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Infection Control & Patient Safety

New Technologies for Cleaning Hospital Environments

Published November 1, 2013 12:30 PM by Barbara Smith
When I first began as an Infection Preventionist, staff often asked about terminally cleaning a room by fogging it. This was usually requested after a particularly contaminated case or for patient with lice. The staff was referring to a practice of fogging a room with a chemical or steam in an attempt to destroy any microbes and other living things like a pesky louse.

I'd never actually seen this method. It was abandoned because there was no scientific evidence that it changed the "flora" of the patient room. Additionally, one of the chemicals used - paraformaldehyde - is no longer registered for use with the EPA. And finally, it was inconvenient because the room was unusable for a period of time.

More recently, the recognition that a patient's room can serve as a fomite for transmission of organisms has renewed interest in more encompassing methods of room disinfection. For example, in a 2006 article, Kramer and his colleagues report that Klesbiella species can last from 2 hours - months and C. difficile spores can last for 5 months!

Technologies to address this concern have been introduced in hospitals. One technology is the use of vaporized aqueous hydrogen peroxide. A portable machine is wheeled into a vacated area and the vapor is delivered into this closed space. Another example is the use of ultraviolet radiation to decontaminate a room. The unit is placed in a room and is timed to work while the environmental service staff remains safely outside the room. Both of these technologies have been used in other industries - air handling and water treatment (UV) and pharmaceutical and medical device sterilization (peroxide). Both methods have been shown to reduce microbial contamination.

Rooms must still be physically cleaned before use of these technologies. But traditional cleaning is sometimes ineffective and these technologies have the advantage of disinfecting all surfaces that are exposed to the light or the chemical.

While far from commonplace, these technologies have been successfully implemented for cleaning high risk areas such as OR and isolation room so keep an eye out for them in your facility.

posted by Barbara Smith

4 comments

thanks Alexander - it 's does really help when infection preventionist are included in construction plans for new buildings or remodeling existing units.  Your experience as a nurse sounds like it would be quite helpful during design times too.

The APIC website has some information on construction.

http://www.apic.org/Search/Index?Keywords=construction&x=-959&y=-52

Barbara Smith November 26, 2013 11:06 AM

Over a decade of work as an agency nurse has taken me in to the bowels every hospital in South Florida. This is the first I hear of the practice of fogging.

It sounds nice. Patients coming in to a room would find it reassuring. As a nurse I would like it to, granting we find an effective non toxic fogging agent. But, there is a bigger obstacle in the way of fogging.

Many hospital rooms are semi private, divided by curtains. It is exceptionally rare to have both Patients in a room discharged simultaneously. The ensuing patient shuffling required to terminally clean by fogging would pose an insurmountable obstacle to the continuous and consistent delivery of patient care.

Most hospitals in the metropolitan area I work were built in the 1970's. Their room layouts, air purification and conditioning systems would require major overhauls to accommodate the practice of fogging. These changes may be neither affordable or possible for most facilities.

This problem highlights the importance of having infection control experts on the ground floor when planning the construction of new hospitals or other healthcare facilities as we move forward.

Alexander Menchero, Stepdown - RN November 19, 2013 8:34 AM
Miami FL

Lea- I guess we're showing our age!

all of the new methods have some drawbacks AND some positives!

Have to keep looking at the literature

Barbara November 13, 2013 6:12 PM

Interesting Theory. I remember fogging back in the late 60's. Ive often wondered why we have not brought it back. One thing for sure though is that you have to have the air handling unit shut off to that room or you will take the fogging  product to areas you do not want it. Hydrogen peroxide would not get my vote. We need something that kills everything and completely and hopefully not harmful. We would need to challenge the modern day chemists to come up with something.

Lea , all - CLeaning Consultant November 13, 2013 12:13 PM
Surrey BC Canada

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    Occupation: Infection Control Professionals
    Setting: Welch Allyn; St. Luke’s Hospital (Smith)
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