Infection Control With Steam Proven Effective Results for Decontamination

New cleaning technologies and methodology for successful application in the healthcare environment STUDY OF DRY SUPERHEATED STEAM VAPOUR & MICROFIBRE CLEANING Advancing hygiene standards & infection prevention in the patient environment

Healthcare-associated infections (HCAI) persist despite increasing resources Pathogens remain viable for weeks or months Some outbreaks are attributable to the environment Pathogens should be removed Physical Force Biocidal agent / detergent The Challenge

How Clean is Clean?

High Impact Interventions Reducing the risk Peripheral Intravenous cannula care Central venous catheter Urinary tract infections Indwelling urethral catheters Infection and presence of Clostridium difficile Ventilator associated pneumonia Surgical site infections Renal dialysis catheter careENVIRONMENT

Biocides therefore considered essential –Halides –Phenols –Oxygen releasing compounds –Quaternary ammonium compounds Problems associated with common biocides –Harmful to health –Degrade built environment –Promote antimicrobial resistance Physical force with conventional cleaning equipment alone is not considered sufficient

Destructive Decontamination Damage to the fabric of the patient environment reduces cleanability Increases the challenge for rapid and consistent cleaning results

Destructive Decontamination

Study of dry superheated steam cleaning AIMS Studies designed to validate Dry Superheated Steam (DSS) and purpose designed steam delivery tools as a cleaning and sanitising process, applicable to the healthcare environment. Study focussed on validation of safe removal of bio-film and procedures to achieve microbiological decontamination of ‘risk’ contact surfaces in the patient environment.

Test Equipment Portable steam generating units Dual DSV outlets Dual action steam & Vacuum extraction Water filtration Decontamination ‘autoclave tank’ Thermal disinfection

Steam cleaning methods and applications System can be fitted with task specific cleaning tools for detail or large area cleaning Restoration cleaning Combination steam + MicroFibre tools

Steam cleaning Portable steam generating units Dual action steam & Vacuum extraction Water filtration of extract Vapour penetration emulsifies and aids soil removal, vacuum and microfibre absorption Thermal disinfection Does not support microbial resistance or hyper sporulation

Study of potential applications for steam cleaning Study of ‘risk’ contact surfaces in the patient environment Patient bed & mattress Patient furniture Wheelchairs Bedside equipment (trolleys, drip stands) Curtains Bathroom & Toilet surfaces

15 Conventional mop/clothDry Steam Vapour Methods of Cleaning

A study of Dry Steam Vapour, and novel proprietary steam & microfibre tools * designed for cleaning the healthcare environment November 2006 – March 2008 TNO Report V7683 Netherlands Organisation for Applied Scientific Research * Patent PendingOspreyDeepclean UK © 2008 TNO

The definition of cleaning / disinfection performance, within the context of this study, is stated as “The successful and safe removal of contaminant from the target surfaces using a combination of steam vapour cleaning method, through penetration and physical removal (vacuum extraction and or microfibre adsorption) and in some instances degrees of thermal disinfection and elimination of susceptible micro-organisms”

Test Micro-organisms Methicillin resistant Staphylococcus aureus (MRSA), UCLH clinical isolate Acinetobacter calcoaceticus-baumannii (ACCB), UCLH clinical isolate Staphylococcus aureus, NCTC Pseudomonas aeruginosa, NCTC Bacillus subtilis, NCTC Candida albicans, NCTC Aspergillus niger, UCLH clinical isolate Vancomycin resistant Enterococcus (VRE), UCLH clinical isolate Enterococcus faecalis, ATCC Clostridium difficile spores (010 strain) UCLH clinical isolate Enterococcus hirae, NCTC

Method Intentionally contaminated with (10 5 spores /10 6 bacteria ) organisms within a manufactured bio-film spread evenly on 100cm 2 surface and allowed to dry MRSA Acinetobacter calcoaceticus baumanii (ACCB) Klebsiella pneumoniae Clostridium difficile spores Vancomycin resistant Enterococcus (VRE) Aspergillus niger Contact plates used before and after cleaning to validate effective removal of micro-organisms from the hospital surfaces

Contaminant dispersion & aerosolisation Dispersion and aerosolisation experiments were conducted to evaluate the risk factor associated with steam cleaning, using a range of standard and the new generation of custom designed steam delivery tools. Evaluation based on measures of microbiological decontamination efficacy, and patient safety.

Contaminant dispersion & aerosolisation Bio-film was inoculated with Bacillus stearothermophilus Patient bed was contaminated. The cleaning procedure was monitored by air sampling during cleaning and post clean settle plates (60 min.) Aerosolisation tests repeated using MRSA, ACCB, E coli, Clostridium difficile spores Each cleaning tool was evaluated for dispersion using dye & fluorescence marker tests

Aerosolisation tests Bed contaminated with heat resistant Bacillus stearothermophilus spores. Recovery of aerosol by settle plates and air sampling. RESULT: No spores were detected

Aerosolisation & Dispersion tests Aerosolisation tests repeated using MRSA, ACCB, E coli, Clostridium difficile spores. Air sampling placed 10 cm from point of steam contact with surface being cleaned. Safranin innoculum on smooth hard surface. Steam challenge to remove stain using paper blotter capture points to detect dispersion (steam & vacuum tool)

Aerosol test squeegee flat surface tool Aerosolisation tests repeated using MRSA, ACCB, E coli, Clostridium difficile spores. Air sampling at point of cleaning RESULT: No aerosol was detected by Microbial Challenge Impactor (MCI) three stage air sampler during the cleaning process. (sampled at squeegee head)

Aerosol Test – Steam Mop Floor inoculated with Clostridium difficile spores. RESULT: No aerosol was detected by Microbial Challenge Impactor (MCI) three stage air sampler during the cleaning process. (sampled at mop head)

1. MATTRESS TOOLUCLH May AEROSOLIOSATION TEST Clostridium difficile spores (1,000 sq cm) RESULT – No Aerosol was detected during cleaning process RUN 1Air Sample Left Air Sample Right Bed 1 Sample area Blank control Test Test Test Bed 2 Sample area Blank control Test Test Test Bed 3 Sample Area Blank control Test Test Test Bed 4 Sample Area Blank control Test Test Test

Contaminant dispersion & aerosolisation RESULT We conclude that with the correct selection of tool and cleaning technique, dry saturated steam does not cause an aerosol contamination hazard

Surface microbiological measurement Clostridium difficile spores (inoculum 1,000 per sq cm) Mattress surface cleaned with steam tool with Microfibre pad RESULT: 5 fold reduction (99.99%) with steam vapour and microfibre cleaning method TEST POINTS CONTACT PLATE METHOD Total Viable Count PRE CleanPost Clean 1Post Clean 2Post clean 3 >500 cfu Confluent growth Surface decontamination challenge

Results Surface decontamination Consistent results demonstrated for VRE, Bacillus subtilus, Pseudomonas aeruginosa Clostridium difficile spores

Results Bio-Film Removal Bio-film removal was consistent across all test surfaces (plastic laminates, vinyl, stainless steel, ceramic tiles wood and painted finishes). Rough textured surfaces and crevices posed challenges, but were overcome by selection of appropriate cleaning tool and technique. e.g. steam + Microfibre

Conclusion With competency based staff training, dry superheated steam vapour cleaning technology, delivered via purpose-designed tools, provides cleaner hospital environments without the use of ecologically damaging biocides. - Improved cleaning productivity - Enhanced daily & preventative maintenance - Reduced damage to material surfaces - improved patient safety

How Safe is Cleaning? “Disinfectant wipes designed to eradicate MRSA are helping to spread the deadly superbug because staff are using them to clean more than one surface” Failure of Material? - Method? – Training? Lack of knowledge? – Insufficient research? Some or All of the above???? Presentation to American Society of Microbiology, General Meeting, Boston Dr Gareth Williams, Wales School of Pharmacy, Cardiff University

The OspreyDeepclean Dry Steam Vapour Healthcare Tools Patents Pending

Mechanical Strength Cotton FibreMicrofibre

Scanning Electron Micrographs demonstrating the action of microfibre Ultra microfibre Strands Static attraction of dust Dirt captured within fibre

Microbiological studies: Pre & Post clean Ultra Microfibre vs. J-type cleaning cloth

SOP Training Tools

Steam Floor mop with Microfibre pad DSV Steam Cleaning Standard Operating procedure (SOP*)

Steam Cleaning Standard Operating procedure Hard surface Steam Cleaning hand tool with Microfibre pad

Steam Cleaning Standard Operating procedure Left: Mattress steam Cleaning hand tool with Microfibre pad Above. Tube cleaning detail tool

Steam Cleaning Standard Operating procedure Steam and Vacuum squeegee tool. Hard surface and upholstery cleaning

Huntley bed cleaning procedure

Netherlands Organisation for Applied Scientific Research Acknowledgements Study supported by OspreyDeepclean, UK.