Hand Washing with Contaminated Soap Study
Hand Washing with Contaminated Soap Study
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April 5, 2013
Turn on any do-it-yourself channel and you’ll find a professional teaching you how to do something.
Whether it’s cooking a breakfast frittata or renovating your kitchen, show hosts proudly display the final gorgeous product, assuring that you too can achieve that result if you follow their process.
Failure to follow the suggested steps — for example, adding the egg after baking the frittata or laying new floors atop the old tile — will likely result in a final product less desirable than that which you hoped.
Floor cleaning is no different; if you want to maintain clean and safe floors that look inviting to guests, you need to follow the proper steps in order to achieve the desired results.
The floor care trifecta — the three essential steps to any program regarding ongoing cleaning and maintenance — encompasses:
Neglecting to follow these essential steps will leave you with lackluster floors — those that are unfit for showcasing.
Why Doesn’t Cleaning Alone Work?
When a large national quick service restaurant chain headquartered in Southeast Texas began testing a new floor cleaning program, they knew they wanted a system that would provide clean and safe floors throughout their 230 locations.
The goal was to have floors that not only looked clean but stayed clean — and remained safe even after heavy use.
When testing a potential floor care program, they focused trials on 12-year-old flooring — large ceramic tile in dining areas and quarry tile in kitchen areas.
After mopping and cleaning the floors, testers identified the wet static coefficient of friction (WSCOF) on all floors using standards established by the National Floor Safety Institute (NFSI) and the American National Standards Institute (ANSI); this established baseline measurements for the program.
Testers then deep cleaned the floors, measuring the WSCOF at the same location they measured previously and added a traction treatment application to help enhance floor safety.
The WSCOF was measured periodically over the course of the next three weeks to identify the overall condition of the floors.
Floors were only maintained during the course of this testing period; soiling was not prevented and the floors were not protected by a comprehensive matting system.
On the day of the benchmark test, testers found a substantial improvement in the overall traction of floors in the dining room areas — from .46 before deep cleaning to .60 after the deep cleaning.
In kitchen and food preparation areas, floor traction increased from .70 to .80 following deep cleaning.
And, after the application of the traction treatment, WSCOF in the dining and kitchen areas increased to .80 and .81, respectively.
Following the three-week trial, testers measured the WSCOF in the same areas.
The floors had been regularly cleaned throughout the testing period; however, the audit revealed that the overall traction of the floors had actually declined, particularly in the dining areas.
The floors in the dining room showed a WSCOF value of .55, and the floors in the kitchen and flood preparation areas showed .70.
To improve floor traction in the dining room — the area showing the largest decline in overall floor traction — testers suggested integrating a matting program into their floor care process.
Mats would be placed around beverage stations and buffet bars, as well as in transitional areas like those between food preparation stations and the dining room.
In addition, it was recommended that floors be deep cleaned more frequently to keep floor appearance high and to further reduce the opportunity for slip-and-fall accidents.
The Trifecta Revealed
As the study shows, comprehensive hard floor care should involve three primary steps.
Deep cleaning, protecting and maintaining floors — and consistently following the process in that order — helps ensure that the WSCOF levels remain high regardless of the current stage in the program.
1. Deep clean
The first step of the hard floor care trifecta is to deep clean.
The initial task when revitalizing a floor surface is a thorough deep cleaning, which should be completed on all hard floor surfaces.
Daily vacuuming and mopping reduces surface-level particulates, but often fails to capture and remove all contaminants.
As a result, floors become worn over time, and white grout lines become black from grease and other organic buildup.
Periodic deep cleanings revive floors to enhance the image of the business and protect staffs and patrons.
In addition to making floors look better, deep cleaning helps improve hard surface traction, effectively making them safer for use.
When combined with a traction treatment, particularly with natural substrates like quarry tiles, deep cleaning increases the traction by removing surface polishing of the tile due to foot traffic and rejuvenating the naturally rough surface.
Selecting a deep cleaning provider that is certified by the Carpet and Rug Institute (CRI) or a service certified by the NFSI can help guarantee superior levels of clean.
The second step of the hard floor care trifecta is to protect.
Once floors are restored, the next step is to protect them from indoor and outdoor contaminants that could create conditions conducive to a slip-and-fall accident or that could mar the floor’s finish.
Mats act as the first line of defense in buildings by capturing dirt and water before they enter the facility.
Strategically place mats throughout your facility to capture dirt and water and reduce slips and falls.
At entrances, combine rubber scraper mats outside of the building with carpet mats inside to reduce the amount of water, dirt and contaminants tracked into the building.
Limit the tracking of interior soil by placing matting in critical locations like exposition areas or in transitional walkways such as those leading from the kitchen to dining areas.
This can be the last line of defense to help prevent common materials such as grease, oil or other organic matter from building up throughout guest areas, thereby improving image and limiting hazards.
Transitional mats can also be effective in areas leading into restrooms — a frequent site of water buildup.
The NFSI tests mats in laboratory and real-world settings to ensure they meet the highest safety standards.
Select mats that are certified to provide “High Traction” by the NFSI to reduce the risk of slips, trips and falls.
The third step of the hard floor care trifecta is to maintain.
Possibly even more so than other locations, daily floor maintenance is essential to a clean and safe foodservice operation.
Dedicate one mop to each area within a restaurant — kitchen, dining and restroom areas — to further reduce the chance for cross-contamination.
And, while it might seem like common sense, make sure all tools and equipment are sanitized before any cleaning is completed.
A dirty mop fails to remove soils and increases the risk of cross-contamination — essentially nullifying your efforts.
However, damp or wet mopping by itself doesn’t clean a floor: Agitation using deck brushes or other tools that work with a mop, such as an autoscrubber for larger areas, is important to keep surfactants and soils from building up on flooring.
In addition, proper dilution is essential to ensuring floor care chemicals work properly.
Many cleaning professionals use wall-mounted dispensing units that accurately dilute chemicals to ensure there isn’t an excess or lack of chemical concentration.
Provide ongoing training so employees know how to properly clean floors, remembering to reinforce cleaning frequencies with checklists so other team members know exactly when the floors were last cleaned.
The Final Product
Whether you want to develop a hard floor care program for a new substrate, to restore an old one, for protecting building occupants against slip-and-fall incidents or to simply keep your floor care program in line with industry best practices, following the three steps of the floor care trifecta is essential.
Adhering to the three-step hard floor care process of deep cleaning, protecting and maintaining will help ensure that your floors remain in top condition so you can showcase the final results with pride.
Protect Your Floors With Matting
Consider the following four areas for matting placement to help limit indoor contaminants from slips, trips and falls:
These areas include front and back entrances and peripheral doors that lead to the outdoors.
Zones of increased risk include transitional walkways between risk areas.
For example, spaces between the kitchen and front-of-house areas or offices and hallways leading from restrooms to dining areas are particularly susceptible.
Most hallways and corridors in restaurants are considered to be high-traffic zones and should be protected with a matting program.
Also, consider cashier and check-out stations, as there is often increased foot traffic in these locations.
Areas where staff members or patrons frequently stand, such as work stations, check-out counters or produce kiosks, are considered to be productivity zones that can benefit from the placement of matting.
Ann Nickolas is director of foodservice for Cintas.
Carpets cleaned professionally using the extraction method should dry in four to six hours. However, drying time can depend on a variety of issues, from how soiled the carpet is to how much chemical is used in cleaning. CFR’s Doug Berjer offers the following 10 steps, which are designed to help carpet cleaning technicians and professionals dry carpets faster:
By Mary Shinn
The healing hands of a healthcare professional too often bear the risk of spreading infection while administering care. According to the Centers for Disease Control and Prevention (CDC), failure to engage in proper hand hygiene is the leading cause of healthcare-associated infections and the spread of multidrug-resistant organisms (MDROs), including vancomycin-resistant Enterococcus (VRE), methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile. Unfortunately, proper hand hygiene can be easily forgotten by busy healthcare workers. A study of 2,834 opportunities for hand hygiene found that hands were cleansed only 48 percent of the time, according to a World Health Organization (WHO) report (2009).
Diane Jacobsen, director of the Institute for Healthcare Improvement (IHI), says visible reminders to complete hand hygiene can be powerful. “Staff are busy responding to unexpected calls from the bedside,” she says, “so things as simple as making sure that hand hygiene supplies are very visible are helpful. Make sure there are sinks or alcohol-based hand sanitizers outside the patient room, so staff don’t have to go down the hall and the around the corner to find a sink,” she says. “Keep things very much within their work stream. Those are simple changes, but they make a big difference.”
Some programmatic changes can be implemented on one unit to help a hospital see what kind of reminders — such as posters near sinks, –work best for their hospital, Jacobsen says. Starting small can also help the hospital identify the factors particular to their work environment that prevent healthcare workers from practicing good hand hygiene, she adds. “The hospital would look at their own local environment because not the same thing is going to work in every single organization,” Jacobsen says.
The WHO reports indicates that a lack of time, insufficient or inconveniently located sinks and irritated hands as some reasons healthcare professionals give for not engaging in hand hygiene. According to the 2009 WHO report, working as a doctor or nursing assistant was associated with a lower rate of compliance. In addition, working in intensive care, surgical care, and emergency care was associated with poor hand hygiene. Understaffing and overcrowding also contributed to low compliance, according to the report.
Keeping positive data visible can be a powerful technique in encouraging staff to work together to create a culture in which best practices are the priority, Jacobsen says. “Not all infections are totally preventable, but many of them are, and just keeping that kind of information visible to people in their staff lounge − for example, to say it’s been 20 days since an infection. Again, it engages everybody as a team,” she says.
The WHO report (2009) notes that healthcare workers often contaminate their hands or gloves by touching the environment before touching a patient. As such, hand hygiene would be more effective if implemented in conjunction with environmental hygiene, says Philip C. Carling, MD, director of infectious diseases and epidemiology at Caritas Carney Hospital and a professor at Boston University School of Medicine. “If we don’t have good environmental hygiene, then as good as we want to get with hand hygiene, we’re not going to get as much bang for the buck as we could if we had good environmental hygiene, because hand hygiene is not perfect,” Carling says. “You can’t be cleaning (the environment) all of the time, just like you can’t be doing hand hygiene all of the time. And so you need the combination of optimizing both practices.”
The WHO and the CDC recommend established best practices for hand hygiene. According to the WHO, there are five key moments when a healthcare worker should engage in hand hygiene:
– before touching the patient
– after touching a patient
– before touching an area of at risk of infection
– after body fluid exposure risk
– after touching the patient environment
Hand hygiene should also be practiced after touching wound dressings and before handling medication or preparing food. Hand hygiene is also needed before putting on gloves to insert an invasive device, such as a catheter. After removing sterile or non-sterile gloves, hand hygiene should also be practiced. The CDC says that bacteria linger on the hands of healthcare workers after they remove gloves. It is thought pathogens penetrate glove defects or hands get contaminated when healthcare workers remove their gloves. Depending on the procedure, hand hygiene is also recommended before wearing gloves.
Alcohol handrubs and soaps should not be used at the same time. Here is a review of the appropriate times for each:
– Wash with soap and water after using the restroom, before eating and when hands are visibly contaminated. It is also recommended when multi-resistant spores are present. The mechanical friction of handwashing helps remove the spores and should be practiced in conjunction with wearing gloves. Medicated soap does make a difference in this case.
– Wash hands for 40 to 60 seconds and avoid hot water because it increases skin irritation
– Pat hands dry using paper towels or use hand driers to reduce the risk of recontamination. Patting hands dry reduces hand irritation. Hand dryers should dry hands quickly without aerosolizing pathogens.
– Use a paper towel to turn off the tap to avoid recontamination.
– Use alcohol-based handrubs for hand hygiene at every other hand hygiene opportunity when handwashing is not recommended.
– Use a palm full of alcohol handrub and cover hands completely. Rub hands until dry, this should last between 20 seconds to 40 seconds. If it takes less than 15 seconds you should use more of the product.
Mary Shinn is a writer for ICT.
1. World Health Organization. Guidelines on Hand Hygiene in Health Care. World Health Organization. 2009 Accessed at: http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf
2. MMWR. CDC Guideline for Hand Hygiene in Health-Care Settings. 2002. Accessed at:http://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf
Question: What are the top SIX activities in cleaning that will have the greatest impact on safety and health?
Answer: Here is my list of the top SIX activities necessary to impact the health and safety of our public.
Reference: Darrel Hicks, April 16, 2013; Infection Prevention Q&A Part 3, Darrelhicks.com
As a supplier and distributor of “cleaning” solutions we are always amazed at the passion our customer base has for their profession. We are looking forward to blogging our shared passion of cleaning and contributing innovated solutions in all facilities and organization we touch. More to come!
Cold and flu season is upon us. Is your child’s school clean enough to prevent the spread of those germs? Watch as Bill Balek, ISSA’s director of legislative and environmental services, discusses the importance of cleaning and disinfection during the Health Watch news segment on CBS affiliate WDJT-TV. In this clip, he also explains how looks can be deceiving, when it comes to cleanliness.