How to clean, disinfect while preventing harmful exposure: 5 things to know

The Cleaning and Disinfecting in Healthcare Working Group of the National Institute for Occupational Safety and Health, comprised of more than 40 members from four countries, has reviewed current knowledge of healthcare-associated infections and developed an integrated framework to minimize harmful cleaning and disinfecting exposures to healthcare workers without reducing the effectiveness of infection prevention.

The study reports a growing a demand for effective cleaning and disinfecting strategies, but also increasing evidence that exposure to cleaners and disinfectants can result in acute and chronic health effects for healthcare workers. Here are five things to know about the report.

1. There are two categories that represent gaps in basic knowledge and practice that have prevented an integrated approach.

• How effective environmental surface cleaning and disinfecting is in reducing the rate of infectious diseases and colonization in healthcare workers and patients.
• The adverse health impact of cleaning and disinfecting agents and practices on healthcare workers and patients.

2. Potentially harmful occupational exposures from cleaning and disinfecting, according to the study, are a function of the following factors.

• The chemical characteristics of the cleaning or disinfecting product.
• The physical characteristics, such as aerosols or liquids.
• The methods of product application, such as spraying or wiping.
• The characteristics of the structural environment, including the size of the room and the quality of ventilation.

3. Further research is needed specifically in the following areas to better assess the hazards of cleaning and disinfecting and the effectiveness of safer alternatives.

• Methods to assess toxicology risk for respiratory and dermatologic illness.
• Assessment of application methods and work practices as well as scrutiny of the specific products being used.
• The development of practical exposure measurement methods, which is both time- and resource-intensive and therefore infeasible for health practitioners to routinely quantify.

4. Green cleaning and newer technologies for cleaning and disinfecting have the potential to reduce exposure and may be effective for infection prevention, however the study deems the following steps necessary for proper integration.

• Standardized criteria to define green cleaning that include the effect on human health and the environment.
• Although some green cleaning products may prevent fewer health hazards and be more environmentally preferable, proper evaluation of green cleaning products on health is lacking.
• Research is needed on the effectiveness of green cleaning infection prevention in all types of healthcare settings.
• There is a need for guidance regarding the feasibility and effectiveness for infection prevention and safety of nonchemical alternatives for cleaning and disinfecting.
• When planning renovations or new construction, prevention through design should be implemented proactively to minimize hazards.

5. The following improved guidance is needed to assist healthcare institutions in selecting from a range of effective and safe products and practices.

• There is a need to identify best cleaning and disinfecting practices for each area in a healthcare facility.
• There is a need for both improved guidance related to cleaning and disinfecting floors in healthcare settings and additional research on floor surface materials that clean well and do not provide reservoirs for microbes or promote slips.
• Further evaluation is needed to determine the frequency with which cleaning and disinfecting should be performed.
• Personal protective equipment should be selected based on the type of cleaning products, technologies and methods being used to clean and disinfect. This is challenging because the products used are complex mixtures.

More articles about infection control:

Just because you are using a disinfectant, doesn't mean you are disinfecting: The business case for improving infection prevention
Hidden risk of hospital construction projects: HAIs
7 sins of suboptimal disinfecting and how to mitigate them


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