Taking back control

“ The steam is used to reduce the amount of scrubbing required by cleaning staff so that the process is very effective and much quicker than using traditional methods.”
Trial of Microfibre and Steam for Clinical Area Cleaning Proves Positive 
Elizabeth Gillespie, Co-Director Sterilisation and Infection Control at Monash Health is working on the implementation of microfibre cloth technology and steam as a cleaning system for clinical settings. Elizabeth tells AHHB about the trial and the positive findings so far. 
Microfibre cloth technology has been used in Scandinavia for a number of years but there are few reports of its adoption in health in other parts of the world, especially for clinical areas. While there have been reports from the United Kingdom of the use of steam with microfibre in healthcare settings, a literature search in 2011 found little documented in peer reviewed journals. Monash Health is Victoria’s largest health service with over 2100 beds and 13,500 staff, who provide more than 250 programs and services to a catchment of greater than one million of the population.
What did Monash Health do? 
A review of the contemporary methodologies and products used for cleaning in Victorian clinical settings highlighted a lack of evidence for some recently adopted cleaning regimes.¹ This lead to a search for alternative cleaning methodologies and a review of the potential for microfibre and steam technology.
We microbiologically tested microfibre with steam cleaning in patient rooms and bathrooms, following discharge. This included rooms where patients, known to be colonised with vancomycin resistant enterococcus (VRE) had been accommodated for at least four days. We microbiologically sampled rooms before cleaning and then again after cleaning.
During this phase we used a fluorescent marker² to confirm (by visual assessment) that the rooms had been cleaned.The aim was to assess the outcome of the microfibre and steam technology.
Based on our findings we commenced a trial, in May 2011. We began using microfibre and steam in a 60-bed residential aged-care unit at Chestnut Gardens and in a 32-bed acute ward at Casey hospital.³ The protocol for each site was slightly different to allow for the difference in patient requirements while promoting a work flow from clean to dirty areas.
What is microfibre cloth technology? 
Microfibre cloths are a combination of polyester and polyamide. The polyester scrubs and cleans the surface, while the polyamide provides the absorbent quality. By applying friction, particles of dust and dirt are attracted to and trapped by the individual microfibres. Microfibres are more effective when used with small amounts of water. By working like a magnet, the microfibre cloth attracts dirt, soil and bacteria into the fibres by capillary action. Ultra-microfibres have a weight of less than 0.3 decitex and demonstrate the most superior clean. The scientific literature reports on the benefits of using ultra-microfibre over microfibre for cleaning.⁴
What is steam technology? 
Steam technology uses very high temperatures (140 degrees Celsius) and dry steam (97 per cent dry) to scrub surfaces.Most bacteria and viruses are killed at 60 degrees Celsius so a disinfection advantage is possible. ⁵ This technology, when used in conjunction with ultra-microfibre, is a substitute to two-step cleaning with detergent and water followed by disinfection with hypochlorite solution. The steam is used to reduce the amount of scrubbing required by cleaning staff so that the process is very effective and much quicker than using traditional methods.
What did we find? 
Our trial demonstrated water saving of 90 per cent for cleaning and the use of detergent and hypochlorite solution was eliminated.
The risk of falls was reduced, together with the risk of back injury since buckets of water requiring emptying or refilling were no longer used.
Our microbiological testing showed that where VRE was present before cleaning, it was completely gone after using the microfibre and steam technology.
Where previously a patient room and bathroom required a discharge 2-step clean taking 160 minutes, the time was reduced by at least 100 minutes to 50 – 60 minutes.
Our cleaning staff were very enthusiastic and pleased to be using the new technology. After the trial, they insisted that we keep the new methodology in place, which we did.
Why use these technologies? 
Microfibre cloths are very effective at removing soil – better than detergent and water cleaning.The advantage is a superior infection control system but also chemicals are not required and only small amounts of water. Time is saved where two-step discharge cleaning was required but also every patient’s room can now be cleaned routinely, at discharge, at this superior level. This means we have cleaner surfaces, reduce our environmental footprint, limit waste, and reduce time delays for patients to access a bed but also reduce occupational, health and safety risks for our cleaning staff.
In October 2012, there was a gastroenteritis outbreak in communities south east of Melbourne involving Norovirus. Many patients were admitted for treatment to Casey hospital with vomiting and diarrhoea. The ward where microfibre and steam technology were used for cleaning demonstrated this technology is as effective in managing environmental contamination from viral gastroenteritis as two-step cleaning using detergent and water followed by hypochlorite solution.⁶
Next steps 
Monash Health is now implementing this microfbre and steam technology across all clinical areas. Around 700 of the 2150 beds are already using the new technology. This includes all our 500 residential aged care beds and subacute beds and 200 of our acute beds. The implementation process is expected to be completed by the end of August 2013.
The implementation process includes the first private hospital in Australia,Jessie MacPherson Private hospital, which implemented the system in March 2013 and the first intensive care unit in Australia to implement this system, Dandenong intensive care unit, in April 2013.
The first of our 28 operating rooms will implement the new technology in the month of May 2013 with a specific protocol and standard operating procedures developed for our operating suites.
In June 2013 Monash Medical Centre Clayton will commence implementation of this technology followed by the remaining clinical areas at Dandenong hospital in July and Casey hospital in August.
Elizabeth Gillespie and colleagues regularly run seminars on this cleaning innovation: Cleaning without chemicals in clinical settings. Go to www.monashhealth.org.au for more information. 
REFERENCES 
[1] Gillespie E, Scott C, Wilson J, Stuart R. pilot study to measure cleaning effectiveness in health care. Am J Infect Control 2012;40:477-8
[2] Gillespie E. Standard for using a fluorescent marker. Am J Infect Control 2012;40:85-6
[3] Gillespie E, Wilson J, Lovegrove A, Scott C, Abernethy M, Kotsanas D,Stuart R. Environment cleaning without chemicals in clinical settings. Am JInfect Control 2013;41:461-3
[4] Wren M, Rollins M, Jeanes A et al. Removing bacteria form hospital surfaces:a laboratory comparison of ultra-microfibre and standard cloths. Journal of Hospital Infection 2008;70:265-71
[5] Sexton J, Tanner B, Maxwell S et al. Reduction in the microbial load on high-touch surfaces in hospital room by treatment with a portable saturated steam vapour disinfection system. Am J Infect Control 2011;39:455-62
[6] Abernethy M, Gillespie E, Snook K, Stuart R. Microfibre and steam for environmental cleaning during an outbreak. Am J Infect Control 2013 ( in press)