This document provides guidance on environmental cleaning and infection prevention in healthcare facilities. It describes the importance of cleaning in reducing pathogen transmission, and outlines proper procedures for using cleaning solutions and disinfectants, cleaning different areas like patient rooms and operating theaters, and handling soiled equipment. Guidelines are provided for preparing cleaning solutions, cleaning techniques, personal protective equipment usage, and monitoring cleaning effectiveness. The goal is to maintain a clean environment through regular cleaning and disinfection practices.
2. Objectives
At the end of the session learners will be able to:
Describe the importance of environmental cleaning
in health care facilities
Describe the general principles on the proper use of
personal protective equipment during environmental
cleaning
Describe different disinfectants for environmental
cleaning
Prepare disinfectant cleaning solution
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3. Objectives
At the end of the session learners will be able to:
Explain the guidelines for cleaning specific areas of
health care facilities
Explain the guidelines for cleaning spills of blood or
other body fluids
Explain how to handle cleaning items/equipment
appropriately
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4. Environmental cleaning
(introduction)
Contamination of surfaces in the health care
environment plays an important role in the
transmission of many pathogens.
These organisms can be transferred from surfaces to
the hands of health care workers to vulnerable
patients.
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5. Environmental cleaning: definition
Environmental cleaning refers to the:
o general cleaning of surfaces and non-critical
equipment in health care facilities.
o process of maintaining a clean, healthy, and
pleasing patient and work environment.
It includes the removal of visible dirt from objects and
surfaces, normally accomplished manually or
mechanically, using water with detergents or
enzymatic cleaners.
7. Benefits of environmental
cleaning
Housekeeping is important in order to:
Reduce the number of microorganisms that come
in contact with clients or staff.
Reduce the risk of accidents through the
prevention of falls.
Provide a pleasant environment.
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8. Logistics for cleaning
(Cleaning solutions)
Cleaning solution is any combination of soap
(detergent) and water, with or without a chemical
disinfectant, used to wash or wipe down
environmental surfaces.
Several combinations are available commercially or
can be prepared as needed at the health care facility
(e.g., alkaline detergents with chlorine compounds).
Note: Not all soaps (detergents) and disinfectants are
compatible.
9. Logistics for cleaning
(Cleaning solutions)
Commonly used solutions
Plain detergent and water: used for low-risk areas
and general cleaning tasks.
Disinfectant solution (0.5% sodium hypochlorite
solution: used for high risk and other patient care
are
10. Preparing disinfectant cleaning
solution
Prepare a 0.5% chlorine solution or obtain any
disinfectant that contains 5% carbolic acid like lysol.
Add some detergent and mix.
Continue adding detergent until the solution
becomes mildly foamy or bubbly.
Note: chlorine solutions should never be mixed
with cleaning products containing ammonia,
ammonium chloride or phosphoric acid as this
will result in release of chlorine gas.
11. Factors to consider when
selecting cleaning solutions
Intended use (e.g., cleaning, disinfection, or both)
Efficacy (e.g., does it claim to kill organisms that are
commonly found in the local environment at the
recommended contact time)
Acceptability (i.e., smell, leaves a film, ability to
damages surfaces)
Safety (i.e., side effects)
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12. Factors to consider when
selecting cleaning solutions
Cost and availability (i.e., does it fit the budget, is it
easy to obtain in the required amounts)
Volume needed and size of product available
based on facility requirements
Easy of preparing diluted solution
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13. Cleaning solutions for different care
areas
Cleaning patient care areas (general wards,
treatment rooms, washrooms, sluice rooms, etc)
o Use disinfectant cleaning solution.
Cleaning non-patient care areas (offices, waiting
rooms, etc) - Domestic cleaning is adequate. May
use only detergent and water.
14. Cleaning different care areas
Isolation rooms and other areas that have
patients with known transmissible infectious
diseases should be cleaned with disinfectant
cleaning solution.
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19. Environmental Cleaning
(general guidelines)
All wards and units must have cleaning schedules.
Always wear utility gloves, plastic aprons, protective
shoes and mask when cleaning.
Cleaning should always progress from the least
soiled areas to the most soiled areas.
Use damp or wet mop or cloth for walls, floors, etc.
Complete damp dusting before starting other
cleaning in the room
20. Environmental Cleaning
(general guidelines) …
Clean or wash surfaces from top to bottom
Use sweeping brush not broom.
Pay attention to high-touch surfaces such as door
handles, light switches, countertops, bedrails and end
of beds
Change cleaning solution whenever it appears dirty.
Use separate equipment for high risk areas.
Decontaminate mop and other items after use.
22. Flooding and fogging
Flooding: Areas with floor drains can be flooded with
cleaning solution. The cleaning solution should be
drained away using the floor drain. Any excess fluid
should be removed using a mop that absorbs the
remaining fluid left on the floor.
Fogging: As a general rule do not perform
disinfectant fogging for air and surface disinfection for
general infection control in routine patient-care areas
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23. Cleaning spills
Small spills:
disinfect with disposable absorbent material (e.g.,
disposal clothes) soaked in disinfectant cleaning
solution and clean.
Large spills:
First remove the visible organic matter with
absorbent material, e.g., disposable towel or paper,
and discard into an appropriate leak-proof bin then
disinfect with 1%-5% sodium hypochlorite
disinfectant. Mop and clean the area and allow to
air-dry.
24. Cleaning spills
Clean up spills of potentially infectious
materials immediately. Besides preventing the
spread of infections, prompt removal also
prevents accidents.
Staff who are cleaning up spills must wear
appropriate protective clothing.
25. Spill management
Nature of the spill, e.g. blood, urine, faeces
Possible pathogens that may be involved
Size of the spill, e.g., spot, splash, puddle,
large spill
Type of surface involved, e.g., linoleum, carpet
Area involved, e.g., preparatory laboratory,
teaching areas, common access areas, etc.
Likelihood of bare skin contact with the soiled
area
27. Cleaning spills
Large spills of cultures – flood with
disinfectant (e.g. 0.5% chlorine solution or
available stock strength of chlorine), clean and
apply fresh disinfectant, clean and allow to air
dry.
Note: A suggested technique when flooding
the spill with germicide is to lay absorbent
material down on the spill and apply sufficient
germicide to thoroughly wet both the spill and
the absorbent material.
28. How to clean used cleaning
equipment
Mob, mop bucket and brush
Empty mop buckets or container, decontaminate and
clean, rinse and air-dry.
Ensure to wipe brush handles and cleaning carts (if
used) by wiping with disinfectant cleaning solution,
then wide down with a new cloth soaked in soapy
water, rinse and air-dry.
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29. How to clean used cleaning
equipment
Dusters, etc
Soak in 0.05% chlorine solution, wash and air-dry
Curtains, screens, etc.
All health facilities should have schedule for
changing and washing curtains, screens, etc
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30. Cleaning surgical settings
(General guidelines)
Wear scrub suit
Cleaning must NOT be conducted in the presence of
any open sterile packs or sterile instruments
Use clean, lint-free cloth moistened with disinfectant
cleaning solution
Clean after each surgical or invasive procedure and
do terminal cleaning at the end of each day and
each 24-hour period during the regular work week.
31. Terminal cleaning/ Cleaning after
discharge
This is the process used to clean a patient’s
room
after the patient has been discharged or
transferred
for patient treatment areas including
operation theaters at the end of the day.
34. Terminal cleaning/ Cleaning after
discharge
Disinfect beds, lockers and cupboards, etc with low-
level disinfectant e.g. Cetrimide
Change all linen
Disinfect plastic covering of pillows and mattresses
and air-dry for at least an hour before the next
admission.
All mattresses and pillows must have plastic
covering.
35. Fumigation
Fumigation does not reduce contamination in
your facility and should not be used. They are
just time consuming, waste valuable
resources and do not decrease the risk of
infection in the facility.
Formaldehyde have no scientific basis.
Besides being ineffective, these agents are
toxic and irritating to the eyes and mucous
membranes.
36. Monitoring cleaning
Common methods
Physical examination of absence of dirt, debris and
stains on surfaces
Collecting environmental cultures to test for
microorganisms on different surface
38. Summary
Globally, there has been an increased interest in the
role the environment plays in the transmission of
infections.
Cleaning is a process of maintaining a clean,
healthy, and pleasing patient and work environment
and involves sweeping, mopping, dusting and
scrubbing.
Disinfectant cleaning solution should be used for
patient care areas while detergent and water could
be used for non-patient care areas
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39. Summary
Appropriate use of PPEs in imperative
In order to be effective, the cleaning staff must be
well trained on the appropriate cleaning methods
Fumigation for the purposes of IPC is not
recommended.
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These organisms can be transferred from surfaces to the hands of health care workers to vulnerable patients (Weber, Anderson, and Rutala 2013)
Plain detergent and water
This is used for low-risk areas and general cleaning tasks. Detergents remove dirt and organic material and dissolve or suspend grease, oil and other matter so it can easily be removed by scrubbing.
2. Disinfectant solution (0.5% sodium hypochlorite solution – see Section 8: Patient Care Equipment)
Disinfectants rapidly kill or inactivate infectious micro-organisms during the cleaning process. Disinfectants are also used to decontaminate an area so that it is safer for staff to clean. In most settings, a 0.5% sodium hypochlorite solution made from locally available bleach is the cheapest disinfectant, but alternatives include commercial disinfectants that have bactericidal, fungicidal and virucidal properties.
Cleaning should always progress from high (e.g., ceilings and walls) to low areas so that the dirtiest areas and debris that falls on the floor will be cleaned up last.
Dry sweeping, mopping, and dusting should be avoided to prevent dust, debris, and microorganisms from getting into the air and landing on clean surfaces. Airborne fungi and bacteria may act as opportunistic human pathogens (i.e., pathogens that take advantage of individuals with low immune responses).
Cleaning cloths, mops, and cleaning solutions should be changed regularly, when visibly dirty, after cleaning an isolation room, and after cleaning the most soiled areas. Studies have shown that wiping hard surfaces with contaminated cloths can contaminate hands, equipment, and other surfaces.
Cleaning equipment must be kept clean and in good repair. (Bush et al. 2006; CDC 2008)