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GREENING OF HOSPITALS WORKSHOP Cleaning of Surfaces in Patient Care Areas Results From New Hospital Studies.

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Presentation on theme: "GREENING OF HOSPITALS WORKSHOP Cleaning of Surfaces in Patient Care Areas Results From New Hospital Studies."— Presentation transcript:

1 GREENING OF HOSPITALS WORKSHOP Cleaning of Surfaces in Patient Care Areas Results From New Hospital Studies

2 Two Paradigm Shifts in Patient Room Cleaning 1 st Going from the string mop to the flat mop system for floor cleaning 2 nd Moving from cleaning patient areas with a detergent + disinfectant to a detergent-free cleaner + bleach

3 Using Flat (Microfiber) Mopping Systems in Hospitals Paradigm Shift #1

4 Take Home Message 1. Practical, common-sense approach for patient care areas, but WILL NOT meet all mopping needs. 2. Immediate water and chemical savings, but most cost savings are a result of reduced labor. 3. Improved ergonomics and cross- contamination infection control 4. Proactively address potential hurdles to implementation.

5 Mopping Requirements  Patient care areas cleaned daily; common areas cleaned more often  Floor cleaners can contain dangerous chemicals  Special precautions required to avoid cross- contamination

6 Why Hospitals Switch to Flat Mopping Systems  Ergonomic issues  Labor savings  Reduced chemical and water usage  Cross-contamination concerns related to conventional mopping

7 What is Microfiber? Split wedged shape of Polyester fiber 1/100 th of human hair

8 What is Microfiber? Microfiber String Mop Strand Human Hair (1/10 th of a human hair) Hook Feature (Cross-section)

9 …and what difference does it make for mopping?  Increases the effective surface area of your mop  More effective in cleaning up especially small particles  Microscopic fibers thoroughly clean surfaces

10 Flat Mopping Systems: How Do They Work? 1. Place 2. Mop 3. Peel 4. Launder

11 vs. Conventional Loop Mops 1. Dip and Wring 2. Mop 3. Repeat 3x 4. Change Water 5. Send to Industrial Laundry

12 Ergonomic Benefits  During use, similar gross motor skills required  Unfavorable positions for both methods, but flat mopping systems significantly reduced the frequency and severity of the risk factors “Case Study: Are Microfiber Mops Beneficial for Hospitals?" Sustainable Hospitals Project

13 Ergonomic Analysis “Case Study: Are Microfiber Mops Beneficial for Hospitals?" Sustainable Hospitals Project TasksString MoppingFlat Mopping Lift empty metal/plastic bucket from cart Lift metal bucket (5 lbs) Trunk flexion 60° Lift plastic basin (1 lbs) Trunk flexion neutral Carry empty bucket/basin and walk 3 feet Forces at trunk, shoulders, elbow, hands (carrying 5 lbs) Negligible forces (carrying 1 lb) Fill and lift bucket/basin Forces acting on neck, back, hands, wrist, shoulders (water 16 lbs) Less forces acting due to lower weight (8 lbs) Lift bucket of water, walk to cart Flexion of trunk, hips, knees, shoulders. Forces at trunk, wrist, shoulder, elbow Upper body posture is neutral; less forces acting on trunk, wrist, shoulder, and lower body

14 Ergonomic Analysis TasksString MoppingFlat Mopping Carry bucket of water, walk to cart Forces at trunk, wrist, shoulder, and elbow No longer performed Lift bucket of water and place on cart surface Wrist and elbow flexion. Forces acting as previously. No longer performed Walk to closet for bottle of cleaning solution on shelf. Reach and grasp. Neck extension, hips flexion, shoulder flexion 120° Same Add cleaning solution and replace bottle on shelf Neck extension, hips flexion, shoulder flexion 120° Same “Case Study: Are Microfiber Mops Beneficial for Hospitals?" Sustainable Hospitals Project

15 Ergonomic Analysis TasksString MoppingFlat Mopping Pick up wringer and hook it onto lip of bucket Trunk flexion 80°, elbow flexion 60°, shoulders flexion 80°. Forces acting at trunk. No longer performed Push cart to room, distance 25’ Walking with trunk flexion 30°, shoulder and elbow flexion 80°. Forces acting at trunk. Walking with trunk flexion neutral. Pushing cart with standard equipment. Remove excess water from mop Palmar grasp, shoulder elevation and flexion, elbow flexion (using mop wringer) Wring cloth, wrist/hand twisting with grip force “Case Study: Are Microfiber Mops Beneficial for Hospitals?" Sustainable Hospitals Project

16 Ergonomic Analysis TasksString MoppingFlat Mopping Mopping the floorTrunk flexion Mopping the floor Place mop in bucket of water, wring, and continue mopping. Same risks as previous steps Turn mop head downside up and replace cloth at mop head “Case Study: Are Microfiber Mops Beneficial for Hospitals?" Sustainable Hospitals Project

17 Microfiber Considerations Non-industrial washing machines must be used to wash microfiber mop heads  Cannot be used in areas contaminated with blood or body fluid  Some products ineffective in greasy, high traffic kitchen areas  Sticky floors?

18 CA DHS – Licensing and Certification March 2002 Memo: “…acceptable to install household washing machines to launder microfiber mops…” provided: Water Temp between 130 and 140 degrees F Separately from other textiles No bleach/fabric softener “…as long as (these conditions) are met, there should be no infection control related issues.”

19 Not All Mopping Systems are Created Equal…  No governing body or industry definition of “microfiber”  Density of fibers per square inch can affect pricing and cleaning ability  …vs denier (diameter of fiber)  Some are pretreated with antimicrobials

20 Should I Use Disinfectants for Cleaning Floors?  Some microfiber products are treated with triclosan or other antimicrobials  Concerns about general use of antimicrobials  Potential for causing antimicrobial resistance  Unknown long term consequences of its use

21 How many mops handles/heads needed? Mop Handles = Number of Janitors Mops Heads = + twice the number of rooms cleaned daily + “shrinkage” + special circumstance – large rooms, extra dirty rooms

22 Case Study : University of California Davis Medical Center  Reasons for change…  Increase in worker’s compensation claims  Frequent “light duty” ergonomic requirements  Reduce cleaning time for patient rooms  Reduce chemical use and disposal

23 Cost Analysis: Lifetime Mop Costs Conventional Wet Loop Mops  $5 each  55 to 200 washing lifetime  22 rooms cleaned per washing  $0.11 to $0.41 per 100 rooms  $4.00 each  500 to 1,000 washing lifetime  1 room cleaned per washing  $0.40 to $0.80 per 100 rooms Microfiber Mops

24 Cost Analysis: Chemical Costs Conventional Wet Loop Mops  10.5 ounces per day  $0.22 per ounce  20 rooms cleaned per day  $11.55 in chemicals per 100 rooms  0.5 ounces per day  $0.22 per ounce  22 rooms cleaned per day  $0.50 in chemicals per 100 rooms Microfiber Mops

25 Cost Analysis: Water Use Conventional Wet Loop Mops  21 gallons per day  20 rooms cleaned per day  105 gallons of water used per 100 rooms  1 gallon per day  22 rooms cleaned per day  5 gallons of water used per 100 rooms Microfiber Mops

26 Cost Analysis: Labor Costs Conventional Wet Loop Mops  20 rooms cleaned per 8 hour shift  $12 per hour  $480 per 100 rooms  22 rooms cleaned per 8 hour shift  $12 per hour  $436 per 100 rooms Microfiber Mops

27 Flat Mopping Systems Performance Summary  Microfiber last 5 to 10 times longer  Increase production by 10%  Use 95% less chemical  (2.5 vs. 53 ounces per 100 rooms cleaned)  Use 95% less water  (5 gals vs. 105 gals per 100 rooms cleaned)  Overall costs about 5-10% less - not including workers comp savings

28 Costs/Benefits That Are Not Quantified  Reduced risk of cross- contamination related to mopping  Reduced worker’s compensation claims  Reduced water use  Patients say: “quieter, quicker, less disruptive”

29 Discussion 1. Who’s currently using microfiber mops? 2. How satisfied are you with them in patient care areas? 3. What hurdles did you have to overcome? 4. What have you seen as the greatest benefit to using microfiber mops?

30 Take Home Message 1. Practical, common-sense approach for patient care areas, but WILL NOT meet all mopping needs. 2. Immediate water and chemical savings, but most cost savings are a result of reduced labor. 3. Improved ergonomics and cross- contamination infection control 4. Proactively address potential hurdles to implementation.

31 Resources EPA Factsheet Sustainable Hospitals 10 reasons to use microfiber mops Practice Greenhealth

32 The Need for Action The number of Healthcare Acquired Infections is too high Even with interventions: Hand hygiene education Gel stations installed throughout patient care areas Closer oversight of drug administration  HAIs and associated deaths continue  Cost of a patient room runs $9,462 per day

33 Unnecessary Deaths: The Human and Financial Cost of Hospital Infections  By Betsy McCaughey, Ph.D.  HAIs are the fourth largest killer in America  HAIs add an estimated $30.5 Billion to the cost of healthcare in the US each year  There is compelling evidence that nearly all HAIs are preventable This creates a new legal issue

34 Estimated Hospital Cost of HAIs 2,000,000 Estimated HAIs per year in USA X $15, Average additional hospital costs per HAI = $30.5 Billion Per year treating HAIs

35 Cleaning is Essential Cleaning hands is the first step – preventing recontamination is the second Two studies showed that over half of objects that should have been cleaned or disinfected were overlooked As long as surfaces in a hospital are not cleaned, caregivers’ hands will be recontaminated

36 Cleaning of Environmental Surfaces is Essential Cleaning of environmental surfaces is so important that if not done properly, the placing of a patient into a room previously occupied by a patient with C-diff can be a fatal error

37 Studies of Patient Room Cleaning Studies undertaken by HospAA of two-step cleaning process Studies measured the current cleaning prior to implementing the two-step cleaning process  Current process used cleaners with quaternary ammonium disinfectant  This process leaves a residue that can lead to a biofilm

38 Paradigm Shift #2 Two-Step Cleaning First step: Clean to remove biofilm with non- detergent cleaner that contains 218 ppm bleach  Sodium Chloride is used to soften water  Sodium Citrate is used to chelate hard water mineral deposits  Sodium Carbonate is used to saponafy organic soils into soaps that are easily rinsed  Sodium Bicarbonate is used as a builder and sequester Second step: Wipe the 14 HROs with bleach of 1,000 ppm

39 How Detergent-Free Cleaners Work Cleaning is defined as: the ability to clean or remove soil from a surface Accomplished by one or more of the following  Lowering surface and interfacial tensions  Solubilization of soils  Emulsification of soils  Suspension of removed soils  Saponification of fatty soils  Inactivation of water hardness  Neutralization of acid soils

40 Background for Studies Used luminometers manufactured by 3M to measure adenosine triphosphate (ATP) ATP measured in relative light units (RLUs) The 14 high risk objects (HROs) outlined by Dr. Philip Carling in his studies were measured

41 ATP Luminometer

42 Carling’s 14 High Risk Objects Objects:  Sink  Toilet Seats  Over Bed Tray  Bed Side Table  Toilet Handle  Bed Side Rail  Nurse Call Box  Visitor Chair Arm Rest  Patient Telephone  Rest Room Door Knob  Restroom Hand Rail  Bedpan Cleaner  Patient Room Door Knob  Restroom Light Switch

43 Using the ATP Swab

44 Results of Studies Three hospitals: Tested a minimum of 25 terminally cleaned rooms in Phase I  1,011 measurements made of the 14 HROs Mean Measurement was 441 RLU Worst HROs:  Nurse Call Box 900 RLU (N=75)  Patient Telephone 742 RLU (N=68)  Visitor Chair Arm Rest 624 RLU (N=75)  Bedside Rail 503 (N=77)  Rest Room Door Knob 489 RLU (N=53)  Sink/Counter 445 RLU (N=79)  Rest Room Hand Rail 411 RLU (N=76)

45 Efforts to Standardize Studies Attempted to measure a minimum of 25 terminally cleaned rooms in each phase  No disturbance of patients  The room was ready for re-occupancy Trained staff doing ATP measurements  Uniformity in swabbing  Focused on the worst of Dr. Philip Carling’s 14 HROs Sampled with staff and monitored results

46 Results From Four Hospitals Phase I (cleaner/quaternary ammonium disinfectant) (N= 408)  Worst Five measured at each facility  Mean 1,360 RLU (r=468 RLUs – 2,290 RLUs) Phase II (DFC + bleach) (N= 412)  Mean 143 RLU (r=89 RLUs – 199 RLUs)

47 Four Hospital Study Results HRORLUs Before* RLUs After* (Phase I) (Phase II) Restroom Door Knob 1, Nurses Call Box 2, Patient Telephone 1, Bed Side Rail Visitor Chair Arm Rest 1, Restroom Hand Rail Sink/Counter * These are Mean scores in RLUs

48

49 Percent of Samples Found “Clean” A surface is deemed to be clean at a reading of 250 RLU or less using the 3M luminometer Results from the four hospital studies:  Phase I: Found 25.0% were below 250 RLU  Phase II: Found 87.4% below 250 RLU

50

51 Future Patient Rooms

52 Continuous Improvement Train EVS staff in use of DFC + bleach Use ATP monitoring to measure change Continue use of ATP monitoring for training and quality assurance Monitor HAIs Develop a Process Improvement Story


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