Environment Cleaning

Environmental cleaning & Disinfection

  • The health care environment contains a diverse population of microorganisms and can be a reservoir for potential pathogens.
  • If environmental cleaning is not performed correctly, then environmental contamination can contribute to the spread of multidrug- resistant organisms and health care-associated infections.
  • Collaboration between Infection Prevention and Control (IPC) and Environmental Services (EVS) staff limits the role of the health care environment in disease transmission.

1. Infection Prevention and Control (IPC) & Environmental Services (EVS)

Infection prevention and control (IPC) works with environmental services (EVS) to Limit the role of the health care environment in disease transmission. Collaboration between EVS and IPC is essential to make sure cleaning standards are met.

Examples of EVS procedures include

Routine cleaning of patient rooms

Terminal cleaning of patient rooms

Cleaning of common areas (waiting rooms and lobbies)

Cleaning of areas such as operating theatres

Standard precautions for cleaners

EVS staff should be included in IPC trainings

The IPC focal point or committee should also review and approve

EVS products, such as disinfectants

2. The Health Care Environment & Environmental Cleaning

The health care environment & environmental cleaning involves two of the following

A. Environmental surfaces

are patient beds, bathrooms, bed rails, tabletops, and floors

patient beds

Bathrooms

Floors

Tabletops

B. Medical equipments

involved in patient care are monitors, IV pumps, and blood pressure equipment.

IV Pumps

Monitors

Blood Pressure Equipment

3. Frequently Touched vs Frequently Contaminated Surfaces

A. Frequently Touched

Patients and health care personnel touch some surfaces more than others, providing a greater risk of transmission. These are called “high-touch,” or frequently touched, surfaces. Frequently touched surfaces include door handles, light switches, bed rails, ends of beds, patient charts, monitor buttons, IV pumps and poles, and faucet handles.

*Red dots indicate the areas often touched by health care workers (HCW) or patient hands.

B. Frequently Contaminated Surfaces

Patients and health care personnel touch some surfaces more than others, providing a greater risk of transmission. These are called “high- touch,” or frequently touched, surfaces. Frequently touched surfaces include door handles, light switches, bed rails, ends of beds, patient charts, monitor buttons, IV pumps and poles, and faucet handles.

4. Chain of Infection & Environmental Cleaning

For any infection to spread, all the links in the chain of infection must be intact. The key to stop the spread of infection is to break at least one link in the chain. Within the chain of infection, the health care environment can act as a reservoir for pathogens.

Environmental cleaning reduces the number of microorganisms on environmental surfaces and medical equipment surfaces. Mitigating the role of the environment in the transmission of infectious agents requires collaboration between environmental services and IPC.

5. General Functions of Environmental Services

  • • Cleaning is the physical removal of foreign material, including dust, soil, and organic material such as blood, secretions, excretions, and microorganisms.
  • • Cleaning physically removes rather than kills microorganisms with water, detergents, and mechanical action.
  • • Cleaning is always essential prior to disinfection or sterilization.
  • • A surface that has not been cleaned effectively cannot be properly disinfected or sterilized.
  • • Disinfection is the inactivation or killing of most microorganisms on surfaces and items. It usually involves chemicals, heat, or ultraviolet light.

A. Routine Cleaning

Assess

  • • Follow instructions on transmissi- on-based precautions signage.
  • • Visually inspect area to determine what needs to be replaced, such as supplies and worn-out or broken items.

Assemble supplies

  • • Make sure clean clothes are available.
  • • Dilute cleaning (detergent) and disinfection solutions correctly.
  • • Restock missing or low-stock supplies.

Hand Hygiene

  • • Perform hand hygiene and put on gloves

Assemble supplies

  • • Clean room or bed spaces, working from clean to dirtier areas and from high to low.
  • • Check ceilings and walls and all areas for any visible soiling, and clean if required. If privacy curtain, check for visible soiling and replace if required.
  • • Clean all furnishings in the area including chairs, tables, and desks. Concentrate on frequently touched surfaces.
  • • Clean any light switches.
  • • Clean medical equipment in area (IV pole and pump, monitors).
  • • Clean bed rails and any bed controls.
  • • Clean commode or other private bathroom space.
  • • Mop floor with detergent only; use of disinfectants is not recommended.

Disposal

  • • Put used cloths in container to be laundered.
  • • Segregate and place waste in appropriate containers (general waste, infectious waste).

Hand Hygiene

  • • Perform hand hygiene and put on gloves

B. Terminal Cleaning

If a patient room or bed becomes vacant, terminal cleaning is indicated. This is also called discharge cleaning. Terminal cleaning is meant to remove microorganisms that could contaminate the next patient occupying that space.

Assess

  • • Follow instructions on transmissi- on-based precautions signage.
  • • Visually inspect area to determine what needs to be replaced, such as supplies and worn-out or broken items.

Assemble supplies

  • • Make sure clean clothes are available.
  • • Dilute cleaning (detergent) and disinfection solutions correctly.
  • • Restock missing or low-stock supplies.

Hand Hygiene

  • • Perform hand hygiene and put on gloves

Assemble supplies

  • • Clean room or bed spaces, working from clean to dirtier areas and from high to low.
  • • Check ceilings and walls and all areas for any visible soiling, and clean if required. If privacy curtain, check for visible soiling and replace if required.
  • • Clean all furnishings in the area including chairs, tables, and desks. Concentrate on frequently touched surfaces.
  • • Clean any light switches.
  • • Clean medical equipment in area (IV pole and pump, monitors).
  • • Clean bed rails and any bed controls.
  • • Clean commode or other private bathroom space.
  • • Mop floor with detergent only; use of disinfectants is not recommended.

Patient Bathroom

  • • Clean commode or other private bathroom space

Floors

  • • Mop floor (with detergent only; disinfectants are not recommended).

Disposal

  • • Put used cloths in container to be laundered.
  • • Segregate and place waste in appropriate containers (general waste, infectious waste).

Hand Hygiene

  • • Perform hand hygiene and put on gloves

6. Blood and Body Fluids Spills Management

Areas contaminated with these spills need to be cleaned and disinfected to prevent patient or health care personnel contact with infectious materials.

A. Small spills (splashes and drips) Management

Preparation: wear non-sterile gloves.

Wipe area immediately with paper towel or absorbent cloth (discard towels as infectious waste).

Disinfect area with 10,000 ppm of hypochlorite (bleach) solution.

Dry surface with disposable paper towels.

Discard gloves and paper towels as infectious waste.

Perform hand hygiene, preferably with soap and water given exposure to body fluid risk.

B. Large spills Management

Preparation: wear non-sterile gloves utility gloves may be preferred. If contamination of the front of the body is likely, wear a single-use plastic apron.

If spill occurs in traffic path, block off area so others do not step through it.

  • • Cover area of spill with disposable towels or cloth soaked in 10,000 ppm of hypochlorite solution and leave it for 3-5 minutes.
  • • Don’t pour the solution directly onto the spill it may cause splashing and widen the area of contamination.
  • • Pick up soiled paper towels/cloths and discard into infectious waste bag.
  • • Clean the area with detergent solution.
  • • Wipe the surface area with fresh 1,000 ppm of hypochlorite solution to disinfect.
  • • Rinse with water, as hypochlorite solution can be corrosive
  • • Dry surface with disposable paper towels.
  • • Remove gloves and plastic apron and discard as infectious waste (in accordance with local policy).
  • • Perform hand hygiene, preferably with soap and water given the body fluid exposure risk.

7. Cleaning and Disinfection of Operating Theatre

Proper cleaning and disinfection of an operating theatre contributes to safe surgery. Operating theatre (OT) staff, environmental services, and infection prevention and control must collaborate to ensure a clean surgical environment. This team makes sure that there are facility protocols in place for cleaning the operating theatre.

An operating theatre is cleaned at three distinct times

Before the first case of the Day

Before surgical supplies are brought into the operating theatre for the first surgery of the day, a few duties are recommended. Any overhead lights, the operating table, and any other flat surfaces are damp dusted. Any countertops should also be damp dusted.Surgical equipment trays for the first case should not be opened until after this clean is completed.

Between cases

After a surgical procedure, surgical equipment, the floor immediately surrounding the surgical bed, and any furniture is considered contaminated. Clean and disinfect them along with any other objects identified by the facility. Remove soiled linen, trash, and infectious waste.

After the last case of the Day-

Perform a terminal cleaning of the operating theatre. This is a detailed process that follows specific facility protocols. A terminal clean of an operating theatre includes removing infectious waste and soiled linen, cleaning from top to bottom of all surfaces including overhead lights, cleaning the operating table including the mattress, and mopping the floor.

8. Contamination During Cleaning

9. Protecting EVS Staff

Environmental services staff should adhere to standard precautions when cleaning and follow any transmission-based precautions in place. This includes:

  • • Hand Hygiene
  • • Use of personal protective equipment (PPE) when indicated

A. Hand Hygiene

Hand hygiene is important during environmental cleaning activities.

B. Personal protective equipment (PPE)

Gloves

Wear gloves when handling hazardous materials such as cleaning solutions, disinfectants, or cleaning surfaces that are visibly soiled with blood or body fluids (such as large spills of blood).

Gowns

Wear a gown (or apron) if contamination of clothing or skin is anticipated (such as cleaning bed of incontinent patient).

Face mask

Wear a face mask and goggle (or face shield) when there is a risk of splashes or sprays of chemicals or blood or other body fluids

10. Chemicals Used by EVS Staff

A. Cleaning Solutions

(Detergents)

Cleaning solutions contain detergents that remove dirt and debris organic material) from surfaces. Detergents do not kill pathogens, but rather assist in removing them from surfaces. It is important to protect cleaning solutions from contamination as they can easily become contaminated during the cleaning process. Ideally, cleaning solutions used in a facility are hospital-approved detergents.

B. Disinfectants

Disinfectants inactivate or kill microorganisms on surfaces that have been cleaned. They are not intended for use as antiseptics. Like cleaning solutions, disinfectant solutions in buckets can easily become contaminated, which can transfer more microorganisms to surfaces. Replace these solutions frequently.

Commonly used disinfectants include

  • • Alcohols (60-90% ethyl or isopropyl) for small surfaces
  • • Hypochlorites: If using hypochlorite, prepare a fresh solution every day using a standardized dilution and keep prepared solutions in a labelled container with a lid (to protect from sunlight and debris). Discard the hypochlorite solution at the end of the day even if it has not been used.

11. ENVIRONMENTAL MONITORING

It's important to monitor and assess environmental cleaning to make sure that it meets best practices and is performed consistently and correctly.

A. Observation

Direct observation is watching an individual’s cleaning routine and giving feedback. Sometimes this method results in an individual changing their behavior because they know they are being observed.

Indirect observation is watching an individual’s cleaning routine and giving feedback. Sometimes this method results in an individual changing their behavior because they know they are being observed.

B. Environmental marking

This is the application of a colourless solution to surfaces. After the surface is cleaned, ultraviolet light detects any remaining solution. Here is an example of a sink handle in a patient room. This image below shows the solution on the unclean handle.

This image below is the same handle after cleaning. You can see that cleaning was inadequate because there are still fluorescent markings on the handle.

c. Swab test

Swabs for environmental culture and Adenosine Triphosphate (ATP) testing to assess the residual Bio-burden are available