Protecting the elderly in the age of COVID-19

As COVID-19 continues to threaten the lives of aged care residents in New Zealand, the focus within the hygiene and cleaning sector is on innovative equipment and products, industry education and stopping the next wave of infections.

Almost three years into the COVID-19 health crisis, Kerry Boon and the team at commercial cleaning equipment supplier Proquip NZ have had a chance to sum up some of the best hygiene solutions for aged care facilities.

Three key points have emerged – do not underestimate the importance of floorcare, go with battery-powered equipment where possible, and think about using steam for cleaning.

Given the risk of spreading viruses, bacteria and fungus on shoes, Boon, the sales and marketing manager at Proquip, believes the emphasis on proper floorcare in healthcare and aged care facilities has been underplayed.

With regard to cleaning safety and efficiency, too, he says the use of battery-powered technology for floorcare and other tasks should be a no-brainer in aged care centres.

“If you have cords across an aged care facility when you’re cleaning, you have to lock down that room because people can easily trip and fall,” Boon says.

With battery technology constantly improving, the ability to get more grunt out of battery-powered equipment than in the past also makes a difference.

In the fight against COVID-19, Boon says machines such as the Blue Evolution steam and vacuum cleaner have proven popular with facility managers, whether it be to target floors or other areas such as bathrooms that often contain pathogens and bacteria.

“Steam is chemical free and it’s really efficient at neutralising those organisms and, even if they’re not fully neutralised, they are then treated with an ultraviolet lamp in the machine that presents a strong germicidal action that eliminates germs and bacteria.”

Deadly impact

With people aged over 70 accounting for 1847 out of the total of 2106 deaths from COVID-19 in New Zealand as of October 30, 2022, the impact of the pandemic on the elderly – and, in particular, aged care residents – remains very real

Infection-prevention expert Dr Greg Whiteley says there are four key risk groups for COVID-19 – the unvaccinated, the immune-compromised, those with multiple co-morbidities and the elderly.

“In aged care, COVID is still killing people,” says Dr Whiteley, chairman of Whiteley, a manufacturer of sterilants, disinfectants and professional cleaning technologies.

He expects annual vaccinations will be one of the key health mechanisms to protect the community, especially for those aged over 60. This will include people working in the cleaning sector.

“Most of the cleaning supervisors are aged under 50, but some of the cleaners are older and the company owners are typically older. So, they’re the ones at risk,” Whiteley says.

In considering the plight of aged care facilities dealing with COVID-19 and deadly bugs, he laments that they cannot replicate one action that many hospitals are taking to combat the problem.

In the hope of minimising infections, hospitals are simply discharging patients much faster, where possible.

“But you can’t do that in aged care,” Dr Whiteley says.

“People are in those facilities and going through progressive levels of care and, in some cases, they could be there for years. If they catch one of these bugs, they can die quite quickly and unnecessarily.”

Dr Whiteley and his team are at the forefront of efforts to ensure that facilities such as aged care and retirement homes are healthy and hygienic.

Arguing that the fight to safeguard aged care residents is “moving at a glacial pace”, he also warns cleaning contractors to get their disinfection and hygiene systems right, or risk facing possible reputational and legal repercussions.

“Because with modern genetics you can track who got the bug first, where it went to on surfaces, who then touched it and who got the bug,” Dr Whiteley says.

In short, there is no place to hide if cleaning contractors do not do their job.

Training evolution

The imperative of high hygiene standards as a result of the pandemic has prompted some training reforms in New Zealand, especially for the hospital and aged care sectors.

Penny Barrett, Team Leader for vocational pathways and the cleaning sector at Careerforce – a business division of Te Pūkenga Work Based Learning that supports employers and employees across the health and wellbeing sectors – says the main impact has been an additional focus on training around infection control.

“That’s happening across hospitals and also aged residential care facilities,” she says.

“It’s always been important, but we have noticed a big uptake in training in relation to infection control.”

Barrett says information and advice for cleaners has changed at “dizzying speed” since the start of the pandemic, including through a better understanding that the virus is mostly spread through aerosol transmission. “Therefore, the training has changed to reflect that.”

The proper procedures for putting on and taking off PPE gear have also become critical in the hospital and aged care sectors, especially.

“Rolling off gloves properly and getting the sequencing right is the key so that users are not reinfecting their PPE gear,” Barrett says.

While Careerforce has enjoyed a strong reputation for its cleaning programs for many years, it has developed new courses to zero in on hand-washing and infection prevention for clients such as the New Zealand Ministry of Health. Programs have also been refreshed to reflect the ever-greater need for infection control.

“We’ve consulted widely with the cleaning industry and the aged residential care sector – in fact, the whole health sector – to ensure our courses are meeting COVID-19 needs,” Barrett says.

Rigour required

As COVID-19 becomes more of a background endemic health issue in the years to come, Dr Whiteley expects the focus to switch back to deadly bacteria.

He notes that the global mortality rate for COVID-19 is about 1.3 for every 1000 people who contract the virus, whereas for bacteraemic cases that death rate rises to about three to five people for every 10.

“Therefore, you’re 10 to 100 times more likely to die and those are the bugs that we will really need to worry about in the future,” he says.

Dr Whiteley says these bugs can be carried in the air, but are mostly transmitted by contact. He explains that if people touch a surface with bugs on it, and especially if biofilm bugs are present, those bugs will stay on the hands for up to 19 subsequent touches.

“Hands are the most dangerous things in the world,” he says. “And if the bugs are on your gloves, the same rule applies.”

Such scenarios drive home the importance of rigorous hand hygiene, especially in an aged care setting where outbreaks can be devastating. Dr Whiteley encourages more cleaning contractors to get GBAC STAR Service Accreditation that validates their cleaning, disinfection and infection-prevention program.

Boon says one key focus for any cleaning operator must be to get their processes right. While the choice of appropriate machinery and chemicals is crucial, the risk to aged care residents and others can stem from the inappropriate use of that technology and products. This includes rigour around the most efficacious dwell time for chemicals.

“It’s all about having the right processes,” Boon says. “You can have the best machines and products in the world, but if they’re not used properly the outcomes won’t be good.”

To that end, Proquip is introducing online training programs to ensure that cleaning staff are using cleaning equipment in the right way.

Communication crucial

With the stakes being so much higher in the aged care sector with hygiene control, Boon stresses the importance of clear communication between facility managers, cleaning contractors and distributors.

He believes site managers are more open to discussions now about new innovation and technology options in the wake of COVID-19, whether it is around steam-cleaning products or better chemical choices.

“They’re more receptive to new ideas,” he says. “And, because COVID has been such a big health issue, they generally have more funding available for hygiene solutions now, whereas five years ago if they applied to head office for a $12,000 steam machine, for example, it would have been a tough ask.”

Barrett has no doubt that higher protocols around hygiene and cleaning are here to stay in the wake of COVID-19. She also believes there is greater understanding in New Zealand about the need for upskilling and education within the hygiene and cleaning space.

With unemployment levels hitting historic lows across the country, the cleaning sector is struggling to recruit and retain appropriate talent.

“But there are good opportunities in the cleaning sector for employment pathways,” Barrett says.

Retention rates for cleaning staff are more stable within hospitals because of better pay rates and employment deals under MECA agreements.

However, Barrett believes the key in the future to having a steady pipeline of workers in the aged care sector and others is to strengthen gateway programs in secondary schools.

She says one element that favours the cleaning sector is a renewed appreciation of cleaning as a result of COVID-19.

“People now realise that a world without cleaners will come to a screaming halt.”

This article first appeared in the November issue of INCLEAN NZ magazine

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