An Upstream Approach: Strategic Use of Bleach to Prevent Healthcare-Acquired Infections

In a world where pathogens are increasingly problematic, a proactive approach to preventing healthcare-acquired infections (HAIs) before they can occur is more important than at any other time. Not only is it the right thing to do for patients, but managing patient infections also helps reduce the workload on an already stretched healthcare workforce. These infections also have significant financial implications for healthcare facilities. In this blog, I will describe an upstream approach to reducing healthcare-associated infection (HAI) risk through the strategic use of bleach for environmental cleaning and disinfection.

Pathogens are becoming more drug resistant and novel, high consequence infectious diseases (HCIDs) are emerging faster than ever before. Recent studies have highlighted the increased risk of pathogen acquisition for patients admitted to rooms previously occupied by infected individuals.1 To reduce infection risk downstream, a proactive cleaning strategy is needed, and it needs to start further upstream.

With its broad spectrum of kill and ability to inactivate harder-to-kill pathogens, bleach is positioned at the top of the disinfectant hierarchy. A little-known fact, according to the Spaulding scheme, is that bleach is actually an intermediate-level disinfectant. With challenging pathogens like Clostridioides difficile (“C. diff”), Candida auris, and norovirus, every healthcare facility should have bleach in their cleaning arsenal. That said, there is a time and a place for everything, and this includes the use of bleach for environmental cleaning and disinfection. At Clorox Healthcare, the recommendation is to target specific indications for bleach. These use occasions include outbreak management, isolation room cleaning, and terminal cleaning of all discharge rooms - regardless of the patient’s infection status.

Rationale for our Recommended Bleach Use Occasions

Outbreak management. Outbreaks are very disruptive, costly, and resource intensive. During an outbreak, enhanced infection prevention and control measures are indicated to reduce the risk of spread within a facility. Depending on the pathogen, one case of an HCID can be considered an outbreak. Because pathogens can persist in the environment for prolonged periods, eliminating environmental surfaces as a source is essential to outbreak control. In fact, eliminating the hazard (or pathogen in this case) is at the top of the hierarchy of controls.1 This presents an ideal opportunity to use ready-to-use (RTU) disposable bleach disinfecting wipes, which reduce the risk of exposure associated with reprocessing or inadequately laundered reusable cloths.. RTU products also ensure the correct dilution every time, supporting consistent and effective disinfection. Some pathogens require very specific disinfectant chemistries such as sporicidals (like bleach). Examples include Clostridioides difficile (“C. diff”) Learn more about outbreak management from one of my previous blogs titled “So You Think You Have an Outbreak.”

All Isolation Rooms. For many of the same reasons outlined above in relation to outbreaks, standardizing disinfection practices is also crucial. A consistent approach reduces variation in processes and helps prevent errors. One study found 6 critical errors when multiple disinfecting wipes were available in isolation carts. Upon standardizing to bleach wipes, the number of critical errors was reduced by 67%.2 Standardizing isolation room cleaning to a single disinfectant – the one with the broadest kill spectrum (bleach) - means there is less for staff to remember, such as which product to use, contact time, etc., and therefore less chance of error. While the use of a sporicidal agent is not necessary for all pathogens requiring isolation precautions, the idea here is to keep it simple for staff. Standardization makes the right thing to do the easy thing to do.

All Discharge Rooms. We recommend that all discharge rooms be cleaned and disinfected with bleach, regardless of the prior occupant’s infection status. Why? Because we often don’t know what pathogen(s) a patient may be harboring. Studies have found that more than half of patient rooms are contaminated with multidrug-resistant organisms (MDROs), and 1 in 4 rooms have been found to be contaminated with C. diff spores despite terminal disinfection.3 Therefore, it’s not surprising that the risk to the next patient to be admitted to a room can be up to four times higher when the room was previously occupied by a colonized or infected patient. 4 Together, these data could explain why 20-40% of HAIs occur from direct and indirect contact (e.g., contaminated surfaces).5 The good news is that the use of bleach for all post-discharge rooms has been shown to reduce environmental contamination with C. diff spores in non-C. diff rooms from 24% to 5%6 Performing post-discharge cleaning with an intermediate-level disinfectant provides that next patient the highest level of clean possible.

Adopting a proactive, and standardized approach to environmental cleaning and disinfection with bleach can significantly reduce the risk of HAIs. This strategy not only protects patients but also supports healthcare workers and improves the financial health of healthcare facilities. Every patient deserves the highest standard of cleanliness and bleach is a powerful tool in achieving that goal.