Best Practices for Environmental Cleaning

Module 4 – General Cleaning

Part A - Cleaning Principles

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Learning Objectives

1.1. To identify factors that determine frequency of To identify factors that determine frequency of cleaning.cleaning.

2. To correctly sequence tasks for cleaning.

3. To demonstrate proper procedures for different cleaning applications.

4. To describe other considerations in environmental management (e.g. waste handling, sharps safety, biological spill cleaning)

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General Cleaning

These principles apply to all settings where “hospital clean” is required.

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Hotel Clean & Hospital Clean

Hotel Clean:

• is a measure of cleanliness based on visual appearance that includes dust and dirt removal, waste disposal and cleaning of windows and surfaces.

Hospital Clean is a hotel clean PLUS:

• High touch surfaces in patient/resident/client care areas are cleaned and disinfected with hospital grade disinfectant

• Non-critical medical equipment is cleaned and disinfected between patients/residents/clients AND

• Cleaning practices are periodically monitored and audited with feedback and education

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Cleaning Frequencies – Factors Influencing Frequency

• Surfaces high-touch or low-touch

Door knob vs window sill

• Type of activity taking place in the area and risks associated with the activity

Critical care vs office setting

• Vulnerability of patients/residents housed in the area

Intensive care vs patient/resident room

• Probability of contamination based on the amount of body fluid contamination in the area

Washroom vs lounge

• Presence of antibiotic resistant organisms (AROs)

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Cleaning Frequencies – Factors Influencing Frequency

High-Touch Surfaces:

• Are those that have frequent contact with hands. Examples: doorknobs, elevator buttons, telephones, call bells, bedrails, light switches, computer keyboards, etc.

• High-touch surfaces in care areas require more frequent cleaning and disinfection than minimal contact surfaces. Cleaning and disinfection is usually done at least daily and more frequently if the risk of environmental contamination is higher e.g. in intensive care units, during outbreaks.

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Cleaning Frequencies – Factors Influencing Frequency

High-touch surfacesExamples of High-touch Items and Surfaces in the Health Care Environment NOTE: Dots indicate areas of highest contamination and touch

High-touch surfaces

How many high touch surfaces can you identify in this picture?

Figure 1

Cleaning Frequencies – Factors Influencing Frequency

High-touch surfaces

More examples of high-touch Items and Surfaces in the Health Care Environment. Note: the dots indicate areas of highest contamination and touch

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Cleaning Frequencies – Factors Influencing Frequency

Low-Touch Surfaces:

• Are those that have minimal contact with hands. Examples - floors, walls, ceilings, mirrors and window sills.

• Require cleaning on a regular (but not necessarily daily) basis, when soiling or spills occur, and when a resident is discharged from the health care setting.

• Many low-touch surfaces may be cleaned on a periodic basis rather than a daily basis if they are also cleaned when visibly soiled.

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Cleaning Frequencies – Factors Influencing Frequency

High-Touch vs Low-Touch Surfaces:

• The frequency of cleaning and the level of cleaning are dependent upon the risk classification of the area to be cleaned

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Factors that Impact Cleaning

• Factors that will impact the frequency of environmental cleaning include:

Probability of contamination with pathogens

Vulnerability of clients/patients/residents to infection

Potential for exposure

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Probability of contamination

• Heavy – surfaces/equipment routinely exposed to copious amounts of fresh blood or other body fluids (e.g. birthing suite, ER, bathrooms if visible soil)

• Moderate – surfaces/equipment does not routinely (but may) become contaminated with blood or body fluids (all bathrooms)

• Light – surfaces not exposed to blood or other body fluids or items that have contact with these (e.g. lounges, libraries, offices)

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• Vulnerability of client/patient/resident

More susceptible – those who are susceptible to infection due to medical condition or lack of immunity e.g. elderly individuals who have underlying illnesses

Less susceptible – all other individuals and areas

• Potential for exposure

High-touch surfaces – those that have frequent contact with hands

Low-touch surfaces – those that have minimal contact with hands

Vulnerability to infection

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• Determine the risk

Probability of Contamination with pathogens

High-touch surfaces(score = 3)

Low-touch surfaces(score = 1)

More susceptibleScore=1

Less susceptibleScore=0

More susceptiblescore=1

Less susceptibleScore=0

HeavyScore=3

7 6 5 4

ModerateScore=2

6 5 4 3

LightScore=1

5 4 3 2

Risk Stratification

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• Determine the cleaning frequency based on risk stratification matrix

Total Risk Score

Risk Type Minimum Cleaning Frequency

7 High Risk Clean after each case/event/procedure and at least twice per dayClean additionally as required

4-6 Moderate Risk Clean at least once dailyClean additionally as required (e.g. gross soiling)

2-3 Low Risk Clean according to a fixed scheduleClean additionally as required (e.g. gross soiling)

Risk Stratification Matrix

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Example - Hospital

An Intensive Care Unit:

• Probability of contamination is heavy = 3

• Potential for exposure is high (high touch) = 3

• Vulnerability of patients in ICU - more susceptible = 1

• Total score = 7 – Clean at least twice per day and additionally as required e.g. if gross soiling

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Example - LTC

A Resident Activity Room:

• Probability of contamination is moderate = 2

• Potential for exposure is high (high touch) = 3

• Vulnerability of residents – Those participating in activities may be considered less susceptible = 0

• Total score = 5 – Clean at least once daily and additionally as required e.g. if gross soiling

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Learning Checkpoint

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Learning Checkpoint

• Identify whether the following items are ‘high-touch’ or ‘low-touch’ surfaces.

Toilet handle

Soap dispenser

Baseboard

Wall

Bathroom mirror

Faucet handles

Window coverings

Ceiling lights

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Learning Checkpoint Answers

• The correct answers are:

Toilet handle - high

Soap dispenser - high

Baseboard - low

Wall – low

Bathroom mirror – low

Faucet handles - high

Window coverings – high/low depending on setting – use risk stratification matrix

Ceiling lights - low

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References

Fig 1-2:Provincial Infectious Diseases Advisory Committee (PIDAC). Best Practices for Environmental Cleaning for Prevention and Control of Infections in All Health Care Settings. 2009 [cited March 27, 2013]:28-29 Available from: http://www.oahpp.ca/resources/documents/pidac/Best%20Practices%20for%20Environmental%20Cleaning.pdf

ThankThank You!You!

Image Sources – Module 4A

• Microsoft Clipart used in Slide 18

• Images in slides 7, 8 & 10 are © PHO 2013