Critical cleaning in LTC settings: Colleen Dillon explains how informed use of housekeeping products helps to keep a facility competitive and operating efficiently.

Maximizing the impact of housekeeping and environmental services on quality is critical to success for the long-term care facility operator. Maintaining a clean, attractive, fresh-smelling, and outbreak-free facility directly links to continued growth by reinforcing the excellence of your entire operation to potential residents and their families. With continued pressure to link quality measures with Medicare and Medicaid funding, the facility administration team can't afford to take housekeeping and maintenance basics for granted. Maintaining a focus on effective cleaning and disinfection for your housekeeping staff can have a real return on your top and bottom lines.

First Impressions Last

Housekeeping is one of the critical behind-the-scenes functions that affects your ability to attract new residents and drive revenue. Focusing on the first impression you make on residents and family members, as well as paying close attention to the details of regulatory compliance in this area, are critical to your reputation.

Good cleaning that applies the right tool for the job is the first defense against the biggest turnoff for prospective residents and their families--an unkempt facility. Strange odors; dirty, dusty floors; and less-than-fresh linens can make potential clients turn up their noses and leave.

Odor Control

Malodors are a key indicator that may trigger concern to potential clients about the quality of care delivered. Effective and timely cleaning is the foundation of odor control. When tackling an odor problem, focus on soil removal--not on the use of perfumes, enzymes, or other "miracle" products--to eliminate the source of the odors.

Among the biggest contributors to odor problems in an LTC facility are body fluids and waste--liquid and solid--that end up on a variety of surfaces, from bed linens to clothing, from carpeting to floorcoverings. Your facility staff need to work together as a team, including the nursing, housekeeping, laundry, and maintenance staff, to design a program that addresses the unique needs of your facility for handling the removal, transport, cleaning, and/or replacement of soiled linens or surfaces.

OSHA regulations require that soiled bed linens must be removed from resident areas, color coded, and transported in a leakproof container to the laundry to avoid cross-contamination, which puts a greater burden on the laundry staff to remove soils and stains before they have time to set.

A laundry program that incorporates state-of-the-art surfactant and enzyme chemistry will aid in soil removal and help to save water, time, and energy. These new technologies also eliminate odors, extend the life of the linens, and use safer, less harsh chemicals. These innovations leave less chemical residue in the linen, thereby lessening their contribution to bedsores and, as a result, support better overall satisfaction for residents and their families. Also, work with your laundry team to match the correct laundry formulas with the soil load that is typically handled. If your resident population has a high degree of incontinence, for example, laundry formulas should be tailored to address the additional soil load.

Urine odors that are prevalent even after resident rooms or common areas are cleaned often can be attributed to floors that haven't been properly sealed, thus allowing the odor-causing soils to penetrate through the finish layers and remain in the floor even after surface cleaning. Look for a stain-resistant sealer for hard floors to protect them from the above-mentioned soils. The sealer should be applied after a thorough stripping of the finish and before any new finish coats are reapplied. After stripping the floor, be sure to incorporate a flood of clear-water rinse to remove any residual alkalinity and follow with a flood-rinse of disinfectant for ten minutes. Remove the solution with a wet/dry vac.

Disinfection

State health requirements mandate that an LTC facility be prepared to prevent facility-acquired (nosocomial) infections and minimize cross-contamination. You'll need a quaternary cleaner (a cleaner formulated with quaternary ammonium compounds that provide excellent cleaning and disinfection properties) registered with the EPA with a hepatitis B virus (HBV) claim that it can handle blood and other potentially infectious material (i.e., other body fluids that are not blood) spills. Tuberculocidal activity can be achieved with a quaternary product that contains both alcohol and quaternary ammonium compounds. These are typically ready-to-use products. HBV-effective quaternary disinfectants should have a claim against antibiotic-resistant bacteria, such as MRSA and VRE. Check label claims and directions to make sure efficacy fits the intended use.

Quaternary disinfectants are easier and safer to use than other types of disinfectants. Their milder formulations are compatible for most hard-surface cleaning tasks. They are ideally suited for use on finished floors and have good cleaning abilities.

You also may have a phenolic-based disinfectant with a tuberculosis (TB) claim for combating the disease caused by Mycobacterium tuberculosis. The CDC recommends phenolics for combating the noroviruses (Norwalk virus). These products are typically more efficacious than the quaternary disinfectants because they are formulated to be effective against TB. Phenolic-based disinfectants have a characteristically strong smell and are not recommended for routine use on finished floors. Also, they tend to be harsher on skin than quaternary-based disinfectants but typically have good cleaning ability.

If your facility is experiencing an outbreak of Clostridium difficile, experts recommend using a 1-to-10 dilution of bleach for hard-surface cleaning via a bucket-and-wipe or a mop-bucket application to avoid aerosolization of the bacteria. The cleaning tools should be disposed of or laundered after use.

The use of bleach as a standard disinfectant, except in outbreak situations, is not recommended because of its aggressiveness and poor cleaning ability.

Green Products

Emphasis is being put on supporting the use of "green" products in the housekeeping, laundry, and maintenance areas. The federal government has established a Green Seal certification for products that want to make a legitimate green claim. The Green Seal is awarded after rigorous evaluation, testing, and a plant visit. Green Seal products have attributes associated with lower environmental burden and impacts, which include the following:

* They are nontoxic to humans when diluted for use.

* They are noncombustible and noncorrosive to the skin and eyes.

* They are safe for aquatic life when diluted for use.

* Their ingredients are readily biodegradable.

* They have no chlorine, NPE (nonyl phenol ethoxylate), EDTA (ethylene diamine tetracetic acid), or NTA (sodium nitrilotriacetate).

* VOC levels are less than 1% when diluted for use.

* They are free of known carcinogens and reproductive hazards.

If you incorporate products that have been awarded the Green Seal, use them where they make sense, but don't sacrifice effective cleaning, especially in areas where poor cleaning will lead to increased odor problems or where disinfection is required. Common product categories that are available with a Green Seal award include all-purpose cleaners, nondisinfectant bathroom cleaners, and laundry detergents. For more information, visit www.greenseal.org.

Attention to Basics Is Key

We will always be challenged to be competitive in the marketplace and operate a facility cost-effectively. More information on the role of housekeeping is available at www.cdc.gov. Housekeeping and maintenance staff are a critical resource in helping you achieve your goals. Focusing on the basics, and providing the right products, training, and tools to handle cleaning and disinfecting challenges quickly and effectively, will provide a better environment for your residents and staff and a good reputation in your community.

Colleen Dillon is Vice-President of Marketing--Hospitality and Healthcare at Ecolab and has more than 20 years' of product development and marketing experience in healthcare, industrial, institutional, and hospitality markets. For more information, call [phone] or visit www.ecolab.com. To send your comments to the author and editors, e-mail [e-mail]. To order reprints in quantities of 100 or more, call [phone].