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Featured Article:

Standardization of Chemistries to Improve Workflows

Chris Romagnolo

Healthcare facilities are losing control over the multitude of chemicals in their housekeeping closets and central storage areas.  On any given day, there may be as many as seven different chemicals for different purposes, each with a unique set of instructions.

 

Overview of Current Cleaning Processes

 

Historically, diverse protocols have been used to clean, sanitize and disinfect each aspect of a healthcare facility, such as floors, surfaces, restrooms, and food service areas.  Add mold remediation, odor control and other challenges to the list and the prospect of success is even more daunting. Implementing separate procedures for every need usually means employing a variety of job-specific tools, equipment and a range of specialized chemicals. 

 

Accomplishing every task can mean using more than seven types of chemicals, including a neutral floor cleaner, a general disinfectant for hard surfaces, a sporicidal for deep disinfection, bleach to clean restrooms, a food-safe sanitizer for eating areas, a mold remover, an odor eliminator, and more.  The sheer enormity of managing labels, safety data sheets, usage guidelines, language translations, and expiration records for all these products is a fulltime job in and of itself.

 

Additionally, each chemistry is applied differently and often require dilution, followed by separate procedures. Some facilities use dilution stations for full concentrate chemicals.  There are a number of reasons this approach might raise concerns, chief among them being human or equipment error.  Unbeknownst to most cleaning staff, chemicals are frequently left in dilution station tubing and should be flushed out when finished.  Otherwise, the next time the equipment is used, it will contain leftover chemical that is no longer effective.  Furthermore, it has been well documented that there are wide variances in the set dilution strength and the actual concentration of the mixed product.  As a result, accurate strength dilutions can only be guaranteed by testing each batch of product when it is mixed.

 

Lately, hospital floors have become another area of concern as new research suggests best practices require daily floor disinfection to prevent dissemination of contaminants to multiple surfaces in a patient’s room and other parts of the environment.  Until recently, floor disinfection wasn’t an option due to a lack of suitable chemicals.  However, it may soon come to pass that floor disinfection will replace floor cleaning, adding further confusion to already intricate processes.

 

Facility and healthcare management have complex, and often insurmountable jobs, which are compounded by time limitations, labor issues, worker safety, and budget restrictions.  With the continuing rise of public health threats, burdens are increased exponentially.  If managers don’t find ways to simplify current processes, it could result in more incidents of breakdown that cause cleanliness and compliance issues.

 

Streamlining Chemistries and Processes

 

Long entrenched in the cleaning sector, the chemical industry managed to convince the public using a plethora of “single purpose” products in healthcare is necessary.  In today’s world, is that still really true?

 

In the last several years, a chemistry composed of Sodium Dichloro Isocyanurate (NaDCC) has shown exceptional promise. NaDCC is available in tablet concentrate form and, when mixed with normal tap water, creates hypochlorous acid (HOCI) solutions.  NaDCC is an organic chlorine donor that does not produce any caustic.  Not only is this chemistry environmentally-preferable and safer for people, equipment and floors, but it results in a flexible broad-spectrum disinfectant that can be used throughout the cleaning process.  When diluted at different strengths, NaDCC can act as sanitizer, hospital grade disinfectant, sporicidal or tuberculocidal.  This multi-purpose solution allows facilities to use one chemical for daily cleaning, disinfecting high-touch areas, sanitizing food surfaces, addressing terminal cleans and everything in between.  In addition, unlike other emerging floor disinfectants, NaDCC has a similar pH to neutral floor cleaners and can be used without damaging finishes.

 

There are also NaDCC tablet concentrates that contain a surfactant to kill bacteria in biofilm, which is a serious problem in healthcare environments.  In fact, NaDCC formulations with included surfactants are the first chemistries with an EPA registered kill claim against bacteria present in biofilm.  Statistics show that 93% of all critical surfaces in hospitals harbor dry surface biofilm.  In today’s environments where there are more antibiotic resistant bacteria than ever before, there is an urgent need for a more effective disinfecting solution.

 

Imagine eliminating at least half a dozen chemicals from housekeeping closets, central storage areas and individual cleaning protocols.  It’s easy to visualize how much this could simplify the entire process and measurably improve work flows.  Yet, myriad valuable benefits beyond higher efficiencies would be realized in overall facility health, profitability and compliance.

 

Safety, Economy and Efficacy

 

Standardizing around a single chemistry that cleans, sanitizes and disinfects can upgrade safety in four distinct ways:

 

  1. It eliminates potential failure points caused by human error.  Instead of multiple chemical usage guides and dwell times, one chemistry with one set of directions for every stage of the cleaning process would take the guesswork out of what to use when. 
  2. The quick dissolving tablet concentrate ensures more accurate dilution than chemical dispensers and removes the risk of mixing mistakes.
  3. HOCI produced by NaDCC is rated 0,0,0 by the NFPA, which presents a less hazardous alternative to some of the more corrosive sporicidal grade chemicals used today.  Moreover, improvement in worker safety will inspire greater support and adoption amongst housekeeping staff, ensuring higher levels of ongoing compliance around its use.
  4. With a pH of 6.5 - 7.0, versus bleach at 12 - 13, NaDCC exhibits very good surface compatibility and won’t damage equipment or dull floor finishes.

Financially speaking, by consolidating around a single chemistry, facilities could save tens of thousands a year in at least four key areas:

  1. Shipping and storage costs would be reduced up to 90% by switching to a non-hazardous class tablet concentrate versus more expensive hazardous classified liquid concentrate alternatives.
  2. HOCI solutions produced from NaDCC are effective at much lower concentrations than bleach derived HOCI, thereby reaping chemical savings and achieving equivalent results without the risk of corrosive damage.
  3. Chemical waste would be significantly less since NaDCC diluted solutions remain stable for three days in closed containers and, when formulated for electrostatic sprayers, decrease the amount of chemicals used by 60% per square foot.
  4. Higher productivity and performance would effectively lower labor expenses.
  5. Infectious outbreak losses could be successfully mitigated while other HAI-associated costs would drop dramatically.

 

Greater safety and economic value are only part of a complete chemical evaluation. Efficacy is also of utmost importance.  

 

At sporicidal strength, NaDCC is proven to kill C. diff in 4 minutes and is on the EPA K list of approved products recommended by the CDC for C. auris and other emerging pathogens. Moreover, the residual action of NaDCC based disinfectants presents an opportunity for the healthcare industry to not only address pathogens during normal daily cleaning, but also provide longer-term protection against recontamination.  Because the chemical equilibrium of an NaDCC derived HOCI solution is approximately 50/50 free chlorine/bound chlorine, when in the presence of microbes or organic material, the free chlorine is used up, triggering the release of more free chlorine to restore equilibrium.  Therefore, a reservoir of chlorine is available for biocidal action, or reserve killing power, that continues long after application.

 

Switching to NaDCC tablets for chemical organization also provides the opportunity to leverage enhanced disinfection systems using new electrostatic spraying technologies that provide a safer and more economically viable option for more complete environmental sanitation than many of the alternatives that exist today.  Electrostatic disinfection has already begun to transform the cleaning industry by delivering 80% faster application time and three-times greater surface coverage per ounce.  Equipment that’s fine tuned to ensure safe, consistent, and reliable application of chemical disinfectants for repeatable outcomes is critically important for scalability and long-term success amongst facilities and teams of all sizes.  According to the CDC, current processes leave an estimated 50% of hospital surfaces uncleaned and, outside of healthcare, the percentage is even worse.  With time at a premium, having the ability to expedite application and more thoroughly disinfect would be a game-changer for healthcare and for facilities of all types.

 

Simplified Compliance Management

 

Standardization of cleaning and disinfection processes would go a long way toward solving many compliance concerns.  Ultimately, levels of compliance are directly proportional to cleaning success.

 

Best practices include consolidating around a universal broad-spectrum disinfectant that achieves maximum safety and effectiveness.  Less chemical variation leads to simpler processes, training and procedures, better tracking and monitoring, and vastly improved outcomes. Programs designed for simplicity are consistently more compliant in almost any industry. But in the cleaning industry, where multi-lingual staff and high turn-over are prevalent, it’s all the more crucial for training programs and processes to be simplified so they can be replicated and easily scaled. High level compliance around industry best practices will result in more efficient and effective facilities sanitation, better quality results, healthier populations, safer and cleaner facilities.

 

The cleaning industry is ready for reinvention. Revamping for improvement means consolidating and streamlining processes, starting with the chemicals we use.  At the end of the day, standardizing chemistries will make the immense jobs of facility managers and healthcare executives a whole lot easier.

 

 

 

 

 

ABOUT CHRIS ROMAGNOLO

Chris Romagnolo is Vice President, National & Strategic Accounts at EarthSafe Chemical Alternatives.  Since 2014, Chris has led development of protocols to prevent infectious outbreaks for the EvaClean Infection Prevention System from EarthSafe. Chris also creates training programs and educational videos for all end-user verticals, as well as manages several national distributor partners and major accounts in the senior living, long term care, healthcare and athletic industries.  Previous roles as Environmental Services Manager, Area Safety Coordinator and Support Services Director for multiple hospitals and medical centers have given Chris a profound knowledge-base in healthcare.  Chris is a Veteran of the U.S. Air Force and hails from Braintree, Massachusetts where he lives with his wife and 2 children.  www.evaclean.com

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