Cleaning clinical areas without chemicals – hospital cleaning in Victoria Australia

smallerCleaning clinical areas without chemicals – an overview

Monash Health (formerly Southern Health) is undergoing a major change in environmental cleaning. The technology being implemented across the entire health service uses microfibre and steam and is based on the findings of a pilot study conducted at Monash Health in 2011. This was undertaken in a 32 bed acute ward and a 60 bed aged care ward and the details of the pilot have been published elsewhere.1

The health service has around 2150 inpatient beds, employs 500 cleaning staff and more than 13,000 clinical and support staff. Over 8,000 babies are born each year and more than 250 programs and services are delivered.

Jessie MacPherson Private Hospital is the first private hospital in Australia to implement clinical cleaning without chemicals and Dandenong intensive care unit is the first intensive care unit in Australia to implement cleaning without chemicals. Moorabbin hospital is the first to introduce environmental cleaning without chemicals in the operating suite. This operating suite consists of 4 operating rooms with recovery and holding bay facilities. The unique component of this pilot is that cleaning technology has been extended to operating room nurses and technicians who clean and monitor medical equipment. This extension of the technology is piloting a system that, once established ,will be rolled out to all 28 operating rooms across Monash Health.

 

Before commencing the initial pilot at Monash Health in 2011, clinical testing was undertaken to assess the capacity of microfibre and steam technology to remove significant pathogens such as vancomycin resistant enterococcus and clostridium difficile. A specific cleaning assessment method was also developed using a fluorescent cream applied to 10 high touch points.2 This is an inexpensive way of validating cleaning, costing less than 10 cents per room and with the advantage of obtaining the results at the time of the assessment. The feedback from cleaning staff has been overwhelmingly positive when using this simple, timely and inexpensive education tool.

How does microfibre and steam technology work?

Microfibre cloths are a combination of polyester and polyamide.  The polyester scrubs and cleans the surface, while the polyamide provides the absorbent quality.  By applying friction, particles of dust and dirt are attracted to and trapped by the individual microfibres.

Microfibres are more effective when used with small amounts of water.  By working like a magnet, the microfibre cloth attracts dirt, soil and bacteria into the fibres via capillary action.  Ultramicrofibre has a weight of less than 0.3 decitex and has been demonstrated to give the most superior clean.3 Microfibre technology is a substitute to traditional cleaning with detergent and water, including a second step of disinfection. Lifting buckets of water to fill and empty, has been eliminated, along with wringing of mops before use.

Steam technology uses very high temperatures (140 degrees celsius) and dry steam

(97% dry) is used to replace the need to scrub surfaces.  Most bacteria and viruses are killed at 60 degrees Celsius so a disinfection advantage is possible.  However, when used in conjunction with ultra-microfibre,  the steam is able to reduce the amount of scrubbing or abrasive cleaning  required by cleaning staff and the microfibre attracts the soil, then physically removes it from the environmental surface. 3,4

Our results

Where undertaking 2-step cleaning (detergent and water cleaning followed by disinfection with hypochlorite) the time taken on average was 160 minutes per room and bathroom. With the new technology we have been able to demonstrate a time reduction of 100 minutes from 160 minutes to 50 – 60 minutes.

The 2-step cleaning also cost us $142 AUD per room and bathroom which included  dry cleaning window drapes and engagement of staff to remove and replace window drapes. Dry cleaning of window drapes has now been eliminated and replaced with steam cleaning or the drapes have been replaced with blinds.

We estimate there were on average, more than 150 2-step discharge cleans, being undertaken every week across the entire health service.

This microfibre and steam technology has been shown to be very effective at removing bioburden. The results are similar to a 2-step clean and because is takes around the same time as a normal discharge clean it can be used every time for every patient discharge. This creates an enormous infection control advantage for health care since every discharge clean now uses the highest level of cleaning everytime.

The combination of microfibre and steam has the advantage of environmental and occupational health and safety benefits. These include

  1. The elimination of chemicals.
  2. The reduction in water use by 90%
  3. The reduction in risk of back injury
  4. The reduction in risk of slips and falls
  5. The reduction in risk of allergy/chemical irritation

 

Following our initial pilot we conducted focus groups of our cleaning staff. They told us that they were less exhausted after their shift because the steam and microfibre technology saved them having to manually scrub surfaces. They were also overwhelmingly positive about the new technology and following the initial pilot begged us not to take it away. As a result the technology has remained in place for these 92 beds for  almost 30 months.

In October 2012, a large number of patients were admitted to our 32 bed ward where the microfibre and steam technology was in place. The technology proved to be as effective in controlling environmental contamination from gastroenteritis as the traditional method.5

The future

Across the health service, nurses and other healthcare professionals continue to clean medical equipment using the traditional method – detergent and water or detergent and water followed by disinfection with hypochlorite for 2-step cleaning.

There is an exception in the operating suite, where the pilot is currently underway. Once the system is established, it can be implemented in other controlled areas such as intensive care units, central sterilising departments and haemodialysis units for healthcare workers and technicians who clean and monitor medical equipment. With each new area, the system can be adapted, using the infection control principles established during the initial pilot.

By the end of 2013, Monash Health will be releasing an e-learning tool that provides competency training for microfibre and steam cleaning. This will be available on the websites of Electrolux, Karcher and KTEX who have proudly sponsored this e-learning package. The content has been provided by Monash Health Infection control and Epidemiology unit and access will be freely available from each of the sites.

www.electrolux.com.au; www.karcher.com.au; www.ktex.com.au;

References

  1. Gillespie E, Wilson J, Lovegrove A, Scott C, Abernethy M, Kotsanas D, Stuart R. Environment cleaning without chemicals in clinical settings. Am J Infect Control 2012; Nov [Epub ahead of print]
  2. Gillespie E. Standard for using a fluorescent marker. Am J Infect Control 2012;40:85-6
  3. Wren M, Rollins M, Jeanes A et al. Removing bacteria form hospital surfaces: a laboratory comparison of ultramicrofibre and standard cloths. Journal of Hospital Infection 2008;70:265-71
  4. Sexton J, Tanner B, Maxwell S et al. Reduction in the microbial load on high-touch surfaces in hospital rooms by treatment with a portable saturated steam vapour disinfection system. Am J Infect Control 2011;39:455-62
  5. Abernethy M, Gillespie E, Snook K, Stuart R. Microfibre and steam for environmental cleaning during an outbreak.  Am J Infect Control 2013 in press.

By

Elizabeth Gillespie BN, RM, Dip Project Mx, SIC, Cert OR Mx, MPubHlth(Melb)

Clinical Nurse Consultant – Infection Control

Sterilisation and Infection Control – Co-Director

Monash Health

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