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Best Practices for Environmental Cleaning Module 4 – General Cleaning Part A - Cleaning Best Practices for Environmental Cleaning Module 4 – General Cleaning Part A - Cleaning Principles

Learning Objectives 1. To identify factors that determine frequency of cleaning. 2. To correctly Learning Objectives 1. To identify factors that determine frequency of 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) 2

General Cleaning These principles apply to all settings where “hospital clean” is required. 3 General Cleaning These principles apply to all settings where “hospital clean” is required. 3

Hotel Clean & Hospital Clean Hotel Clean: • is a measure of cleanliness based 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 4

Cleaning Frequencies – Factors Influencing Frequency • Surfaces high-touch or low-touch § Door knob 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) 5

Cleaning Frequencies – Factors Influencing Frequency High-Touch Surfaces: • Are those that have frequent 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. 6

Cleaning Frequencies – Factors Influencing Frequency High-touch surfaces How many high touch surfaces can Cleaning Frequencies – Factors Influencing Frequency High-touch surfaces How many high touch surfaces can you identify in this picture? High-touch surfaces. High-touch Items and Surfaces in the Health Care Environment Examples of NOTE: Dots indicate areas of highest contamination and touch Figure 1 7

Cleaning Frequencies – Factors Influencing Frequency High-touch surfaces More examples of high-touch Items and 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 8

Cleaning Frequencies – Factors Influencing Frequency Low-Touch Surfaces: • Are those that have minimal 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. 9

Cleaning Frequencies – Factors Influencing Frequency High-Touch vs Low-Touch Surfaces: • The frequency of 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 10

Factors that Impact Cleaning • Factors that will impact the frequency of environmental cleaning 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 11

Probability of contamination • Heavy – surfaces/equipment routinely exposed to copious amounts of fresh Probability of contamination • Heavy – surfaces/equipment routinely exposed to copious amounts of fresh blood or other body fluids birthing suite, ER, bathrooms if visible soil) (e. g. • 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) 12

Vulnerability to infection • Vulnerability of client/patient/resident § More susceptible – those who are Vulnerability to infection • 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 13

Risk Stratification • Determine the risk Probability of Contamination with pathogens High-touch surfaces (score Risk Stratification • Determine the risk Probability of Contamination with pathogens High-touch surfaces (score = 3) Low-touch surfaces (score = 1) More Less susceptible Score=1 Score=0 score=1 Score=0 Heavy Score=3 7 6 5 4 Moderate Score=2 6 5 4 3 Light Score=1 5 4 3 2 14

Risk Stratification Matrix • Determine the cleaning frequency based on risk stratification matrix Total Risk Stratification Matrix • Determine the cleaning frequency based on risk stratification matrix Total Risk Score Risk Type Minimum Cleaning Frequency High Risk Clean after each case/event/procedure and at least twice per day Clean additionally as required 4 -6 Moderate Risk Clean at least once daily Clean additionally as required (e. g. gross soiling) 2 -3 Low Risk Clean according to a fixed schedule Clean additionally as required (e. g. gross soiling) 7 15

Example - Hospital An Intensive Care Unit: • Probability of contamination is heavy = 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 16

Example - LTC A Resident Activity Room: • Probability of contamination is moderate = 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 17

Learning Checkpoint 18 Learning Checkpoint 18

Learning Checkpoint • Identify whether the following items are ‘high-touch’ or -touch’ surfaces. ‘low Learning Checkpoint • Identify whether the following items are ‘high-touch’ or -touch’ surfaces. ‘low § Toilet handle § Soap dispenser § Baseboard § Wall § Bathroom mirror § Faucet handles § Window coverings § Ceiling lights 19

Learning Checkpoint Answers • The correct answers are: § Toilet handle - high § 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 20

References Fig 1 -2: Provincial Infectious Diseases Advisory Committee (PIDAC). Best Practices for Environmental 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%20 Practices%20 for%20 Environmental%20 Cleaning. pdf 21

Thank You! Thank You!

Image Sources – Module 4 A • Microsoft Clipart used in Slide 18 • Image Sources – Module 4 A • Microsoft Clipart used in Slide 18 • Images in slides 7, 8 & 10 are © PHO 2013