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How Do We Know It is Clean?
By Colin Butterfield
MRSA, C-difficile, VRSA, Norwalk disease, Hepatitis C, Asian flu; every day there are reports that our schools, health facilities, workplaces and public spaces are becoming serious health risks. Microbiologist Dr. Jay Glasel is quoted as saying:
'Pathogens can remain alive and active even on dry surfaces, and be picked up by hands, feet, etc. A large percentage of seemingly normal asymptomatic individuals can be carriers of pathogens. MRSA is a good example of this. Perhaps 15-30% of so-called normal individuals are carriers of MRSA; that's why the problem is so widespread.'
There is an expectation that the cleaning service in these facilities will help protect occupants from these risks by ensuring that surfaces are properly cleaned. Meeting health-related expectations has been the task of cleaning services for over 100 years since it was realized that many soils harbored germs, and that germs caused disease. Before that, it was believed that 'miasmas' (bad air) were the cause of illnesses and that cleaning was often of limited value.
We now know how important cleaning is to healthy buildings and people, as demonstrated in the work of Dr. Michael Berry in his book, 'Protecting the Built Environment: Cleaning for Health'. Dr. Berry's work has brought real science to the cleaning industry and has led the way for others to measure and quantify the results of cleaning processes.
So, after the cleaning process is complete, how do we know it's clean? In the earliest days of organized cleaning, particularly in health care settings, there was the 'smell of cleanliness' from the pink carbolic acid soap used to scrub the floors, hands of physicians, and other surfaces. There was some comfort in this process but no real proof that germs had been eliminated, although they had surely been reduced because of carbolic acid's role as a pungent germicide.
In other facilities, visual inspection was the accepted method of gauging cleanliness levels, e.g., the 'white glove test', where a supervisor wearing white cotton gloves would wipe a finger over cleaned surfaces and assess the cleanliness by how soiled the white glove became. This largely unscientific method is actually still in use in some areas, in the belief that if it looks clean it must be clean.
Fifty years ago we saw the practice of taking swabs from environmental surfaces and culturing the results in a growth medium to confirm the presence of pathogenic organisms. This method was at least scientific, however there were drawbacks. First the tests took time, so the result was only confirmation that the surface was clean or contaminated yesterday, or even the day before. Long-term testing results could show a trend of cleanliness levels and identify persistent areas of risk so the cleaning staff could be directed to make a special effort in those areas.
But, in addition to the time lag, the testing was expensive, required lab resources, and wasn't always the laboratory's top priority. Plus, outside of health care settings - schools, offices and hotels - lab facilities did not exist.
More recently, UV light devices, known as black lights, were introduced for testing. Primarily used in the carpet cleaning industry as a visual check for urine in fibers, these testers are also used to scan washroom surfaces for the presence of body fluid contamination. While this method offers immediate results, harmless surface contaminants (like soap film) will also be visible under black light, leading to possibly erroneous conclusions about sanitation levels.
What the cleaning industry needed was a reliable scientific method of determining the environmental result of the cleaning process, and a cleaning process that delivered reproducible results. What is required is an Integrated Cleaning and Measurement (ICM) system designed to deliver a sanitary result as validated by testing. This is in contrast to untested combinations of germicide, equipment and methods that result from a piecemeal process of buying a cleaning product and then buying equipment separately without carefully planning the method of cleaning that maximizes the synergy of product and equipment, and without a clear expectation of what the result will be, in terms of removal of pathogenic soils.
A recent article that deals with this topic is 'Kaivac, Cleaning and Public Restrooms' by Doctor Jay Glasel (quoted earlier), Professor Emeritus of the Department of Microbial, Molecular and Structural Biology at the University of Connecticut Medical/Dental School in which he examines the High Flow Fluid Extraction (HFFE) method of cleaning. This method, also referred to as ‘spray and vac' is shown to be more effective in the removal of contaminated soils on environmental surfaces than either traditional wet mopping or microfiber flat mopping. Several factors contribute to the effectiveness of HFFE:
• Agitation, needed to dislodge soils from the substrate is provided by the turbulent spray action which loosens soils that are not reached by mopping;
• Only clean chemical solutions are used (dispensed fresh from the spray nozzle), as opposed to conventional wet mopping which results in progressively more soiled solution being mopped onto the surface as cleaning continues.
• Vacuuming which is more effective at removal of the used solution than mopping and wringing. This results in faster drying of surfaces, helping to deprive remaining organisms of the moisture they need to reproduce.
• Integral with the process is rapid confirmation of cleaning effectiveness using the ATP measurement system in a compact handheld device which measures Adenosine Triphosphate (ATP), the universal energy molecule found in all animal, plant, bacterial, yeast, and mold cells. ATP is a widely-recognized tool used by organizations of all sizes for measuring the hygiene levels of surfaces to help ensure consistent sanitation practices as well as public safety.
The effectiveness of this process is clearly demonstrated by results obtained by Dr. Glasel in the report 'Removing Soil: A Comparison of Cleaning Methods'. The report stated in part: 'the (HFFE ) cleaning process removed 98 percent of urine residue on both smooth hard surfaces and grout lines. Both string and flat mops left 30 times more urine residue than the (HFFE) system on grouted surfaces and 12-13 times more on smooth tile surfaces.'
With these advances in integrated process, and the ability to quickly test for the before and after level of cleanliness, we are seeing a fundamental change in the cleaning industry's ability to provide assurance of the health and safety of the facilities being cleaned. A system of Integrated Cleaning and Measurement (ICM) provides much-needed validation of health-related cleaning results, to help us to know when a surface is hygienically clean.