The problem with “bringing a knife to a gunfight” in the protection of occupant health
In recent years, the cleaning industry has been the prime protector of the health of building occupants. We understand that our services can provide effective defenses against the spread of pathogens. Yet, we also know that MRSA, asthma, staph infections and other ailments still persist, even in healthcare facilities.
This raises some questions:
- Is the removal of soils and microbes from surfaces in buildings by cleaning service providers the real key to controlling the spread of infection and disease to building occupants?
- Are we successfully cleaning for the health of building occupants through surface cleaning alone?
The Proper Context
To answer these questions, we must place cleaning in its proper context. For example, it is well-established that surface cleaning is the process of removing unwanted visible substances (dirt, dust, grit, lint, litter, grime, etc.) from surfaces. This is accomplished through the transfer of these undesirable substances to a cloth, mop head, or a vacuum air stream, as well as by literally flushing these substances away with a pressure wash or a carpet rinse. Along with the soil, we remove any micro-organisms through these processes as well. In this way, cleaning that improves a surface’s appearance (which is the metric by which cleaning success is often judged) also increases safety and preserves the surface, which then makes that surface “healthier”.
Furthermore, the outcome of surface cleaning by service cleaning providers is generally not health protection. To make a comparison that demonstrates this point, when we consider the outcome of washing a vehicle, we know that we seek to improve the vehicle’s appearance, preserve its finish, and even enhance the safety of its operation. Yet, when considering the outcome of washing a vehicle, we rarely intend to make the vehicle healthier for ourselves when we drive it. Health considerations are often considered unnecessary in this circumstance. In a similar way, cleaning service providers may consider the health of building occupants as unnecessary when addressing desired outcomes of a surface cleaning in a building.
It would also be misleading to connect all surface cleaning outcomes to issues concerning health. The removal of soils, not micro-organisms, is the purpose of the majority of surface cleaning, although we know that micro-organisms abound on many of the surfaces that have just been cleaned. The reason for this is that, after mopping a floor, our footwear will immediately deposit E. coli on the surface that was just cleaned. However, this hasn’t been considered to be a real problem for many cleaning service providers due to their understanding that it is unlikely that people will move infectious organisms from that floor to their mouths.
Frequent, Effective Handwashing
In this way, contaminated surfaces, by themselves, are harmless to humans until someone touches them by hand and moves the infectious material to a body. However, this is the manner in which infection is known to be commonly spread in healthcare facilities.
This is why, in the healthcare community, constant emphasis is placed on handwashing. The message is repeated often that washing your hands properly and frequently will stop the spread of healthcare-associated infections (HAIs). This is message is strong because healthcare professionals understand that infectious materials on a surface do not leap onto a bed-ridden patient—they are transmitted through touch.
Although surface cleaning, especially in healthcare facilities, is still essential to keeping microbiological growth to a minimum, it is not the frontline defense against cross-infection by micro-organisms. The frontline defense against HAIs is frequent, effective handwashing.
Indoor Air Quality
We can wash our hands often to minimize the transfer of unknown microorganisms to our body, but we have little control over protecting ourselves from the air that we breathe in our daily lives. The normal air intake each day by a person is roughly 400 cubic feet, depending on the person and activity. That is a lot of air, mostly inhaled indoors where ventilation may be limited.
Studies have connected poor indoor air quality to asthma, heart disease, stroke, COPD, and other respiratory ailments. Asthma and allergies alone are two persistent ailments that are often triggered by either particle irritants (dust) or chemical irritants (VOCs) in the air. Furthermore, very fine particulate matter reaching deep into the lungs causes serious damage resulting in lung cancer or emphysema. Recent research has also linked some common sinus infections and chronic breathing problems to the presence of fungi, such as mold, in the air.
Research by the CDC confirms that the air we inhale every day in order to live has the potential to pose a greater risk to our health than bacteria or virus-laden surfaces in a building. Airborne ultra-fine particles and microbes are invisible and detection is possible only with the proper instrumentation. These inhaled particles, including viruses, are generally about 0.5 micrometers in diameter, which is less than a human hair at about 100 micrometers in diameter. Furthermore, while volatile organic compounds (VOCs) may have distinct odors betraying their presence, the microscopic particles that can reach deep into our lungs and even enter our bloodstream do not.
In the cleaning industry, we are often faced with dusting and vacuuming in a building after work hours when the HVAC has been turned off, and there is no more ventilation. Often floor tile stripping and refinishing (VOCs) occurs on weekends when the situation is the same.
Dusting and vacuuming, dust mop use, even the exhaust from portable floor and carpet maintenance equipment can move fine particles and droplets into the surrounding air. Custodial workers are exposed to this particulate matter in less than ideal conditions for extended periods of time.
Considering how long fine particles can remain suspended in the air, the building occupants entering the next day will also be exposed to the same risks to their lungs as those stirring up the particulate matter the night before. If this takes place every night of the work week for months on end, the buildup of particulate matter overtime may become a real problem.
Without becoming alarmists, we should recognize that poor IAQ may be a greater threat to the health of building occupants than biological contamination on surfaces, especially in healthcare environments. Air contaminants transfer to humans unavoidably and constantly, and in healthcare environments, what is in the air specifically may be more problematic than in other working environments. Furthermore, due to their size, particulate matter can remain airborne for long periods and has the potential to be inhaled readily. Addressing this issue may need to take a central focus in order to overcome the spread of infection in buildings, and specifically the spread of HAIs in healthcare facilities.
In this way, surface cleaning by cleaning service providers may be akin to “bringing a knife to a gunfight” if IAQ is not first addressed. Such methods of health protection may be offering helpful protection, but, in reality, surface cleaning alone may not be the most effective method of addressing the health hazards that are present in air we cannot avoid to breathe.
By Lynn E. Krafft, Owner, Krafft Cleaning Services, Inc.