There is no question; the COVID-19 pandemic has impacted everyone, from how we do business to how we think about the spread of illnesses. The effects will be felt for a long time to come. For the cleaning and disinfection industry, the public’s attention on infection prevention and public health has never been greater. People are looking beyond aesthetics and while they want safe, clean spaces, they also want to use disinfectants responsibly.
How are businesses finding this balance? One example is the wide adoption of touchless surface disinfection technologies, such as electrostatic sprayers. These devices allow businesses to target specific surfaces (think high risk, high touch), or all surfaces in an area (e.g., restrooms), efficiently and effectively. Operators can disinfect surfaces in a matter of seconds while using less disinfectant overall. In fact, some electrostatic sprayers can disinfect four times faster and use up to 65% less disinfectant compared with traditional trigger sprayers. This is due to the even coating and efficiency of the charged droplets. This means fewer bottles, fewer refills, less potential surface impact, less disinfectant, lower overall cost, and less time spent disinfecting. As with most things, less is truly more.
Clorox® first launched an electrostatic device in March 2017. While the technology had previously been successfully used in industries such as agriculture and inkjet printing, electrostatics were new to the surface disinfection space. In the first two years, electrostatic devices were primarily used in the education, automotive, healthcare, and office industries. Over the past 17 months, electrostatic sprayers have become increasingly popular. Clorox now offers devices in all shapes and sizes, to accommodate all types of usage occasions, including carts, backpacks, and handheld devices.
As the pandemic progressed, more and more businesses began adopting touchless disinfection technologies. In an effort to better understand which businesses and industries were mobilizing electrostatic devices in their surface disinfection arsenal and how use has changed since before the pandemic, we took a deep dive into our current electrostatic users. Results showed that while electrostatic devices are still very popular in schools, offices, and healthcare, they are becoming increasingly popular across a spectrum of various public spaces and facilities. In total, we found that 72 new industries began using electrostatics since the beginning of the pandemic. Businesses of all sizes, from family-owned restaurants and independent daycare centers to large companies like United, Live Nation, and the NBA have adopted electrostatic technology into their regular disinfecting practices to ensure their facilities are as safe and healthy as possible.
Here is what we found:
As highlighted recently by the former director of the Centers for Disease Control and Prevention (CDC), Dr. Robert R. Redfield, “when we’re talking about making sure high-touch surfaces are disinfected and actually safe to touch, I certainly recommend electrostatic sprayers over non-automated options – the improved surface coverage makes a big difference when it comes to deactivating virus particles.”1
To learn more about which type of electrostatic devices are best for your facility, visit https://www.cloroxpro.com/products/electrostatic-technology/
1. Dr. Redfield interview from July 2021
In the past year, the words aerosol, particle, and droplet have all been brought front and center as we learn more about SARS-CoV-2, the virus that causes COVID-19 and its transmission. In the world of surface disinfection, these words are equally important particularly when it comes to evaluating new disinfection technologies. However, in my experience both inside and outside the public health community, these words tend to be used interchangeably. It leads me to question how the cleaning industry is supposed to differentiate and identify the information most relevant to them and the safety of their workers. Are all droplets really aerosols? Are particles the same as droplets? How does the particle or droplet size impact the safety of the various surface disinfection applications?
To help clarify, let’s break it down:
- Aerosol: A suspension of tiny particles or droplets in the air.1 Aerosol is often used both to define respiratory droplets and particles that are small in size, as well as to explain the collection or cloud of these droplets in the air.2
- Particle (also known as particulate matter): Tiny pieces of solids or liquids that are in the air. Examples of these particles include things like dust, smoke, dirt, and drops of liquid. Particles can range in sizes. Some are big enough (or appear dark enough) to see with our naked eye, e.g., you can often see smoke in the air. While others are so small that you cannot see them in the air. As illustrated in the below image, the range of particle size can vary considerably.3
- Droplet: Simply defined as a tiny drop of liquid.4 A droplet is a type of particulate matter.
In April 2021, the Centers for Disease Control and Prevention (CDC) released their updated guidance for prevention of COVID-19 when using electrostatic sprayers, foggers, misters, or vaporizers. In this guidance, they caution operators that “these devices aerosolize chemicals, or suspend them in the air, and they can stay in the air for long periods of time, especially if the area is not well ventilated.” In terms of safety, the size of the droplets or particulate matter in the air is what matters when determining if something is truly inhalable or breathable and sizes can vary greatly.6 Large droplets or particles generally fall to the ground quite quickly because of gravity. To provide scale, inhalable particles or droplets that enter the airways are usually anything below 30 µm (30 microns) and respirable particles or droplets are typically defined as anything less than 10 microns in diameter.7 5 The CDC guidance correctly points out that users should review the requirements and safety protocols for these technologies, but it is important to knowthat the technologies provide different levels of performance and require different safety precautions.
So where do the common surface disinfection technologies fall in terms of particle or droplet size?
- Misters or Foggers have the smallest particle size (typically average size about 10-30 microns).8,9 These droplets are so small that they often hang in the air for a while before being pulled down by gravity. These small particles are also well within the breathable range. This means they have the potential to reach the deep lung after inhalation. Because of this, you will see higher Personal Protective Equipment (or PPE) requirements, instructions for sealing vents and leaving the area during fogging, and longer re-entry times.
- Trigger and Pump Sprayers deposit large droplets on a surface (average > 100 microns). These large droplets are dependent on gravity to fall to surfaces, have patchy distribution patterns, and are clearly visible to the applicator.
- Electrostatic Sprayers have a more medium-sized particle size (average > 40 microns).8 If you were goldilocks, you might say they are “just right” because they have high coverage rates and emit droplets that are on average outside the inhalable and respirable range. This means that vents do not need to be sealed and there are generally no or very low re-entry times for bystanders when using this technology. Additionally, unlike the trigger sprayer or foggers and misters, the electrostatic particles have an electrical charge making them attracted to the surfaces being sprayed. This results in the particles dropping out of the air quickly and not just waiting for gravity to pull them down.
As you can see, foggers, trigger sprays and electrostatic sprayers offer a range of disinfecting benefits. While electrostatic sprayers and foggers are often considered similar, their performance demands different levels of personal protective equipment (PPE), room preparation, and room re-entry wait times. Regardless of the technology you decide is right for your cleaning and disinfection protocols, the droplet size of the delivery system does make a difference.
1. CDC. The National Institute for Occupational Safety and Health (NIOSH): Aerosols [Internet]. Centers for Disease Control and Prevention. 2010 [cited 2021 Apr 28]. Available from: https://www.cdc.gov/niosh/topics/aerosols/default.html
2. CDC. Science Brief: SARS-CoV-2 and Potential Airborne Transmission - Updated Oct. 5, 2020 [Internet]. Center for Disease Control and Prevention. 2020 [cited 2021 Apr 28]. p. 4. Available from: https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/scientific-brief-sars-cov-2.html
3. CDC. Air Quality: Particle Pollution [Internet]. Centers for Disease Control and Prevention. 2019 [cited 2021 Apr 28]. Available from: https://www.cdc.gov/air/particulate_matter.html
4. Merriam-Webster. Droplet [Internet]. 2021 [cited 2021 Apr 28]. Available from: https://www.merriam-webster.com/dictionary/droplet#:~:text=Medical Definition of droplet,drop (as of a liquid)
5. CDC. Safety Precautions When Using Electrostatic Sprayers, Foggers, Misters, or Vaporizers for Surface Disinfection During the COVID-19 Pandemic [Internet]. Centers for Disease Control and Prevention. 2021 [cited 2021 Apr 28]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/php/eh-practitioners/sprayers.html
6. Baron P. Generation and Behavior of Airborne Particles (Aerosols) [Internet]. National Institute for Occupational Safety and Health. 2020 [cited 2021 Apr 28]. Available from: https://www.sdpt.net/rd/Aerosol_101.pdf
7. European Aerosol Federation. Guide on Inhalation Safety Assessment for Spray Products. 2013.
8. EPA. Instructions for Adding Electrostatic Spray Application Directions for Use to Antimicrobial Product Registrations [Internet]. United States Environmental Protection Agency. 2021 [cited 2021 Apr 28]. Available from: https://www.epa.gov/pesticide-registration/instructions-adding-electrostatic-spray-application-directions-use
9. WHO. Space spray application of insecticides for vector and public health pest control [Internet]. World Health Organization - WHO. 2003 [cited 2021 May 1]. p. 45. Available from: https://apps.who.int/iris/bitstream/handle/10665/68057/WHO_CDS_WHOPES_GCDPP_2003.5.pdf?sequence=1
If there were a theme song for the past few months, I think we would all agree it would be something closely resembling Hear Comes the Sun, the classic by the Beatles. The smiles are returning, and it certainly feels like years since the long, cold lonely COVID-19 winter began! However, as a public health professional, I wish we were all singing the 80’s classic Don’t Stop Believin’ by Journey because this epidemiologist wants you holding on to the feeling of hygiene. I want us, though we are excited to re-open, to remember what we have learned and continue to embrace the public health awareness brought on by the pandemic.
But I cannot say everyone agrees. In the past few weeks, the number of articles written to combat “Hygiene Theater” disinfection antics is increasing at an alarming pace.1,2 The pendulum of public opinion is swinging and we are ready to move into the future by returning to the pre-2020 “normal” instead of a “new normal” as I had hoped. As I sit here contemplating how to articulate why I feel strongly we should not return to old behavior, I need to pause to reach for a tissue. I have a cold. This is a strange and rare phenomenon lately, but I have concerns it will soon be a wide-spread experience as more of us begin to re-emerge from our homes and our careful precautions give way to old habits. Instead, my hope is that as we enter a post-pandemic world, we bring forth the lessons we have learned over the past year to create a healthier future for all.
Here’s what we know: COVID-19 can be transmitted on surfaces, but it is unlikely to be the main source of transmission.
We all remember the early days of the pandemic when we would wipe down our groceries, packages, and lived in constant fear of catching the virus. We did this because we did not yet know enough about this emerging pathogen and we wanted to protect our loved ones. We now know much of this was unnecessary as the principal mode of transmission of SARS-CoV-2 is through exposure to respiratory droplets in the air and not through surfaces (or fomites).3 Though some might call this theater, I think it was simply our attempt to mitigate the risk of a very scary pathogen from entering our homes. Similarly, out of this fear and with a hope to restart our economy during a pandemic, our communities and businesses went into disinfection and sanitization overdrive (i.e., Hygiene Theater).
If a business is purely using disinfectants for show and more importantly, not using them safely and in accordance with label instructions, then I believe we will all lose sight of the lessons we have learned over the past year.
In this way, I agree with many voicing their concerns publicly. However, we cannot just throw away the public health awareness we have gained over the past year and we cannot make the mistake of thinking COVID-19 is the only pathogen posing a threat to our future health, safety and economy. My optimism on this subject in my November Hygiene Theater Blog still holds true today. We have an opportunity to turn this heightened awareness of germ transmission into actionable infection prevention in our communities.
Over the past year, we have also seemingly forgotten about all the other microbes and pathogens that live and thrive on our surfaces.
Illnesses such as the Flu have virtually been wiped out by our COVID-19 precautions but as evidenced by my current nasal congestion, they have not gone away and will return to our spaces with us. Norovirus, for example, is a virus that causes vomiting and diarrhea and thrives on surfaces in areas where large numbers of people congregate. Norovirus outbreaks are common and frequently found on cruise ships, in long term care facilities, and in school and childcare settings. You may hear norovirus illness referred to as “food poisoning,” “stomach flu,” or “stomach bug” and because of the large number of variants, we can be infected repeatedly.4 Close quarters, shared spaces, and high-touch surfaces make it easy for norovirus to spread.
Although the number of norovirus outbreaks have been drastically reduced during the pandemic, norovirus, on average, each year results in over 19 to 21 million cases of vomiting and diarrhea in the United States. It is estimated by the age of five, 1 in 110,000 children will die and 1 in 160 will be hospitalized due to norovirus.4 In 2016, researchers estimated that norovirus resulted in a total of $4.2 billion in direct health system costs and $60.3 billion in societal costs (including productivity loss and income) per year.5
People are ready to return to normal life and we have an opportunity to impact what that looks like.
We must, now more than ever, implement sanitation protocols and base them on risk assessments and scientific evidence. One of the best examples of this is hand hygiene. The simple act of washing our hands more frequently is our first line of defense yet hand hygiene compliance rates are low and we often contaminate surfaces without even realizing it. In fact, nearly 80% of infectious diseases are spread by our hands and the surfaces we touch.6 This is why surface disinfection is such a critical tool in our efforts to break the chain of infection. Our approach to the use of disinfectants and sanitizers needs to be in a way that is not only effective but also efficient. This involves prioritizing places where the risk of pathogen spread is greater, like high traffic, shared spaces, and frequently touched surfaces. By utilizing SMART Disinfection practices (think “work smarter, not harder”), we can target disinfecting higher risk areas to reduce pathogen transmission while also optimizing the use of disinfectants and hopefully preventing concerns of overuse in our communities.
The curtain might be closing on COVID-19 theater, but that doesn't mean our work is done.
1. Thompson D. Deep Cleaning Isn’t a Victimless Crime The CDC has finally said what scientists have been screaming for months: The coronavirus is overwhelmingly spread through the air, not via surfaces. [Internet]. The Atlantic. 2021. Available from: https://www.theatlantic.com/ideas/archive/2021/04/end-hygiene-theater/618576/
2. Anthes E. Has the Era of Overzealous Cleaning Finally Come to an End? [Internet]. The New York Times. [cited 2021 Apr 23]. Available from: https://www.nytimes.com/2021/04/08/health/coronavirus-hygiene-cleaning-surfaces.html
3. CDC. Science Brief: SARS-CoV-2 and Surface (Fomite) Transmission for Indoor Community Environments - Updated Apr. 5, 2021 [Internet]. Centers for Disease Crontrol and Prevention. 2021. p. 5. Available from: https://www.cdc.gov/coronavirus/2019-ncov/more/science-and-research/surface-transmission.html
4. CDC. Norovirus Burden of Norovirus Illness in the U.S. CDC [Internet]. Centers for Disease Crontrol and Prevention. 2020 [cited 2021 Apr 23]. Available from: https://www.cdc.gov/norovirus/trends-outbreaks/burden-US.html
5. Bartsch SM, Lopman BA, Ozawa S, Hall AJ, Lee BY. Global economic burden of norovirus gastroenteritis. PLoS One [Internet]. 2016; Available from: https://pubmed.ncbi.nlm.nih.gov/27115736/
6. Healthcare T-C. Gross! Hand hygiene and other germy facts [Internet]. 2018 [cited 2021 Apr 29]. Available from: https://www.tchc.org/blog/2018/12/12/hand-hygiene-and-germ-facts/
The world of touchless disinfection is growing quickly and there is a lot of varying information available. Taking on a new technology can be daunting. Maybe you have done your homework and you are interested in adding electrostatic sprayers at your facility. Or maybe you have already added them in and still have questions. Below I have laid out some best practice recommendations. Ultimately, there is no one-size-fits-all for acute healthcare settings, but hopefully some of these give you and your team a place to start.
- Educate Internally
Electrostatics, foggers, misters, oh my! You might have these technologies straight in your mind (if not, check out Breaking Down Electrostatic Technology: Everything You Need to Know), but there is a good chance your colleagues are not completely clear on the key differentiators. As with all areas of Infection Prevention and Public Health, education up front can do a lot to mitigate concerns and misinformation. It can also help to identify those on the Environmental Services (EVS) team that will be your key operators and trainers. I recommend leveraging trainings offered by your electrostatic sprayer and/or disinfectant manufacturer. Many offer online training videos and resources to assist you in setting up a plan for initial and ongoing training.
- Confirm your Disinfectant is EPA Approved for Electrostatic Use
This one seems obvious, but I think it is an important reminder. Your electrostatic sprayer manufacturer should provide a list of safe chemicals that have been tested and approved by the United States Environmental Protection Agency (EPA) for use through an electrostatic sprayer. This ensures safety not only for the operators but also for patients and other staff members in the area. Not all devices are created equally. Similarly, not all disinfectants are safe or effective when used through an electrostatic sprayer. If you are not sure if a disinfectant has been approved for electrostatic use, you can look up the Master Label on the EPA website by using the EPA Registration Number.
- Target Your Electrostatic Disinfectant Based on Area
Once you have identified the list of safe EPA-approved chemicals, consider selecting more than one electrostatic disinfectant for your facility. Your decision to use one disinfectant versus another may vary depending on the type of area, surface compatibility, frequency of use, and the number of devices you are planning on employing. The same strategies you use in your protocols now with wipes and trigger sprays should also be considered when you are adding electrostatic sprayers to your arsenal. For example, you may choose to use a sporicidal product in your patient areas where the risk of C. difficile is a concern and then use a more general hospital disinfectant in your lobby and waiting rooms. Your individual risk assessments can also help to drive these decisions.
- Develop a Step-by-Step Protocol
Having a clear and easy-to-understand protocol will help to prevent any potential issues. Here are some suggestions for setting electrostatic sprayer operators up for success in your protocol development:
- Always recommend gathering supplies in advance, performing hand hygiene, and putting on appropriate personal protective equipment (PPE) prior to spraying.
- Have operators remove all linens, paper products and trash from the spray area. I recommend placing a sign outside to indicate that cleaning is in progress. Of note, most products do not recommend use of an electrostatic sprayer while bystanders are in the area. Re-entry time will depend on the disinfectant in use and can be affected by other factors such as air exchange rates, temperature, and humidity.
- Be sure to include a step for cleaning visible soil. Electrostatic sprayers can be an adjunct to routine manual cleaning and disinfection or a stand-alone step if there is no visible soil on the surface.
- Don’t Forget About Spraying Strategy
Make sure to clearly spray target surfaces and avoid just spraying into the air. Stick to one spraying path: clockwise or counterclockwise. Use a zone approach to spray, starting with the far side of the area and working towards the door. Spray using a slow, side-to-side motion, working from high to low surfaces. Stand the appropriate distance from surfaces when spraying. The required distance may vary by electrostatic sprayer. Your goal is to have surfaces wet but not saturated. HINT: If you see dripping or pooling of liquid, you have sprayed too much! Try to maintain a consistent spraying approach with the exception of sensitive electronics and glass or mirrored surfaces. These surfaces may require a wiping step after the contact time has been reached to remove residue and to keep surfaces looking polished.
What do smallpox, polio, and measles1 all have in common? They have all been successfully eliminated in the U.S. via wide-spread vaccination. After ten long months, the COVID-19 vaccine roll-out is finally happening and we are well on our way to successfully combating another infectious disease.
What will determine if the new vaccines are successful?
Simply put, people need to get vaccinated for a vaccine to be effective. Yes, the vaccine itself must be safe and have high efficacy (i.e., create an adequate immune response in those vaccinated), but ultimately what determines if a vaccine is truly successful at eliminating a disease in a population comes down to herd immunity.
What is herd immunity?
Herd immunity is the act of protection that is provided when enough of a population gains immunity to an illness that it halts transmission. Every infectious disease has a reproduction number or R0 (pronounced “R naught”). This calculation is the average number of people an infected individual will infect in an at-risk (non-immune) population. Inevitably, for any given disease, the R0 calculations can vary widely, but are generally based on three primary characteristics:
- How long an individual is contagious while infected
- The likelihood of infection per contact between an infectious person and a susceptible person
- How often people are encountering one another (contact rate)
With COVID-19, R0 estimates change based on location and population, but some studies calculate it being as high as 5.7 (95% CI 3.8–8.9) .2 So, if I am infected with COVID-19 and interacting with a completely vulnerable group of individuals, on average, I could expect to infect five other people. To reach herd immunity, you essentially need to pass an immunity threshold that makes it so that an infected person has no one to transmit the infectious disease to because no one around them is susceptible (R0 < 1).3
Why do we need to get vaccinated?
Herd immunity has been a hot topic throughout the pandemic as there are only two ways to truly achieve it: 1) natural immunity via infection and 2) immunity via vaccination. Unfortunately, when it comes to most infectious diseases, natural immunity through active infection might not be enough to offer full protection and any immunity provided could dissipate over time leaving some individuals vulnerable to reinfection. Additionally, waiting for a population to become infected, and therefore immune, can take a very long time and may result in unnecessary deaths and long-term health implications.
One great example of this is chickenpox. Not long ago, parents would purposely expose their children to infectious individuals to ensure immunity was developed at a young age. I can remember vividly being forced on a play date while covered in spots. Unfortunately, to achieve this natural herd immunity, each year, over 10,000 were hospitalized and an estimated 100-150 died. After the vaccine became widely available in the U.S. in 1995, more than 3.5 million cases of chickenpox are now prevented each year.4
How many people need to get vaccinated to achieve herd immunity?
The estimated number of people that need to get vaccinated to achieve herd immunity depends on several factors:
- The infectious disease and how contagious it is.
- The proportion of people that are susceptible in a population.
- The overall effectiveness of the vaccine.
Experts do not yet know what that threshold is for COVID-19. This is because we do not know how many of us already have immunity. Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, estimates that around 75% of the public needs to get vaccinated for herd immunity to provide protection and truly stop the spread of COVID-19.5
How do we learn more about the COVID-19 vaccines and the plan to reach herd immunity?
Concerns over the speed with which these vaccines were developed are warranted. We should all do our due diligence with any new public health intervention. Thankfully, the information on safety is widely available. Here are three comprehensive resources to help address any concerns you, your family, or your staff may have:
- CDC COVID-19 Vaccine Update Resource including all safety information
- Coronavirus Vaccine Tracker including the latest updates and information on all COVID-19 vaccines (safety and efficacy)
- How CDC Is Making COVID-19 Vaccine Recommendations
What can we do now?
The Centers for Disease Control and Prevention (CDC), in consultation with the U.S. Advisory Committee on Immunization Practices (ACIP), is prioritizing vaccine distribution in a fair and ethical way and continuing to provide transparent updates on the vaccine roll-out plan. While we wait for our turn to be vaccinated, we need to remind our family, friends, and staff to continue to do all the things that we have been doing – wear masks, maintain social distance, avoid indoor and poorly ventilated spaces, wash our hands, and clean and disinfect regularly. We do these things to protect ourselves, but more importantly, to protect others. That is also true of vaccines. We get them to create herd immunity and protect those in our society that are most vulnerable. I, for one, am looking forward to adding another eliminated disease to the above vaccine success list – smallpox, polio, measles, and COVID-19!
- Measles Elimination [Internet]. Centers for Disease Control and Prevention (CDC). 2020. [cited 2020 Dec 8] Available from: https://www.cdc.gov/measles/elimination.html
- Sanche S, Lin YT, Xu C, Romero-Severson E, Hengartner N, Ke R. High Contagiousness and Rapid Spread of Severe Acute Respiratory Syndrome Coronavirus 2. Emerg Infect Dis [Internet]. 2020. [cited 2020 Dec 8] Available from: https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article
- Delamater PL, Street EJ, Leslie TF, Yang YT, Jacobsen KH. Complexity of the basic reproduction number (R0). Emerg Infect Dis [Internet]. 2019. [cited 2020 Dec 8] Available from: https://wwwnc.cdc.gov/eid/article/25/1/17-1901_article
- Chickenpox (Varicella) [Internet]. Centers for Disease Control and Prevention (CDC). 2020. [cited 2020 Dec 8] Available from: https://www.cdc.gov/chickenpox/about/index.html
- Armour, S. Fauci Calls Coronavirus Vaccine a Game Changer, Decries Misinformation [Internet]. The Wall Street Journal. 2020 Dec 8. [cited 2020 Dec 8] Available from: https://www.wsj.com/articles/deborah-birx-and-anthony-fauci-to-discuss-coronavirus-response-11607432098
Within the past three months, there have been more and more articles written about “Sanitization or Hygiene Theater.”1 The concept is based off “Security Theater,” a term which was used post-9/11 to describe the increased TSA measures that, arguably, did little to prevent future attacks.2 The comparison is founded on the notion that all the pandemic-induced cleaning, sanitizing, and disinfecting may be completely unwarranted and even wasteful in terms of time and money. In August 2020, Dr. Emanuel Goldman, a Professor of Microbiology at Rutgers University published a commentary based on comprehensive scientific literature review in The Lancet stating that “the chance of [SARS-CoV-2] transmission through inanimate surfaces is very small, and only in instances where an infected person coughs or sneezes on the surface, and someone else touches that surface soon after the cough or sneeze (within 1–2 h) [is there a risk].” Dr. Goldman goes on to say that “although periodically disinfecting surfaces and use of gloves are reasonable precautions especially in hospitals, I believe that fomites that have not been in contact with an infected carrier for many hours do not pose a measurable risk of transmission in non-hospital settings.”3
As a Public Health Professional, I cannot help but pause to contemplate this perspective. On one hand, the CDC confirms that “COVID-19 is thought to spread mainly through close contact from person-to-person, including between people who are physically near each other (within about 6 feet).” Though guidance still encourages “routinely clean[ing] and disinfect[ing] frequently touched surfaces.”4 On the other hand, I have been advocating for better disinfection practices in both healthcare and private settings for my entire career. I see this new world mindset as an incredible public health achievement. Infection Prevention is no longer a term isolated to the four walls of the hospital — we, now more than ever, are all more aware of the need for disinfection within our businesses as employees (or owners), as consumers, and even in our own homes. If you were to travel back to pre-pandemic times (possible via a quick Google search), illnesses such as the flu, common colds, and stomach bugs (gastroenteritis) were already a substantial burden in terms of absenteeism, diminished productivity, and increased healthcare costs.5 Influenza infections in adults alone resulted in an estimated $87 billion per year in terms of healthcare costs, projected lost earnings, and loss of life.6
Even knowing all of this, prior to the pandemic, employees and customers accepted a certain level of risk when it came to the safety of our shared public spaces. Post-pandemic, that accepted trust in the world around us is gone. Deloitte recently published a Safety and Cleanliness Survey7 which demonstrated that in addition to wearing masks and providing hand sanitizer, the top interventions businesses can take to rebuild trust are:
- Surfaces cleaned after each interaction (62%)
- Extra cleaning precautions & preventions taken (59%)
- Regular spraying/fogging to disinfect shared furniture spaces (57%)
- Regular cleaning of equipment and shared space by a cleaning service (64%)
- Regular spraying/fogging to disinfect shared furniture spaces (60%)
Source: Deloitte Safety & Cleanliness Survey, Deloitte Consulting LLP, 2020
Not only are these practices what we should have been doing all along, it is evident that the public is now looking for consistent displays of safety and cleanliness to trust businesses moving forward. However, as highlighted in the recent CloroxPro blog, Smart Disinfection: Making the Most of Your Disinfectants, it is important to develop a plan for using disinfectants efficiently and effectively. There is undoubtedly a balance that businesses need to find, and “hygiene theater” cannot be the only public health protocol put into practice. Any cleaning and disinfection efforts need to be used in combination with other CDC recommended initiatives, including social distancing, mask wearing, handwashing, staying home when sick, and improving indoor ventilation.4 The idea of Dr. James Reason’s 1990 “Swiss Cheese Model” still holds true today. The safeguards recommended represent the multiple layers needed to protect consumers and employees, alike. As pointed out by the Cleveland Clinic, “when used together consistently, the holes (or weaknesses) in any single layer of protection should be offset by the strengths of another layer of intervention.”8 We have to address every area of potential spread to truly create a safe and healthy environment for all.
- 1. Thompson D. Hygiene Theater Is a Huge Waste of Time: People are power scrubbing their way to a false sense of security. [Internet]. The Atlantic. 2020 [cited 2020 Oct 6]. p. 1–8. Available from: https://www.theatlantic.com/ideas/archive/2020/07/scourge-hygiene-theater/614599/
- 2. Judkis M. Deep cleans and disinfecting mists might not keep us from getting the virus , but they sure make us feel better [Internet]. The Washington Post. 2020 [cited 2020 Oct 6]. Available from: https://www.washingtonpost.com/lifestyle/style/deep-cleans-and-disinfecting-mists-might-not-keep-us-from-getting-the-virus-but-they-sure-make-us-feel-better/2020/09/05/f428b8ee-e965-11ea-97e0-94d2e46e759b_story.html
- 3. Goldman E. Exaggerated risk of transmission of COVID-19 by fomites [Internet]. Vol. 20, The Lancet Infectious Diseases. 2020. p. 892–3. Available from: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30561-2/fulltext
- How COVID-19 Spreads [Internet]. Centers for Disease Control and Prevention (CDC). 2020 [cited 2020 Oct 6]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html
- 4. Bramley TJ, Lerner D, Sames M. Productivity losses related to the common cold. J Occup Environ Med. 2002.
- 5. Keech M, Beardsworth P. The impact of influenza on working days lost: A review of the literature. PharmacoEconomics. 2008.
- 6. Safety and cleanliness – make it or break it. [Internet]. Deloitte Consulting, LLP. 2020 [cited 2020 Oct 6]. p. 1–5. Available from: https://www.deloittedigital.com/content/dam/deloittedigital/us/documents/offerings/offering-20200626-safety-cleanliness-covid.pdf
- 7. Return to Work Amid COVID-19 [Internet]. Cleveland Clinic. 2020 [cited 2020 Oct 9]. p. 5. Available from: https://my.clevelandclinic.org/-/scassets/files/org/employer-solutions/covid-19-returning-to-work-guide.ashx