Where are the germs in long-term care?

Healthcare environments including long-term care facilities are notorious harborers of bacteria (MRSA, VRE, C. difficile, acinetobacter), viruses (influenza, RSV, rotavirus, norovirus) and fungi. While visitors and staff can bring microorganisms into eldercare facilities, sick residents also shed microorganisms into the healthcare environment, making good cleaning and disinfection of all areas in the LTC facility vital. This is true not only for obvious sources of germs like toilets or soiled textiles, but for places one might not consider hotbeds of infection.

It’s easy to see how a cycle of infection perpetuates itself. Consider all of the things that come into daily contact with the hands of a healthcare worker. Nurses or other staff continually touch not only residents but many potentially contaminated surfaces around the resident during the course of care (bedside tables, call buttons, bed rails, faucets, door handles and many more). Those hands in turn can quickly contaminate other surfaces and equipment, such as nurse station desktops, countertops, computer keyboards, hard charts, faucets and telephones. Studies from the Centers for Disease Control and Prevention (CDC) and other sources have proved that bacteria, viruses and fungi are routinely transferred directly from contaminated surfaces to patients or residents. But studies also show that simple decontamination can stop the colonization and spread of bacteria, viruses and fungi and lower a facility’s rates of infection.

STOPPING THE SPREAD

Research from the CDC reaffirms the common-sense notion that simple cleaning disrupts the cycle of contamination and infection. It bears repeating that—especially in cold and flu season—“high-touch” surfaces require particularly close attention. Daily housekeeping in LTC facilities should include not only obvious reservoirs of micro-organisms such bathrooms and linens, but all horizontal and high-touch surfaces outside resident rooms and other care areas. While nurses and aides will clean visibly soiled surfaces, too many germy spots go uncleaned.

Environmental services consultant, author and trainer William R. Griffin has seen examples of both effective and ineffective healthcare housekeeping practices and says clear standards for cleanliness must come from the top. “Somebody needs to determine what exactly is going to be cleaned, as well as when and how it will be done,” he says. Specific plans and procedures are essential, including frequency of cleaning, and what products and tools are to be used. “Staff should be shown how to clean the desk, the phone, computer or floor; how to dump trash, et cetera. The higher the quality of the institution, the more of these types of [directives] you will find in place,” he says.

Again, consider all resident care and administrative areas with which staff members come into contact in a given day. While equipment that comes into contact with a patient has its own strict set of cleaning and disinfecting directives, a basic checklist for any facility’s environmental services department should include daily cleaning of all telephones, computer keyboards and touch screens, as well as elevator buttons, drinking fountains, light switches, doorknobs and other surfaces.

Nurses and aides can and should do their part as well. “Keeping a pop-up container of disinfectant wipes right next to computers and phones can really help,” says Kim Strelczyk, RN, MSN, ACNS-BC, CIC, president of Specialists in Infection Prevention & Control, LLC and author of several academic papers on infection prevention. “If the container is right there in plain sight, the staff will use them.”

Another overlooked source of microorganisms: computers. Because of the dust collected in and around computer towers and the fans used to cool them, fungal spores become aerosolized, posing a pulmonary hazard for many LTC residents. Regular removal of dust from these places is therefore essential.

Food storage is another easily overlooked source of contaminants. “Refrigerators can breed germs if they’re not cleaned regularly. The same goes for coffeepots and microwaves, anywhere there is food storage or preparation,” says Strelczyk. Ice machines and water spigots are also places mold and bacteria can grow and go on to infect residents and staff.

CLEANING PRODUCTS

In recent years, there has been some movement away from high-level disinfectants and toward simple cleaning with water, detergents and friction—also known as good old fashioned elbow grease. The CDC endorses this practice for non-patient areas where disinfection is not required. When and where disinfection is called for, there is also a push toward gentler products where and when they will suffice. Quaternary ammonium compounds are losing favor to accelerated hydrogen peroxide products for disinfection.While just as affective as harsher chemicals, they leave behind no residue and release no volatile organic compounds, and are thus safer. Peroxide products are also popular now in healthcare settings because peroxide is the only agent, besides bleach, that works against C. difficile. The downside: “Although peroxide products are easier on the environment and equipment and surfaces than other cleaners, they are more expensive, which can be a hard sell to your administrators,” says Strelczyk.

There is also a push toward environmentally friendly products. Griffin says, “General purpose cleaners remain the standard, but we are definitely seeing a trend toward ‘green’ or sustainable products. For cleaning, they have so far proven to be just as effective and price-competitive, so it’s difficult not to make a case for them.” For disinfecting, however, Strelczyk cautions, “There’s no such thing as a ‘green’ disinfectant, and don’t let anyone tell you otherwise. They simply don’t exist.”

Finally, Strelczyk says, the best way to prevent infections in LTC settings is to pay attention to the basics: vaccinating staff against influenza and practicing good hand hygiene. “These are the most obvious precautions,” she says, “but they sometimes get missed.”

Gina LaVecchia Ragone is a freelance writer based in Cleveland, Ohio.

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