Clean And Disinfect To Prevent MRSA

Within hospitals, wound clinics, urgent care centers, emergency rooms and other medical settings, cleaning after a life-threatening bacteria like MRSA becomes critical. When MRSA skin infections occur, cleaning and disinfection should be performed on surfaces that are likely to contact uncovered or poorly covered infections.

• Cleaning surfaces with detergent-based cleaners or EPA-registered disinfectants is effective at removing MRSA from the environment.

• It is important to read the instruction labels on all cleaners to make sure they are used safely and appropriately.

• Only employees who have been trained and have consistently proven their job skills and attention to detail should be assigned to post-infection cleaning of any facility.

• The EPA provides a list of EPA-registered products effective against MRSA http://www.epa.gov/oppad001/list_h_mrsa_vre.pdf.

Surfaces to Clean-Focus on surfaces that touch people’s bare skin each day and any surfaces that could come into contact with uncovered infections. For example, frequently touched surfaces such as bedrails, doorknobs, bed linens, gowns, overbed tables, blood pressure cuffs, computer table, bedside tables and various medical equipment.

Careful cleaning of patient rooms and medical equipment contributes substantially to the overall control of MRSA. The major focus of a control program of MRSA should be the prevention of hand transfer of the organism. Routine cleaning and disinfection of the housekeeping surfaces (e.g., high touch surfaces including cubicle or privacy curtains) should be adequate for inactivation of MRSA.  

Some facilities use a color-coded system of microfiber cloths: Gray (or blue) cloth for windows and mirrors, Green cloth for disinfecting all the horizontal and high-touch surfaces, and a Orange (or red) cloth for cleaning/disinfecting the rest room. The implementation of this system should prevent the spread of organisms on frequently touched surfaces.

The ideal way of setting this up, is to put a quart (or, liter) of properly diluted disinfectant in a bucket. Add 5-7 green and orange (or,red) microfiber cloths to the solution. When a cloth is taken out of the bucket, excess solution is wrung from the microfiber and the cloth is folded in half, and then in half again. This practice will provide eight wiping surfaces on a single cloth. The used cloth, when done, is placed in a container for items to be laundered. Soiled cloths never go back into the in-use solution. When additional microfiber cloths are needed to replenish the used ones, simply add them to the in-use solution. 

In a similar manner, set up your mop bucket with microfiber mops. Use one mop per patient room.

There is no evidence that spraying or fogging rooms or surfaces with disinfectants will prevent MRSA infections more effectively than the targeted approach of cleaning frequently touched surfaces and any surfaces that have been exposed to infectious materials. However, there are hydrogen peroxide fogging units and UV-C lights that can be brought into a “terminally cleaned, post-infection room” and the machine will disinfect virtually every surface in the room. This technology has been used effectively to impact hospital-acquired infections but can be pricey. Do your homework before buying.

Contact Times for Surface Disinfectants

This is an important issue concerning the use of disinfectants for noncritical surfaces in healthcare settings. The contact time specified on the label of the product is often too long to be practically followed. The labels of most products registered by EPA for use against HBV, HIV, or M. tuberculosis specify a contact time of 10 minutes. Such a long contact time is not practical in “the real world” of disinfecting environmental surfaces in a healthcare setting.  In actuality, most surfaces stay wet less than 3 to 5 minutes.  Multiple scientific papers have demonstrated significant microbial reduction with contact times of 30 to 60 seconds (I will provide references to those studies upon request).

The U.S. EPA will approve a shortened contact time for any product for which the manufacturer will submit confirmatory efficacy data. Currently, some EPA-registered disinfectants have contact times of one-three minutes. By law, users must follow ALL applicable label instructions for EPA-registered products. Ideally, product users should consider and use products that have the shortened contact time on the label. However, disinfectant manufacturers also need to obtain EPA approval for shortened contact times so these products will be used correctly and effectively in the healthcare environment.

Depending on how diligent housekeepers are and how well hand hygiene is performed, your facility might have a very low, HAI rate for MRSA. Don’t lose sleep wondering, “Am I just that good? Or, just that lucky?” Keep surfaces and hands clean. The life you save may be your own, your coworker’s or one of your patient’s.

J. Darrel Hicks, REH, CHESP, is the author of "Infection Control For Dummies" and has over 30 years of experience in the jan/san industry. For a free 30-minute phone consultation, contact him at darrel@darrelhicks.com or through his website at www.darrelhicks.com.