INFECTION PREVENTION AND CONTROL
that means bathrooms, offices, hallways. Stuff gets missed.”
Hospital rooms may be cleaned for half the time as a typical hotel room, Zuberi asserted, and not all rooms are cleaned daily. What’s more, not all surfaces are cleaned thoroughly – with the right chemicals, in the right concentrations, and for the right length of time.
“Cleaners do not know how to get surfaces microbially safe - it’s just superficial,” said Prof Assadian. “They may not fully understand the difference between cleaning and disinfecting; after all, a toilet cleaned in two minutes may appear sparkling but remain teeming with pathogens.” Numerous studies have linked outsourced cleaning to higher rates of infection. Among 126 English NHS hospitals studied, those using outsourced cleaners reported nearly 50% more MRSA infections than hospitals with in-house cleaners. “Contracting out NHS services may save
money, but this is at the price of increasing risks to patients’ health,” wrote study co- author David Stuckler, PhD, MPH, a public health expert at the London School of Hygiene and Tropical Medicine. “When these full costs are taken into account, contracting may prove to be a false economy.”46
territory in a paper titled “Superbugs versus outsourced cleaners.”47 superbugs win.
American researchers explored the same Their conclusion:
Among 126 English NHS hospitals studied, those using outsourced cleaners reported nearly 50% more MRSA infections than hospitals with in-house cleaners.
Their study of California hospitals found “strong evidence” linking outsourced cleaning to incidence of C. difficile, a bacterium that can form spores that linger on sheets, floors, and toilets, and is readily spread via equipment and human hands. In this study, 73% of hospitals that did not outsource cleaning reported C. difficile cases in the year studied. But among hospitals that outsourced much of their cleaning, C. difficile infection incidence reached 91%.
The California study underscores a second reason hospital surface cleaning falls short: Even when it’s done right – when standards are high and in-house cleaning crews are motivated, well trained, and well paid – cleaning cannot wipe out pathogens for long. As anyone with a kitchen knows, “clean” is a temporary condition. In a study of a medical intensive care unit (MICU) in South Carolina, 36 bed rails were sampled for bacteria immediately before cleaning with two different hospital-approved disinfectants and checked at four intervals afterward. One disinfectant was more effective than the other, but in both cases,
within three hours of disinfection, the bacterial burdens had rebounded to unacceptable levels.48 “Our study suggests that cleaning approximately every two hours would be necessary to maintain the population of this pathogen at the proposed nondetectable level,” the researchers concluded. This is no small finding, as bed rails are the most contaminated surfaces in a hospital room,49
and dangerous microbes are easily transferred from bed rails to healthcare workers’ hands.
A study conducted in Chicago, for example, found VRE bacteria were transferred to gloved hands nearly half of the time after contact with bed rails. In fact, healthcare workers were almost as likely to have contaminated their hands or gloves after touching objects in a patient’s room as after touching infected patients themselves.50
And transfer of VRE
happens quickly: 46% of handprint cultures grew VRE after five seconds of contact with the bed rail or side table in a patient’s room. It goes without saying that no hospital can afford to disinfect bed rails 12 times a day.
SEPTEMBER 2018
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