The continued rise of antibiotic-resistant superbugs is creating a serious and growing public health threat. Most wanted on the Infectious Diseases Society of America’s “superbug” hit list: Methicillin-resistant Staphylococcus aureus, a.k.a. staph or MRSA, which in recent years has killed more U.S. citizens than AIDS.

Once found almost exclusively in medical facilities, MRSA has expanded its reach to community settings including schools, day care centers, dormitories, gymnasiums, fitness centers, locker rooms, cafeterias, military facilities and prisons, and the frequencies of these reports are skyrocketing. A study published in The Journal of the American Medical Association in October 2007 revealed that of 8,987 observed cases of invasive MRSA, 58.4 percent were “community-onset” infections, and 13.7 percent were “community-associated.” Community-onset refers to having obtained MRSA in a healthcare setting other than a hospital, and community-associated refers to situations in which patients don’t have established healthcare risk factors.

While skin-to-skin contact through skin abrasions is the most frequent form of transmission, MRSA also lives on soft and hard surfaces. No facility is immune — which is putting a spotlight on building service contractors’ ability to prevent cross-contamination and outbreaks for an increasingly diverse group of clients.

Teaching from experience

Tim Murch, president of Mitch Murch’s Maintenance Management Co. (4M) in St. Louis, got first-hand experience with MRSA last year.

He believes he acquired the bug in the locker room where he prepares for hockey. After a typical Friday morning workout, his elbow started hurting, and by Saturday night, he was checked into the emergency room.

“They looked at it and knew immediately what was,” says Murch. “It was very, very painful, and I had an IV and pain killer. I got antibiotics, and they told me it would be a week to 10 days, and to hang low. It affected my productivity. I was very concerned, due to fact that you can die from it.”

Murch has friends whose children play sports and who have had MRSA multiple times on various regions of the body. The more a person has MRSA, the more resistant to antibiotics it becomes, he says, creating a vicious cycle.

Murch’s professional response to MRSA matches his progressive approach to his cleaning business: to proactively educate prospects and clients about MRSA’s severity, risks and bottom-line implications such as health insurance costs, absenteeism, presenteeism, productivity and profitability. He began offering stepped-up cross-contamination services 16 months ago, but hasn’t had many takers yet. The spoiler is the necessary dwell time for effective sanitization, which raises the cost.

Prevention

BSCs looking to target MRSA and other superbugs will place a heavy priority on preventing cross-contamination, through strict training, the proper use of tools and chemicals, and color-coding.

4M uses the superbugs discussion to review standard cross-contamination prevention tactics already being employed, including color-coded microfiber cloths and mops, four-filter backpack vacuums, and disinfecting high-touch areas like light switches and door handles.

“We’ve also introduced hand sanitizers in restrooms, lobbies and break areas,” Murch adds.

San Francisco-based Service By Medallion’s philosophy of green cleaning cites preventing cross-contamination at its core, says Director of Special Projects Elias Nacif. The company began addressing superbugs intently in early 2006.

“The program focuses on preventing cross-contamination: This is how we do it, and how we’re different,” Nacif explains. “It’s really about best practices, and not moving any bacteria from one place to another.”

The BSC uses double-loop, color-coded microfiber rags and mops that have disinfectant and antimicrobial protection built-in. Color-coding is also the rule.

Dual chamber buckets and flat head mops that keep dirty water apart from clean water also helps stop a spread of germs. In controlled environments like labs and clean rooms, flat mops are predipped into cleaning solution, and rolled inward incrementally so that it’s all rolled into a separate compartment until the cleaner leaves the room.

“It’s time-consuming and not cheap,” says Nacif, “but some areas have to be cleaned that way.”

Most clients aren’t asking the company to disinfect anywhere other than restrooms, Nacif says. Hand sanitizers are placed in common areas such as break rooms and coffee stations.

Other BSC clients, such as hospitals and schools, need more thorough disinfection of facilities.

School strategies

Especially when dealing with vulnerable populations, such as children, BSCs need to be vigilant about the science of cleaning. PMM Companies of Baltimore cleans educational buildings — and a few recent MRSA tragedies have driven home the importance of cleaning and disinfecting in schools.

“In the Washington Metro area a couple of children died from it,” says Mitch Lustig, executive vice president. “That certainly disturbed complacency. It’s been a gigantic learning curve for us, and our customers. Our response has been disinfecting, education and training.”

What kills MRSA is disinfectants, he says.

“We spray, let it cure for 10 minutes, and wipe with microfiber, wearing gloves and goggles,” he continues. “We try to concentrate on the touch points: sinks, water fountains, countertops, doorknobs, toilets, urinals and light switches. With a 10-minute cure time it’s a tall order to do everything nightly, so you have to pick the highly visible touch points.”

In addition to utilizing color-coded microfiber products, and providing hand sanitizers in locker rooms and the nurse’s office, Lustig promotes hand washing and hygiene training for the children, installing hands-free restroom products, and distributing informational flyers from his suppliers regarding topics such as stopping the spread of staph infections. During weekly meetings he talks with his clients about upcoming events and scheduling, and reminds them that his company is always thinking in terms of preventing cross-contamination.

“It’s not just bathrooms, locker rooms and showers. It’s gyms, equipment, weight rooms, computer rooms, play rooms, cafeterias,” Lustig says. “A lot of our facilities have gone to hand-washing stations, and provide hand-washing seminars for the children, along with teaching them about hygiene, keeping wounds clean and covered, and not sharing soap, clothes, towels and utensils.”

If an outbreak occurs, remediation is done with foggers, which kill 100 percent of microorganisms.

“Our people wear respirators, and full body suits,” says Lustig. “I think it takes 30 minutes. We generally do it on a Friday when the school’s empty. You have a safe environment in a rapid amount of time, but it is expensive to administer — and you can’t assure that a fogger this week means you’re protected next week. The reality is, if you’re not practicing safe hygiene techniques, it could come back to bite you in a week.”

Just as green cleaning presented big opportunities for BSCs, superbugs are adding an entirely new gravitas to the services a BSC has to offer. BSCs who offer sound cross-contamination prevention services are proving ever more valuable to a growing number and variety of clientele.

Lauren Summerstone is a freelance writer based in Madison, Wis.




POSTED ON: 10/1/2008