While the COVID-19 pandemic appears to be slowing down, the next pandemic is knocking at our door – infections caused by antibiotic resistant organisms (ARO). The post-antibiotic era isn’t coming – it’s here.1 According to Dr. Arjun Srinivasan with the Centers for Disease Control & Prevention (CDC), “The COVID-19 pandemic has created the perfect storm for antibiotic resistance. Prolonged lengths of stay; crowding; and infection control challenges, such as training gaps and shortages in PPE, all contribute.”2 It is estimated that in the next 30 years, deaths caused by AROs will surpass those caused by all cancers combined.3
The two AROs we’ll focus on are Candida auris (C. auris) and Clostridioides difficile (C. diff), both of which are considered urgent threats, according to the CDCs most recent Antibiotic Resistance Threats Report. What these two pathogens hold in common is their ability to cause severe infections, survive in the environment for prolonged periods, and spread easily between hospitalized patients and nursing home residents. In 2018, there were only 323 known clinical cases of C. auris.1 As of November 2020, the total has climbed to 1,595 which represents a nearly 400% increase in just two years.4 Moreover, to demonstrate how quickly the C. auris yeast can spread, in March 2017, a single case of C. auris was identified on a ventilator unit in Chicago. Sixteen months later, C. auris prevalence on the unit was 71%.5
Regarding C. diff, while we have made progress in reducing healthcare-onset rates in recent years, some studies show that these rates may have increased during the pandemic.6 But there are also studies that show a decrease.7,8,9 With the CMS reporting waivers during the pandemic, we may never know the true impact, at least not for a while. Regardless, C. diff remains the most common cause of healthcare-associated infections, more than half of which occur among recently hospitalized long-term care facility residents.1
Deviations from recommended infection control practices during the pandemic, fueled by fear of a novel pathogen, staffing challenges and supply chain challenges may have contributed to outbreaks of these two pathogens. For example, at one facility, a C. auris outbreak involving 35 patients was attributed to such deviations. In addition to missed hand hygiene opportunities, the CDC investigators found incorrect use of PPE and inconsistent disinfection of mobile computers and medical equipment between uses. . However, one of the control measures that helped in stopping this outbreak was enhanced cleaning and disinfection practices.10
Take Action to Prevent the Spread
The importance of infection prevention and control measures cannot be over-emphasized. The strategies to control these two pathogens are similar and include antibiotic stewardship, surveillance, diagnostic testing, transmission-based precautions, hand hygiene, inter-facility communication, and cleaning and disinfection of environmental surfaces and medical equipment. In this final section, we will focus on cleaning and disinfection.
Both of these contact-spread pathogenscan survive for prolonged periods on surfaces. C. auris can survive for weeks and C. diff can survive up to 5 months making cleaning and disinfecting an imperative practice.11,12 Below are some key points around cleaning and disinfection when C. diff or C. auris are present:
- Use products that are EPA-approved against the specific pathogens – C. auris and/or C. diff. For C. auris, do not use a product with C. albicans or fungicidal claims as they may not be effective.13
- If the product does not have a C. auris claim, use a disinfectant with a claim against C. diff spores or a 10% bleach solution. The EPA’s List K of Registered Antimicrobial Products Effective against C. diff Spores shows some products, but may not be complete or up-to-date. It’s best to check the EPA Master Label listing all microorganism claims.14
- Always follow the manufacturer’s directions for product use and application, including the correct contact time.13
- Create daily and terminal cleaning protocols and checklists for patient-care areas, including areas outside the patient room such as radiology and equipment.15
- Daily and terminal cleaning of the patient-care environment and of medical equipment between uses is recommended.13 Special attention should be paid to high-touch surfaces.
- Consider expanding the use of sporicidal agents effective against C. diff spores for daily and terminal cleaning in all rooms on affected units.15
- Consider use of electrostatic sprayer technology, which offers superior surface coverage.16
- Routine auditing of the adequacy of room cleaning is imperative – we can’t manage what we don’t measure.
These two urgent threat pathogens have many factors in common, which include an affinity for environmental surfaces, including medical equipment and for causing outbreaks. Robust cleaning and disinfecting programs are a key infection control measure.
- CDC. (2019). Antibiotic Resistance Threats in the United States. [online]. [cited 2021 Mar 13]. Available from https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf.
- Medscape Nurses. (2020). CDC Doc Addresses Today’s Pandemic and the Next. [online]. [cited 2021 Mar 13]. Available from https://www.medscape.com/viewarticle/941169.
- WHO. . New Report Calls for Urgent Action to Avert Microbial Resistance Crisis. [online]. [cited 2021 Mar 13]. Available from https://www.who.int/news/item/29-04-2019-new-report-calls-for-urgent-action-to-avert-antimicrobial-resistance-crisis.
- CDC. (2021). Tracking Candida auris. [online]. [cited 2021 Mar 14]. Available from https://www.cdc.gov/fungal/candida-auris/tracking-c-auris.html
- Chicago Department of Public Health. (2018). 23rd Annual Infection Control Conference: Candida auris Emergence and Containment Efforts in the Chicago Region. [online].[cited 2021 Mar 14]. Available from https://www.chicagohan.org.
- Lewandowski K, Rosołowski M, Kaniewska M, Kucha P, Meler A, Wierzba W, et al. Clostridioides difficile Infection In Coronavirus Disease (COVID-19): An Underestimated Problem? Pol Arch Intern Med. 2021 Feb 26;131(2):121-127.
- Assi M, Doll M, Pryor R, Cooper K, Bearman G, Stevens MP. Impact of COVID-19 on Healthcare-Associated Infections: An Update and Perspective. Infect Control Hosp Epidemiol. 2021 Mar 12:1-9.
- Bentivegna E, Alessio G, Spuntarelli V, Luciani M, Santino I, Simmaco M, et al. Impact of COVID-19 Prevention Measures on Risk of healthcare-Associated Clostridioides difficile Infection. Am J Infect Control. 2020 Oct 5:S0196-6553(20)30891-9.
- Ponce-Alonso M, Sáez de la Fuente J, Rincón-Carlavilla A, Moreno-Nunez P, Martínez-García L, Escudero-Sánchez R, et al. Hospital-Onset Clostridioides difficile Infections During the COVID-19 Pandemic. J.Infect Control Hosp Epidemiol. 2020 Sep 8:1-5.
- CDC. (2021). MMWR Vol. 70: Candida auris Outbreak in a COVID-19 Specialty Care Unit – Florida, July-August 2020. [online].[cited 2021 Mar 15]. Available from https://www.cdc.gov/mmwr/volumes/70/wr/mm7002e3.htm
- Fekety R, Kim KH, Brown D, Batts DH, Cudmore M, Silva. Epidemiology of antibiotic-associated colitis; isolation of Clostridium difficile from the hospital environment. Am. J. Med. 1981; 70:906–908.
- CDC. (2019). Candida auris: Healthcare Professional FAQ.[online]. [cited 2021 Mar 14]. Available from https://www.cdc.gov/fungal/candida-auris/c-auris-health-qa.html
- CDC. (2020).Infection Prevention and Control for Candida auris. [online]. [cited 2021 Mar 14]. Available from https://www.cdc.gov/fungal/candida-auris/c-auris-infection-control.html#disinfection.
- EPA. (nd). Pesticide Product and Label System. [online]. [cited 2021 Mar 19]. Available from https://iaspub.epa.gov/apex/pesticides/f?p=PPLS:1.
- CDC. (2019). Strategies to Prevent Clostridioides difficile Infection in Acute Care Facilities. [online]. [cited 2021 Mar 15]. Available from https://www.cdc.gov/hai/prevent/cdi-prevention-strategies.html.
- Donskey C, Cadnum J, Jenscon A, Livingston S, Li D, Redmond S, et al. (2020). Evaluation of an electrostatic sprayer disinfectant technology for rapid decontamination of portable equipment and large open areas in the era of SARS-CoV-2. AJIC, (48):951-954.
A Little About Me
I have been a nurse since 1993 and have worked as an Infection Preventionist (IP) for the past 20 years. Throughout my infection control career, I’ve faced challenges such as the potential weaponizing of smallpox after 9/11, the SARS outbreak in 2003, the H1N1 pandemic in 2009, and the Ebola outbreak in 2014 (just to name a few). I have seen a lot of tragedy and hardship, most of which I never would have dreamed of seeing in a million years.
In 2018, I made a big change in my infection control path. I was afforded an opportunity to join the Clorox Healthcare team as a Senior Infection Preventionist. After completing my first year in my new role, the COVID-19 pandemic was just beginning – a monumental pandemic that we will likely never see again in our lifetimes. In a matter of a few months, COVID-19 spread like wildfire to nearly every continent. We spent most of 2020 in lockdown, and infection prevention became more relevant than ever.
My COVID-19 Pandemic Story
In March of 2020, as part of the emergency response to COVID-19, California Governor Gavin Newsom released an executive order allowing the state of California to commandeer hotels and medical facilities to treat COVID-19 patients. This was termed “Project Roomkey” 2 and local counties were tasked with manning these shelters.1
In my local county, some of these hotels are being used as temporary isolation housing for unsheltered residents. The intent is to reduce transmission in the community from infected persons who are experiencing homelessness or live in congregate or over-crowded settings (e.g., prisons, etc.). Meanwhile, some of the hotels (named Safer Ground sites) are designated for medically fragile persons who meet the above criteria and have not been diagnosed with COVID.2
The other hotels (named Operation Comfort sites) serve as shelters to quarantine or isolate COVID-positive or COVID-exposed individuals who meet the criteria listed above. Project Roomkey takes referrals from hospitals, clinics, prisons, emergency shelters, and homeless outreach teams.
Last summer, I learned through a friend that our local county public health department was looking for nurses to replace the public health nurses at the shelters, who were desperately needed by the county to return to their usual public health roles. With a full-blown pandemic underfoot, I had been chomping at the bit to be able to put my IP skills to work and contribute in a substantive way. I was hired part-time to supervise nurses at the COVID-positive shelters. Since July 2020, I have been working every other weekend with medically fragile COVID-positive individuals in the hotels in an underserved area of East Oakland, California.
Challenges from the Front Lines
Since an “isolation/quarantine” hotel had never been created or utilized in modern times, we’ve had to continuously learn and adapt to new situations. This often means that our protocols, along with the CDC guidance for COVID-19, is also continuously evolving. Furthermore, as is often the case in public health nursing, we are with faced limited resources. This includes things as simple as having a consistent supply of environmental surface disinfectants. Just about every time I report for duty, we have a different disinfectant which means having to learn the instructions for use, including the contact time. Also, with the supply chain shortages, it means we have to remember to save our empty bottles and trigger sprays for refilling.
As if fighting COVID-19 were not enough, we’ve also had to address the complicated health and social issues our patients face on a daily basis outside of the pandemic, such as mental health and/or substance abuse disorders. My fellow nurses and I must simultaneously monitor our patients’ COVID symptoms as well as any withdrawal or suicidal ideation indicators. Some of our patients also have complex health issues (e.g., diabetes) so we work diligently to coordinate the appropriate care.
Additionally, patients at Project Roomkey come from all types of socioeconomic backgrounds. For low-income community members, having to quarantine for 14 days or stay isolated at a hotel could mean missing a paycheck or risking the next meal for their family. Meeting these patients’ social or other medical needs is not easy when your patient also has an infectious disease like COVID-19. I quickly realized that it’s not the same as working in the hospital outside the pandemic where virtually every resource you need to do your job is on-hand.
In addition to our patients, our nursing staff also come from a variety of backgrounds, which range from new graduates to veteran caregivers. Clinical backgrounds include hospital (ICU, OR, and Medical-Surgical), long-term care, home care, infection prevention and control, behavioral health, public health, and even nurses from academia. What I appreciated this past year was that no one used their specialty to appear superior to anyone else. We simply leaned on each other’s strengths and got the work done.
Finding Inspiration Among the Hardship
Since this work takes place in addition to my regular “day job” with Clorox Healthcare, I’ve had to find inspiration to keep showing up every other weekend. Fortunately, this did not prove to be too difficult as I’ve found great inspiration in both my patients and my coworkers. The most vulnerable in our community needed us during this historic event and as a nurse, I felt that it was my duty to help.
Like me, many of my fellow hotel coworkers took on this work in addition to their “day jobs.” Their dedication motivates me to keep showing up week after week. These amazing individuals not only give their time and skills, but they often donate items to these families in need - things like winter clothing, children’s toys, and games to keep them occupied during quarantine. In addition to nurses, the healthcare team includes nurse practitioners, physicians, mental health providers, substance abuse providers, and pharmacists. Meanwhile, we couldn’t do any of this without the relentless work of the facilities team, housing support staff, housekeepers, cooks and security guards in the hotels. The team collaboration and the comradery of this group has been truly something amazing to be a part of.
Finally, I would be remiss if I didn’t recognize the inspiration provided by all of my fellow IPs out there wherever they have been working during this pandemic. Your dedication to our profession is nothing short of remarkable.
Relief is in Sight
When both the Moderna and Pfizer vaccines were granted Emergency Use Authorization (EUA) from the Federal Drug Administration in December 2020, I was beyond elated to help run the staff vaccination clinic.3 Along with a few of my coworkers, we administered nearly 140 first doses to our fellow shelter workers, which included nurses, medical assistants, housing support staff, housekeepers, cooks, and security guards. I was more than happy to do it all over again four weeks later, too. Being able to offer hope through a vaccine has brought me such joy that I have volunteered to administer vaccinations to the general public as well.
As public health officials, healthcare workers, and members of our community continue to come together to help fight the spread of COVID-19, I’m grateful for the resilience I’ve witnessed first-hand over the past year. This virus is not done with us yet and we are not done fighting, but I have hope for the future. Before the pandemic struck, 2020 had been designated the International Year of the Nurse in honor of the 200th anniversary of Florence Nightingale’s birthday.4 While this may have been lost in the chaos of the pandemic, we nurses will never forget the additional meaning behind this past year.
- Alameda County Public Health Care for the Homeless. Isolation Housing for COVID-19 [nternet]. [cited 2021 Mar 7]. Available from: https://www.achch.org/isolation-housing.html
- Office of the Governor Gavin Newsom. Governor Newsom Issues New Executive Order Further Enhancing State and local Government’s Ability to Respond to COVID-19 Pandemic [internet]. [cited 2021 Mar 7]. Available from: https://www.gov.ca.gov/2020/03/12/governor-newsom-issues-new-executive-order-further-enhancing-state-and-local-governments-ability-to-respond-to-covid-19-pandemic/
- Federal U.S. Food & Drug Administration. COVID-19 Vaccines [internet]. [cited 2021 Mar 7]. Available from: https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccines
- World Health Organization. Executive Board Designates 2020 as the “Year of the Nurse and midwide.” [internet]. [cited 2021 Mar 7]. Available from: https://www.who.int/news/item/30-01-2019-executive-board-designates-2020-as-the-year-of-the-nurse-and-midwife-
In the last few months, it’s emerged that a number of variants of SARS-CoV-2, the virus that causes COVID-19, are circulating globally. Variants arise through a process called mutation where the virus undergoes changes to its genetic structure. The new variants can have characteristics that are different from the original virus. You may see the terms “variant” and “strain” used interchangeably, and in this context, they mean the same thing.
Currently there are three variants of note: one that emerged in the UK in September 2020 and has now been detected in the US, one from South Africa that was first reported in October 2020, and one from Nigeria that emerged at the end of 2020. The UK and South Africa variants appear to spread more rapidly than the original SARS-CoV-2 virus, but do not appear to cause more severe disease and can still be detected by currently available viral tests.
In January 2021, the United States Environmental Protection Agency (EPA) issued a statement saying that it expects disinfectants on List N Disinfectants for Coronavirus (COVID-19) to kill all strains of SARS-CoV-2. This is to be expected based on the structure of viruses. Let’s take a look and see why.
Viruses can be split into three classes. Enveloped viruses, large non-enveloped viruses, and small non-enveloped viruses. An enveloped virus is surrounded by a fatty layer which breaks apart very easily making the virus very easy to kill with disinfectants. Non-enveloped viruses have a tough outer coating making them much harder to kill with disinfectants.
SARS-CoV-2 is an enveloped virus but also contains protein “spikes” that stick through the fatty outer layer, creating a “crown”-like structure — one that you’re no doubt familiar with.
The key point is this: the variant resulting from a mutation in an enveloped virus is still an enveloped virus with the easy to penetrate fatty layer, and therefore equally susceptible to disinfectants as the original. The mutation may slightly change the make-up or characteristics of individual parts, such as the protein spikes, but it does not change the physical structure of the virus. This scientific rationale is the basis for the EPA’s determination that viruses on List N are expected to kill all strains, or variants, of SARS-CoV-2.
Disinfectant antiviral efficacy in practice
In practice, we can see the fact that different strains or variants of viruses are equally easy to kill when we look at kill claims (or contact times) for influenza A viruses on product labels. There are many variants of this virus including H5N1, H1N1, H3N2. However, when the microorganism claims on a product label include more than one variant of this virus, the kill time (or contact time) is always the same for all variants. The EPA recognized this in 2009 when there was an outbreak of a new strain of influenza A, H1N1. At that time, the EPA ruled that any disinfectant that killed a known strain of influenza A would also be effective against the new strain.
Many disinfectants can kill SARS-CoV-2 with contact times ranging from 15 seconds to 2 minutes. As EPA suggests, we can expect that List N disinfectants will be effective against all variants of SARS-CoV-2 including the current ones from the UK, South Africa and Nigeria.
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
This post is part of our "Ask The Pros" blog series for which our internal panel of experts address the latest questions from industry professionals. This month's query,
"It seems like we have a new disinfectant product every week and it's hard to keep up with how and where to use the products. What strategies do you recommend for as little disruption as possible to our current process?"
The year 2020 has certainly been a challenging one thus far. The COVID-19 pandemic has created supply challenges in this country that we could not have anticipated that range from U.S. Mint coin shortages to personal protective equipment (PPE) for healthcare workers. The disinfectant manufacturing industry has also been challenged to keep up with an extraordinary increase in demand. While production facilities are operating 24/7, supply continues to fall short of demand due to production capacity and raw material shortages. As a result, many healthcare facilities are having to adjust and adapt to new disinfectants products, whether that means different formats, applications, or actives. While this may be frustrating, healthcare teams are resilient and they know how to triage. In response to disinfectant shortages, changes in product and potentially in protocols, we will apply the methodology of triage to the use of disinfectant products in formats that may differ from our usual product. A plan of action can then be developed for the appropriate use of the environmental disinfectants available.
The first step when an issue is identified is to assess the risks involved and the potential consequences. In this case, the issue is that our usual product(s) may be temporarily unavailable, or in limited supply. I recommend downloading and adapting a risk assessment tool from the Centers for Disease Prevention and Control (CDC). Considerations with the risk assessment are:
- The patient population
- Location within the facility where the disinfectant will be used
- The staff using the product
- The disinfectant chemistry and format
Once the risk assessment has been completed, the next step is to formulate a plan to mitigate and determine what, if any, safeguards should be put into place. Your plan should include goals and objectives to tackle high-risk issues. Note that your plan should also address how you will swiftly communicate the change in product and educate staff as the new products come in to your facility. Your vendors may be able to help!
Much like the CDC has recommended a strategy to prioritize the use of PPE to preserve supply, consider doing something similar in regards to disinfectants. I am not proposing cleaning less frequently, but rather to prioritize which products will be used where and by whom. If you have a limited supply of disinfectant wipes, but you also have some spray bottles of disinfectant, consider prioritizing disinfectant wipes for critical departments, or equipment. For example, you wouldn’t want to use the spray disinfectant in the ICU where you have patients on a ventilator, so this would be a department in critical need of disinfectant wipes. Another example might be to take the large format disinfectant wipes that Environmental Services (EVS) often use and distribute them to nursing staff for use on the units. EVS is more accustomed and likely more equipped to utilize different formats of disinfectants such as spray disinfectants, dilutable chemistries and microfibers so consider reserving these formats for them.
Instructions for Use
Through all of this, it is imperative that the product instructions for use (IFU’s) are reviewed, staff is educated on the IFU’s, and compliance is monitored and enforced by leadership. Healthcare-grade disinfectants registered by the U.S. Environmental Protection Agency (EPA) undergo stringent testing requirements in order to prove their efficacy and safety. For the best results, users should follow the product IFU’s.
For example, Clorox Healthcare® Fuzion, a next-generation sporicidal bleach disinfectant, has an engineered dual-chambered nozzle that combines the active ingredients at the point of dispensing (or spraying). While highly efficacious, this product is most effective when applied directly to the surface from the bottle itself. If concerned about using sprays but that is all that is available, a better approach would be to consider where use of sprays might be more appropriate, such as in public or common areas after-hours. Finally, until this pandemic is behind us, be sure you are selecting products approved as being effective against SARS-CoV-2, the virus responsible for COVID-19 disease. You can find these products on the EPA’s List N.
Posts for the Ask The Pros blog series are published every other month. Please submit your cleaning and disinfecting questions to AskThePros@clorox.com for consideration to be addressed in a future edition.
In part one of this 3-part blog series, we learned about SARS-CoV-2, the virus responsible for COVID-19 infection. We reviewed how infections occur using the Chain of Infection framework, including ways in which the chain can be broken to stop transmission. A special emphasis was placed on the role of environmental surfaces in transmission. In part two, we focused on preventing the transmission of COVID-19 within the hospital, looking at both what hospitals are doing and what patients can do. Next, we shared ways to prevent transmission to household contacts within the home environment. In this final part, we will review disinfectant safety and understanding the label.
The COVID-19 pandemic has brought to light the need for safe use of cleaners and disinfectants. Calls to Poison Control Centers regarding exposures to cleaners and disinfectants have increased since the beginning of 2020. In fact, the CDC published a Morbidity and Mortality Weekly Report (or MMWR) on this very topic in June of this year. They conducted a survey and found knowledge gaps in the safe use of household cleaners and disinfectants. Approximately one-third of the respondents reported engaging in non-recommended high-risk practices with the intent to prevent the spread of COVID-19 virus. Some of these unsafe practices include washing produce with bleach, applying these household cleaner-disinfectants to bare skin, and intentionally inhaling or ingesting these products.
It’s important to be knowledgeable about cleaning and disinfectant products being used. The product label provides a wealth of information so be sure to read it. A very important piece of information to look for is the registration number from the Environmental Protection Agency (EPA). All disinfectants in the US are required to be registered with the EPA. Failure of a disinfectant product to be registered with the EPA is not only against federal law, without it, the safety and efficacy of unregistered products cannot be guaranteed.
Other important information that can be found on the product label are the chemicals or active ingredients, the germs they kill ("kill claims"), precautions, and directions for use (DFUs). Keep in mind that SARS-CoV-2 is a new pathogen so it may not yet be listed on the label. However, if the product has the emerging viral pathogen claim and is listed on EPA’s List N, then the product is approved for use against the COVID-19 virus.
The precautionary text informs the user of potential hazards when using (or misusing the product). Signal words used in the precautionary text include CAUTION, WARNING, or DANGER and informs the user of physical or chemical hazards such as flammability and corrosiveness. This label section also advises on first aid instructions and if the product should be kept out of reach of children.
The DFUs focus on what task (e.g., disinfect, sanitize, deodorize, etc) the product is intended to perform and how to correctly use the product. This includes surfaces that the product can safely be used on as well as those the product should not be used on. The DFUs provide the contact time or how long the surface must remain wet with the disinfectant in order to be fully efficacious. It also addresses whether it’s safe or not to mix the product with other products or chemicals. For example, toxic fumes can result when bleach is mixed with ammonia or vinegar. Adherence to the DFUs is key. If product DFUs state to apply the product directly to the surface followed by wiping once the contact time has been met, then applying the product to the cloth first may impede efficacy.
Some key safety measures to consider include:
- Ensure the room being cleaned and disinfected has adequate ventilation
- Don’t mix bleach with other chemicals including vinegar and ammonia
- When diluting bleach, always add bleach to the water and not vice versa
- Don’t use cleaners and disinfectants on your bare skin
- Don’t ingest or inhale disinfectants
- Wear appropriate personal protective equipment such as gloves and eye protection according to manufacturer’s written instructions for use
- Wash hands after cleaning and disinfecting tasks or contact with any cleaners-disinfectants
- Store disinfecting products according to manufacturer’s instructions for use and keep them out of reach of children
In this 3-part blog series, we addressed the safe transition from hospital to home during a pandemic as it can be a very scary experience. And we learned that with basic infection control measures we can protect both ourselves and our loved ones. The COVID-19 pandemic has shown a glaring light on the need to faithfully adhere to these basic practices. Frequent hand hygiene, respiratory etiquette, and routine cleaning and disinfection go a long way in preventing transmission of pathogens, including SARS-CoV-2, the cause of COVID-19.
Be sure to educate yourself on proper cleaning and disinfection and understand what is in the bottle and how to safely use it. Always follow the instructions for use. Be sure you allow surfaces to remain wet long enough to kill the targeted pathogens. This means adhering to the contact time on the label for the product you are using.
To learn more, visit the CloroxPro Resource Center which includes valuable educational resources such as videos, pathogen education sheets, CE webinars and more.
1. Coronaviruses. Retrieved from https://www.niaid.nih.gov/diseases-conditions/coronaviruses
2. Coronavirus Disease 2019: Frequently Asked Questions. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/faq.html
3. Disease 2019: How it Spreads. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/prepare/transmission.html.
4. New coronavirus stable for hours on surfaces. Retrieved from https://www.nih.gov/news-events/news-releases/new-coronavirus-stable-hours-surfaces.
5. COVID-19, FAQ, Spread. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/faq.html#:~:text=At%20this%20time%2C%20CDC%20has,Coronavirus%20Spreads%20for%20more%20information.
6. Coronavirus Disease 2019: Symptoms. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
7. Are You at Higher Risk for Severe Illness? Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhigh-risk%2Fhigh-risk-complications.html
8. Severe Outcomes Among Patients with COVID-19 – United States, February 12-March 16, 2020. Retrieved from https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm
9. COVID-19 Cases in U.S. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html
10. CDC Media Telebriefing: Update on COVID-19, March 9, 2020. Retrieved from https://www.cdc.gov/media/index.htmlhttps://emergency.cdc.gov/coca/calls/2020/callinfo_013120.asp
In part one of this blog series, we described COVID-19 disease and used the chain of infection to demonstrate how this and other infections occur. In part two of this series, we will address how the spread of COVID-19 can be prevented within the hospital, as well as how to prevent its spread to loved ones within the home.
Preventing Transmission in the Hospital
Measures the healthcare team is taking to prevent transmission of COVID-19 to patients and others within the hospital walls include:
- Screening everyone who enters the building for signs and symptoms consistent with COVID-19, including temperature checks or exposure to persons infected with SARS-CoV-2
- Having separate areas for evaluating patients suspected of having COVID-19 infection
- Restricting visitors
- Implementing isolation precautions as indicated
- Use of personal protective equipment such as masks or respirators, face shields, gloves, and gowns
- Performing frequent hand hygiene
- Ensuring spatial separation of at least six feet including in nurses stations and waiting rooms
- Use of barriers such as plexiglass to eliminate exposures
- Postponing elective surgeries and procedures
For additional recommendations, see CDC’s Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic.
For disinfectants effective against the SARS-CoV-2 virus, see the Environmental Protection Agency’s (EPA) List N. This list includes disinfectants used in healthcare settings as well as disinfectants used at home. It’s important to note that while SARS-CoV-2 can cause severe illness in some, the virus is very easy to kill on surfaces with appropriate disinfection.
Hierarchy of Pathogen Kill
For patients admitted for a health issue other than COVID-19, there are things that they can do to protect themselves from getting COVID-19 while in the hospital. First and foremost, patients must be their own advocate. This means speaking up when something doesn’t look or seem quite right. This includes reminding healthcare workers and visitors to perform hand hygiene before touching you. Along these same lines, patients should be sure to perform hand hygiene before they eat or before taking oral medications, after they use the restroom, and upon returning to their room from a test or procedure or even a walk in the halls. It’s also important to ensure your room and bathroom are cleaned every day you are in the hospital. Focal points for cleaning should include surfaces that are frequently touched such as the over-bed table, bed rails, call light, and tv remote to name a few. Additionally, patients should ensure that the healthcare team has disinfected any medical equipment that will come into contact with them. Lastly, during the pandemic, patients should wear a mask as tolerated while in the hospital to help prevent inadvertent exposure to COVID-19.
Similarly, there are things that essential workers can do to prevent bringing COVID-19 home from work with them and infecting their family members. The COVID-19 pandemic has certainly made us take a closer look at how we can safely transition from work to home each day to protect not only ourselves but our loved ones. Please see my blog post from March 2020 titled “From Outside In: 6 Tips for Minimizing the Risk of Bringing COVID-19 Home After Your Shift”.
Preventing Transmission in the Home
There are measures that patients infected with COVID-19 can do to prevent infecting their loved ones when it’s time to be discharged from the hospital. Adherence to the 6 basic measures that we all should be doing will go a long way in preventing the spread of COVID-19:
- Stay home if feeling unwell
- Practice social distancing
- Wear a mask and cover coughs/sneezes
- Avoid touching the face
- Perform frequent hand hygiene
- Perform frequent cleaning and disinfection of environmental surfaces
To clean surfaces in the home that may be contaminated with the SARS-CoV-2 virus be sure to use an EPA-registered household disinfectant. Most of these will be effective as this is not a difficult virus to kill (see Hierarchy of Kill image above). For a complete list of appropriate household disinfectants for COVID-19, visit the Clorox Coronavirus Resource page to view a list of approved products and tips on how to safely and effectively disinfect surfaces in the home. Additionally, diluted jug bleach can be used to disinfect surfaces.
1:10 Jug Bleach Dilution
In addition to frequent cleaning and disinfection of frequently touched surfaces in the home, only one person in the household should take care of the person who is ill. And this person should not be someone in the high-risk group for COVID-related complications. In addition to the 6 basic measures mentioned earlier, the ill person should:
- Stay home and stay away from other people,
- Follow the care instructions from their healthcare provider and be sure to get plenty of rest and stay hydrated, and most importantly,
- Monitor their symptoms and seek immediate medical attention by calling 911 in the event of difficulty breathing or you otherwise think it’s an emergency.
Everyone in the household, especially the ill person, should practice respiratory etiquette which includes covering coughs and sneezes, properly discarding used tissues, and performing frequent hand hygiene. Also, avoid sharing personal items with others in the home including dishes, towels, and bedding.
The COVID-19 infected person should remain separated from others in the household, including pets, by staying in a designated room. This person should also have a separate bathroom, if possible. If the bathroom must be shared, then after each use, the frequently touched surfaces should be cleaned and disinfected.
The bathroom and the “sick room” are not the only rooms in the house that should be cleaned frequently. All frequently-touched surfaces in the home should be cleaned and disinfected daily at a minimum according to the Centers for Diseases Control & Prevention (CDC), but it certainly doesn’t hurt to disinfect more frequently.
If sleeping in the same room is necessary, put a curtain up to act as a divider. And if you must share a bed, sleep head-to-toe. Weather permitting, open doors and windows and use fans to help circulate fresh air. The ill person should not prepare food and should eat separately from the rest of the family.
Read part 3 of the blog series as we end with the safe and proper use of disinfectants.
Transitioning from hospital to home once diagnosed with an infectious disease can be frightening for a patient. The biggest concern is spreading the infection to their loved ones. This blog post focuses on SARS-CoV-2, the virus responsible for COVID-19. In addition to providing some information on this pathogen and the infection that it causes, key things to consider when it’s time to go home for preventing transmission to others will be addressed.
According to the National Institute for Allergy and Infectious Diseases (NIH), over the past 20 years, three new pathogenic Coronaviruses have emerged from animal reservoirs.1 They are a large family of viruses that commonly cause respiratory illnesses in people as well as in many different animal species.2 Examples include Severe Acute Respiratory Distress Syndrome (SARS) back in 2003 and more recently, Middle Eastern Respiratory Syndrome (MERS).2 The COVID-19 strain, genetically related to the SARS virus, has not been identified in humans until now.3 Our lack of immunity to this virus explains its readiness to spread from person-to-person.
And how is this virus spread? Well, the primary mode is through respiratory droplets when an infected person coughs or sneezes.4 These droplets have about a 6 foot reach.4 While there is some evidence that persons without any symptoms can transmit the virus, persons are most infectious when they are actively ill.4 Additionally, it appears to be possible to acquire COVID-19 by touching surfaces or objects contaminated with the virus and then touching your mouth, nose, or eyes5, but this is not thought to be the main way that this virus is spread.4 Studies are being published at lightning speed and indicate that the virus can survive from several hours to several days on various surfaces.6 Finally, it’s important to point out that this virus is not spread through food or water.
Symptoms of COVID-19 illness are very similar to influenza and include fever, cough, muscle aches, fatigue, and shortness of breath.6 However, the incubation period is longer than influenza ranging from 2-14 days (average of 4-5 days).6,7 Influenza and COVID-19 illnesses both come on more suddenly as compared to the common cold which tends to come on more gradually. Like influenza, COVID-19 illness can range from mild to severe.8
Coronavirus Sympton Comparison with Other respiratory Illnesses
The vast majority of persons (80%) with COVID-19 infection will experience only mild illness and will recover uneventfully.9 Persons at high-risk of complications from this disease tend to have more severe illness.10 These high-risk individuals include those over the age of 60 years and those with chronic conditions such as heart or lung disease and diabetes.10 Of the older population, those over the age 80 years are at highest risk of complications from COVID-19.10 Currently, there is no specific treatment to cure COVID-19 and there is no vaccine but experts are currently working on both. The mortality rate in the US is approximately 1.3%.10 This means we can expect approximately 1.3 persons in every 100 cases to die as a result of the infection. While this does not seem like a high mortality rate, keep in mind that this is an average. The mortality rate is significantly higher in high risk individuals and lower in low risk individuals.
The Chain of Infection
A framework that can help us to understand how infections occur is the “chain of infection” which describes the sequence of events that must occur in order for an infection to occur. This chain applies to all pathogens. When considering this framework, envision the links of a chain connected in a continuous circle in which the cycle repeats itself unless or until broken.
The chain of infection is made up of six links. Each link must align in order for an infection to occur, starting with an infectious agent such as SARS-CoV-2, the virus responsible for COVID-19. The second link is the reservoir for the infectious agent. Reservoirs can include people, environmental surfaces, water, air, and so on. And there must be a portal of exit (which is the third link) for the pathogen from its reservoir. An example of a portal of exit would be the respiratory tract of a coughing patient infected with COVID-19. The fourth link is the mode of transmission. This is how the infectious agent or pathogen is carried from one place or person to another. For example, COVID-19 is spread in the droplets of saliva or mucous coughed out from an infected person. And if those droplets land on and contaminate an environmental surface, the virus can potentially be transmitted by touching that surface and then rubbing one’s eyes or nose. The fifth link in the chain is the portal of entry. This is how the pathogen enters its host or a susceptible person. The portal of entry for the COVID-19 virus is when a susceptible person breathes in the virus carried in droplets from an infected person coughs, sneezes, sings, or talks. The final link is a susceptible host. This is a person who is not immune to or is otherwise susceptible to the infectious agent they are exposed to. In essence, since COVID-19 is caused by a new strain of Coronavirus, we all are susceptible hosts to some degree.
The good news is that we can stop infections from occurring by breaking just one link in the chain. This can easily be accomplished through actions such as covering coughs, performing frequent hand hygiene, cleaning and disinfecting environmental surfaces routinely, and keeping current on immunizations. For COVID-19, we can break the chain of infection for (and possibly put the brakes on this pandemic) by doing these things plus practicing social distancing – keep at least six feet from others and wear a mask. Remember, my mask captures my droplets which protects you and your mask captures your droplets which protects me.
Read part two of this blog series where we discuss preventing the spread of COVID-19 in the hospital, as well as at home.
- Coronaviruses. Retrieved from https://www.niaid.nih.gov/diseases-conditions/coronaviruses
- Coronavirus Disease 2019: Frequently Asked Questions. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/faq.html
- Disease 2019: How it Spreads. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/prepare/transmission.html.
- New coronavirus stable for hours on surfaces. Retrieved from https://www.nih.gov/news-events/news-releases/new-coronavirus-stable-hours-surfaces.
- COVID-19, FAQ, Spread. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/faq.html#:~:text=At%20this%20time%2C%20CDC%20has,Coronavirus%20Spreads%20for%20more%20information.
- Coronavirus Disease 2019: Symptoms. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
- Are You at Higher Risk for Severe Illness? Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhigh-risk%2Fhigh-risk-complications.html
- Severe Outcomes Among Patients with COVID-19 – United States, February 12-March 16, 2020. Retrieved from https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm
- COVID-19 Cases in U.S. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html
- CDC Media Telebriefing: Update on COVID-19, March 9, 2020. Retrieved from https://www.cdc.gov/media/index.htmlhttps://emergency.cdc.gov/coca/calls/2020/callinfo_013120.asp
Have you been asked to take on the role of part time cleaner in your facility or business? If so, welcome to the club!
With the COVID-19 virus still widespread across the U.S., employers everywhere, from schools, offices, athletic facilities, movie theaters, hotels, restaurants, hospitals, and more, are asking non-cleaning staff to clean.
In a recent back to school survey, more than half (58%) of 120 educators polled responded that they would be asking current staff members/teachers to do some cleaning and disinfecting as part of their regular duties. In other facilities, box office staff, airline gate attendants, check-out clerks, nurses, receptionists and more are being asked to help out with daily cleaning and disinfecting of frequently touched and shared surfaces. The CDC has even stated in the Reopening Guidance for Cleaning and Disinfecting Public Spaces, Workplaces, Businesses, Schools, and Homes, that “This guidance is intended for all Americans.”
Depending on your personality and past experiences, you may have had any one of these three reactions:
- What? No way, cleaning isn’t in my job description and I don’t have time for that!
- Great, cleaning is easy enough. I just use common sense, right?
- OK, but I don’t know how to clean properly. Where do I get training?
The good news is that no matter which group you fall into, the COVID-19 pandemic is offering up an opportunity to learn about something many of us wouldn’t have taken the time to do before. And that is how to clean and disinfect properly.
The truth is, although many don’t realize it, properly cleaning and disinfecting surfaces takes education, training, and even practice to perfect. In fact, there is an entire industry focused on helping to ensure that cleaning professionals get what they need to do their job well. IICRC, ISSA, and AHE are just a few examples of organizations with this goal in mind.
While your employer is ultimately responsible for making sure you are educated and trained, here are some basics to help get you started. You can use this information to talk to your employer about what’s important, and potentially even as a starting place for a “new cleaner” training guide for your facility.
What is the difference between cleaning, sanitizing, and disinfecting?
- Cleaning is the physical removal of unwanted matter, including dirt, dust, soil and some pathogens.
- Sanitizing is the killing of bacteria, and is most often applicable in food service.
- Disinfecting destroys or inactivates both the bacteria and viruses (like SARS-CoV-2) on hard, nonporous surfaces.
Does cleaning always need to be done before disinfecting?
No. Cleaning and disinfecting can be done at the same time if these criteria are met:
- The surface is free of visible soil.
- The product is a “one-step” cleaner disinfectant, which means the product is both a cleaner and disinfectant.
How can I be sure I’m using a product that kills “xyz” germ?
- Check the back label on the product. If the product has an EPA Registration number and says that it kills “xyz” germ then you can be confident that the product works. Just make sure to also read the directions for use, including the dilution ratios if appropriate, on the label and follow them in practice.
- For SARS-CoV-2, the virus that causes COVID-19, make sure you are using an EPA-registered product on list N.
- Never mix cleaning products! This is important for efficacy AND safety.
What else is important to understand about the product, and where can I get the information?
- What the contact time is — see the product label
- What Personnel Protective Equipment (PPE) and precautions are needed to protect you from:
- The product — see the product label
- The contaminants (e.g., SARS-CoV-2) in the environment — check with your employer and the CDC website.
- How to store and dispose of the product safely — see the product label
- Mixing/dilution information — see the product label
What else do I need to know to clean and disinfect properly?
- Know what you are responsible for and how often you should be cleaning and disinfecting. Ask your employer for clarity if not clear.
- Focus on preventing cross contamination — this is what happens when germs are inadvertently spread from one area to another. Here are some best practices to help avoid cross contamination during cleaning and disinfecting:
- Always clean from top to bottom so the dirt, dust and pathogens that fall down will get cleaned up as you move lower.
- Always clean from clean to dirty to avoid spreading germs from dirty areas to clean areas.
- Fold each cloth until it is the size of your hand. After each use, find a clean side of the cloth to use on the next surface.
- Know what jobs require the professional custodial/EVS team (e.g., blood and body fluid clean-up) and call them when needed instead of doing it yourself.
COVID-19 has presented us with quite a challenge to say the least. Fortunately, there have also been a few “silver linings” along the way. One is the knowledge and skills about cleaning and disinfecting properly that few had before. If you have been asked to take on additional cleaning and disinfecting responsibilities as part of your current role, as in any profession, education and training on how to do the job right are essential. This will not only help ensure goals of the job (e.g., to reduce the spread of germs in the environment) are achieved, but to also ensure that the job is done safely.