Terminal cleaning is a thorough, deep-cleaning of a patient room between occupants. Its purpose is to rid the room of infectious agents and provide the new occupant a sanitary space for recovery and healing. Terminal cleaning protocols vary by hospital, but the CDC, or Centers for Disease Control and Prevention, has recommendations for environmental cleaning, including terminal cleaning. This advice includes the staff involved in monitoring and evaluating cleaning, the training of environmental staff, and the analysis of data collected through regular assessments.
As concerns over hospital-acquired infections have grown over the past decades, innovative technologies have been invented to aid in the reduction of germs in the patient room, what specialists call the "bioburden". Since numerous studies have proven that patients are infected as a result of a contaminated environment (and not just contaminated individuals) these technologies have emphasized testing the surfaces in the room for proof of effective cleaning. Only recently has bacteria-killing technology emerged that supplements the cleaning done by environmental staff. This post will outline the 4 innovative technologies that assist a hospital in ensuring a clean, sanitary room for each patient.
We all know that humans are subject to error. We are not robots programmed to complete tasks perfectly over and over again. When it comes to protecting patients from harmful pathogens, however, perfect performance is required! As a result, the first two technologies used to improve terminal cleaning focus on making sure the human processes are performed correctly.
Monitoring Cleaning ProcessesDirect observation of each room cleaning is not possible. As a result, technologies have emerged that help confirm that proper cleaning protocols have been followed. After the cleaning protocol is set up (in what order the room is cleaned, what cleansers are used, what disposal procedures are required) the cleaning protocol can be evaluated through an innovative technology: Fluorescent Markers. These powders, lotions, or gels are applied to high-touch objects prior to cleaning. After the room is cleaned, a special light is shined on these objects to see if the marker has been removed during the process of cleaning. If a marker remains, further investigation can reveal whether the object was missed, improperly cleaned, or in some other way overlooked. Based on research, the CDC recommends that these markers be used in conjunction with our following item, as a surface may conceivably be "effectively disinfected but less effectively cleaned." (Clean, according to the CDC, means removal of surface debris.)
Testing for the Presence of PathogensThe next innovative technology used to improve terminal cleaning is testing for the presence of pathogens through ATP Bioluminescence. ATP is adenosine triphosphate, an enzyme used by cells in metabolism, the chemical activity that keeps a cell alive. A swab of a surface is taken and then exposed to a luminometer, which measures the amount of ATP on the swab. If high levels of ATP are shown, then the possibility of live pathogen contamination is high. This rapid method of testing improves upon other testing methods using swab cultures or agar slide cultures, which require more time in both collection and analysis. The CDC warns that ATP monitors vary in sensitivity, however, and that some non-pathogenic material could result in high ATP numbers. Also adds that bleach-based disinfectants may "quench the ATP bioluminescence reaction", that is, lower the monitor's ability to recognized ATP presence. Despite these drawbacks, studies show that ATP monitoring can improve daily cleaning and help monitory progress in cleaning high-touch surfaces.
The next two categories represent ways to actually reduce the bioburden in the room as a supplement to human cleaning processes. The first is a one-time or punctate cleaning method, and the second is a continuous sanitizer.
One-Time SanitizersThere are two emerging technologies that support terminal cleaning as one-time sanitizers. The first is hydrogen peroxide misters, also called foggers. These devices emit a hydrogen peroxide vapor, which falls on all the exposed surfaces of a room, killing bacteria and other pathogens. The other technology is UV light emitters. These devices emit light at a frequency that destroys pathogens in a line-of-sight exposure. These devices share many characteristics: Both are wheeled into a room after terminal cleaning and operated remotely in a sealed room, both take between 1-several hours to complete a cycle, and both require regular replacement of the kill mechanism (hydrogen peroxide or bulbs). While the UV systems are significantly more costly, both technologies require significant investment depending on the number of units per beds ratio.
Continuous SanitizersIn recent years, the emergence of copper as a continuous sanitizer has led to a new category of infection prevention technology. Copper has been proven to actively kill >99.99% of bacteria* in under 2 hours, even after recontamination. There are two options for healthcare application of copper: Metallic alloys and EOSCU, a polymer material infused with copper oxide. These materials destroy bacteria by disrupting the cell wall, by poisoning the cell, and through free radicals released during oxidation. The key benefit of these surfaces is their ability to kill bacteria continuously, pre- and post-terminal cleaning, continuously reducing the bioburden in a patient's room.
Research focused on reducing hospital-acquired infections has never been more intense. At the same time, never have more products flooded the marketplace claiming to solve the problem of HAIs. In a future post, we will cover the criteria to use when considering an infection prevention product.
Editor's Note: This post was originally published in August 2015 and has been updated for freshness, accuracy and comprehensiveness.
*Testing demonstrates effective antibacterial activity against Staphylococcus aureus (ATCC 6538), Enterobacter aerogenes (ATCC 13048), Methicillin-resistant Staphylococcus aureus (MRSA-ATCC 33592), Escherichia coli O157:H7 (ATCC 35150) and Pseudomonas aeruginosa (ATCC 15442).