In an effort to promote good sanitation in my health center, I have been communicating messages on proper cleaning technique to my health center staff. For months now I have been promoting the use of a 10% bleach solution as a basic cleaning agent. This is a solution recommended by the US Center for Disease Control (CDC) and adopted by most health facilities in the US. Currently when cleaning occurs however, I only see moping of the floors, and it is done intermittently with only water, or water and laundry soap. I see no wiping down of surfaces before or between patients, and often see the floor, beds, and other surfaces covered with a multitude of bodily fluids.

I have had many conversations with Dr. Sera the Health Center Director about the need for more frequent cleaning and the need for using bleach. He recognizes this as a need, and expresses support for the idea, yet little has come of it. The idea of more frequent and thorough cleaning has been slow to catch on. I often hear from him (this is a paraphrase), “yes, I tell the cleaners, but they do not make much money, so what can I do?” This is a common truth in Cambodia, and it is a barrier to change. The two cleaners here, who are responsible for  cleaning 6 buildings and maintaining the grounds make about eighty dollars a month.

A few weeks ago, I was helping a mother in the exam room and her baby urinated all over the bed. Children here rarely wear diapers. There was nothing to clean it up with, and no one even seemed to notice. The next patient just came in and sat on the wet bed. The next day I brought in a rag and spray bottle I filled with the 10% bleach solution I had been talking about. I started using it between each patient to wipe down the bed.

That afternoon the Consultation Nurse Saran (above) I often work with, who is also the Assistant Health Center Director, asked me if I could get more bottles so he could have one in every room. Of course I said. My take away from this experience is that people respond slowly to spoken ideas here, but when they see or can experience an idea, it is easier to absorb. I am actually very much the same way.

The next week after some slightly more aggressive prompting, I finally got the health center to buy some spray bottles and bleach. I held a small staff training workshop focusing efforts on how to mix and clean with the bleach solution. I focused the effort on the cleaning staff who have no medical training and little knowledge of disease and infection. Some of the key medical staff attended as well. We talked about why they need to use this solution, either from the spray bottle, or mixed in a bucket for mopping, whenever there is blood, urine, feces, or any other bodily fluid present. We talked a bit about infectious disease, its transmission, and the role proper cleaning with bleach plays in keeping the staff and patients healthy. I also stressed the importance of using Universal Precautions, such as gloves, masks, wearing their uniforms, and washing hands.

I still don’t see bleach is being used as often as it should, but it is getting used. It will clearly take time to create this new habit. I guess that is one good reason I will be here for another 13 months.