Disinfection practices are important when it comes to preventing C. diff
transmission in health care facilities. More often than not, health care workers are trying to turn over rooms quickly in order to get another patient in the room. As a result, disinfection practices can suffer. Can you speak to that a little bit?
When a decision is made to discharge a patient, the physician must come in to write the order, see the patient, and then discharge them. Then the patient has to wait for family members to come and pick them up. That usually happens anywhere from late morning to afternoon. Typically what happens is that all the discharges are done on the evening shift, and they have very limited people on that shift; sometimes it’s just 1 person doing all of the discharges.
If the cubicle curtains have to be changed, they have to get a guy—most of them want to use a man—to climb up on a ladder and unhook all of the cubicle curtains, especially in precaution rooms. That’s another delay in that room, preventing a new patient from inhabiting the room. Also, sometimes the rooms can’t get cleaned on the night shift and they’re left all night long until the next day. Those are some of the challenges that we have with getting the rooms cleaned.
Health care workers do cut corners; I’ve done a lot of observational studies of room turnovers. A couple of things happen if they’re using sani cloths they don’t use enough of them, and they don't change them as often as they should. I saw one situation where a person took 1 cloth and used it to wipe the whole backside of the bed, the lights, and then went over to try to do the bed before I had to stop them and say, ‘No, you have to keep changing your cloths.’ You also have to have the appropriate contact time; If you’re using a cloth that requires 3 minutes of contact, the worker has to keep the surface covered with disinfectant for 3 minutes—which is a long time in health care.
On top of that, they have to clean all of the walls, the bathrooms, and the floor. Terminal cleaning of a discharge can be pretty intensive—a lot of work—and if you don’t have the staff to do it or the staff is in a rush, they’re going to cut corners. This is what Dr. Phil Carling showed in his study that I mentioned earlier, why approximately only 50% of rooms are getting disinfected.