Infection prevention and control, while taken seriously in healthcare settings, isn’t always a priority in educational facilities, where appearance sometimes takes precedence over cleaning and disinfecting high touch points.
Using proper chemicals, materials and cleaning practices, along with ongoing custodial education, is fundamental in preventing the spread of pathogens, according to Brad Fedyk, manager of custodial services at Upper Grand District School Board in Ontario.
“There are many things to touch, with multiple people touching them throughout the day,” he says. “Sometimes, there’s not enough focus on infection prevention.”
He utilizes his background working in hospitals to promote such practices in school systems, and flags a few issues that may currently affect infection prevention methods.
While it depends on the school board, more children, staff and teachers are becoming environmentally sensitive to the environment, with some boards oversimplifying chemicals to the point where they are not effective. Windex, for instance, creates a false sense of infection control as it’s often perceived to be a disinfectant because of the ammonia it contains. Vinegar and water, which has no real disinfectant properties, is also used quite often.
Some boards even have students clean their own desks due to cleaning cut-backs and declining enrollments, but children cannot use products that will be a risk and they won’t be able to fully understand label instructions. Students may learn social responsibility and basic skills, but it’s in the absence of a truly healthy environment.
Meanwhile, many smaller schools employ a custodian first thing in the morning and after school, with no one there during the day except for teachers and principals who clean only as needed.
Common Disinfectants Vs Virucidals
Disinfectants containing Quaternary Ammonium Compounds (quats), typically used in schools, may not necessarily kill all bacteria or viruses like norovirus and influenza.
“Custodians need to understand what types of disinfectants to use for certain outbreaks. If dealing with a norovirus outbreak, custodians must use a disinfectant with a virucidal claim. If it’s not a virucidal disinfectant, they are wasting their time as the disinfectant won’t kill a virus,” says Keith Sopha, president of the Canadian Association for Environmental Management and founder of CleanLearning.
It is also essential to understand the disinfectant dwell time—the time required for disinfectants to kill the bacteria they claim.
Some dwell time can be as high as ten minutes, meaning the surface has to be completely wet for ten minutes to meet the kill factor of the disinfectant claim, which may be an unrealistic feat.
Education and Training
On the bright side, more schools are educating their teams on best practices for cleaning and disinfection. Twenty-eight managers at the University of Alberta recently became certified through CAEM’s Clean Learning program, which uses the guiding principles of hospital cleaning in a non-clinical environment. The managers are currently rolling out training to front-line custodial staff.
Cases of community-acquired infections spreading within schools are making headlines across Canada. It’s important to understand the potential for cross contamination on environmental surfaces in all types of facilities where people congregate and where infections, like norovirus, can quickly spread and cause sickness and resulting absenteeism.
“There has to be a formal training program for educational facilities,” says Sopha. “Schools should also continue to respect the importance of the custodial team and the importance of applying best practices of cleaning and disinfection.”
During professional development days, Fedyk brings in speakers and plans demos from vendors and educational sessions and encourages self-training through online modules during down time. He sees infection prevention training growing alongside mandated training, such as working from heights and other occupational health and safety guidelines.
“I’m currently working on developing an infection prevention module for the custodial training we provide to head caretakers who are shift supervisors in the school,” he notes. “They’re the first responders to messes and accidents and potential blood-born pathogens.”
He uses a combination of standards from the ISSA and the APPA: Leadership in Educational Facilities. He also uses Infection Prevention and Control (IPAC) Canada standards and processes approved by the Provincial Infectious Diseases Advisory Committee (PIDAC) to guide his cleaning protocol and outbreak response.
“We also encourage teachers to let us know about cases, so we can up the cleaning use and high-level disinfectants and localize outbreaks, rather than allow them to spread through a whole school.”
Environmental Surface Selection
An infusion of infrastructure funds are pouring into educational facilities across Ontario and other provinces, with some boards overseeing millions of dollars in construction projects. This brings an opportunity for better environmental surface selection. Surface materials must be scrutinized, Sopha says, not far different from surfaces found in healthcare systems.
“They have to be cleanable, but also stand up to disinfectants. This will make a custodial team’s job easier.”
Selecting environmental surfaces, including furnishings that are seamless and fluid-resistant, will also improve cleanability. Bacteria harbour within porous surfaces with seams, crevices and cracks. If these areas are not properly scrubbed out, the residual will remain and there is risk of transmission.
Proper infection prevention training is important, but once a custodial team is educated, efficient auditing systems must be in place to ensure the lessons learned are continuously applied.
“Supervisors need a process in place to ensure school systems are being cleaned and that in- house or contract cleaners are applying the principles they’ve been taught,” says Sopha. “Some people fall back to bad habits really quickly. Routine observation audits is one great process to ensure staff continue to follow best practices as taught.”