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Preventing Gastroenteritis Outbreaks

Multilevel approaches to cleaning and disinfection, using solutions such as AHP, contribute to better health outcomes for hospital patients, aged care residents, staff and visitors.Norovirus image

Gastroenteritis can be costly in terms of reputation, productivity, staff health and patient outcomes. When it comes to infection, prevention is better than cure.

Contamination of high-touch environmental surfaces (eg, bedside rails) and shared clinical equipment (eg, blood pressure cuff) plays a significant role in transmission of pathogens in hospitals1,2,3. Pathogens are shed by colonised residents onto mattresses, bedrails, furniture and other surfaces they have touched. They are then picked up on workers’ and visitors’ hands and transferred to others and the infection cycle continues. Despite our best intentions, we simply aren’t cleaning well enough. A bedrail may be touched around 200 times daily by different people. Yet it is cleaned only once. And in many cases, probably not at all.

The cost of labour and the cost of infection should form part of a facility’s calculation when evaluating the selection of cleaning products. The buy price of a particular product does not necessarily reflect its long term value as a safe, effective cleaner or disinfectant.

Neutral detergents should be the mainstay of general facility cleaning, together with a sound floorcare regimen. Microfibre is a great adjunct because it removes significant bacterial load from surfaces and effectively eliminates worker’s compensation events related to cleaning.

Disinfectants are important for high-touch surfaces The main chemistry groups are sodium hypochlorite (chlorine bleach), benzalkonium chloride (quaternary ammonium), and accelerated hydrogen peroxide (AHP).

Chlorine bleach is ideal for drains and wet areas but its irritancy profile makes prone to over-dilution and ineffective application. Quaternary ammonium is low irritant but it builds up over time and does not degrade.

AHP is powerful and fast acting. AHP is also non-toxic, non-irritant, and breaks down to just oxygen and water. These reasons explain the emergence of AHP as a popular choice for healthcare disinfection in recent years.

There are practical ways to prevent the spread of infection that do not involve cleaning at all. Norovirus in particular is very small and can float suspended in the air for hours.  Always close toilet seats before flushing to prevent clouds of norovirus spreading around the facility.

According to Bonifait (2015), a healthcare worker could inhale up to 60 copies of human norovirus during a 5-minute stay in the room of a symptomatic patient. For some individuals, this quantity could be sufficient to cause the disease. Rotate staff if necessary so that long tasks like dressings are not interrupted. Educate visitors.

The outbreaks of gastroenteritis in our healthcare facilities would be far less frequent if attention to detail is incorporated to environmental cleaning and disinfection, as it is done in Food Safety.

1Yingying Hong PhD a, Peter J. Teska MBA b, Haley F. Oliver PhD, Contents lists Effects of contact time and concentration on bactericidal efficacy of 3 disinfectants on hard nonporous surfaces. American Journal of Infection Control 45 (2017) 1284-5.

2Weber DJ, Rutala WA, Miller MB, Huslage K, Sickbert-Bennett E. Role of hospital surfaces in the transmission of emerging health care associated pathogens: norovirus, Clostridium difficile, and Acinetobacter species. Am J Infect Control 2010;38(Suppl):S25-33.

3Han JH, Sullivan N, Leas BF, Pegues DA, Kaczmarek JL, Umscheid CA. Cleaning hospital room surfaces to prevent health care-associated infections. Ann Intern Med 2015;163:598-607.