Maintaining safe facilities

Public health and hygiene issues are often in the news, with increasing media interest in all matters relating to publicly accessible toilets. Unfortunately, many healthcare premises toilets do not conform to best practice.

Toilet hygiene is particularly critical as infection risks must be identified and any opportunities for cross contamination eliminated. Toilet design, functionality, facilities, cleaning practices, maintenance and monitoring of hygienic conditions all form parts of BTA Best Practice Advice.

Infection risk
Infections which may be found in healthcare toilets include streptococcus, staphylococcus, E. coli and shigella bacteria, hepatitis A virus, the common cold virus, and various sexually transmitted organisms. It has been quoted that between about 20 per cent and 70 per cent of HAIs are preventable.

It is vitally important that clean and hygienic healthcare premises toilets are available to provide facilities for all types of toilet users: males, females, children, babies, the aged and those with a disability. Toilet hygiene is particularly critical in hospitals and clinics as infection risks must be identified and any opportunities for cross contamination eliminated.

Education about infection control in toilets is an important tool in the war against superbugs and hospital infections. There are measures that hospitals and clinics can take to prevent the spread of infection in toilets.

It is not sufficient for hospitals just to provide the means to wash hands. We know from experience that many men, women and children fail to wash their hands after using a toilet (up to 40 per cent in healthcare premises). Displaying signs telling users to wash their hands helps but education is also needed to ensure that toilet users and toilet providers understand why it is absolutely essential that hands are germ free before they leave the toilet.

84 per cent of people that wash their hands don’t wash them effectively. Signs should be displayed indicating the effective way to wash hands.

Design & Build
Toilet designers and managers of healthcare premises need to consider what the infection risks are in a toilet and how to avoid any opportunity for cross contamination. The building materials used inside toilets need to be hygienic and easy to clean. Intelligent design and built-in durability will reduce long-term maintenance and cleaning costs. For use in public areas, however, it is also important, that they are resistant to graffiti and vandalism.

Toilets should be designed with a view to easy cleaning and maintenance from the start (with smooth surfaces and avoiding little gaps and crevices). All drains and waste pipes should be easily accessible for cleaning and maintenance including concealed systems. Continuous flooring should be used in preference to material with joins. Tile grouting absorbs urine and is more difficult to keep clean and odour free. Surfaces can be coated with anti-MRSA agents, which reduces stains and odours while killing bacteria, fungus, and microbes.

Wall hung lavatory pans should be used in preference to pedestal lavatory pans. This makes the facilities easier to clean as there are fewer places for dirt and germs to collect on the floor.

Non-touch facilities
It has been recorded that 80 per cent of infectious illnesses are transmitted by touch. Cross-contamination occurs when germs are spread from one person to another simply by touch – directly or indirectly. Once a surface is touched, bacteria are transferred to it, regardless of the length of time the surface was handled.

Measures can be used to prevent the spread of infection in toilets such as non-touch facilities and the coating of must touch surfaces with substances that kill germs, for example hands free lighting, toilet tissue dispensing, cistern flushing, wash basin taps, soap dispensing and hand drying. Hospitals can also consider supplying toilet seat covers that are replaced after each use, or sanitizer sprays to protect the otherwise “must touch” toilet seat. Toilet seat covers act as a physical and protective barrier between the user and the toilet seat.

The door at the entrance to and exit from the toilet is normally a must touch surface. Coatings are now available, that are invisible and can be applied to must touch surfaces, including door handles, and destroy both micro-organisms, and foul odours, using nanotechnology. Products are also available that provide a fresh sleeve door handle cover for each user or spay a germ kill solution on the handle before each use.

Effective cleaning
It is important to ensure effective cleaning and eradication of germs in toilets. Organisms that can be harmful to health can survive on environmental surfaces. Viruses, in particular, can be excreted in large numbers in respiratory secretions and stools, and can stay on surfaces for hours and even days. In addition to hand washing, hygienic toilet and hand washing facilities are vital to prevent the person-to-person spread of infections.

The importance of high quality cleaning in all hospital toilets cannot be overstated. Higher standards of cleaning are achieved by having clear cleaning specifications and properly trained staff. Cleaning requirements must be set out in a cleaning specification – including cleaning procedures and specified cleaning materials to be used and their frequency of use. The cleaning specification will detail the daily, weekly and monthly tasks that must be completed in each toilet.

Cleaning solutions are available for all surfaces that provide 99.9 per cent effective sterility and germ kill. They are effective against MRSA, E Coli, and other forms of bacteria. New cleaning products and systems are available which kill bacterial cells and inactivate pathogenic viruses without using chemicals.

Training course should be provided for operatives and supervisors in toilet washroom cleaning. It is highly recommended that the people charged with the cleaning responsibilities are suitably trained to the British Institute of Cleaning Science (BICSc) level of competence; and that they have attended and completed the Cleaning Operators Proficiency Certificate (COPC).

Monitoring & inspections
Monitoring of cleaning activities through daily or weekly inspections is considered essential to maintain high standards. Toilets should be monitored regularly as part of a documented rota and policy. A cleaning audit checklist should be located in the toilets, dated and signed by the inspecting cleaning supervisor at regular intervals throughout the day.

A faults and repair audit checklist should also be maintained. These records must be regularly scrutinised and managed by the cleaners’ supervisors.

Healthcare premise deep clean programmes should include use of products recommended by the Health Protection Agency to fight the bugs such as MRSA and Clostridium difficile during the deep clean that was, effectively, put in place to combat them.

Even the most careful cleaning can leave traces behind. Black Light technology can be used to show residual splashes and stains. It reveals proteins that the eye can’t see and not only uses a scientific process to establish the degree of cleanliness but also helps cleaning supervisors to understand what surfaces need more effective cleaning.

Maintenance
It is important that healthcare staff know what to do immediately when a toilet is not working properly. Sound preventative maintenance programmes and proper programme performance monitoring will ensure that operational problems are minimised along with reduced closure periods. Supplies of toilet paper, soap, and paper towels must be re-stocked throughout the day. Emergency repairs must be done promptly to minimise disruption to the service and planned maintenance should take place outside of normal toilet opening hours whenever possible.

The British Toilet Association’s ‘Where can I go?’ campaign focuses attention on the need for high standards of public or away from home toilets in all areas, and this includes healthcare environments such as hospitals and clinics.

BTA welcomes new members from the healthcare sector and can provide help and advice with all of their toilet provision enquiries. The British Toilet Association is recognised as the unique expert source of information and support in all matters related to away from home or public toilets across all market sectors including private and public healthcare locations.

For more information:
Tel/Fax: 01403 258779
E-mail: enquiries@britloos.co.uk
Web: www.britloos.co.uk