The Employee And Infection Control
In the past, customers and travelers have selected a place to stay or eat based on factors such as:
- Business needs
- Vacation objectives
- Special services and athletic facilities.
In general, infection control has not been a major factor in the selection of a lodging or eating establishment. However, today’s travelers are more aware of infectious diseases due to media coverage of food poisoning, Legionnaires’ disease, AIDS, and other serious disease outbreaks.
Within the food service and lodging industry, the second most important considerationafter the implementation of an effective infection control program based on appropriate guidelines from recommended authoritiesis the hiring, training, and motivation of competent personnel. Since at the entry level of employment there is a great deal of turnover, and since infection control is a continuous learning process, ongoing programs are necessary to encourage management staff to get involved and to formalize standard procedures which all employees can easily follow.
Personal Care and Hygiene
Customer protection begins with personal care and hygiene of each staff member.
Proper staff dress is important to a well-rounded infection-control program. If uniforms are worn by housekeeping and restaurant personnel, they should be simple, as seamless as possible, and have short sleeves. Studies have shown that microorganisms accumulate on the cuffs of long-sleeved uniforms worn by auxiliary personnel. Similar conclusions could be made about any long-sleeve or cotton uniforms worn by housekeepers or food service personnel.
The uniform should withstand frequent and multiple washings. Synthetic materials retain fewer microbes and are sturdier than cotton. When possible, uniforms should be kept on the premises; personnel wearing their uniforms while commuting by public transportation, or even in private vehicles, can soil or contaminate a fresh uniform. It doesn’t make sense to properly disinfect work surfaces and other countertops and at the same time wear contaminated clothing.
All personnel should have short manageable hair; long hair should be kept restrained or covered.
All employees, regardless of work assignments, should wash their hands frequently. Hands should be washed even if disposable gloves are worn. The University of Georgia College of Agriculture  has studied hand washing extensively, and the results of their work emphasizes the value of multiple washings and the use of antimicrobial sanitizing soap. Fingernails should be kept short and clean and should never be cleaned with a sharp, pointed object, which could break the skin under the nail. It has been shown that many pathogens can be protected for many days under fingernails. Artificial fingernails are not recommended.
Hand Washing Technique
An acceptable hand washing technique in conjunction with an antimicrobial soap requires only 30 to 45 seconds. The soap should be applied and rubbed over the hands and wrists and then rinsed off with warm water. The second soap application should be more rigorously rubbed and rinsed. Using the double application technique, with the first application slightly heavier on soap than on water and the second soap application and scrubbing procedure immediately following, provides a quick and safe way of protecting the hands.
In most cases all guestroom baths are equipped with standard hand-actuated faucets. These should be disinfected between guests. Restroom facilities should be disinfected frequently. Employees should always use disposable paper towels to dry their hands and should use the towel to turn off the faucet. The towel will serve as a protective barrier, avoiding contamination from the faucet.
All soap and lotion dispensers used by employees should be wall-hung or foot-actuated. Hot air dryers are recommended. Cloth towels should not be used unless absolutely necessary, and they should only be used once.
Screening For Risk
Unfortunately, there is no way of avoiding risk by screening the guests who check in or order a meal. Any precaution taken or disinfectant product effectively introduced into the environment, therefore, can help to reduce the possibility of cross-contamination.
Hotel, motel, or restaurant managers may wish to ask, as part of the screening process for all entry-level employees, very specific questions pertaining to disease.
The continuum shown below lists procedures that cover the levels of cleanliness:
- Clean guest room
- Disinfect surfaces:
- Sink and counters
- Mattress covers
- Disinfect food preparation countertops
- Disinfect food preparation utensils
- Disinfect eating utensils
- Disinfect tables or change table cloths; replace placements when applicable
- Food handling personnel pre-work scrub with antimicrobial soap
- Use antimicrobial lotion/gloves
- Follow all state codes on hygiene
- Use mattress covers and disinfect to include all bedding
- Sterilize and bag silverware where applicable
Employee And Management Do’s And Don’ts
DO wear hand protection when a cut, nick, or other irritation is visible.
DON’T allow exposed cuts or skin lesions the opportunity to come in contact with food or possibly touch a contaminated surface.
DO use disposable hand towels.
DON’T use cloth towels for employees or in public facilities.
DO chemically treat air conditioning systems or filters.
DON’T invite stagnation in air conditioning systems.
DO follow the manufacturers’ directions on contact time and temperature for effective elimination of microorganisms.
DON’T misuse disinfectant products, making them ineffective.
DO practice multiple hand washing after food preparations and certain cleaning procedures.
DON’T touch faucet handles, reuse towels, or reuse soap when hand washing.
DO routinely disinfect drapes, carpets, pillows, blankets, bedspreads, and mattresses.
DON’T just vacuum carpets and allow long periods of time in between shampooing them or dry cleaning drapes, pillows, blankets, bedspreads, and mattresses.
DO train personnel to be aware of cross-contamination.
DON’T delegate cross-contamination procedures to untrained personnel.
DO train personnel to think about liability.
DON’T delegate anti-liability practices to untrained personnel.
DO separate clean linens from soiled linens and trash on the housekeeping cart.
DON’T hang clean sheets over the waste receptacle on the housekeeping cart.
DO maintain appropriate levels of heat necessary for coffee service.
DON’T cover coffee pots with any cloth or other material to maintain heat.
DO use disinfectant presoaked table cleaning cloths to wipe smooth surface tables between customers.
DON’T wipe tables with dirty or soiled cleaning cloths.
DO use disposable disinfectant table wipes where applicable.
DON’T use past manufacturers’ suggested reuse capability for disinfection holding solutions.
DO apply disinfectant to all room surfaces based on housekeeping infection-control protocol recommendations.
DON’T forget to disinfect!
DO take special care in changing the linens.
DON’T forget about the potential of infection from daily cell slough and bodily fluids on linens.
DO apply disinfectant to telephone receiver and unit.
DON’T forget how many millions of microorganisms can be transmitted daily on the telephone receiver.
DO maintain an effective level of disinfection or sanitizing chemicals in the appropriate sink compartment.
DON’T allow negligence to cause a transmission of microorganism on improperly cleaned glasses, dishes, and silverware.
DO periodic culture samples on critical surfaces or other important areas to verify chemicals’ effectiveness.
DON’T use ineffective disinfection products or sanitizing chemicals.
DO purchase the least hazardous chemicals available for sanitizing and disinfecting.
DON’T create employee complaints by using toxic chemicals for sanitizing and disinfecting.
Environmental Surface Disinfectants
Many surfaces in hotels, motels, and restaurants are likely to become contaminated and should be treated by application of a chemical disinfectant to eliminate microorganisms. For example, any surface exposed to human breath, fluids, or wastes should be disinfected to protect anyone who subsequently comes in contact with it. Body fluids and wastes include blood, saliva, urine, feces, semen, and discharges from any wound or lesion.
The surfaces most frequently and heavily contaminated are those in the lavatorythe tub, commode, sink, and floor. Each can receive large doses of contaminants. The floor is also an area that can receive potential contaminants, if not properly cleaned and disinfected. The sink will receive blood and saliva during tooth brushing as well as fluids from any oral lesions such as herpes and syphilis. The commode will invariably become highly contaminated with body wastes. The tub will receive a variety of microorganisms form skin slough, discharge from lesions and wounds, occasionally some blood, and semen. Disinfection of these surfaces is absolutely necessary.
It is important to understand what a disinfectant is, what it can and cannot do, and how it should be used. A disinfectant is a liquid containing chemical energy that is capable of killing or inactivating certain microorganisms. A disinfectant can kill or inactivate some, or even most microorganisms, but not the more resistant spore forms. The effectiveness of disinfectants varies widely; some are capable of high-level disinfection, while others are relatively ineffective. The yardstick for high-level effectiveness is the ability to kill one specific pathogenic microorganism, the very resistant mycobacterium tuberculosis, or tubercle bacillus, the causative agent of tuberculosis. A disinfectant with the capability of killing both gram-negative and gram-positive bacteria is referred to as a “hospital-grade disinfectant.” Virucidal and tuberculocidal activity are additional dimensions of disinfection. Most household disinfectants are capable of only low-level efficacy and leave many potentially pathogenic microorganisms untouched.
According to the CDC, the most important step in disinfection or sterilization is adequate pre-cleaning of the surface or instrument. There are two reasons why pre-cleaning is essential. If there is organic material such as blood on a surface, enormous numbers of microorganisms can be present, making effective disinfection difficult. Also, the organic material protects the microorganisms from the chemical energy of the disinfectant, again reducing the effectiveness of even the highest-level disinfectant. Thus pre-cleaning is a necessity for maximizing the effectiveness of any disinfectant. Some disinfectants can be used for both pre-cleaning and disinfection, because they contain a small amount of detergent. Even in this case, the disinfectant must be applied in two steps.
After the cleaning step, the disinfectant is reapplied and left wet. The chemical energy of the material is released only when the product is applied to a surface and left moist.
In selecting a disinfectant several criteria should be considered:
- Is it registered with the EPA?
- Is it tuberculocidal?
- Is it recommended by the Centers for Disease Control?
- Does the product application satisfy the needs of the property?
- Is the product manufactured by a reputable company?
- Is there documentation available from the manufacturer to verify claims?