Clostridium Difficile Training for Environmental Cleaning Staff

the purpose of this video program is to provide basic infection prevention and control training for staff involved with cleaning and disinfection of the environment and equipment of residents or patients who have Clostridium difficile infections C difficile is often referred to as c diff it is a common healthcare associated infection that is caused by an invisible spore-forming bacteria these fours can be found in the intestines and feces of people who have the infection the c diff spores are very Hardy they travel through the intestinal tract of infected residents or patients and can contaminate the environment during episodes of diarrhea c diff spores can survive on environmental surfaces for months at a time new infections can occur when the spores from an infected individual find their way into the stomach of another vulnerable patient recent antibiotic treatment being immunocompromised or elderly place patients at highest risk c diff infections can be mild to life-threatening symptoms of infection include watery diarrhea fever and abdominal pain proper cleaning and disinfection practices can remove and kill bacteria on contaminated surfaces these surfaces include bed rails commodes floors medical equipment and other frequently touched surfaces in the patients or residents room or environment how do these germs travel around the healthcare facility most often they travel from person to person on contaminated equipment as well as on the hands of caregivers the worker touches the patient or resident or a surface that has the spores on it and then if their glove use and hand hygiene practices are not adequate they can transfer the germ to another patient resident or environmental surface watch how this happens in the following story [Music] cliff is a hospitalized patient with a c-diff infection he has been in the hospital for a week in contact precautions his room has become heavily contaminated with invisible seeded spores unfortunately his caregivers don't always follow all of the requirements for contact precautions in fact on this particular day they didn't wear an isolation gown or gloves when in his room the c-diff germs are now on the caregivers hands since she didn't perform hand hygiene the germs will now be left on the next surface she touches unfortunately for Bob she's also his caregiver she unknowingly brings cliff's germs into Bob's room and transfers them to the bedside table when he drinks water from his cup which had contact with the contaminated bedside table Bob ingests the c-diff germs his caregiver brought from Cliff's room a few days later Bob transfers to a rehab facility to recuperate from his hip surgery inside of him c-diff spores grow and multiply soon Bob begins to feel terrible and develops non-stop diarrhea meet his new caregiver he doesn't know that Bob will soon be diagnosed with a c-diff infection he is very busy and needs to check Bob's vital signs and it says several other residents in nearby rooms he doesn't wear gloves or wash his hands when caring for Bob he has a busy day in front of him so he dashes off to help other residents and one by one he spreads Bob's c-diff spores to surfaces equipment and residents in other rooms at the facility so you can see how easily c-diff spores can be spread each facility should have a specific infection control policy they follow although infection control policies may differ between facilities the best practice recommendations that are included here should apply to healthcare settings in general if you have questions be sure to ask your supervisor or infection preventionists in this next section let's look at the role environmental cleaning staff have in preventing the spread of c-diff spores let's cover this in three sections standard precautions and contact precautions hand hygiene and environmental cleaning practices standard precautions plus contact precautions in health care standard precautions should be followed for each and every patient or resident regardless of their diagnosis this includes performing hand hygiene before and after caring for each patient or resident and their environment use of disposable gloves and other personal protective equipment such as gowns to prevent contamination of staff with blood or body fluids and effective cleaning and disinfection of the care environment or equipment in addition to standard precautions contact precautions are usually added when caring for patients or residents with symptoms of active c diff infections some facilities may require individuals to be in contact precautions until they are discharged or have completed their CDI treatment in hospitals contact precautions added to standard precautions include placing the patient in a single room with a dedicated bathroom when possible staff members applying gloves and gowns before entering the room and removing them and completing hand hygiene before exiting dedicating equipment to the isolated patient when possible and proper cleaning and disinfecting of items before removing them from the patient room patients with C diff infections are considered contagious during the time that they have diarrhoea in long-term care facilities use contact precautions for residents with active c diff infections this includes the following provide separate toilets or a commode chair if a seed if confirmed resident is sharing a room with a non-infected resident dedicate patient care equipment to the c-diff resident use gowns and gloves when caring for the seed if resident or for contact with their environment while in the room the environmental cleaning staff should use care to prevent cross contamination of the germs in the room and items outside of the room including the EVs cleaning cart only leave the contact precautions room after removing gloves and gowns and completing hand hygiene items including cleaning equipment must be properly cleaned and disinfected prior to removing from the residence room it is acceptable to place contaminated equipment into a plastic bag to be cleaned and disinfected in a more appropriate location hand hygiene an important part of preventing the spread of C diff infections in healthcare depends on effective hand hygiene practices published studies have demonstrated that in general health care workers often follow proper hand hygiene practices less than 50% of the expected times the most effective way to keep hands free from seed if spores is to use disposable gloves apply clean gloves to clean hands before beginning tasks that may result in c-diff for contamination upon completion and before exiting the room remove the gloves at doorway and perform hand hygiene the amount of hand hygiene product used should be as directed by the manufacturer the required amount of time in the manufacturer's instructions should also be followed when using soap and water you should wet your hands and apply to soap and spend at least 15 seconds rubbing your hands with soap so the germs and debris become detached from the layers of the skin and are rinsed down the drain dry hands with a paper towel and use the towel to turn off the faucet when using alcohol-based hand rubs you should apply the amount of product required into the palm of your hand and rub the solution over your hands fingers and fingertips rub them until the solution evaporates which is around 20 seconds during times of C difficile outbreaks and other times when increased rates are experienced some facilities may require staff to wash with soap and water instead of using the alcohol based hand rub products when caring for patients with c-diff this is because the spores are not killed by alcohol like most other germs be sure to know what your facility policy is and to follow it environmental cleaning practices for c-diff prevention and control now let's look at the role of environmental cleaning daily cleaning and discharge room cleaning is very important the more often the frequently touched surfaces are cleaned the lower the burden of organisms will be the overall cleaning techniques used by environmental cleaning staff are important to prevent cross-contamination follow these basic infection control rules when cleaning and healthcare settings clean from high to low from the cleanest areas to dirtiest areas and move around the room in one direction cleaning effectively to prevent c-diff transmission includes both cleaning and disinfection cleaning refers to the physical removal of visible dirt dust and organic matter disinfection on the other hand is the inactivation of disease producing germs surfaces must be cleaned before they can be properly disinfected best practice recommendations include the use of microfiber cloths and mops published studies show that this type of technology when properly maintained is proven to be superior in removing microorganisms compared to other non microfiber textiles the folded cleaning cloth should be dampened with the appropriate disinfectant solution use friction and change the claws as frequently as needed in order to prevent cross-contamination your goal is to remove as many of the invisible spores as possible through mechanical cleaning continuing to use your standard facility approved disinfectant cleaner may be appropriate unless the facility is experiencing an outbreak of c-diff or if it has been requested by your infection Preventionist when there is a concern that the physical cleaning aspect is not removing sufficient seed if spores the facility's infection Preventionist may at times recommend the use of a special sporicidal disinfectant cleaning product in place of the standard facility disinfectant for discharge patient room cleaning this is because seed if spores are resistant to most Hospital disinfectants the special group of surface disinfectants referred to as spore asides include bleach-based products as well as a group of newer hydrogen peroxide peracetic acid products which have a vinegar odor most EPA registered hospital disinfectants are a combination of a detergent cleaner plus a disinfectant in one solution these are referred to as one-step disinfectant cleaner bleach solutions may fresh each day from a concentrated bleach requires a two-step process surfaces need to be cleaned first with a detergent before disinfecting with the bleach solution it should be noted that the popular EPA registered healthcare bleach wipes used in many facilities are often a one-step cleaner disinfectant product and would not require two steps for cleaning and disinfecting check the label on the product you are using for more information disinfectant solutions should be applied to the surface either by a saturated cloth towel or a pour spout type of container make sure the surface is wet with the disinfectant liquid and remains damp on the surface for the required contact time according to the label directions disinfectants should never be aerosolized by spraying from a container onto healthcare surfaces some facilities now have purchased one of the new no touch types of technology for discharge patient room surface disinfection if your facility has this type of technology specialized training according to many factures directions is required along with demonstrated competencies before the devices are used by the cleaning staff to review what we have learned in this final section the specific ways environmental cleaning staff can reduce the risks that c-diff germs include always following standard precautions and contact precautions always following proper hand hygiene policies assuring that the best practices for the physical and chemical cleaning and disinfection of c-diff are used as the environmental cleaning staff you are the team that lead the way in preventing the environmental spread of c-diff germs in your healthcare facilities the more you are able to reduce the number of germs in the patient environment the more the risk of spread to vulnerable patients is reduced thank you for what you do every day to make the health care facility where you work as safe as possible for patients visitors and your fellow health care workers [Music]