Rosie D. Lyles, MD, MHA, MSc Head of Clinical Affairs, Clorox Professional Products Company Clinical Focus • 10+ years studying the epidemiology and prevention of multidrugresistant organisms and infections like Clostridium difficile (C. diff), Methicillin-resistant Staphylococcus aureus (MRSA) and Carbapenem-resistant Enterobacteriaceae (CRE). Organizational Engagement • Active member of: o Association of Professionals in Infection Control and Epidemiology (APIC) o Infectious Disease Society of America (IDSA) o Society for Healthcare Epidemiology of America (SHEA) • Peer reviewer for the National Institutes of Health, New England Journal of Medicine and American Journal of Infection Control Education • Doctor of Medicine, St. Matthew’s University School of Medicine • Master of Health Service Administration, St. Joseph College • Master of Science in Clinical Research and Translational Sciences, University of Illinois, Chicago 1 Combating Public Enemy #1: Infectious Pathogens Wednesday, October 21, 2015 2 Agenda 1. 2. 3. 4. 5. 6. 7. The impact of cleaning and disinfecting in public settings Understanding the dual challenge: cleaning for aesthetics and cleaning for health Infection prevention in public settings Breaking the chain of transmission Improving infection prevention and protocol compliance Conclusion Q&A Session Learning Objectives: • Learn key terminology associated with environmental cleaning, disinfection and best practices. • Learn how cross-contamination occurs and understand its implications for public health. • Improved understanding of environmental cleaning and disinfection strategies for preventing the spread of infections on hard and soft surfaces. 3 Why Do We Clean? Cleaning public spaces serves several important purposes: to keep public spaces inviting, appealing and usable, prevent the spread of germs, and encourage patronage. The Bottom Line It also pays to clean. When it comes to the business of public spaces, cleanliness can have a real impact on revenue. Health-related “lost productive time” costs employers $225.8 billion per year, or $1,685 per employee per year. 4 The Dual Challenge: Cleaning for Aesthetics & Cleaning for Health • Consumer perceptions of facility cleanliness can have a serious impact on a business’ bottom line, but it’s always important to remember that cleanliness serves a critical public health function: preventing the spread of bacteria, viruses and fungi that cause infection. • In an ideal world, these two jobs – cleaning for appearance and health – would always be top of mind and consistently accomplished through cleaning and disinfection protocols. But how close to the ideal are we really? Cleaning for Health Cleaning for Appearance 5 What Does Clean Mean? • A recent survey of cleaning industry professionals found that only 49% of respondents believe their staff is aware of the risks associated with the spread of germs in the restroom. • 68% said their staff does not understand or only somewhat understands the differences between cleaning, sanitizing and disinfecting. 6 What Does Clean Mean? Disinfecting Sanitizing Cleaning • Disinfecting kills germs on surfaces or objects using chemicals. The process does not necessarily clean dirty surfaces or remove germs, but killing germs on a surface after cleaning can further lower the risk of spreading infections. • Sanitizing lowers the number of germs on surfaces or objects to a safe level, as judged by public health standards or requirements, to lower the risk of spreading infection. • Cleaning removes germs, dirt, and impurities from surfaces or objects. Cleaning works by using soap (or detergent) and water to physically remove germs from surfaces, but does not necessarily kill them. 7 What is Infection Prevention & Control Infection prevention and control strategies address factors related to the spread of infections within a given setting and are aimed at breaking the chain of transmission. 8 Infectious Agents It is important for professional cleaning staff to be familiar with the some of the most common and highly transmissible and infectious germs found in public spaces so they can implement infection prevention and control protocols designed to protect against them. Methicillin-resistant Staphylococcus aureus (MRSA) Influenza Norovirus Rhinovirus 9 Reservoirs From a facility maintenance perspective, the most important reservoirs of infectious agents is the physical environment. BSCs / Offices: Athletic Facilities: Hospitality: Restrooms Foodservice: Schools & Universities: 10 Transmission There are two general classifications for modes of transmission, direct and indirect. Direct Direct & Indirect Contact (e.g., MRSA, Norovirus) Droplet (e.g., Influenza, Rotavirus, Bacterial Meningitis) Indirect Airborne Vectorborne Vehicle (e.g., TB, Measles Chickenpox) (e.g., West Nile, Malaria) (e.g., Salmonella, Listeria, Hepatitis A) 11 Transmission: Cross Contamination Cross-contamination occurs when bacteria and viruses are transferred from one surface to another. This is especially true of public restrooms (e.g., when a woman’s purse is placed on a restroom floor and then placed on a sink counter, the germs and bacteria on the floor can be transferred to the purse and then to the sink.) One study found that 20% of handbags contained more germs than the average toilet flush and could potentially cross-contaminate other surfaces. 12 Susceptible Host • • • Anyone can be the next sick person, but some settings and building occupants may be at increased risk for infection. Characteristics that influence susceptibility can include: – Age – Immunization status – Underlying illness – Lifestyle Remember, host susceptibility can have different implications for different types of settings. settings. 13 Breaking the Chain of Transmission While each facility needs to determine the best infection prevention protocol for their needs, there are some basic steps every facility should follow to help prevent the spread of germs that could impact public health. 1. Identifying your enemy 2. Reduce the reservoir 3. Target transmission 4. Reduce host susceptibility 14 Breaking the Chain: Identifying Your Enemy Thorough cleaning and disinfection is the first line of defense against familiar threats and new challenges. You can’t always predict what type of germs will walk through the door so cleaning professionals need proven products that have extensive kill claims and broad surface compatibility. TIPS: • Select products specifically formulated and (EPA)-registered to kill some of the most contagious and hard-to-kill pathogens. Bleach and hydrogen peroxidebased products are especially effective. • Disinfectants with short kill times and a wide range of kill claims provide the best value, since they do a lot with less, in a short amount of time. 15 Breaking the Chain: Reducing the Reservoir Hard Surface Disinfection • Take notice of aesthetic issues – in many facilities, visible stains, soiled surfaces and odors can also signal the presence of harmful microorganisms which are commonly found in restrooms and are associated with outbreaks of illness. • Pre-clean surfaces first to remove debris and bodily soils such as urine, feces and vomit and then use an EPA-registered disinfecting product to kill germs. • Pay particular attention to disinfecting frequently touched surfaces such as faucet handles, countertops and doorknobs which need to be disinfected at least once a day. TIP: Ready-to-use disinfecting wipes can offer an easy solution for disinfecting high touch surfaces because they are pre-moistened to deliver the proper concentration of active ingredients every time they are used. 16 Breaking the Chain: Reducing the Reservoir Soft Surface Sanitization Research has shown not only the presence of pathogens on soft surfaces, but also that organisms can persist on porous surfaces from several hours to as long as three months. Improve soft surface sanitization with three simple steps: 1. Routinely launder washable curtains, bedding, linens, employee uniforms and other soft surfaces in your facility. 2. Use an EPA-registered product to kill bacteria on soft surfaces between laundering and on soft surfaces that cannot be laundered. 3. Encourage good hand hygiene practices by staff during and between routine cleanings. TIP: Spray products that are EPA-registered to kill bacteria on soft surfaces and can be easily incorporated into a regular cleaning routine 17 Breaking the Chain: Target transmission Cross Contamination Prevention Cleaning tools and equipment can become contaminated during the cleaning process, so it is important not to clean multiple areas with the same supplies. Dirty cloths, sponges and mops can spread viruses and bacteria to anything else they come in contact with. Staff should regularly clean and disinfect or replace equipment Cleaning professionals can help prevent crosscontamination in restrooms by focusing on germ-prone surfaces and objects such as counter tops, urinals, toilets, door knobs, toilet handles, stall locks, etc. TIP: Ready-to-use wipes can help decrease cross-contamination risks since they are designed to be thrown out after each use. Janitorial carts and closets should also be kept clean to prevent dirt and germs from traveling throughout a building on equipment. 18 Breaking the Chain: Reduce Host Susceptibility Building occupants also have a role to play in preventing cross-contamination and infections. Encourage everyone to wash their hands regularly with soap and warm water, especially after sneezing or coughing, touching used tissues or using the bathroom, and to stay home when they are sick to avoid spreading germs throughout the environment and to others. Remember, infection prevention is everyone’s responsibility. 19 Conclusion Make sure staff understand the terminology associated with environmental cleaning, disinfection and best practices. Know your enemy and implement protocols to guard against MRSA, norovirus, influenza and other important pathogens. Explain how cross-contamination occurs, why it has important implications for public health and how to prevent it in your facility. Environmental cleaning and disinfection strategies are only effective if they are implemented correctly and consistently. Invest in ongoing training and education to ensure staff understand the important role they play in preventing the spread of germs on hard and soft surfaces. 20 Q&A Session 21 References • • • • • • • • • • • • • • • • • • • • • • • • Clorox Professional Products Company and Opinion Research Corporation. (March 2013). Restroom Pet Peeves Omnibus Survey. (Survey of 1,005 U.S. adults). Stewart, W. R. Lost productive work time costs from health conditions in the United States: results from the American Productivity Audit. Journal of Occupational Environmental Medicine. 45.12 (2003). Clorox Professional Products Company and ClearVoice Research. (February 2012). Online Survey of Professional Cleaning Service Industry Decision Makers. (Survey of 933 cleaning industry decision makers across various industries). Stop MRSA Now. Get the Facts – MRSA 101. Web. 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