Biofilms can develop in any facility, but in a healthcare location or a long-term care or senior living community, they can pose a serious health risk. They are complex colonies of microorganisms, typically different forms of bacteria that can cause and spread disease, including antibiotic-resistant diseases.

Essentially, biofilms are films or slime-housing micro-organisms. That’s about the best way to describe them. They act as a shield, not only covering, but also protecting, these micro-organisms from heat, cold, ultraviolet light, antibacterial drugs and many types of chemical disinfectants.

They are very hearty, and the fact that they cannot be eliminated using disinfectants — or for that matter, most traditional cleaning methods — makes them all the more difficult to eradicate.

In many facilities, biofilms can build up and thrive in damp areas around leaking faucets and sprayers, unused toilets, damp utility rooms, janitorial closets and, most specifically, in floor mop sinks.  

These floor sinks are found in most senior living and long-term care janitorial closets, as they are in many other types of facilities. They are used to fill and dump mop bucket cleaning solution.

The fact that biofilms build up in these mop sinks creates an entire host of problems.  What can and often does happen is they attach themselves to floor mops — or grow in the floor mops — where they can then be spread to other locations in the facility during the mopping process. (Biofilms, for instance, are a constant concern in commercial kitchens. They build up in damp areas such as around faucets and drains. They can then spread to food preparation areas and surfaces, where they can be tough to eradicate and are an ongoing cause of food spoilage.)

Because we now know that biofilms can cause serious illness, this means, inadvertently and unknowingly, that custodial workers may be spreading disease in your facility. This is the exact opposite of the goal of cleaning, which is to keep building users healthy.

Biofilm history

Biofilm has existed as long as bacteria have been on the planet, meaning from the beginning of time. Historically, there has been little knowledge of biofilms for a straightforward reason: they can be tough to see, and scientists were not always sure what to look for.

This makes our understanding of biofilm and their negative effects on health all relatively recent. It was not until the 1970s, for instance, that scientists first began to study biofilms and begin to believe that they could pose a health risk. More research in the 1980s and 1990s uncovered that they do pose a health risk, and not just to people, but to the entire indoor environment.

This is because recent studies have found that biofilm can develop on medical instruments if they are not properly cleaned or sterilized effectively. For patients or residents in a medical facility, senior living or long-term care facility, biofilms also have been found on catheters, prosthetic joints and medical devices used for day-to-day care.

Eradication, disruption and removal

The elimination of biofilm has three components:

1.   Eradication of the microorganisms;

2.   Disruption to remove the biofilm, which is also referred to as agitation; and

3.   The actual removal of the biofilm.

Typically, this is a multi-disciplinary approach involving a cleaning solution, a disinfectant and manual rinsing and scrubbing of surfaces to loosen and remove the biofilm.

All are necessary. The job has not been completed just because a disinfectant has killed microorganisms. If the film still is present, then it soon can become housing for a new colony of bacteria.

In most cases, a standard cleaning solution can be used to clean surfaces and areas where biofilm is located or suspected of being located. Then bleach often is used to abolish biofilm.  

Although it has served us well, bleach can be noxious and unsafe both for the user and the environment. Instead of bleach, many experts recommend the use of hypochlorous acid, or HOCI. This is an EPA-registered, hospital-grade disinfectant that has less effect on the user or the environment.1

As mentioned, surfaces must be scrubbed, first with the cleaning solution and then again with HOCI. The area should then be rinsed clean with pure water and allowed to air dry.2

This process, however, often is time-consuming and labor-intensive. A faster, and what is believed by some to be a more effective approach is to pressure-clean surfaces, using what ISSA, the worldwide cleaning association, calls spray-and-vac or no-touch cleaning systems.

In this case, the machine applies a cleaner / disinfectant to all surfaces to be cleaned. The combination cleaner / disinfectant used in the machine begins dissolving soils, and the disinfectant kills the bacteria.

To disrupt the biofilm, the machine is then used to rinse these same surfaces. The rinsing process sometimes is referred to as “blasting” because a high-pressure spray is used to blast clean the surfaces, but without damaging walls. When completed, all moisture, bacteria, as well as the biofilm, is vacuumed up, removing it from the area just cleaned.

Other cleaning options exist as well. For instance, in some cases, steam generators can be used. These systems rely on high-pressure nozzles to eradicate, disrupt and remove the biofilm. They can prove very useful, buy they can be dangerous. The steam must be 250 degrees F or higher, and the process tends to be slow.

Whatever process is used, training and education are crucial, because the entire cleaning process must be done effectively and safely. Administrators and cleaning workers must always remember that the microorganisms in a biofilm can pose a severe health threat, not only to other people but to themselves.

1The Environmental Protection Agency evaluates disinfectants as to their efficacy. If they meet or exceed their standards, then they can become EPA-registered. A hospital-grade disinfectant is the most potent type of disinfectant.

2 Rinsing is necessary for many reasons, but among them is the fact that without rinsing, chemical residue is left on the surface, attracting new soils.