
An estimated 1 trillion species of microbes live on earth. Approximately 15000 different types of microorganisms live on and in a human body. Most of them are harmless and very useful. We could not live without them. However, a relatively small number of these little creatures can give us serious trouble. Seriously enough to cause irreversible body damage or even death. Worldwide more people die because of a hospital associated infection (HAI) than by traffic accidents. Micro-organisms are invisible to the eye. Therefore micro-organisms are perceived as dirty and frightening to many of us. And so we fight them, specifically the bad ones that can harm us. Targeted and in a very organized way, but unfortunately also unfocused and insufficient. Especially in the latter lies a possible danger.
Meet the invisibles
There are many varieties of microorganisms. Examples you probably have heard of are yeast, fungi, bacteria and viruses. As said before, most of them are very useful, however some can make you sick. These are called pathogenic microorganisms. Pathogenicity varies. The extent to which a microorganism can cause damage to its host is called Virulence.
Although viruses and bacteria have totally different characteristics they are often mixed up.
What changed when Corona came into our lives?
For sure the code of conduct changed. During Covid, governments introduced rules which were mandatory and finable in case of violation. Rules constantly changed depending on the status quo of the knowledge we had about the behavior of the virus.
Something else that seemed to change is what I call the move from “visible clean” to “hygienically safe”. Organizations that host people for a short or longer period have to create trust. A visitor or user of a public facility like for instance a hotel wanted to be confident that it is hygienically safe. You can see with your own eyes if an environment is clean, but you need equipment and knowledge to check if it is hygienically safe as well. That is why trust is so important.
Finally our cleaning behavior changed. We started to clean or disinfect everything all the time. In many cases it was not needed from an IPC (Infection Prevention & Control) point of view, but we still did it because it reduced our fear. But,…as you know fear can be a bad guide.
Today the “hygiene crisis” caused by the SARS-CoV-2 virus is almost forgotten, but surveys are showing that things have changed. For instance, a survey of the Bradly Corporation (USA) says that since 2009, more Americans declare to wash their hands more
diligently due to flu and/or coronavirus outbreaks.
Microbes are top defenders
Imagine we are confronted with a highly contagious pathogen microorganism that can survive on a surface for a few days? Facility managers can feel the need to do something and decide to disinfect door handles every 3 hours. It might be perceived as a good procedure but in fact it has less impact than you would suspect. Only the first person that touches the handle right after it was disinfected is safe. All the others that touch the handle in the remaining time until the next disinfection takes place, are only safe if no contaminated person has touched the door handle after disinfection. This story is not made up, during the Mexican flue facility managers did it. And probably during the Corona pandemic it happened again. A real life example of ineffective disinfection.
You need targeted and well thought disinfection procedures. Otherwise there possibly could be a risk that microorganisms become resistant to disinfection products, a phenomena that is already a big problem with antibiotics. In the worst case scenario people get infected and sick because the disinfection product no longer kills the pathogenic micro-organism. Once you are sick, they can't be cured because the same microorganism is also resistant to antibiotics. If that happens, the AMR (Antimicrobial Resistance) problem is even bigger as it is today. IPC experts, but also governments, are increasingly aware of this problem. The Dutch government for instance asked a committee of scientists about the risk of microorganisms getting resistant to disinfectants. The answer is, yes this is not unthinkable, yes we have to handle disinfection with care and yes more research is needed(2).
We have to realize that microorganisms are smart top defenders. Bacteria multiply under favorable conditions every twenty minutes. As a result they develop mechanisms that make them resistant to attackers like antibiotics, relatively quickly. Humans reproduce much slower. It takes a very long time for the human body to adapt to changed circumstances. In that sense we are far behind micro-organisms.
Human behavior strengthens the power of microorganisms
Humans help microorganisms to get stronger.
We frequently and easily travel all over the world. Micro-organisms travel with us. In that sense we help them spread out to new environments.
The human population is still growing. We need more space to live and to grow food. That space is taken from the habitat of wild animals. And if a bat cannot sleep in the woods it will sleep in cities and in the tree of your garden. Wild animals and us will not live in separate worlds anymore, we have to share our habitat. Meaning that we will also share the microorganisms that we are hosting.
In our attempts to fight the threatening microorganisms we try to reduce or kill them. For instance by cleaning (removing) or disinfecting (killing) processes. However if we disinfect a surface in the wrong way, the weak microbes will die. The strongest survive and multiply which makes the population even stronger.
It is not an exception that a wrong disinfectant is used, the wrong dilution is used, the surface is insufficient moistened with disinfectant, the prescribed contact time is not respected (a disinfectant needs a certain contact time to perform), the surface is not cleaned before disinfection (some disinfectants are partly inactivated by specific dirt and bio-films have to be removed before disinfection), the surface is clean but not yet dry (which is causing a dilution of the disinfectant) or the surface was simply not “touched all over”. I have seen it all happening.
Mass attacks with disinfectants stimulate micro-organisms to adapt and develop defense systems. I visited hospitals in the US, Australia and India where “everything is disinfected every day”. Just to be sure. But also in the UK I experienced nurses “cleaning” all day with ready to use, disposable disinfection cloths, unintentional stimulating bacteria to create defense mechanisms and become stronger.
What about professional cleaning?
It looks like it is time to improve. Important questions are, “do we clean as professionally as we should” and “do we really have to disinfect so much”. Probably not. In most cases the knowledge is there, we have the protocols and we know how to clean and disinfect. The major thing we have to change is our behavior in cleaning and disinfection: do what we have to do, do it consistently and do it according to the instructions. Ask yourself if this really happens in your organization. Not because you believe it, but because you checked it. It is possible that over time good intentions devalue. Because of cost savings, lack of education, less operational guidance by supervisors and architectural obstacles which hinders the cleaning and disinfection.
What to do?
As said, we don’t have to change things drastically. But it is advisable to pay attention to certain aspects.
- Check your cleaning and disinfection protocols. Up to date? Is there a need to change, specifically disinfection protocols? Does everyone who has cleaning tasks (EVS, nurses, medical assistants, volunteers,…) know the protocols and have access to them?
- Identify the contamination hotspots and risks of your building. Adapt protocols if needed.
- Train (and repeat) all persons that have cleaning tasks.
- Check cleaning equipment. Is it professional, without defects and clean.
- Invest in understanding and motivation. Explain to everyone that has cleaning and disinfection tasks the importance of infection prevention and the choice of cleaning system. Understanding creates motivation and involvement.
- Change behavior if needed. It will take a long time, but it sure pays off.
- Create trust in your “customers”, the users of the facility. Hygienically safe is the new clean.
About the author:
Ing. P.B. (Paul) Harleman is the Global Application Manager at Vileda Professional. He is the Chief editor of Vileda Professional Hygiene Magazine and member of the technical committee VSR (Dutch Association Cleaning Research)