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Clinical Nurse Specialist, Claire Underwood was left inspired, motivated and eager to learn more after hearing about an Australian Hospital going Chemical free. Melbourne based Monash Health transformed hospital environmental cleaning by introducing chemical free cleaning across its entire health service which has more than 40 sites. Claire’s interest and frequent questions led her and colleague Manager, Domestic Service, Debbie Jennings to get an invite to attend a seminar to learn more.

This resulted in a major shift in cleaning processes and thinking throughout the Hutt Valley District Health Board as it moves towards being chemical free. The DHB has trained its staff in chemical free cleaning and now Industry Training Organisation Careerforce, is aligning its assessments so that staff can complete the New Zealand Certificate in Cleaning (Level 3) qualification.

Careerforce is working with the Hutt Valley DHB and their operations. It is working towards reviewing, updating and adapting its learning resources and assessment questions so that trainees using microfibre and steam can still achieve the qualification.

“Careerforce provides education for our domestic staff,” says Claire.   “This method of cleaning has required a lot of teaching and we have had to engage with the organisation to design a new teaching package.”

Chemical free cleaning makes use of steam and ultramicrofibre cloths to perform daily and terminal cleaning without the use of chemicals. These cloths are dampened with water for daily wiping and dusting of surfaces. Steam machines are used in bathrooms, toilets and isolation rooms to loosen stubborn dirt and bacteria and viruses which are then collected as the item or area is wiped over with the microfibre cloth.

The microfibre works by static attraction. So instead of killing germs, it traps and holds them tightly in the cloth and does not re-distribute them. Steam machines deliver steam at high temperatures to a surface which will have a sterilising effect.

“We first trialled this method of cleaning in our isolation rooms and we sourced steamers and microfibre cloths,” says Claire. “This type of microfibre did not exist in New Zealand. We then presented it to our Infection Prevention and Control Committee who agreed to roll it out slowly across the DHB.

“We trained the domestic service staff to clean this way and then rolled it out to other areas in the hospital. Next we will roll it out to nursing staff after successfully procuring a disposable microfibre cloth for equipment cleaning.”

Chemical free cleaning offers a broad range of benefits that include cost savings, health and safety, quality and environmental areas. According to Claire, the Hutt Valley DHB has seen a number of benefits from introducing these processes:

“Sensitive equipment and soft furnishings can be damaged or discoloured by bleach products and other cleaning chemicals.

“The dry cleaning of curtains can be very costly. Instead window drapes are cleaned using steam and microfibre, while still hanging.

“Another issue is that some of the cleaning wipes with chemicals were causing fluid ingress into equipment that was causing damage. When we examined and looked at how things were cleaned, we also found that not a lot of cleaning was taking place – staff were wiping things with a ‘powerful kill- all chemical’ – a disinfectant which doesn’t do its job unless you clean with soap and water first and that can account for a high rate of some infections. 

“Effective cleaning with chemicals requires a two-step process with detergent and water and then effective contact time with a disinfectant. This is very time consuming in a hospital that requires cleaning to take place quickly. Steam and microfibre offers a system that is one step which speeds up cleaning and does not rely on contact time of chemicals.

The DHB needed to prove that this method of cleaning really worked. A cleaning audit was introduced to assess if cleaning had taken place. Invisible fluorescent markers were placed on ten high touch points (light switches, door handles, taps, bed rails, call bells) and then the area was exposed to cleaning. Twenty-four hours later the presence of the markers was audited with an ultraviolet light. If the marker had disappeared, it demonstrated that the cloth was wet to the required standard and had removed the marker.

“We’ve also tested this method of cleaning by assessing for the presence of Adenosine Triphosphate, a protein present in all living things,” says Claire. “It’s also a bench mark for cleaning standards in many NZ hospitals. With this microfibre/steam method of cleaning, we are seeing very low levels of this protein present after cleaning.

“We’ve also seen a drop in Clostridium difficile infections. This type of bacteria is very resistant to chemicals and the spores can thrive in the hospital environment for a very long time.

Other benefits of chemical free cleaning include:

  • reduced environmental impacts by eliminating chemicals, and reducing the amount of water used. Cost savings resulting from the elimination of chemicals.
  • Additionally, chemical free cleaning usually means less physical effort as the use of steam eliminates the need for scrubbing and scouring surfaces, so staff do not become as tired and cleaning can be completed quicker.

According to Claire, some staff resisted this form of cleaning at first. Once the fluorescent marker removal properties of the cloth and the Adenosine Triphosphate results were demonstrated, these staff were amazed. We still use some chemicals – namely detergent and water and bleach for spill management as per standard precautions. Staff on the whole supported the use of less chemicals and appreciate feedback of audit results.

“For other organisations wishing to introduce this system of cleaning, you need to have full support of staff and management and resilience,” adds Claire

Reproduced courtesy of INCLEAN NZ August 2018