Environmental Hygiene: Tips for Microfiber,

Other Healthcare Textile Use

January 11, 2013
 Environmental Hygiene, Clinical Interventions

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. 

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