Cleaning for health

On 9th February 2011,the World Federation of Building Service Contractors resolved to make Cleaning for Health a key priority in the coming years. Its new project will define the role of the cleaning industry in the promotion of public health,explains Jennifer Simmonds

Cleaning is our first defence against the ongoing threat of 'super bugs', influenza viruses, and more recently E.coli outbreaks.

In healthcare settings the importance of cleaning, disinfecting and sterilizing is widely accepted and its implementation is usually strictly enforced .

However, outside the healthcare environment, in our schools, offices and public transport systems; the value of cleanliness is less understood.

We are all aware of the importance of personal hygiene measures, such as washing our hands before we eat, covering our mouths when we cough; but is this enough to stop a potential pandemic disease from spreading? Different microbes have different modes of transmission.The biggest threats to health in our communities today are likely to come from MRSA, Clostridium difficile,Norovirus and influenzas such as swine and avian flu.All of these diseasecausing microbes can either be directly transmitted from person to person or indirectly via an infected surface. If someone touches a contaminated surface with their hands, and then touches their face, eyes or mouth, the pathogen can enter the body and has the potential to cause illness.

Microbes can survive several months on surfaces, so in order to stop this contamination and transmission cleaning and disinfection of surfaces is essential.

Over the next few months the WFBSC will be amassing peerreviewed science and information from governmental bodies and international organisations regarding the most effective methods to prevent the spread of infection in the community.We will identify gaps in our existing knowledge and propose further studies to address them.

New web resource In the autumn we will create a website communicating evidence and advice on cleaning for health which will be coherent, accessible and widely endorsed.

In this ambitious project we aim to place the WFBSC as a central source of information on cleaning for the control of infection.

Already we have found some interesting and controversial information regarding cleaning methods.

For example, the use of sodium hypochlorite, or bleach, to kill any microorganism is recommended in several texts. It works fast, effectively and is non-discriminatory between different microbes.

Some microbes, such as C.difficile which can cause severe infection of the colon, are notoriously difficult to kill in the environment.This is because C. difficile is spore-producing. Spores are resistant to commonly used disinfectants. In fact, spore-production can increase when exposed to nonchlorine-based cleaning agents.Therefore researchers have recommended use of dilute solutions of bleach for routine environmental disinfection.

However, cleaning contractors are reluctant to use bleach due to the health risks of chlorine inhalation and the long-term damage it can cause to surfaces. It is a priority to find effective and practical alternatives to bleach to kill all microbes, including spores.

Another controversial issue that our research has unearthed is the adherence to recommended contact times.The contact times required to kill a population of microbes should be listed on the chemical cleaner container by the manufacturer.The minimum contact times are based on the most resistant types of microbes.

However, some of the specified times are too long to be practically followed. For example, M.tuberculosis, the bacteria that can cause tuberculosis, requires 10minutes of exposure to a disinfectant before there is a sufficient reduction in infectivity (a decrease of ~99.9%). Also, the more microbes present on a surface, the more time a germicide needs to destroy them.

Therefore in highly soiled areas, these contact times may increase.This is a practical problem that cleaning clients and contractors need to address; efficacy should not be at the expense of efficiency.

Even with our knowledge base on cleaning for health, and the prospect for much more to come, the question still remains, is there the political will to enforce our recommendations? In the event of an outbreak of a new pandemic strain of disease, it would be very unlikely that a specific vaccine would be available to inoculate the public during the first wave of the pandemic. In addition, dependent on the severity of the outbreak, there may not be sufficient quantities of antiviral medications to go around. Instead governments and councils will have to focus their efforts on the prevention of transmission of the disease within our communities.As there are no indicators as to when an outbreak may happen, councils will need to stockpile and maintain chemicals, equipment, personal protective equipment (PPE) and trained personnel for immediate action in a pandemic scenario.

This is a costly investment and its use may be rare.Are public authorities willing to invest substantial resources as a precaution when the return is unforeseeable? What we do know, is that a major pandemic is inevitable.Within the last century we have had four major flu pandemics, along with HIV and SARS and experts are sure there are more to come.Despite having improved methods of prevention, detection and treatment than in the past; our high-density living in urban areas will accelerate transmission of disease which could have a devastating impact.

Jennifer Simmonds WFBSC Cleaning for Health Project Intern