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Since the turn of the 21st Century Clostridium difficile infection (CDI), often referred to as C. diff, has increased in both prevalence and severity worldwide, particularly in acute-care hospital settings.
Usually, this most impacts high risk individuals such as older people and children. But today, CDI is emerging in populations previously considered low risk.
To prevent this, CDI awareness and prevention programs are increasingly necessary in healthcare environments, along with more effective cleaning strategies. It is believed that together, these can reduce outbreaks and help keep people healthy.
C.diff Case in Point
In 2014, an Ontario hospital experienced a facility-wide C.diff infection outbreak. Further and believed related to this, nosocomial illnesses had risen significantly behind baseline rates, alarming hospital administrators. To address these problems, improvement initiatives were undertaken with a special focus on, what the hospital termed, “environmental and equipment cleaning.”
This is where Swish was brought in. Swish is one of the oldest and largest janitorial distributorship in Canada.
Swish cleaning experts were asked to assess the current cleaning processes and procedures in the hospital and provide solutions to help improve cleaning results. The ultimate goals: reduce the number of CDI infections, as well as lower the incidences of nosocomial illnesses.
The first step the Swish experts took was an initial assessment of the current environmental service cleaning processes. They found that a one-step cleaning and disinfecting procedure was in place. This, it was concluded, was a key contributor in the CDI/nosocomial infection spike. Why this is a problem will be explained later.
Further, tests were conducted using an adenosine triphosphate (ATP) monitoring system. These tests indicated a lack of efficacy (cleaning effectiveness) in the current cleaning processes.
For instance, the ATP tests revealed counts of between 300 to as high as1000 ATP units on high-touch hospital surfaces such as wheelchairs, bed tables, bed rails, mattresses and toilets. These numbers are far too high and likely a major reason for the CDI and nosocomial infections the hospital was experiencing.
Looking for Product Solutions
Upon completion of the initial cleaning audit, the Swish cleaning experts recommended the hospital switch to a two-step cleaning and disinfecting process using two specific products, PCS ECOgent® Stabilized Bleach Cleaner and PCS 5000 Oxidizing Disinfectant.
By using these products and separating cleaning and disinfecting into two tasks, Swish experts told hospital administrators the following:
- Cleaning efficacy would increase significantly
- Cleaning surfaces prior to disinfecting would increase the disinfectant’s ability to make direct contact with C. diff. bacteria, allowing for more effective disinfecting results
- With these products and processes in place, other forms of bacteria and germs that might be causing the increase in nosocomial illnesses would also be killed and their threat eliminated
To further ensure the effectiveness of the products and program, an extensive, hands-on training and communication program was also provided by Swish. The goal here was to confirm that all housekeeping staff, Health & Wellness and Infection Prevention & Control administrators, as well as the nursing staff were fully educated on how to use the recommended products and cleaning procedures.
After an eight-month trial of the products and cleaning procedures recommended, a follow-up assessment was completed. The following was uncovered:
- Using the two-step cleaning and disinfecting process, post-cleaning ATP readings were consistently under 50 units. These are far safer readings.
- Overall, the hospital experienced a 64 percent decrease in CDI cases by adopting the new process.
- The nosocomial infection rate was also reduced, bringing the rate closer to baseline infection rates.