|Assigning Infection Risk Levels in Correctional Facilities|
|By Robert Kravitz, President AlturaSolutions|
In August 2007, reports surfaced that “dozens” of prison guards at Folsom Prison in California tested positive for staph infections—the most serious infliction was methicillin-resistant Staphylococcus aureus, or MRSA, a highly contagious strand that’s often resistant to medication. As unfortunate as this was, what mystified prison administrators was that the infection rate increased very quickly over a four week period, averaging about four new cases each week.
All told, by the time the report was issued, 25 prison employees, including secretaries and office workers, reported contracting a staph infection during the first seven months of 2007. Further, there were 35 confirmed cases of MRSA among Folsom inmates during this period as well. In fact, the infection rate moved so fast that 20 of those cases were reported in just two months.
A recent New York Times editorial reported that prison inmates are the “sickest people in society,” with infection rates far higher than the general population.* The focus of the editorial was not only the health and welfare of the inmates but concerns that they would spread disease to the general public once released from prison. Additionally, the Folsom Prison incident shows that prison staff is not immune to these infections and diseases.
What actions should correctional administrators take when a widespread infection grips their facility? Although the usual steps are encouraged, including proper and more frequent hand washing, use of sanitizers, glove wearing by staff, and seeking medical attention for staff and inmates as soon as a possible infection is noted, increased cleaning and maintenance procedures should also be implemented immediately. Furthermore, this cleaning regimen should specifically address floor areas, as well as all other horizontal surfaces, and of course all “high touch” contact points.
Cleaning plays a significant role in reducing the spread of minor afflictions, such as the cold and flu, as well as much more serious diseases, such as MRSA and other diseases caused by superbugs. And, floor care is essential because floors are not only the largest surface areas in a facility, but they typically are the biggest reservoir of bacteria as well.
Ranking Infection Risk
According to Mark Warner, Product Manager for Disinfectants and Sanitizers, for a leading manufacturer of professional-grade Green cleaning chemicals says, managers in all types of facilities, including correctional facilities, typically have a set cleaning program in place but do not know when or how to “ramp it up” when a contagious environment develops. Warner currently works with janitorial distributors and facility managers as well as federal, state, and local governments, including the U.S. Department of Homeland Security, instructing how to properly address infection threats and cross contamination issues.
Warner says there are four risk levels, referred to as the DEFCON ranking system, with each level requiring facility managers and cleaning personnel to adjust cleaning procedures and frequencies as well as implement different chemicals and tools to address the infection problem at hand. These four DEFCON levels are:
DEFCON 1: No dangerous infection or pathogen risk exists. Cleaning personnel should follow proper cleaning procedures using neutral and all-purpose cleaners in most areas with sanitizers and disinfectants primarily used to clean restrooms, food service areas, and floors.
DEFCON 2: This level signals that a contagious disease, infection, or virus is present in a community or area, but not in a specific building. For example, the swine flu has been reported in several schools and colleges, but its impact has been minimal on many other types of facilities. However, this level requires that neutral and light-duty, all-purpose cleaners be replaced with products that have greater cleaning efficacy and use disinfectants with stated kill claims for the pathogen(s) of concern, which should be indicated on the product’s label. There should also be an increased focus on cleaning and disinfecting floors, other horizontal surfaces, and cross contamination contact points, in this order.
DEFCON 3: At this level, more specific and extensive measures must be implemented because the disease or virus is present in the facility. Cleaning procedures of all surface areas should be increased significantly with floors cleaned and disinfected first, then walls, counters, fixtures, and high touch-point areas, and then the floors again. Surfaces should be pre-cleaned with an effective cleaner or cleaner/disinfectant (see sidebar) and then the disinfectant should be applied, allowed to remain wet (dwell) on the surface per the label directions.
DEFCON 4: This is the most serious risk level and denotes the presence of a dangerous biohazard. This situation calls for experts who are trained in hazardous agent removal.
Focus on Floors
Some healthcare administrators place a great emphasis on disinfecting high touch contact surfaces in their facilities, but place very little importance on disinfecting floors. “This is a serious oversight,” says Warner. “I cannot say it is one reason nosocomial disease is such a problem in our country, but it does tell me that medical facilities are not being cleaned and disinfected as thoroughly as they should be.”
But how can floors transmit disease? According to Warner, studies from various settings indicate that we have 50 direct and indirect contacts with floors every day. “This happens whenever we drop something on the floor and then pick it up, or when our shoe laces drag along the floor and then we tie them up,” he says. “If the floor is contaminated, those germs and bacteria may now be on our hands, starting the chain of cross contamination.”
For instance, studies confirm that a woman’s purse is often covered with bacteria and pathogens, adds Warner. When using the restroom, women often place their purses on the floor. If floor contaminants are present, germs and bacteria latch onto the purse.
To help alleviate this problem and keep floors healthier—minimizing or eliminating floor contaminants—Warner suggests the following:
Accurately rating infection levels is one way of keeping a serious situation from becoming a catastrophe. And, Warner strongly advises correctional managers: “Cleaning and disinfecting applies to all surfaces, including floors. A clean, healthy, disease-free facility starts with the floors.”
Robert Kravitz is a former building service contractor, author of two books on the professional cleaning industry, and a frequent author of articles in major trade publications on health and cleaning related issues. He may be reached at firstname.lastname@example.org
Unless the disinfectant is labeled as a “cleaner/disinfectant,” it does not clean surfaces and should not be used in the pre-clean phase. However, if the label does state “cleaner/disinfectant,” the same product can be used first to clean the surface, and then a second time to disinfect. Always consider the cleaning efficacy, microbial efficacy, PPM, and stated kill claims versus your pathogen(s) of concern.
Cleaning and disinfecting are a three-stage process. When using cleaners and disinfectants, failing to follow the necessary procedure or use inappropriate products may not produce the desired results:
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