Soft surface disinfection is one of the more commonly overlooked environmental cleaning issues in healthcare. Providers and companies are continually working together to create solutions requiring less work for healthcare workers, while providing more protection against contamination and hospital-acquired infections.
Here, Kelly A. Reynolds, MSPH, PhD, an associate professor at the Tucson-based University of Arizona's Zuckerman College of Public Health, co-director of the Environment, Exposure Science and Risk Assessment Center and researcher associated with Clorox Professional, discusses the challenges of soft surface decontamination and how providers can lower transmissions of HAIs on soft surfaces in their environments.
Question: What is the biggest single challenge to soft-surface decontamination?
Dr. Kelly A. Reynolds: I believe the biggest challenge to soft-surface decontamination is a lack of awareness surrounding the issue. Currently, there is no approved guideline or standard protocol that outlines steps for regularly treating soft surfaces in healthcare environments between launderings or for addressing soft surfaces that cannot be laundered. This lack of guidance means soft surface decontamination often goes overlooked, which in turn can put patients, visitors and staff at risk for infection.
In a recent Association for Professionals in Infection Control and Epidemiology survey, infection preventionists were asked how often privacy curtains in their facilities are cleaned, and 37 percent of respondents answered only when visibly soiled, 13 percent answered every month, 13 percent answered every three months and another 13 percent answered once per year. Meanwhile, it takes a standard privacy curtain only two days to become contaminated.
Q: What are the typical barriers to soft surface decontamination?
KR: Traditionally, laundering has been the only option for soft surface decontamination, but fabrics can remain contaminated with viable and potentially harmful organisms even after laundering. Even to the extent that laundering is effective, some frequently contaminated fabrics such as privacy curtains are often not laundered unless visibly soiled, and others, like upholstered furniture, cannot be laundered at all. Research has shown that microorganisms can survive on soft surfaces for extended periods of time, leaving the potential for them to contribute to cross-contamination and the spread of infections.
Q: How would you describe the state of soft surface decontamination practices in healthcare?
KR: The importance of hard surface decontamination is widely understood, and established guidelines inform the daily protocols [that are] in place in hospitals and other healthcare facilities all around the country. Yet infection preventionists and environmental services professionals still struggle with the best way to deal with soft surfaces.
Soft surfaces — such as privacy curtains, upholstered furniture and clothing — comprise roughly 50 percent of the healthcare environment yet are often overlooked in infection control protocols. New resources, like the Society for Healthcare Epidemiology of America's guidance on Healthcare Personnel Attire in Non-Operating-Room Settings help raise awareness of how contaminated soft surfaces, such as white coats, can pose a risk for infection and even undermine hard surface disinfection routines. However, further research aimed at identifying pathogen transmission patterns and the degree of contamination of soft surfaces in common areas and patient rooms would be beneficial. Additionally, there is a need for further education and greater understanding of soft surface exposure risks.
Q: How do hard surface disinfection and soft surface decontamination differ?
KR: One of the biggest differences between hard surface disinfection and soft surface decontamination is the type of product you can use. When selecting Environmental Protection Agency-registered products for use in healthcare settings, it is always important to first consult the manufacturer's instructions and examine the label for relevant kill claims and approved uses. Many product labels include language limiting applications to hard, non-porous surfaces, however some EPA-registered spray products are now available to kill microorganisms on both hard and soft surfaces in just 30 seconds. These multiuse products can easily be incorporated into existing cleaning routines to help prevent the spread of infection-causing pathogens.
In my work with Clorox Healthcare, I tested one such product, Clorox Healthcare® Citrace® Hospital Disinfectant and Deodorizer, in three different healthcare settings and found that it effectively reduced the concentration of heterotrophic plate count bacteria by up to 98.5 percent on soft surfaces, including waiting room chairs, patient room chairs and privacy curtains (Reynolds, K.A., Sexton, J.D. “Evaluation of a Soft Surface Sanitizer in Healthcare Environments.” Presented during IDWeek 2013).
Q: Are there any best practices for soft surface decontamination?
KR: Healthcare professionals can implement a comprehensive approach to environmental hygiene by adding a few simple steps to improve soft surface decontamination practices. Regularly laundering soft surfaces and targeting items such as privacy curtains, upholstered furniture, office chairs and mouse pads with a U.S. Environmental Protection Agency (EPA) registered soft surface product between laundering will go a long way to reduce the risk of infection.
The three key steps to follow are:
1. Routine laundering of privacy curtains, linens, employee uniforms and other soft surfaces in your facility.
2. Use of an EPA-registered product to kill bacteria on soft surfaces between laundering and on soft surfaces that cannot be laundered.
3. Hand hygiene practices by healthcare professionals during and between patient care.
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