By Mark Wiencek / Special to Healthcare Facilities Today

Good news spreads fast. But bad news about healthcare-associated infections (HAIs) can spread even faster. The frequent and frightening reports we hear are as catching as the pathogens themselves. HAIs, also known as nosocomial infections, can cause pneumonia and infections of the blood, urinary tract and intestines. Many pathogens are now resistant to antibiotics, further complicating patient recovery.

Report of HAI rates can easily damage the reputation and bottom line of a hospital — or an entire health system. In 2018, hospitals in most states have been penalized with cuts in Medicare payments for having too many infections, in addition to patient injuries (1).

And the health outcome of infections can be dangerous to patients. In fact, 85 percent of consumers surveyed said HAI rates were important when choosing a hospital (2). Consumers are right to be vigilant:  the CDC reports that on any given day, about 1 in 25 hospital patients has at least one healthcare-associated infection (3).

However, the majority of HAIs — 70 percent, by one estimate — are preventable (4). The solution lies in understanding the path of transmission — and using the most effective cleaning methods and tools to help prevent the spread of pathogens.

Many paths for pathogen transmission

Due to a stream of consumer health warnings and publicly-available HAI-rating systems, more consumers are becoming aware of the alphabet soup of HAI-causing germs, including the most common multi-drug resistant organisms like MRSA, VRE, CRE, PRSP and ESBLs.

These and other species of bacteria, fungi and viruses make themselves at home on any space that hasn’t been properly cleaned, sanitized or disinfected. Patients and visitors introduce potentially pathogenic microbes into hospitals and critical-care facilities, but healthcare providers may also contribute to the microbial community of these built environments.

Such microbes can harbor on surfaces that are frequently touched by hands — like bed rails and call buttons. In turn, those hands can transfer pathogens to new locations around the room, onto patients and throughout facilities (5). While not often considered a high-touch surface, the floors of hospitals and other healthcare facilities harbor and transmit germs more easily than most would think possible — clandestinely moving from the floor to high-touch objects to the patient.

Don’t ignore the floor

If microbes stayed on the floor and the bottom of shoes, perhaps we could ignore the floor. However, consider how often high-touch objects like cellphone chargers, blood pressure cuffs, or even bed sheets may contact the floor. According to a recent study in the American Journal of Infection Control, of 100 occupied hospital rooms surveyed, 41 percent had one or more high-touch objects in contact with the floor — from a patient’s personal items to medical devices and supplies (6). When a health care worker or patient touches any of these items, they can inadvertently advance the chain of transmission.

While we are making some progress in the fight against HAIs — according to the CDC, hospitals following infection control recommendations have lowered C. difficile infection rates by 20 percent in less than two years (7) — many hospitals and clinics are overlooking a common transmission culprit: ineffective tools used to clean and disinfect floors and other high-touch surfaces.

Recycling pathogens in the wash
Too often, the very tools we rely on to clean critical patient areas, including mops and wipes, may be putting patients at risk for dangerous infections. Laundered mops and wipes — whether processed inside the facility or through an outside vendor — can themselves become a source of cross-contamination.

Housekeeping and laundry staff gather and sort the soiled wipes and mop heads used on a variety of floors and surfaces. The cleaning textiles are combined and washed together in a washing machine. Although the CDC recommends minimum temperatures, times and laundry additives to help clean and sanitize the contaminated textiles (8), it is not an easy process to control or standardize across all types of textiles and institutions. If the textiles are not handled and processed correctly, even one item contaminated with fecal matter containing C. difficile spores can cross-contaminate an entire load. Once the mops and wipes are reused, they have the potential to redeposit dangerous pathogens back into the patient-care space.

The benefits — and drawbacks — of microfiber
To improve cleaning outcomes, many facilities have switched from reusable cotton towels and string mops to cleaning products made from microfiber textiles. The results of rigorous studies (9) and everyday experience have revealed the superior cleaning performance of microfiber-based products, which are engineered to grab and hold dirt, debris and particles.

Unfortunately, the same properties that allow microfiber textiles to capture and retain dirt and bioburden can become an issue when these products are laundered and reused. As a result, these microfiber mops and wipes accumulate debris and residual detergent with each laundry cycle. Those residues can neutralize disinfectants such as quaternary ammonium compounds the next time the wipe or mop is used, compromising the efficacy of the critical disinfection process.

As powerful as they are, microfibers are six times smaller than the average human hair, making them susceptible to damage from laundering. To kill some of the most dangerous bacterial contaminants in the healthcare environment (e.g., spores of C. difficile), the laundry must use extended exposure to high temperatures and/or 50-150 ppm bleach.

For example, the minimum conditions for disinfecting healthcare textiles require a temperature of 160°F (71°C) for at least 25 minutes (8). During this process, the delicate microfiber can be damaged by elevated temperatures, bleach-based chemicals and abrasion through mechanical action during the washing and drying process.  

Laundry facilities are faced with a difficult choice: either subject the microfiber products to proper laundry conditions that end up damaging the cleaning efficiency of the microfibers, or minimize the harshness of laundry treatment conditions, resulting in potentially incomplete cleaning and decontamination.

A better alternative: single-use microfiber
We know that microfiber textiles work best the first time they are used, which is why more infection prevention experts are recommending a better alternative: single-use, disposable microfiber cleaning tools.

These mops and wipes are engineered to do what microfiber does best: attract and trap bioburden, dirt and debris. Since they are single use, there is no way any accumulated dirt, debris and bioburden can be transferred back into the facility or interfere with cleaning and disinfection. This can help lead to cleaner hospital and critical-care spaces, reduced infection rates and improved HCAHPS scores.  

While the transition from cotton to microfiber cleaning tools has improved cleaning effectiveness and efficiency, evidence suggests the complicated process of using laundered mops and wipes can result in products with unreliable cleaning ability. Disposable microfiber cleaning products, used with appropriate detergents and disinfectants, provide superior and consistent results with no risk of cross-contamination in the healthcare environment.

Some may claim that use of disposable products is only a matter of convenience and a nice to have. The performance and ease of using disposable cleaning textiles is convenient. But convenience leads to compliance, and compliance has been shown time and time again to generate improved outcomes.

Mark Wiencek, Ph.D., is a technical manager - microbiology for Contec Inc.

References:

1. Hospitals Nationally Hit Hard By Medicare's Safety Penalties, 2018: https://www.npr.org/sections/health-shots/2018/01/05/575737693/many-hospitals-hit-hard-by-medicare-s-safety-penalties  

2. McGuckin, M., et al. 2013. Public Reporting of Healthcare-Associated Infections: Epidemiologists' Perspectives. Infect Control Hosp Epidemiol 34(11):1201-1203.

3. HAI Data and Statistics: https://www.cdc.gov/hai/surveillance/index.html  

4. Up to 70 Percent of HAIs Can Be Prevented, Expert Says, 2011: http://www.infectioncontroltoday.com/general-hais/70-percent-hais-can-be-prevented-expert-says  

5. Weber DJ, et al. 2013. The role of the surface environment in healthcare-associated infections. Curr Opin Infect Dis. 26(4):338-344.

6. Deshpande, A, et al. 2017. Are hospital floors an underappreciated reservoir for transmission of health care-associated pathogens? AJIC 45(3):336-338.

7. Making Health Care Safer, 2012: https://www.cdc.gov/vitalsigns/pdf/2012-03-vitalsigns.pdf

8. Centers for Disease Control and Prevention (CDC). (original: 2003). Environmental Infection Control Guidelines, G. Laundry and Bedding. Updated version available at:  www.cdc.gov/infectioncontrol/guidelines/environmental/index.html

9. Trajtman, AN. et al. 2015. Microfiber cloths reduce the transfer of Clostridium difficile spores to environmental surfaces compared with cotton cloths. AJIC, 43(7):686-689.