The scrutiny applied to hospital hygiene practices sometimes causes healthcare professionals to overlook the basics of healthcare hygiene. Everyday surfaces and non-invasive equipment require frequent and targeted sterilisation but they are often disregarded because of the necessary attention required to equipment that is more obviously contaminated. How do hospitals tackle this disparity and who is responsible for ensuring all surfaces and equipment are appropriately sterilised?
According to the Nursing Times, several studies have discovered pathogens on a wide variety of everyday surfaces: ‘door handles (Barker et al, 2004; Oie et al, 2002), computer keyboards (Schulz et al, 2003), soap dispensers (Griffith et al, 2000); Brooks et al, 2002), and sink taps (French et al, 2004). These surfaces are found in most buildings, offices in particular. Offices are infamous for their pathogen spreading abilities, a topic we have previously discussed in our The Germy Grind blog, so it is not news that these surfaces spread infection. Furthermore, these ubiquitous surfaces tend to be the most frequently touched, which reasserts the obviousness of their contamination potential. Why then, are they so often overlooked in hospitals, arguably the most sterile of environments? It seems that the health focus of hospitals and the ways in which they differ from other offices and large sites, has led to the overlooking of common surfaces.
Hospital cleaning staff should, therefore, pay more attention to those everyday surfaces and those in managerial roles should ensure, when outsourcing to private cleaning companies, that those members of staff are properly trained in healthcare hygiene. Imagine: an administrator works on a keyboard that has not been sterilised for a few days. They then hand a doctor a file. The doctor then opens the door to a room and has physical contact with a vulnerable patient. It is easy to see how pathogens can spread. Cleaning should thus be more frequent on those office surfaces and simple practices should not be disregarded.
In a similar fashion to the way in which common surfaces are overlooked within the hospital environment, non-invasive hospital equipment is less regularly sterilised than their invasive counterparts. The Nursing Times again reports that a number of studies demonstrated ‘pathogens can be recovered from a range of non-invasive clinical equipment, including stethoscopes, lifting equipment and ultrasound probes’. They recognise that whilst ‘none of these studies demonstrated a link between contamination and infection’ but clinical equipment ‘can act as a vehicle by which microorganisms are transferred between patients, which may result in infection’. So, it is critical that hospital staff are aware of the instruments they use and do not assume that the contamination potential of non-invasive equipment is negligible.
This overlooking of commonly touched surface and non-invasive equipment calls for an acknowledgment of basic cleaning practices in hospital environments. The blog post by EOScu, ‘Cleaning House Part 2: Know Your Household Pathogen’, actually refers to the standard, yet necessary, attention given to pathogen identification in hospital rooms.
‘Hospitals clean with great attention to what organisms caused illness within that patient room. The pathogen could be a virus, a bacteria, a fungus, or other microorganism. Each pathogen has its own unique characteristics that dictate the kind of cleanser needed, the frequency of cleaning required, and many other factors.’ [sic]
So, who requires this level of healthcare hygiene knowledge? There is some disagreement regarding who is responsible for ensuring that the hospital environment and equipment is suitably sterile. The Deb Group advises a general program.
‘There should be a continuing program for staff training. This program should stress personal hygiene, the importance of frequent and careful washing of hands, and cleaning methods (e.g., sequence of rooms, correct use of equipment, dilution of cleaning chemicals and disinfectants, etc.)’
Whilst all staff members should know the basics of hospital hygiene practices, training programs should be tailored to the individual staff roles so that staff fully understand the equipment and environments they use, as well as the likely pathogens present in these circumstances. The Nursing Times highlights the importance of tailored staff awareness.
‘Expectations that cleaners will be able to do everything are unrealistic, so it is important that all health-care staff participate in keeping the environment clean and tidy. While routine general cleaning should be undertaken by trained cleaning staff, nurses and other health-care workers should familiarise themselves with the whereabouts of equipment should they need to use it. It is also important that staff are trained how to clean and how to use cleaning equipment’.
Anyone working in the healthcare industry should be well educated in healthcare hygiene practices and updated as these practices change and more research is completed. Whilst all staff should have this general knowledge regarding cleaning best practices, they should also receive training on the cleaning and maintenance of the specific environments or equipment most used by them, at least to the extent that they should recognise the need for further sterilisation or tool replacement. Tailored training programs should not only familiarise staff with the equipment they use, but should outline the necessary products and cleaning supplies needed to combat the most likely present pathogens.