Show me the evidence
October 1st 2006

Are some microfibre cleaning products falling dangerously short of the mark? Dr.

Stephen Dalton C.Chem,MRSC,Technical Director, JohnsonDiversey offers some insight

You are hiring a nanny to care for your child.Two candidates apply for the job. Both interview well, but only one can provide valid references confirming their capabilities.Which do you choose? Similarly, which microfibre product or system does a hospital place its faith in, based on the growing spread available on the market? Particularly when each claims to perform just as well as the next and the cloths and mop-heads often look so similar?

If trusts are to successfully halve their MRSA statistics by 2008, this is a question that those responsible for the procurement of any hospital's cleaning and hygiene products should solemnly consider.

'Which products will enable my infection control teams to deliver the levels of cleaning safety and hygiene so critical to providing a clean, safe environment?'

Because in reality – and it is a rather startling reality -– the vast majority of those involved in this vital decision-making process are, through no fault of their own, pitifully ill-informed about the products or systems they are basing their decisions on. Notably, with regards to microfibre.

Despite all manner of enticing claims, from cloth effectiveness, to durability, to longevity etc, the term 'microfibre' has inadvertently and mistakenly become synonymous with 'excellent infection control'.The assumption is that one microfibre product is just as effective as the next.However, this couldn't be further from the truth.'Microfibre' does NOT translate to 'high-spec' (by law you can call any piece of material 'microfibre' provided it is less than 1 denier – the finer the denier, the more finely the fibre can be split and the greater the level of dust particulate and bacteria it will collect). Fabrics vary significantly, as do quality and infection-control credentials.

And yet few microfibre manufacturers are able to provide any hard evidence to substantiate the claims they make to trusts.Not a single document from a hospital or laboratory proving that, for example, before-and-after swabs have been independently taken, tested, recorded and the results published.Or, rather than focusing on how many hundred washes their cloths will withstand, that any proof exists as to how effective those cloths will actually be at eliminating bacteria after that time.

Abolishing old-fashioned mop and bucket, or standard cloth cleaning (which rely on chemicals, collect a paltry 30 per cent of germs and grime, and allow bacteria to fester for periods that don't bear thinking about) in favour of modern technology such as microfibre is, most now accept, timely.

But, if manufacturers can't prove their product claims, are they not acting irresponsibly making those claims at all? Particularly in the wake of MRSA, where the ability to delivery outstanding levels of germ removal is key.As Chief Nursing Officer Christine Beasley has already identified, the financial burden of HCAIs falls directly on the NHS, to the tune of around £1billion a year, and patients themselves, who suffer "needless pain, increased hospital stay and possible death".

Bear in mind that those who pitch their products and systems to healthcare organisations are represented by experienced sales people, with highly skilled powers of persuasion. Salesman's license simply wonνt wash – besides, those who are confident that they can back up their claims won't object in the slightest to being asked to.

Moving to an unvalidated microfibre system not only puts hospitals in a highly dangerous position, it is potentially fatal.

To date, no formal guidelines or regulations have been published in the UK stipulating the spec a microfibre cloth should meet or exceed.We are all keenly watching this space.

But there ARE questions that hospital decision-makers should ask in order to establish the products that are equipped to deliver outstanding infection control (versus those which are effectively pulling the wool, or in this case the cloth, over hospitals' eyes).

These include:

Have you got the lab reports showing the level of bacteria your cloth removes?

Can you provide independent test data validating your cleaning system versus a detergent disinfectant?

Has any of your support data been critiqued by the Department of Health?

Has your system been recommended to bypass submitted to – or approved by – the Government's Rapid Review Panel?

You say your cloths are long-lasting but have tests been conducted showing how well they actually work after your stated period and do they come with a guarantee?

Can you offer technical support and full site training to help users understand your product or system and achieve optimum results?

If – and only if – the answer to all of these questions is a resounding 'Yes' and can be supported with evidence, healthcare organisations are safe to assume that the product is equipped to deliver. Because the product in question can only be the Jonmaster System.

The Jonmaster System is the ONLY microfibre system to have been independently reviewed by – and subsequently recommended to by-pass – the Rapid Review Panel for immediate NHS implementation, on the advice of Professor Brian Duerden, Inspector of Microbiology at the Department of Health (be wary of those who might imply that their cloth or system has also achieved this merit – or indeed is one and the same product – that simply isn't the case).

The Department of Health, which does not endorse specific products or services, stated in a letter to JohnsonDiversey that: "It is clear that your development and implementation programme has taken the Jonmaster System beyond the stage at which a submission to the Rapid Review Panel would be appropriate".

Evidence presented included tests conducted at the Swedish National Testing and Research Institute confirming that Jonmaster's outstanding dust removal properties were "nearly twice as effective as conventional systems".

The system exceeded the Government's highest recommendation, which states that:'Basic research and development, validation and recent in-use evaluations have shown benefits that should be available to NHS bodies to include as appropriate in their cleaning, hygiene or infection control protocols'.

The Jonmaster System has been proven to remove 99.9 per cent of deadly bacteria from surfaces without the need for harmful chemicals. Its cloths are, accoding to the company, the only ones on the market guaranteed to deliver the same exceptional standards of bacterial removal after 500 washes.

The system is also the only cleaning product on the market that has been independently subjected to an in-depth swab evaluation programme and proven to be "as effective in controlling bacteria as 1 per cent sodium hypochlorite solution"– Source Lone Sarosi, Deputy Director of Infection Prevention and Control,Whipps Cross Hospital.

Lone Sarosi has gone on to report on Jonmaster System's userfriendly ergonomics (the system is 26 per cent faster than traditional methods), stating that:"Operators were unanimously positive and reported a more user-friendly, speedier system and visually cleaner appearance where the Jonmaster system had been used, which left more time available to do high cleaning due to the additional accessories (e.g. extension rods and moulded tools) the system offers", concluding that the "additional benefits of the Jonmaster system mean it should be considered as a new way of cleaning."Source: BMJ.com.

The Actex microfibre in the Jonmaster System exceeds the spec for ultra microfibre in Europe and Japan (the latter boast the most rigorous microfibre standards in the world).

As each Jonmaster cloth comes into contact with the surface being cleaned, it reacts with a static charge when used dry, or capillary action when used damp, drawing germs directly into the cloth and trapping them for the short time before thermal sanitation takes place. By using freshly laundered, newly sanitised cloths for each new area being cleaned, the system significantly reduces the risk of cross-contamination. Helpful colour coding ensures each clean cloth is returned to its place of origin after washing.The National Audit Office estimates that 15 per cent of MRSA cases could be prevented by better practices alone.

The system also removes a minimum of 90 per cent of floor soil, resulting in hospitals and care homes that are freer of dirt and grime than ever before (with public confidence in the cleanliness and safety of hospitals in need of reaffirmation, this must surely be welcome news), and is flexible enough to accommodate large floors, or patient curtain tracks and hard-to-reach areas like the backs of radiators where dust can build up.

Full site training and comprehensive technical support are also provided to enable the user to gain optimum cleaning and hygiene results (the Jonmaster System was created in conjunction with NHS trusts to ensure it is as practical and effective as possible).

In conclusion, drastic changes are being seen at all levels, with Health Ministers introducing shorter hours and pay-rises as part of steps to invest in our cleaning workforce and inspire a greater sense of involvement and value. But, as Christine Beasley and Sir Nigel Crisp have gone to great pains to stress, realising infection control targets is everyone's responsibility, with each and every person having a crucial role to play.

"The hard working dedication of our domestic staff needs to be supported by all NHS staff," says Christine Beasley. And also,we steadfastly believe, by all manufacturers of cleaning products and systems.

Alongside the nine key challenges that underpin the Saving Lives Plan-Do-Act-Assess Model, are 'signposts which identify information sources, best practice examples and reference materials which help users access the right information and material to inform their action plan.'

If we are to give our healthcare workers the best possible opportunity to tackle hospital acquired infections, now must surely also be the time to fully inform them about the innovative technology we have at our disposal. Only then will they be able to make a fully-educated decision about which product best arms them in the fight to combat MRSA and – in turn – achieve safe, clean environments we can all be proud of.

The Jonmaster system has appeared on ITV and BBC News,and featured on a GMTV special following its role in helping Milton Keynes hospital achieve high standards of cleanliness and infection control.

The system has already been embraced by Airdale,Woodend,and University College London hospitals, to name but a few.Of note,BUPA Care Homes were amongst the first to integrate the Jonmaster System into their 250-plus establishments, and – noting first hand evidence of the benefits of its one-cloth-per-room system – have since taken a repeat consignment of new cloths and mops.

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