Carpeting has been
used for more than 30
years
in both public and
patient-care areas of healthcare
facilities, and its benefits
and disadvantages are
well known.
Advantages of carpeting in
patient-care areas include the
following:
• Its noise-limiting characteristics;
• The “humanizing” effect on health care;
and
• Its contribution to reductions in falls
and resultant injuries, particularly
for the elderly.
Compared to hard-surface
flooring, however,
carpeting is harder to keep
clean, especially after
spills of blood and body
substances. It is also
harder to push equipment
with wheels (e.g., wheelchairs,
carts, and gurneys) on carpeting.
Several studies have documented the
presence of diverse microbial populations,
primarily bacteria and fungi, in carpeting; however the variety and number of microorganisms
tend to stabilize over time,
according to the CDC’s “Guidelines for
Environmental Infection Control in
Health-Care Facilities.”
New carpeting quickly becomes colonized,
with bacterial growth, plateauing
after about four weeks. Vacuuming and
cleaning the carpeting can temporarily reduce
the numbers of bacteria, but these
populations soon rebound and return to
pre-cleaning levels. Bacterial contamination
tends to increase with higher levels
of activity.
The CDC says, soiled carpeting that is
or remains damp or wet provides an ideal
setting for the proliferation and persistence
of gram-negative bacteria and fungi.
Carpeting that remains damp should be
removed, ideally within 72 hours.
Despite the evidence of bacterial
growth and persistence in carpeting, only
limited epidemiologic evidence demonstrates
that carpets influence healthcare–
associated infection rates in areas
housing immunocompetent patients.
The CDC’s guideline, therefore, includes
no recommendations against the use of carpeting
in these areas. Nonetheless, avoiding
the use of carpeting is prudent in areas
where spills are likely to occur (e.g., laboratories,
areas around sinks, and janitor
closets) and where patients may be at
greater risk of infection from airborne environmental
pathogens (e.g., burn units,
ICUs, and ORs).
An outbreak of aspergillosis in one facility
was recently attributed to carpet
contamination and a particular method of carpet cleaning. A window in the unit had
been opened repeatedly during the time of
a nearby building fire, which allowed fungal
spore intrusion into the unit.
After the window was sealed, the carpeting
was cleaned using a “bonnet
buffing” machine, which dispersed Aspergillus
spores into the air. Wet vacuuming
was instituted, replacing the dry
cleaning method used previously; no additional
cases of invasive aspergillosis
were identified.
The care setting and the method of
carpet cleaning are important factors to
consider when attempting to minimize
or prevent production of aerosols and
dispersal of carpet microorganisms into
the air.
Both vacuuming and shampooing or
wet cleaning with equipment can disperse
microorganisms to the air. Vacuum cleaners
should be maintained to minimize
dust dispersal in general, and be equipped
with HEPA filters, especially for use in
high-risk patient-care areas. Some formulations
of carpet-cleaning chemicals,
if applied or used improperly, can be dispersed
into the air as a fine dust capable
of causing respiratory irritation in patients
and staff.
Cleaning equipment, especially those
that engage in wet cleaning and extraction,
can become contaminated with waterborne
organisms (e.g., Pseudomonas
aeruginosa) and serve as a reservoir for
these organisms if this equipment is not
properly maintained.
Substantial numbers of bacteria can
then be transferred to carpeting during the
cleaning process. Therefore, keeping the
carpet cleaning equipment in good repair
and allowing such equipment to dry between
uses is prudent.
Carpet cleaning should be performed
on a regular basis determined by internal
policy. Although spills of blood and
body substances on non-porous surfaces
require prompt spot cleaning using standard
cleaning procedures and application
of chemical germicides, similar decontamination approaches to blood
and body substance spills on carpeting
can be problematic from a regulatory
perspective.<br><br>
Most, if not all, modern carpet brands
suitable for public facilities can tolerate
the activity of a variety of liquid chemical
germicides. However, according to
OSHA, carpeting contaminated with
blood or other potentially infectious materials
can not be fully decontaminated.
Therefore, facilities electing to use carpeting
for high-activity patient-care areas
may choose carpet tiles in areas at high
risk for spills.
In the event of contamination with
blood or other body substances, carpet
tiles can be removed, discarded, and replaced.
OSHA also acknowledges that
only minimal direct skin contact occurs
with carpeting, and therefore, employers
are expected to make reasonable efforts
to clean and sanitize carpeting using
carpet detergent/cleaner products.
Over the last few years, some carpet
manufacturers have treated their products
with fungicidal and/or bactericidal chemicals.
Although these chemicals may help
to reduce the overall numbers of bacteria or fungi present in carpet, their use does
not preclude the routine care and maintenance
of the carpeting.
Limited evidence suggests that chemically
treated carpet may have helped to
keep health-care-associated aspergillosis
rates low in one facility, but overall, treated
carpeting has not been shown to prevent the
incidence of health-care-associated infections
in care areas for immunocompetent
patients.
Cloth Furnishings
Upholstered furniture and furnishings
are becoming increasingly common in patient-
care areas. These furnishings range
from simple cloth chairs in patients’
rooms to a complete decorating scheme
that gives the interior of the facility more
the look of an elegant hotel.
Even though pathogenic microorganisms
have been isolated from the surfaces of cloth
chairs, no epidemiologic evidence suggests
that general patient-care areas with cloth furniture
pose increased risks of health-care–associated
infection compared with areas that
contain hard-surfaced furniture.
Allergens (e.g., dog and cat dander)
have been detected in or on cloth furniture in clinics and elsewhere in hospitals in
concentrations higher than those found on
bed linens. These allergens presumably are
transferred from the clothing of visitors.
Researchers have therefore suggested that
cloth chairs should be vacuumed regularly
to keep the dust and allergen levels to a
minimum.
This recommendation, however, has
generated concerns that aerosols created
from vacuuming could place immunocompromised
patients or patients with
preexisting lung disease (e.g., asthma)
at risk for development of health-careassociated,
environmental airborne disease.
Recovering worn, upholstered
furniture (especially the seat cushion)
with covers that are easily cleaned (e.g.,
vinyl), or replacing the item is prudent;
minimizing the use of upholstered furniture
and furnishings in any patient
care areas where immunosuppressed patients
are located reduces the likelihood
of disease. ❑
Source: “Guidelines for Environmental
Infection Control in Health-Care Facilities:
Recommendations of CDC and
the Healthcare Infection Control Practices
Advisory Committee (HICPAC).”
