Enhanced Environmental Hygiene for K-12 Schools
- By Eugene C. Cole
- 05/01/22
With so many students working together in close
quarters, schools can be breeding grounds for infection. But as
studies routinely show, simple interventions can substantially
reduce absenteeism by providing a healthy, productive learning
environment for students, teachers and staff.
PHOTO © HALFPOINT
As an administrator, you play a key role in creating a
healthy and high-performing school environment. It starts
with gathering stakeholders, including custodial and facility
management personnel, to establish acceptable standards of
environmental quality and safety. While much of the focus
recently has been on indoor air quality (IAQ), these standards
must also include effective cleaning to control contaminated
sources and occupant exposures, with the goal of ultimately
decreasing health risk. While the practice of Environmental
Hygiene encompasses the effective cleaning of general surfaces,
you can better control the spread of infectious disease agents
by implementing Enhanced Environmental Hygiene, which
identifies and targets key surfaces, “hot spots” or “high-contact
touchpoints”—recognized as significant reservoirs of potential
human disease agents. Such surfaces require more frequent
attention to effective cleaning and disinfection.
Multiple studies have been published on pathogen transfer
between hands and surfaces, as well as on microbial pathogen
survival on the skin and on surfaces. One particular study
showed that a hand contaminated with virus can contaminate
up to seven other surfaces. When we touch an object, we
transfer organisms to that surface and/or accumulate more and/or different organisms on our hand. In a crowded environment
like a school, a surface contaminated by one student can be
touched by many others, who then touch other surfaces as they
move around. And then each of those contaminated surfaces
can be touched again by other people, and so the touching
and contamination process continues. This has been referred
to as the surface touch network, which allows the transfer of
microbes between hands and surfaces, resulting in a surface
contamination network.
Research studies have also collectively indicated that
enhanced environmental hygiene in schools, and targeted
cleaning of biological residual contamination related to
frequent-contact points, resulted in reduced illnesses tied to
bacterial contamination reservoirs (Staphylococcus aureus,
Shigella outbreaks), reduced sick building syndrome symptoms
and reduced absenteeism due to infectious illnesses. And while
school hygiene programs such as handwashing promotion are
admirable and well-intentioned, they typically neglect the
rapid recontamination of hands via high contact touchpoints
that are usually poorly cleaned, and thus student illness and
absenteeism rates fail to change.
Consequences of the Spread of Infectious Illnesses
Students who develop an illness due to the transmission
of an infectious disease agent in the school environment risk
consequences to themselves and others, which may include:
- Absenteeism, which may interfere with the learning process
and, if prolonged, can affect academic performance.
- Family healthcare costs for the sick child, as well as a
potential economic burden on a working parent who must
stay at home and care for the child.
- The risk of disease transmission from the sick child to other
family members.
The survival of microbial pathogens on surfaces and the
resultant potential for the transmission of infective agents to individuals
depends upon multiple factors, including temperature,
relative humidity, the physical properties of the surface material,
and whether the organisms are embedded in a protective film,
such as respiratory secretions from humans or animals. Thus,
many potential human pathogens may survive on hard or soft
materials for hours or even days, and be available for transmission
to susceptible persons, the latter of which include children,
pregnant women, those on various medicinal therapies, and those
with chronic illness such as heart, kidney, and/or lung disease.
Such chronic conditions for example, are recognized as extremely
significant risk factors for SARS-CoV-2 (COVID-19) disease.
Cleaning and Disinfection
Prior to the current COVID-19 pandemic, and certainly since its
recognition, the need for Enhanced Environmental Hygiene has
never been more important. This targeted hygiene approach typically
involves manual detergent cleaning, followed by the application
of an appropriate EPA-registered disinfectant, or the use of a
one-step cleaner-disinfectant, sometimes followed by an additional
antimicrobial enhancement provided by the use of a disinfectant
wipe or disinfectant spray (with appropriate EPA approval).
The cleaning process, through friction, physically removes microbes and their associated films in which they may be embedded,
such as saliva and/or nasal secretions from the nose or
mouth, as generated by coughing or sneezing. Thus, the cleaning
process is crucial, as it removes soils, respiratory secretions,
and other substances that may block
or interfere with the antimicrobial
action of the biocide to kill or
otherwise inactivate any remaining
microbial residues. The value of this
two-step process of cleaning and
disinfection to maximize the reduction
of infectious agent transmission
has been previously confirmed in a
controlled laboratory study.
Cleaning and Disinfection
Frequency
Once cleaning and disinfection
protocols are established for
high-contact touchpoints within any
particular venue, the key element to
reducing human exposures and the
potential for infectious agent transmission
is the effective frequency at
which the protocols are carried out.
Thus, improved cleaning of floors
and desks in schools has been shown
to reduce upper respiratory symptoms,
and the reduction of air pollutants through effective surface
cleaning practices and hence, reduced occupant exposures
and health risks, was demonstrated in a long-term cleaning
effectiveness study.
The key is to assess, as best as
possible, the time necessary after the
cleaning and disinfection of surfaces
for the microbial population to
reestablish itself to the level it was
before the surfaces were cleaned. Recently,
the time for the reestablishment
of microbial contamination on
student desks in schools was determined.
The study showed that as the
cleaning of desks physically removed
about 50 percent of bacteria, fungi,
and human cells, a full recovery of
the surface contamination concentrations
prior to cleaning occurred
within 2-5 days. Based on such data,
it’s practical that schools implement
the cleaning and disinfection of all
student desks and similar "hot spots”
every day—or, if not economically
or logistically feasible, then at least
every 2-3 days.
Areas and Surfaces of Focus
While classroom surfaces (desks, tables, chairs) remain a
major concern regarding microbial contamination in schools,
other components of school environments—such as cafeterias,
restrooms, locker rooms and gyms—require similar attention
to cleaning, with a targeted focus on reducing the infectious
disease potential. School kitchens and related areas, as
obligated by public health code, must be cleaned and sanitized
to prevent environmental contamination and transmission of
bacterial pathogens such as E. coli, Listeria and Salmonella.
Similarly, restrooms must be effectively cleaned and
monitored to prevent exposure and resultant student illnesses
from a variety of pathogens, both gastrointestinal (noroviruses,
E. coli) and respiratory (COVID-19, cold, and flu viruses).
This is emphasized by results of a study in two daycare centers
where 19 percent of surfaces tested were positive for rotavirus.
Rotavirus contamination was found on drinking fountains,
water play tables, toilet handles, and telephone receivers.
There can also be other consequences associated with poor
cleaning of school restrooms, with students describing them
as “unpleasant, dirty, smelly, and frightening” and refusing to
use them while at school, thus suffering consequences such as
constipation, urinary tract infections, and incontinence.
Likewise, school locker rooms and gymnasium surfaces and
materials, if improperly cleaned and disinfected, can increase
transmission of infectious agents such as athlete’s foot fungi,
Staphylococcus aureus, and Herpes viruses, with the potential
for widespread outbreaks amongst students. A recent extensive
review of the significance of surfaces in the spread of respiratory
and enteric viral disease stated that “the rapid spread of viral
disease in crowded indoor establishments, including schools,
daycare facilities, nursing homes, business offices, and hospitals,
consistently facilitates disease morbidity and mortality,” and
that “level of cleanliness” is one of a number of factors involved.
Enhanced Environmental
Hygiene in Action
Over the past three decades, increasing attention has been given
through applied research and resultant improved practices to
providing healthy building environments in order to protect
occupants and promote their productivity. It includes, in
particular, school environments, where proper operation and
maintenance provides acceptable air quality and physical
cleanliness that promotes student learning; reduces the rate of
illnesses and absenteeism in children, teachers, and staff; and
effectively works to prevent and control disease outbreaks.
Within this framework, an understanding of the science of
cleaning and disinfection in schools, supported by studies of
norovirus and influenza outbreaks, as well as experience with the COVID-19 pandemic, can help modify custodial practices
to routinely include enhanced environmental hygiene in their
protocols.
In the development of these protocols in schools, custodial
and facility management personnel work together to:
- Identify surfaces considered as high-contact touch points
associated with risk of disease transmission.
- Facilitate the cleaning of high-contact surfaces in key areas,
such as classrooms, media centers, and others as identified,
using an EPA-approved one-step cleaner/disinfectant.
- Facilitate the rapid disinfection of frequent touchpoints using
an EPA-approved aerosol disinfectant spray in common areas,
such as hallway railings and knobs, push plates and breaker
bars on entrance and exit doors, restroom faucets and stall
door and flush handles, and locker room handles and bars.
- Ensure that cleaning equipment is maintained and cleaned
properly to reduce the risk of spreading contamination.
- Address custodian health and safety by ensuring the supply
and proper use of basic, disposable personal protective
equipment (PPE), including gloves, and as necessary, face
masks (K95) and coveralls; and be trained in the safe storage
and use of chemical products; and engage in frequent
handwashing.
Once cleaning and disinfection protocols are in place, schools
may wish to evaluate performance 2 or 3 times each year, using
ATP testing. An explanation of this process has been developed
and published by the ISSA in its ISSA Clean Standard
0714-2014, Measuring the Cleanliness of K-12 Schools25.
Information can be found at: www.issa.com
Conclusion
An examination of the science of cleaning tells us that when
school districts adopt a custodial program of enhanced
environmental hygiene, they are making a profound investment
in promoting the health and well-being of their students,
teachers, and staff. In particular, when children are healthy
and in attendance, their learning process is enhanced, and their
academic performance is more likely to be maximized.
This article originally appeared in the Spring 2022 issue of Spaces4Learning.