There is an epidemic of healthcare acquired infections within hospitals, out-patient surgical centers, nursing homes and medical clinics. The number of hospital acquired infections alone is staggering. About 1 in every 15 patients get an infection while hospitalized and up to 98,000 Americans die from these infections each year. That makes infections the most common complication in hospital care and one of the nation’s top 10 causes of death. In California, an estimated 200,000 patients develop hospital infections each year, resulting in 12,000 deaths.

The problem is much larger than official statisitcs because the numbers fail to account for millions of patients treated in outpatient surgery centers, community clinics, nursing homes and other care facilities.

About six and one half percent of patients admitted to US hospitals—nearly 5,500 daily, or two million annually—get sick from a hospital-acquired infection. This adds 19 days of hospitalization and $43,000 in costs totaling more than $45 billion a year to U.S. medical bills

Under the new Affordable Healthcare Law consumers will be able to learn hospital infection rates. Hospital Infection rate information will be posted on a Department Health and Human Services website called Hospital Compare. This new reporting requirements applies to hospitals that participate in Medicare and Medicaid programs which are virtually every hospital in the country. Beginning in October 2012, Medicare payments to hospitals will be tied to how well they protect patients from these infections. Hospitals with infection rates exceeding national averages will lose 1 percent of their Medicare funding, starting in 2015. This is a huge dollar amount considering the federal government spent $563 billion last year on 49 million recipients and Medicare spending is expected to grow to $970 billion by 2021.

II        MARKET

Hospital Cleaning is the removal of all dust, oil, and organic materials such as blood, secretions, excretions and microorganisms. Cleaning reduces or eliminates the populations of potential pathogenic organisms. It is accomplished with water, detergents and mechanical action. Hospital Disinfection is the inactivation of disease producing organisms. Disinfection does not destroy high levels of bacterial spores. Disinfectants are used on inanimate objects. Disinfection usually involves chemicals, heat or ultraviolet light. Levels of chemical disinfection vary with the type of product used.

 There are three types of cleaning and disinfection markets within hospitals and healthcare facilities. These are critical, semi-critical and non-critical.

A.        Critical Applications

Medical devices and items that represent a high risk for infection if they are contaminated with any microorganism. Objects that enter sterile tissue or the vascular system must be sterile because any microbial contamination could transmit disease. Critical cleaning and disinfection includes surgical instruments, cardiac and urinary catheters, implants, and ultrasound probes used in sterile body cavities. These items are to be sterilized with steam if possible. Heat-sensitive objects can be treated with EtO, hydrogen peroxide gas plasma; or if other methods are unsuitable, by liquid chemical sterilants.

B.         Semi-Critical Application

Devices to include vaginal-rectal ultrasound probes, endoscopes, laryngoscope blades, cystoscopes, esophageal manometry probes, anorectal manometry catheters, respiratory/anesthesia equipment, all GI scopes, transesophageal echocardiogram probes and rhinoscopes. Medical devices and equipment that contact mucous membranes or non-intact skin minimally require high-level disinfection.

C.        Non-Critical Applications

Devices are those that come in contact with intact skin but not mucous membranes.  Intact skin acts as an effective barrier to most microorganisms; therefore, the sterility of items coming in contact with intact skin is “not critical.”  Non-critical items are divided into non-critical patient care items and non-critical environmental surfaces.  Non-critical patient-care items are bedpans, blood pressure cuffs, crutches and computers.


 A segment within the non-critical environmental surfaces market is Terminal Room Cleaning. Terminal Room Cleaning means a thorough cleaning of a patient room after being discharged. The concept is to eliminate the residual bacteria left in a “contaminated room” whether it is a hospital room, OR room, ER room, nursing home room or any room in which another patient can potentially come into contact. The potential market of Terminal Room Cleaning is huge. For example, there are 35,000,000 patient “discharges” per year in more than 7000 hospitals and 15,000 outpatient surgery centers.

Transmission of many healthcare acquired infections are related to contamination of patient surfaces, in-room equipment, high touch surfaces with patient rooms.

Patients shed microorganisms into their environment by coughing, sneezing or having diarrhea. Bacteria and viruses can survive for weeks or months on dry surfaces in a patient environment. When another patient, doctor, nurse or visitor, touches that surface the microorganisms are transmitted throughout the hospital. The following are example of “at-risk” patient environments.

  1. Acute Care, the patient environment is the area inside the curtain, including all items and equipment used in his/her care, as well as the bathroom that the patient uses.
  2. Intensive Care Units (ICUs), the patient environment is the room or bed space and items and equipment inside the room or bed space.
  3. Nursery/Neonatal setting, the patient environment is the bassinet and equipment outside the bassinet that is used for the infant.
  4. Ambulatory Care, the patient environment is the immediate vicinity of the examination or treatment table or chair and waiting areas.
  5. Long-term care, the resident environment includes their individual environment (e.g., bed space, bathroom) and personal mobility devices (e.g., wheelchair, walker).

Terminal Room cleaning is performed by the Environmental Services Staff. The cleaning includes emptying trash and removing any loose items, changing bed linen, wiping the mattress with a disinfectant, washing walls with detergent, cleaning bathroom sink and toilet with a disinfectant, wiping all bed rails, tables, light switches, door handles, telephone, call buttons, privacy curtain and other “high touch” items with a disinfectant then mop the floor with a detergent cleaner and disinfectant. Once the Environmental Staff completes the terminal room cleaning, the Environmental Service Supervisor inspects the room. The Supervisor will look for any visible dirt, blood, secretions, etc. They will also use a bio-luminescence meter to measure bacterial contamination. If the Environmental Service Supervisor rejects a room, the entire room is re-clean and disinfected.


In the US the average time from patient discharge to another patient occupying the same room is 27 minutes. The work required (as noted above) by the Environmental Service Staff to terminally clean the discharged patient room in the 27-minute timeframe is almost impossible. This creates extreme pressure and stress on the Environmental Service Staff resulting in poor cleaning and very high job turnover. Other factors contributing to poor cleaning and high turnover is the use of toxic and corrosive detergents and disinfectants. To improve cleaning performance, stronger and more toxic chemicals are required. However, these chemicals slow down cleaning time. The Staff must be more careful in handling these chemicals, adding a rinse step and allow time for the room to dry and “air out”.

Using stronger and more toxic cleaning and disinfecting chemicals does not always provide the level of disinfecting required by hospital guidelines. The over prescribed use of antibiotics have created “super-bugs”. These “super-bugs” can develop a resistance to disinfectants. There are sixteen hospital identified “super-bugs”. A few of these are MRSA (methicillan resistant staphylococcus aureaus), C. diff (clostridium difficle), VRE (vancomycin resistant enterococci) and acinetobactor baumannii.

To reduce the human factor in terminal room cleaning and eliminate the chemical resistance of “super-bugs” new technologies have been developed and are currently marketed. One new technology is called VHP (vaporize hydrogen peroxide). VHP meets and exceeds hospital guidelines for environmental surface disinfection.  The guideline for hospital cleaning was developed by HICPAC (Hospital Infection Control Procedures Advisory Committee). This committee is Infection Control doctors and researchers within the medical community specializing in Non-Critical Environmental surface disinfection. The level of surface disinfection for terminal room cleaning is called 6-log reduction. 6-log cleanliness is basically a sterile surface. VHP provides 6-log surface cleanliness but requires 4 hours to clean, disinfect and “air out” the room. In addition the Vaporized Hydrogen Peroxide equipment cost more than $200,000 and requires a company representative located full-time at the hospital to operate the equipment.

Another new technology for terminal room cleaning is UV-C light. UV light has been used for surface disinfection for many years. Used properly UV-C can provide a 6-log level of disinfection. However, UV-C is difficult to use because the light must be directed at an exact angle to the surface, the light requires a long contact time and the light must be checked regularly to insure the proper wavelength. A properly cleaned and disinfected room using UV-C equipment takes more than 90 minutes.

These technologies and others meet the HICPAC cleaning guidelines for terminal room cleaning but they do not come close to the time requirements for most hospitals. Electrolyzed Water is the only new technology that can provide 6-log disinfection within the 27-minute time requirement. In addition electrolyzed water is non-toxic, requires no chemical storage, mixing, dries faster and does not require Staff to wear protective clothing. Electrolyzed water can eliminate the pressure and stress of the Environmental Service Staff reducing turnover. It has no odor or chemical residue that can cause patient sensitivities.

After years of working in hospitals with Environmental Service and Infection Control Professionals, the most important cleaning solution proved to be electrolyzed alkaline water. Alkaline water’s cleaning performance is due to its alkalinity and very negative ORP (oxidation-reduction potential). The more negative the solution the greater cleaning power and faster drying properties. Electrolyzed Alkaline Water’s negative ORP has a very short shelf life. It is usually less than 1 hour in an open container exposed to air.  The key for electrolyzed water technology’s acceptance in hospitals is making the Environmental Service Staff job easier, safer and less pressure. As a result, electrolyzed water must be a direct replacement to detergents and work in their cleaning process. For example, the Environmental Service Staff at the start of their shift fill an open container with a detergent solution and add 8 to 10 micro-fiber mop heads. One mop head per room is used to mop walls and floors. As the staff changes mop heads and agitates the solution, the ORP of ordinary electrolyzed alkaline water is quickly lost. However, a patent-pending product enhancement (enhanced alkaline water) preserves the negative ORP and actually continues the electrolysis process maintaining the alkaline water above pH11. The product will keep the alkaline water’s pH and ORP for at least 1 day. Enhanced alkaline water can be used into the mop head containers, spray bottles or other applicators. The product will maintain negative ORP with the addition of dyes, surfactants or other cleaning aids.

Once surfaces are cleaned with alkaline water, the surface has a negative charge. At this point, the electrolyzed acidic water disinfectant can be applied with an electrostatic spray device. This device will put a 5 to 10 mil coating on every surface within the room. Electrostatic sprayers can reach every side of a surface even if the sprayer is not pointed directly at the surface. Electrostatic spraying of a patient room takes less than 3 minutes. This technique enables the Environmental Surface Staff to take more time cleaning with the alkaline water and still finish under the 27-minute time requirement.

Electrolyzed Water technology and application equipment can reduce a hospital’s overall chemical costs, cut Environmental Service labor requirements and reduce the hospital liability insurance premiums. This is proven technology that has been used in Japanese hospitals for more than 20 years. In Japan electrolyzed water technology has reduce healthcare acquired infections to less than 2%.

For more information, please contact info@aquaox.net

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