Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com1
Do’sandDon’tsforhospitalcleaning
ProfessorStephanieDancerNHSScotland&EdinburghNapierUniversity
HostedbyProf. Jean-YvesMaillardCardiffUniversity,Wales
www.webbertraining.com April 25, 2017
A.DenverRussellMemorialTeleclassLecture
Howshouldweapproachcontrolofantimicrobial
resistance?
2
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com2
...butpatientsacquireresistantpathogensfromthecontaminatednear-patientenvironment
SocontrollingAMRrequiresattentionon:i)vertical (direct)effectsbyantimicrobialdrugsii)horizontal (indirect)spreadcausedbyinfectionprevention&controldeficits
DancerSJ,‘TheeffectsofantibioticsonMRSA’,JAntimicrobialChemother(2008)
Antimicrobialstewardship?
Antimicrobialdrugsmightbeencouragingresistance..
3
InvisibleAesthetic bias
Pathogen detection Evidence-based science?
No accepted measureWomens’ workFabric deficits
Costly
Low paid; low status; and dirty
WHY are we still debating the value of cleaning?
4
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com3
SurvivaltimeInfectiousdose
MRSA 7daysto>7months4cfu’s
Acinetobacter 3daysto>5months250cfu’s
C.difficile >5months5spores
VRE 5daysto>4months<103cfu’s
E.coli 2hrsto16months102-106cfu’s
Klebsiella 2hrsto>30months102cfu’s
Norovirus 8hrsto7days<20virions
Kramer,BMCInfectDis,2006;DancerSJ,ClinMicrobiolRev2014
Propertiesofhospitalpathogens
5
Increased risk associated with the prior room occupant. The figures of difference in risk are unadjusted based on raw data.
Otteretal,AmJInfectControl2013Mitchelletal,JHospInfect2015
Isriskrelatedtoenvironmentallongevity?
6
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com4
Where are the pathogens in a hospital?
Hayden et al, SHEA 2004 7
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com5
9
Adamsetal,JHospInfect201710
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com6
Fluorescent gel placed on chosen sites
After patient discharge, a site is considered cleaned if the fluorescent material is removed or disrupted
Carling et al, Am J Infect Control, 2006
Ecolab®
How do we measure hospital cleaning?
11
Removal of marker may not correlate with cleaning of alternate sites on the same surface Sitzlar et al, ICHE 2013
12
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com7
What’s the long term effect?
Maintenance of environmental services cleaning and disinfection in the ICU after a performance improvement project
Fitzgerald et al, AmJIC 201213
Howdowemeasurehospitalcleanliness?
Whatisclean?
“whatanindividualthinksitis”
82-91% Visually clean
10-24% ATP clean
30-45% Microbiologically clean
GriffithCJetal,JHospInfect200014
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com8
Surface evaluation using ATP bioluminescence
Swab surface luciferase tagging of ATP Luminometer
Used in the commercial food preparation industry to evaluate surface cleaning and as an educational tool for more than 30 years
15
Site Before* After*Site Mean
ATP BeforeSite Mean
ATP After
Locker (M) RangeMean
15-316106
17-14847
120 69Locker (S) RangeMean
7-325134
5-20891
L Bed (M) RangeMean
4-243106
4-1512206
105 131L Bed (S) Range
Mean4-181103
32-11556
O/B Table (M) RangeMean
28-625116
13-7536
181 309O/B Table (S) RangeMean
33-550246
55-3846581
R Bed (M) RangeMean
3-409145
3-20060
132 57R Bed (S) RangeMean
0-266118
16-12854
ATP values (RLU’s) for sites on medical & surgical wards
Mulveyetal,JHospInfect2011*Benchmark=100RLU’s 16
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com9
ChanMC,LinTY,ChiuYH,etal.ApplyingATPbioluminescencetodesignandevaluateasuccessfulnewintensivecareunitcleaningprogramme.JHospInfect2015;90:344–346.
ATPsystemsencouragecleaningeffectiveness,buttheydonotnecessarilymeasuresurfacecleanliness.HighATPvaluesdonot
necessarilymeanpresenceofmicrobialpathogens!
WhateffectdoesATPmonitoringhave?
Studyin2ICUsinapublic1800-bedhospitalinTaiwan
CleaningefficacywasmonitoredbyATPbioluminescenceaftercleaning;<45%of221surfacespassed
Afteranewcleaningprotocol,88%of270surfaceswerecleanaccordingtoATPcriteria.CombinedHAIratesintheICUsapparentlydecreasedbyhalf!
17
5 cfu/cm2 45 cfu/cm2
Slide from Chris Griffith
Would microbiological standards help?
18
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com10
Standard1Thereshouldbe<1cfu/cm2 pathogen(MRSA;
C.difficile;VRE;etc)onhealthcaresurfaces
Standard2AerobicColonyCount(ACC)ortotalmicrobialgrowthlevelfrom
ahandtouch surfaceshouldbe<5cfu/cm2
Thesestandardsarebaseduponfoodindustrycountsasappliedtofoodpreparationsurfacesbutcouldbeutilisedfor
frequenthandtouchsurfacesinhospitals
DancerS,JHospInfect2004
Microbiologicalstandardsforsurfacehygieneinhospitals
19
Istherearelationshipbetweenenvironmentalbioburdenandhospital-acquiredinfection?
White et al, AmJIC 2008
20
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com11
.
Sowhichisthebestmethodformeasuringhowcleanahospitalis?
Aimforasystemwhichshowsmeasurablebenefitforpatients:aesthetics,cleaningfocus,cleanersurfaces,
andifyou’relucky,HAIrates;but….wouldn’titbenicetohaveasystemthatgivesusearly
warningofanimminentoutbreak?
21
Correlatingcleaningeffectagainstsurfacecleanlinessindicators
Boyce et al, ICHE 2011
Fluorescent marker vs ACCs; how well have surfaces been cleaned
Fluorescent marker vs ATP; which surfaces need cleaning
22
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com12
Correlatingcleaningeffectagainstsurfacecleanlinessindicators
Boyce et al, ICHE 2011
Fluorescent marker vs ACCs; how well have surfaces been cleaned
Fluorescent marker vs ATP; which surfaces need cleaning
23
Whatistheevidenceforcleaningasaviablecontrolmechanismforhospital-acquiredinfections?
BBC website, 2008
Twomatchedwardsreceivedoneextracleaner(MondaytoFriday),witheachwardreceivingenhancedcleaningforsixmonthsinacross-overdesign;
Enhancedcleaningledtoa33%reductioninlevelsofmicrobialsoilathand-touchsites;and27%reductioninnewMRSAinfections,despitehigherbedoccupanciesandMRSAcolonisationpressures(p=0.032:95%CI7.7%,92.3%).
Dancer et al, BMC Med, 200924
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com13
Totalaerobiccolonycounts(ACC)fromhand-touchsitesontwomatchedwards;thecleanermovedfromWardAtoWardBatweek26
Danceretal,BMCMed,200925
Keepyourcleaningstaffin-house!
Toffoluttietal, SocialScience&Medicine2017;174:64–69
MRSA Incidence rate by type of cleaning service in 2010
26
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com14
Clostridium difficile infection incidence for units A and B combined, before and after the intervention
HAI, hospital-acquired CDAD; INC, overall CDAD incidence; PD, patient days; PT, patient.
Orenstein et al, ICHE 2011
WipingOutClostridiumdifficile
27
BasichygienemeasuresreducedVREincidence
28
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com15
=Hand Hand-touch site
...isequalandoppositeDancerSJ,ICHE2010
The Hand-Touch equation:
29
Onesurprising! findingwasthatpatienthandhygienewasassociatedwithreducedcontaminationofenvironmentalsurfaces………….
Sunkesulaetal,ICHE2016
ImpactofaHand-HygieneInterventiononContaminationofPatient’sHandswithHealthcare-AssociatedPathogens
30
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com16
Dailycleaning?
TheTelegraph,UK,2008
31
Contact plates from patient locker surfaceLeft to right: Pre clean, 1 hour, 2 hour, 3 hour assessment
MRSA rapidly recontaminates high-touch sites in ICU after H202 vapourHardyKJetal,JHI2007
Mike Rollins, Osprey
Howlongdohospitalsurfacesstay‘clean’?
32
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com17
gg
Stewart et al, ICHE 2014
Effectofdetergent(blueline)anddisinfectant(redline)cleaningontotalACCathand-touchsitesover48hours
5cfu/cm2
33
Stewart et al, ICHE 2014
EffectofdetergentanddisinfectantcleaningontotalMSSA/MRSAathand-touchsitesonone30bedwardover48hours
34
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com18
Vickery et al, J Hosp Infect 2015
Dobiofilmsonhospitalsurfacesprotectviablepathogensfromcleaning?
35
‘Chemzyme Plus’AsoupofBacillussubtilis!
Adisinfectantcontaininggoodbacteriareduced‘bad’bacteriaby1,000-foldcomparedwithstandardcleaning
PhagedisinfectantsBacteriophages thattargethospitalpathogenscanbeincorporatedintodisinfectants
NeutralElectrolysedwater
New disinfectants on the Block
http://www.phageworks.com
http://chemexuk.com
MeakinNetal,JHospInfect2012
Normaltapwaterwithaddedsaltthathashadanelectriccurrentpassedthroughit
36
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com19
ElectrolysedwaterWhatisit?
Electrolysedwaterisnormaltapwaterwithaddedsaltexposedtoanelectriccurrent.Non-toxic!
Itismicrobiocidalduetothepresenceofhypochlorousacid.ThisacidisonlypresentinverylowconcentrationssothattheproducthasaneutralpH,thesameasordinarywater.
Howgoodadisinfectantisit?Isitbetterthanbleach?
Alsoeffectivefordecontaminatingsensitiveclinicalequipment
MeakinNetal,JHI2012;Danceretal,HealthcareInfection201537
ColdPlasmaTechnologyreducessurfacebacterialcounts
Multiple-jet air decontamination of patient tray tables over 8 weeks (n= 6; NS, non significant; *P< .05). Claro et al, Infect Control Hosp Epidemiol 2017
38
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com20
Song et al, AmJIC 2012
EffectofbleachvssteamagainstE.coli biofilm
<1secondsteamachievesbetterdisinfectionthan10ppmsodiumhypochloritefor10-20minutes
39
Antimicrobial surfaces
• Copper(toiletseats,sinks,handles,etc)• Silver(textiles,etc)• Triclosan(tootpaste,choppingboards,etc)• Paintscontainingpolyurethanes,epoxymaterials,styreneacrylics• Polymer‘conjugatedpoly-electrolyte’plusfluorescentlight• Nanocoating(nanotubespluslysostaphin)
PageetalJMaterChem2009
‘….antimicrobialcoatingsmustnotunderminetraditionalhygienemethodsandneithershouldconventionalcleaningberelaxedifantimicrobialcoatingsareemployed’
ChildT,www.allbusiness.com 2005 40
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com21
Failureofcopper-basedNanoCote/Aqua-Basedantimicrobialpaintinahospitalsetting
LaminatedwoodbedsidetablecoatedwithNanoCotefollowingwaterspillage
LaminatedwoodbedsidetablecoatedwithNanoCoteHD-WR(beforecuring).Close-upviewshowingunevendistributionafterapplication
Ramsdenetal,JBiologPhysChem,201641
Pailhoriès et al, ICHE 2016
FourMSSAandfourMRSA;Twodifferentorientationsofoakused
Potentialantimicrobialactivityofoak(Querceusspp.)wastestedagainstapanelofS.aureusisolates
Oakshowedantimicrobialactivitytowardsalltheisolatestested;BUT….diameterofthewoodendiscswas9mm,asopposedto2mmforastandardantibioticdisc
‘Oakinhospitals,theWorstEnemyofStaphylococcusaureus?’
42
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com22
Disinfecteverything…..
DancerSJ,ClinMicroRev2014;
Po&Carling,ICHE201043
DoesH202 improvedisinfectionofICUrooms?
ProspectivecrossoverstudyinaFrenchhospital;roomswerecleanedwithquat&sodiumhypochlorite,followedbyeitherH2O2vapouroraerosolizedH2O2combinedwithperaceticacid;
BEFOREanyH202disinfection,only23(1.5%)of1,456sampledsurfacesand15(8%)of182roomswereMDRO-positiveafterpatientdischarge;
H2O2disinfectionreducedESBLsonly,sincenootherMDROswerefoundafterroutinecleaning;
TheseESBLswerefoundmostlyfromsinks..
BlazejewskiCetal,CritCare201544
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com23
ButtheriskofacquiringClostridiumdifficile,MRSAandmultidrug-resistantGram-negativebacilliwas‘notsignificantlyreduced’;
ThesignificancequotedfortheoverallresultcamefromtheVREdataonly.
Patientswere64%lesslikelytoacquireMDROsand80%lesslikelytoacquireVRE(P < 0.001)followingH202 terminalcleaning……...
Passarettietal.ClinInfectDis,56(2013):27–35
TerminaldecontaminationofroomsusingH202vapour
45
AnEnvironmentalDisinfectionOdyssey:evaluationofsequentialinterventionstoimprovedisinfectionofC.difficileisolationrooms
Sitzlaretal,ICHE2013
35%ofroomsremainedculturepositiveforC.difficileafteruseofUVdevices46
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com24
Theeffectofdistanceontheefficacyofthe
PX-UVdevice
Nerandzicetal,ICHE2015
Good
Poor
47
IncidenceofMDROsandClostridiumdifficile fromJanuary2009untilApril2013;pulsedUVlightintroducedMay2011
HaasJetal,AmJIC201448
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com25
IncidenceofMDROsandClostridiumdifficile fromJanuary2009untilApril2013;pulsedUVlightintroducedMay2011
HaasJetal,AmJIC2014
$$$
49
Dancer et al, IJAA 2013
*
**
50
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com26
Hydrogenperoxidecan’tpenetratelinen,pillowsorsoftfurnishings
51
CanUVCwavesgoroundcorners?
That’saNO,then?52
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com27
Toxicity?
HumansSurfacesPlasticsPlantsAnimals
53
Timetakenfordecontamination
Needtoremovethepatient;
NeedtototallysealoffaroombeforeH202exposure;NeedtorepositionUVCapparatusforuniformcoverage;
Needtotrainstaff;Needtoprepareroom;Needtoremovesoftfurnishings;
Can’tdoopenplan….
54
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com28
..iscurrentevidenceonclinicalbenefitsufficientlyplentiful,andindeed,robust,toallocatescarcehealthcareresourcesforthesesystems?’ DancerSJ,FloorWarsletter,JHI2013
‘TheH202robotsystemcostsaboutUS$40,000;theUVlightsystemcostsmorethanUS$100,000……..
55
Aggressivemarketingbyrobotcompaniesencourageshealthcaremanagerstochoosethesemethods…
…butnooneknowswhetherplainoldsoapandwatermightactuallydothejobjustaswell,formuchlesscostandminimaleffectonpeopleandenvironment
Buy my robot! It kills all known germs
My robot’s called Jim
56
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com29
Man-agersaremorelikelytochoosepush-buttongadgetsratherthanreducebedoccupancyorengage
morecleaners
57
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com30
true
59
true
60
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com31
AlfaMJetal,BMCInfectDis2010,10:268
Theefficacyofanycleaning/disinfectantagenttestedisdependentonphysicalaction....
61
Evenifalltheroomsaredecontaminatedbyrobots,westillneedstafftomanuallypickuplitter…
62
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com32
Time to get PHYSICAL!C.difficile and cleaning – alternative options to using chlorine-releasing disinfectants……..could C.difficile be removed by routine physical cleaning?
Awadel-Kariem et al, J Hosp Infect 2011
PhysicalremovalofC.difficilesporesismoreimportantthansporicidalinactivation Rutala et al, ICHE 2012
A single clean can reduce contamination by around 90%.....
Speight et al, J Hosp Infect 2011
When surfaces are wiped 3 or more times, detergent wipes are just as effective as disinfectant wipes Berendt et al, AmJIC 2011
Detergent gives the same result as disinfectant for cleaning clinical equipment
Petti et al, AmJIC 2012
63
CONCLUSION
DOvaluetraditionalcleaning
DOmonitorcleaners;cleaning;orwhatisleftbehind(howeveryoulike)
DO keepyourcleanersin-house!
Don’tprioritisehandhygieneovercleaning
Don’twastemoneyonrobotsorantimicrobialpaint
Don’t believeeverythingthatsalesmentellyou!64
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com33
NB.Nodisclosures
65
Do’s and Don’ts for Hospital CleaningProf. Stephanie Dancer, NHS Scotland & Edinburgh Napier University
The A. Denver Russell Memorial Teleclass Lecture
Hosted by Prof. Jean-Yves Maillard. Cardiff University, WalesA Webber Training Teleclass
www.webbertraining.com34