Preventing COVID-19 or spreading germs?

I went to a grocery and observed a cleaner wiping the handles of customers’ trolleys. What struck me was she was using the same rag from one cart to the next.

Businesses taking measures to prevent the spread of the COVID-19 is commendable but are they really effective?  At another grocery, a worker was wiping the cold storage of goods with a rag. She had a small plastic container with water which she dipped and continued wiping. The water was dirty. When I called this to her attention, her response was that she was “washing out” the rag in the water. At a pharmacy, they installed sinks for customers to wash their hands before entering.

We are hypervigilant about avoiding COVID-19. People rushed out to buy wipes, rubbing alcohol, methylated spirits. News reports have shown public health workers at home and abroad wearing protective wear spraying buildings and frequented areas. I saw a social media video from another country, showing a woman spraying a young man who had just returned home on a motorbike after shopping for food.

Before COVID-19, pathogens were circulating. One day you are well, the next, suddenly stricken with one or more symptoms: a sore throat, runny nose, fever, headache, diarrhoea. The Ministry of Health recorded over 3,000 “suspected” and 300 confirmed influenza cases and 40 deaths for the flu season October 2019 to May this year. Keeping pathogens at bay can be the difference between life and death.

Think of the patient going to have a surgical procedure, the risk of infection increases if the surgical theatre, equipment, instruments are not sterile. Even the surgeon and others in the theatre can impact outcomes if they do not practise proper hand hygiene.

“Failure to properly disinfect or sterilize equipment carries not only risk associated with breach of host barriers but also risk for person-to-person transmission (e.g., hepatitis B virus) and transmission of environmental pathogens (e.g., Pseudomonas aeruginosa)” cdc.gov ‘Disinfection and Sterilization Guidelines’.

Cleaning, sterilising, disinfecting—What’s the difference?

Though the words are being used interchangeably, cleaning, sterilising and disinfecting are not the same. In cleaning soap/detergent and water are used to physically remove dirt etc. This process does not automatically kill germs, but by removing them, “it lowers their numbers and the risk of spreading infection,” the CDC states.

Chemicals are utilised for disinfection of surfaces or objects. This method can lower the risk of infection. However, disinfecting “does not necessarily clean dirty surfaces or remove germs”.  For disinfectants to be effective, surfaces have to first be cleaned of dirt. Care should be taken when using disinfectants, make sure to follow the instructions on products. For example, a multi-surface cleaner recommends leaving the product on surfaces for one minute when sanitising and for ten minutes before wiping to disinfect.

Solution of diluted household bleach (1/3 cup/gallon of water or 4 teaspoon bleach per quart of water) can be used for disinfecting. Bleach should not be mixed with other cleaners. If alcohol is used to disinfect it should be at least 70 per cent.

Sanitising, by cleaning or disinfecting is aimed at reducing the number of germs on surfaces or objects to a safe level, in keeping with public health standards. The risk of spreading infection is lowered.  Research had found the COVID-19 virus can survive on different surfaces—plastic/stainless steel, 2-3 days; copper up to 4 hours; cardboard up to 24 hours. www.medrxiv.org “Aerosol and surface stability of HCoV-19 (SARS-CoV-2) compared to SARS-CoV-1”.

A Fact Sheet ‘Environmental Cleaning and Disinfection for Influenza’ (lapublichealth.org) containing guidelines for nursing facilities is instructive.

1. Don’t spray (fog) rooms with disinfectant or air sanitisers. There is no demonstrated benefit in controlling diseases and may be dangerous
2. Dry dusting may move viruses into the air. Damp cleaning with wet rags or mops is recommended. Clean floors, window sills, countertops and shelves. Clean frequently touched areas: door knobs, telephones, equipment buttons, faucet handles
3. Frequently change mop heads, rags, etc. and disinfectant solutions during the decontamination procedure. If possible, use disposable cleaning items
4. Start from areas of light contamination to heavier
5. Use double bucket method: one for cleaning solution and the other for rinsing.
6. Clean, disinfect and dry, cleaning utensils after each use
7. Sanitising wipes for computer keyboards, hand held electronics

Gloves should be worn for cleaning/disinfecting and properly disposed afterwards. Care must be taken when removing gloves not to contaminate hands. Many people are donning gloves as a precaution but washing hands with soap and water is paramount.

Gloves may give some psychological comfort but also spread germs. The World Health Organisation (WHO) “Glove Use Information Leaflet for health care workers” said “prolonged use of gloves for contact precautions in the absence of considering the need to perform hand hygiene can result in the transmission of germs”. Research has found using gloves caused healthcare workers to contaminate hospital surfaces with bacteria and health workers are less likely to clean their hands before and after contact with patients.