Prevention of Infection: Selecting and Using Disinfectants

Disinfection Insights You Can Use Today

Part 2 of 3: Selecting and Using Disinfectants

According to a recent study reported by APIC, the significant presence of multidrug-resistant gram-negative bacteria (MDR-GNB), such as E. coli, among nursing home residents demonstrates the need for heightened infection control prevention and control measures in nursing homes. In the release, APIC President Linda Greene says, "This study underscores the importance of having strong infection prevention programs in all nursing homes and long-term care facilities."

A holistic industry-wide approach to infection prevention and control is paramount if healthcare-associated infections (HAIs) are to be eliminated. Bedrock measures are necessary to be effective.

Kelly M. Pyrek writes, "Education and training is the cornerstone of HAI prevention, and the WHO guideline recommends that IPC education should be in place for all healthcare workers by utilizing team- and task-based strategies that are participatory and include bedside and simulation training to reduce the risk of HAI and antimicrobial resistance."

The following brief by J. Darrel Hicks focuses on the selection and use of disinfectants.

Cleaning executives have trusted in the efficacy that an EPA registration implies for the disinfectants used by staff. But now users are being informed by the EPA Office of Inspector General — in the 2016 report — that, “Once the EPA tests a product and it passes, it is listed as Agency Confirmed Efficacy on the agency’s website and is typically not tested again; the long-term efficacy of the product cannot be assured.”

The IG also revealed that the EPA relies on manufacturers to voluntarily submit product samples for testing. And in the last three years, out of the approximately 300 registered disinfectant products yet to be tested, manufacturers submitted only 12 samples to the EPA for ATP efficacy evaluation.

However, this isn’t a new problem. In August 1990, the U.S. Government Accountability Office (GAO) released “Disinfectants: EPA Lacks Assurance They Work.” The report reads, “…historical enforcement and other data estimated that 20 percent of disinfectants on the market did not work as claimed, posing health risks to users.”

It was this report that launched the initial Antimicrobial Testing Report in 1991, and successes have been slow coming ever since. According to an IG report in 2010, “after nearly 19 years, over 40 percent of registered products have not been tested . . . [and] those that have been tested have experienced a consistently high failure rate.”

What does all this mean for environmental services managers today? Continue reading the full article here.

Selecting And Using Disinfectants. Reproduced and used with permission from CleanLinkFacility Cleaning Decisions. Copyright 2017 by CleanLink.

EMist is dedicated to infection prevention and control. The patented EM360™ Electrostatic Spray System coupled with the Health-E™ Certified Healthy Process make disinfecting better, easier and more cost effective. We help break the chain of infection. Visit our website for more information:

Ensuring The Efficacy Of Disinfectants

Disinfection Insights You Can Use Today

Part 1 of 3: Ensuring The Efficacy Of Disinfectants

According to a recent Time Article, "The world is not ready for the next pandemic ... From Ebola in West Africa to Zika in South America to MERS in the Middle East, dangerous outbreaks are on the rise around the world. The number of new diseases per decade has increased nearly fourfold over the past 60 years, and since 1980, the number of outbreaks per year has more than tripled."

Waging war against deadly germs, a recent article from Facility Cleaning Decisions reported the following.

A recent announcement from the U.S. Environmental Protection Agency (EPA) might make the job of cleaning and disinfecting much more difficult for those in the business of providing clean and sanitary public spaces. Managers in the know may have already read the report, but not all realize how it relates to a hospital, medical facility, ambulatory, or long-term care center."

It is common knowledge that antimicrobial pesticides are designed to destroy or suppress harmful bacteria, viruses, and other microorganisms on inanimate objects and surfaces in healthcare settings.

Most managers also know that the EPA has a testing program — the Antimicrobial Testing Program (ATP) — which has a purpose to ensure that EPA-approved hospital disinfectants and tuberculocides in the marketplace continue to meet stringent efficacy standards. Products found to be effective are reported to the public on the EPA website, and those that do not meet the ATP efficacy standards need to be brought into compliance.

"But according to the Office of Inspector General for the EPA, there are flaws in the process of ensuring the efficacy of hospital-grade, hard-surface disinfectants. The findings were revealed in a report titled “EPA Needs A Risk-Based Strategy To Assure Continued Effectiveness Of Hospital-Level Disinfectants” on September 19, 2016.

The Inspector General (IG) report concluded that the EPA’s Antimicrobial Testing Program, “does not assure that hospital disinfectant products continue to be effective after they are registered,” and that some products listed as effective on the EPA’s website, “could now be ineffective” due to inconsistencies in the manufacturing, product degradation or improper quality assurance.

Read the full article here.

Ensuring The Efficacy of Disinfectants. Reproduced and used with permission from CleanLink - Facility Cleaning Decisions. Copyright 2017 by CleanLink.

E-Mist is dedicated to infection prevention and control. The patented EM360™ Electrostatic Spray System coupled with the SanoTech 360™ Certified Healthy Process make disinfecting better, easier and more cost effective. We help break the chain of infection. Visit our website for more information:

Proactive School District Preventing the Spread of Influenza and Norovirus

First U.S. School to Implement Electrostatic Infection Prevention Systemwide Azle ISD announced it has purchased and trained staff on the implementation of electrostatic technology to disinfect all eleven campuses, athletic facilities and the transportation department making it the first school in the nation to proactively fight against the spread of common infections such as Norovirus found in schools across the country.

In partnership with E-Mist Innovations, Inc., Azle ISD has invested in portable electrostatic technology used worldwide to combat the spread of infections. The innovative portable application system disinfects touchable surfaces at the rate of 80,000 sq. feet an hour and uses 35-50% less chemical solution than a spray bottle.

“In a school district serving 6,300 students, with 800 staff, among a population of 11,000, this will have significant impacts on the community by ensuring less days of school are missed with kids and families home sick,” said Superintendent Dr. Ray Lea.

E-Mist developed and patented a breakthrough disinfectant application technology and system that places a positive charge on the liquid droplets as they leave the spray nozzle. The dispersed droplets spread out more evenly and seek out a negative or neutrally charged surface. The end result is that the disinfectant is more targeted, provides more uniform coverage with less waste, and like a magnet, attracts to a surface with remarkable force.

“We are proud to partner with Azle ISD and our channel partner Joe W. Fly Company in their commitment to serve their students and community and we believe they will have great results from their proactive, healthy learning environment approach,” said E-Mist CEO Josh Robertson.

About E-Mist Innovations First used in 2009 to combat H1N1 flu in schools, E-Mist application systems are at work in K-12 schools, hospitals, long-term care facilities, emergency medical transportation, and has expanded to building service contractors for the disinfection of a wide range of environments from professional buildings and airliners to fitness centers and food production facilities. The patented Electrostatic System and SanoTech 360 Process delivers better, easier outcomes at a lower cost to help break the chain of infection. Learn more here.

Case Study: First U.S. School to Implement Electrostatic Infection Prevention Systemwide

Schools and Businesses Should Take Mold Remediation Seriously

Molds are part of the natural environment, and can be found everywhere, indoors and outdoors. Molds are various types of fungi (singular = fungus) that grow in filaments and reproduce by forming spores. The term mildew is sometimes used to refer to some kinds of mold, particularly mold in the home with a white or grayish color or mold growing in shower stalls and bathrooms. Mold may grow indoors or outdoors and thrives in damp, warm, and humid environments. Mold can be found in essentially any environment or season.

E-Mist's patented electrostatic technology can be used in the mold remediation process. The EM360 makes disinfecting better, easier and more cost effective.

You can also read the U.S. Environmental Protection Agency (EPA) guidelines, Mold Remediation in Schools and Commercial Buildings.

Mold can spread quickly through a property if left untreated. Concern about indoor exposure to mold has been increasing as the public becomes aware that exposure to mold can cause a variety of health effects and symptoms, including allergic reactions.

"Molds can be found almost anywhere; they can grow on virtually any organic substance, as long as moisture and oxygen are present. There are molds that can grow on wood, paper, carpet, foods, and insulation. When excessive moisture accumulates in buildings or on building materials, mold growth will often occur, particularly if the moisture problem remains undiscovered or unaddressed. It is impossible to eliminate all mold and mold spores in the indoor environment. However, mold growth can be controlled indoors by controlling moisture indoors.


Molds reproduce by making spores that usually cannot be seen without magnification. Mold spores waft through the indoor and outdoor air continually. When mold spores land on a damp spot indoors, they may begin growing and digesting whatever they are growing on in order to survive. Molds gradually destroy the things they grow on.


Many types of molds exist. All molds have the potential to cause health effects. Molds can produce allergens that can trigger allergic reactions or even asthma attacks in people allergic to mold. Others are known to produce potent toxins and/or irritants. Potential health concerns are an important reason to prevent mold growth and to remediate/clean up any existing indoor mold growth.


Since mold requires water to grow, it is important to prevent moisture problems in buildings. Moisture problems can have many causes, including uncontrolled humidity. Some moisture problems in buildings have been linked to changes in building construction practices during the 1970s, ’80s, and ’90s. Some of these changes have resulted in buildings that are tightly sealed, but may lack adequate ventilation, potentially leading to moisture buildup. Building materials, such as drywall, may not allow moisture to escape easily. Moisture problems may include roof leaks, landscaping or gutters that direct water into or under the building, and unvented combustion appliances. Delayed maintenance or insufficient maintenance are also associated with moisture problems in schools and large buildings. Moisture problems in portable classrooms and other temporary structures have frequently been associated with mold problems.”1

Mold Remediation/Cleanup and Biocides

According to the EPA, "The purpose of mold remediation is to remove the mold to prevent human exposure and damage to building materials and furnishings. It is necessary to clean up mold contamination, not just to kill the mold. Dead mold is still allergenic, and some dead molds are potentially toxic. The use of a biocide, such as chlorine bleach, is not recommended as a routine practice during mold remediation, although there may be instances where professional judgment may indicate its use (for example, when immune-compromised individuals are present). In most cases, it is not possible or desirable to sterilize an area; a background level of mold spores will remain in the air (roughly equivalent to or lower than the level in outside air). These spores will not grow if the moisture problem in the building has been resolved.

If you choose to use disinfectants or biocides, always ventilate the area. Outdoor air may need to be brought in with fans. When using fans, take care not to distribute mold spores throughout an unaffected area. Biocides are toxic to humans, as well as to mold. You should also use appropriate PPE and read and follow label precautions. Never mix chlorine bleach solution with cleaning solutions or detergents that contain ammonia; toxic fumes could be produced.

Some biocides are considered pesticides, and some states require that only registered pesticide applicators apply these products in schools. Make sure anyone applying a biocide is properly licensed, if necessary. Fungicides are commonly applied to outdoor plants, soil, and grains as a dust or spray—examples include hexachlorobenzene, organomercurials, pentachlorophenol, phthalimides, and dithiocarbamates. Do not use fungicides developed for use outdoors for mold remediation or for any other indoor situation.1

Antimicrobials are also used to maintain quality of life by mitigating microorganism growth that causes odors, visual contamination resulting from mold and mildew growth, and other microbiologically induced contamination.3

Types of antimicrobial pesticides Disinfectants and biocides can kill mold spores and take away their ability to reproduce. However, these products should not be used alone in addressing a mold-growth problem.

Antimicrobial pesticides are used to destroy or stop the growth of microorganisms such as bacteria, viruses, and fungi. They are designed to be used on inanimate objects only and can be found as sprays, liquids, concentrated powders, wipes, and gases (mostly for hospital use).

There are several different types of anti-microbial products and it is important to know their intended use. The US EPA has very specific definitions for each one:

  • Cleaner: A product that physically removes debris from the surface.
  • Sanitizer: A product that kills 99.9% of the germs identified on its label.
  • Disinfectant: A product that kills nearly 100% of the germs identified on its label. Destroys most pathogens but not bacterial spores.
  • Sterilizer: A product that destroys all microorganisms, including bacterial spores.

The Centers for Disease Control (CDC) further classifies disinfectants as high, intermediate, and low level disinfectants, which has to do with which particular microorganisms it inactivates and the concentration at which it is active.

The antimicrobial activity of the product is affected by the concentration of the active ingredients and the dwell time.

  • Dwell time: The amount of time that the product must remain on the surface for optimum antimicrobial activity. Typically included on the label.
  • Concentration of active ingredients: The concentration of an active ingredient varies from product to product, so read the label to determine if a product can be used as a disinfectant or only as a sanitizer. The percent of the active ingredient and the inert ingredients in a product may also change the hazards associated with a particular product.

The US EPA registers antimicrobial products and ensures that labels may not make claims about their effectiveness that are not supported by data. They have also compiled a list of registered products that are effective against specific pathogens, including tuberculosis bacteria, HIV-1 virus, and hepatitis C. For the lists of these products and others, see their website on Selected EPA-Registered Disinfectants.

Mold Remediation in Schools and Commercial Buildings

This document is widely used for mold remediation in schools and commercial buildings. Click here to access/download.

FAQ: Mold

The following FAQ by the CDC, provides information about mold.

What are molds? Molds are fungi that can be found both indoors and outdoors. No one knows how many species of fungi exist but estimates range from tens of thousands to perhaps three hundred thousand or more. Molds grow best in warm, damp, and humid conditions, and spread and reproduce by making spores. Mold spores can survive harsh environmental conditions, such as dry conditions, that do not support normal mold growth.

What are some of the common indoor molds?

  • Cladosporium
  • Penicillium
  • Alternaria
  • Aspergillus

How do molds affect people? Some people are sensitive to molds. For these people, exposure to molds can cause symptoms such as nasal stuffiness, eye irritation, wheezing, or skin irritation. Some people, such as those with serious allergies to molds, may have more severe reactions. Severe reactions may occur among workers exposed to large amounts of molds in occupational settings, such as farmers working around moldy hay. Severe reactions may include fever and shortness of breath. Some people with chronic lung illnesses, such as obstructive lung disease, may develop mold infections in their lungs.

In 2004 the Institute of Medicine (IOM) found there was sufficient evidence to link indoor exposure to mold with upper respiratory tract symptoms, cough, and wheeze in otherwise healthy people; with asthma symptoms in people with asthma; and with hypersensitivity pneumonitis in individuals susceptible to that immune-mediated condition. The IOM also found limited or suggestive evidence linking indoor mold exposure and respiratory illness in otherwise healthy children. In 2009, the World Health Organization issued additional guidance, the WHO Guidelines for Indoor Air Quality: Dampness and Mould [Click Here To Download PDF - 2.52 MB]. Other recent studies have suggested a potential link of early mold exposure to development of asthma in some children, particularly among children who may be genetically susceptible to asthma development, and that selected interventions that improve housing conditions can reduce morbidity from asthma and respiratory allergies, but more research is needed in this regard.

Where are molds found? Molds are found in virtually every environment and can be detected, both indoors and outdoors, year round. Mold growth is encouraged by warm and humid conditions. Outdoors they can be found in shady, damp areas or places where leaves or other vegetation is decomposing. Indoors they can be found where humidity levels are high, such as basements or showers.

How can people decrease mold exposure? Sensitive individuals should avoid areas that are likely to have mold, such as compost piles, cut grass, and wooded areas. Inside homes, mold growth can be slowed by controlling humidity levels and ventilating showers and cooking areas. If there is mold growth in your home, you should clean up the mold and fix the water problem. Mold growth can be removed from hard surfaces with commercial products, soap and water, or a bleach solution of no more than 1 cup of household laundry bleach in 1 gallon of water.

If you choose to use bleach to clean up mold:

  • Never mix bleach with ammonia or other household cleaners. Mixing bleach with ammonia or other cleaning products will produce dangerous, toxic fumes.
  • Open windows and doors to provide fresh air.
  • Wear non-porous gloves and protective eye wear.
  • If the area to be cleaned is more than 10 square feet, consult the U.S. Environmental Protection Agency (EPA) guide titled Mold Remediation in Schools and Commercial Buildings. Although focused on schools and commercial buildings, this document also applies to other building types.
  • Always follow the manufacturer’s instructions when using bleach or any other cleaning product.

Specific Recommendations:

  • Keep humidity levels as low as you can—no higher than 50%--all day long. An air conditioner or dehumidifier will help you keep the level low. Bear in mind that humidity levels change over the course of a day with changes in the moisture in the air and the air temperature, so you will need to check the humidity levels more than once a day.
  • Use an air conditioner or a dehumidifier during humid months.
  • Be sure the home has adequate ventilation, including exhaust fans.
  • Add mold inhibitors to paints before application.
  • Clean bathrooms with mold killing products.
  • Do not carpet bathrooms and basements.
  • Remove or replace previously soaked carpets and upholstery.

What areas have high mold exposures?

  • Antique shops
  • Greenhouses
  • Saunas
  • Farms
  • Mills
  • Construction areas
  • Flower shops
  • Summer cottages

I found mold growing in my home, how do I test the mold?

Generally, it is not necessary to identify the species of mold growing in a residence, and CDC does not recommend routine sampling for molds. Current evidence indicates that allergies are the type of diseases most often associated with molds. Since the susceptibility of individuals can vary greatly either because of the amount or type of mold, sampling and culturing are not reliable in determining your health risk. If you are susceptible to mold and mold is seen or smelled, there is a potential health risk; therefore, no matter what type of mold is present, you should arrange for its removal. Furthermore, reliable sampling for mold can be expensive, and standards for judging what is and what is not an acceptable or tolerable quantity of mold have not been established.

A qualified environmental lab took samples of the mold in my home and gave me the results. Can CDC interpret these results?

Standards for judging what is an acceptable, tolerable, or normal quantity of mold have not been established. If you do decide to pay for environmental sampling for molds, before the work starts, you should ask the consultants who will do the work to establish criteria for interpreting the test results. They should tell you in advance what they will do or what recommendations they will make based on the sampling results. The results of samples taken in your unique situation cannot be interpreted without physical inspection of the contaminated area or without considering the building’s characteristics and the factors that led to the present condition.

What type of doctor should I see concerning mold exposure? You should first consult a family or general health care provider who will decide whether you need referral to a specialist. Such specialists might include an allergist who treats patients with mold allergies or an infectious disease physician who treats mold infections. If an infection is in the lungs, a pulmonary physician might be recommended. Patients who have been exposed to molds in their workplace may be referred to an occupational physician. CDC is not a clinical facility. CDC does not see patients, diagnose illness, provide treatment, prescribe medication, or provide referrals to health care providers.

My landlord or builder will not take any responsibility for cleaning up the mold in my home. Where can I go for help?

If you feel your property owner, landlord, or builder has not been responsive to concerns you’ve expressed regarding mold exposure, you can contact your local board of health or housing authority. Applicable codes, insurance, inspection, legal, and similar issues about mold generally fall under state and local (not federal) jurisdiction. You could also review your lease or building contract and contact local or state government authorities, your insurance company, or an attorney to learn more about local codes and regulations and your legal rights. CDC does not have enforcement power in such matters, nor can we provide you with advice. You can contact your county or state health department about mold issues in your area to learn about what mold assessment and remediation services they may offer. You can find information on your state's Indoor Air Quality program here.

I'm sure that mold in my workplace is making me sick. If you believe you are ill because of exposure to mold in the building where you work, you should first consult your health care provider to determine the appropriate action to take to protect your health. Notify your employer and, if applicable, your union representative about your concern so that your employer can take action to clean up and prevent mold growth. To find out more about mold, remediation of mold, or workplace safety and health guidelines and regulations, you may also want to contact your local (city, county, or state) health department.

You should also read the U.S. Environmental Protection Agency (EPA) Guidelines, Mold Remediation in Schools and Commercial Buildings, at

I am very concerned about mold in my children’s school and how it affects their health. If you believe your children are ill because of exposure to mold in their school, first consult their health care provider to determine the appropriate medical action to take. Contact the school’s administration to express your concern and to ask that they remove the mold and prevent future mold growth. If needed, you could also contact the local school board.

CDC is not a regulatory agency and does not have enforcement authority in local matters. Your local health department may also have information on mold, and you may want to get in touch with your state Indoor Air Quality office.

Also, see these Web sites for more indoor air quality tools for schools:


1 Mold Remediation in Schools and Commercial BuildingsBenefits of Antimicrobial Pesticides in Public-Health and Industrial Uses

FSMA: Sanitary Transportation of Human and Animal Food

The FDA Food Safety Modernization Act (FSMA)

Sanitary Transportation of Human and Animal Foods Rule Important Dates:  The earliest compliance date for most entities will be one (1) year after the final rule is published, on April 6, 2017.

Companies need safe and reliable solutions to ensure food safety and operational efficiencies in food processing. The following, issued by the FDA, outlines key information and dates.

The FDA Food Safety Modernization Act (FSMA) rule on Sanitary Transportation of Human and Animal Food is now final, advancing FDA’s efforts to protect foods from farm to table by keeping them safe from contamination during transportation. The earliest compliance dates for some firms begin one year after publication of the final rule in the Federal Register.

The first FSMA deadline comes September 2016, when large companies (having 500 or more full-time equivalent employees) must comply with the preventive controls rules for human food. Small companies (fewer than 500 employees) will have until September 2017, and very small businesses (less than $1 million in average annual sales), until September 2018. Large companies dealing with animal food also have until September 2016 to implement the current Good Manufacturing Practices (GMP) requirements of that rule. In addition, FDA intends to implement “as soon as possible” the third-party auditor certification program for U.S. importing companies, regardless of size. That final rule was published in November 2015. The other FSMA rules have staggered deadlines, but companies will generally have between one and three years following publication to comply, depending on their number of employees or average annual sales volume.

This rule is one of seven foundational rules proposed since January 2013 to create a modern, risk-based framework for food safety. The goal of this rule is to prevent practices during transportation that create food safety risks, such as failure to properly refrigerate food, inadequate cleaning of vehicles between loads, and failure to properly protect food.

The rule builds on safeguards envisioned in the 2005 Sanitary Food Transportation Act (SFTA). Because of illness outbreaks resulting from human and animal food contaminated during transportation, and incidents and reports of unsanitary transportation practices, there have long been concerns about the need for regulations to ensure that foods are being transported in a safe manner.

The rule establishes requirements for shippers, loaders, carriers by motor or rail vehicle, and receivers involved in transporting human and animal food to use sanitary practices to ensure the safety of that food. The requirements do not apply to transportation by ship or air because of limitations in the law.

Specifically, the FSMA rule establishes requirements for vehicles and transportation equipment, transportation operations, records, training and waivers.1,2

The goal of every sanitation program is to rid the processing environment of bacteria and to prevent bacteria from entering the plant, whether it invades via people, insects/vermin, or equipment.

Manufacturing and processing facilities must also maintain risk-based supply chain programs for raw materials and ingredients and provide GMP education and training to their relevant employees.

Training: Training of carrier personnel in sanitary transportation practices and documentation of the training. This training is required when the carrier and shipper agree that the carrier is responsible for sanitary conditions during transport.

Compliance Dates

  • Small Businesses - businesses other than motor carriers who are not also shippers and/or receivers employing fewer than 500 persons and motor carriers having less than $27.5 million in annual receipts would have to comply two years after the publication of the final rule.
  • Other Businesses - a business that is not small and is not otherwise excluded from coverage would have to comply one year after the publication of the final rule.

(1) FSMA Final Rule on Sanitary Transportation of Human and Animal Food (2) KEY REQUIREMENTS: Final Rule on Sanitary Transportation of Human and Animal Food (PDF Download)

Reducing HAIs and Improving LTC Resident Health

More than 5 million Americans reside in nursing homes, skilled nursing facilities and assisted living facilities. These long-term care facilities (LTCFs) provide a variety of services, both medical and personal care, to people who are unable to manage independently in the community. Data about infections in LTCFs are limited, but the most recent statistics in medical literature estimate:

  • 1 to 3 million serious infections occur every year in LTCFs.
  • Infections include urinary tract infection, diarrheal diseases, antibiotic-resistant staph infections and many others.
  • Infections are a major cause of hospitalization and death; as many as 380,000 people die of infections in LTCFs every year.

Common infections in long-term care settings are becoming more difficult to diagnose. This longer process can lead to multiple issues for residents, including ongoing discomfort, chronic poor health and a higher risk of hospitalization or even death. Unfortunately, one-third of all deaths in seniors result from infectious diseases, according to the American Academy of Family Physicians. Seniors are more susceptible to infection due to a weakened immune system, and seniors with dementia may be at even greater risk.

This life-threatening epidemic demonstrates the need for improved infection control in healthcare facilities. Although significant progress has been made in preventing healthcare-associated infections (HAIs), additional steps need to be taken to control and mitigate this high risk of infection. HAIs are preventable and often caused by poor facility conditions or human error. The Centers for Disease Control and Prevention research shows that when facility staff and vendor employees are aware of infection problems and take specific steps to prevent them, HAI rates can decrease by more than 70 percent. Successfully decreasing HAI rates involves all departments working together toward improving care, protecting patients and saving lives.

Lacking infection control training LTCFs are required to maintain infection control and prevention programs to comply with federal regulations. The expectations for those programs are outlined in the Centers for Medicare and Medicaid Services’ Interpretive Guidance for Infection Control. Unfortunately, most LTCFs lack adequately trained and committed personnel to fulfill all the infection control needs.

A New Hampshire study found that there are 75 percent fewer Infection Preventionists (IPs) in long-term care facilities than in acute care facilities. More commonly, the IPs in LTCFs have multiple responsibilities and can only devote limited time to infection prevention practices. According to the same study, only 10 percent of the assigned Infection Preventionists in LTCFs have any specific Infection Control Prevention training, whereas 95 percent of acute-care IPs have the appropriate training.

A LTCF can implement a facility-wide training model that can be accessed by vendors 24/7 to ensure that the staff is well-educated to make a difference and improve patient care. Address issues that healthcare staff members encounter on a daily basis to eliminate reoccurrence. Every vendor employee that enters the facility should have completed the training courses and learned about their role in HAI prevention.

Reducing HAIs in LTCFs provides multiple benefits to residents, staff and vendors, including healthier residents, happier resident families, less disruption and financial burden for families of residents and stabilized financial benefit for the facility.

Transmitting infections The two most common mechanisms of infection transmission in a long-term care facility involve direct contact via person-to-person or contaminated objects. LTCFs provide an ideal environment for acquisition and spread of infection. LTCF residents are more susceptible to infection when sharing sources of air, touchable surfaces, food and healthcare in a crowded institutional setting.

Many pathogens associated with HAIs survive on various surfaces such as common area furniture, remotes and light switches. As a result, frequently touched surfaces play a key role in transmitting infections between persons. The disinfection of surfaces is vital in infection prevention planning.

Moreover, visitors, staff and residents constantly come and go throughout the facility, increasing the likelihood of bringing in contaminated pathogens from outside sources. Reducing the number of entrances that staff, families and vendor employees use to enter a LTCF will minimize the risk of spreading potential bacteria to residents inside.

In addition, lack of proper use of disinfectants can also mean dangerous fungi and bacteria are not killed. Chemicals designed for disinfecting require different “dwell” times, or the amount of time the chemical agent must remain wet on a surface to be effective in eliminating the pathogens. Proper application requires training and then additional reinforcement of training to assure an effective kill-rate.

Prolonged lengths of stay, limited capacities for diagnosis and ineffectual infection-control programs often allow outbreaks to propagate and persist for many months. The transfer of infected or colonized residents, which is a common occurrence, may export outbreaks to other facilities, including hospitals and medical centers.

Improving facility profits In addition to providing quality needs to the residents, long-term care facilities must thrive financially. A healthy bottom line for care providers means adequate staffing, healthy facilities and effective programs for the residents. Unfortunately, reimbursement programs have been cut so drastically that financial survival has to be the first focus for LTCFs.

Financial stability of a LTCF can mean the difference between an improved lifestyle for residents versus a questionable environment and negative outcomes. There are not credible statistics supporting the difference between profit versus loss and how residents benefit from a well-managed and profitable facility. Even non-profits that are financially healthy mean improved facilities, happy residents and a positive workforce.

The most common areas where LTCFs spend money that is beneficial to the residents are:

  • Hiring and maintaining additional staff members
  • Education programs for staff improvement
  • Repairs to facilities for safety and comfort
  • Environmental issues

One loosely defined study makes the case for non-profit long-term care facilities providing more hours of attendant focus per resident versus for-profit facilities. The report also attempts to make the case for improved outcomes and fewer deaths. However, when closely reviewed, the infection rate in for-profit facilities was less, even though the age of the resident was older when compared to a non-profit facility.

Based on my personal experience in all types of nursing home facilities, I have found the financially stable non-profits and for-profit are basically the same. Both have visibly cleaner, healthier facilities, along with staff members that follow a plan for patient care.

Facilities in financial trouble due to older buildings, a high percentage of resident dependency on government reimbursements and high employee turnover rates suffer when it comes to offering quality care.

Conclusion Combating HAIs requires concentrated efforts by all LTCF personnel and its outside vendors. Taking a multidisciplinary approach to manage HAIs can mitigate the risk of spreading life-threatening infections. Proactive risk management can decrease HAI rates, improve patient satisfaction scores–and most importantly–save patient lives.

Author: Thom Wellington. Article used with permission. Thom is the co-founder of Infection Control University.

About E-Mist E-Mist helps healthcare organizations prevent and reduce HAIs. Founded on a legacy of electrostatic science and technology, the E-Mist Infection Control System and Process eliminates traditional disinfectant methods. The EM360 System is mobile, touchless, safer, cordless, and more cost-effective approach to environmental surface disinfection. E-Mist makes disinfection better, easier and more cost effective.

Doing this will save a life today

By Patrick Boshell Abstract

Infectious diseases continue to be a health challenge and economic burden within our communities. Though effective hand hygiene education is critical, there has been a steady decline in hygiene promotion, especially in the home.

The impact of poor hand hygiene habits is linked to increased occurrences of illness, absences, and their associated costs. A renewed commitment to “shared responsibility” in our homes and classrooms may be one of our most important infection prevention strategies.

Main Article

Hand hygiene at home, school and within our communities plays an essential role in helping to reduce the spread of infectious diseases. However, there has been a steady decline in the promotion of hygiene practices in modern homes, mainly due to changing family demands and structure (Scott, 2013). Children are usually taught to wash their hands when they are young, but reinforcement of hand washing by parents often decreases when children reach school (Guinan, 2002).


Studies demonstrate that poor hand hygiene practices can contribute to an increase in community-based infections including gastrointestinal, skin and respiratory infections (Scott, 2013). Additionally, there has been a steady increase in the global burden of infectious diseases, resulting in an estimated 13 million deaths annually (Scott, 2013). Between 1980 and 1992, deaths attributed to infectious disease increased by 22% (Scott, 2013). This is a cause for concern as we continue to see a decline in hand hygiene promotion and education.

Students have Poor Hand Hygiene Habits

A recent study in the American Journal of Infection Control looked at the impact of poor hand hygiene by college students (Prater, 2016). Specifically, the study linked poor hand hygiene practices to increased occurrences of infectious diseases, medical visits and absence from class and work. College and university campuses have a high risk for the spread of infectious diseases, as students live in close proximity, are exposed to both environmental and indoor pathogens and travel frequently on campus and within their communities.


Teaching ranks as the ‘top germ profession’ compared to other occupations, due to the high bacterial count per square inch in schools. (Landro, 2009). In fact, surfaces that teachers regularly touch contain up to 10 times more bacteria per square inch than those of other professions (Landro, 2009). Touch screens, in particular, create the perfect medium to host pathogens, due to the combination of warm temperatures and unclean hands (Rolfe, 2016).

Though most students in the study claimed to wash their hands frequently, the results indicated 57.7% of the hands surveyed were colonized with all types of microbial contaminants, which could be linked to increased occurrences of infectious diseases, absences, and medical visits (Prater, 2016). Researchers found that hand hygiene could be significantly improved when students followed CDC handwashing guidelines. The researchers concluded, “It is critical to promote education on proper hand washing in colleges, in grade schools, and at home to improve health and learning outcomes (Prater, 2016).”

Effect of a Comprehensive Hand Hygiene Program

Similar to colleges and universities, elementary and high schools have a predisposition for the transmission of microorganisms and cross contamination. In the United States, the number of lost school days annually from kindergarten through to 12thgrade is 164 million, which averages 4.5 days a year per student (Guinan, 2002). A survey revealed that 83% of teachers think absenteeism is the main problem they face in school (Guinan, 2002). Additionally, 96% of parents list infection prevention as an extremely important part of a school health program (Guinan, 2002).

A recent study indicated that hand hygiene compliance amongst elementary aged children is 58% after using the washroom, except soap usage averages 28% for girls and only 8% for boys (Guinan, 2002). This lack of effective hand hygiene practices often leads to acute gastrointestinal illness in elementary school-aged children (Guinan, 2002).

Five elementary schools in Pennsylvania participated in a study, which combined classroom learning, fun videos, hands-on practice, take home pamphlets and hand sanitizer in the classroom. Absenteeism data collected over 3-months showed a 50.6% improvement (Guinan, 2002). In addition to the health benefits, this reduction in absenteeism resulted in a savings of $167 per student and a projected annual savings of $24,300 for the school (Guinan, 2002).

Recommendations for Hand Washing at Home and at School

The CDC (2015) provides these practical hand washing guidelines:

When to wash your hands:

  • before and after preparing food
  • before eating food
  • after using the toilet
  • before and after caring for someone who is sick
  • after handling pets, their food or treats
  • after touching garbage

How to wash your hands:

  • scrub your hands with soap and water for 20 seconds
  • rinse your hands under clean, running water
  • dry your hands with a clean towel (or air dry them)

Hand Hygiene Promotion is a Shared Responsibility

According to the CDC, hand washing is the single most effective way to prevent the spread of disease. Teaching children appropriate hand hygiene habits can result in the decrease of infections, absenteeism, and associated costs. Many experts agree that for hand hygiene promotion to be effective in changing behaviours, we need to ensure a family-centred approach (Scott, 2010), starting with the home and reinforced in the classroom, community and through popular media.

With the popularity of social media, easy access to the Internet, and increased use of entertainment education, it is becoming easier to reach children and reinforce these healthy habits with more traditional reminders both at home and in the classroom.

Educators and parents agree, having shared responsibility in the promotion of hand hygiene is one of our most important infection prevention strategies.


  1. CDC, (2000). Why is Handwashing Important? Center for Disease Control. Retrieved August 16th, 2016 from
  2. CDC (2015). When and how to wash your hands. Retrieved August 19, 2016 from
  3. Guinan, M. (2002). The effect of a comprehensive handwashing program on absenteeism in elementary schools. American Journal of Infection Control. Retrieved August 12, 2016 from
  4. Landro, L. (2009). Afraid of germs? Don’t even think about becoming a teacher. The Wall Street Journal. Retrieved August 12, 2016 from
  5. Prater, K. (2016). Poor hand hygiene by college students linked to more occurrences of infectious diseases, medical visits, and absence from classes. American Journal of Infection Control. Retrieved August 12, 2016 from
  6. Rolfe, T. (2016). Touchscreens: The mosquito of the digital age. Retrieved August 12, 2016 from
  7. Rosen, L. (2010). Spreading the handwashing message: An alternative to traditional media campaigns. American Journal of Infection Control. Retrieved August 12, 2016 from
  8. Scott, E. (2013). Community-based infections and the potential role of common touch surfaces as vectors for the transmission of infectious agents in home and community settings. American Journal of Infection Control. Retrieved August 12, 2016 from
  9. Scott, E. (2010). Prevention of the spread of infection: The need for a family-centred approach to hygiene promotion. American Journal of Infection Control. Retrieved August 16th, 2016 from

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