By Jim Flieler, Vice President Sales & Marketing Canada, Charlotte Products Ltd.
A key to any successful infection prevention program is awareness of critical cleaning of contact points, or knowing your high-, moderate- and low-touch surfaces. Once you understand how to classify every surface in your facility, you will be able to treat those surfaces with the proper line of defense against infection. The idea is to kill the germs on the most critical contact points while making sure not to over-do your disinfection, spraying stronger chemicals where they are not needed.
Understanding an Excellent Resource
We refer to and often utilize the PIDAC: Best Practices for Environmental Cleaning for Infection Prevention and Control document to help support critical contact identification. Deep inside this detailed document is a handy tool called “Risk Stratification Matrix to Determine Frequency of Cleaning.” This was designed specifically for the healthcare setting, but it can be used in all different types of facilities, especially food service, schools and hotels. Taking a look at this matrix, and the Cliff’s Notes I provide here, will help you understand the differences between high-, moderate- and low-touch surfaces and allow you to plan an infection prevention program that is effective and efficient.
Once you understand your surfaces, you can create a plan that corresponds with your facility’s objectives, which can be followed as recommended by PIDAC:
- Low-risk surfaces need to be cleaned according to a fixed schedule and additionally as required.
- Moderate-risk surfaces need to be cleaned and disinfected at least once daily, and additionally as required.
- High-risk surfaces need to be cleaned and disinfected after each use, which is at least twice per day and additionally as required.
Three Simple Questions
There are three simple questions you can ask to assess the risk and determine which type of surface you’re dealing with.
- How much is it touched?
It’s true that any surface could become contaminated, but the risk is much higher on those surfaces that are constantly being handled by different people throughout the day. High-touch surfaces are those items and surfaces that frequently come into contact with occupants’ hands, such as doorknobs, elevator buttons, light switches, telephones, and toilet flushes. Low-touch surfaces don’t get touched that often. Think: floors, mirrors and ceilings. Moderate touch surfaces include everything in between. Incidentally, most items in the bathroom are considered moderate-touch surfaces. Many programs believe they will need to treat bathrooms as high-risk areas, but there are many parts of a bathroom including the floor and even parts of the toilet that aren’t as critical as say, a doorknob or a lightswitch.
- How Likely Is It to Touch Bodily Fluids?
Contamination with bodily fluids, or pathogen exposure like raw chicken, can be considered when you think about the types of activities that occur on and around each surface. In the healthcare setting, this becomes easier to determine as birthing suites and emergency departments have very high probability for exposure to bodily fluids, while waiting areas have lower probability. But when you look at a school, you’ll note that water fountains and even some toys will likely be exposed to bodily fluids. All bathrooms are generally considered moderately contaminated.
- How Vulnerable Are Your Building Occupants?
Think about your building occupants. Does anything about them make them more susceptible to infection? There are the obvious vulnerabilities: children in a school setting, patients in a hospital. But then there are even more levels of vulnerability to consider. In a healthcare setting, this comes into play most frequently. Burn units, intensive care units and cancer treatment centers host patients that have higher susceptibility to infection. More of the surfaces in these types of facilities should be considered high risk. Do you have immunocompromised building occupants? If you aren’t sure, you’ll want to find out.
Use the Answers to Write Your Infection Prevention Plan
Assign a score to each surface in your environment based on the answers to these three questions. The Appendix linked to within the PIDAC resource has an in-depth guide that helps explain how to score. These answers and scores will help you to determine whether each surface in your facility is low-, moderate- or high-risk. Then you will be able to determine a cleaning and disinfection procedure for each surface based on the PIDAC’s recommendations.
Your job is not done there. Planning is critical, but without documenting your procedures and then training continuously, your Infection Prevention program won’t work. Documented, on-site, hands-on training that includes presentations and written instruction should be an integral aspect of your infection prevention program. Infection prevention can be very complicated and intimidating, as you can see from just this one Appendix we have broken down here. That’s why it is critical that you teach in a simplified manner, stressing the importance of following the plan for each surface. Armed with a properly designed plan and the knowledge to back it up, your employees are our first line of defense against infection.