According to a study published in the American Journal of Infection Control, the official journal of the Association for Professionals in Infection Control and Epidemiology (APIC), hospital room floors may be an overlooked source of infection.

INCLEAN’s Lizzie Hunter spoke to several industry professionals in the Australian cleaning industry to find out what this kind of research means for the cleaning industry and the future of infection control and prevention in the healthcare sector.

The study, ‘Are hospital floors an underappreciated reservoir for transmission of health care-associated pathogens?’ published in the March 2017 edition of American Journal of Infection Control, found that hospital room floors may be an overlooked source of infection due to the likelihood of items in a patient’s room touching the floor, allowing pathogens from the floor to rapidly move to the hands and high-touch surfaces throughout a hospital room.

“Understanding gaps in infection prevention is critically important for institutions seeking to improve the quality of care offered to patients,” said APIC president Linda Greene, RN, MPS, CIC, FAPIC.

“Even though most facilities believe they are taking the proper precautions, this study points out the importance of ensuring cleanliness of the hospital environment and the need for education of both staff and patients on this issue.”

Truvox International’s sales and marketing director Gordon McVean agrees, telling INCLEAN magazine that the cleaning and hygiene industry should welcome this research and its important message – neglecting to clean floors to a high hygienic standard risks undermining infection control.

“The health sector’s focus on common touch points is understandable, but responsible cleaning contractors have long recognised that floors can be a source of cross-contamination,” McVean said.

“We know also that the health sector is not immune to the outdated reliance manual floor cleaning methods such as mopping that’s seen across many sectors.”

In the study by Abhishek Deshpande, MD, PhD and colleagues, researchers cultured 318 floor sites from 159 patient rooms (two sites per room) in five Cleveland-area hospitals. The hospital rooms included both C. difficile infection (CDI) isolation rooms and non-CDI rooms.

Researchers also cultured hands (gloved and bare) as well as other high-touch surfaces such as clothing, call buttons, medical devices, linens, and medical supplies.

The researchers found that floors in patient rooms were often contaminated with Methicillin-resistant Staphylococcus aureus (MRSA), VRE, and C. difficile, with C. difficile being the most frequently recovered pathogen found in both CDI isolation rooms and non-CDI rooms.

Of the 100 occupied rooms surveyed, 41 per cent had one or more high-touch objects in contact with the floor. These included personal items, medical devices, and supplies. MRSA, VRE, and C. difficile were recovered from six (18 per cent), two (6 per cent), and one (3 per cent), respectively of bare or gloved hands that handled the items.

“Efforts to improve disinfection in the hospital environment usually focus on surfaces that are frequently touched by the hands of healthcare workers or patients,” said Deshpande.

“Although healthcare facility floors are often heavily contaminated, limited attention has been paid to disinfection of floors because they are not frequently touched. The results of our study suggest that floors in hospital rooms could be an underappreciated source for dissemination of pathogens and are an important area for additional research.”

Whiteley Corporation’s executive chairman Greg Whiteley says the debate on cleaning hospital floors has raged on since 1967, when a paper published in the Journal of Hygiene (Cambridge Press) by Professor Geoffrey Ayliffe and his colleagues in Birmingham, showed that floors get regularly contaminated with nasty germs, and disinfecting the floors did not stop their recontamination.

“Over the past few years, the issue of cleaning around the patient bed has focused on what are now termed High Touch Objects (HTO),” he told INCLEAN magazine.

“This includes everything around the patient that gets touched regularly. Of course, most people don’t wipe their hands on the floor, so the floor has been widely regarded as not much of a problem for cleaning.

“Yet, cleaning is vital in healthcare settings. The role of cleaning staff is to remove transmissible and pathogenic bacteria from in and around the patient surrounds, and in the wards generally, and there is no better way than regular cleaning and hygiene.

“There has never been a more important time to value our hospital cleaning staff,” said Whiteley.

“Our hospital cleaning staff do a fantastic job, sometimes in difficult circumstances, and often without much acknowledgment. With antimicrobial resistance on the rise, cleaning and disinfecting with correct methods and materials is a critical part of any infection prevention protocol.”

Fiona Nemetz, system director of EVS, Safety & Security at Northside Hospital, Atlanta says the study serves as a perfect introduction to the question, ‘do you have a floor care cleaning program?’

“What cleaning product are you using? Is the product compatible with the flooring and does the cleaning solution selected reflect the acuity of the traffic on that floor? And what is the cleaning frequency of floor cleaning? In a patient care area, floor cleaning should occur at a minimum of once a day, if not more frequently,” she said.

Bill Basset, managing director of Interclean, agrees with Nemetz, pointing out that a hospital floor is actually the most touched surface in the facility.

“Next time you walk into a healthcare facility, count how many steps you take and how many different rooms you walk into in a five minute period,” he said. “Most of us take two steps per second – that’s 600 steps in five minutes – and are capable of moving through an entrance, a hallway, a public bathroom, a patient room and an office in that period.

“Multiply this by 100 members of staff, visitors, patients or residents and you can quickly see that the most touched surface by the most people in your facility is actually the floor.”

He said hospitals need to reduce the chance of touching a contaminated surface or breathing in dust or airborne germs to reduce transmission of hospital acquired infections.

“It may only be your shoes that you think have touched that floor, but think about how many patients or residents are rolling over that floor in a wheel chair and how many of them are resting their hands on those wheels.

“That wheel or foot rest or even your shoe could well be the number one source of hospital acquired infections you are capable of touching with your hands.

“To reduce transmission of hospital acquired infections we need to reduce the chance of touching a contaminated surface or breathing in dust or airborne germs. This can be done by reducing exposure to contaminated surfaces or by making sure those surfaces are clean before they are touched.”

This first appeared in the May/June issue of INCLEAN magazine. To subscribe, click here.