Clostridium difficile - a dangerous and formidable foe
By: Peter J Sheldon, Vice President of Operations for Coverall Cleaning Concepts
Clostridium difficile is a frequently nosocomially transmitted bacteria causing illness and even death in many residential health, long term care and hospital environments around the world today. The source of the bacterial illness is fecal spores from the waste of patients that are on antibiotic medication.
Common routes of transmission result from improper hand washing and glove changing procedures as well as poor cross contamination cleaning practices. The spores are shed from the fecal matter onto surfaces such as toilets and can provide a source which may be transmitted by a nurse touching the toilet and visiting the next patient without changing gloves or thoroughly washing their hands.
Cleaning technicians utilising cleaning cloths and tools in multiple areas can also lead to cross contamination transmission. The critical nature of this growing exposure problem creates the immediate need to implement an effective defence against this killer beginning with an active and enforced soap and water hand washing and glove changing protocol. Without these procedures in place and strictly enforced any other efforts will be futile.
C. diff itself is a spore forming bacteria, which makes it particularly challenging to kill. Spores by their very nature are designed to protect and provide the vehicle of transmission for the organism. Traditional quaternary and even phenolic disinfectants which are Environmental Protection Agency approved for tuburculocidal applications are not effective against this pathogen's defence system. To further confuse matters there have been various chemical manufacturers making C. diff kill claims backed up by EPA registration. Yet, there is much more to the story. Essentially, the kill claims they list are applicable only for the bacteria in its vegetative state and once it has entered its spore forming stage these products are equally ineffective.
For an answer most facilities managers and contractors have turned to the Centers for Disease Control and Prevention. According to the CDC, bleach along with mechanical methods of removal seems to be the current best method of reducing the spread of this dangerous pathogen.
Killing the bacteria in its vegetative state and the physical removal of the spores is separate and distinct in a proper cleaning regimen. Rather than a quick damp wipe with a disinfectant, a cleaning technician must ensure a surface is thoroughly wet, left to dwell and then flushed for complete removal of all soil along with bacterial spores.
Many facilities that have been affected by outbreaks are conducting complete terminal cleaning procedures to remove any spores lingering on surfaces. At our organisation we follow the lead of the CDC and chemistry experts like Procter & Gamble. At Coverall we recommend using P&G Professional Comet with bleach, which exceeds the EPA requirement for bleach disinfection. We then recommend flooding each surface with a bleach and water mixture and then removal of the remaining liquid either through a drain or through the use of a wet vacuum procedure. We also recommend implementing a strict programme of color coded micro fiber cleaning to eliminate cross contamination and to enhance mechanical soil and material removal.
Cleaning processes centered on complete soil removal currently represent our best line of defence. To that end we also recommend another soil removal cleaning process option involving the use of 'no touch' cleaning technology which has been developed and perfected by another one of Coverall's impact partners at Kaivac in Hamilton, Ohio. Essentially Kaivac machines provide the ability to apply a low pressure stream of water and disinfectant to surfaces, force all soil and material to the floor with a high pressure rinse and then remove it though the use of a wet vacuum, all contained in one simple to use package. In the right environment the Kaivac technology is perfect for soil and spore removal.
Also, implementing a colour coding system with all cleaning tools will help limit cross contamination. This is a simple but critical step to control infection. It reduces the risk of cross contamination by ensuring that the same tool is not used on multiple surfaces.
Similarly, utilising advanced soil removal implements such as microfibre technology in all cleaning cloths and mopping programs is 99% more effective at soil and matter retention than traditional cleaning tools. And using flat mopping technology - with its super absorbent fabric to trap germs and contain them in their place of origin - increases efficiency, improves soil removal and further eliminates cross-contamination.
Unfortunately, science and technology have yet to provide healthcare facilities with the ability to effectively eliminate the growth of C-diff spores from their inception. Our best chance at winning this battle is to kill the organism in its vegetative state and remove the lingering spores from surfaces through proper containment and removal techniques.
Until technology provides us with effective chemistry to deal with the C. diff spores, every healthcare facility and the contractor providing cleaning services to it must have an effective an enforceable programme of hand washing, glove changing and cleaning methods using proper disinfectants to kill the organism in its vegetative state followed by the mechanical removal of soils and lingering spores. This is our current best chance at winning this battle and defeating this formidable foe which is claiming more and more lives each day.
Ed: Peter Sheldon Sr., CBSE, brings over 17 years of experience in the Building Services Contracting industry to his position as Vice President of Operations of Coverall Cleaning Concepts. He has been a key contributor to the Company's expansion into the Healthcare market and has developed many of the processes that make the company's dedicated Health-Based Cleaning System unique to Coverall Cleaning Concepts.
T: 1-800-537-3371
10th July 2008