We Don’t Throw Out Babies with Bathwater, Why Would We Throw Out Cleaning & Disinfection with Hygiene Theatre?

With about 125 million infections, nearly 2.8 million deaths, and an economic cost of $28 trillion to date, the SARS-CoV-2 virus has caused an enormous amount of fear worldwide.

Recently, the term “Hygiene Theatre” has entered the lexicon. It describes an elaborate show involving technicians in full PPE “spacesuits” broadcast spraying disinfectants to do battle with COVID-19. Effective theatre, it has calmed fears and generated specialty income for some contractors during the COVID-19 pandemic. But at what expense has it done so?

In an extraordinary twelve months, the world has gone from knowing nothing about this stray piece of replicating protein, to having a vast array of scientific information, published papers, and multiple vaccines. The speed of change has been remarkable. Yet it is the visual show of exaggerated cleaning and hygiene that, for many, calms fears of infection and death.

A growing chorus is calling this hygiene theatre a farce. The spread, they say, is overwhelmingly through air, not surfaces. The time and money spent cleaning and disinfecting surfaces would be better spent elsewhere. Why not, they ask, just acknowledge the airborne spread and focus on social distancing, mask wearing, hand hygiene and improved ventilation?

Before continuing, let us agree that this chorus of cleaning naysayers has a point. Those of us long involved in the cleaning industry have been horrified at some of the theatrics we have observed. Visually heroic “first responders” dressed in spacesuits with hand-held fogging machines pouring out disinfectants for surface decontamination may look impressive, but at best this visual is scientifically unproven and at worst it can be dangerous, because the chemicals being disbursed are, for the most part, poisons.

But let’s not throw out the baby with the bathwater. If we look at the facts, all the facts, we will see that effective cleaning and disinfection always plays an essential role in promoting public health, including during these times of pandemic.

First, let’s consider the science on this virus and the epidemiology of this COVID-19 pandemic. It is an RNA virus. It is a midsized and enveloped virus, evolutionarily enabled to survive for longish periods of time. Importantly, it is relatively easy to kill using an array of cleaning and disinfecting materials.

The virus is primarily spread through aerosolized droplets exhaled by people who are infected. Some infected people produce huge numbers of viruses, while others have lower levels of infectious output. Once these droplets are aerosolized, lots of things happen. First, the big droplets fall out of the air onto surfaces. Second, many droplets lose moisture and become lighter; they can stay suspended for quite a while. The SARS-CoV-2 virus doesn’t seem to mind a little dehydration because the droplets usually contain all sorts of other stuff from our mouth and nose which work to keep the virus protected and viable.

If you want to infect a lot of people in one “super-spreader” event, place a couple infectious people with others in a poorly ventilated room without masks or social distancing, then have a party. While certain mitigations may limit the spread, this scenario offers the virus maximum opportunity to do what it does: move from infected people into non-infected people. After the party is over, most of the surfaces will be contaminated with SARS-CoV-2, but the risk of virus acquisition from those surfaces is a “one-person-at-a-time” risk, rather than a super-spreader.

What place, then, has surface cleaning and disinfection? An important one. Three points:

First, as we have seen, the surfaces around an infected person will become contaminated with the virus, so effective cleaning is a first line of defense against one-at-a-time spread. Research shows that some pathogens, once you have touched them on a surface, will stay on your fingers for up to 19 subsequent touches. Your contaminated fingers or hand then act as the vehicle of transmission. So touching a contaminated surface poses a risk. Two actions are used to mitigate this risk: hand hygiene and cleaning of surfaces.

Effective cleaning is defined as “removing all of the unwanted material” (Dr. Michael Berry [retired] U.S. EPA). For disinfectants to work, cleaning is always the first step. Moreover, cleaning alone beats disinfectants or bleach in almost every scenario. The evidence supporting effective cleaning for surface hygiene is indisputable. In the context of this pandemic, what is really important is demonstrating that the cleaning has been effective. Unfortunately, the cleaning industry has largely ignored this type of quality assurance, despite multiple studies and the inexpensive and ready availability of simple, real-time testing (such as the use of ATP testing).

Second, SARS-CoV-2 is now a human virus. It will continue to evolve and mutate, including its modes of transmission, and it will continue to circulate within the global community. Although the pandemic will subside, in one form or another the virus is here to stay. Consequently, fundamental and proven mitigation strategies such as cleaning and hand hygiene will remain important for safe human activity.

Third and most important, this will not be our last pandemic, nor is COVID-19 our only disease of concern. While the pandemic has all of our attention, the “superbugs” have continued to wreak havoc and death, especially among hospitalized and vulnerable patients. In a report from the U.S. Centers for Disease Control and Prevention (CDC) in November 2019 (that long-ago time before the pandemic), it was clearly described how these superbugs will continue to enact a terrible toll. The best first line of defense for these ongoing risks? Hand hygiene, surface hygiene and barrier protection including masks and gloves. The rule of thumb in healthcare: Whatever is touched is potentially contaminated, so whatever gets touched must be cleaned and disinfected.

Effective cleaning of surfaces, including our hands, must be here to stay. Likewise, wider acceptance of quality assurance measures is more important than the Hygiene Theatre show. The science of effective cleaning is clear: maximum extraction, minimum residue. Do this and the result will be improved health.

For companies charged with delivering effective cleaning, that’s better than good theatre; that’s good business.

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John Downey, a veteran of more than 45 years in the cleaning industry, is the executive director of the Cleaning Industry Research Institute (CIRI).

Greg Whiteley, PhD is a specialist in cleaning science, hygiene, disinfection and mitigation of hospital acquired infections (HAI). He serves as a member of CIRI’s Science Advisory Council.