As we all walk around with masks, there is much focus on air-transmitted microbes. However, a critical issue equally as dangerous is the deadly microbial transmission issue is staring down at us with little attention. That is surface-based microbes and transmission.
For two decades, scientists and researchers have published research and raised the alarm that surface microbial transmission is being ignored by healthcare professionals and facilities. Currently the go to solution is to clean and disinfect them better. WARNING cleaning and disinfection of the surfaces could be unknowingly setting healthcare professionals up for failure because the majority of surfaces cannot be cleaned and disinfected without causing damage.
Our attempts at cleaning and disinfecting the thousands of surfaces in a typical healthcare facility is also not working, because there are many different types of surfaces and microbes, and they cannot be cleaned or disinfected in the same way. In fact, much of the disinfection attempts are causing more harm than good, such as damaging what we consider hard non-porous surfaces, thereby making them porous and harbingers of microbes.
Why does this all matter? Because nearly 100,000 people each year are dying from Healthcare Acquired Infections (HAIs), and most of those infections are caused by surface and device-based pathogens.
While we need to maintain focus on microbial transmission via air, it is crucial to note that aerosolized pathogens will eventually fall to the surfaces. There is sufficient research to show that microbes can survive on surfaces for days, weeks, months, and even longer, depending on the type of microbe, despite ongoing cleaning and disinfection.
More research is needed to help us understand how microbes survive on surfaces. Research that provides insight into the ways specific surfaces support microbes and the ability to destroy them given the material type. Current research is providing us with scientific data about biofilm formation – a matrix of cells that can protect the microbe. So much more information is needed.
Cleaning and disinfection infection prevention guidelines vary within healthcare settings. As do the disinfection chemistries. How a room or area is cleaned and disinfected depends on the level of care. An example is ICU or a patient care area for transplant patients may have different infection prevention guidelines than a typical medical patient care room. The type of microbe environmental services professionals are trying to remove, also impacts the type of cleaning and disinfection required to achieve the outcome expected. Daily cleaning is different from an outbreak or terminal cleaning. There are many variables that must be evaluated and must be evaluated before purchase.
It is shocking to learn that disinfectants used within the healthcare setting frequently cause surface damage. This problem leads us to the following question: Can this surface material be cleaned and disinfected using healthcare-grade disinfectants? And can it do so WITHOUT damage? Has the surface materials and product been tested to validate?
Initially, unseen damage creates tiny, microscopic holes and fissures in the material suitable for safe harbor and proliferation of the very microbe’s healthcare professionals are trying to destroy. Assumptions are made that a surface is clean and disinfected by a visual inspection. Because there is no soil or issue seen, it is determined the surface is clean. We all know microbes are invisible and, therefore, cannot be seen.
Therefore, the first issue is that assumption by visual inspection. The second issue is we need to determine and analyze the surface and how or if it can be cleaned or disinfected before it is purchased. Much too often, there is no discussion between healthcare facility professionals and manufacturers around how the surfaces involved can be maintained, cleaned and disinfected.
Data supports this. In a recent poll we conducted of seventy-five healthcare professionals, 85% of respondents confirmed they had never evaluated any cleaning or disinfection requirements or learned how to care and maintain a surface before specifying or buying surface materials.
We have asked this same question at HSI events throughout the year, and the numbers remained high, with between 35% to 85% confirming they never even looked at this information when making a purchase decision.
It is impossible to create a healing environment if you don’t know how or if the surfaces can be cleaned and disinfected effectively. This is a foundation issue being overlooked. What’s more, to treat all surfaces in a healthcare environment the same is dangerous and is one seriously overlooked foundational issue of why we are dealing with so many HAIs.
Infection prevention begins at the design of the built environment and the design of products for patient care. If you don’t know if the materials being used for design can be efficiently and effectively cleaned and disinfected, it should not be used or purchased.
There is also a critical disconnect between real-world healthcare challenges and manufacturers’ recommendations for cleaning and disinfection products and infection control guidelines. Healthcare professionals know how they need to clean and disinfect the healthcare setting. They understand what disinfectants will kill specific microbes, and typically any professional environmental services (EVS) professional will have several different disinfectant products on their cart. However, that doesn’t mean the disinfectant being used complies with the manufacturer recommendations. If the product is a medical device under FDA regulatory compliance requirements this can also set the hospital up for failure when the disinfectant recommended is either not used by the hospital or and infection prevention guidelines does not allow its use in patient care areas. A problem that can be addressed by communication prior to purchase.
The best way to describe what an EVS professional faces is to take you into an emergency room scenario, based on the following realities:
- High traffic depending on the size of the hospital
- High contamination – people come in with a wide variety of illnesses and injuries
- Quick room turnover times. This is a regulatory time requirement and part of the accountable care act.
The photos below are of an emergency room ready to accept more than one patient for care. The second photo is the aftermath of a trauma.
Let’s look at all the surfaces that must be cleaned and disinfected to ensure the room is safe and ready for the next patient. Every single product in that room has a different instruction for use (IFU) or a cleaning and maintenance document with a wide variety of cleaning products each manufacturer recommends for use. There are at least 41 different IFU’s or care and maintenance documents in this emergency room alone, none of which have the same recommendations for cleaning and disinfection. This post-trauma mess must be turned over and be ready and safe for the next patient in 30 minutes. Think about that.
The time is Now to address the critical surfaces issue. The Healthcare Surfaces Institute recommends the following steps be taken by manufacturers, healthcare facilities, EVC professionals, and anyone involved in the design, manufacture, use and maintenance of surfaces.
- Develop a minimum standard for validation of surface disinfectant compatibility that test categories of disinfects instead of proprietary products
- Designate a single point of contact within a healthcare organization to facilitate collaboration between manufacturers and healthcare professionals, and to communicate important matters to all parties. Typically a value analysis professional.
- Establish a greater understanding for everyone involved of the real-life challenges healthcare professionals face when working to mitigate the spread of infections within the healthcare setting.
- Build an awareness and checklist for the selection of surface materials during the design phase for a built environment or a specific product. Raw materials must meet specific minimum requirements before they are used for the design of products used for patient care or within the healthcare setting..
- Create guidelines for product review before purchase and checklists for healthcare selected teams within the healthcare setting that provides them with needed information for product value analysis professionals.
- Medical device supplies should provide maintenance training and cleaning and disinfection review for healthcare professionals.
Healthcare workers around the globe are exhausted as we enter our third year of a pandemic. While addressing the surface-based pathogen issue will not solve all issues we are facing, it could save hundreds of thousands of lives and protect the health of medical professionals. This is a microbial issue presently being addressed at a macro level. What you can’t see may kill you. Focusing primarily on air-transmission is missing the boat, because just as critical, if not more so, are surface-based microbial pathogens.
Linda Lybert is the Founder and Executive Director of the Healthcare Surfaces Institute. For the past 20 years, she has focused her work on surfaces and their role in acquiring and transmitting pathogens in healthcare facilities. She introduced the Seven Aspects of Surface Selection© to bring insight into the surface issue’s complexity and how they are active in spreading pathogens that cause deadly infections.
Over the years, she has worked with many thought leaders and high-level professionals from diverse areas of expertise, all of whom have provided powerful insight into one or more aspects of the problem. Realizing everyone was working on the same issue, separately, she and a board of world-renowned experts founded the Healthcare Surfaces Summit Inc. dba Healthcare Surfaces Institute (HSI). HSI is the first collaborative of multidisciplinary experts to focus on surfaces, and they have the most comprehensive vision of the path forward for addressing all aspects of the problem.
Linda has served as a member of the FGI Guidelines for the Design and Construction of Healthcare Facilities Revision Committee and the ASHE Facility Planning Design and Construction Committee. She is an active participant with ASHE and APIC and continues to impact the healthcare industry through speaking events and her consulting practice.