How to properly clean reusable protective equipment

Clean medical inhaler
Photo by Mockup Graphics on Unsplash

When we talk about disinfection, we talk about the prevention and control of infection in the environment. Therefore, equipment used for respiratory therapy is considered semi-critical. The equipment must then be cleaned and disinfected properly between patients. The WHO gives us the proper maintenance of respiratory equipment in procedures to follow. The procedures are checklists in steps of a cycle. Let’s explore all the summarized steps up to the cycle finish. And yes, the cleaning step is before the disinfection step!

Checklists for care, cleaning, disinfection and sterilization of respiratory devices

1. Perform hand hygiene

The title and image say it all

2. Don appropriate personal protective equipment

The personal protective equipment to be worn during the disinfectant preparation includes surgical mask/respirator, googles/face shield, long-sleeved fluid resistant gown/gown plus apron, rubber gloves and boots or closed work shoes.

3. Wash with detergent and rinse with clean water

The external device surfaces must be wiped with a damp cloth or disposable wipe that is soaked in detergent and clean water. Then, remaining detergent residue must be wiped off with a dry lint-free cloth. A mechanical action (scrubbing/brushing) should be used to remove visible dirt deposits and calcifications.

4. Disinfect

4a. Physical disinfection – Heat for heat resistant equipement (steam/hot-water)

A high-level of physical disinfection can be achieved with steam (e.g. autoclaving at lower temperature) or hot-water at least 121°C. This is an inexpensive and effective method for sterilization or high-level disinfection.

4b. Chemical disinfection for plastic plus other parts that can be damaged by heat

b) If the disinfection needs to be with chemicals solutions, it should be performed in a well-ventilated area and away from patients. Use a disposable wipe or a fresh cloth that is soaked in a compatible disinfectant. Hydrogen peroxide 0.5% or ethanol 70-90%. Wipe from top to bottom and avoid contact with electrical connectors.

5. Dry equipment / Rinse equipment

a) Physical equipment often has a drying feature within the machine (e.g. washer, pasteurizer or autoclave). Following pasteurization, the wet equipment is typically dried in a hot-air drying cabinet or air-dried. Make sure to carefully inspect and ensure that no water is left in the equipment.

b) If a chemical solution was used for disinfection, rinse the equipment with sterile or clean water (i.e. water boiled for 5 mins and cooled down). It is preferred to use sterile water for rinsing off residual liquid chemical disinfectant from the respiratory device.

6. Store equipment in closed packages

Last step. Title says it all.

This was a summary of the Care, cleaning and disinfection of respiratory equipment in sterile services department’s article by World Health Organization.

This article is a free translation of WHO’s article.

Source:
World Health Organization
– https://www.who.int/publications/m/item/care-cleaning-and-disinfection-of-respiratory-equipment-in-sterile-services-department
– https://www.who.int/images/default-source/health-topics/coronavirus/care-cleaning-disinfection-of-respiratory-equipment.tmb-479v.png?sfvrsn=14530f0b_1

What’s best? To clean or to disinfect?

When it comes to cleanliness, some people are mixing technical terms leading to ambiguity. It is like mixing chemicals together: That is not a good idea! To keep it simple, we’ll just give a real definition.

Deteriorated surfaces definition

A deteriorated surface shows wear off sign often caused by time or misuse.

Deterioration is one of three elements of impairment of property, the others being functional obsolescence (or obsolescence) and economic obsolescence.

surfaces-vetustes definition

Safe surfaces definition

Safe surface means that it is safe to health. Such surface is healthy or good for health often because of risk management. In the food industry, this is why we often refer to it as food safety.
Safe is also synonymous to hygienic !

corridor-hopital-lalema definition

Disinfected surfaces definition

Disinfection is a voluntary momentary removal operation of certain bacteria (if it comes to “all germs” we refer more to sterilization), so as to stop or prevent infection or the risk of infection or superinfection by pathogenic or undesirable microorganisms or viruses.

For example:

  • To sanitize a surface eliminates 99.9% of microorganisms (This is a 1,000 X reduction)
  • To disinfect a surface removes 99.999% of microorganisms (This is a 100,000 X reduction)
  • To sterilize a surface or instrument removes 99.9999% of microorganisms (This is a 1,000,000 X reduction)

Obviously, “momentarily” is a key fator because the surface will be contaminated again as soon a a contaminant will enter in contact with the it. That’s why some disinfectants have a residual effect that prolongs the action of disinfectant for a certain time.

biofilm-1024x767 definition

To learn more

Visit l’Academy Lalema for a whole lot of online training in sanitation and surface disenfection..

Sources: Larousse, Wikipedia, Linternaute

GPT3: An AI generated blog post about disinfection

GPT3 AI generated image : “A janitor cart in a hospital patient room”

GPT3 Input

gpt3> write a 250 words article about how hard surface disinfectant will become more essential in the future.

GPT3 Output

As the world becomes more populated and the spread of disease becomes more prevalent, the need for hard surface disinfectants will become more essential. Hard surface disinfectants are a key part of preventing the spread of disease, and as the world becomes more connected, the need for these products will only increase.


There are a number of factors that contribute to the spread of disease, and hard surface disinfectants are an important part of preventing the spread of infection. The main factor that contributes to the spread of disease is contact with contaminated surfaces. Hard surface disinfectants kill the bacteria and viruses that are present on surfaces, preventing the spread of infection.


Another factor that contributes to the spread of disease is the presence of food and water sources that are contaminated with bacteria and viruses. Hard surface disinfectants can also be used to clean these contaminated surfaces, preventing the spread of disease.


In addition to these two factors, there are a number of other factors that contribute to the spread of disease. These include the presence of sick people in close proximity to others, the sharing of contaminated items, and the exposure to contaminated air. Hard surface disinfectants can also be used to clean these contaminated surfaces, preventing the spread of disease.


The need for hard surface disinfectants will only increase as the world becomes more populated and the spread of disease becomes more prevalent. Hard surface disinfectants are a key part of preventing the spread of disease, and as the world becomes more connected, the need for these products will only increase.

Now what?

Visit our disinfectant product category

Disposable Microfiber, The First Step In The Disinfection Process

Disposable microfiber cloth system

In the past, we have often lauded the advantage of microfiber for cleaning. This is repeated today, but with the use of a disposable microfiber as the first step in the disinfection process. Of course, we are talking about cleaning first, then disinfecting. However, the products highlighted in this article are compatible with common disinfectants. These products are Rubbermaid‘s Hygen single-use microfiber swabs and wipes.

WHAT IS A MICROFIBER AGAIN?

Microfiber is a synthetic textile fiber (polyester, polyamide or a mixture) that is very fine and light with a denomination which is less than one decitex. A microfiber (filament) is characterised by its small diameter, the nature of its fiber and its structure. Therefore, not all microfibers are the same or of the same quality. This revolutionary material has quickly become a must in the hygiene, health and automotive sectors. To know more about it, read this article, Spotlight on microfiber!

THE HYGEN LINE FROM RUBBERMAID

The Hygen line was designed specifically for the healthcare industry. It is an excellent option for any facility looking to improve its cleaning efficiency, especially during the COVID-19 period. The HYGEN disposable microfiber pad and wipe contribute to the area cleaning as the first step in the disinfection process.

Microfiber pads and wipes

Disposable Microfiber Pads HYGEN
  • They eliminate 99.7% or more of the viruses and bacteria tested to help improve cleaning efficiency. And this was tested with water only
  • Help reduce cross-contamination with disposable pads/wipes that encourage cleaning with new pads/wipes for each area or task
Disposable Microfiber Wipes HYGEN
  • They are compatible with common disinfectants, including Quat (does not bind), bleach and hydrogen peroxide
  • Built-in scrub strips are made of polyester to help effectively remove dirt

DEMONSTRATION OF THE DISPOSABLE MICROFIBER

Here’s a video from Rubbermaid Commercial Products. They demonstrated the benefit of their Hygen disposable microfiber wipe compared to a paper towel and a disinfectant wipe. They use a fluorescent marker to demonstrate and verify cleaning practices.

Thus, using this disposable microfiber with a disinfectant provides an added layer of assurance. They will clean and disinfect well your floors and surfaces by combining the microbe removal power of the microfiber with the disinfectant’s killing power.

The proper maintenance of respiratory equipment

Clean medical inhaler
Photo by Mockup Graphics on Unsplash

When we talk about disinfection, we talk about the prevention and control of infection in the environment. Therefore, equipment used for respiratory therapy is considered semi-critical. The equipment must then be cleaned and disinfected properly between patients. The WHO gives us the proper maintenance of respiratory equipment in procedures to follow. The procedures are checklists in steps of a cycle. Let’s explore all the summarized steps up to the cycle finish. And yes, the cleaning step is before the disinfection step!

Checklists for care, cleaning, disinfection and sterilization of respiratory devices

1. Perform hand hygiene

The title and image say it all

2. Don appropriate personal protective equipment

The personal protective equipment to be worn during the disinfectant preparation includes surgical mask/respirator, googles/face shield, long-sleeved fluid resistant gown/gown plus apron, rubber gloves and boots or closed work shoes.

3. Wash with detergent and rinse with clean water

The external device surfaces must be wiped with a damp cloth or disposable wipe that is soaked in detergent and clean water. Then, remaining detergent residue must be wiped off with a dry lint-free cloth. A mechanical action (scrubbing/brushing) should be used to remove visible dirt deposits and calcifications.

4. Disinfect

4a. Physical disinfection – Heat for heat resistant equipement (steam/hot-water)

A high-level of physical disinfection can be achieved with steam (e.g. autoclaving at lower temperature) or hot-water at least 121°C. This is an inexpensive and effective method for sterilization or high-level disinfection.

4b. Chemical disinfection for plastic plus other parts that can be damaged by heat

b) If the disinfection needs to be with chemicals solutions, it should be performed in a well-ventilated area and away from patients. Use a disposable wipe or a fresh cloth that is soaked in a compatible disinfectant. Hydrogen peroxide 0.5% or ethanol 70-90%. Wipe from top to bottom and avoid contact with electrical connectors.

5. Dry equipment / Rinse equipment

a) Physical equipment often has a drying feature within the machine (e.g. washer, pasteurizer or autoclave). Following pasteurization, the wet equipment is typically dried in a hot-air drying cabinet or air-dried. Make sure to carefully inspect and ensure that no water is left in the equipment.

b) If a chemical solution was used for disinfection, rinse the equipment with sterile or clean water (i.e. water boiled for 5 mins and cooled down). It is preferred to use sterile water for rinsing off residual liquid chemical disinfectant from the respiratory device.

6. Store equipment in closed packages

Last step. Title says it all.

This was a summary of the Care, cleaning and disinfection of respiratory equipment in sterile services department’s article by World Health Organization.

This article is a free translation of WHO’s article.

Source:
World Health Organization
– https://www.who.int/publications/m/item/care-cleaning-and-disinfection-of-respiratory-equipment-in-sterile-services-department
– https://www.who.int/images/default-source/health-topics/coronavirus/care-cleaning-disinfection-of-respiratory-equipment.tmb-479v.png?sfvrsn=14530f0b_1

To clean or to disinfect? a simple definition.

When it comes to cleanliness, some people are mixing technical terms leading to ambiguity. It is like mixing chemicals together: That is not a good idea! To keep it simple, we’ll just give a real definition.

Deteriorated surfaces definition

A deteriorated surface shows wear off sign often caused by time or misuse.

Deterioration is one of three elements of impairment of property, the others being functional obsolescence (or obsolescence) and economic obsolescence.

surfaces-vetustes definition

Safe surfaces definition

Safe surface means that it is safe to health. Such surface is healthy or good for health often because of risk management. In the food industry, this is why we often refer to it as food safety.
Safe is also synonymous to hygienic !

corridor-hopital-lalema definition

Disinfected surfaces definition

Disinfection is a voluntary momentary removal operation of certain bacteria (if it comes to “all germs” we refer more to sterilization), so as to stop or prevent infection or the risk of infection or superinfection by pathogenic or undesirable microorganisms or viruses.

For example:

  • To sanitize a surface eliminates 99.9% of microorganisms (This is a 1,000 X reduction)
  • To disinfect a surface removes 99.999% of microorganisms (This is a 100,000 X reduction)
  • To sterilize a surface or instrument removes 99.9999% of microorganisms (This is a 1,000,000 X reduction)

Obviously, “momentarily” is a key fator because the surface will be contaminated again as soon a a contaminant will enter in contact with the it. That’s why some disinfectants have a residual effect that prolongs the action of disinfectant for a certain time.

biofilm-1024x767 definition

To learn more

Visit l’Academy Lalema for a whole lot of online training in sanitation and surface disenfection..

Sources: Larousse, Wikipedia, Linternaute

COVID-19 generated hygiene and sanitation costs of $ 12,604.22 per hospitalization in 2020-2021

COVID-19 generated hygiene and sanitation costs of $ 12,604.22 per hospitalization in 2020-2021.

A BIG THANK-YOU

Great good for us, because all this work in hygiene and sanitation, with working conditions not always easy, is an integral part of our health system. It’s a whole.

Thank you for this great job to all the teams who have worked and who are still working hard to keep the spaces clean and well disinfected in our healthcare facilities.

2020-2021 FINANCIAL ANALYSIS

According to public financial data issued by the Ministry of Health and Social Services, between April 1, 2020 and March 31, 2021, assuming a “normal” increase of 6% based on the 3 previous years, the extraordinary costs associated with hygiene and sanitation increased by + 49%. As this unpredictable surplus was not budgeted a priori, it was considered non-recurring and was entered as an “adjustment” in the vast majority of health establishments.

The main if not the only reason for this discrepancy is of course the surpluses required from the hygiene and sanitation teams due to COVID-19, but also the costs generated by the numerous ex situ screening and vaccination clinics.

Budget 2020-2021 - Hygiène et salubrité en pandémie de COVID-19

2020-2021 HOSPITALIZATION ANALYSIS DUE TO COVID-19

According to INSPQ data, between April 1, 2020 and March 31, 2021, there were 20,628 hospital admissions. Of this number 17,262 hospitalizations are said to be outside intensive care and 3,366 hospitalizations are in intensive care.

COSTS GENERATED BY COVID-19 IN HYGIENE AND HEALTH

So in 2020-2021, we can estimate that the budget surpluses are in the order of $ 260 million. A lot of money you will tell me? Yes and no. We are talking about an addition of about 3,000 hygiene and sanitation workers who cover a total area of ​​over 8.3 million square meters! This surplus is distributed as follows:

COST OF HYGIENE AND SANITATION PER HOSPITALIZATION IN THE COVID-19 PANDEMIC

By taking the budget surplus ($ 260M) by hospitalizations (20,628), we arrive at the sum of $ 12,604.22. Of course, this figure includes all direct and indirect expenses related to hygiene and sanitation such as supervision, maintenance of public places, cleaning and disinfection of places associated with prevention such as screening and vaccination sites. .

SOURCES

INSPQ Data on COVID 19

MSSS 2020-2021 Financial Data

Cleaning in Hospitals (part 4)

Work_Organization

How can proper work organization contribute to the cleanliness of a hospital? How to be in the right place with the right equipment? Here are the questions we are going to answer in this post of the Cleaning in Hospitals series.

Evaluation of production needs

First, we need to assess the needs in hygiene and cleanliness. In order to do this, a standard evaluation is preferable but it needs to be adjusted based on the type of place, units, and traffic.

It is during the evaluation of needs that the hygiene and cleanliness estimate (see Cleaning in Hospitals part 2) is going to be determined. All daily, weekly, monthly, and annual tasks have to be considered.

Usually, the results are presented by production yields (square meters/hour) or FTE (Full Time Equivalent).

How to reduce time waste

How to measure productivity in a context where an important aspect of the task is moving? Actually, hygiene and cleanliness departments are almost always in the basement, whereas most of their work happens on the floors!

We increase productivity by reducing traveling.

It is for this reason that the cleaning cart needs to be as complete as possible and the water sources or janitor’s closets well stocked with supplies (i.e.: paper products or waste bags), equipment, and sanitary products.
Moreover, it is important to remember that a good entrance carpet can greatly reduce dirt.

Have a successful day!

Here are a few hints on how to have a successful day:

  • Establish a sequence of actions to perform in a day/week/month
  • Define a sequential order of rooms
  • Integrate linked and periodical tasks (monthly)
  • Make sure to have time gaps to focus on periodical tasks (dusting of high surfaces, polishing, etc.)
  • Minimize traveling
  • Work by space and not by task
  • Distribute tasks equitably
  • One look is worth a thousand words: choose a colorful plan together with some graphics instead of a list of tasks on a word file!

This is all for this series of posts on Cleaning in Hospitals! Don’t forget that we’re always here to help, don’t hesitate to book an appointment by calling 514.645.2753 or subscribe to one of our training seminars. I really hope that you liked this serie of posts!

References:
Hygiène et salubrité en milieux de soins – Démarche pour le développement de stratégies d’entretien des surfaces, MSSS, 2010, 52 pages.

Cleaning in Hospitals (part 3)

cleaning-hospital-staff

The hygiene and cleanliness staff represents a key element in the fight against infections in hospital environments. Often little valued, their role in the global strategy of surface cleaning is extremely important.

The hygiene that comes from the work of the cleaning staff requires a high performance level. In order to reach that, the executing staff and the managers need to master all the different elements representing this profession.

Cleaning products and equipment are undeniably crucial in order to ensure performance during the environment asepsis of any establishment. Therefore, it is important to associate the day-to-day actions of the cleaning staff with a range of products and equipment that favor the quality of their performance.

Since several years, partly due to the devotion and the involvement of many members in the healthcare system, we take into consideration new factors:

  • Provincial training
  • Establishment of an AEP hygiene and cleanliness in healthcare environments of 630 hours now offered by many school boards
  • Provincial day of hygiene and cleanliness
  • Etc.

Having said this, the hygiene and cleanliness staff deserves our deepest gratitude. Thank you so much!

The next post is going to talk more in detail about one aspect of their profession: work organization.

Don’t miss any posts about this series, subscribe to this blog!

References:

Hygiène et salubrité en milieux de soins – Démarche pour le développement de stratégies d’entretien des surfaces, MSSS, 2010, 52 pages.

Cleaning in Hospitals (part 2)

cleaning-hospitals

Cleaning in hospitals allows reducing risks of infection among patients. This is not the only factor, of course: good personal hygiene habits such as washing hands and the use of protective equipment such as overalls, gloves, masks, or protective glasses are also important elements.

For this reason, interventions must be well coordinated in order to have a good surface maintenance plan. The manager of hygiene and cleanliness should therefore take into account:

  • The type of place associated to the level of risk
  • The tasks to perform
  • The required cleaning frequency

If well applied, a detailed estimate allows validating the cleaning performance.

The global approach is going to be determined by type of place:

  • Regular eradication (e.g.: operating rooms)
  • Keeping environmental effects as light as possible (e.g.: low infection risk such as individual office spaces)
  • Balance of microorganisms. This approach is based on the competition between good and bad microbes. The presence of good microbes guarantees less space for bad microbes to grow (e.g.: living environments)
  • Green cleaning. Approach that uses less toxic products
  • Review and improve arrangements and/or surfaces (during conception or renovation)

The next post of this series is going to talk about another key factor: the hygiene and cleanliness staff.

References:

Le nettoyage dans les hôpitaux du 21e siècle by Dr. Stephanie J. Dancer, Medical, Microbiology, Hairmyres Hospital, UK appeared on the magazine Le Nettoyage professionnel, July/August 2012.

Hygiène et salubrité en milieux de soins – Démarche pour le développement de stratégies d’entretien des surfaces, MSSS, 2010, 52 pages.

Cleaning in Hospitals (part 1)

hospital-cleaning

For a long time, cleaning has been all about the look; fresh smell and the absence of stains or dirt were the criteria to determine that a place is clean. Today, these criteria are still generally accepted in environments such as offices and classrooms.

It’s common knowledge, however, that microbes (bacteria or viruses) invisible to the human eye represent a risk for spreading infections. Take the example of the influenza virus: it can survive for up to 48 hours on a hard surface!

Without cleaning and disinfection procedures or a quality check procedure, microbes can survive in hospital environments.

Three key elements have to be considered in order to perform an infective risk analysis:

  • Is the patient carrying a disease agent? Disease agents are classified based on their spreading capacity and their virulence. The choice of a disinfectant will be based on this.
  • Do the functional activities of a sector represent a risk of spreading infections from the environment? E.g.: food service, offices, Intensive Care, etc.
  • The intensity of contact is related to the traffic and the surfaces that are more likely to be touched. E.g.: bathroom fittings.

Have you already performed an infective risk analysis? The next post is going to explain how cleaning allows reducing risks of infection among patients.

Don’t miss any posts about this series, subscribe to this blog! You just need to write your e-mail address, it’s that easy!

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References:

Le nettoyage dans les hôpitaux du 21e siècle by Dr. Stephanie J. Dancer, Medical, Microbiology, Hairmyres Hospital, UK appeared on the magazine Le Nettoyage professionnel, July/August 2012.

Hygiène et salubrité en milieux de soins – Démarche pour le développement de stratégies d’entretien des surfaces, MSSS, 2010, 52 pages.

Clean first, then disinfect

Cleaning with a microfiber cloth

Cleaning and disinfection have long been routine in any facility. Of course, the COVID-19 pandemic has further highlighted these operations since SARS-CoV-2 can persist on various surface materials for hours or days. Facilities have sought to improve these cleaning and disinfection practices. Therefore, it is imperative that this process be orderly. Therefore, this article addresses the importance of cleaning before disinfecting. Cleaning and disinfection should be a 2-step process to reduce the risk of transmission of environmental infections.

Clean first! Why?

Primum nitidare – “D’abord nettoyer (Clean First)”. It is a book that my coworker, Gaétan Lanthier, wrote in 2019. It is to say that this is not a new subject!

Centers for Disease Control and Prevention (CDC) cites: “cleaning is “the necessary first step of any sterilization or disinfection process” or, more
simply, you must clean first before you can disinfect.”

The CDC adds: “Cleaning is the necessary first step of any sterilization or disinfection process. Cleaning is a form of decontamination that renders
the environmental surface safe to handle or use by removing organic matters, salts, and visible soils, all of which interfere with microbial inactivation.”

It’s in the mechanical action (friction)

As the CDC mentions it: “The physical action of scrubbing with detergents and surfactants and rinsing with water removes large numbers of
microorganisms from surfaces.”

Studies have shown that friction or mechanical action is at the heart of cleaning. This facilitates the effective removal of dirt, debris, microbes and soiling, making a surface ready for disinfection if necessary.

It’s a matter of interference

The CDC defines cleaning as the “necessary first step” in any disinfection process for “at least two” important reasons: it removes any barrier between the disinfectant and the target pathogen, and it removes materials that could potentially inactivate the disinfectant.

In order to effectively kill pathogens, disinfectant chemicals must have direct contact with the pathogen; however, soils, dirt, and debris can coat or
protect microorganisms, essentially serving as a protective barrier between the chemical and the target.

The build-up to biofiolms

Another important reason to clean first before disinfecting has less to do with the immediate action of a disinfectant on a surface. Rather, it is in prevention of a future problem, namely the buildup to biofilms.

Biofilms are populations of microorganisms attached to a solid surface and protected by a “viscous layer”. This layer is an extracellular matrix of polysaccharides and non-cellular materials.

Biofilms can virtually form on any hard surface, from the countertop to the water pipe. They are involved in a range of infectious diseases.

What about touch-free technology?

Comac ULVC Electrostatic Sprayer for Disinfection

Although research has shown that many of these systems, from ultraviolet light (UV-C) to hydrogen peroxide vapor (HPV) to electrostatic sprayers, can reduce microbial contamination, experts caution that they should be used as a complement to standard manual cleaning and disinfection rather than as a replacement.

Organic matters, dirt and grimes are a limiting factor for UV-C technology.
A light or heavy organic load has a significant negative impact on the destructive efficiency of the devices.

In short, clean first with mechanical action (friction) to remove dirt, debris and microbes. The disinfection step is to be done when the interferences are removed by cleaning in order to kill microbes. This reduces the risk of transmission of environmental infections by keeping surfaces clean.

Loose translation of Rubbermaid TWO STEPS FOR A REASON:
THE CASE FOR CLEANING PRIOR TO DISINFECTION

https://www.rubbermaidcommercial.com/resource-center/1b113258af3968aaf3969ca67e744ff8/The_Case_for_Cleaning_Prior_to_Disinfection_White_Paper/

Sources:
https://www.cdc.gov/coronavirus/2019-ncov/community/disinfecting-building-facility.html

Surface Cleaning Methods & Products with RCP

Hygen microfiber from Rubbermaid Commercial Products
Hygen microfiber from Rubbermaid Commercial Products

The COVID-19 has led us to adopt new protocols to ensure patient and staff safety in healthcare facilities. Having said that, it is crucial to equip yourself with the right surface cleaning and disinfection products in healthcare facilities! What are the right products? How should you clean? Let’s explore them with the help from Rubbermaid Commercial Products, a world leader in the commercial cleaning industry! Of course, in these strange days, depending on the availability of some products, Lalema has suggestions as well ;)!

SURFACE CLEANING PRODUCTS

First of all, here are some products suggested by RCP for surface cleaning. Overall, most of them are available. Otherwise, we have replacements.

Recommended surface cleaning products
Recommended surface cleaning products

Hygen microfiber cloths – Rubbermaid Commercial Products’ all-purpose 16″ x 16″ HYGEN microfiber cloths remove 99.9% of the viruses and bacteria tested on surfaces.

Bowl Brush – This bowl brush has a plastic handle. The brush is made of polypropylene bristles. It is odor and stain resistant.

Toilet brush holder – This toilet brush holder is made of polypropylene. It is stain and odor resistant.

Bottle and Sprayer: Graduated bottle for inserting and spraying cleaning solutions.

As a replacement for Hygen disposable microfiber cloths and its charging tub system, we suggest this:

Dry Wipes and MYOSAN TB Kit – Kit of dry wipes and MYOSAN TB designed to disinfect and eliminate microorganisms on hard surfaces. It should inactivate the new coronavirus SARS-CoV-2, the virus that causes COVID-19.

Dry Wipes and MYOSAN TB Kit
Dry Wipes and MYOSAN TB Kit

BEST PRACTICES

Second, as expectations for cleanliness and hygiene rise, facilities must ensure that they have an established surface cleaning and disinfection process. This includes regular cleaning of high-traffic areas. Below are the best surface cleaning practices used in hospitals around the world today.

CLEANING TIPS

  1. Clean systematically, clockwise or counterclockwise – No surface is forgotten, this process saves time and is more ergonomic
  2. Go from clean to dirty – This reduces the likelihood of the spread of infections and contaminants
  3. Clean from the top to the bottom – Any dust or debris dislodged from the upper surface will naturally fall to the lower surfaces
  4. Wipe in one direction (unidirectional wiping) – Unidirectional wiping ensures that the solution is applied over the entire surface, while circular wiping re-contaminates areas
  5. Color Coding – Use single color wiping cloth for each zone. For example:
  • Red for high risk areas
  • Blue for mirrors
  • Yellow for baths and showers

8-SURFACE FOLDING METHODOLOGY

Finally, the 8-surface folding methodology! This is the 8-sided folding for microfiber cloths. It optimizes the use of the cloth while reducing the risk of cross-contamination during the cleaning process. Here are the steps:

8-SURFACE FOLDING METHODOLOGY
8-SURFACE FOLDING METHODOLOGY

8-surface folding methodology by Rubbermaid Commercial Products

  1. Start by opening a clean microfiber cloth
  2. Fold the microfiber cloth in half
  3. Fold the microfiber cloth into four pieces
  4. Clean surfaces with both sides of the cloth exposed
  5. Open the microfiber cloth once to change the sides
  6. Fold over to expose both clean cleaning surfaces
  7. Fully open the microfiber cloth when all four sides have been used
  8. Repeat steps 2 to 7 to use all eight sides

In short, these tips are only general since we could have gone deeper into the details or in further checklists. However, the importance is to set up a methodology for surface cleaning and disinfection and to be equipped with the right products. Don’t forget to wear personal safety equipment! Let’s save the subject of floor cleaning for another day!

Lalema would like to thank and salute all the staff in the healthcare facilities for their services!

Are technological devices a source of hospital-acquired infections?

Source: Air Force Medical Service

You’ve already seen on this blog just how dirty cellphones can get, but did you know that cellphones and other electronics such as tablets and laptops can also cause contamination in a healthcare setting, potentially making them a source of HAIs? Hospital staff use technology throughout their workday, whether it be to enter patient information in a computer or for personal use on their breaks. If they don’t wash their hands before and after using the device, it can become contaminated causing those workers to spread the bacteria all throughout the hospital.

According to Kelly M. Pyrek (2019),

“A casual online poll of ICT readers shows that 83 percent of survey respondents use their personal mobile technology devices within the hospital, and just 68 percent said they clean/decontaminate these devices regularly. Fifty-seven percent of respondents indicated they use a hospital-issued mobile technology device in the course of their workday; 56 percent report cleaning the device themselves, while 7 percent let someone else clean the device.”

Kelly M. Pyrek, Infection Control Today, 2019

Many hospitals are now realizing that technological devices are a potential source of the spread of infection within a healthcare setting and some of them are beginning to implement protocols regarding the use and disinfection of electronics.

That being said, the cleaning and monitoring of technological devices can be complicated. As James Davis, MSN, RN, explains to Infection Control Today (2019), tech companies such as Apple only tell people to wipe down their devices with a damp cloth. However, that recommendation does not take into consideration the use of devices in a healthcare setting, where bacteria and infection are everywhere.

Some recommendations that Davis and Shivek, Phd, senior product engineer, give include:

  • Always washing your hands before and after using your device
  • Placing a layer between the device and the environment is key
    • Phone covers are becoming increasingly popular, however must be replaced frequently
    • Placing the mobile device in a ziploc bag is another option, especially if it’s being brought into an isolation room
  • No matter what, always wipe down the device before and after using it. Even if it was in ziploc bag or had a cover over it, wiping your device is key to ensuring that harmful bacteria are eliminated.

The cleaning and monitoring of technological devices is a daunting task for healthcare facilities, especially if it is an employee’s personal device. Davis (2019) stresses that because of this, employees should be personally responsible for the cleaning and disinfecting of their mobile devices. Although a complicated task, the recommendations provided by Infection Control Today allow us to understand how to better prevent the contamination of our mobile technology, which may in turn help prevent the spread of infection.

Sources:

https://www.infectioncontroltoday.com/transmission-prevention/contaminated-mobile-technology-making-it-part-your-institutions-cleaning-and

https://www.infectioncontroltoday.com/transmission-prevention/mobile-technology-disinfection-contaminated-devices-pose-threat-patients

Myosan TB, indirect claim against SARS-CoV-2

Myosan TB is a ready-to-use disinfectant cleaner has a broad spectrum virucidal claim. In accordance with Health Canada’s recommendations, we are authorized to make an indirect claim against SARS-CoV-2, the virus responsible for COVID-19 [1] [2] .

Myosan TB

MYOSAN TB

Myosan TB can therefore be used as a disinfectant against SARS-CoV-2, the coronavirus that causes COVID-19, since it is qualified as part of Health Canada’s approach to emerging viral pathogens for hard-to-use surface disinfectants. against SARS-CoV-2.

Coronaviruses are enveloped viruses, which means that they are among the easiest types of virus to kill with an appropriate disinfectant, when used according to the label directions for use.

To obtain Myosan TB, contact us at (514) 645-2753, or infos@lalema.com, or visit www.myosantb.com. Thank you.

SARS-COV-2 (COVID-19)

Coronavirus are enveloped viruses, which means that they are among the easiest types of virus to kill with an appropriate disinfectant, when used according to the label directions.

VIRUCIDAL

Said of a substance capable of destroying a virus.
A virus is an organism made up of at least two things: genetic material (DNA) and proteins. Being dependent on another organism to reproduce, the virus must find a viable host to multiply.

TUBERCULOSIS

A tuberculocidal agent is a real killer of tuberculous bacilli, tuberculosis creating an infection with the mycobacterium Mycobacterium tuberculosis.

BACTERICIDE

Said of a substance having the capacity to kill bacteria.
A bacterium is a single-celled living organism composed of a membrane, genetic material and cellular machinery. It differs from the virus in that it does not need a host to reproduce; the bacteria is an independent organism.

FUNGICIDE

Said of a substance that destroys fungi.
Fungi, commonly called fungi, are sometimes unicellular, sometimes complex multicellular organisms. Composed of a nucleus, a membrane and a cellular machinery, the fungus reproduces itself.

SPREAD THE INFO, NOT THE VIRUS


[1] https://www.canada.ca/fr/sante-canada/services/medicaments-produits-sante/desinfectants/covid-19.html

[2] https://www.canada.ca/fr/sante-canada/services/medicaments-produits-sante/medicaments/demandes-presentations/lignes-directrices/desinfectants/exigences-matiere-innocuite-efficacite-relatives-desinfectants -assimilate-drugs-hard-surfaces.html # b5

The Prevention of Waterborne Hospital-Acquired Infections

Source: Flickr

On this blog, we have already learned that healthcare-associated infections can be spread through the water and plumbing systems of hospitals. There are many possible reservoirs for the growth and spread of harmful pathogens; including potable water, sinks, faucets, showers, bathtubs, toilets, etc. It is therefore crucial that healthcare facilities develop water-management programs, in order to reduce the risk of infection.

In a recent article from Infection Control Today 2019, it is stated that:

“facilities must develop and adhere to policies and procedures that inhibit microbial growth in building water systems that reduce the risk of growth and the spread of Legionella and other opportunistic pathogens in water.”

Kelly M. Pyrek, Infection Control Today, 2019

Infection Control Today (2019) discusses many different policies that should be adopted by healthcare facilities.

In terms of potable tap water and hospital water systems, recommendations include:

  • Hot water temperatures at the outlet should be at the highest temperature allowable, preferably >51C.
  • In the case of water disruptions, signs should be posted and the drinking of tap water should be prohibited.
  • Standards for potable water must be maintained (<1 coliform bacterium/100 mL).
  • Equipment should be rinsed first with either sterile water, filtered water or tap water and an alcohol rinse should follow.
  • Periodic monitoring of water samples should be done in order to test for Legionella growth.

In terms of sinks in hospitals, recommendations include:

  • The use of separate sinks for handwashing and disposal of contaminated fluids.
  • The decontamination or elimination of sinks if epidemic spread of gram-negative bacteria via sinks is suspected.

In terms of showers in hospitals, recommendations include:

  • Prohibit the use of showers in neutropenic patients.
  • Control Legionella colonization of potable water.

The article discusses many more recommendations for other water-related reservoirs that are potential sources of infection. For more information on these other reservoirs, please refer to Infection Control Today’s website.

In addition to this, it is recommended by Tim Keane, a consultant with Philadelphia-based Legionella Risk Management Inc, that healthcare facilities hire engineers that are “building water system expert(s) who specialize in risk management for building water systems” (Infection Control, 2019). This will provide healthcare facilities with the expertise needed to develop a concise water-management program.

Preventing the spread of infection is no easy task, especially when there are constantly new sources of HAIs in healthcare facilities. That being said, with the help of very specific programs and procedures, such as the recommendations described above, it is possible to reduce the risk of infection and the spread of bacteria.

Source:

Infection Control Today. Vol. 23. No. 3. March 2019.

Hospital Staff Cuts and its impact on hospital cleaning

Source: Pixabay

Healthcare-associated infections (HAIs) are one of the biggest risks in healthcare today and Canada is no exception to this. In fact, Canada has one of the highest occurrences of HAIs out of all developed nations, with 200,000 cases per year and consequently, 8000 deaths (Statistics Canada, 2016). The spread of HAIs can be prevented, as we have seen on this blog, with proper handwashing techniques as well as proper disinfection protocols for equipment and patient rooms. The problem is that hospitals need A LOT of staff in order to properly disinfect, and control and prevent infection. And yet, Canada, as well as other countries, are seeing cuts in hospital staff.

According to a report prepared by Venrock (2018), one of the predictions for trends in healthcare for 2018 was the continuation of cutting and hiring less hospital staff. This is mostly due to hospitals working to balance their budgets. But at what costs does this balancing of budgets come at?

Although not a recent report, CBC’s Marketplace investigation of hospital cleanliness from 2012 does a good job at showing the consequences of hospital staff cuts (see video below). They interviewed nurses, doctors and hospital cleaners to find out more about staff cuts and its relation to infection control.

One hospital cleaner described the following:

“They’ve really cut staff, and we don’t have a lot of time to actually get done what we’re supposed to get done in a day. We used to have one person to one wing of the hospital to clean, but now we have three floors to clean.”

Anonymous, Hospital Cleaner (2012)

According to the report, in order to sufficiently clean a hospital room, it would take just over an hour. However, with the staff cuts being made, hospital cleaners are only getting on average 15 minutes for each room. This leads to a lot of uncleaned surfaces, leaving harmful pathogens in patient rooms. Furthermore, sometimes the harmful bacteria will even be spread from one room to another, since cleaners either don’t have the time to change cleaning materials or there aren’t enough cleaning materials. One example given in the report is that a cleaner will mop a patient’s room and then continue mopping into another room with the same water, simply because they don’t have the time to change the water.

Hospital staff cuts may save hospitals money, however, the potential risks that result from staff cuts are very significant and should not be overlooked. Leaving surfaces infected by pathogens can be detrimental to both patients and staff, and that is why it is essential to have an adequate number of educated staff to control the spread of infection.

To learn more about the consequences of hospital staff cuts, refer to this CBC Marketplace video:

Sources:

https://www.youtube.com/watch?v=UIOHKrfzJzI

https://www.cnbc.com/2017/11/27/venrocks-health-investors-make-predictions-for-2018.html

https://www.cbc.ca/news/canada/sudbury/health-sciences-north-funding-meeting-1.4902836

Is Ultraviolet disinfection the new technology for reducing the risk of hospital-acquired infections?

According to a study published in the American Journal of Infection Control, the use of ultraviolet (UV) disinfection technology in an operating room eliminated up to 97.7% of pathogens (infectious agent), which otherwise could have caused hospital-acquired infections. The UV light technology that was used is by PurpleSun, a New York based company. PurpleSun’s UV technology can reach and clean multiple surfaces in several seconds, compared to traditional disinfecting methods which use chemicals and does not eliminate bacteria as well. Traditional methods also take longer, since it is normally humans cleaning with a disinfectant.

Source: Wikimedia Commons

What is ultraviolet disinfection?

Ultraviolet disinfection is the use of UV light to disinfect. UV light is absorbed by the DNA and RNA of microorganisms, which in turn causes changes in the structure of the DNA and RNA. This makes the microorganisms incapable of replicating. According to Bolton (2008), “because they cannot multiply, they cannot cause disease, even though technically they are still metabolically alive.” Ultraviolet disinfection is more commonly used for the disinfection of water, however, it may soon become an effective method to eliminate bacteria causing hospital-acquired infections.

PurpleSun: pioneer in ultraviolet disinfection technologies?

PurpleSun is a New York based company, and is set to be the first company to launch ultraviolet-based technology as a disinfectant. Their mission, as stated on their website, is to reduce hospital-acquired infections, in order to save lives, reduce costs, and enhance safety in healthcare facilities.

On their website, they have identified 3 limitations with hospitals’ current disinfection process:
1) Everything is done by hand
2) There are thousands of surfaces, and not enough time to clean them all
3) There is no room for human error

PurpleSun’s light disinfectant will allow rooms to be cleaned within seconds, disinfect all the surfaces in the room and has been proven to be very effective in eliminating harmful pathogens.

Is ultraviolet technology the next step that healthcare facilities must take to reduce the risk of HAIs?

Light technology as a disinfectant is still in the process of experimentation in healthcare facilities. That being said, the study conducted produced highly favorable results. PurpleSun as a company has also been doing extremely well on a global scale, being named one of the 50 most promising companies in the world. Furthermore, many firms and organizations have been investing in and partnering with the company, demonstrating that the company has a lot of potential. The effectiveness of ultraviolet light as a disinfectant is undeniable, but for now, we will just have to wait and see what the future holds for it in healthcare facilities.

Sources:

https://www.infectioncontroltoday.com/environmental-hygiene/study-says-ultraviolet-disinfection-977-effective-eliminating-pathogens

https://purplesun.com/

Bolton, James R. Cotton, Christine A.. (2008). Ultraviolet Disinfection Handbook (1st Edition). American Water Works Association (AWWA) . Retrieved from:
https://app.knovel.com/hotlink/toc/id:kpUDHE0001/ultraviolet-disinfection/ultraviolet-disinfection


One-wipe cleaning system in hospitals proven to be effective

Source: Flickr

According to Infection Control Today (2018), a recent study carried out in a hospital in the UK has determined that a “one wipe” cleaning system was proven to be more effective than the traditional “two wipes” system in reducing the risk of MRSA in hospitals. Between 2013-2016, the hospital had been using a “two wipe” system, which consisted of first using a detergent wipe and then using an alcohol wipe as a disinfectant. In May 2016, a universal cleaning and disinfection wipe was introduced to the healthcare facility, and it made a significant difference.

According to Infection Control Today (2018),

“Using a Poisson model the researchers demonstrated that the average hospital acquisition rate of MRSA/100,000 patient bed days reduced by 6.3 percent per month after the introduction of the new universal wipe.”

Infection Control Today (2018)

These results were significant, and led to a big change in how this UK healthcare facility cleans its equipment. Not only did the universal disinfectant wipes lead to higher efficacy, but they also led to higher efficiency, since healthcare workers now only have to go over the equipment once and are assured that it will be clean.

Keeping this in mind, there are many different types of disinfectant wipes to choose from. If you would like to learn more about different types of disinfectant wipes, and how each of them work, feel free to visit our official website, and view our product offerings, or contact us directly by phone or email.

Click on the link below to view our product offerings for disinfectant wipes.

http://www.lalema.com/catalog/disinfecting-wipers-101

Source:

https://www.infectioncontroltoday.com/environmental-hygiene/simple-one-wipe-system-cleaning-nurses-effective-strategy-researchers-say

https://www.healthcarefacilitiestoday.com/posts/Study-says-one-wipe-cleaning-system-for-nurses-is-effective–20336

Hospital Privacy Curtains: A Harbour for Infectious Agents

Source: Wikimedia Commons

On this blog, we have already reviewed many of the sources of a major health problem: hospital-acquired infections (HAIs). And yet, every day, researchers seem to discover new sources of HAIs. One of the latest discoveries is that hospital privacy curtains in hospital rooms are extremely contaminated with pathogens. A study conducted in Winnipeg, Canada, revealed that freshly hung hospital curtains with minimal contamination became more contaminated each day that they hung in the hospital rooms. Furthermore, after 14 days of being in the room, 87.5% of the curtains were tested positive for methicillin-resistant Staphylococcus aureus (MRSA).

Kevin Shek (Bsc), the leader of the study on hospital privacy curtains carrying pathogens, writes,

“We know that privacy curtains pose a high risk for cross-contamination because they are frequently touched but infrequently changed.”

Kevin Shek (2018)

Healthcare facilities have been placing a great amount of effort in reducing the risk of HAIs in terms of hand-washing and the cleaning of equipment and high-touch surfaces, however, other things such as curtains, mattresses, and bedsheets have often been overlooked. A survey that was conducted to determine how hospital privacy curtains are cleaned/changed revealed frightening results. Only about half of the hospitals had a written policy which specified how often the curtains needed to be changed. 37% of respondents answered that hospital curtains were changed only when visibly soiled. 13% of respondents answered that the curtains were changed only once per year. Considering the results obtained from the Winnipeg hospital study, where curtains became increasingly more contaminated with each day that they remain in a patient’s room, the responses from the survey are alarming.

In terms of controlling the spread of infection, hospitals really need to consider that almost anything in the facility could be contaminated. Hospital cleaning is becoming increasingly complicated, as there are so many places where harmful pathogens can be found. It will be increasingly important that healthcare facilities develop new protocols and policies to prevent HAIs.

Sources:

https://www.infectioncontroltoday.com/transmission-prevention/new-study-says-hospital-privacy-curtains-may-harbor-infectious-pathogens

https://www.infectioncontroltoday.com/transmission-prevention/hospital-privacy-curtains-and-bed-sheets-soft-surface-contamination-and

Hospital floors, yet another source of Hospital-Acquired Infections

The list of potential areas of contamination in hospitals seems to keep growing, leading us to identify more sources of hospital-acquired infections (HAIs) and making hospital cleaning continuously more complicated. To add to this, researchers are now finding that hospital floors are a significant source of hospital-acquired infections. Every day, hospital and clinic floors are flooded by thousands of people. Shoes soles, wheels from equipment, such as monitors or stretchers and bodily fluids all contribute to the contamination of hospital floors.

It seems so obvious; floors are dirty in general. Hospital floors must be even dirtier. However, as Koganti, et. al. (2016) describes,

“… hospital floors are often heavily contaminated but are not considered an important source for pathogen dissemination because they are rarely touched. However, floors are frequently contacted by objects that are subsequently touched by hands (e.g., shoes, socks, slippers). In addition, it is not uncommon for high-touch objects such as call buttons and blood pressure cuffs to be in contact with the floor.”

(Koganti, et. al. (2016).

In addition to this, shoe soles and wheels on equipment also frequently touch hospital floors. Shoes of healthcare professionals can lead to the spread of infection since these workers are visiting many different patient rooms. Similarly, equipment such as monitors, stretchers or infusion pumps all have wheels which touch the floors of multiple hospital rooms.

Now you might be thinking, ‘but surely hospital floors are routinely cleaned?’ While that is true, researchers are now finding that much of the floor cleaning that is done is relatively ineffective since the bacteria is able to reproduce so quickly. So, what can be done to help reduce the risk of hospital floor contamination?

A good hygiene program for hospital floors, to reduce the risk of contamination

The cleaning and the disinfection of floors are essential elements of an effective hygiene program for hospitals. Regular floor maintenance implies the systematic elimination of hidden bacterias, which can be achieved by using vacuums, mopping and other elimination processes.

A good floor disinfection program consists of using effective disinfectants/detergents and procedures that are notable for reducing the risk of contamination. It is also important that cleaning equipment be properly cleaned and maintained, so that bacteria doesn’t spread when cleaning.

Cleaning hospital floors seems like a daunting task, especially since bacteria has been able to reproduce and spread itself so quickly. Healthcare facilities will need to become more exigent with their floor cleaning programs, if they are going to seriously tackle the threat of hospital-acquired infections.

Source : 
https://www.infectioncontroltoday.com/environmental-hygiene/shoe-sole-and-floor-contamination-new-consideration-environmental-hygiene

Candida auris : A new threat ?

Candida auris

After the coming of hospital’s contracted diseases such as C. difficile or MRSA (Methicilin-Resistant Staphylococcus Aureus), another difficult to treat bug seems to emerge. This time, it is a fungus: Candida auris.

This fungus or more precisely this yeast, has first been discovered by scientists in 1996. Then, a first infected human case has been reported in Japan in 2009. 1,2 To this date, Candida auris has been detected in hospitals of more than 20 countries such as the United States of America, England and many Europe countries. The first case in Canada has been reported in 20173.

Candida auris poses a specific threat because of the following characteristics4:

  • Infections by this microorganism have a high mortality rate.
  • The microorganism resists antifungal agents.
  • The microorganism is difficult to identify in clinical microbiology laboratories which results in wrong diagnostic. The identification is important in the choice of antifungal treatment.
  • The microorganism is known for its virulence.
  • The microorganism colonizes surfaces such as catheters used for healthcare.

Among recommended precautions by American and Canadian governments, disinfection of surfaces plays an important part. However, specific disinfectants are to avoid: this is notably the case for quaternary ammonium-based disinfectants which are ineffective5. The following procedure is rather recommended:

« Healthcare facilities that have patients with C. auris infection or colonization should ensure thorough daily and terminal cleaning and disinfection of these patient’s rooms with hospital-grade disinfectant effective against Clostridium difficile spores. »6

Sporicidal sodium hypochlorite-based disinfectant against C. difficile are for example great disinfectants to prevent and control contact transmission of Candida auris. In other words, scientists are only starting to understand and study this recently discovered microorganism. More studies will allow the discovery of effective treatment.

Until that time,in need of sporicidal products against C. Difficile to face Candidaauris new threat? Get our products right now!

References:

 1) Lee WG, Shin JH, Uh Y, Kang MG, Kim SH, Park KH, et al., (2011), First three reported cases of nosocomial fungemia caused by Candida auris. J Clin Microbiol, 49:3139-3142.

2) Satoh K,Makimura K, Hasumi Y, Nishiyama Y, Uchida K, Yamaguchi H., (2009), Candida auris sp. nov., a novel ascomycetous yeast isolated from the external ear canalof an inpatient in a Japanese hospital. Microbiol Immunol., 53:41-44.

3) Schwartz IS, Hammond GW., (2017), Premier cas de Candida auris multirésistant au Canada. Relevé des maladies transmissibles au Canada., 43(7/8):168-72.

4) Anuradha Chowdhary, Cheshta Sharma et Jacques F. Meis., (2017), Candida auris : A rapidly emerging cause of hospital-acquired multidrug-resistant fungal infections globally, PLoSPathogens, 13(5):e1006290

5) Institut National de Santé Publique du Québec, (Janvier 2018), Mesures de prévention et de contrôle dans les milieux se soins, Comité sur les infections nosocomiales du Québec, 2377 :1-11

6) Relevé des maladies transmissibles au Canada, (juillet 2017), Premier cas de Candida auris déclaré au Canada, Agence de santé publique du Canada, 43-7/8

Are hospitals disappearing?

Hospitals have always had ups and downs, according to the New York Times (2018). During the 19th century, wealthier people preferred being treated by doctors in their homes and hospitals were seen as a place for poorer people. Hospitals were not known for having good conditions. However, research led hospitals to learn some of the best practices and new technologies, such as anesthesia, which allowed hospitals to give better treatment than at home.

These new pratices and technologies caused more people to start going to hospitals. But now, people are once again shifting towards medical assistance at home or choosing to go to small clinics rather than going to hospitals. Why are these changes happening and what has been the implications for healthcare facilities?

hospitals

Source: Wikimedia Commons

Why are hospitals shutting down?

According to the New York Times (2018), the maximum number of hospitalizations in the US was over 39 million, in 1981. Even though the population has increased, hospitalizations have decreased by 10 percent! (New York Times, 2018). There are many different reasons explaining these numbers.

Aside from less patient admissions, the number of days a patient spends in a hospital is much shorter than before. Previously, a patient who had surgery could spend a week or longer in the hospital. However, now patients who have surgery sometimes stay only one day! This is one of the reasons for the reduction of hospital beds. According to Modern Healthcare (2015), new technologies and better medications can either reduce the length of the stay of a patient, or receive the necessary treatment outside of a hospital.

Second, one of the biggest problems that hospitals face today are hospital-acquired infections and trying to control the spread of infection. Hospital-acquired infections are becoming an increasingly serious problem, especially with the rise of drug-resistant suberbugs.

According to the Center for Disease Control and Prevention, in 2002, there were 1.7 million cases of HAIs, and that number has only been increasing. Controlling the spread of bacteria in hospitals has become increasingly challenging and, as you have seen on this blog, researchers are constantly finding new sources of infection. As people are becoming more aware of this risk, they are opting for either smaller healthcare facilities with less risk or at-home care.

One of the biggest causes for hospital closures is lack of funding; some hospitals simply cannot sustain themselves. In the US especially, this is in part due to patients being unable to pay hospital fees or having complications with insurance companies and, therefore, postponing their treatments. Hospitals are now scrambling to cut costs, however, this does not always work and has led to many closures.

The costs of shutting down hospitals

The majority of hospitals being shut down are in rural and small town areas, where people are far from cities. These closures can lead to many problems for these people. Doctors may lose their jobs or have to relocate to other cities to practice. Similarly, patients no longer have the option of having a regular, family doctor and need to relocate themselves in order to seek medical attention. They will also incur higher costs to reach the hospital, since they have to travel to hospitals. They lose time travelling, which may even be deadly in some cases. Finally, in the video example below, we see that the loss of jobs from a hospital closure can be detrimental to a small town’s economy, leading to the closure of other companies.

What does the future for hospitals look like?

So what is going to happen to hospitals? Will they eventually all disappear? Although a total disappearance is highly unlikely, it seems that hospital closures are becoming unavoidable, due to the risks associated with hospital-acquired infections, changing consumer preferences and lack of funds to maintain hospitals. There has already been a signifcant number that have been closed since 1981; in 1981, the US had 6933 hospitals and by 2017 this number had dropped to 5534 (New York Times, 2018). And this trend is expected to continue in Western countries. We’ll just have to wait and see what the outcome will be…

Sources:

http://www.huffingtonpost.ca/michelle-cohen/ontario-rural-hospitals_b_16290384.html

http://www.modernhealthcare.com/article/20150221/MAGAZINE/302219988

Water, a source of hospital-acquired infections?

Hospital-acquired infections are a serious threat in healthcare facilities today and researchers keep finding new sources of these infections. We know that sources of HAIs include surfaces, high-touch objects, hands and medical devices, but did you know that these infections can also occur due to the water and plumbing systems in healthcare facilities?

Source: Public Domain Pictures

According to Infection Control Today (2018), “Potable and utility water systems in healthcare settings are reservoirs and vectors of Hospital-acquired infections, resulting in pneumonias, bacteremias, skin infections, surgical site infections, eye infections and others.”

Hospitals are major users of potable water, whether it be for drinking, bathing, hand-washing or rinsing medical devices. It is therefore important that healthcare facilities realize that the water entering their facilities is not considered sterile.

Why is the water in plumbing systems infected? The design of and water use patterns in premise plumbing creates biofilms, which provide shelter and food for harmful bacterias. According to Infection Control Today (2018), “Biofilms in premise plumbing systems are complex ecosystems, and it is within these biofilms that bacteria, fungi and amoeba find the food, water and shelter they need.” Many bacteria develop in the biofilms, such as Legionella, Ancinetobacter aumanniii, Aspergillus flavus, etc.

Legionella – what is it and how does it affect patients in a healthcare setting?

Legionella colonies

Hospital-acquired infections

       Source: Wikimedia Commons

Legionella is one example of a bacteria that is found naturally in water. This bacteria is known for causing Legionnaires’ disease: a severe form of pneumonia. This disease is one of the most significant waterborne infections. Legionnaires normally has a mortality rate of only 10%, however, if acquired in a hospital, this rate goes up to anywhere between 25-50% (Infection Control Today, 2018)! Hospitals experience the highest number of outbreaks of Legionnaires disease (compared to other types of buildings) due to having a large number of patients with weakened immune systems or that have chronic diseases. It is important to note that the majority of Legionnaires cases in hospitals are due to the drinking water system.

How to reduce the risk of wHAIs: education and water management programs

So now that we are aware of waterborne hospital acquired infections (wHAIs), is there a way to reduce the risk that potable water poses to healthcare facilities? Infection Control Today (2018) suggests both education and water management programs as possible solutions to reducing the wHAI risk. Firstly, through education, it is important that healthcare workers know that potable water does carry bacteria and does cause an increase in HAIs. Second, once this idea of water carrying bacteria is understood, it will be important to implement water management programs. There can be no standardized water management programs, as all facilities differ in factors such as age of establishment and system, overall design of plumbing system, populations served, etc. Some hospitals have already tried different methods of water disinfection. Examples of these methods used to reduce risk include the use of sterile water in high-risk patient areas, engineering controls and point-of-use water filters.

To summarize, healthcare facilities must realize the risk that water and plumbing systems pose to their patients and employees. Hospital-acquired infections are one of the leading causes of death in North America and it is therefore crucial that hospitals take action against any source that could spread these infections. Education and water management programs are the best ways to help reduce the risk of wHAIs, according to Infection Control Today (2018).

Learn more about Hospital-acquired infections in this free webinar

Source: Infection Control Today. Vol. 22. No. 2. February 2018. 

Medical hygiene monitoring badges: how new technology is helping to prevent the spread of microorganisms

Hygiene and cleanliness are already monitored closely in hospitals and healthcare facilities. Hand sanitation is a crucial hygiene practice for both medical professionals’ well-being, as well as their patients. However, according to TrendHunter (2014), hand hygiene compliance in US hospitals is only achieved 50% of the time. And this is only an example of hand hygiene in the US. Studies would probably show similar, if not worse, percentages in countries across the globe. That is why Biovigil invented a medical hygiene monitoring badge.

Source: Pixabay

The Biovigil monitoring badge is specifically made for hand sanitation. The badge can be clipped on to a scrub or lab coat. It reminds healthcare workers to clean their hands when they leave or enter a patient’s room. It also works by telling either healthcare professionals or patients if their hands have been properly sanitized by turning green when the worker places their hand over the monitor. The badge also collects data on hand sanitation and sends it to be analyzed. While these badges are not heavily used yet, they could prove to be very efficient in eliminating the spread of hospital-aqcuired infections.

It is not, then, unreasonable to ask what other sort of technology could be developed in order to better monitor hygiene and sanitation in healthcare facilities. With the technological resources we have today, it is highly possible to create new products such as this. For now, most hygiene monitoring technologies revolve around hand sanitation. But as we’ve seen in other posts, there are way more sources of contamination and spread of bacteria than just hands; hospital bed mattresses, marked medical instruments, surface damages on medical equipment, etc. Why not create a technology that monitors the hygiene of these things as well? Similarly to the hand sanitation monitor, there could be monitors for other medical equipments that alert healthcare cleaners to check if they are clean and safe to use.

 

Source: https://www.trendhunter.com/trends/biovigil

How certain medical instrument marking methods can enable the growth of microorganisms – and what to do about it

In order to make it easier to identify a medical instrument, many doctors use different marking systems.The methods in which medical instruments can be marked are quite strict, in order to prevent the spread of bacteria. For example, instruments cannot be engraved because bacteria can get stuck in the small holes and grow. The article “Instrument Marking Methods Must be Maintained Properly”, by Nancy Chobin, describes three different methods of marking medical instruments and how these methods still have disadvantages and need to be maintained.

medical instrument

Source: Wikimedia Commons

First method for marking a medical instrument

Firstly, instruments are often marked by different colored tapes, however, many healthcare professionals fail to realize that the tape on the instruments can harbour bacteria and must be very carefully maintained. The tape should be replaced as soon as it begins to chip, as those small tears in the tape could allow for microorganisms to grow. According to Chobin “All tape and adhesive residues should be completely removed and the instrument washed before it is re-taped.” It is also stressed that a sharp object should not be used to remove tape, as this could simply create small fissures on the instrument where bacteria could grow.

Two other methods for marking a medical instrument

There are two other methods for marking instruments that are considered “acceptable”; chemical etching and color-bonding. These methods also come with some disadvantages, such as color-bonded instruments also chipping sometimes, however, seem to be more “sanitary” than using tape.

Why is this important? The general goal of healthcare facilities is to improve the health of its patients, while at the same time controlling and preventing the spread of infections and contamination. This means that healthcare facilities should aim to prevent, at all costs, the growth of bacteria. In order to be able to do so effectively, healthcare workers must know where all sources of bacteria may come from.

Source: Infection Control Today. Vol. 21. No. 12. December 2017.

Surface Damage and its implications for healthcare facilities

Preventing and controlling the spread of contamination and infection is of very high importance for healthcare facilities, and it is safe to say that many measures have already been taken in order to reach these goals. However, like many things, there is still much room for improvement moreover when it is about surface damage.

medical equipment surface damage

Source: Shaw Air Force Base

Evidently healthcare facilities use a wide variety of equipment, from monitors to surgical instruments to cleaning tools, and over time, this equipment wears down. Sometimes, equipment will break completely and be unusable, however sometimes there will only be a few scratches or other small damage.  But what happens when these scratches or other forms of damage become shelters and areas of growth for microorganisms? This is an example of how surface damage may not only impede the prevention of bacteria growth, but also provide the microorganisms with a place to grow.

What is surface damage?

According to Infection Control Today, surface damage is defined as:

a quantifiable physical or chemical change from the original manufactured state of an object (surface or device).

While it is recognized that surface damage of medical equipment poses a potential threat in the spread of bacteria in healthcare facilities, there is no standardized method for healthcare workers to determine what is considered surface damage, and at what point the damage is likely to cause the spread of bacteria. In a later blog post, I will discuss the ideal surface damage testing protocol, proposed by Peter Teska et al. in “Infection Control Today.” In this article, the authors discuss ideal methods of avoiding the problems that surface damage presents.

Are your surfaces damaged?

At Lalema, when we talk about hygiene and cleanliness, we offer a wide range of technical and consulting services. Find out more.

You can also read this article about The complete guide for hospital cleanliness.

Source: Infection Control Today. Vol. 21. No. 12. January 2018.

Hospital bed mattresses: An overlooked healthcare hazard (Follow up)

As a follow-up to my previous blog post about the problem of hospital bed mattresses being contaminated, I would like to go into further detail the recommendations provided by the Food and Drug Administration (FDA). As previously mentioned, the FDA recommends that healthcare facilities take preventative measures against contamination of hospital bed mattresses in four simple steps: inspection, removal and replacement, maintenance and the development of an inspection plan.

Hospital bed matressesSource: Flickr

Inspection involves routinely checking the bed mattress cover for any signs of damage, stains or tears, as well as checking if the bed mattress cover is past its expiry date (Yes – bed covers do have a limited lifespan). It is also important to frequently remove the cover and check the inside surface, as well the mattress itself for these same conditions.

Next, it is important to replace any mattress covers with visible signs of damage or stains. Also, mattresses with damage or visible stains should be removed immediately.

For maintenance, it is important to clean and disinfect undamaged bed mattress covers. This can be done according to the bed cover cleaning guidelines given by the manufacturer.

Finally, FDA suggests that healthcare facilities develop an inspection plan that can be applied for all medical bed mattresses and covers. It is important to check the expected life of the bed mattress, as well as the cover.

 

Source: Infection Control Today. Vol. 22. No. 1. January 2018.

Hospital bed mattresses: An overlooked healthcare hazard

Hospital beds are composed of many different parts: the bed frame, which includes the bed side rails, as well as a mattress and a mattress cover. Once a patient is discharged from the hospital, normally, the room will go through a substantial amount of cleaning, including the bed. The rails and bed frame will be wiped down and the bed cover will be changed in order to prepare for the next patient. However, one factor is often dismissed: the hospital bed mattress.

hospital-bed-matresses

📷 pixabay.com

According to the ECRI Institute:

Bed and stretcher mattresses can remain contaminated after cleaning, putting patients and staff at risk of exposure to body fluids or microbiological contaminants. Reported incidents include patients lying on an apparently clean bed or stretcher when blood from a previous patient oozed out of the support surface onto the patient.

While hospital bed covers are changed regularly, many health care facilities fail to examine these bed covers for damages, heavy stains or tears. It is also important to note that mattress covers have an expected lifespan, and will become ineffective after this duration of time. All of these factors can lead to blood or any other body fluids leaking onto the hospital bed mattress, therefore leaving it contaminated.

The FDA (Food and Drug Administration) makes several recommendations in order to overcome this healthcare hazard:

  • Inspect
  • Remove and Replace
  • Maintain
  • Develop an Inspection Plan

While companies who sell the mattress covers have the responsibility in properly explaining to healthcare facilities how to properly disinfect, clean and dispose of bed covers, it is crucial for healthcare facilities to use the necessary materials and procedures in order to clean and disinfect. Healthcare facilities must also regularly inspect both mattress covers and mattresses in order to prevent infection as much as possible.

Reference:

Infection Control Today. Vol. 22. No. 1. January 2018

The complete guide to hospital cleaning

hospital-cleaning

For a long time, cleaning has been all about the look; fresh smell and the absence of stains or dirt were the criteria to determine that a place is clean. Today, these criteria are still generally accepted in environments such as offices and classrooms.

It’s common knowledge, however, that microbes (bacteria or viruses) invisible to the human eye represent a risk for spreading infections. Take the example of the influenza virus: it can survive for up to 48 hours on a hard surface!

Without cleaning and disinfection procedures or a quality check procedure, microbes can survive in hospital environments.

Three key elements have to be considered in order to perform an infective risk analysis:

  • Is the patient carrying a disease agent? Disease agents are classified based on their spreading capacity and their virulence. The choice of a disinfectant will be based on this.
  • Do the functional activities of a sector represent a risk of spreading infections from the environment? E.g.: food service, offices, Intensive Care, etc.
  • The intensity of contact is related to the traffic and the surfaces that are more likely to be touched. E.g.: bathroom fittings.

Infective Risk Analysis

Cleaning in hospitals allows reducing risks of infection among patients. This is not the only factor, of course: good personal hygiene habits such as washing hands and the use of protective equipment such as overalls, gloves, masks, or protective glasses are also important elements.

For this reason, interventions must be well coordinated in order to have a good surface maintenance plan. The manager of hygiene and cleanliness should therefore take into account:

  • The type of place associated to the level of risk
  • The tasks to perform
  • The required cleaning frequency

If well applied, a detailed estimate allows validating the cleaning performance.

The global approach is going to be determined by type of place:

  • Regular eradication (e.g.: operating rooms)
  • Keeping environmental effects as light as possible (e.g.: low infection risk such as individual office spaces)
  • Balance of microorganisms. This approach is based on the competition between good and bad microbes. The presence of good microbes guarantees less space for bad microbes to grow (e.g.: living environments)
  • Green cleaning. Approach that uses less toxic products
  • Review and improve arrangements and/or surfaces (during conception or renovation)

The Cleaning Staff: key to success

The hygiene and cleanliness staff represents a key element in the fight against infections in hospital environments. Often little valued, their role in the global strategy of surface cleaning is extremely important.

The hygiene that comes from the work of the cleaning staff requires a high performance level. In order to reach that, the executing staff and the managers need to master all the different elements representing this profession.

Cleaning products and equipment are undeniably crucial in order to ensure performance during the environment asepsis of any establishment. Therefore, it is important to associate the day-to-day actions of the cleaning staff with a range of products and equipment that favor the quality of their performance.

Since several years, partly due to the devotion and the involvement of many members in the healthcare system, we take into consideration new factors:

  • Provincial training
  • Establishment of an AEP hygiene and cleanliness in healthcare environments of 630 hours now offered by many school boards
  • Provincial day of hygiene and cleanliness
  • Etc.

Having said this, the hygiene and cleanliness staff deserves our deepest gratitude. Thank you so much!

Work Organization

How can proper work organization contribute to the cleanliness of a hospital? How to be in the right place with the right equipment? Here are the questions we are going to answer in this post of the Cleaning in Hospitals series.

Evaluation of production needs

First, we need to assess the needs in hygiene and cleanliness. In order to do this, a standard evaluation is preferable but it needs to be adjusted based on the type of place, units, and traffic.

It is during the evaluation of needs that the hygiene and cleanliness estimate (see Cleaning in Hospitals part 2) is going to be determined. All daily, weekly, monthly, and annual tasks have to be considered.

Usually, the results are presented by production yields (square meters/hour) or FTE (Full Time Equivalent).

How to reduce time waste

How to measure productivity in a context where an important aspect of the task is moving? Actually, hygiene and cleanliness departments are almost always in the basement, whereas most of their work happens on the floors!

We increase productivity by reducing traveling.

It is for this reason that the cleaning cart needs to be as complete as possible and the water sources or janitor’s closets well stocked with supplies (i.e.: paper products or waste bags), equipment, and sanitary products.

Moreover, it is important to remember that a good entrance carpet can greatly reduce dirt.

Have a successful day!

Here are a few hints on how to have a successful day:

  • Establish a sequence of actions to perform in a day/week/month
  • Define a sequential order of rooms
  • Integrate linked and periodical tasks (monthly)
  • Make sure to have time gaps to focus on periodical tasks (dusting of high surfaces, polishing, etc.)
  • Minimize traveling
  • Work by space and not by task
  • Distribute tasks equitably
  • One look is worth a thousand words: choose a colorful plan together with some graphics instead of a list of tasks on a word file!

Want to know more?

Look this free webinar from my collegue Remi:

Need help?

Don’t hesitate to call 514.645.2753 or subscribe to one of our training seminars. I really hope that you liked this post!

Good Practices in Waste Management

Waste management can be a real headache especially if you work in a hospital or university! In Quebec, the legal and regulatory framework has evolved for more than 50 years and in 2017, several municipal, provincial and federal laws and regulations are in force. Let’s see how we can classify and demystify the different types of waste.

Waste Management

Credit photo Joseph Barrientos via unsplash

Good practices in waste management

To properly manage waste, it is imperative on one hand to be well aware of the characterization of your waste and on the other hand to know the regulations that apply to your situation.

Safe Handling

The safe handling of waste, whether at the time of its production, handling, storage or disposal, must be accomplished with appropriate protective measures for your own safety, safety of of others and protection of the environment.

Communication

Each department must also be informed of the way in which they dispose of the waste they produce in a safely manner. That’s why a good communication plan is also important!

Reduction at source

Take action by initiating gradual changes in how you manage your residual materials on the basis of the 3RV-E principle that promotes source reduction, reuse, recycling and valorise until residual materials must be eliminated.

  • Reducing at source is the fundamental principle of management to decrease the quantity of goods consumed, which necessarily decreases the amount of natural resources consumed.
  • Reuse is to give a second life to objects and use what others do not need anymore.
  • Recycling is the process of converting a residual material into a raw material for the manufacture of a new product
  • Valorisation is to give a second life to the products but in different ways, usually this is done by the biological way for example compost or energy like biofuels
  • Elimination when all efforts have been made in the 3RV and waste is finally disposed of.

Classification of waste by category

In industrial and institutional environments, waste is generally grouped into 7 categories:

  • General Waste
    • Non-recyclable waste with no reuse or recovery potential
  • Biomedical waste
    • Human anatomical waste
    • Animal anatomical wastes
    • Non-anatomical waste
      • Piercing, sharp or breakable objects that have been in contact with blood
      • A liquid or a biological tissue
      • Biological tissues, cell cultures, cultures of micro-organisms;
      • Live strain vaccines;
      • Containers of blood and blood-soaked equipment, etc.
  • Pharmaceutical waste
    • Hazardous pharmaceutical waste
      • Drug residues
      • Toxic expired drugs
      • Cytotoxic drugs
    • Non-hazardous pharmaceutical waste
      • Other drug residues
      • Non-hazardous expired drugs
  • Chemical waste
    • Chemicals from laboratories
      • Laboratory reagents
      • Laboratory solvents
    • Pressurized containers
  • Radioactive waste
    • Residues containing radioactive isotopes above standard
    • Syringes, reactors, lead cylinders (nuclear medicine)
  • Electronic waste (or with heavy metals)
    • Hardware
      • Computers
      • Screens
    • Cell phones
    • Battery
    • Articles containing mercury
      • Thermometers
      • Fluorescent or compact fluorescent bulbs
  • Recyclable waste
    • Paper
    • Cardboard
    • Plastic
    • Glass
    • Metal
    • Food and compostable residues
    • Organic waste
    • Construction debris
      • Brick
      • Concrete
      • Unpainted gypsum board
      • Metal
      • Wood

Legislative and regulatory framework for waste management in Quebec

  • Loi sur la qualité de l’environnement (chapitre Q-2)
  • Règlement sur l’enfouissement et l’incinération des matières résiduelles (c. Q-2, r. 19)
  • Règlement sur la santé et la sécurité du travail (chapitre S-2.1,r. 13)
  • Code de sécurité pour les travaux de construction (chapitre S-2.1,r. 4)
  • Règlement sur les déchets biomédicaux (c. Q-2, r. 12)
  • Code de la sécurité routière (chapitre C-24.2)
  • Règlement sur le transport des matières dangereuses (c. C-24.2, r. 43)
  • Règlement sur les matières dangereuses (c. Q-2, r. 32)
  • Règlement sur la récupération et la valorisation de produits par les entreprises (c. Q-2, r. 40.1)
  • Code de sécurité pour les travaux de construction – amiante (chapitre S-2.1, r. 4)
  • Loi sur la sûreté et la réglementation nucléaires (L.C. 1997, ch. 9)
  • Règlement général sur la sûreté et la réglementation nucléaires (DORS/2000-202)
  • Règlement sur la radioprotection (DORS/2000-203)
  • Règlement sur l’emballage et le transport des substances nucléaires (DORS/2000-208)
  • Règlement sur les substances nucléaires et les appareils à rayonnement (DORS/2000-207)

Learning, Understanding, Implementing, Enhancing

Have you enjoyed this post and would like to learn about this topic or about hygiene and sanitation in general? Great! Why not check out our training and consulting catalog now?

Source: Guide de gestion des déchets du réseau de la santé et des services sociaux

How to make cleaning safer in 7 steps

According to ASSTSAS, falls and slips account for 18% of workers’ compensation costs in the province of Quebec. This is the third leading cause of workplace accidents in the health and social services sector and it includes all types of jobs.

Causes of workplace accidents

There are many other causes of workplace related accidents :

  • Fall and slide accidents
  • Muscle problems related to lift and flexion
  • Eye and skin lesions, often related to the handling of chemicals
  • Respiratory problems, often the result of working with chemicals and equipment
  • Accidental exposure to electrical hazards or biological hazards

Seven ways to make cleaning work safer

  1. Ensure periodic review of working methods and procedures
  2. Identify and evaluate “at risk” situations including load lifting, repetitive movements, exposure to chemicals, air quality, work organization
  3. Determine tasks requiring personal protective equipment such as gloves, goggles, masks, protective sleeves, etc.
  4. Wear non-slip shoes when stripping or laying floor finish
  5. Install “wet floor” safety panels when washing floors. Remove the panels when the floors are dry.
  6. Inspect the electrical wiring of your equipment regularly. Never pull the wire to disconnect a device.
  7. Consider the presence of any body fluid or blood as a real biological hazard and clean up only if you have received the proper training.

Sources:

Click to access FT13_chutes_WEB.pdf

http://www.cleanlink.com/news/article/Seven-Ways-To-Make-Cleaning-Work-Safer–20393 (via Kim B., thanks!)

Free Webinar: Fighting Healthcare Associated Infection with Environmental Hygiene

Fighting Healthcare Associated Infection with Environmental Hygiene.


The main objective of this webinar is to review the basics of cleaning and disinfection:

  • The updated burden of HAI’s in Canada
  • Why do we disinfect
  • Best practices in cleaning and disinfection
  • Using the right product
  • Validation technique

This 40 minutes long webinar was originally broadcast on December 15th, 2016. Watch it now on replay for a limited time!