatres and clinic• Adult elective surgery

• Subspecialties: breast, plastics, ENT, urology, gynaecology, gynae oncology, orthopaedics, facio-maxillary

• Number of patients: approximately 30-40 patients/day

Background

Cleaning methods:

• Traditional cleaning • Detergent wipes - tuffies and HC90• Sling mops - buckets of water• Disinfectant for contaminated cases - Miltons• Not evidence based!

• Before traditional cleaning with detergent:• Methylated spirits• Fogging - for dirty cases

Cleaning in the Operating Theatre

• Stages of cleaning• Between patients: nurses and technicians• End of surgical session: PSA• Cleaning after hours: environmental services

What is chemical free cleaning?

• Water only!

• No detergent or disinfectants anymore!

• Involves cleaning of surfaces using two techniques:

• Ultra - microfibre cloths (used to wipe down all surfaces)

• Steam cleaning (performed at end of surgical session)

How does it work? - Microfibre

• Combination of polyester and nylon fibres

• Static attraction - positively charged attracts bacteria and dirt that are negatively charged

• Use cloths to wipe surfaces

• Dirt held tightly in the fibres, not transferred

• We use microfibre mops for floors - synthetic pad fit on a plastic handle

How does it work? - Steam cleaning

• Portable steam generator

• Dry steam delivered with a nozzle

• Steam applied using back and forth motion for five to ten seconds

• Bacteria and viruses loosened

• Dirt, grease, stains easily extracted using cloth

• Safe, rapid, leaves no residue

Chemical free cleaning - evidence based

• Monash Health Infection Control Unit (2011)

• Pilot study in two separate clinical settings • Residential aged-care ward - 60 beds• Acute medical ward - 32 beds• Baseline data collected using traditional

cleaning methods (May 2011)• Implementation of ultra microfibres and steam

(June 2011, supported with a grant and scholarship)

Chemical free cleaning - evidence based

• Post implementation data collected (August 2011)

• Use of fluorescent markers to assess level of cleaning (inexpensive method) with use of ultraviolet light

• Visual assessment by external auditors, pre and post implementation, unaware of changing the cleaning technique

• Results all favorable:• 91% pre implementation• 96% post implementation

Chemical free cleaning - evidence based

• Another study was published in 2013

• Outbreak of norovirus gastroenteritis occurring concurrently on two wards - 53 patients and staff affected by the outbreak

• Traditional cleaning used on one ward and chemical free cleaning used for the second ward

• Microfibre-steam cleaning proved effective, efficient and appropriate during an outbreak scenario

• Chemical free cleaning:• 25-30% time savings• 90% reduction in water consumption

Chemical free cleaning - evidence based

• Gillepsie et al. (2013). Environment cleaning without chemicals in clinical settings. American Journal of Infection control. 41 (5), 461-46

• Abernethy et al. (2013) Microfiber and steam for environmental cleaning during an outbreak. American Journal of Infection Control. 41 (11), 1134-1135

Chemical free cleaning - evidence basedGrowth of viable bacteria (VRE) after attempted removal with different wipes

control Paper towel

Detergent wipes

Reusable microfibre cloth

Disposablemicrofibre cloth

Chemical free cleaning - evidence based

• Managing CRE in the sink - ICU

• Highly resistant gram negative bacteria

• 1 min steam used in the sink – CRE not detectable, but returning every 72 hours

• Daily steam used until plumbing replaced

Chemical free cleaning - evidence based

• Moorabbin Operating Theatres - article submitted for approval by our infection control unit

• To be published in the American Journal of Infection control

Why chemical free cleaning at Moorabbin Theatres?

• Floors excessively wet

• Increased number of OH&S issues - slips and falls, inhalation of chemicals

• Towards end of shifts, floors were mopped with dirty water as no changing of it during the shift - double dipping

Why chemical free cleaning at Moorabbin Theatres?

• To have a cleaner environment

• To reduce time and costs associated with cleaning

• Pilot project in operating theatre - Australia’s first

Implementation of chemical free cleaning in OT

• Purchasing equipment – cloths, mops, buckets, containers, steam cleaners

• Decision to implement reusable cloths/mops versus disposable before implementation (cost worthy for the volume we use, less waste disposal)

• Liaising with environmental services - need of new washer for microfibre items only as special laundering required

Implementation of chemical free cleaning in OT

• Education of staff from all disciplines

• Development of laminated task cards and mops/cloths trolley

Journey of a microfibre cloths and mops

Washing Machine

Tumble Dryer

OT Microfiber

Trolley

Operating Theatre

Bucket outside

OT

Barriers to implementation

Logistics• Personnel involved in the process - taking cloths to

environmental services, bringing them back, folding them, etc.

Reluctant staff• New cleaning technique will be inefficient• New process might be more time

consuming• Increased risk of burns• Exposure to aerosolization

Studies show steam has little to no effect on contamination of adjacent surfaces

Barriers to implementation

• Equipment• Difficulties finding appropriate containers

for cloths• Cloths and mops unevenly wet, after

addition of water (solution found for mops - to be place sideways)

• Staff non-compliance• preparation of cloths and mops • maintenance of steam cleaners (e.g.

descaling)

Barriers to implementation

• Progression from plain cloths to silver impregnated cloths

• Plain cloths required

reprocessing if not used on the day prepared with water

• Silver impregnated cloths can be reused following working day resulting in reduced volume of reprocessing of cloths, can last up to a week

Outcomes – Cleaner Environment

• Cleaner theatres, drier floors• Infection control audits - regular data collection to

verify efficacy – Agar plates, visual look & UV indicators

• New cleaning schedule developed • Used by techs, PSA, environmental services and

nursing staff• All staff accountable for the cleaning of the theatre

environment • Provides a record of cleaning of all areas

Outcomes – Economical Solutions

• Saving time, water (90% reduction in water usage), budget savings, less waste disposal

• Huge budget savings!!!

• Detergent wipes 16 AUD/package; 12 packages/week=192 AUD/week= 9984

AUD/year

• Microfiber cloths 1.70 AUD/cloths, we purchased 600 cloths= 1020 AUD can be used up to five years

Outcomes – Staff Satisfaction

• Happier staff • reduced cleaning times required (e.g VRE)• easier process

• Less OH&S issues• no more lifting of water buckets • no chemical exposure

• Better patient outcomes (infection rates decreased)

Things to improve

• Staff compliance (preparation of cloths and mops, steamer – descaling)

• Adherence to cleaning schedule

• Tracking of washing of cloths and mops

• Using cloths for appropriate purpose (not using to clean whiteboard, not for heavily soiled surfaced, etc.)

The End

Thank you for your attention!

Questions?