In a continued effort to provide the best and most responsible practices to the Healthcare industry, the Provincial Infectious Diseases Advisory Committee (PIDAC) has recently released the Best Practices for Environmental Cleaning for Prevention and Control of Infections. The latest updated document – December 2009, provides guidelines and recommendations for cleaning the environmental surfaces in a healthcare setting. In addition to practices recognized as effective and traditional, this document includes a Section (6.4) on New and Evolving Technologies in an effort to provide those entrusted with the maintenance of facilites with a tool set to most effectively achieve the best results.
With regards to New and Evolving Technologies, the recommendations concerning implementation can be summarized as follows:
1. Efficacy of New Product versus Current Method
2. Ease to Implement New Technology in the Healthcare Setting
3. Is the New Technology Non-Toxic
4. Are there any resulting effects on patient care from implementing the New Technology
5. Is the New Technology Ergonomic, Safe for Staff Use and in compliance with Occupational Health and Safety requirements
6. Cost Implications of implementing New Technology
The PIDAC document reinforces the importance of involving all areas – Infection Prevention and Control, Environmental Services and Occupational Health and Safety – in all decision making processes relating to changes in cleaning and disinfection procedures and products.
Reference 160 cites the study in the American Journal of Infection Control, performed with a portable steam vapour cleaning system.
Using the tools supplied with a steam vapour cleaning system, cracks, crevices, large surfaces (vertical and horizontal), soft and hard surfaces and equipment can be cleaned and disinfected in one step. Table 1 in the document lists the items found to harbour microorganisms in the Healthcare Environment. The use of steam on these items will disrupt the transmission of microorganisms. Eliminating the need for dwell time on bed frames, bed rails, door and faucet handles combined with the unique ability of steam to reach areas such as bed frames, all areas of overbed tables, crevices in hoist/lift and slings, mattressess, sink drains, and hinges on toilet seats and commode chairs provides the opportunity for a thorough clean and disinfection.
The process of cleaning with steam eliminates several concerns addressed in the document associated with chemical methods:
1. Dilution ratios
2. Dwell times
3. The need to appropriatley label and safely store cleaning chemicals
4. Risk of contamination, inhalation, skin contact or personal injury
5. Requirement for MSDS and WHIMIS Training
6. The belief that no one product is compatible with all surfaces or effective against all viruses, bacteria, fungi and spores.
7. Effectiveness at varying temperatures
8. Irritant and allergy concerns
9. Reactions with other chemical products existing on surfaces
10. Environmental Responsibility
11. Requirement for automated dispensing systems
12. The need for pre-cleaning prior to disinfection.
The use of this broad spectrum cleaning method also aids in the ability to improve the accuracy of a visual assessment to measure cleanliness. When steam is used to provide a visibly clean surface, the heat transfer associated ensures removal of residues (organic or inorganic).
Box 16 offers a sample procedure for room cleaning. All critera are met with a steam vapour cleaning system, including the following concerns:
1. Eliminate ‘double-dip’ concerns
2. Eliminate need to monitor cloth saturation
3. Perform tasks such as tape removal, stain removal and glass cleaning with one tool
4. Refresh privacy curtains
5. Perform bed and mattress cleaning and pest control without a prolonged bed drying time
6. Clean bathroom and shower
7. Clean floors
Box 19 is another example of tasks made easier and safer with a steam vapour system:
1. No need for cleaning solution, PPE or MSDS
2. No wet floor is created with steam
3. Avoid repetitive action of wringing out mop
4. Eliminate concern over splashed walls and furniture
5. No need to change mop head
6. No need to monitor cleaning solution in bucket.
Box 30 is the Sample Procedure for VRE Situations – again made simpler and more efficient and thorough using a steam vapour cleaning system.
Within the document, many disadvantages and comments are presented to provide an unbiased and thorough evaluation, allowing for best informed decisions and best practices to be followed in our Healthcare system. The disadvantages of all chemical applications are listed, and should be evaluated. The use of tap water to create steam vapour continues to be the most environmentally responsible and broad spectrum cleaning option available. Lab reports and clinical trial updates are available upon request to verify the efficacy of steam vapour in Healthcare settings.
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