Enhanced Environmental Hygiene for K–12 Schools
- By Dr. Gene Cole
- May 23, 2022
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.
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 Schools. Information can be found at: https://www.issa.com/wp-content/uploads/cleanstandard_how-to-use_inhouseservice.pdf
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 May / June 2022 issue of Campus Security & Life Safety.