HOUSE KEEPING IN A HOSPITALDr. A. K. KHANDELWALCONSULTANT HOSPITAL MANAGEMENTASSESOR OF NATIONAL ACCREDITATION BOARD FORHOSPITAL AND HEALTH SERVICEPROVIDERMEDICAL DIRECTORANANDALOKE HOSPITAL &NEUROSCIENCES CENTRESILIGURI
Housekeeping is defined as the provision of a clean,comfortable and safe environment for the patients andpublic in a hospital setup.The need for a separate housekeeping departmenthas arisen due to the increasing public awareness ofhealthcare, technology and increasing competitioninhealthcare fields.
The concept of housekeeping is simplistic but when oneconsiders maintaining a ‘house’ of several hundreds ofrooms and numerous public areas, the task becomesgigantic.In most of the hospitals of modern times, thehousekeeping workers are under the direction ofhousekeeping department and not under the direction ofnursing service personnel.The advantage of this arrangement is that the headnurse is relieved of the housekeeping responsibilitiesand has more time to devote to nursing administration
Aims of Housekeeping department* Achieve the maximum efficiency possible in the careand comfort of the patients and in the smooth runningof the hospital.* Establish a welcoming atmosphere and a courteous,reliable service from staffs of all departments.* Ensure a high standard of cleanliness and generalupkeep in all areas.* Train, control and supervise the staffs ofhousekeeping department.* Establish a good working relationship with otherdepartment.* Ensure that safety and security regulations arefollowed.
RESPONSIBILITIES OF THE HOUSEKEEPINGDEPARTMENT Cleanliness (Includes Infection control)Maintenance (Civil, Electrical, Plumbing, Carpentry &House keeping related activities)Prevention of fire- Aesthetic upkeep of the hospital
QUALITIES OF A GOOD HOUSE KEEPER:• Develop procedures with specific goals of the hospitalhousekeeping department and with abroad overall goal ofthe hospital• Coordinate programs• Delegate authority• Analyze problems and make decisions, taking into fullconsideration a wide range of factors and requirements• Communicate effectively with a wide variety of people.• Develop familiarity with hospital rules and regulations, inareas such as budget, personnel• Develop knowledge of hospital housekeeping methodsand techniques; of various floor, wall, and ceiling coveringmaterials and their properties; and of current developmentsconcerning new cleaning agents, techniques andequipment.
SUPERVISORY HOUSEKEEPER’STASKS• Coordinate and supervise work activities of cleaningpersonnel, to ensure clean, orderly, and attractiverooms.• Assign duties, inspect work, and investigatecomplaints regarding housekeeping service andequipment• Confirm to prescribed standards of cleanliness andtake corrective action.• Take periodic inventory for purchase of housekeepingsupplies and equipments.• Prepare reports concerning room occupancy, payroll,and expenses.• Recommend for improvement of service and ensuremore efficient operation.
• Conduct meetings to discuss policies and patrons’complaints.• Evaluate records to forecast manpower requirements.Conducts orientation training and in service training toexplain policies, work procedures• Demonstrate use and maintenance of equipment.• Record data regarding her subordinate’s workassignments, personnel actions, time cards andprepare periodic reports and recommends for promotions,transfers, and dismissals.• Obtain list of rooms to be cleaned immediately and listof prospective checkouts or discharges to prepare workassignments.• Perform cleaning duties in cases of emergency or staffshortage.
JUNIOR HOUSEKEEPER’S TASKSThey are responsible to,• Make note of complaints and arrange for relevantperson to deliver it.• Make note of meetings / seminars / workshops /examinations and the events of the hospitalsand make necessary arrangements like chairarrangements, over-head projector, drinkingwater etc.• List the inventories like cleaning solutions etc., andbring to the notice of the SupervisoryHousekeepers.• Examine building to determine need for repairs orreplacement of furniture or equipment, andmakes recommendations to the management.• Supplies equipment and accessories to workers.
GUIDELINES FOR ROUTINE CLEANING OFHOUSEKEEPING SURFACESRankingsRecommendations are categorized according to thefollowing designations:Category IA - Strongly recommended for implementationand strongly supported by well-designed experimental,clinical, or epidemiological studies.Category IB - Strongly recommended for implementationand supported by some experimental, clinical, orepidemiological studies and a strong theoreticalrationale.Category IC - Required by state or federal regulations,rules, or standards.
Category II - Suggested for implementation andsupported by suggestive clinical orepidemiological studies or a theoreticalrationale.No recommendation - Unresolved issue.Practices for which insufficient evidence or noconsensus regarding efficacy exists.
Cleaning and Disinfecting Strategies forEnvironmental Surfaces in Patient-Care Areas1 Do not use high-level disinfectants/liquid chemicalsterilants on non-critical surfaces for disinfection.Category IC2 Follow manufacturers’ instructions for cleaning andmaintaining non-critical medical equipment. Category II3 In the absence of manufacturers’ cleaning instructions,follow these procedures: .a Depending on the nature of the surface and thedegree of contamination, clean non-critical medicalequipment surfaces with a detergent/disinfectant or soapand water, followed with an application of low-tointermediate-level chemical germicide at proper usedilution and for the full contact time required Category II b Do not use alcohol to disinfect large surfaces.Category II
.c Use barrier protective coverings as appropriate fornon-critical surfaces that are: 1) touched frequently withgloved hands during the delivery of patient care; 2) likelyto become contaminated with blood or body substances;or 3) difficult to clean. Category II.4 Keep housekeeping surfaces (e.g., floors, walls,tabletops) visibly clean on a regular basis and as spillsoccur. Category II a Use a one-step process and water/detergent or anEPA-registered hospital grade disinfectant/detergentdesigned for general housekeeping purposes. CategoryII .b Follow manufacturers’ instructions for proper use ofcleaning/disinfecting products, paying close attention tospecified use dilutions and stated contact timesCategory II
c Clean and disinfect high-touch surfaces (e.g.,doorknobs, bedrails, light switches, surfaces in andaround toilets in patients’ rooms) on a more frequentschedule compared to that for minimal touchhousekeeping surfaces. Category II d Clean walls, blinds, and window curtains in patient-care areas when they are visibly dusty or soiled.Category II5 Do not do disinfectant fogging for routine purposes inpatient-care areas Category IB6 Avoid large-surface cleaning methods that producemists or aerosols or disperse dust in patient-careareas.9, 20, 109, 262 Category IB
7 Follow proper procedures for effective use of mops, cloths,and solutions: Category II a Prepare cleaning solutions daily or as needed, andreplace with fresh solution frequently according to facilitypolicies and procedures. Category II b Use clean mops and cloths every time a bucket of cleaningsolution is emptied and replenished with clean, fresh solution.Category II c Clean mops and cloths after use and allow to dry beforereuse, or, use single-use, disposable mop heads andcloths.915, 929 - 931 Category II8 After the last surgical procedure of the day or night, wetvacuum or mop the operating room floors with a single-usemop and an EPA-registered hospital disinfectant. Category IB9 Do not use tacky mats at the entrance to operating rooms orinfection-control suites. Category IB
10 Use proper dusting methods for patient-care areas designated forimmunosuppressed patients (e.g., HSCT patients):Category IB a.Wet-dust horizontal surfaces daily using cloths moistened with an EPA-registered hospital disinfectant. Category IB b Avoid dusting methods that disperse dust (i.e., featherdusting). CategoryIB11 Keep vacuums in good repair, and equip vacuums with HEPA filters foruse in high-risk patient-care areas. Category IB12 Close the doors of immunocompromised patients’ rooms whenvacuuming corridor floors to minimize exposure to airborne dust. CategoryIB13 Take precautions when using phenolic disinfectants in neonatal units.Category IB a Prepare solutions to correct concentrations in accordance withmanufacturers’ use instructions, or, use pre-mixed formulations. Category IBb Do not use phenolics to disinfect bassinets or incubators during an infant’sstay. Category IB c Rinse phenolic-treated surfaces with water Category IB
CLEANING SPILLS OF BLOOD AND BODYSUBSTANCES1 Promptly clean and decontaminate spills of blood or otherpotentially infectious materials. Category IC (OSHA)2 Follow proper procedures for site decontamination of spillsof blood or blood-containing body fluids. Category IC .a Use protective gloves and other personal protectiveequipment appropriate for this task. Category IC (OSHA).b If the spill contains large amounts of blood or body fluids,clean the visible matter with disposable absorbent material,and discard the used cleaning materials in appropriate,labeled containment. Category IC.c Swab the area with a disposable cloth moderately wettedwith disinfectant, and allow the surface to dry. Category IC
3 Use intermediate-level germicides (germicidesregistered by the EPA for use as hospital disinfectantsand labeled tuberculocidal) at recommended dilution andfull contact time to decontaminate spills of blood andother body fluids.Category IC (OSHA)4 Use a one-step cleaning/disinfecting procedure forsmall spills. Category II5 If sodium hypochlorite solutions (e.g., householdchlorine bleach) are selected for use: .a Use a 1:100 dilution (500 ppm available chlorine) todecontaminate nonporous surfaces after cleaning a spillof either blood or body fluids in patient-care settings.Category IB.b If a spill involves large amounts of blood or body fluids,or if a blood or culture spill occurs in the laboratory, use a1:10 dilution (5,000 ppm available chlorine) for the firstapplication of germicide before cleaning. Category IB
CARPETING AND CLOTH FURNISHINGS.1 Vacuum carpeting in public areas of healthcare facilitiesand in general patient-care areas regularly with well-maintained equipment designed to minimize dust dispersion.Category II.2 Perform a thorough, deep cleaning of carpetingperiodically as determined by facility policy using a methodthat minimizes the production of aerosols and leaves little orno residue. Category II3 Avoid the use of carpeting in high-traffic zones in patient-care areas or where spills are likely (e.g., burn therapy units,operating rooms, laboratories, intensive care units). Category II.4 Follow proper procedures for managing spills on carpeting.Category I
.a Spot-clean blood or body substance spills promptly.Category IC.b If a spill occurs on carpet tiles, replace any tilescontaminated by blood and body fluids or body substances.Category IC.c Thoroughly dry or replace wet carpeting within 72 hours toprevent the growth of fungi. Category IB5 No recommendation on the routine use of fungicidal orbactericidal treatments for carpeting in public areas of ahealthcare facility or in general patient-care areas.Unresolved issue
6 Avoid the use of carpeting in hallways and patientrooms in areas housing immunosuppressed patients(i.e., PE areas). Category IB7 Avoid the use of upholstered furniture and furnishingsin high-risk patient-care areas and in areas withincreased potential for body substance contamination(e.g., pediatrics units). Category II8 No recommendation on the use of upholsteredfurniture and furnishings in general patient-care areas.Unresolved issue
Flowers and Plants in Patient-Care Areas.1 Flowers and potted plants need not be restricted fromareas for immunocompetent patients. Category II2 Designate the care and maintenance of flowers andpotted plants to staff not directly involved with patientcare. Category II.3 Do not allow flowers (fresh or dried) or potted plants inpatient-care areas for immunosuppressed patientsCategory II
PEST CONTROL1 Develop pest control strategies, with emphasis onkitchens, cafeterias, laundries, central sterile supplyareas, operating rooms, loading docks, and other areasprone to infestations. Category II2 Install screens on all windows that open to theoutside; keep screens in good repair. Category II.3 Contract for routine pest control service by acredentialed pest control specialist who will tailor theapplication to the needs of a healthcare facility.Category II.4 Place laboratory specimens (e.g., fixed sputumsmears) in covered containers for overnight storage.Category II
SPECIAL PATHOGENS.1 Develop and maintain cleaning and disinfectionprocedures to control environmental contamination withantibiotic-resistant gram-positive cocci (e.g., MRSA, VISA,VRE). Category IB.a Pay special attention to cleaning and disinfection ofhigh-touch surfaces in patient-care areas (e.g., bedrails,carts, charts, bedside commodes, bedrails, doorknobs,faucet handles); Category IB.b Ensure compliance by housekeeping staff with cleaningand disinfection procedures Category IBc Use chemical germicides appropriate for the surface tobe disinfected (e.g., either low- or intermediate leveldisinfection) for the full contact time and correct usedilution as specified by the manufacturers’ instructions.Category IB
2 Environmental surface culturing can be used to verifythe efficacy of hospital policies and procedures beforeand after cleaning and disinfecting rooms that housepatients with VRE. Category II.a Prior approval from infection control, in collaborationwith the clinical laboratory, must be obtained. CategoryII.b Infection control, with clinical laboratory consultation,must supervise all environmental culturing. Category II
.3 Develop and maintain cleaning and disinfectionprocedures to control environmental contamination withClostridium difficile Category IBa Thoroughly clean and disinfect environmental and medicalequipment surfaces on a regular basis using disinfectants atproper use dilutions and full contact time. Category IBb Use appropriate hand hygiene or handwashing, personalprotective equipment (e.g., gloves), and isolation precautionsduring cleaning and disinfecting procedures. Category IB.4 Advise families, visitors, and patients about the importanceof handwashing or hand hygiene to minimize the spread offecal contamination to surfaces. Category II5 Do not use high-level disinfectants (liquid chemicalsterilants) on environmental surfaces. Category IC27
.6 No recommendation on the use of specific low- orintermediate-level disinfectants with respect toenvironmental control of C. difficile. Unresolved issue.7 Develop and maintain cleaning and disinfectionprocedures to control environmental contamination withrespiratory and enteric viruses in pediatric-care units.Category II.a Clean surfaces that have been contaminated with bodysubstances; disinfect cleaned surfaces with anintermediate-level disinfectant at proper use dilution andcontact time.1075 Category II.b Use disposable barrier coverings as appropriate tominimize surface contamination. Category IIII
.8 Develop and maintain cleaning and disinfectionprocedures to control environmental contamination withCreutzfeldt-Jakob disease (CJD) agent in patient-careareas. Category II.a In the absence of contamination with central nervoussystem tissue, extraordinary measures (e.g., use of 2Nsodium hydroxide [NaOH] or full-strength sodiumhypochlorite [chlorine bleach]) are not needed for routinecleaning or terminal disinfection of a room housing aknown or suspected CJD patient. Category II.b Use standard procedures for containment, cleaning,and decontamination of blood spills on surfaces aspreviously described (3-2). Category II
.c Use: 1) a sodium hypochlorite solution of >20,000ppm [1:2 dilution] for 2 hour contact time; or 2) 1NNaOH for 2 hours contact time; or 3) 2N NaOH for 1hour contact time to decontaminate operating roomor autopsy surfaces with central nervous system orcerebral spinal fluid contamination from a known orsuspected CJD patient.Category IId Use disposable, impervious covers to minimizebody substance contamination to autopsy tables andsurfaces. Category
ENVIRONMENTAL SAMPLING General Recommendations.1 Do not conduct random, undirected microbiologicsampling of air, water, and environmental surfaces inhealthcare facilities. Category IB.2 When indicated, conduct microbiologic sampling aspart of an epidemiologic investigation. Category IB.3 Limit microbiologic sampling for quality assurancepurposes to: 1) biological monitoring of sterilizationprocesses; 2) monthly cultures of water and dialysatein hemodialysis units; and 3) short-term evaluation ofthe impact of infection control measures or changesin infection control protocols. Category IB
2 Air, Water, and Environmental Surface Sampling.1 Select a high-volume air sampling device ifanticipated levels of microbial airborne contaminationare expected to be low. Category II.2 Do not use settle plates to quantify the concentrationof airborne fungal sporesCategory II.3 When sampling water, choose growth media andincubation conditions that will facilitate the recovery ofwaterborne organisms Category II.4 When using a sample/rinse method for sampling anenvironmental surface, develop and document aprocedure for manipulating the swab, gauze, or spongein a reproducible manner so that results are comparableCategory II.
5 When environmental samples and patient specimensare available for comparison, perform the laboratoryanalysis on the recovered microorganisms down to thespecies level at a minimum and beyond the specieslevel if possible. Category II.6 When conducting any form of environmentalsampling, fully document departures from standardmethods Category II.
DISINFECTIONSpaulding proposed three levels of disinfection for thetreatment of devices and surfaces that do not requiresterility for safe use. These disinfection levels are"high-level," "intermediate-level," and "low-level
HIGH LEVEL DISINFECTIONThe process of high-level disinfection, an appropriate standardof treatment for heat-sensitive, semi-critical medicalinstruments (e.g., flexible, fiberoptic endoscopes), is capable ofinactivating all vegetative bacteria, mycobacteria, viruses,fungi, and some bacterial spores if they are present. High-level disinfection is accomplished with powerful,sporicidal chemicals Glutaraldehyde, Peracetic acid, Hydrogen peroxideThese are not appropriate for use on housekeeping surfaces.
INTREMEDIATE LEVEL DISINFECTIONIntermediate-level disinfection does not necessarily killbacterial spores, but does inactivate Mycobacteriumtuberculosis var. bovis, which is significantly moreresistant to chemical germicides than ordinary vegetativebacteria, fungi, and medium- to small viruses (with orwithout lipid envelopes). Chemical germicides withsufficient potency to achieve intermediate-leveldisinfection: Sodium hypochlorite Alcohols, Some phenolics,Some iodophors.
LOW LEVEL DISINFECTIONLow-level disinfectants, which may also be referred to as"sanitizers,“Low-level disinfection inactivates vegetative bacteria, fungi,enveloped viruses (e.g., human immunodeficiency virus[HIV], influenza viruses), and some non-enveloped viruses(e.g., adenoviruses).These include: Quaternary ammonium compounds, Some phenolics,Some iodophors.Germicidal chemicals cleared as skin antiseptics are notappropriate for use as environmental surface disinfectants.
BARRIER PROTECTIONBarrier protection of surfaces and equipment is useful,especially if these surfaces are: 1) touched frequently bygloved hands during the delivery of patient care; 2) likelyto become contaminated with body substances; or 3)difficult to clean. Impervious-backed paper, aluminum foil, plastic or fluid-resistant covers are suitable for use as barrier protection.An example of this approach is the use of plasticwrapping to cover the handle of the operatory light indental care settings. Coverings should be removed anddiscarded while the healthcare worker is still gloved. Thehealthcare worker, after ungloving and hand hygiene,covers these surfaces with clean materials before thenext patient encounter.