Environmental Hygiene: Tips for Microfiber, Other Healthcare Textile Use

Infection Control Today asked members of industry to share their best advice to infection preventionists and purchasing managers when evaluating microfiber and healthcare textiles relating to infection prevention best practices.

There is one word that can be used when evaluating a product category for infection prevention Consistency. Consistency in three main elements: procedures, training and product. Following a consistent procedure reduces the risk of areas missed or tasks skipped  when cleaning. Consistent product allows you to produce the same results every time and quickly identify items not part of the proven procedure. The only variable left is your attention to training. Train on the significance/why these products are being used and how to use them for example, how your cart should be organized and checklist procedures involved. With the products, procedures and training in place you can now spend more time catching people doing things right! Without these three main elements in place, you are more susceptible to widely varying results and good or bad, they are your results.
-- Jim McBride, healthcare segment manager, Rubbermaid Commercial Products

To achieve desired environmental cleaning outcomes, it is critical to ensure that the right amount of disinfectant is delivered to surfaces. When used with a quaternary ammonium (quat) disinfectant, all textiles, including microfiber cloths, absorb some of the disinfectant and impact the concentration of disinfectant that is ultimately delivered to surfaces. This phenomenon is known as quat absorption. Environmental hygiene programs that are not designed to effectively control this variable can yield unexpectedly poor cleaning and disinfection outcomes. Microfiber cloths do not all perform the same. When evaluating microfiber products, you should be aware of the issue of quat absorption and ask your microfiber supplier for clinical testing to show how their cloths interact with the disinfectant used in your facility. A best practice would be to use a program that controls the factors impacting quat absorption, including disinfectant concentration, disinfectant volume per cleaning cloth, fabric type, and the time cleaning cloths spend in the disinfectant solution.
-- Linda Homan, RN, BSN, CIC, senior manager, clinical and professional service, Ecolab Healthcare

We suggest the following things to consider when evaluating antimicrobial curtains:
  Seek a physical (ionic) microbe elimination instead of chemical this prevents cellular mutation.
Ask the manufacturer to present third-party efficacy data regarding microbe elimination.
Verify continued antimicrobial efficacy when laundered per the makers instructions, as well as the recommended lifecycle of the fabric.
Consider the housekeeping benefits, especially faster or less change-outs when cleaning a room post-discharge.
Verify low or no human interaction impacts from contact with the fabric.
In a broader sense, were advocating that facilities personnel need to begin considering a 24/7 approach to antimicrobials. Academic research conducted in hospitals has shown privacy curtains get contaminated shortly after laundering, and surfaces are not being adequately cleaned. Therefore, antimicrobial products have to step in to fill the breach.  They have to become one more line of defense in the fight against contamination.
-- Mark Alan, senior vice president of product management and development, InPro Corporation

We now know that environmental hygiene and increased patient infection rates are linked. Given the changes in regulations on reimbursements, it is clear that HAIs have a negative impact on both patient outcomes and hospital profits.  With this knowledge, it is more important than ever to evaluate products and processes based on cost-outcome benefits. Patients in critical-care areas are at the highest risk of HAIs, yet the environmental service department responsible for cleaning tends to be among the lowest paid and least trained personnel in the hospital. To improve performance:
Train EVS personnel to properly turn over and maintain critical-care areas.
Encourage EVS to attend local APIC meetings.
Take advantage of vendor education programs.
Utilize latest technologies to enhance cleaning efficacy:
  - Microfiber fabrics for efficient bacterial removal.
  - Single-use products where available reduce cross-contamination.
  - Focus best practices and products in the operating room, hospital pharmacies and other high-risk areas.
-- Robert Deck, business development, Contec

Ask lots of questions to ensure the product is the correct choice. For example, do the "microfiber" products you're thinking of buying really support your infection prevention programs? Unfortunately, the category "microfiber" is little understood by most vendors and sales people. Virtually all companies selling "microfiber" to healthcare in the United States are Jan-San dealers or textile distributors who have no involvement or expertise in the manufacture of the products -- private labeling dominates the market. Further complicating the matter is the fact that peer-reviewed, published studies demonstrate that if six different "microfiber" wipers are tested -- you get six different results most of which do not support infection prevent programs. Other questions to ask: Do the products include a "true" color-coded system that supports a one-per-room methodology? This is an absolute necessity to reduce the risk of cross contamination. Is there a color-coded product that isolates the toilet from the rest of the washroom? This is critical today to reduce the spread of Clostridium difficile infections, which are at historic highs. Do the products meet the CDC Guidelines for Bloodborne Pathogens? That is, can they be laundered in hot water with a minimum of 150 ppm of sodium hypochlorite (bleach) and dried efficiently at higher temperatures in a dryer? Read the product labels, many state the product should be air dried and heat should not be used. Ask yourself, is this clinically acceptable?
-- George Clarke, CEO, UMF Corporation

The medical field is founded on evidence-based medicine. Evaluating products that support infection prevention should be no different. Decisions should be based on randomized controlled studies in peer-reviewed publications. This is why PurThread technology has been tested in a first of its kind study that was double-blinded, randomized and controlled. No other textile products with antimicrobial properties have gone through such a trial. Titled "Novel Hospital Curtains with Antimicrobial Properties," it was published in the Journal of Infection Control and Hospital Epidemiology. The study showed that the median time to first contamination of PurThread curtains took seven times longer than control curtains. Studies like this suggest that efforts to reduce bioburden on surfaces in the patient environment can have positive impacts.
-- Kathryn Bowsher, vice president of clinical regulatory strategy, PurThread

It has been proven that soft surface fabrics (lab coats, privacy curtains, uniforms and bed linens) in the healthcare environment are contaminated. It has also been proven that cross contamination to healthcare workers hands occurs and laundering alone is not the complete answer, as fabrics are quickly re-contaminated after being put into use. Because they constitute 90 percent of the patient environment, its important that soft surface fabrics are incorporated into an overall infection prevention protocol to effectively mitigate the risk for healthcare-associated infections (HAIs). There have been significant innovations in antimicrobial fabric technology over the past decade and new solutions are available for healthcare. When evaluating antimicrobial fabrics, choose one that is EPA registered and one where the antimicrobial property works continuously, comprehensively and lasts the life of the product (does not wash out). To be approved under EPAs non-public health regulations, manufacturers have proven to decrease microbial growth on the fabrics, reduce degradation of the fabric over time and control odor. There are also antimicrobial fabric options which require no behavior modification on the part of staff, making compliance a non-issue.
-- Peg Luebbert, MS, MT (ASCP), CIC, CHSP, for Noble Biomaterials

Any best practice is rooted in the peer-reviewed, presented and published medical literature on a topic. Thomas J. Walsh, MD, FACP, director of Cornell University's transplantation-oncology infectious diseases program, has presented several studies on active barrier protective uniforms. He explains, Bacteria are highly adherent organisms. Look for a fabric that is designed to repel most fluids.(1) Fluid repellency stops organisms from sticking to fabrics so there are fewer germs on the on the fabric.(2) This also protects the wearer from unexpected sprays and splashes of dangerous substances. As Walsh adds, The second mechanism of action may be direct antimicrobial effect of the disinfectant embedded into the fabric.  Sometimes antimicrobials are successful in the lab and then disappointing in the real world. Be sure the product has had its performance verified with peer reviewed and published clinical data(3) that reflects real use conditions... The fabric should also breathe, so it's safe(4) and comfortable to wear. 
1.  Elam K, Nair V, et al.  Barrier Protective Properties of Treated Textiles as a Tool for Infection Control in the Health Care Setting.  In:  Program and Abstracts of the Society of Healthcare Epidemiology of America, April 1-4, 2011; Abstract 184.
2.  Cotton M, Hardwick M.  Fabric Challenge Assays:  new standards for the evaluation of the performance of textiles treated with antimicrobial agents.  Presented at ID Week, Oct.  22, 2012.
3.  Bearman, et al.  A Crossover Trial of Antimicrobial Scrubs to Reduce methicillin-resistant Staphylococcus aureus Burden on Healthcare Worker Apparel.  Infect Control Hosp Epidemiol  2012; 33:268-275.
4.  Elam K, Walsh T. Assessing the Safety of Antimicrobial Textiles to be Worn by Healthcare Workers.  Poster presented at Emergency Nurses Association meeting, October, 2011.
-- Lorrie Anderson, director of marketing, Vestagen Technical Textiles

Compiled by Jessica Barreras