Concepts in Cleanability for Equine Practices

Efforts toward cleaning efficacy can create a safer environment for your patients and employees.
Quasi-wet spaces such as barn aisles are the most difficult to design, because water is both a friend and an enemy. | Adobe Stock

When we examine the qualities of a safe and efficient equine veterinary space, the focus quickly narrows to cleanability. The more time your team spends cleaning, the less time they spend doing money-making or value-added work. In this article, we will explore concepts in cleaning, focusing on the interrelated goals of safety and efficiency.  

Declutter 

Decluttering is most important. Clutter leads to many problems in health care environments, including: 

  • Reduced cleanliness. Would you clean the wheels of a rolling cart? It’s likely you’ve never thought to do so. Yet, if the cart lives in a space where it is rolling around on floors used for procedures, it could become a fomite and carry infections from one area of your hospital to another. 
  • Decreased well-being. Clutter inhibits decision-making and can reduce the ability to concentrate. 
  • Decreased safety. This can come from trips and falls, blocking exit paths or important electrical gear (you likely have items stored in your electrical room), or from a horse crashing into an item left in a pathway.  

Here are some ideas to help you create a decluttered clinic: 

  • Purchase an inexpensive storage building. A prefabricated, bulk-storage building could help refresh your entire clinic. Store all extra bulk items in this building. While you are at it, dispose of everything you do not need. You can hire a professional to assist. He or she can also help you rehome useful items and alleviate the guilt and procrastination that often accompanies decluttering.  
  • Designate an enclosed space in your hospital for equipment storage. Equipment for ambulatory doctors is notorious for cluttering hallways and entryways. Find a safer place for this equipment, and keep it enclosed. An example could be a climate-controlled, locking, exterior-facing enclosure, near where trucks are stocked. 
  • Carve out storage closets in your treatment and exam spaces so you can store equipment out of the way of sprayed water, aerosolized bacteria, etc.  
  • Keep items off the floor. Upper cabinets are great because you can access them without bending over. Wall-mounted boxes are excellent for storing items such as personal protective equipment. Your practice could order mops and broom holders for every room at approximately $30 apiece. Hang cleaning tools off the floor where they can dry completely. Every item stored helps create a safer, cleaner hospital. 

Design to Support Cleaning Protocols 

A space cleaned with a hose has different architectural solutions than one cleaned with a mop. Outlined below are the different types of spaces within the hospital and their design criteria.  

Dry spaces such as lobby, offices, and laboratory

We design these spaces understanding that they still need to be sanitary. Therefore, we never use carpet for flooring. A great solution for floors is luxury vinyl tile (LVT), which often comes in a wood-like plank style. You will see this product used in many human medical client spaces, including outpatient center lobbies. Assuming a good floor product, we use these tools to make cleaning dry spaces easier: 

  • Use a small, easy-to-use floor cleaning machine, such as the Mini Autoscrubber from Health Technologies (htproducts.net)
  • Most people do not provide training for cleaning processes. We recommend inviting a representative of a janitorial product manufacturer to demonstrate the possible cleaning techniques and resources available. Rubbermaid, for example, provides free guides and resources at rubbermaidcommercial.com/resource-center. Pay special attention to human health care applications, as they also apply to veterinary spaces. 
  • Always use cleaning products in the right dilution levels, compatible with the surfaces. Do not overdisinfect, as this can degrade the surfaces and increase biofilm growth due to the increase in surface area.   

Quasi-wet spaces, such as barn aisles 

  • These are the most difficult to design, because water is both a friend and an enemy. Low ventilation (as is often found in barns) combined with high humidity increases biofilm growth. The worst thing to do is hose materials not intended to be hosed, such as wood stall partitions or floors with loose rubber mats. Do not trap water in areas where it cannot dry. At best, trapped water decreases a space’s sanitation, and at worst it can harbor dangerous bacteria such as Salmonella. 
  • We talk with our clients about minimizing water use in quasi-wet areas such as healthy barns. Focus water usage where it is truly needed, such as within wash stalls. For wash stalls, use sealed, hose-cleanable walls and sealed mats on floors, and create sanitary joints around drains and between the walls and the floor. Other areas of the barn should not be cleaned with a hose regularly, unless they have been designed to ensure water is not trapped. Barns are healthiest when they are dry. 

Surgery rooms 

  • These are the most important spaces on which to focus. Unfortunately, the use of biocides in health care spaces can lead to the evolution of drug-resistant microorganisms in the hospital. Surgery rooms are the most likely areas to harbor multi-drug-resistant bacteria. In human health care, surgery rooms are completely dry. The primary reason is that moisture causes problems—drains, for example, are potential sources of pathogens in health care environments. 
  • Unfortunately, due to the volume of a horse’s body, it is not practical to keep an equine surgery room dry. You must be able to hose it thoroughly. As a result, we pay most attention to this space, and we follow these guidelines: 
  • Use a floor material that holds up to cleaning protocols. We often use a cementitious urethane flooring, which is more resistant to chemicals and less prone to failure than epoxy. If this is a standing surgery room and horses are awake on the floor, you will need to use an equine, slip-resistant product instead. Use the most sealed, most durable solution available. 
  • Pay attention to joints. We love a coved product that runs up the wall several inches and tucks into the first joint of the masonry wall, or under the seamless wall material. 
  • Place a seamless, waterproof material on the wall. Our favorite material is concrete block, with three coats of block filler and two to three finish coats of a hard, glossy, industrial coating for an impervious surface. 
  • Keep everything off the floor. Roll equipment out of the way, and store it in a dry closet. Hose reels keep hoses off the floor when not in use. 

ICU and isolation stalls  

  • Handle ICU and isolation stalls just like surgery spaces in terms of seriousness. They should be physically separated from each other. ICU patients are the most vulnerable, and isolation patients are the most infectious.  
  • You might need to take special precautions with ventilation systems to prevent harboring bacteria. We often directly exhaust isolation stalls to eliminate ductwork. 

Medical barns 

  • Medical barns are in between healthy barns and ICU/isolation stalls in terms of approach. Worrying about water is still relevant. Our rule of thumb is if water is used for cleaning, the space must be designed for water. This might seem obvious, but it is not. Problems have occurred, particularly in academic settings, when risky populations of horses are housed in facilities that never dry properly. 

Design for the Cutting Edge of Cleaning 

Human health care is a great place to study the evolution of cleaning techniques. We love new ideas. Many of them have promise for improving your practice, and it is worth considering if any of the following apply right now: 

  • Touchless technologies. From sinks to automatic doors, touchless technologies are improving. Touchless sinks could be the best fit for your equine practice. They can greatly improve hand hygiene.  
  • Moving to different oxidizers. Right now, hydrogen peroxide is considered the best disinfectant for both animal and human medical spaces. Nevertheless, the industry continues to move forward to try to balance the efficacy of a disinfectant with protection of surfaces. Safety is also a concern. Safer and gentler yet effective disinfectants are in development. Citric acid disinfection is one example. Keep an eye out for the latest disinfectant products for your practice, particularly if you are building or remodeling.  
  • UV-C disinfection. Unlike chemical control, UV disinfection and sterilization does not run the risk of encouraging resistant microbial growth. UV simply destroys DNA and works very effectively for disinfection of human hospitals. The best possible applications to equine veterinary hospitals are: 
  • Spot disinfection. Using a portable light to spot disinfect an area of special concern, such as stocks.  
  • Surgery room disinfection. Because the equine surgery room must be hose-cleaned, you’ll want to have additional tools for disinfection. An example could be UV-C overhead lighting to be turned on after the room has been cleaned and dried. These lights are now used in human surgery rooms. 

Summary 

Many equine practices have not had training or a design focus on cleaning as an activity, and yet cleaning takes up a lot of time and might not even be effective in maintaining a sanitary environment. If you cannot find time to get into the details, then focus on the simplest strategies for improving your hospital cleaning effectiveness. These include keeping decluttered and tidy spaces, followed by aligning cleaning protocols with interior materials and finishes. Efforts toward cleaning efficacy will create a safer environment for your patients and employees.  

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