Measuring for Health
Sitting in class not too long ago, students sneezed, coughed, bled and touched their way through each day and didn't think twice about it. You know how it was: what you couldn't see wouldn't hurt you.
How things have changed. Given today's health risks, 'out of sight, out of mind' just isn't good enough (and really never was). Media headlines are filled with 'invisible' problems caused by the likes of H1N1, MRSA, c-diff and other microbial contaminants. Cleaning concerns are no longer limited to those jotted down during a visual inspection; it's critical that systems be implemented that allow for the measurement of contaminants, in order to adopt the right cleaning-system approach.
Nowhere are those concerns more prevalent than in schools. It's been suggested that teachers have the 'germiest' jobs in America. In fact, that's exactly what Dr. Charles Gerba, a microbiologist at the University of Arizona, has concluded. Teachers sit, stand and eat alongside more than 50 million students, and spend each day inside buildings with millions more microbial pathogens that can cause serious illness and even death.
'The concept of measuring for health — rather than for image only — is gaining momentum as educators and facility managers reach a better understanding of how cleaning measurement can affect the building's occupants, staff and visitors,' Dr. Gerba said. 'Measuring cleaning efficacy with an eye on health helps reduce ‘sick building syndrome,' infections and respiratory problems — and it benefits not only the building's occupants, but also the cleaning employees, since cleaner and healthier workplaces tend to experience less absenteeism among workers.'
Integrated Cleaning and Measurement, an open-source, unified-systems approach to institutional and industrial cleaning, uses measurement as a product and process selection, enhancement and validation tool. A primary purpose of ICM - beyond incorporating various tools and equipment to measure the presence of microbial, particulate or other contaminate to evaluate cleanliness - is to create a unification of elements and holistic view of building environments. Measurement is used as a means to assess progress and track the benefits of synergies.
The initial point of integration is at appearance cleaning and health-oriented cleaning. That is, facilities must not only look clean and healthy, they must actually be clean and healthy as evidenced by the proven and measured removal of unwanted – both seen and unseen – matter.
Effective systems integrate in a variety of ways and across a number of fronts when they are comprehensive and synergistic; equipment for detecting ATP; fungal enzyme; RODAC plate; Petrifilm; particle counters; airborne dust mass; infrared/moisture detection and other device and measurement platforms are becoming increasingly available, portable, and affordable. However, it doesn't stop there.
Implementing an ICM approach, aligned companies regularly conduct comprehensive diagnostic evaluation for key performance measures, including operational effectiveness and aggregate summary costs in the education industry. These indicators are benchmarked against industry best-in-class performance metrics.
The measurement process typically focuses on randomly selected representative items and a variety of types of space throughout a facility. Delivering a cleaning system that satisfies occupants, presents an attractive appearance and creates a healthy environment is the goal.
“As institutions measure and improve what they actually are doing — and publicize these successes — the benefits to student and teacher health and building operations will raise the level of respect that a district, school administration and parents have for the custodial department,” Dr. Gerba said. “Measurements will show supervisors, the school board, concerned parents and the community that the cleaning team is using the very best in cleaning systems. But, most important, by giving custodians the tools they need to [help] eliminate diseases, mold and fungus, institutions can be measurably cleaner, safer and more healthful.”
With this in mind, four high-level measures are targeted as part of ICM:
- Occupant Satisfaction
- Facility Cleanliness
- Indoor Air Quality
- Organic Matter/ATP Findings
Occupant Satisfaction and Facility Cleanliness
There are two powerful events that cause the cleaning operation to act quickly in any situation: vocal complaints about soiling conditions, especially from senior management and primary customers, which can disrupt any cleaning program, and when there is an identifiable cleanliness failure. In either case, the cleaning program becomes less stable.
The value of measuring cleanliness and occupant satisfaction lies first in reducing the need for service replacement due to inadequate cleaning activities. In addition, when facility occupants identify unacceptable soiling conditions, satisfaction with their work environment is diminished, morale suffers, productivity can be affected and complaints may be lodged.
High soil levels also create a feeding ground for microbes and may lead to other health-related problems. Measuring and managing cleanliness and occupant satisfaction anchors a proactive strategy to prevent complaints, reduce costs, and deliver a healthier environment.
Indoor Air Quality
The value of measuring particulates is to monitor IAQ risks that might exist due to inadequate mechanical filtration and cleaning activities. Monitoring particulate counts is an attempt to identify the presence of pollutants that impact IAQ, including:
- Biological contaminants (mold, dust mites, pet dander, pollen, etc.) Dust
- Environmental tobacco smoke (ETS) or secondhand smoke
- Fine particulate matter (PM2.5)
- Lead (Pb)
The strategy is not intended to detect all possible pollutants, but to gauge the overall presence of particulates in general. Measuring and managing particulate counts allows a proactive maintenance and cleaning strategy to reduce costs, deliver healthier IAQ and support a commitment to continuous process improvement for particulate reduction.
Generally, there is no standard for indoor vs. outdoor air quality readings, as there are multiple causes for particulate levels to differ; many IAQ investigators often find that the particulate levels inside a dwelling are higher than those outdoors. The IAQ industry "guideline" suggests a goal of at least 30 percent fewer particles indoors than outdoors. While not a standard, it does offer a commonly accepted baseline.
It is worth noting that while 98 percent of all airborne particles are 1 micron or less in size, and that 92 percent to 95 percent of the total particulate count falls in the range of 0.3 to 10 microns, there is no judgment that any specific particulate count is good, bad, right or wrong. These counts are a basis for establishing current particulate levels and tracking the systems and process changes that lower or raise those counts; the value lies in a period-to-period measurement of process improvement.
Organic Matter/ATP Findings
The value of organic matter/ATP findings lies in identifying and reducing the presence of significant levels of organic matter in the facility. High levels create a feeding ground for potential bacterial growth and other health-connected risks.
Note that high ATP levels are not the same as having high levels of bacteria or any specific health risk; the presence of ATP identifies an environment where these events may occur. Nonetheless, measuring and managing ATP underpins a proactive strategy to improve cleanliness, reduce costs and deliver a healthier environment through H1N1 remediation and similar cleaning processes.
What is ATP?
ATP (adenosine triphosphate) is the universal unit of energy found in all living cells, and is present in virtually all organic material. ATP is produced and/or broken down in metabolic processes in all living systems.
Processes such as photosynthesis in plants, muscle contraction in humans, respiration in fungi, and fermentation in yeast are all driven by ATP. Therefore, most foods and microbial cells will contain some level of naturally occurring ATP.
The testing protocol uses bioluminescence to detect residual ATP. Thus, ATP is a measure of luminescence, referred to as Reflective Light Units. The presence of ATP on a surface indicates the presence of microbial and/or organic matter, including food residue, allergens and/or bacteria. There are no absolute standards for ATP measurements that could be judged as good, bad, right or wrong; although lower readings are better than higher readings.
Organic matter is everywhere. Nonetheless, there is a general assumption that less organic matter is better than more in the context of surface cleanliness.
A study was recently conducted to assess the potential for reducing ATP levels in campus restrooms. A “before” ATP reading, reflecting the current restroom cleaning process as performed by in-house cleaning staff, was taken. ATP readings were also taken after cleaning with a no-touch system operated by trained staff, to determine if current restroom cleaning procedures were more or less effective than a no-touch system for reducing organic matter in restrooms.
Forty-five “before” and “after” ATP readings were taken in the test buildings’ restrooms and offices. While the sample is too small to generalize about the campus as a whole, they show a reduction of nearly 78 percent in the RLU readings after no-touch cleaning compared to the current cleaning processes.
ATP readings by types of surface were also reviewed on a percentage basis, to more clearly understand the impact of the no-touch cleaning system in reducing ATP levels. High volume touch points exhibited RLU readings that dropped in each test case, and by more than 64 percent on average after cleaning for all surfaces tested in restrooms.
With ever-growing pressure to deliver better, healthier and more cost-effective services, no educational campus can afford to wait for and then respond to cleaning failure. Once a health threat has taken hold, everyone wants to know why it happened, how to recover and how to prevent future failure. The answer lies in proactive, ongoing measurement of the key metrics of cleaning system performance. The open-source, unified-systems approach ICM is a good place to start.
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