By: Jim Flieler, VP Sales Canada Charlotte Products
You can have the best plan, the most thorough disinfection process and a legion of chemicals with the highest kill claims but if you don’t monitor how well you’re doing, then your infection prevention program will flounder. There’s a reason we stress the key role that auditing plays in infection prevention: Without it, you’ll never know if you’re actually doing what you set out to do. Plus, monitoring your cleaning and disinfecting can reduce high-risk surface contamination by an average of 68 percent.
We use the word persistence to refer to the auditing step of infection prevention because it’s about more than just measurement. It’s about continuous monitoring, tracking data, reporting, and improvement based on analysis of the data.
An oft-told story…
Once upon a time, there was a state-of-the-art healthcare facility who invested hundreds of thousands of dollars in an ATP-based auditing program. Staff would come around monthly to swab the cracks in the facility’s flooring and hard surfaces to test for microbes, collecting tons of data. I visited with that facility after this program had been functioning for about a year. I asked them to show me the data they had been collecting, expecting to see analysis reports. Guess what? That data was stored in a filing cabinet down in the basement of the facility, but nobody had ever looked at it to draw any conclusions. Nobody was reviewing the data, comparing it to changes in process or using it to analyze their overall infection prevention program.
To be honest, I wasn’t surprised. This sort of thing happens all too often at facilities who have the best intentions of checking every box when they set up an infection prevention program. Without a plan for persistent monitoring that includes analyzing all the data collected, that infection prevention program will continue to do just that—check the boxes.
What Is Persistent Auditing?
By its very definition, auditing means checking your practice against a set standard. Your audit should examine the current situation (i.e. how many microbes are left on a surface) against a benchmark. You want to verify and validate the type of audit you are using. Is the method you are using verified somewhere? Is there support in literature for it? You will need to assign an audit team that handles planning performance and analysis of results. Audit results may be provided to others through various types of reporting.
There are four main ways to audit a surface to tell if it’s been cleaned (and sometimes, disinfected):
- Visual inspection. This is the most basic method of auditing, and it’s not recommended for a true measure of your infection prevention efforts. In fact, 90 percent of surfaces that appear clean still have pathogens on them.
- Black light or Glo Germ is a visual marker system that can be used to test whether a surface has been cleaned. It’s like an invisible BINGO dabber that you tap on a surface and with a black light you can see if your staff cleaned that mark off. It won’t be monitoring the presence of germs, but it can at least show you if your staff is attending to every surface.
- ATP (adenosine triphosphate testing) is an extremely common method of measurement used in the cleaning industry for the past ten years. It can detect if living cells are present on a surface and give results within seconds. Most people in modern facilities are aware of some of ATP’s limitations, including variability of effectiveness among devices and interference from certain chemicals.
- Newer imaging technologies are just coming to market that provide precise information about exactly what pathogens are present and where. Technologies like OptisolveⓇ actually capture an image of the microbial contamination present on a surface and can even produce a map that shows where they are and how much is there.
Remember, any data point is only as good as the response that comes from it. Some auditing systems are better than others, but regardless of what you use, you must have a team and a process in place to track the data and respond to your findings. If you are finding that one surface continues to have pathogens present even after disinfection, then it’s time to look at your process. Is dwell time being adhered to? Are soils being cleaned prior to disinfection? Will you need to adjust your disinfectant to find something with a broader kill claim or a shorter dwell time? Will you need to plan for more staff? These are responsive questions you’ll need to ask as you continue to analyze your results. Remember, we don’t call this step persistence for nothing. Continuous improvement requires continuous attention!
There are three major reasons we recommend every facility audit their infection prevention programs:
To protect your facility and brand image from what you otherwise wouldn’t see
To ensure consistency between your staff and different areas of your facilities
To provide positive feedback to your staff – both areas of excellence and opportunities for improvement