According to the PEW Charitable Trust, delivering adequate, on-site health services to the more than one million inmates in state-operated correctional facilities 'is a growing challenge, in part because of the high costs and complex logistics required to hospitalize people who are incarcerated.'
We could add that complicating issues is none other than the Centers for Disease Control and Prevention (CDC), especially when it comes to floorcare and the health of medical facilities. In 2003, the CDC stated the following regarding cleaning floors in health care facilities:
'Extraordinary cleaning and decontamination of floors in healthcare settings are unwarranted. Studies have demonstrated that disinfection of floors offers no advantage over regular detergent/water cleaning and has minimal or no impact on the occurrence of healthcare-associated infections.'
Their reasoning for this conclusion?
• People in hospitals rarely touch floors
• Floors only need to be cleaned when they are 'visibly' soiled.
Some correctional administrators may still be following this CDC proclamation. However, they should know that in 2016, a group of researchers decided to test the CDC's conclusions. The researchers enrolled ten hospital patients in a test. For each patient, a section of the floor adjacent to their hospital bed was coated with bacteriophage, a virus that can infect bacteria and potentially destroy it.
The ten patients were not aware of the precise area of the bacteriophage. The hospital staff was not alerted that a study was even taking place.
While the test was being conducted, all cleaning protocols remained the same. High-touch and commonly touched surfaces were cleaned with bleach and wipes each day. Following the CDC's recommendations, the floors were cleaned only when visibly soiled. Here is what the researchers found:
• The bacteriophage was detected on multiple surfaces near the patient beds within one day after the experiment began.
• Within three days, the bacteriophage was detected on various surfaces within three feet of the bed.
• After three days, contamination was found on high-touch surfaces in adjacent hospital rooms, in the nursing station, and on portable equipment such as wheelchairs, medication carts, and vital signs equipment.
Wondering how this could happen, the researchers concluded the bacteriophage was:
'Probably acquired during direct contact with the contaminated floor site adjacent to the bed. During removal of footwear, patients could easily acquire the virus on their hands, with subsequent transfer to touched surfaces and other skin sites. The finding of contamination in adjacent rooms and the nursing station suggests that health care personnel contributed to the dissemination. This happened after acquiring the virus during contact with contaminated surfaces or patients.' 1
What can correctional administrators learn from these studies? Among them are the following:
• Inmates and staff have scores of indirect contacts with floors every day. Every time we touch a contaminated floor, pathogens from that floor can be transferred from to our hands and then on to our mouth, nose, or eyes, and other surfaces. When this happens in a crowded correctional facility, disease can be passed on to other inmates as well as staff.
• Pathogens on floors can become airborne. In this experiment, it was found that when pathogens are located on the soles of shoes, not only can they be walked on to other floor surfaces, but they can also become airborne and land on nearby surfaces.
• While 'extraordinary' steps taken to disinfect floors may be unnecessary, by the CDC saying a disinfectant is not necessary for floorcare is likely going too far. An effective floorcare program in an on-site, correctional medical setting should include the use of disinfectants, detergents, cleaning agents, and tools.
• As for tools, the CDC suggested that mops be used to clean floors. While that may have been one of the few floor cleaning options available in 2003, 'we know now [that] mops spread germs and contaminants,' says Marc Fergusson with Kaivac, developers of the OmniFlex family of floorcare cleaning systems. 'For instance, 'auto vac' systems are used as a floor mopping alternative in many types of facilities, helping to eliminate the use of mops and traditional floor-mopping procedures.'
The CDC also failed to address cleaning frequencies. In medical facilities, keeping floors both visibly clean and healthy requires dividing floorcare into three categories.
1. Daily maintenance involves the removal of dry soils on the surface. Vacuuming instead of sweeping is the most robust way to perform this type of cleaning. Alternatively, the floors can be cleaned using a no-mop floor-cleaning alternative mentioned earlier.
2. Periodic maintenance consists of scrubbing floors with an auto-vac floor cleaning system or a more costly automatic scrubber.
3. Restoration and refinishing. Restoration involves removing soils, contaminants, and the old finish from the floor. A new finish is then applied.
We should add – and correctional administrators should know - that the CDC has realized its past errors when it comes to floorcare. Recent CDC guidelines are now placing considerably more emphasis on the need to keep floors clean and healthy.
Robert Kravitz is a frequent writer for both the professional cleaning and correctional industries.
1 Koganti, et. al. Evaluation of hospital floors as a potential source of pathogen dissemination using a nonpathogenic virus as a surrogate marker. Infect Cont & Hosp Epidemiol, 2016; 37 (11): 1374-1377.
Robert Kravitz is a former building service contractor, having owned, operated, and then sold three contract cleaning companies in Northern California.
He is the author of two books about the industry and continues to be a frequent writer for the industry.
Robert is now president of AlturaSolutions Communications, which provides communications and marketing services for organizations in the professional cleaning and building industries.