CLEAN.DISINFECT.

PROTECT A Never Ending Challenge

What Does Clean Mean To You?
Everyone who says the word clean whether the facilities department, housekeeping partner or building maintenance - knows exactly what they mean. Unfortunately the person who hears the word clean, or is responsible to perform the cleaning may have a very different professional understanding. At BHS-ES we are unsure as to whether the dictionary clarifies the confusion or adds to it! The Merriam-Webster on-line dictionary defines clean as (a): free from dirt or pollution or (b): free from contamination or disease. With respect to building dynamics, the built environment and building occupants, these two definitions are not equivalent. The term clean carries different meanings depending on the context. By context, we mean (1) what is the purpose of cleaning activities; (2) what is the condition of the space being cleaned; (3) what are the customer / users expectations; (4) what type of building or facility and (5) what is the use of the space. Out of context, less certain situational understandings, if loosely used clean has significant implications in setting and achieving expectations. The Centers for Disease Control and Prevention (CDC) define cleaning as the removal of visible soil (e.g., organic and inorganic material) from objects and surfaces and normally is accomplished manually or mechanically using water with detergents or enzymatic products. This definition correlates well with free from dirt or pollution.

How Do You Know If It Is Clean?

Opinions vary. A range of options exist from visual inspect for the clean appearance to whether there is sufficient commotion to ensure that building occupants feel that the building is being cleaned based on the presence of staff. Additionally, there are sophisticated measures, sampling and testing protocols, such as the ATP meter and swabs BHS-ES utilizes, available based on different conditions and risk. Cleaning and its effectiveness are a significant component of the total health of a building and its occupants.

What Does Sanitize Mean to You?

Sanitize is a term mainly used in food related services. Sanitize is a process intended to reduce - but not necessarily eliminate, germs and microorganisms from the inanimate environment to levels considered safe as determined by public health codes or regulations.

Why Use Hand Sanitizers?

The preferred treatment according to the CDC is to wash your hands. However, since 2002, the Center for Disease Control (CDC) has recommended the use of alcohol-based hand sanitizers in hospital settings as a supplement to regular hand washing. But to be effective, hand sanitizers must be used properly, and to use them properly, it helps to understand how they work. The CDC recommends using a concentration of 60 percent to

95 percent ethanol or isopropanol alcohol as their formal hand-washing trials have proven this to be the most effective. Almost all hand sanitizers claim they kill 99.9 percent of bacteria and germs even when they have a lower concentration of isopropanol alcohol but read the label for guidance. Use at least a dime-sized dollop, and rub it briskly all over your hands for 30 seconds. If the hand sanitizer dries in before 30 seconds, you have not used enough for it to be effective. If your hands are visibly soiled, the alcohol in your hand sanitizer is not going to wipe the dirt away for you. If you do not have access to soap and clean water, however, using a hand sanitizer is better than nothing.

What Does Disinfect Mean to You?

Not too many people with the responsibility of cleaning of a space use the term disinfect with respect to building discussions. It is difficult to determine whether that is due to its inclusion in the use of the term clean or whether it is overlooked or ignored. Regardless, the term has a precise definition. The CDC defines disinfection as the process that eliminates many or all pathogenic microorganisms except bacterial spores on inanimate objects. Disinfection is the process that correlates with the Merriam-Webster dictionarys second definition free from contamination or disease. The processes to achieve either of these two different meanings of the word clean are clearly different. Perhaps, the second definition contributes to some of the confusion of the word clean in the building maintenance environment. If building owners and property managers are to turn the corner on creating built environments that do not contribute to negative health consequences of occupants or residents beyond their normal state of health, we are going to have to pay more attention to how we disinfect in certain targeted locations. An important issue, perhaps the most important, concerning use of disinfectants for high touch surfaces, especially in toilet rooms, elevators and other common building space is that the dwell time for contact specified on the label of the product is either ignored unintentionally or acknowledged as just too long to be practically followed by staff. The process and protocols for sanitization and disinfection should be based on the degree of risk for infection involved in the interaction and use between a building space and the occupant. Unfortunately, multiple scientific studies in rigorous hospitals have documented the lack of compliance with established guidelines for disinfection in an environment where the consequences are significantly elevated beyond a normal building. So, without testing or surveillance, we may not actually know whether a surface has been adequately sanitized or disinfected to offer the desired protection.

How Do You Know If Target Locations Have Been Sanitized or Disinfected?

This is even more challenging than making a determination on cleanliness. Visual inspection does not work. Factors that affect the efficacy of disinfection include prior cleaning; type and level of microbial contamination; concentration of and dwell time compliance of the disinfectant; physical nature of the surface and frequency of use or touches. In order to overcome these challenges of determining if a surface or object is clean and/or disinfected, BHS-ES utilizes an ATP Detection Program which is state-of-the-art. Adenosine Triphosphate (ATP) is an energy molecule found in all plant, animal and microbial cells. Detection of ATP on a surface, with a swab sample, indicates the presence of biological matter that may not otherwise be visible to the eye. A luminometer provides instant feed back on cleanliness of a surface allowing not only correction but covert evaluation of effectiveness.

What Does Protect Mean to You?

If you desire protection, the first question has to be protection from what risk litigation, danger, sickness, germs or an unhealthy environment to name a few. In this context, the built environment, what are your options for protection assuming that both cleaning and disinfection activities are adequately accomplished. Cleaning and disinfection activities have time frames of availability, mostly out of facilities control, as access is subject to use and occupancy patterns of building occupants. Clean a surface right now.dirty soon. Disinfect a surface right now.contaminated by the next touch. If protection is a goal, it becomes a function of a repetitive clean and disinfect cycle with frequencies to minimize deterioration of the condition. Generally, the disinfectant protection is subject to the frequency with which a surface is properly disinfected. However, this lasts only until the next person contaminates the object or surface with a touch. This is not comforting as the deterioration of the disinfected condition is a function of occupant behavior as well as use patterns.

What Does Protect Mean to BHS-ES?

What is emerging today, as a dominant issue in building-related health, is germ transmission among occupants. Public concern is over infectious diseases; a principal concern is contaminated surfaces as evidenced by the placement of hand sanitizer dispensers everywhere in buildings. The source is not the building systems or building performance but the building dynamics created by the occupants presence and behavior. The major outcome is transmission of disease, absence from work, and lost or reduced productivity while at work, rather than a life-threatening disease. Protection, from BHSES medically-based perspective, is taking the necessary steps to develop procedures and protocols to ensure that buildings do not contribute to negative health consequences of its occupants beyond their normal state of health. A structured, multidisciplinary educational intervention should be prepared for the environmental services staff of each building. It has been proven in adverse hospital

environments that implementation of educational interventions has resulted in a consistent and statistically significant improvement. These include redirecting cleaning activities. By combining assessment with educational interventions that incorporate direct-object feedback for the environmental services staff, cleaning and disinfecting practices can be improved, and the gains can be sustained. BHS-ES suggests development of targets for cleaning and disinfecting activities which are directed at High Touch Objects (HTOs) - surfaces, devices and objects subject to almost constant use which are more frequently contaminated, such as door handles, counter tops, common area bathrooms and elevator control panels.

Why Consider BHS-Environmental Solutions?

BHS-ES has the expertise and products to clean, disinfect and protect from a health-based perspective. Our environmental solution is programmatic and ultimately your protection is from Aegis Microbe Shield Technology. The electrostatic application of mPale on thoroughly cleaned and properly disinfected surfaces provides continuing anti-microbial protection between regular, structured cleanings. The microbe shield is appropriately named as the word aegis is identified with protection by a strong force or shield. This organosilane molecule uses a covalent bond to adhere to target surfaces and objects. Its molecular structure is similar to a spike or sword with a minute, positive electrical charge that pulls negatively charged microbes onto the sword where they are destroyed. The mPale anti-microbial does not lose strength over time. It creates a protective coating that is an impenetrable, interlocking network of the microscopic spikes which blankets the treated surfaces with an invisible bio-barrier that shields occupants from microbes. Although individual protocols and procedures are developed by building owners and property managers to ensure adequacy of cleaning and disinfection activities by housekeeping, there is no standard method to assess effectiveness of such activities. BHS-ES will develop an enhanced high clean / disinfect protocol for preparation of services to receive the long lasting, electrostatically-applied antimicrobial. Studies show that enhanced cleaning and disinfecting activity significantly decreases environmental contamination. It is important to optimize cleaning and secure protection between cleanings. You may want to re-assess or re-think the sequence and frequency of specific, defined, cleaning and disinfection activities to support a verifiable healthier built environment with the protection of an anti-microbial shield. BHS-ES can assist you.