Quality Custodial Programs – One Tool in Minimizing Infections

• By Edward M. McMilin
• 12/01/07

On Oct. 17, 2007, a research study conducted by the federal Centers for Disease Control and Prevention (CDC) was released and published in the Journal of the American Medical Association. This study concluded that methicillin-resistant Staphylococcus aureus or MRSA infections were a major health care problem that was linked to more than 18,000 deaths in the U.S. in 2005. Since that time there has been intense media coverage of the infection in school facilities. To date, reports of incidents of the MRSA infection have been reported in 38 states, and deaths of students in four states blamed on MRSA.

What is MRSA?

MRSA is a strain of Staphylococcus aureus, a common bacterium that is resistant to a broad spectrum of antibiotics such as penicillin or amoxicillin. Common staph bacterium is carried harmlessly by 25 to 30 percent of the U. S. population, and MRSA is found in one percent of the population. Both strains typically infect a person through a break in the skin, such as a cut or scrape. Typically, they appear as boils or pimples and often are misdiagnosed as insect bites. That was the case at South Glen Elementary School in Franklin, WI, when a third grade student was ultimately diagnosed with MRSA after coming to school for several days with what was originally thought to be a boil. In that case, the student was infected outside the school and brought it to school. After discovering that the “boil” was in fact MRSA, the district immediately disinfected the entire classroom and its contents.

Both common staph and MRSA infections are not a recent phenomenon. They have been most prevalent in hospitals. MRSA was first diagnosed in hospitals in the 1960s and has been found in the general population for more than 10 years. In hospitals, it was found to have spread by improper hygiene — most notably poor hand washing. (It should be noted that the CDC report specified that 85 percent of the MRSA incidents still occurred in hospital settings.) Outside of hospitals, it is spread by skin-to-skin contact in settings such as athletic venues and fitness centers. Most experts agree that the best way to avoid infections is to practice good hygiene — hand washing and showering after exercise — and not sharing personal items, such as towels, uniforms, or exercise equipment.

Since its release in mid-October, the CDC report has generated significantly increased media attention. In a Nov. 8, 2007 column in the Milwaukee Journal Sentinel entitled “Run for Your Lives!* (*super strain of staphe is nothing new.),” Leonard Pitts said that during a computer search he found that staph infections were mentioned in newspapers 155 times during the first two weeks in October, and 1,650 in the previous two weeks. Pitts, who is a columnist for the Miami Herald, lightheartedly made fun of his colleagues by asking, “So did staph somehow become deadlier in the past two weeks than it was before?” Of course, the answer is no. He went on to point out that the infection has been around for decades, and that a little reported finding of the CDC study was that because of methodology concerns, comparisons with previous data could not be made with precision. His lighthearted column wasn’t downplaying the seriousness of the infection, only the media obsession with it.

In Milwaukee, the incident at South Glen Elementary School was covered by the local electronic media as the lead story on the 10 o’clock news as “Breaking News,” with pictures of various reporters in front of the school building detailing the incident. Was it an important news item? Probably. Was it “Breaking News” material? I personally don’t think so. It does, however, serve as an excellent example of the type of coverage occurring all over the country by all forms of the media.

In the Nov. 7, 2007 edition of Education Week, there are two articles entitled, “Infections Put Administrators to the Test” and “School Athletics on the Front Line in MRSA Prevention.” They highlight the problem school districts are facing in dealing with the MRSA problem in this time of heightened media attention. Both present a balanced view of the issues and the steps school districts are taking as they grapple with the issue. I commend them both of them for their information.

In my previous article published in Nov. 2006, entitled “Quality Custodial Programs — More than Just Cleaning.” I listed the advantages of a quality-cleaning program. These included the following.

1. Increase indoor air quality.
2. Prolong the life of building components and equipment.
3. Increase attendance by creating sanitary environments, thereby eliminating conditions that cause illnesses.
4. Reinforce the perception that the building is well maintained by keeping grafitti removed, paper and trash removed, and providing an environment conducive to learning.
5. Include preventive maintenance, like changing filters to increase operating efficiency of building systems, and contribute to better indoor air quality.

In this article I want to emphasize number 3 and its role.

I spent some time with Michael R. Gutierrez, project manager in the Buildings, Grounds, and Fleet Section of the Division of Facilities and Maintenance of the Milwaukee Public Schools (MPS). Mike is a Certified Executive Housekeeper (CEH) and has been with the district for 32 years. In particular, we discussed what procedures and materials are used to keep MPS facilities clean and sanitary.

Like all other quality programs, MPS has detailed procedures for each type of space — classrooms, toilets, stairs, locker rooms, etc. I want to highlight the daily cleaning procedures for locker/shower rooms.

1. Beginning in the shower room, with a proper mixture of disinfectant cleaner and water in a pump sprayer, spray down the walls, showerheads, fixtures, and soap bowls. Scrub the walls with a hand scrubbing brush. Be sure not to miss corners. Rinse walls with the sprayer and let air dry.
2. With a clean cloth, wipe the showerheads, fixtures, and soap bowls.
3. Using the same solution, scrub the floor of the shower room and the drying room with a deck brush. Particular attention should be paid to shower scum, gutters, and the lower three ft. of walls.
4. Rinse the entire floor area with clear water using a floor squeegee toward the drain if necessary.
5. Spray down and, with a toilet brush, clean the inside surfaces of each toilet and urinal fixture using a disinfectant cleaner solution. Flush each fixture before you begin cleaning. Use the disinfectant solution liberally making sure that all areas are cleaned including protrusions and lips. Lift out and clean under and around all removable urinal traps and strainers.
6. Sweep the floor with the floor broom using the putty knife to remove objects stuck to the floor. With the dustpan, pick up the dirt accumulation and discard it in the trash collection cart. Pay special attention to corners and under the commodes.
7. Spray and wipe all benches in locker room. With a mop and disinfectant cleaning solution, wet mop the entire locker room area.
8. Clean drain covers of any accumulation.
9. Clean and store supplies and equipment.
10. Check for burned-out light bulbs and other repairs.

In addition to these daily procedures, similar ones are in place for summer/project cleaning where all walls in locker rooms are cleaned and all lockers cleaned and disinfected.

Of particular note in the above is the heavy use of disinfectant cleaning supplies on the various surfaces. Mr. Gutierrez indicated that because not all disinfectant cleaning products are equally effective in controlling bacteria, the Material Data Sheets for all products being considered for use in the district are reviewed prior to purchase to make sure they promote maximum hygiene. All disinfectant cleaners currently being used by the district are rated to eliminate MRSA and other bacteria. Daily use of these supplies greatly aids in maintaining the most sanitary conditions possible.

This example highlights the role that a high-quality cleaning program can play in maintaining safe, sanitary conditions in schools and minimizing the spread of all bacteria. Public health officials across the country have stressed that schools are not any more likely to be the site of MRSA or any other type of infections because they can occur wherever unsanitary conditions exist. A high-quality cleaning program when combined with the use of good hygiene practices, such as hand washing, and diligence on the part of school personnel all contribute to minimizing the chance for MRSA or any other infection to affect our students.

Edward M. McMilin is the president of E. McMilin Planning Services LLC. He is the former facilities planner for the Milwaukee Public Schools where he served for 32 years.