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Tough to Kill
C. Diff
A New
Challenge for Healthcare Cleaning Professionals
B Y
ROBERT
KRAVITZ
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In recent years
we have
heard quite a bit about the potentially deadly disease known as
methicillin-resistant Staphylococcus aureus, or MRSA. In fact,
according to Medical News Today, MRSA infections are more common
in the United States than was previously thought.
Worse yet, the disease, which once was
contracted only in healthcare settings, has now found its way
into schools and other public facilities.
Another disease that is getting less attention
but growing in speed of infection and virulence is called
Clostridium difficile, or C. diff. This disease, which is
primarily a hospital-acquired illness found in healthcare
settings such as long-term care centers and nursing homes, may
now be spreading to other types of facilities as well.
C. diff is most frequently contracted by the
elderly and those with recent exposure
to
hospitals, nursing homes and other healthcare institutions. It
is transmitted by hand contact with items contaminated by feces.
In the past five years, a more virulent and antibiotic-resistant
strain has developed that has been associated with more serious
disease, treatment failures and deaths.
A report recently released by the Association
for Professionals in Infection Control and Epidemiology (APIC)
found that:
• Thirteen out of every 1,000 patients in U.S.
medical facilities, approximately 7,178 people on any given day,
are infected or colonized with C. diff (94.4 percent were
infected).
• The rate is 6.5 to 20 times higher than
previous incidence estimates.
• The report estimated that these infections
cost between $17.6 million and $51.5 million, and cause or are
one reason for the deaths of as many as 400
patients
every day Managers in these types of facilities, along with
building service contractors that clean them, need a good
understanding of how this disease is spread and how they can
protect themselves and the facility users.
As with many diseases, the source of C. diff
bacteria is typically fecal spores from the waste of patients.
The spores are shed onto surfaces and fixtures such as toilets
and can be spread by nurses or cleaning attendants who touch an
infected toilet and then visit the next patient or room without
properly washing their hands or changing their gloves.
“Additionally, cleaning technicians utilizing
cleaning cloths and tools in multiple areas can [spread the
disease] and cause cross contamination,” says Peter J. Sheldon
Sr., vice-president of Operations for Coverall Cleaning
Concepts, which is involved in the cleaning and maintenance of
healthcare facilities throughout the United States.
“Recent studies by microbiologists have reported
this as well.”
Sheldon maintains that the first line of defense
in stopping the spread of C. diff is active and enforced hand
washing by all medical and cleaning personnel in these
healthcare settings. Also, adding that wearing gloves does not
offer protection unless the gloves are removed properly. Proper
glove-changing protocol involves removing the gloves without
ever actually touching contaminated areas of the glove.
Tough to Kill
In addition to proper
hand-washing and glove-changing procedures, the most effective
way to stop the spread of C. diff is more thorough, hygienic
cleaning. However, unlike MRSA, which can be removed from
surfaces using proper cleaning systems and disinfectants, C.
diff has proved to be much more difficult to remove.
“The [C. diff] spores, by
their very nature, are designed to protect and provide [for] the
spread of the organism,” says Sheldon. “Complicating matters,
traditional quaternary and even EPA-registered phenolic
disinfectants are not effective against this pathogen,”
according to the EPA.
More problems arise because
some chemical manufacturers’ kill claims regarding C. diff,
which are backed by the EPA, are applicable only when the
bacteria is in its less common vegetative state.
“But once it has entered its
[more common] spore-form stage, these products are ineffective,”
explains Sheldon.
Mechanical Measures
Looking for ways to eradicate
C. diff spores and promote more healthful, hygienic cleaning,
the Centers for Disease Control and Prevention suggests using a
bleach and water combination along with “mechanical methods of
soil removal.”
Although the use of bleach may
not be the most environmentally preferable choice, the
seriousness of the disease and the fact that its victims are
often older people with weaker immune systems warrants its use.
If bleach and water are used,
Sheldon suggests that maintenance staff flood the surfaces to be
cleaned and then remove the solution through drains or with a
wet/dry vacuum system. They should then use microfiber cleaning
cloths to wipe clean the surfaces, utilizing a fresh cloth or a
fresh area of the cleaning cloth for each surface. Recently, a
new form of microfiber cleaning cloth was introduced that can be
folded into a number of quadrants.
This way, the cleaning
technician can use a fresh quadrant for each surface with less
waste.
As to using mechanical methods
of soil removal, Sheldon suggest the use of spray and-vac
cleaning technology or high-flow fluid extraction. With this
system, technicians apply a disinfectant to surfaces to be
cleaned. “The high-pressure rinse forces soil and contaminants
to the floor, where they are removed with the machine’s wet
vacuum,” he explains. “This technology has proved to be
effective for soil and spore removal.”
With all the talk about germs
and diseases such as C. diff, MRSA, SARS, and others, it is no
wonder that many people are becoming germaphobic. Germs are all
around us, but in most cases, our natural immunities protect us
from them.
However, some germs, such as
C. diff, can cause serious illness for even the most healthy
among us, and, as referenced earlier, they especially impact
those with the weakest immune systems. By implementing the
procedures discussed here, along with more hygienic cleaning and
some good old common sense, we can substantially reduce the
spread of these dangerous diseases.
❑
C. Diff on the Rise
None of us lives in a
bubble—germs are everywhere. But the vast majority of germs,
even in hospitals, are essentially harmless. Generally speaking,
most of these germs either have no impact on our lives or are
actually beneficial, helping to clean up waste and pollution.
C. diff bacteria, however, are
more dangerous because they can produce toxins that attack the
human body. C. diff can be treated successfully with
antibiotics, but they must be the right antibiotics or sometimes
the right combination of antibiotics. However, the overuse of
antibiotics in recent years has made it more difficult to treat
this disease, which is why it has become more prevalent and
even, in some cases, fatal.
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