The war against healthcare-associated infections (HAIs) can be daunting. First, the enemy is invisible. Second, there's usually pressure to fight — and win — quickly. And third, the war never ends. No matter how thoroughly you rout the opposition today, reinforcements will appear tomorrow, forcing you to engage again. So you can never let up. When it comes to surface disinfection, effective strategies are the key to staying ahead. What's your battle plan, and — just as importantly — how will you recognize and motivate your foot soldiers on the front lines? Here are some practical suggestions.
TOUCH TYPE High-touch surfaces for patients often get the lion's share of attention, but don't ignore high-touch areas for staff, such as keyboards.1 Remember low-touch surfaces, too. Naturally, you want the people doing the cleaning and disinfecting to focus much of their attention on high-touch surfaces like bed rails, over-bed tables and bathrooms. But they should also make sure they disinfect areas that patients don't contact as much, but your staff do — things like light switches, doorknobs, privacy curtains and keyboards.
HITS AND MISSES It helps to spot check how well your staff is doing with a swab and a luminometer, but use the test to teach, never to punish2 Test for thoroughness. There are several commercial products designed to make your invisible enemy more visible. You can measure how well staff are doing by swabbing an area after they've finished cleaning and then inserting the swab into a light meter or luminometer. The more areas that were missed or cleaned insufficiently, the higher the level of light units it will register. You can also deposit fluorescent material on random surfaces and then shine a black light on those surfaces to reveal what's been left behind. Just keep in mind that the goal of testing is not to be punitive, but rather to create teachable moments. There are a lot of surfaces and it's easy to miss things. More on this in No. 10 below.
3 Do spot checks. Chances are you don't have the resources to check every room every time. That would take too much time and too much money (typically each swab costs between $3 and $4). Instead, consider conducting spot checks. As part of our citywide C. difficile prevention collaborative, each facility is required to do 25 random spot checks a week. That's enough to pinpoint who's doing a good job and who needs more training.
DRY TIME? Allow adequate drying time and follow all label directions with solutions and wipes.4 Pay attention to manufacturers' directions. One key to effective surface disinfection is that you use products appropriately. That includes allowing adequate drying time and following all label directions with solutions and wipes. A pet peeve of mine is when the cover on the disinfectant wipes container doesn't stay down tightly and firmly. When it pops up with a wipe sticking out of the top, chances are the wipe's going to dry out. A staff member who then uses that wipe will just be spreading germs around. As with most products, the wipes are great if used correctly, but if not, they may do more harm than good.
