WHAT LURKS BENEATH The hidden dangers of surface disinfection incompatibility
By Linda Lybert
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nurse wheels a patient out of their room to complete their discharge. Within 10 minutes, the environmental services (EVS) team enters the room with their cart of cleaning and disinfectant products. They have less than 30 minutes to turn it over as another patient is waiting to be admitted. EVS professionals know which disinfectant products to use based on hospital infection prevention guidelines and the type of microbes they are working to remove from the patient room. At some healthcare facilities, this process is followed by ultraviolet disinfection or electrostatic disinfection. Once their work is complete, the EVS team visually inspects the room. When there are no visible stains, soils or other issues, the room is deemed to have been effectively terminally cleaned. But why is this assumption made when microbes can’t be seen?
30 CANADIAN HEALTHCARE FACILITIES
Visual observation of any environment is not going to find microbes lurking in and on surfaces. Unfortunately, there are often no clear directions for cleaning and disinfection. And specific surface materials or products are rarely tested to ensure the act of cleaning and disinfection doesn’t cause significant damage. Case in point is a recent study of a large hospital in the Midwest United States that purchased several hundred noninvasive medical devices. Within two years, they had become visibly damaged due to chemical exposure during the disinfection process. The instructions for use (IFU) called for a quaternary ammonium wipe disinfectant. But because the hospital’s infection control guidelines do not allow quaternary ammonium disinfectants to be used in patient care areas due to patient and healthcare worker risk, a bleach-based disinfectant was utilized instead. Through deep dive analysis, it was determined that the bleached-based disin-
fectant was not approved by the manufacturer for use on the monitoring devices, leading to their damage. This is not an isolated incident. Infection prevention guidelines don’t necessarily match manufacturer instructions. Cleaning and disinfection protocols also don’t always address issues with broken, cracked or porous surfaces that could easily be harbouring microorganisms. For instance, privacy curtains are rarely changed unless visibly soiled, yet these porous surfaces can be harbingers of deadly pathogens. Surfaces are a foundational issue that must be addressed as the industry works to mitigate healthcare-associated infections (HAIs). While healthcare professionals focus on cleaning and disinfecting products and protocols, the fact is the majority of surfaces in a healthcare environment are difficult if not impossible to clean and disinfect. According to the U.S. Centers for Disease Control and Prevention (CDC), approxi-
