Health and Safety Cannot Rely On Guesswork Any Longer

The current need for evidence-based standardization, monitoring, and continuous improvement of environmental hygiene

Many of the ways facilities managed cleaning prior to 2020 have been changed irrevocably by the COVID-19 pandemic. What once was aesthetically “good enough” won’t cut it in the new landscape of enhanced cleaning, disinfection, and public health. Top among those relics of the past are outdated methods of environmental hygiene monitoring that relied heavily on guesswork and a patchwork system of processes without standardization.

In this article, we will look at the role that guesswork plays in existing best practices for environmental hygiene monitoring and how those systems are no longer adequate after the COVID-19 pandemic. We will outline the new challenges facilities and custodial teams face due to the pandemic. Lastly, we present three reasons for introducing evidence-based evaluation tools into cleaning programs to elevate productivity and improve duty of care outcomes.

The Current State of Environmental Hygiene Monitoring

The options available to facilities management teams to objectively evaluate environmental hygiene are acknowledged to have both strengths and weaknesses. Overall, processes rely heavily on guesswork, and experts recommend a combined use of multiple evaluation methods to account for a lack of accuracy in reporting. Let’s take a closer look at the options for assessment of environmental cleaning recommended by the U.S. Centers for Disease Control and PIDAC.

Visual observation

One of the most common approaches to monitor cleaning and cleanliness is a visual observation performed by a trained supervisor. This method is appropriate when determining a “hotel clean,” i.e. beds are made and a floor has been vacuumed. In addition, it allows for direct feedback between supervisors and cleaning personnel to assist in training and continuous improvement.

For those reasons, and the fact that visual observation is easy to implement, this method of environmental hygiene evaluation is widespread across facility types and industries.

Unfortunately, it is also widely acknowledged that this system of assessment does not provide any level of validation of surface cleanliness, cannot indicate microbial contamination, and that results often vary widely depending on the observer.

ATP bioluminescence

The use of ATP meters is common throughout a wide variety of facilities, from food service and education to healthcare. This technology is a swab-based methodology, and currently one of the most popular forms of environmental hygiene monitoring. ATP (Adenosine triphosphate) is a substance found on living cells. ATP meters can be used to determine if a specific, quantitative level of ATP is present on a surface. ATP meters are relatively easy to implement and provide quick feedback. However, the use of ATP meters comes with known limitations. The technology’s efficacy may be corrupted by a number of products including bleach, hydrogen peroxide, quaternary ammonium compounds and even the use of microfiber cloths. In addition, there is a lack of consensus on benchmarks for ATP readings that indicate “safe” or adequately cleaned surfaces. Lastly, the technology’s efficacy varies depending on the monitor type and manufacturer.

Other options for environmental hygiene evaluation

An additional method to test for the presence of specific pathogens on a surface is environmental culturing. Environmental cultures are not commonly practiced outside of regulated environments because they are more costly and require a level of access to labs and technology not available in most settings. In addition, the process for taking environmental cultures can be slow, limiting teams’ ability to incorporate results in training and quality management programs. Environmental markers are sometimes used to evaluate surface cleanliness. This is a process when a surrogate invisible tracing agent, often a fluorescent marker, is applied to a surface prior to cleaning. After a surface is cleaned, an audit using a revealing agent determines whether the agent has been removed. This process is easy to implement, however it is reactive, does not measure actual contamination on a surface, and is viewed as an enhanced version of visual assessment.

The Limitations of Guesswork

The level of guesswork involved in all of the current methods of environmental hygiene monitoring is particularly high, especially in a post-pandemic context. Not only does the lack of real-time data contribute to poor results and an increased risk of infection, but other aspects of cleaning effectiveness are also directly related to the ability to verify cleaning outcomes. When validation measures are standardized and integrated seamlessly into a quality management system, cleaning for health and safety can be improved at all levels of performance. Some of the other aspects of a cleaning team that are impacted by improved validation measures include:

Training and Education

Facilities across the globe are under pressure to hire more cleaning workers as public health regulations, new protocols and an attentive public demands more of their teams. Increased cleaning frequencies, more disinfection tasks, the need for social distancing and the new imperative to have cleaning workers be visible to the public mean more new cleaning workers to train. For a facility to be cleaned efficiently, personnel must be trained properly and continuously from day one. Cleaning workers often come from many different backgrounds, education levels and even speak various languages. This has always been a challenge for facilities teams in the past, but it will continue to become even more pronounced as they hire more entry level workers in the future. That means there will continue to be a need for feedback incorporated into training.

Environmental testing and validation that relies too heavily on guesswork, is subjective or is not tied with benchmarks that will be difficult to integrate into education programs that meet the new hiring and training demands for facilities departments. There will be a need for more robust test results that can be incorporated into individualized training programs to not only help educate new employees, but also to provide the necessary motivation to keep those employees coming back.

Product Validation 

The fight against infections goes well beyond COVID-19. In fact, drug-resistant infections are currently the fourth leading cause of death worldwide and predicted to be the leading cause of death by 2050. Because of this alarming rise in the threat of infection to human health, more and more new cleaning and disinfection products are hitting the market every year. The market is moving quicker than it has in the past, meaning there are more products to choose from, with more impressive claims than have been available in the past. The guesswork lies with purchasing officers and facility management to decide which of these new products is effective and cost-efficient. Purchasing decisions will be further complicated by tighter facilities budgets.

A straightforward method of product testing that can be backed up with data will be a valuable tool for facilities managers dealing with these new challenges. If a team can already have a system in place that integrates real-time environmental test data into standard operating procedures, then new purchasing decisions will become much easier to make. Rather than relying on manufacturers’ marketing initiatives or the word of those with incentive to sell products, facilities will be able to independently, objectively measure the claims of new products, test their worth and pilot them in their cleaning programs. Purchasing decisions could become more efficient, less costly and more effective.

Standardizing Process

A facilities team can have the best people working and the best possible products, but without standard operating processes and policies, it won’t be able to achieve continuous success. Standardization and automation are critical factors for an effective cleaning process. When weaknesses are identified, better data will help with root cause analysis to put stronger processes in place. These factors allow cleaning teams to implement a continuous feedback loop to identify strengths as well as opportunities for improvement. This takes dedicated work. In the past, facilities haven’t been provided the support and resources needed for advanced level infection prevention programs. In the future, facilities must find ways to incorporate standardization and automation into their standard operating procedures to provide the level of service being demanded of them,

The Path Ahead

As facilities teams look for ways to adapt to increased pressure in a post-pandemic landscape, there will be a continued push away from the guesswork that once dominated evaluation methods in the field, across industries and facility types. Facilities teams can take the following steps to begin the move away from guesswork toward a data-based approach to environmental evaluation that will lift their cleaning teams toward success.

Enhanced validation tools

While many facilities managers have had to rely on a combination of multiple forms of surface testing to account for limitations in their results, there will be an imperative for teams to find higher quality testing measures. Any tool that can bring strong data into assessment of processes will be a significant step in improving infection prevention processes.

Optisolve Pathfinder™ is answering this call. Using smart-technology and analysis techniques, Pathfinder captures macroscopic surface images and generates contamination density maps. It enables facilities teams to eliminate the guesswork of what’s happening on a surface, providing real-time data to inform improved processes and best practices.

Integrated standard operating procedures

To get the most out of enhanced validation measures, a facilities team must establish standard operating procedures that are accessible to all, continuously revisited and revised, and which form the basis of all education and training programs. Robust standard operating procedures should include everything from the types of products being used to the processes for using them. The goal of standard operating procedures will be to ensure consistent, effective outcomes. When data and analytics can be used to complement standard operating procedures, they become a powerful tool for continuous improvement. Optisolve SAVI™, a cloud-based quality management system, allows facilities managers to input existing cleaning procedures, specify test methodologies and measure key performance indicators. SAVI then helps cleaning organizations tie test results to performance, procedures, products or other aspects of the cleaning program in detailed analytics and reporting.

A culture of continuous improvement

This brings us to the last factor that is essential for success in any facility today—a culture of continuous improvement. Change is often difficult for people to accept, and that reluctance to improve or disrupt more traditional, if not as effective, methods of doing things can become an impediment for any team looking to compete in a modern world. In order for facilities to keep up with the challenges of cleaning public spaces in the wake of the COVID-19 pandemic and into the future, a culture of constant reflection and continuous improvement must exist. Everyone from the top down in the organization must have the desire to do their best work, the open mind to want to improve and a process that includes feedback with the goal of cleaning more efficiently, more effectively and more safely for everyone.