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Environmental Cleaning

Environmental Cleaning. Objectives. Understand types of cleaners most commonly used in long term care facilities Understand how to write a policy and procedure for environmental cleaning in a patient room Understand how to monitor environmental cleaning.

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Environmental Cleaning

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  1. Environmental Cleaning

  2. Objectives • Understand types of cleaners most commonly used in long term care facilities • Understand how to write a policy and procedure for environmental cleaning in a patient room • Understand how to monitor environmental cleaning

  3. Environmental Cleaning and Its Relevance to Infection Prevention & Control • Primary focus must remain on protection of client/resident, staff and visitors • Practices must help minimize spread of infection • Practices are understandable and attainable • Practices must incorporate workflow measurement • Practices must be reviewed regularly to keep them current

  4. How Long Can Germs Live??? • Entercocci and staphylococci on hospital fabrics and plastics up to 90 days • MRSA outbreak strains-up to 9 weeks after drying • Gram-negative bacteria (pseudomonas aeruginosa, salmonella, E.coli etc)-on hospital fabrics and plastics up to 60 days • VRE-58 days on countertops • Influenza-48 hours on nonporous surfaces

  5. Principles of Effective Cleaning • Apply to all settings where care is delivered • Process • Selection of appropriate product for the task • Frequency

  6. Environmental Cleaning Principles Highest point and work towards the lowest From the outside to the inside From the cleanest to the dirtiest

  7. Environmental Cleaning Principles CLEAN IN AN ESTABLISHED PATTERN • Cleaning in a determined pattern will ensure that all surfaces are being cleaned • You will know where you left off if you are interrupted during cleaning

  8. Choosing a Disinfectant Microorganisms present a range of resistances to chemical disinfectants and no single disinfectant is effective in all situations. • Type of microorganism, number and presence of spores • Physical situation (e.g., surface type) • Contact available between disinfectant and microorganisms • Possible interaction between disinfectant and materials • Contact time allowable • Concentration • EPA registered Consider the following points when selecting a disinfectant:

  9. Choosing a Disinfectant • “Hospital disinfectant” effectiveness • Pseudomonas aeruginosa • Staphylococcus aureus • Salmonella choleraesuis • “Tuberculocidal” indicator of effectiveness • Broad spectrum

  10. Types of Disinfectants • Chlorine compounds • Generally used in the form of sodium hypochlorite • Alcohols • Ethanol (80% v/v ethyl alcohol) or 2-propanol (60-70% v/v isopropyl alcohol) solutions are used to disinfect skin and decontaminate clean surfaces • Hydrogen Peroxide • A concentration of 3% (weight/volume) generally used for disinfection

  11. Types of Disinfectants • Phenolics • Synthetic phenolics (clear soluble fluids) can be used as general disinfectants in the laboratory • Quaternary Ammonium Compounds • Quaternary ammonium compounds are positively charged surface active disinfectants

  12. Advantages and Disadvantages of Common Disinfectants Rutala WA et al. CDC Guideline for Disinfection & Sterilization In Healthcare Facilities, 2008

  13. Advantages and Disadvantages of Common Disinfectants

  14. Using Disinfectants Wisely • Item or surface must first be free of visible soil (unless using a combined cleaner/disinfectant) • Use according to the manufacturer instructions: • Dilution, temperature, contact time, etc. • No double dipping • No spraying disinfectants • Use proper PPE to prevent exposure to chemical as on MSDS

  15. Frequency of Cleaning High/low touch items Level of contamination Client/resident risk level FREQUENCY OF CLEANING

  16. Frequency of Cleaning: High-touch Surfaces Determine your own high-touch surfaces! • Sink tops • Door handles • Support rails • Toilet handles • Toilet seat • Light switches • Bed pan cleaners • Remote controls • Over bed tables • Telephones • Bed rails • Patient/visitor chairs • Dressers • Computer stations

  17. Frequency of Cleaning Level of Contamination • Heavy contamination • Exposed to major amounts of blood or body fluids (bathrooms of client/resident with diarrhea) • Moderate contamination • Exposed to some amounts of blood or body fluids (client/resident room or bathroom) • Light contamination • Not exposed to blood or body fluids (offices, lounge, library)

  18. Frequency of Cleaning Client/Resident Risk Group • More at risk persons • Chemotherapy, dialysis, burns or other major wounds, indwelling devices, etc. • MDRO patients, CDI patients • Less at risk persons • All others

  19. Determining How Often To Clean = cleaning once a day and when soiled.

  20. Applying the Scores

  21. Documenting Cleaning Policies • Plan components • Defined responsibilities for items and areas • Procedures for various cleaning tasks • Procedures for specific organisms that transmit well in the environment • Procedures for outbreaks • Cleaning standards including how often to clean • Monitoring process • Education

  22. Is It Really Clean? • Not just a visible check! • Must include audits of actual work • May use “markers” e.g. glo germ solution to check for “missed” spots • Cultures are not generally recommended

  23. Exercises DISCLAIMER: The product insert(s) used for the exercises in no way imply endorsement or recommendations of these products by the West Virginia Department of Health and Human Resources. They are used for educational purposes only.

  24. Reading a Product Insert • Which category of cleaner is this product? • What are the ingredients and concentrations? • What organisms is this effective against? • What is the contact time? • How should the product be applied? • Is any PPE needed to use the product? • Are there special instructions for specific organisms?

  25. Group Exercise – Writing a Cleaning Plan for Long Term Care • Scenario: • 86 year old with VRE infection of the urine. • Limited mobility; uses bedside commode and community showers • Incontinent of urine and stool usually contained with adult briefs • Has to be reminded to wash hands

  26. Writing a Cleaning Plan • Materials: • Exercise Worksheet (in notebook) • One copy for each table: • Pictures of patient room • Product Inserts • Using the exercise sheet and the materials provided, write a cleaning plan • Be prepared to discuss your plan

  27. Discussion • Bed rails, call light, TV remote • Product: • How to use: • Contact time: • How frequently? • Who? • (why?)

  28. Discussion • Sink and fixtures: • Product: • How to use: • Contact time: • How frequently? • Who? • (why?)

  29. Discussion • Bedside commode: • Product: • How to use: • Contact time: • How frequently? • Who? • (why?)

  30. Discussion • Bathroom: • Product: • How to use: • Contact time: • How frequently? • Who? • (why?)

  31. Acknowledgments and References • Ontario Public Health Agency of Canada • CDC Environmental Guidelines for Health Care Facilities • APIC Guide to Elimination of MRSA in the Long Term Care Facility

  32. QUESTIONS? THANK YOU!

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