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Hospital Environmental Cleaning & Disinfection, Procedures & Practices

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Environmental cleaning depends on Infection Control risk Assessment as High, Moderate & Low Risk Areas. This document includes Procedures & Practices in Hospital for Environmental Cleaning & Disinfection based on cheapest hospital grade disinfectant i.e Clorox / Household Bleach available for especially third world countries.

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Hospital Environmental Cleaning & Disinfection, Procedures & Practices

  1. 1. Hospital Environmental Cleaning & Disinfection Procedures & Practices Environmental cleaning depends on Infection Control risk Assessment as High, Moderate & Low Risk Areas By Dr Anjum Hashmi MBBS,CCS(USA), MPH Infection Prevention & Control Director and Employees Health Director East Najran Hospital Najran Saudi Arabia 2014 Reviewed By Al Scoggins CEO at Janus Solutions, LLC Great Atlanta, USA.
  2. 2. The contamination of the environment (surfaces in patient care areas and mobile medical equipment) play a major role in the transmission of potential pathogens. TERMINOLOGIES & DEFINITIONS: • Antisepsis: Chemical destruction of vegetative pathogens on living tissue. • Degerming: Mechanical removal of microbes from limited area. • Sanitization: Lowering microbial counts on eating and drinking utensils to safe levels. • Sepsis: Bacterial contamination • Asepsis: Absence of significant contamination • Aseptic technique: To minimizes contamination. • Cleaning: Physical removal of foreign material, e.g., dust, soil, organic material such as blood, secretions, excretions and microorganisms. It is accomplished with water, detergents and mechanical action. • Decontamination: The removal of disease-producing microorganisms to leave an item safe for further Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com handling • Sterilization: Complete elimination or destruction of all forms of microbial life accomplished in healthcare facilities by either physical or chemical processes. • Disinfection: Cleaning some or all pathogenic organisms from an article of which may cause infection. A perfect disinfectant should offer complete and full sterilization, without harming other forms of life, inexpensive, and non-corrosive. Unfortunately ideal disinfectants do not exist. • High level disinfectants: Destroy vegetative bacteria, mycobacteria, fungi, enveloped (lipid) and nonenveloped (non lipid) viruses and bacterial spores but not necessarily all bacterial spores. • Intermediate level disinfectants: Kill vegetative bacteria, most viruses and most fungi but not the bacterial spores. • Low level disinfectants: Kill most vegetative bacteria and some fungi as well as enveloped (lipid) viruses (e.g., hepatitis B, C, hantavirus, and HIV). Low level disinfectants do not kill mycobacteria or bacterial spores. Low level disinfectants are typically used to clean environmental surfaces.
  3. 3. SPAULDING CLASSIFICATION THREE DEVICE CATEGORIES FOR DISINFECTION AND STERILIZATION: • Critical Device enters sterile tissue or vasculature, therefore pose a high risk of infection if contaminated with microorganisms: Require: Sterilization. • Semi-critical Device comes in contact with mucous membranes or skin that is not intact, therefore pose a moderate risk of infection if contaminated with microorganisms: Require: High Level Disinfection. • Non-critical Device comes in contact with intact skin but not with mucous membranes, therefore, pose little to no risk of infection if contaminated with microorganisms: Require: Disinfection. MANAGEMENT OF BLOOD AND BODY FLUID SPILL: TOOLS OF SPILLAGE KIT:- 1. Protective clothing, gloves, gowns, masks and goggle. 2. Tissue papers (Roll paper towels) 3. Forceps for removal of broken glass or other sharps. 4. Container of Sodium Hypochlorite (Clorox/Bleach) or Presept, Haz Tabs. 5. Biohazard disposal bag for infectious waste. 6. Measuring jar CHLORINE-RELEASING AGENTS: Fall into two groups: 1. Sodium dichloroisocyanurate (NaDCC), e.g. Presept, Haz Tabs NaDCC is recommended for spillages. It is less resistant than hypochlorite to organic matter, less corrosive, and has a longer shelf life, as it is manufactured as tablets or granules. 2. Sodium hypochlorites (NaOCl), e.g. Clorox / Household bleach. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com
  4. 4. HOW TO CLEAN BLOOD AND BODY FLUIDS SPILL: 1 Place “Wet Floor” sign near the area of spill. 2. Wear protective clothing and gloves. 3. Put on goggles if splashing is likely. 4. Put on shoe cover to protect shoes if they are likely to become contaminated with the Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com blood spill. 5. If broken glass or any other sharp object is involved, use forceps to pick up and throw into a sharp container before any cleaning or disinfecting is ever attempted. 6. Cover spill with paper towels, pure Clorox solution 1:10 dilution over spill starting from periphery leave for 3-5 minutes. This will ensure ample Contact Time for disinfection. Then wipe all the blood or body fluid from the surface. 7. Again pour or spray the disinfectant 1:10 dilution bleach solution on the area of spill and leave it for 3-5 minutes. This will ensure ample Contact Time for disinfection. 8. Wiped clean with paper towels. 9. Discard all contaminated paper towels into the infectious yellow bag. 10. Dispose all disposable PPE into yellow infectious waste bag. 11. Dispose yellow plastic bag into infectious waste container. 12. Wash hands with antiseptic detergent. 13. Replace and replenish supplies in the “Spill Kit” CLEANING BLOOD AND BODY FLUID STAINS: Wear gloves and others PPE as needed. Clean the items with detergent and water. Make Clorox solution (100ml of Clorox in 900ml water/5000 - 6000ppm available Chlorine) in spray bottle and do heavy spray so that it can take 5 minutes to air dry than clean it.
  5. 5. MANAGEMENT OF OTHER BODY FLUID SPILLS (VOMIT, URINE, FECES): Wear disposable gloves and apron. Use disposable paper towels, to mop up spillage. Dispose of paper towels into clinical waste bag. Wash area with detergent and water. After washing one can disinfect area with Clorox solution (40-50 ml of Clorox in 1 Liter water 2500-2700ppm available Chlorine). Discard protective apparel into clinical waste bag. Wash and dry hands thoroughly. ENVIRONMENTAL DECONTAMINATION: • Cleaning MUST precede decontamination • Disinfectant is ineffective if any organic matter present. • Use mechanical force Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com – Scrubbing – Brushing – Flush with water • Wipe nonporous surfaces with sponge or wet cloth. • Allow to dry. CENTER FOR DISEASE CONTROL [CDC] RECOMMENDED DILUTIONS FOR DISINFECTION (HOW TO MAKE CLOROX/BLEACH SOLUTION): Clorox solution must always be freshly prepared and use within 4-8 hours. 1. 100 ml Clorox + 900 ml water = (1:10 dilution/5000-6000 parts per million (ppm) available Chlorine) 2. 40-50 ml Clorox + 1 Liter water = (2500-2700 ppm available Chlorine). 3. Clorox/bleach solution for sanitizing cooking and eating utensils 15 ml (1 Tablespoon) in 4 liter Water = 200 ppm (must not exceed 200 parts per million available chlorine). The bleach solution must be applied by spraying, soaking or scrubbing. Let air dry (contact time at least one minute 4. Clorox/bleach solution for sanitizing fruits and raw vegetables 7.5 ml (1 ½ teaspoon) in 4 liter of water = 100 ppm (must not exceed 100 parts per million available chlorine). After washing dip them for 15 minutes than wash again with filtered water.
  6. 6. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com HOW TO MOP FLOOR Use a mop or bucket system with a floor cleaner solution, beginning in the far corner of the area, under the bed and then moving toward the bathroom and the door. Mop the floor in 1-2 meter square sections. Mop edges with straight strokes, and then continue working from side to side in a backwards direction, using a figure-of-eight pattern on the remainder of the section, turning the mop frequently. The floor should be fairly dry on completion. HOW TO CLEAN AND DISINFECT BATHROOM • Wash with water and detergent. • Make Clorox/bleach sol (40-50 ml Clorox + 1 liter water) • Disinfect all precleaned hard, nonporous bathroom surfaces. • Start with the highest surface (like the mirror) and leave the toilet for last. • Ensure that all surfaces, including the sink area, mirrors, grab bars and shower fixtures, are thoroughly disinfected. • Disinfect and clean toilet exterior, toilet seat surface, and outer of bowl. • For inner bowel use 250ml pure bleach contact time 2 min. • Ensure all surfaces stay wet.
  7. 7. BATHROOM CLEANING PROTOCAL It is usually best to start with the highest surface (often the mirror) and leave the toilet for last. Clean and disinfect all hard, nonporous surfaces: • Mirror, sink area, and grab bars, shower fixtures, toilet exterior, toilet seat surface and outer and inner bowl. CLEAN AND DISINFECT ISOLATION ROOM • Using a clean mop, mop the entire floor surface, working your way from the far corner back to the entrance. • Visually inspect the room and ensure all surfaces have been cleaned and disinfected. • Then disinfect any cleaning equipment (like mop handles) before returning to the cleaning cart. • Remove PPE and put in a yellow trash bag prior to leaving the room. • Wash your hands. • Return with clean linens and make bed. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com
  8. 8. Cleaning Levels for Different Clinic Areas It depend on Infection Control risk assessment of that areas Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com Low-Risk Areas: These areas are usually not contaminated with blood or body fluids or with associated infectious microorganisms so the risk of infection is minimal. Routine cleaning- the kind of cleaning you would do in your home – is usually good enough for these areas. Clean these areas with a mop dampened with detergent and water. These functional areas included: 1) Administrative areas 2) Waiting rooms 3) Non-sterile supply areas 4) Medical records 5) Engineering workshop 6) Central store 7) Library 8) Conference and Meeting area 9) Staff Change facilities (Staff lounge)
  9. 9. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com Intermediate (Moderate) Risk Areas: These are areas used for the care of patients who are not obviously infectious and not highly susceptible. These areas are cleaned by procedures that control dust, such as damp mopping with detergent cleaners. Dry sweeping or vacuum cleaners are not recommended. The use of detergent solution improves the quality of cleaning. This functional areas includes: 1) Patient Wards 2) Out Patient Department 3) Physiotherapy 4) Pharmacy 5) Laboratories 6) Mortuary 7) Radiology 8) Accommodation (Housing) 9) Employee Health Clinic 10) Cardiology High Risk Areas: This functional areas includes: 1) CSSD (Central sterilization and supply department) 2) Emergency Department (ER) 3) Catering facilities (includes all kitchen and cafeteria) 4) Day surgery unit 5) Treatment room. 6) Maternity Ward 7) Pedia Surgery Ward
  10. 10. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com Very High Risk Areas: In these areas there is a greater potential pathogen contamination with infectious materials and more of a concern about potential infection transmission to both patient and clinic staff. These areas must be cleaned with care using a cleaning solution and separate cleaning equipment; disinfectant detergent solutions are used as needed, according to hospital policy. This functional areas includes: 1) Isolation Room 2) Intensive Care Unit (ICU/PICU) 3) Operating Room 4) Neonatal Care unit (NICU and Nursery) 5) Pharmacy IV Preparation room 6) Delivery Room 7) Immuno-compromised patients areas
  11. 11. DECONTAMINATION OF ENVIRONMENT & EQUIPMENTS NO ITEMS CLEANING PROCESS STAFF RESPONSIBLE 1 Airways/ Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com ventilator tubes Disposable or disinfect with 100ml of Clorox in 900ml water solution dip for 10 minutes. Nursing staff 2 Ambu bags Disposable or disinfect with 100ml of Clorox in 900ml water solution dip for 5 minutes. Nursing staff 3 Baby Baths Clean bath after use with detergent and water. Disinfect with 100ml of Clorox in 900ml water solution spray. House-keeping personnel 4 Bed frames, cradles etc. Disinfect with 100ml of Clorox in 900ml water solution spray. Housekeeping personnel 7 Blood-pressure cuff Tourniquets Clean with damp cloth soaked in detergent and water, dry thoroughly. If contaminated with blood/body fluids spray with 100ml of Clorox in 900ml water solution. Nursing staff 8 Ceilings When visibly soiled, wash with detergent and water. Maintenance Department 9 Commodes/ urinal Clean with detergent and water and disinfect with 250 ml of Clorox (pure) contact time 2 minutes. House-keeping personnel 10 Curtains Should be laundered at least 6 monthly and when visibly soiled. Some curtains may need to be laundered more regularly (high risk area) If unable to send to central laundry clean with detergent and water. Nursing staff & Laundry Dept 11 Dressing trolleys Wash with detergent and hot water and dry before and after use. If contaminated with blood/body fluids or used for a patient with a transmissible infection refer to policy / guidance. 70% alcohols wipes can be used to disinfect trolley between uses if visibly clean/use 100ml Clorox in 900ml of water solution spray. Nursing staff
  12. 12. 12 Drip (IV) stands Start from top to down clean with water and detergent. Rinse and dry thoroughly. If contaminated with blood/body fluids or used for a patient with a transmissible infection use Clorox solution 1:10 dilution /100ml Clorox in 900ml of water solution spray contact time 3 -5 min, wipe or let air dry. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com Nursing staff 13 Examination couch Use Clorox solution 1:10 dilution /100ml Clorox in 900ml of water spray contact time 3 -5 min, wipe or let air dry. Nursing staff 14 Floors 1) Dry Cleaning –Dust-attracting mop. Sweeping machine must not be used in clinical areas. 2) Wet Cleaning – wash with Clorox solution (2500- 2700ppm of chlorine/40-50ml Clorox in 1 L of water). House-keeping personnel 15 Housekeeping Equipment Buffers (Floor polishing machine) Pads Buckets Mops Heads The outside of the machine should be washed with detergent and water and dried after use. Buffing pads should be washed with detergent and water and drip-dried. Pads must not be left under the machine between uses. Clean with water and detergent after use. Disinfect with 100ml Clorox in 900ml water. Dry and store inverted. Disinfect with 100ml Clorox in 900ml of water /Change daily or send to laundry. House- keeping personnel 16 Incubators (baby) If disinfection required refer to manufacturer's instructions. As some allow wash with water and detergent only (better use Savalon) and other allow use of Clorox solution 1:10 dilution/100ml Clorox in 900ml of water solution. Nursing staff
  13. 13. Decontamination of Incubators After Patient Use Incubators should be disinfected between each baby. The incubator shall also be disinfected after every 7 days of hospitalization (every 5 days for babies less than 1 kilogram). After use all removable parts must, be washed and thoroughly cleaned with detergent (better use Savalon).Then soaked in 1: 10 Clorox (5000 ppm available chlorine) for 5 minutes. Rinse and dry thoroughly using paper roll. Then clean incubator with water and detergent (better use Savalon) wipes. Disinfect incubator with 1: 10 Clorox /100ml Clorox in 900ml of water solution wipes and dried using paper roll. Wash outside of incubator, including drip stands shelves, infusion pumps / syringes and dry thoroughly with paper roll. Dispose Clorox wipes and paper roll in the infectious waste bag. Aerate the incubator before re-use. Humidification Chambers Disassemble the humidifier. Clean humidifier and reservoir with Clorox/Bleach 1: 10 dilutions /100ml Clorox in 900ml of water solution. Thoroughly dry parts before reassembly. Decontamination of Incubators in Use All incubators that are occupied should be cleaned daily from the inside and outside. Clean incubator with detergent (better use Savalon) wipes and dries it with paper towels. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com
  14. 14. Always clean inside of incubator first. Dispose wipes and paper roll in the infectious waste bag. Humidification Chambers Humidification chambers not in use should be kept clean and dry. Humidification chambers in use should be checked at the start of each shift and topped up with distilled sterile water as necessary. Humidification chamber in use should be weekly and disinfected with Clorox/Bleach 1: 10 dilution /100ml Clorox in 900ml of water solution. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com 17 Blood & Body fluids suction containers Empty contents carefully down sluice or toilet. Wash carefully in warm water and detergent avoiding splashing and disinfect accordingly. Dip in 100ml of Clorox in 900ml of water solution for 10 minutes. Nursing staff 18 Laryngoscope and blade Handle: wash with detergent and hot water and dry thoroughly. If contaminated with blood/body fluids or used on an infectious patient, use 100ml Clorox in 900ml of water solution spray/use disinfectant approved by Infection Control Department Blade: send to CSSD for reprocessing or dip in 100ml Clorox in 900ml of water solution for 10 minutes. Nursing staff 19 Lockers Clean with detergent and water. Disinfect with 100ml of Clorox in 900ml water solution spray. House-keeping personnel 20 Cot/Incubator Mattresses , Bed Mattresses and pillows Check regularly to ensure the cover is intact. If damaged it must be discarded and changed. The mattress cover should be washed with detergent and water on patient discharge and disinfect with 100ml Clorox in 900ml of water solution spray. House-keeping personnel
  15. 15. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com 21 Medical Equipment Refer to manufacturer's instructions Nursing staff 22 Resuscitation Trolley Clean with detergent and water. Disinfect with 100ml Clorox in 900ml of water spray. Nursing staff 23 Scales (weighing) Clean with detergent and water & disinfect with 100ml Clorox in 900ml of water solution heavy spray let it air dry to met contact time of 3-5 minutes. Nursing staff 24 Scissors Clean with detergent and water, if disinfection required use a 70% alcohol swab following cleaning with detergent and water or 100ml Clorox in 900ml of water spray. Nursing staff 25 Sinks/wash hand basins Clean with detergent and disinfect with (2500-2700 ppm available chlorine /40-50ml Clorox in 1L water) House-keeping personnel 26 Waste bin for infectious waste Wipe clean with 100ml of Clorox in 900ml of water solution and let air dry. Nursing staff 27 Soap dispenser The casing and the nozzle of the soap dispenser should be cleaned daily with water and detergent. Wipe clean with 100ml of Clorox in 900ml of water solution and let air dry. Clean inner casing of dispenser when changing the cartridge. Do not top up liquid soap. House-keeping personnel 28 Sphygmomano meter Clean with detergent and water. Nursing staff 29 Stethoscopes Wipe with 70% alcohol wipes between each patient. Nursing staff 30 Suction bottles If not disposable these should be emptied carefully and disinfect with 100ml Clorox in 900ml of water solution by dipping for 10 minutes. Nursing staff 31 Telephones Damp dust with detergent and water or 100ml Clorox in 900ml of water spray. Nursing staff 32 Thermometers Electronic Disinfect screen with alcohol. Disinfect with 100ml Clorox in 900ml water wipe, if allowed by manufacturer. Nursing staff
  16. 16. 33 Toilets/Bidets Use detergent and water and disinfect with Clorox and water (2500-2700 ppm chlorine concentration/40-50ml Clorox in 1L water) Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com House- keeping personnel 35 Walls All surfaces should be cleaned with Clorox and water (2500-2700 ppm of Chlorine/40-50ml in One Liter water). House-keeping personnel 37 Ventilators Wipe the surfaces of the ventilator clean, working from the top to the bottom. For greasy or stubborn soiling, use the non-abrasive pad. Wipe the screen with alcohol. Body can be wiped with alcohol or Clorox 1:10 dilutions. Allow to dry. Only detergent and water can be used if advised by manufacturer. Nursing staff 38 Baths (shower cubicles) Clean bath after use with detergent and water. Housekeeping personnel 39 Bedpans Empty contents carefully down sluice or toilet and disinfect and rinse with 100ml of Clorox in 900ml water solution. Housekeeping personnel 40 Bowls (patient) Clean with detergent and water. Rinse and dry thoroughly. Disinfect with 100ml of Clorox in 900ml of water solution and let air dry. Store inverted. Housekeeping personnel 41 Wheelchairs Clean with detergent and water. Disinfect with 100ml of Clorox in 900ml of water solution and let air dry. Housekeeping personnel 42 Toys-Hard (Soft toys not suitable for hospital use) Toys must be cleaned if visibly soiled, weekly and on patient discharge. Disinfect with 1:100 dilution of a hypochlorite solution (10ml in 1 L water/500–600 ppm free chlorine). If visibly soiled with blood/body fluids. Dispose if grossly contaminated. Housekeeping personnel
  17. 17. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com 43 Dialysis Unit noncritical surfaces (e.g., dialysis bed, external surfaces of dialysis unit ) Wipe the unit screen with alcohol. Disinfect with 1:10 dilution of a hypochlorite solution (100 ml in 1 L water / 5000 ppm free chlorine) after every dialysis event /Use EPA approved disinfectant. Ref: Guideline for the Prevention and Control of Infections in Dialysis Settings Version 3 – May 2013; Centre for Healthcare Related Infection Surveillance and Prevention & Tuberculosis Control, Queensland Australia Nursing staff 44 Cardiac Monitor Wipe the screen with alcohol. Body can be wiped with alcohol or Clorox 1:10 dilutions. Allow to dry. Only detergent and water can be used if advised by manufacturer. Nursing staff 45 Diagnostic Imaging Portable - Machine Portable - portable grid/ film cassette Mammography - paddles Disinfect with 100ml Clorox in 900ml water damp wipe. When soiled and on leaving Contact precaution room Ideally should be covered (e.g., pillowcase )between patients if not covered Between patients X ray technician 46 ECG Machine and Cables Damp wipe with 100ml Clorox in 900ml water solution. ECG technician 47 Glucometer Damp wipe with 100ml Clorox in 900ml water solution. Nursing staff 48 Ophthalmo-scope Damp wipe with 100ml Clorox in 900ml water solution. Nursing staff 49 Otoscope Handle Ear speculum Damp wipe with 100ml Clorox in 900ml water solution. Damp wipe with 100ml Clorox in 900ml water solution. Nursing staff 50 Reflex Hammer Damp wipe with 100ml Clorox in 900ml water solution. Nursing staff 51 Defibrillator Damp wipe with 100ml Clorox in 900ml water solution . Nursing staff
  18. 18. 52 Stretcher Wash with soap and water and disinfect spray of 100ml Clorox in 900ml water solution and let air dry. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com Housekeeping staff 53 Suction Machines Damp wipe with 100ml Clorox in 900ml water solution Nursing staff 54 Stethoscope Alcohol swab/100ml Clorox in 900ml water damp wipe Doctor/Nursing staff 55 Telemetry Equipment Monitor and Cables Damp wipe with 100ml Clorox in 900ml water solution. Nursing staff 56 Tourniquet Alcohol swab/100ml Clorox in 900ml water damp wipe Nursing staff 57 Ultrasound Transducers Handle and Cable External Alcohol swab Ultrasound technician 58 Wall-mounted Oxygen and Suction Fixtures Damp wipe with 100ml Clorox in 900ml water solution Nursing staff 59 Intravenous (IV) Pumps, Poles, Warmers Damp wipe with 100ml Clorox in 900ml water solution Nursing staff Personal Protective Equipment (PPE) Advised in Environmental Cleaning: 1. Gloves. 2. Face Mask 3. Gown if splashes of disinfectant expected.
  19. 19. MINIMUM CLEANING & DISINFECTION FREQUENCIES IN HOSPITAL No. Element Very High Risk High Risk Moderate Risk Low Risk 1 Weighing scales, manual handling Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com equipment Clean contact points each use, 1 full clean daily & between patient use Clean contact points each use, 1 full clean daily & between patient use Clean contact points each use, 1 full clean daily & between patient use NA 2 Medical equipment including intravenous infusion pumps, drip stands and pulse oximeters (not connected to a patient) 1 full clean daily and between patient use 1 full clean daily and between patient use 1 full clean daily and between patient use NA 3 Patient washbowls 1 full clean daily and between patient use 1 full clean daily and between patient use 1 full clean daily and between patient use NA 4 Bedside oxygen and suction Connectors. 1 full clean daily and between patient use 1 full clean daily and between patient use 1 full clean daily and b/w patient use NA 5 Oxygen Cylinders 1 full clean daily 1 full clean 1 full clean daily NA 6 Alcohol hand gel / soap container / dispenser / bracket / clipboard 1 full clean daily and between patient use if contaminated 1 full clean daily and between patient use if contaminated 1 full clean daily and between patient use NA 7 Chart trolley / Drug trolley 1 full clean weekly 1 full clean weekly 1 full clean weekly NA 8 Patient personal items 1 full clean daily 1 full clean daily 1 full clean daily NA 9 Switches, sockets and data points 1 full clean daily 1 full clean daily 1 full clean daily 1 full clean weekly
  20. 20. 10 Walls Check clean daily, wash twice yearly Check clean daily, wash twice yearly Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com Check clean weekly, wash yearly Check clean weekly, wash, every third yearly 11 Ceiling Wash yearly Wash yearly Wash yearly Wash every third yearly 12 All doors 1 full clean daily and 1 check clean 1 full clean daily and 1 check clean 1 full clean daily and 1 check clean 1 full clean weekly 13 All internal glass 1 full clean daily Check clean daily 1 full clean weekly Check clean daily 1 full clean weekly 1 full clean weekly 14 All external glass 1 full clean yearly 1 full clean yearly 1 full clean every second year 1 full clean every 3rd yr 15 Mirrors 1 full clean daily and 1 check clean 1 full clean daily and 1 check clean 1 full clean daily 1 check clean Full clean daily 16 Television 1 full clean daily 1 full clean daily 1 full clean daily 1 full clean weekly 17 Ventilation grilles, extracts and inlets 1 full external clean weekly and full clean twice yearly 1 full external clean weekly and full clean twice yearly 1 full external clean monthly and full clean yearly 1 full external clean monthly & full clean yearly 18 Floor - polished 2 full cleans daily 1 full cleans daily,1 clean check daily 1 full cleans daily, 1 clean check daily 1 clean check daily 1 full cleans weekly 19 Floor - Non-slip 2 full cleans daily, 1 full cleans daily, 1 clean check daily. 1 full cleans daily, 1 clean check daily 1 full cleans weekly, 1 clean check daily 20 Soft Floor (Carpet not recommended in clinical area) NA NA NA 1 check clean daily, 1 full clean weekly, wash yearly
  21. 21. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com 21 Pest control devices 1 full clean daily 1 full clean daily 1 full clean daily 1full clean weekly 22 Electrical items, e.g. overhead lights 1 check clean daily and 1 full clean monthly 1 check clean daily and 1 full clean monthly 1 check clean daily and 1 full clean monthly 1 check clean weekly & 1 full clean monthly 23 Cleaning equipment Full clean after each use Full clean after each use Full clean after each use Full clean after each use 24 High surfaces 2 full cleans weekly 1 full clean weekly and 1 check clean weekly 1 full clean weekly 1 full clean weekly 25 Low surfaces 2 full cleans daily 1 full clean daily and 1 check clean daily 1 full clean daily 1 full clean weekly 26 Chairs (Note: no soft fabric covered chairs in clinical areas) 1 full clean daily and 1 check clean daily 1 full clean daily and 1 check clean daily 1 full clean daily 1 full clean weekly 27 Beds / Patient couches / Trolleys / Mattresses Bed frame, including all component parts daily, mattress weekly and on discharge, total full clean on discharge Bed frame, including all component parts daily, mattress weekly and on discharge, total full clean on discharge Bed frame, with all component parts daily, mattress weekly and on discharge NA 28 Lockers / Wardrobes /Drawers 1 full clean daily and 1 check clean daily 1 full clean daily 1 check clean daily 1 full clean weekly 1 full clean weekly 29 Tables / Bed tables 1 full clean daily and 1 check clean daily 1 full clean daily 1 check clean daily and 1 full clean weekly 1 full clean weekly 30 All dispensers / holders 1 full clean daily 1 full clean daily 1 full clean daily 1 full clean daily 31 Waste receptacles / Sani-bins / Nappy bins 1 full clean daily and1 check clean daily and 1 deep clean weekly 1 full clean daily and1 check clean daily and 1 deep clean weekly 1 full clean daily and 1 deep clean week 1 full clean weekly & 1 deep clean monthly
  22. 22. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com 32 Curtains (window and cubicle) and Blinds Clean, change or replace yearly. Bed curtains quarterly Clean, change or Replace yearly. Bed curtains twice a year Clean, change or replace all curtains yearly Clean, change or replace two yearly 33 Fridge / Freezer 3 check cleans daily and 1 full clean weekly 3 check cleans daily and 1 full clean weekly 3 check cleans daily and 1 full clean weekly 1 check clean daily and 1 full clean weekly 34 Drinking water fountain / water cooler 1 full clean daily and 1 check clean daily 1 full clean daily and 1 check clean daily 1 full clean daily and 1 check clean daily 1 full clean daily and 1 check clean daily 35 Baths 1 full clean and 1 check clean daily 1 full clean and 1 check clean daily 1 full clean daily 1 check clean daily 1 full clean daily 1 check clean daily 36 Showers 1 full clean and 1 check clean daily 1 full clean and 1 check clean daily 1 full clean daily 1 check clean daily 1 full clean daily 1 check clean daily 37 Wash Hand Basins 3 full clean, 2 check cleans 3 full clean, 2 check cleans 3 full clean, 2 check cleans 3 full clean, 2 check cleans 38 Toilets / Urinals / Bidets 3 full clean, 2 check cleans 3 full clean, 2 check cleans 3 full clean, 2 check cleans 3 full clean, 2 check cleans 39 Computers / Telephones / Office Equipment 1 full clean daily 1 full clean daily 1 full clean daily 1 full clean weekly 40 Dirty Utility room 1 full clean and 1 check clean daily 1 full clean and 1 check clean daily 1 full clean daily 1 full clean daily 41 Cleaning Store /Janitor room Full clean after each use Full clean after each use Full clean after each use Full clean after each use 42 Entrance / Exit 2 full cleans daily 2 full cleans daily 2 full cleans daily 1 full clean daily
  23. 23. 43 Stairs (internal and external) 2 full cleans daily 2 full cleans daily 2 full cleans daily 1 full cleans daily 44 External areas 1 full clean daily 1 full clean daily 1 full clean daily 1 full clean daily 45 Dishwasher / microwave 1 full clean daily and 2 check cleans daily, and emptied after use 1 full clean daily and 2 check cleans daily, and emptied after use Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com 1 full clean daily and emptied after use 1 full clean daily, emptied after use 46 Kitchen Cupboards / Presses 1 full clean weekly 1 full clean weekly 1 full clean monthly 1 full clean 4 monthly 47 Cleaning equipment (Catering) Full clean after each use Full clean after each use Full clean after each use Full clean after each use 48 Diagnostic Imaging Portable - Machine Portable - portable grid/ film cassette Mammography - paddles When soiled and on leaving Contact precaution room Ideally should be covered (e.g., pillowcase )between patients if not covered Between patients When soiled Ideally should be covered (e.g., pillowcase) between patients if not covered. Between patients When soiled Ideally should be covered (e.g., pillowcase) b/w patients if not covered. Between patients NA 49 ECG Machine Cables Daily Between patients Daily Between patients Daily Between patients NA 50 Glucometer Between patients Between patients Between patients NA 51 Ophthalmo- scope Between patients Between patients Between patients NA 52 Otoscope: Handle and Ear speculum Between patients Between patients Between patients NA 53 Reflex Hammer Between patients Between patients Between patients NA 54 Defibrillator Between patients Between patients Between patients NA 56 Stretcher Between patients Between patients Between patients NA 57 Suction Machines Between patients Between patients Daily NA 58 Stethoscope Between patients Between patients Between patients NA 59 Telemetry Equipment Monitor and Cables Between patients Between patients Between patients NA
  24. 24. 60 Tourniquet Between patients Between patients Between patients NA 51 Ultrasound Transducers Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com Handle and Cable External Between patients Between patients Between patients NA 62 Wall-mounted Oxygen and Suction Fixtures Between patients Between patients Between patients NA 63 Intravenous (IV) Pumps, Poles, Warmers Between patients Between patients Between patients NA 64 Call Bell Daily /between patients Daily /between patients Daily /between patients Daily
  25. 25. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com
  26. 26. ENVIRONMENTAL CLEANING OF THE OPERATION THEATER S.NO FREQUENCY TASKS 1 At the Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com beginning of the day Clean floors and all horizontal surfaces operating / procedure tables, examination couches, chairs, trolley tops or Mayo stands, anesthesia machine, lamps, counters, and office furniture – with a cloth dampened with water to remove dust and lint that have accumulated over night. 2 Between patients Clean operating/procedure tables, examination couches, trolley tops or Mayo stands, lamps, counters, anesthesia machine and any other potentially contaminated surfaces in operating theatres and procedure rooms with a cloth dampened with a Clorox/ Bleach solution (100ml Bleach in 900ml water). • Immediately clean spills of blood or other body fluids with a Clorox / Bleach solution (100ml Bleach in 900ml water). • Clean visibly soiled areas of the floor, walls, or ceiling with a mop or cloth dampened with Clorox / Bleach solution (40-50 ml Bleach in One liter water). • Discard waste when plastic bags of waste containers are ¾ full. • Discard safety (sharps disposal) boxes, when they are ¾ full. • Do not perform special cleaning or closing of the operating theatres after contaminated or dirty operations. Thorough, routine cleaning is sufficient to provide a safe environment for subsequent cases 3 At the end of each session or day • Clean all surfaces – including counters, tables, lights, door handles– with detergent, water and disinfect with Clorox / Bleach solution (100ml Bleach in 900ml water) allow it to dry. Pay particular attention to Anesthesia machine operating/procedure tables, making sure to clean the sides, base, and legs thoroughly. • Clean sinks & sluice with water and detergent finally disinfect (40-50 ml Bleach in One liter water). • Wipe over non-metallic surfaces and equipment with Clorox solution (100ml Bleach in 900ml water). • Clean the floors with a mop soaked in a disinfectant solution (40-50 ml Bleach in One liter water). • Check safety boxes and remove and replace them if they are ¾ full. • Remove medical or hazardous chemical waste. Make sure to discard it properly and as soon as possible in order to limit contact with potentially infectious waste. • Clean non-clinical equipment, and containers with Clorox/Bleach solution (100 ml Bleach in 900ml water). 4 Each week • Clean all the areas inside the operating theatre complex with warm water, detergent & Clorox/Bleach solution (40-50 ml Bleach in One liter water). Allow it air dry. • Empty the storage shelves, wipe them, dry them, and then restack.
  27. 27. INFECTION CONTROL PROCEDURES FOR IMAGING CENTERS AND HOSPITAL RADIOLOGY DEPARTMENTS The cleanliness of imaging centers and hospital radiology departments is crucial for reducing the spread of MRSA and other acquired infections. The following are 11 simple procedures to implement that can prevent the spread of these infections. 1. Have a written infectious control policy to include MRI cleaning procedures as well as the cleaning schedule and have it posted throughout the center. 2. Implement a mandatory hand washing / hand sanitizing procedure between patient exams for technologists and any others who come into contact with patients. 3. Clean the MRI tables, inside the bore of the magnet and any other items that come into contact with a patient. Infection control experts recommend this be done between each patient. 4. Clean all pads and positioners with an approved disinfectant. Infection control experts recommend cleaning after each patient. 5. Periodically inspect the pads with a magnifying glass, particularly at the seams, to identify fraying or tearing. If present, the pads should be replaced. 6. Regularly check all padding material with an ultraviolet (black) light and make sure that any biological material detected on the pads can be removed. 7. Replace damaged or contaminated pads with new pads incorporating permanent antimicrobial agents. 8. Use pillows with a waterproof covering that is designed to be surface wiped. Replace pillows when their barrier is compromised. 9. Promptly remove body fluids, and then surface disinfect all contaminated areas. 10. If a patient has an open wound or any history of MRSA/other infection: a. Gloves and gowns should be worn by all staff coming in contact with the patient. These barriers must be removed before touching other areas not coming in contact with the patient, i.e. door knobs, scanner console, computer terminals, etc. b. The table and all the pads should be completely cleaned with disinfectant before the next patient is scanned, if it is not already being performed between every patient. For patients with any known infectious process add 10-15 minutes onto the scheduled scan time to assure there is enough time to thoroughly clean the room and all the pads. 11. All furniture should be periodically cleaned. Ideal surfaces are those that are waterproof and wipe-able. Infection control experts recommend this be done between each patient. Disinfectant Used: Bleach solution 1:10 dilution (100ml bleach in 900ml water) wipes can be use or EPA approved use disinfectant allowed by infection control dept Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com
  28. 28. MATERIAL SAFETY DATA SHEET OF CLOROX / BLEACH: Description: Clear, thin liquid with a mild bleach odor Health Hazard Data Causes moderate eye irritation. Avoid contact with eyes or clothing. Wash thoroughly with soap and water after handling. No medical conditions are known to be aggravated by exposure to this product. FIRST AID: EYE CONTACT: Rinse slowly and gently with water for 15-20 minutes. Remove contact lenses, if present, after the first 5 minutes, and then continue rinsing. If irritation persists, call a doctor. SKIN CONTACT: Rinse with plenty of water. If irritation persists, call a doctor. INHALATION: Remove to fresh air. If breathing problems develop, call a doctor. INGESTION: Drink a glassful of water. Call a doctor. REFERENCES: 1. Peninsula Community Health, Cleaning Policy & Manual, 2012. 2. Environmental hygiene Vol. 16, No. 9 September 2012, available at www.infectioncontroltoday.com. 3. PIDAC: Best Practices for Environmental Cleaning for Infection Prevention and Control, May 2012 4. Clorox service bulletin, 2011. 5. Birmingham Women’s Hospital (2009) Neonatal Unit Policy for Cleaning and Disinfection on Incubators/Cots. 6. Liverpool Women's Hospital NHS Foundation (2009) Infection Control Policy. 7. Carling PC, Parry MM, Rupp ME, Po JL, Dick B and Von Beheren S. Improving Cleaning of the Environment Surrounding Patients in 36 Acute Care Hospitals. Infect Control Hosp Epidem. Vol. 29, No.11. November 2008. 8. Feidhmeannacht na seirbhise Slainte, Health Service Executive, National Cleaning Manual Appendices, September 2006. 9. Centers for Disease Control and Prevention (CDC). Guidelines for Environmental Infection Control in Health‐Care Facilities. Recommendation of CDC and the Healthcare Infection Control Advisory Committee (HICPAC), 2003. 10. Article 3-2.6 of NAVMED P-5010 Manual of Preventive Medicine USA. 11. Preventing Infection in MRI -Best Practices: Infection Control in and around MRI Suites. Peter Rothschild, MD 2008. 12. Operating Theatre, faculty. ksu.edu.sa. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com
  29. 29. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com
  30. 30. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com
  31. 31. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com
  32. 32. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA. E.mail:anjumhashmi61@hotmail.com

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