View Surfaces as an Assembly

Virtually all healthcare surfaces are difficult, if not impossible, to clean. That is a very scary thought considering research shows surfaces are active in the spread of healthcare-associated infections (HAIs).

We continue to learn about emerging diseases and the microbes that survive on surfaces for days and weeks, even after they have been cleaned and disinfected. It is time to look at how surfaces support the spread of infection.

Surfaces are made of different materials and textiles. Soft, hard, porous and non-porous materials that cannot all be cleaned the same way. The selection of materials typically is made based on a “standard” that is established for a specific area. How they look and what they cost are always considered.

Not evaluated, not considered

What is not evaluated effectively, if at all, are the manufacturer’s recommendations for cleaning and disinfecting their product and the warning labels related to disinfectants and cleaning products. Not considered are the ways surface materials are put together, as an assembly, and connected to other surface materials. Soft and hard surface materials have seams and connect or rest on other materials. This has an effect on how effective the cleaning and disinfection process can be.

With the goal to have surfaces that are easy to clean and leaving minimal room for human error when cleaning, we need to look at surfaces in a completely different way.

In high touch, high turnover areas, the need to quickly and effectively disinfect surfaces is critical. It is important to understand who is tasked with room turnover. In some high turnover areas such as an emergency department, staff with primary patient care responsibility (i.e. nurses) may also be required to perform cleaning and disinfection of the area. Identifying these areas and selecting materials that support this process is extremely important. Here are a few things to take into consideration:

  • Identify surfaces that are located in:
    • High traffic
    • High contamination
    • High touch
    • Quick turnover areas
  • How are the surface materials assembled and combined with other types of surfaces and surfacing materials? Are they compatible?
  • Which cleaning and disinfection products can be used on these surfaces without causing damage? (Remember that damage often cannot be seen with the naked eye.)
  • Who is responsible for cleaning and disinfecting this area?

A hard surface example

The hand washing station pictured is located in a 900-bed hospital in a large metropolitan area. They serve everyone and are recognized for serving the underserved. This particular station is located in the emergency department, just outside one of the patient care bays. This area is characterized by high traffic, high contamination and high touch, which clearly results in a high potential for cross-contamination if not cleaned and disinfected often and effectively.

Layered-Surfaces.jpg

Set up for failure

In this very small area there are:

  • Five different surface materials, layered one on top of the other, all requiring different cleaning products and processes to be effectively disinfected
  • Four different surface textures, some of which provide sheltered areas for microbes, contributing to the development of biofilm and formation of colonies
  • Ten different surface areas needing disinfection, making it very easy for those responsible for disinfection to miss ledges, seams and textured surfaces that can harbor microbes

I wish I would have stepped back further to take this photo. You would see that the paper towel dispenser is located on the left side of the faucet, about three inches above the ledge created by the thick vinyl wall protection. As people reach for paper towels, water drips onto the wallpaper and down the back side of the wall protection. There is great potential for mold to become an issue.

While this area really is very attractive and pleasant to be in, there are serious surface issues. This area is difficult, if not impossible, to clean and disinfect effectively. This combination of surfaces provides multiple areas that support microbial growth that can contribute to the spread of infection.