Hospitals and other medical facilities throughout Canada and the United States continue to be concerned about hospital-acquired infections (HAIs). In Canada, there are approximately 220,000 cases of HAIs reported each year, which translates to about one in nine people becoming infected.
Infected patients stay in hospitals longer, require additional medical attention and are in more pain. Furthermore, HAIs are responsible for approximately 12,000 deaths and cost the country an estimated $1 billion annually.*
In response, many hospitals often turn to enhanced cleaning. However, more cleaning can actually be a double-edged sword, producing unintended harmful effects that can impact patients and staff. This is because using conventional cleaning chemicals or not using cleaning products properly in healthcare settings can cause respiratory problems, including asthma attacks, especially among young people and any person with a suppressed immune system. Skin and eye damage among cleaning workers may also increase. Further, some conventional cleaning products can contribute to indoor environmental pollution.
Because of this, numerous hospitals throughout North America, including Canada, are increasingly engaged in Green cleaning strategies where possible. This involves the transfer to certified Green cleaning chemicals, commonly known as proven-Green cleaning chemicals. It also involves cleaning equipment such as HEPA-filtered vacuum cleaners and low moisture carpet extractors and floor machines, and microfibre cleaning cloths and mop heads, which use less chemical and water than conventional cloths and mop heads.
In most medical facilities, the goal of a Green cleaning strategy is three-fold:
(1) Maintain, if not improve, the overall level of cleanliness of the facility and help prevent HAIs.
(2) Protect patients, staff and cleaning workers from the potential harmful health effects of conventional cleaning products.
(3) Reduce cleaning’s overall impact on the environment and promote sustainability.**
IMPLEMENTATION OF GREEN CLEANING AND ADDRESSING STAFF RESISTANCE
Hospital cleaning workers are typically the first to notice the benefits of using Green cleaning products and equipment. However, interestingly, they are also often the first to resist the transfer from conventional products to environmentally preferable products. This pattern originally surfaced over a decade ago. Even today, with elevated awareness on the benefits of Green cleaning products and their improved performance – some products actually perform as well as or better than traditional counterparts, custodial resistance still emerges. However, many medical facilities have found that this resistance can be overcome in a number of ways, including:
Patience. Realizing ahead of time that there may be some resistance, hospital administrators who are patient with their staff and gradually transfer to Green cleaning products find that acceptance of the new products is typically easier and more universal.
Understanding. Many administrators form focus and discussion groups with custodial workers to discuss why the Green cleaning products are being selected and how a Green cleaning strategy is being adopted.
Training. Especially when it comes to the use of some cleaning tools and equipment, proper training is essential to their adoption. For example, the use of microfibre flat mops is often met with initial resistance, partially because these mops are not used in the same ways as traditional string mops. Proper training on how to use microfibre flat mops invariably eliminates resistance.
Testing. Facilities should test a number of products and value-added benefits (training, inspections, trouble shooting, etc.) from various distributors. The benefits of single sourcing or buying from a ‘buying group’ may be far-outweighed by more effective products and training that can help lower labour costs, which typically are 80 to 85 per cent of the overall cleaning costs.
EXAMINING FIVE HOSPITALS AND THEIR GREEN CLEANING PROGRAMS
In order to promote research on the effectiveness of Green cleaning chemicals and products for medical facilities, three independent organizations – The Centre for Health Design (CHD), Health Care Without Harm (HCWH) and the Healthier Hospitals Initiative (HHI) – studied the results of five major American hospitals that transferred to Green cleaning programs in the past 10 years. The hospitals studied were: (1) Dartmouth-Hitchcock Medical Centre, a 396-bed hospital in New Hampshire.
(2) Ridgeview Medical, a 109-bed hospital in Minnesota.
(3) Magee-Women’s Hospital, a 350- bed hospital in Pennsylvania.
(4) Boulder Community Hospital, a 172-bed hospital in Colorado.
(5) Cleveland Clinic, a multi-specialty medical centre with in-patient and out-patient programs in Ohio.
Researchers found that all five locations sought to select only proven-Green cleaning products. However, due to regulations that impact all North American hospitals, some products, including disinfectants, must be used in certain areas of the hospital or clinic, such as operatory areas. These products are not Green-certified. In some cases and where possible, cleaning products that were not certified but considered to have less impact on the worker, building users and the environment, were substituted. Because one goal of a Green cleaning program is to reduce cleaning’s overall impact on the environment, some hospitals determine which areas of their facilities need more extensive cleaning, which typically means using more cleaning chemicals, and which areas require less cleaning attention, reducing chemical usage. For instance, administration areas in three of the hospitals mentioned above were recognized as “low risk” areas. Therefore, only Green cleaning chemicals are used in these areas and used sparingly to maintain appropriate levels of cleanliness.
Another goal of Green cleaning is to benchmark and evaluate the overall cleaning effectiveness of the program. This important step in the evaluation process involves testing surfaces with adrenosine triphosphate (ATP) systems. Some hospitals use ATP meters with fluorescent markers, which reveal soiled or contaminated areas. For other hospitals mentioned in the study, actual cultures were analysed in laboratories to determine if bacteria, germs and other contaminants were found on surfaces at significant, health-threatening levels. To see how well the Green cleaning programs worked in these hospitals, approximately 150 individuals, including physicians, nurses, healthcare staff, and custodial managers and workers, participated in an online survey which indicated that Green cleaning was effective at maintaining, if not improving overall cleaning effectiveness in the facilities, as well as promoting sustainability – including using less water and chemicals.
Another finding noted was fewer complaints from patients and staff about odors and health-related issues typically attributed to the use of powerful cleaning chemicals. Finally, the impact of Green cleaning on the prevention of HAIs was identified as the most important concern in the study. While the researchers suggested more study was needed, it was believed that the implementation of Green cleaning strategies had helped prevent HAIs.***
In healthcare and most facilities, Green cleaning and the use of environmentally preferable cleaning products is a key strategy in promoting and protecting human health. In recent years, as these products have become more cost effective and their performance has improved, the double-edge sword of enhanced cleaning is eliminated. Researchers and medical administrators should be optimistic that further studies will support Green cleaning programs as a viable solution to a persistent HAI problem in Canadian and other North American hospitals.
* Other stats: HAIs are the fourth largest killer in Canada, right behind cancer; it is estimated that 30 to 50 per cent of HAIs are preventable; Canada has the highest HAI rate in the developed world. Sources: American Journal of Infection Control; Auditor General Canada; Auditor General British Columbia.
** Proven Green cleaning products are typically manufactured using non-petroleum-based, renewable ingredients, are often high-concentrated, and packaged in larger containers, helping to promote sustainability.
*** “Cleaning in Healthcare Facilities: Reducing human health effects and environmental impacts;” Health Care Research Collaborative Paper Series; Lowell Centre for Sustainable Production, Lowell, Mass., 2009.
By Jennifer Meek, Director of Marketing at Charlotte Products Ltd.