Infection Control With Steam
Proven Effective Results for
Decontamination
Advancing hygiene
standards & infection
prevention in the patient
environment
New cleaning technologies
and methodology for
successful application in the
healthcare environment
STUDY OF
DRY SUPERHEATED
STEAM VAPOUR &
MICROFIBRE CLEANING
The Challenge
• Healthcare-associated infections (HCAI)
persist despite increasing resources
• Pathogens remain viable for weeks or
months
• Some outbreaks are attributable to the
environment
• Pathogens should be removed
• Physical Force
• Biocidal agent / detergent
How Clean is Clean?
How Clean is Clean?
High Impact Interventions
Reducing the risk
Peripheral Intravenous cannula care
Central venous catheter
Surgical site
infections
Renal dialysis
catheter care
ENVIRONMENT
Ventilator associated
pneumonia
Urinary tract infections
Indwelling urethral
catheters
Infection and presence
of Clostridium difficile
Physical force with conventional cleaning
equipment alone is not considered sufficient
Biocides therefore
considered essential
– Halides
– Phenols
– Oxygen releasing
compounds
– Quaternary
ammonium
compounds
Problems associated
with common
biocides
– Harmful to health
– Degrade built
environment
– Promote
antimicrobial
resistance
Destructive Decontamination
•Damage to the fabric of the patient environment reduces cleanability
•Increases the challenge for rapid and consistent cleaning results
Destructive Decontamination
Study of dry superheated
steam cleaning
AIMS
• Studies designed to validate Dry Superheated Steam
(DSS) and purpose designed steam delivery tools as a
cleaning and sanitising process, applicable to the
healthcare environment.
• Study focussed on validation of safe removal of bio-film
and procedures to achieve microbiological
decontamination of ‘risk’ contact surfaces in the patient
environment.
Test Equipment
• Portable steam
generating units
• Dual DSV outlets
• Dual action steam &
Vacuum extraction
• Water filtration
• Decontamination
‘autoclave tank’
Thermal disinfection
Steam cleaning methods and
applications
• System can be fitted with
task specific cleaning
tools for detail or large
area cleaning
• Restoration cleaning
• Combination steam +
MicroFibre tools
Steam cleaning
• Portable steam
generating units
• Dual action steam &
Vacuum extraction
• Water filtration of extract
• Vapour penetration
emulsifies and aids soil
removal, vacuum and
microfibre absorption
• Thermal disinfection
• Does not support
microbial resistance or
hyper sporulation
Study of potential applications for
steam cleaning
• Study of ‘risk’ contact surfaces in the patient
environment
• Patient bed & mattress
• Patient furniture
• Wheelchairs
• Bedside equipment (trolleys, drip stands)
• Curtains
• Bathroom & Toilet surfaces
Methods of Cleaning
Conventional mop/cloth
15
Dry Steam Vapour
A study of Dry Steam Vapour, and
novel proprietary steam &
microfibre tools designed for
cleaning the healthcare environment
*
November 2006 – March 2008
TNO Report V7683
Netherlands Organisation for Applied Scientific Research
* Patent Pending OspreyDeepclean UK
© 2008 TNO
The definition of cleaning / disinfection
performance, within the context of this study, is
stated as
“The successful and safe removal of
contaminant from the target surfaces using a
combination of steam vapour cleaning method,
through penetration and physical removal
(vacuum extraction and or microfibre adsorption)
and in some instances degrees of thermal
disinfection and elimination of susceptible
micro-organisms”
Test Micro-organisms
•
•
•
•
•
•
•
•
•
•
•
Methicillin resistant Staphylococcus aureus (MRSA),
Acinetobacter calcoaceticus-baumannii (ACCB),
Staphylococcus aureus,
Pseudomonas aeruginosa,
Bacillus subtilis,
Candida albicans,
Aspergillus niger,
Vancomycin resistant Enterococcus (VRE),
Enterococcus faecalis,
Clostridium difficile spores (010 strain)
Enterococcus hirae,
UCLH clinical isolate
UCLH clinical isolate
NCTC 10788
NCTC 13359
NCTC 10400
NCTC 90628
UCLH clinical isolate
UCLH clinical isolate
ATCC 29212
UCLH clinical isolate
NCTC 12368.
Method
• Intentionally contaminated with (105 spores/106 bacteria)
organisms within a manufactured bio-film spread evenly on
100cm2 surface and allowed to dry
• MRSA
• Acinetobacter calcoaceticus baumanii (ACCB)
• Klebsiella pneumoniae
• Clostridium difficile spores
• Vancomycin resistant Enterococcus (VRE)
• Aspergillus niger
• Contact plates used before and after cleaning to validate
effective removal of micro-organisms from the hospital
surfaces
Contaminant dispersion &
aerosolisation
• Dispersion and aerosolisation experiments were
conducted to evaluate the risk factor associated with
steam cleaning, using a range of standard and the
new generation of custom designed steam delivery
tools.
• Evaluation based on measures of microbiological
decontamination efficacy, and patient safety.
Contaminant dispersion &
aerosolisation
• Bio-film was inoculated with Bacillus stearothermophilus
• Patient bed was contaminated. The cleaning procedure
was monitored by air sampling during cleaning and post
clean settle plates (60 min.)
• Aerosolisation tests repeated using MRSA, ACCB, E
coli, Clostridium difficile spores
• Each cleaning tool was evaluated for dispersion using
dye & fluorescence marker tests
Aerosolisation tests
Bed contaminated with heat resistant
Bacillus stearothermophilus spores.
Recovery of aerosol by settle plates and
air sampling.
RESULT: No spores were detected
Aerosolisation & Dispersion tests
•Aerosolisation tests repeated
using MRSA, ACCB, E coli,
Clostridium difficile spores. Air
sampling placed 10 cm from
point of steam contact with
surface being cleaned.
Safranin innoculum on smooth
hard surface. Steam challenge to
remove stain using paper blotter
capture points to detect
dispersion (steam & vacuum tool)
Aerosol test
squeegee flat surface tool
•Aerosolisation tests
repeated using MRSA,
ACCB, E coli,
Clostridium difficile spores.
Air sampling at point of
cleaning
RESULT: No aerosol was
detected by Microbial
Challenge Impactor (MCI)
three stage air sampler
during the cleaning
process. (sampled at
squeegee head)
Aerosol Test – Steam Mop
Floor inoculated with Clostridium difficile spores.
RESULT: No aerosol was detected by Microbial Challenge
Impactor (MCI) three stage air sampler during the cleaning
process. (sampled at mop head)
1. MATTRESS
TOOL
May 21-23
07
UCLH
RUN 1
Bed 1 Sample area
AEROSOLIOSATION TEST Clostridium difficile spores (1,000 sq cm)
RESULT – No Aerosol was detected during cleaning process
Air Sample Left
Air Sample Right
1.1
1.2
1.3
1.1
1.2
1.3
Blank control
0
0
0
0
0
0
Test 1
0
0
0
0
0
0
Test 2
0
1
0
0
0
0
Test 3
0
0
0
0
0
0
1.1
1.2
1.3
1.1
1.2
1.3
Blank control
0
0
0
0
0
0
Test 1
0
1
0
0
0
0
Test 2
0
0
0
0
0
0
Test 3
0
0
0
0
3
0
1.1
1.2
1.3
1.1
1.2
1.3
Blank control
0
0
0
0
0
0
Test 1
0
2
0
0
0
0
Test 2
1
2
0
0
0
0
Test 3
0
2
0
0
1
0
1.1
1.2
1.3
1.1
1.2
1.3
Blank control
0
0
0
0
0
0
Test 1
0
0
0
0
1
1
Test 2
0
1
0
0
0
0
Test 3
0
0
0
0
0
1
Bed 2 Sample area
Bed 3 Sample Area
Bed 4 Sample Area
Contaminant dispersion &
aerosolisation
RESULT
• We conclude that with the correct selection of
tool and cleaning technique, dry saturated steam
does not cause an aerosol contamination hazard
Surface decontamination challenge
Surface microbiological measurement
Clostridium difficile spores (inoculum 1,000 per sq cm)
Mattress surface cleaned with steam tool with Microfibre pad
RESULT: 5 fold reduction (99.99%) with steam vapour and
microfibre cleaning method
TEST POINTS
CONTACT PLATE METHOD Total Viable Count
PRE Clean
Post Clean 1
Post Clean 2
Post clean 3
>500 cfu Confluent growth
0
0
0
>500 cfu Confluent growth
0
2
0
>500 cfu Confluent growth
0
1
0
>500cfu Confluent growth
0
0
0
Results
Surface decontamination
Efficacy of stream in removing ACCB from six
different surfaces
Efficacy of stream in removing MRSA from six
different surfaces
Pre clean Post clean
600
500
400
300
200
100
0
Surface
Stainless
steel
Head
Board
Tile
Trolley
M attress
Cushion
No. of organisms recovered (cfu)
No. of organisms recovered (cfu)
Pre clean Post clean
600
500
400
300
200
100
0
Surface Head Board
Stainless
steel
Tile
Trolley
M attress
Cushion
Consistent results demonstrated for VRE, Bacillus subtilus, Pseudomonas
aeruginosa Clostridium difficile spores
Results
Bio-Film Removal
• Bio-film removal was consistent across all test surfaces
(plastic laminates, vinyl, stainless steel, ceramic tiles
wood and painted finishes).
• Rough textured surfaces and crevices posed challenges,
but were overcome by selection of appropriate cleaning
tool and technique. e.g. steam + Microfibre
Conclusion
With competency based staff training, dry
superheated steam vapour cleaning technology,
delivered via purpose-designed tools, provides
cleaner hospital environments without the use of
ecologically damaging biocides.
- Improved cleaning productivity
- Enhanced daily & preventative maintenance
- Reduced damage to material surfaces
- improved patient safety
How Safe is Cleaning?
• “Disinfectant wipes designed to eradicate
MRSA are helping to spread the deadly
superbug because staff are using them to
clean more than one surface”
• Failure of Material? - Method? – Training?
• Lack of knowledge? – Insufficient research?
• Some or All of the above????
Presentation to American Society of Microbiology, General Meeting, Boston
Dr Gareth Williams, Wales School of Pharmacy, Cardiff University
The OspreyDeepclean Dry Steam
Vapour Healthcare Tools
Patents Pending
Mechanical Strength
Cotton Fibre
Microfibre
Scanning Electron Micrographs demonstrating the action of microfibre
Ultra microfibre Strands
Static attraction of dust
Dirt captured within fibre
Microbiological studies: Pre & Post clean
Ultra Microfibre vs. J-type cleaning cloth
SOP Training Tools
DSV Steam Cleaning Standard Operating
procedure (SOP*)
Steam Floor mop with Microfibre pad
Steam Cleaning Standard Operating
procedure
Hard surface Steam Cleaning hand
tool with Microfibre pad
Steam Cleaning Standard Operating
procedure
Left: Mattress steam Cleaning
hand tool with Microfibre pad
Above. Tube cleaning detail
tool
Steam Cleaning Standard Operating
procedure
Steam and Vacuum squeegee tool.
Hard surface and upholstery cleaning
Huntley bed cleaning procedure
Acknowledgements
Study supported by
OspreyDeepclean, UK.
Netherlands Organisation for Applied Scientific Research