High Cost of Foodborne Illness
A single outbreak of foodborne illness can cost a foodservice operation as much as $75,000 in legal fees, medical claims, lost employee wages, cleaning and sanitizing, discarded food supplies, and lost income from negative publicity and/or being shut down. That figure increases dramatically if the incident involves death or serious injury.
National Restaurant Association
By Paul S. Darby, MD, PhD, MPH, CIME, FACOEM
The question under consideration is: "Does the process of spraying, agitating, and then vacuuming a solution from a contaminated restroom floor have better potential to reduce exposure to specific human pathogens than does the traditional method of mop and bucket?" Based on my survey of the medical literature and scientific 'common sense', I believe this question can be strongly answered affirmatively.
It is obvious to anyone trained in medical microbiology that a cleaning method that simultaneously removes pathogenic organisms while at the same time removing their food source is much more likely to succeed at preventing disease transmission than is the mop and bucket method that simply spreads pathogens around the floor in a rich nutrient broth of contaminated bucket water. The traditional cleaning method essentially turns a restroom floor into a very large culture plate, supplying ample water and nutrition to disease-causing organisms that can rapidly proliferate. As the numbers of organisms rise exponentially, the probability that an infective load will be transferred to a person's skin by a single contact likewise rises because infections generally require a threshold number of organisms to be exceeded before disease results. The spray-and-vac method, as employed by Kaivac, has the ability to prevent such conditions required for bacterial proliferation and disease transmission.
The medical literature supports the contention that traditional cleaning methods may actually increase the risk of disease. From Germany came a study in 2004 of household cleaning and surface disinfection methods. A test organism, Staphylococcus aureus, was found to be disseminated from contaminated flooring to clean flooring by the sweep of a mop when water was used, but also when traditional cleaning solutions were used such as surfactants (detergents) and disinfectants (glycol derivatives, quaternary ammonium compounds, alklyamines). In light of the huge recent increase in methicillin-resistant Staphyloccus aureus (MRSA) infections in hospitals and in the community at large, one has to ponder whether traditional cleaning methods are part of the equation. There has also been a rise in the number of potentially-lethal infections of the human intestine caused by Clostridium difficile, a bacterium which reproduces through the formation of long-lasting spores that can persist in the environment for years and are not affected by typical cleaners. In fact, a British study reported in 2006 found that the use of non-bleach cleaners actually caused the organism to thrive and produce more spores! Clearly a method that physically removes spores from the environment is preferred over one that causes them to proliferate.
References:
1: J Hosp Infect. 2004 Apr;56 Suppl 2:S70-5. Household cleaning and surface disinfection: new insights and strategies. Exner M, Vacata V, Hornei B, Dietlein E, Gebel J. Institute of Hygiene and Public Health, University of Bonn, Bonn, Germany. martin.exner@ukb.uni-bonn.de
Recently, new insights into the persistence of pathogens, their transfer from inanimate surfaces to humans and the risk of contamination and dissemination of pathogens by detergents have been gained. Furthermore, new experimental data on the interruption of chains of infection by disinfectants as well as results of outbreak-control studies are now available. Hence it has become necessary to reassess the potential benefits using disinfectants to prevent and control nosocomial infections. Based on the new findings and in view of the increasing incidence of nosocomial infections and antibiotic resistances, the German Robert-Koch-Institut has issued completely revised recommendations on Household Cleaning and Surface Disinfection. With respect to these recommendations we developed a new test method, which allows comparison of the efficacy of disinfection in reducing the microbial loads and their dissemination with that of cleaning procedures under practical conditions. In a multi-factor approach, mechanical properties (wet mop technique), utensils (different mop materials) and active agents (disinfectant, detergent) were taken into consideration. We found that under the given conditions, dissemination of the test organism Staphylococcus aureus did not take place when using aldehydes and peroxides, it did take place, however, when water, surfactants, and the disinfectants glycol derivatives, quaternary ammonium compounds and alkylamines were used.
PMID: 15110127 [Pubmed - indexed for MEDLINE]
2: Am J Infect Control. 2006 Oct;34(8):513-9. An evaluation of patient area cleaning in 3 hospitals using a novel targeting methodology. Carling PC, Briggs J, Hylander D, Perkins J. Department of Hospital Epidemiology, Carney Hospital, Boston 02124, USA. pcarling@cchcs.org
BACKGROUND: Although environmental cleaning and disinfecting practices have become a cornerstone of patient care, assessment of actual compliance with such procedures has not been reported. Using a novel methodology, we developed a means to monitor directly such activities. METHODS: A nontoxic target solution, which intensely fluoresces with a black light, was formulated to be inconspicuous yet readily removed by housekeeping products. Small volumes of material were confidentially applied to 12 target sites in patient rooms in 3 hospitals following terminal cleaning. The targets were reevaluated following terminal cleaning after several patients had occupied the room. RESULTS: One hundred fifty-seven rooms and 1404 targets were evaluated. In the 3 hospitals studied, only 45%, 42%, and 56% of targets were removed by routine terminal cleaning/disinfecting activities. The frequency with which various individual sites were cleaned varied widely but was similar in all hospitals.
CONCLUSION: The use of a novel target compound to evaluate housekeeping practices confirmed high rates of cleaning of traditional sites but poor cleaning of many sites that have significant potential for harboring and transmitting microbial pathogens. This methodology has the potential for being used to evaluate objectively the cleaning/disinfecting activities in various health care settings.
PMID: 17015157 [Pubmed - indexed for MEDLINE] 3: "Cleaning agents make bug strong'", BBC News Online, 3 April 2006. Retrieved on 2007-06-04.
Dr. Paul S. Darby graduated from Furman University with a B.S. in Chemistry in 1981 and went on to earn a Ph.D. in Organic Chemistry at the University of Georgia. He served in the U.S. Army as a Clinical Chemist before attending medical school on an Army scholarship. He received his M.D. from Georgetown University in 1993 and completed a clinical internship at Madigan Army Medical Center in Tacoma, WA. He served as a staff Emergency Medicine physician at a level II trauma center and as a staff Family Practice physician at various Army hospitals around the world.
He left the active Army in 2000 to pursue civilian residency training at the University of Washington, where he also earned his Master of Public Health degree in Occupational Health. He is board-certified in Occupational and Environmental Medicine and is in full-time practice in a major seaport, specializing in acute industrial trauma, chemically-related illness, and maritime medicine.
He has a particular interest in the chemistry and toxicology of household products, and in encouraging the development of safe, practical, and environmentally-responsible cleaning agents.
He retired as a Lieutenant Colonel from the Army National Guard. He is a Senior FAA Aviation Medical Examiner, a Certified Medical Review Officer, a Certified Independent Medical Examiner, and a Fellow of the American College of Occupational and Environmental Medicine. He is on the clinical faculty of two departments at the University of Washington: the Department of Family Medicine (School of Medicine) and the Department of Occupational and Environmental Health Sciences (School of Public Health). He is a member of the American Chemical Society, the American College of Clinical Toxicology, the Washington State Medical Association, and the Pierce County Medical Society. He maintains an active consulting practice in medicinal chemistry and biotechnology through his company MD_PhD Services, PLLC.
Popular Topics: MRSA | Staph | Norovirus | Flu | E. Coli | C. Difficile | Salmonella | Cleaning for Health | Nosocomial Infections | Disinfection | Bacteria | Viruses | Indoor Air Quality | Asthma | Allergies | Allergen | Mold
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