The invisible battle
Heavily soiled healthcare linens not 'regulated waste,' OSHA confirms
The infection control battlefront is expansive and tricky. One of the toughest challenges is keeping a building environment clean and clear of contaminants such as mold, fungus, bacteria, viruses and pests.
Facilities must constantly keep an eye out for biological or chemical hazards that could jeopardize residents, experts say.
“Yes, in healthcare, there is always room for improvement,” says J. Hudson Garrett Jr., Ph.D., senior director of clinical affairs for PDI. “A clean environment will reduce not only transmission of healthcare-associated infections but reduce the possibility of an environmental surface serving as a reservoir for bacterial growth.
“One of the most fundamental components to success in healthcare initiatives is communication amongst departments. In long-term care facilities, nursing personnel must maintain open communication with environmental services, physical therapy, et cetera.”
At the heart of the defense in germ and bacteria warfare is a well-trained housekeeping staff with ample manpower, says Beverly VanBrocklin, housekeeping manager at The Moorings, a Presbyterian Homes property in Arlington Heights, IL.
“The biggest thing you have to have is consistency,” VanBrocklin asserts.
Oft-used areas and items should get extra attention, says Ernest Henry III, director of environmental services at Spring House Estates, an ACTS Retirement-Life Community in Lower Gwynedd, PA.
“We've implemented a comprehensive daily touch-surface program that includes railings, door handles, chair arms, entry pads, and various surfaces that can involve hand touching,” Henry explains.
And it's not just floors and fixtures that must be addressed. Staff and residents also must take measures to ensure they do not become part of the problem. As at other like-minded facilities, The Moorings offers multiple hand sanitizer dispensers on every wing.
The hardware and strategies in the fight to maximize housekeeping standards evolve on a continual basis.
“Some of these would include the trend of facilities going to microfiber [dusters, towels, mops], compact carts, portable mopping systems, large-area sprayers, [and]ride-on vacuums,” Henry says.
Science and technology will continue to contribute to the choices of state-of-the-art weapons.
“Environmental hygiene is a hot topic in healthcare in general,” said PDI's Garrett. “One of the major challenges that exists is monitoring effectiveness of the facility's environmental cleaning and disinfection program.
“There are innovative new ways to measure compliance using ATP [adenosine triphosphate] monitoring and bioluminescence gel marking within the environment. The challenge with these emerging technologies is identifying best practice, and where the therapeutic threshold is, regarding the numerical identification of bacteria and other bioburdens.
“There is still a lot of learning to be performed in identifying the gold standard for environmental monitoring,” Garrett maintains.
This winter's early, strong flu outbreak presented special challenges for providers. The Centers for Disease Control and Prevention's Influenza Summary Update in mid-January showed that the latest strain of the illness was “widespread” in every state but Tennessee, Georgia and Hawaii.
That led to extreme measures at The Moorings. To stem the spread of the illness and care for its residents, the suburban Chicago facility did not allow visitors or new admissions to its nursing facility for three days.
“We watch the trends,” says Presbyterian Homes' Vice President of Sales and Marketing Robert Werdan. “If it's one case of flu, it's not a big deal. We can take care of that. People get the flu year-round often times. When it's multiple cases that are building on a daily basis … you need to stop that.”
Pests are another major threat that can produce hazards both seen and unseen. Keys against these vectors for illness are vigilance and communication.
“Probably the best thing that nursing homes or long-term care facilities are doing is really focusing on preventing problems. It coincides with their disease prevention, infection prevention, and food-borne illness prevention,” says Greg Baumann, Vice President of Training and Technical Services for Orkin. “Rather than waiting for something to happen, they're very good about [being] proactive.”
The usual suspects are rodents and insects such as ants, flies, roaches and bedbugs.
The last have gotten more than their fair share of press since a re-emergence in the past decade. But the watch for Cimex lectularius Linnaeus should be expanded, experts say.
“To tell you the truth, ‘bed bug' is a bit of a misnomer,” Baumann notes. “They are looking for any tight area. It could be an upholstered chair … it could be an electrical outlet. It could be a ceiling tile. They want to be close to where the human food source is.”
Today, some problems can be controlled with reduced pesticide exposure to residents and caregivers. In the past, a room or larger area might have been sprayed if insect pests were found. The same issue today could be solved with treated food paste placed in a location that only the offenders can frequent.
Effective treatments, just as is the case with resident caregiving, are aided by a team effort.
“The pest management company is not going to be there all day, every day. Staff would be the eyes and the ears and be the early warning,” Baumann says. “That's going to be very beneficial in letting the pest control company know about it as soon as they see it, as opposed to waiting 30 days for the next visit.”
The laundry department also plays a major role in keeping resident and common areas sanitary. The washing cycle, with the use of detergents, chlorine bleach, peroxides and other solutions, coupled with high drying temperatures, does an excellent job of eliminating bacteria and viruses.
But there's more to worry about.
The more difficult part of this cleansing process happens outside of the machines.
“The major culprit for breaking these rules are the things that touch the floors,” says Kim Shady, senior vice president of on-premises laundry sales for Laundrylux. “Not the linens, but the feet, the laundry cart wheels that move from soiled room to clean room. These items automatically transfer the ‘unwanteds.'”
Errors also can compromise the process. One helpful aid in error reduction is to make laundry transfer carts different colors for clean or soiled clothes.
Clean carts should be kept out of areas where soiled clothes are gathered. All carts should be sanitized daily. If the clothes are kept in separate rooms, doors should be kept closed and airflow should start in the clean room and flow to the area with used items.
Workers who handle soiled items can wear gloves and impermeable aprons. After drying, clean items should have as little contact with the washing area as possible.
“In the ideal world, using ‘barrier style' or the ‘pass-through style' of washers would be the very best solution,” Shady says. “The soiled linens are loaded in a washer that has two doors. Each door is on the opposite side of a ‘barrier' wall. With this design, there are never people or carts moving from soiled areas to clean areas. There is no cross-contamination.”
Changes in policy or procedures also can help providers put in place the most effective systems. On Jan. 25, the Centers for Medicare & Medicaid Services updated regulatory information on laundry services. Among other guidelines, the agency emphasized a new strategy of leaving doors open on washing machines after use. Doing so allows the interiors to dry and helps prevent mold growth.
All environmental services play a role in the constant war for sanitized living spaces in nursing and other long-term care facilities. One thing is clear the battles will continue to rage. The key, experts agree, is whether providers will be able to fight the good fight consistently, using strong tools, tactics and teamwork.