Cleaning & Hygiene: The Foundation of Infection Control

Cleaning & Hygiene: The Foundation of Infection Control

The U.S. Centers for Disease Control and Prevention (CDC) warned earlier this year that the country was in for a severe flu season, and its prediction looks to be panning out.

According to the CDC, 6.8 percent of all U.S. deaths during the week of December 14-20, 2014, could be attributed to pneumonia and influenza, a percentage that surpasses the epidemic threshold. And a week later (December 28, 2014-January 3, 2015), 5.6 percent of all patient visits to U.S. hospitals reported through the U.S. Outpatient Influenza-like Illness Surveillance Network were due to influenza-like illness. This percentage is far above the national baseline of 2 percent!

Hardest hit have been people 65 or older, with 91.6 per 100,000 people hospitalized for the flu, followed by 22 per 100,000 children aged 4 or under from October 1, 2014, to January 3, 2015.

The epidemic has been classified as “widespread” in 46 out of the 50 U.S. states and has hit other countries with similar zeal. Adding to the concern is the fact that the particular type of flu strain present this season—influenza A, or H3N2—typically causes more severe outbreaks than others and this season’s vaccine isn’t a perfect match for the particular H3N2 subtype. “Thus far, half of the circulating viruses don’t match the H3N2 strain used to make vaccines,” CDC Director Tom Frieden has said, although he still urges people to get flu shots as they may offer some cross-protection.

In 2009, the flu reached pandemic levels when 348 children died from flu-related causes. Luckily, the number is far lower this year, but “Flu activity is expected to continue in the coming weeks, with increases occurring especially in those states that have not yet had significant activity,” advises the CDC.

Still, health experts caution against panic. Reaching the “epidemic” threshold isn’t actually that unusual, and it’s too early yet to predict how bad the entire influenza season will be. But panic and preparedness are two different things.

Meeting the Challenge

Most of us in the cleaning industry are well versed in the “value of clean,” and its many manifestations: asset preservation, improved indoor environmental quality, decreased absenteeism, enhanced safety, and increased worker and student productivity. But surely topping this list of valuable aspects of cleaning is the critical role cleaning plays in preventing the transmission of infectious diseases and otherwise protecting human health.

Stated simply, a relatively modest investment in an effective cleaning and hygiene program can help avoid or significantly reduce the health and economic impacts of infectious diseases.

To best appreciate the value of clean in the realm of infection prevention, it is helpful to consider the costs associated with the transmission of various environmental pathogens. Consider influenza, a.k.a. “the common” flu, for example.

Financially Speaking

Seasonal influenza in the United States alone is estimated to impose, on average, an economic burden of US$87 billion a year. Of this amount, more than $16 billion is attributed to lost earnings and productivity associated with ill employees. Direct medical costs account for another $10 billion per year of this total. In addition, the common flu results in 3.1 million hospitalized days and 31.4 million outpatient visits per year (source: “The Annual Impact of Seasonal Influenza in the U.S.: Measuring Disease Burden and Costs,” Science Digest, Vaccine 25, 2007).

Of course, there are other infectious diseases of concern, such as Clostridium difficile (C. diff). The rate of C. diff health care associated infections (HAIs) has nearly doubled in the last 10 years to today, where it accounts for 12 percent of all HAIs. The direct medical costs associated with C. diff in the United States are between $6,000 and $9,000 per infection, or a total estimate of $1 billion to $1.6 billion in medical costs annually. Further cost pressures are being imposed upon health care facilities given Medicare’s recent decision to no longer reimburse hospitals for HAIs.

Bill-Balek-Video-Link-ImageClean Prevention

When we look at the universe of infectious diseases that we contend with today—MRSA, Norovirus, Enterovirus D68, and even Ebola—it is apparent that the collective economic costs and the toll on human suffering associated with these diseases are substantial. It is in this context that we can best appreciate the value of clean as truly our first—and front—line of defense.

This dimension of cleaning’s value proposition has been studied at length. Consider a New York University Langone Medical Center study cited in ISSA’s Value of Clean white paper (, where enhanced cleaning practices and a hand hygiene program were directly responsible for averting 85 cases of C. diff, resulting in an estimated savings of $413,000 in direct hospital costs.

In another study cited in the paper, this one conducted in the Mt. Sinai Medical Center, improved cleaning products and practices along with employee training resulted in a 57 percent reduction in C. diff infection rates and a commensurate reduction in custodial worker injuries. These principles of cleaning for infection prevention that have worked to significantly reduce the rate of HAIs apply to institutional facilities overall, including office buildings, schools, daycare centers, and retirement homes.

Disease Reduction

Before fully realizing the degree to which an effective cleaning and hygiene program can reduce the transmission of environmental pathogens, it is important to first briefly explore how infectious diseases are spread.

Infectious diseases are generally spread through harmful microorganisms or environmental pathogens, such as viruses, bacteria, fungi, etc., via direct person-to-person contact with an infected individual or by touching objects contaminated by infected individuals, such as doorknobs, elevator buttons, handrails, and other frequently touched surfaces. These germs are then transmitted from the hands to the nose, mouth, or eyes.

Effective cleaning and disinfecting of environmental surfaces, including “high touch” or frequently touched surfaces, significantly decreases the number of environmental pathogens on those surfaces, which in turn, reduces the risk of transmission and infection.

Routine cleaning removes the soil and dirt that harbors the infectious agents while disinfecting kills the remaining environmental pathogens. Likewise, a hand hygiene program—including proper hand washing

procedures (see below)— significantly reduces the germs present on a person’s hands, with a consequent reduction in the risk of disease transmission.

Cleaning & Disinfecting Practices

The following cleaning and disinfection practices are recommended to help prevent the spread of the flu, common cold, and other infectious diseases.

1. Clean. Do not underestimate the power of simply cleaning to reduce the risk of transmitting germs. Cleaning removes dirt, soil, and impurities that harbor germs and viruses like influenza. Thus, routine cleaning plays a critical role in reducing the spread of flu and other diseases. Cleaning also is often a necessary first step in disinfecting, which actually kills the remaining germs, such as influenza viruses.

2. Clean frequently touched surfaces—frequently. Daily clean and disinfect surfaces and objects that are frequently touched, such as desks, countertops, doorknobs, and faucet handles. Frequency may be increased when there is a known outbreak.

3. Know your germs. It’s important to match your cleaning and disinfecting activities to the types of germs you want to remove. For example, studies have shown that the flu virus can live and potentially infect a person for two to eight hours after being deposited on a surface. Therefore, it is not necessary to close facilities overnight to clean or disinfect every surface in the building to slow the spread of flu.

4. Choose the right product. In selecting an appropriate disinfectant, read the label to make sure it states it is approved by the U.S. Environmental Protection Agency (EPA) for the environmental pathogen of concern. For example, for the flu, select products deemed effective against the influenza A virus.

5. Clean and disinfect correctly. Always follow label directions on cleaning products and disinfectants. It is important to note that the directions on most disinfectant products require the surface to first be cleaned with a general purpose cleaner to remove germs. When an EPA-registered disinfectant is called for, be sure to follow the label directions on the disinfectant for dwell time—the amount of time necessary for the disinfectant to reside on the surfaces. Also, and make sure the surface remains wet during the dwell time to properly disinfect and kill the germs. If time is an issue, select disinfectants that have shorter dwell times compared to other competing products.

If a surface is not visibly dirty, you can clean it with an EPA-registered product that both cleans (removes germs) and disinfects (kills germs). Be sure to read the label directions carefully, as there may be a separate procedure for using the product as a cleaner or as a disinfectant.

Use disinfecting wipes on electronic items that are touched often, such as phones and computers. Pay close attention to the directions for using disinfecting wipes. It may be necessary to use more than one wipe to keep the surface wet for the stated length of contact time. Make sure that the electronics can withstand the use of liquids for cleaning and disinfecting.

6. Train for safety. Ensure that all those who use cleaners and disinfectants read and understand all instruction labels and understand safe and appropriate use. This might require that instructional materials and training be provided in other languages.

Hand Hygiene

Keeping hands clean is also one of the most important steps we can take to avoid spreading germs and getting sick. For example, studies show that proper hand washing reduces:

  • Respiratory illnesses in the general population by 21 percent
  • The number of people sickened with diarrhea by 31 percent
  • Diarrheal illness in people with weakened immune systems by 58 percent.

Conversely, many diseases and conditions are spread by not washing hands correctly, which makes proper, frequent handwashing critical to reducing the spread of infectious diseases.

How to Wash Your Hands.

While it is an activity that we are all familiar with, a recent study indicated that 95 percent of people observed washing their hands were doing it incorrectly. Therefore, it is worthwhile to re-examine proper handwashing technique to ensure maximum removal of infectious agents.

  1. Wet your hands with clean, running water (warm or cold), turn off the water, and apply soap.
  2. Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your
    hands, between your fingers, and under your nails.
  3. Scrub your hands for at least 20 seconds (some say as long as it takes to sing Happy Birthday to yourself!)
  4. Rinse your hands well under clean, running water.
  5. Dry your hands using a clean towel or hot air dryer—being sure they are fully dry. (Studies show germs and bacteria thrive on wet hands).

Washing hands with soap and water is the best way to reduce the number of microbes on them in most situations.

However, if soap and water are not available, use an alcohol-based hand sanitizer, which can quickly reduce the number of microbes on hands in some situations. Keep in mind, however, that sanitizers do not eliminate all types of germs. It also is important to note that hand sanitizers are not as effective when hands are visibly dirty.

Visit for more information about the critical role cleaning plays in protecting human health from infectious agents, including information about the recent Ebola and Enterovirus D68 outbreaks.

ISSA Environmental & Legislative Affairs Director Bill Balek can be reached at; phone, 800-225-4772 (North America) or 847-982-0800.

Reprinted with permission from ISSA Today (February 2015)

Bill Balek

In his current role as Director of Environmental Services for ISSA, which he has held since April, 2010, Bill is involved in the development of public policy, programs and initiatives that are designed to facilitate the success of companies in the green cleaning marketplace. Projects in which he is currently or has recently been involved in include:

1. Managing Transpare, a web-based system designed to communicate the environmental, safety and health attributes of cleaning products.

2. Managing the research that will define "clean" from a public health perspective for K-12 schools as well as establishing scientifically the positive connection between cleaning and health, and student performance.

3. Participated on the EPA committee that developed a pilot program for "green" disinfectants and sanitizers.

4. Co-chaired the committee that developed the guidelines and specifications for the Illinois green cleaning for schools act.

5. Manage the alliance between ISSA and the U.S. EPA Design for the Environment which is designed to promote the development and production of environmentally preferable cleaning products.

In his other role as Director of Legislative Affairs for ISSA, which he has held since August 1985, Bill oversees the association's regulatory and legislative programs. Issues covered include safety and health, transportation, product formulation, and other issues germane to the cleaning industry. Over the past several years Bill has been focusing on issues related to environmentally preferable cleaning products and services.
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