In a hospital, a light switch might be touched by dozens of people a day, including some infected with antibiotic-resistant superbugs or the common cold.
And though it might look clean, the surface could harbour germs, including Clostridium difficile spores that can survive for months.
To tackle such bugs, cleaning staff use chemical solutions, elbow grease and, sometimes, an ultraviolet marking system. Introduced last year at Vancouver Island Health Authority sites, the simple test appears to result in significant improvements to cleaning.
VIHA is using UV marking in at least two facilities and plans to extend it to other sites next year. The Fraser Health Authority, which came under fire earlier this year after doctors raised concerns about C. difficile-related deaths at Burnaby Hospital, has also begun using the system.
VIHA introduced UV markers last year after changing its cleaning contractor.
"What we've noticed is scores rapidly start to improve when they [cleaning staff]see the results," said Murray Hutchison, VIHA's corporate director of general support services.
Based on guidelines developed by Safer Healthcare Now – an arm of the non-profit Canadian Patient Safety Institute – the system involves applying a fluorescent substance, invisible to the naked eye, to 10 "high-touch" points in a room, such as toilet handles. Twenty-four hours later, testers use an ultraviolet light to check if the marker is still there. Cleaning staff don't know where the markers are being placed.
In some instances, scores have been as low as 20 per cent on the first round but quickly improved to 80 or 90 per cent, Mr. Hutchison says.
"It's all about awareness of those high-contact points," Mr. Hutchison said. "The housekeeping staff may not have been aware that they were missing the light switch on a consistent basis. Once they become aware that's going to be a place where a mark might be put down – all of a sudden, they're cleaning the light switch."
Cleaning is considered a key factor in reducing hospital-acquired infections such as C. difficile. One of many bacteria found in human feces, C. difficile can run rampant in people whose systems have been weakened by antibiotics. Symptoms include watery diarrhea, and people can become infected when they touch items contaminated with fecal matter and then touch their mouth or nose. C. difficile is the most common cause of infectious diarrhea in Canadian hospitals and long-term-care facilities.
Current cleaning audits for B.C. hospitals are based primarily on visual tests, along with swiping surfaces such as bed rails with baby wipes in search of blood or feces.
Westech is developing hand-held units that will allow people conducting UV marker tests to track where powder has been laid down and whether the dime-sized spots have been cleaned. Results will be tracked and, it's hoped, used to determine whether employing such tests can reduce infection rates.
B.C.'s Health Ministry says it would consider adding UV tests to its audit regime if the method is shown to improve infection control.
UV audits are cheap and easy to use, says Michael Gardam, director of infection prevention and control with Toronto's University Health Network. But the system isn't foolproof – UV markers, whether a gel or powder, can be sticky and resist scrubbing. So what looks like a "fail" might actually be germ-free, especially if wiped with a disinfecting solution.
"It's a useful tool – provided that people recognize the limitations," said Dr. Gardam, who wrote a February, 2012, review of C. difficile infection-control measures at two Fraser Health hospitals after doctors raised an alarm over infection rates. He also was involved in developing Safer Healthcare Now guidelines.
UV markers are most effective if staff have a role in introducing the system and tracking results, he said, adding that the system shouldn't be seen as a disciplinary tool.
In B.C. and other provinces, health-care unions contend that hospitals' outsourcing of cleaning duties to for-profit contractors has resulted in cost-cutting and employees who are not given enough time or training to keep infections at bay.
For Dr. Gardam, the quality of cleaning depends more on training and oversight than whether it's performed in-house or by a contractor. Problems emerge when staff don't know exactly what they are supposed to do, whether that's using a solution at the proper concentration or cleaning surfaces in a manner that lessens the chance of spreading germs, he adds.
"One of the things that I find when I do work with organizations is that typically, by the time I'm done, they're spending more money on housekeeping," he said.
Besides cleaning, infection control involves elements such as hospital design, with single rooms considered the best way to prevent disease from spreading.
As Fraser Health adds UV audits to its procedures, the region is also implementing 13 recommendations from Dr. Gardam's February report, which included hiring more infection-control specialists. Fraser Health plans to hire six new Infection Prevention and Control officers, bumping the total number of IPCs for the authority to 27. The authority has also added 10 IPC consultant positions and two new management positions focused on infection control.
Dr. Gardam's report found Fraser Health's infection-control program "does not meet any modern staffing recommendations."
In the fight against deadly infections, new weapons are emerging.
Several companies have come up with systems that use ultraviolet radiation to kill germs in hospitals. The concept isn't new – UV disinfecting systems are used in areas ranging from municipal water treatment to purifying air in homeless shelters.
But portable systems designed for use in hospitals are a relatively recent application, driven by the increased incidence of hospital-acquired infections and efforts by authorities to contain them.
In the United States, Lumalier Corp. has placed about 100 of its Tru-D devices in 50 institutions since putting them on the market in 2007, Lumalier president Chuck Dunn says.
The Tru-D system – which can be wheeled from room to room – costs about $125,000 and is equipped with sensors that adjust the "dose" according to the size and shape of the room.
Niagara Health system is using a different company's UV machine and other Ontario facilities are considering them, says Michael Gardam, director of infection prevention and control with the University Health Network in Toronto.
While emphasizing that there is no magic bullet, Dr. Gardam said mobile UV machines could play a role in infection control, envisioning a scenario in which hospitals use the system to clean rooms but also round up equipment such as intravenous poles and wheelchairs for a nightly, germ-killing zap.
"The multi-use pieces of equipment that go around hospitals are something that, universally, people have a hard time figuring out who cleaned it," he said.