NOW AVAILABLE. on CD ROM!

Transcription

1 NOW AVAILABLE on CD ROM!

2 End User Module Table of Contents Account Overview Organizational Chart of Cleaning & Sanitation Responsibilities Personnel Listing Special Departments With Special Needs Labor Cost & Training Important Issues Nosocomial Infection OSHA s Bloodborne Pathogen Standard Types of Disinfectants Departmental Product Listing Health Care Cleaning and Sanitation Procedures Floor Care Carpet Care Patient Rooms Handwashing Wall Chart Handwashing Occupied Patient Room Occupied Patient Isolation Room Patient Restroom Patient Discharge Room Patient Discharge Isolation Room Waste Removal Dietary/Food Service Clean-up Operating Rooms Emergency Room Delivery/OB Elevators Stairways Wall Washing Locker Rooms/Shower Rooms Lounges PT/Fitness Canberra Corporation 1994

3 End User Module Table of Contents (continued) Health Care Cleaning and Sanitation Procedures (continued) Whirlpools Ward Recovery Carts, Closets, Equipment & Supplies Public Restrooms Other Public Areas Glossary of Terms Addendum Vancomycin Resistant Enterococcus Guideline for Isolation Precautions in Hospitals Microbial Resistance to Drug Therapy: A Review Skills Inventory Checklist Daily Housekeeping Form * 3 Dimensional Virtual Reality training available on CD-ROM for this module from your distributor. *All information in this seminar is available on CD ROM.

4 Account Overview Section A Organizational Chart of Cleaning & Sanitation Responsibilities Board of Directors/ Administrator Risk Management Director of Nursing Infection Control Committee Purchasing Agent Environmental Services Director Quality Assurance Dietary Laundry Cardiology Radiology Maintenance Obstetrics/ Pediatrics Surgery Lobby, Visitors Lounges, Rest Rooms Respiratory Care Forensics Pathology Emergency/ Out Patient Services Accounting/ Computer Room Intensive/ Critical Care Units Physical Therapy Other

5 Account Overview (continued) Section B Personnel Listing Infection Control Committee Consists of doctors, Quality Assurance (QA) Nurse, Administrator, Risk Management, Environmental Services, Licensed Practical Nurse (LPN), Public Affairs, Director of Nursing (DON) A doctor is normally appointed as committee chairman Accountable for entire facility as it relates to the control of infectious waste, as well as the protection and sanitization/disinfection of the people, the facility and the instruments therein Infection Control Nurse Meets bi-monthly/monthly with Infection Control Committee and other departments Appointed to the position of Infection Control Nurse (ICN) by Infection Control Committee (ICC) Audits all departments Maintains records of procedures and criteria Ultimately decides upon which suppliers and which disinfectants are to be utilized Is the final word on any products, procedures, and vendors utilized in the cleaning and sanitization program Director of Nurses Usually a Registered Nurse (RN) Trains all nursing personnel May direct personnel in proper sanitization of beds and exam tables during periods between patients in Emergency and Out Patient Services Departments Environmental Services Director Responsible for maintaining a clean and sanitized environment throughout the facility Evaluates potential vendors and products Responsible for training all department personnel Is audited by Infection Control Committee, Infection Control Nurse, Purchasing, Risk Management, QA, and Hospital Administrator May have one or multiple supervisors under this position Responsible for controlling labor costs

6 Account Overview (continued) Section B Personnel Listing Purchasing Evaluates vendors based upon performance rating from requisitioning department Evaluates vendors by delivery, price, quality and customer service criteria Issues purchase orders in most cases Laundry Normally off site Is sometimes managed by Environmental Services Director Use rest room, floor care, office cleaning and maintenance-type cleaners and supplies as well as laundry and sanitizing compounds Launder and sanitize wet mops, as a rule Responsible for departmental budget Dietary Managed by head dietitian Department stands alone and is normally not cleaned by Environmental Services Required to comply with USDA, EPA, OSHA, & FDA cleaning guidelines Consists normally of large food service equipment which requires daily attention Normally evaluates all potential products, services and vendors Responsible for departmental budget Maintenance Managed by maintenance manager and/or supervisor of building & grounds Responsible for entire facility maintenance Evaluates potential products, services and vendors as applicable Controls all buildings and grounds maintenance operations Responsible for departmental budget

7 Account Overview (continued) Section C Special Departments With Special Needs Outpatient Services Emergency Room Laundry Maintenance/Building & Grounds Dietary

8 Account Overview (continued) Section D Labor Cost & Training A. Labor: Factors that effect health care labor costs 1) Budget cuts and limitations 2) Increased procedural requirements caused by regulations a. Frequency of bucket changes b. Waste disposal techniques c. Increased number of isolation cases d. Bloodborne pathogen regulations 3) Liability issues audited by the following regulatory agencies: a. OSHA (O S H A ) b. EPA (E P A ) c. JCAHO ( J C A H O ) d. AHA (A H A ) e. CDC (C D C ) B. Training: Factors that effect training requirements in health care institutions 1) Bloodborne Pathogen Standard (See Important Issues, Section 2) 2) OSHA a. Right to Know Law which requires Material Safety Data Sheets (MSDS) b. Injury prevention measures 3) Increasing complexity of chemical applications 4) Sources for training information a. Interdepartmental policies and procedures b. IEHA (I E H A ) c. AHA (A H A ) d. AOAC (A O A C ) e. CDC (C D C ) f. Vendor inservice training g. Industry trade publications h. APIC (A P I C ) 5) Patient Focused Care (Care 2000) a. Reduce the number of hospital Care providers seeing patient b. Increase use of RTU Disinfectants by non-environmental services personnel ANSWERS: 3a. Occupational Safety & Health Administration b. Environmental Protection Agency c. Joint Commission on Accreditation of Health Care Organizations d. American Hospital Association e. Centers for Disease Control 4b. International Executive Housekeepers Association c. American Hospital Association d. Association of Official Analytical Chemists e. Centers for Disease Control. Association for Professionals in Infection Control and Epidemiology, Inc.

9 Important Issues: Section 1 Nosocomial Infection A. Nosocomial infection: a cross-contamination via person-to-person or inanimate surface-to-person inside the hospital environment. There is increased concern regarding the rate of nosocomial infection nationally, especially the plasmid mediation of antibiotic resistance. B. Three conditions must be present for cross-contamination to occur 1) Source of infection 2) Method of transmission a. Person-to-person b. Inanimate surface-to-person 3) Susceptibility of host C. How to prevent transmission 1) Personal hygiene practices a. Hand washing (See procedures in End User Module) b. Safety/Personal Protective Equipment (PPE) 2) Proper housekeeping practices a. Proper hard surface sterilization and disinfection practices b. Proper clean up and disposal of infectious waste and sharps c. Changing of mop water every three rooms d. Training of housekeeping staff Section 2 OSHA s Bloodborne Pathogen Standard A. OSHA s Occupational Exposure to Bloodborne Pathogens: Final Rule, effective 3/92 1) Concerned with two bloodborne pathogens of most consequence a. Hepatitis B Virus (HBV) b. Human Immunodeficiency Virus (HIV) B. Requires employers to develop an Exposure Control Plan (ECP) to contain the following: 1) Determination of exposure risks by position and procedures 2) Methods of compliance a. Universal Precautions OSHA s accepted method of infectious control b. Engineering and work practice controls c. Personal Protective Equipment d. Housekeeping aa. Written schedule: Requires written schedule for cleaning and decontamination for each location in facility bb. Disinfection 1. Specifies levels of disinfection and procedures which must be followed 2. Defines appropriate disinfectant as an intermediate-level disinfectant which has been certified effective against TB or a HBV-effective product as Registered by the EPA.

10 Important Issues (continued) Section 2 OSHA s Bloodborne Pathogen Standard (continued) B. Requires employers to develop an Exposure Control Plan (ECP) to contain the following: (continued) e. Regulated waste containment and disposal 3) HBV vaccinations (Hepatitis B Virus), post-exposure evaluations and follow up 4) Communication of hazards (training, labels and signs) 5) Record keeping C. Bloodborne Pathogen Compliance Facts: 1) OSHA does recognize EPA Registered HBV Kill claims as Bloodborne Pathogen compliant 2) OSHA still requires an intermediate level disinfectant if not HBV efficacious Section 3 Types of Disinfectants A. Disinfection 1) Disinfection, which is a less lethal process than sterilization, eliminates virtually all recognized pathogenic microorganisms but not necessarily all microbial forms (e.g., bacterial endospores) on inanimate objects. There are these levels of disinfectants: a. High Level The minimum treatment recommended by CDC in guidelines for the reprocessing of semicritical instruments or devices. b. Intermediate Level Not necessarily capable of killing bacterial spores, but does inactivate M. tuberculosis var., bovis, which is significantly more resistant to aqueous germicides than are ordinary vegetative bacteria. c. Low Level Cannot be relied on to destroy, (within a practical period of time) bacterial endospores, mycobacteria, all fungi, or all small or nonlipid viruses. These disinfectants may be useful in actual practice because they can kill rapidly vegetative forms of bacteria and most fungi, as well as medium-size or lipid-containing viruses. 2) Intermediate to low-level disinfectants can make three types of claims: a. General Staphylococcus Aureus (Low Level) Salmonella Choleraesuis b. Hospital Pseudomonas Aeruginosa (Low Level) Salmonella Staphylococcus Aureus (Also those eliminated by general disinfectants) c. Tuberculocidal T/B Microbe (Intermediate Level) (Also those eliminated by hospital and general disinfectants) 3) Antisepsis: The use of antiseptics, which are germicides used on skin or living tissue, for the purpose of inhibiting or destroying microorganisms. 4) Sterilization: The use of agents generally known as sporicides intended to destroy or eliminate living microorganisms in a given environment. The highest level of disinfection available.

11 Important Issues (continued) Section 3 Types of Disinfectants (continued) B. Descending order of resistance of pathogenic microorganisms to germicidal chemicals, from most resistant to least resistant Disinfectant Levels Bacterial Spores Mycobacteria Nonlipid or Small Viruses Fungi Vegetative Bacteria Lipid or Mid- Size Viruses High Level Intermediate Level Low Level Bacillus subtilis & Clostridium sporogenes Mycobacterium tuberculosis var. bovis Poliovirus, Coxsackie virus, & Rhinovirus Trichophyton sp., Cryptococcus sp., & Candida sp. Pseudomonas aeruginosa, Staphylococcus aureus, & Salmonella choleraesuis Herpes simplex virus, Cytomegalovirus, Respiratory syncytial virus, & Human immunodeficiency virus C. Virus: A microscopic organism which lives and reproduces inside the cells of other living organisms. A virus lacks the capacity to reproduce without the host cell. Disease results from the damage done by a virus taking over the host cell. Common diseases caused by viruses: Common cold, HIV-1, AIDS, Herpes Simplex I & II, Influenza. D. Bacteria: Single-celled organism, often disease producing. E. Chemical Antimicrobial Agents (L) = Low Level Disinfectant (I) = Intermediate Level Disinfectant (H) = High Level Disinfectant (S) = Sterilant

12 Important Issues (continued) Section 3 Types of Disinfectants (continued) E. Chemical Antimicrobial Agents (continued) Disinfectant Advantages Disadvantages Alcohols (I) Aldehydes (S) Oxiranes Gases (S) Phenolics Carbolic Acid (I), (L) Ethyl and isopropyl alcohols- Alcohol preparations used on equipment and other material that is not damaged by their solvent action. Formaldehyde can be used as a sporicide and disinfectant in enclosed areas (such as rooms or small chambers) Glutaraldehyde formulations are used in hospitals and dental offices to disinfect and sterilize medical equipment Ethylene oxide is an effective gas widely used to sterilize medical supplies that may be damaged by heat. Effective against TB microbe Methyl alcohol is not generally used for disinfection because it is toxic and is a weak bactericide. Alcohols are flammable. Penetrates poorly Must maintain high humidity Formaldehyde is a potential occupational carcinogen Some products are flammable and explosive. Irritating to health care workers skin (can be absorbed by skin) Causes depigmentation of the skin Toxic Causes hyperbilirubinemia in infants Poor water solubility causes inefective disinfection Upper respiratory irritant Sodium Hypochlorite (Bleach)(I) (Halogen Chemical Family) Low use concentration Low water temperatures Not affected by hard water Rapid kill on precleaned surfaces Corrosive to metals (equipment, furniture) Deactivates when exposed to UV light (sunlight, fluorescent lights) Rapidly deactivates in presence of soil Fresh solutions must be made daily (labor cost) Surfaces require precleaning prior to disinfection (labor cost) Evaporates prematurely when mixed with hot water. Will bleach out carpeting or clothing contacted.

13 Important Issues (continued) Section 3 Types of Disinfectants (continued) E. Chemical Antimicrobial Agents (continued) Disinfectant Advantages Disadvantages Iodophors Halogen (Iodines) Chemical Family (I), (L) Rapid kill time on precleaned surfaces Not affected by hard water Rapidly deactivated by organic soil load Poor cleaner Toxic Must preclean surfaces prior to disinfection (labor cost) Inactivated by anionic detergents Staining of skin, clothes, hard surfaces Interferes with chemistry test evaluations Quats (L) Excellent cleaners allow one-step clean/disinfection High soil load tolerance, remains active Hard water tolerant, remains active Less toxic, less harmful to the skin Non-staining Full spectrum bacteria/virus kill of prime hospital pathogens Has extended shelf life. Broad spectrum kill Easily formulated over a wide ph range (ph-1-13) Will improve cleaning of detergent formulations No residual odor; easily fragranced Excellent long-term storage in both concentrated and diluted forms. Some formulas have obtained intermediate level status Some formulas have obtained VRE/ MRSA efficacy Some formulas have obtained HBV, HCV, VISA, VRSA, VIMRSA and HIV efficacy Some formulas are Bloodborne Pathogen Compliant Not sterilant Not sporicidal

14 Important Issues (continued) Section 3 Types of Disinfectants (continued) F. The Evolution of Quaternary Ammonium Chloride Compounds 1) 1st Generation a. Early 1900 s b. Dimethyl Benzyl Ammonium Chloride c. Good germicide d. Effectiveness compromised by hard water, soap & soils 2) 2nd Generation a. Mid 1900 s b. Ethyl Benzyl Chloride c. Dual quaternary link with Alkyl chain d. Better effectiveness in presence of hard water 3) 3rd Generation a. Mid 1960 s b. Didecyl Dimethyl Ammonium Chloride c. Twin chain compounds d. Remain active in hard water e. Tolerant of Anionic residues 4) 4th Generation a. Late 1900 s b. Alkyl/twin chain combination c. Best combination for cleaning & efficacy d. Tolerant of hard water, soils & Anionic residues 5) 5th Generation a. Late 1990 s s b. Antibiotic Resistent Pathogen Efficacy c. VRE, MRSA, VRSA, VIMRSA d. Intermediate level disinfectant status with T/B claims (RTU) 1. Utilizes glycol-ether to break down protienatious, lipid and wax coatings surrounding the TB Microbe. e. HBV, HCV Efficacy 1. Bloodborne Pathogen Compliant

15 Product Listing by Department Broad Gen. TB Dilu. Environmental Product VRE MRSA Spec. Disn. Claim Rates Services Dietary ER/OPS Maintenance Laundry 302 D/T Y Y Yes *RTU For weekly cleaning For weekly cleaning For weekly cleaning For weekly cleaning Bowl Cleaner & disinfection of & disinfection of & disinfection of & disinfection of toilets & urinals. toilets & urinals. toilets & urinals. toilets & urinals. 305 T/C Bowl/ Yes *RTU } For cleaning & For cleaning & Tile/Porcelain disinfection of disn. of tubs, tile, Cleaner tubs, tile, porcelain, grout 4030 Multi-Sur- 1 oz./ porcelain, grout & fiberglass. face Bathrm. Clr. gal. & fiberglass. 315 Mid Acid Yes *RTU For weekly cleaning For weekly cleaning For weekly cleaning For weekly cleaning Bowl Cleaner & disinfection of & disinfection of & disinfection of & disinfection of toilets & urinals. toilets & urinals. toilets & urinals. toilets & urinals. 319 E/N/A Y Y Yes *RTU Used daily for clean- Used daily for clean- Used daily for clean- Used daily for clean- Disinfectant Clnr. ing & disinfection ing & disinfection ing & disinfection ing & disinfection 320 N/A Bowl Y Y Yes *RTU of toilets, urinals & of toilets, urinals & of toilets, urinals & of toilets, urinals & & Bathrm. Clnr. other hard surfaces. other hard surfaces. other hard surfaces. other hard surfaces. 325 T/N/A Bowl Y Y Yes *RTU & Bathrm. Clnr. 330 Automatic Yes *RTU For control of metal For control of metal For control of metal For control of metal Toilet Bowl deposits on toilet deposits on toilet deposits on toilet deposits on toilet Cleaner back interior. (tank) back interior. (tank) back interior. (tank) back interior. (tank) 400 Bacterial *RTU Treatment of floor Treatment of floor Treatment of floor Treatment of floor Digestant drains, slop sinks, drains, grease traps sinks drains. drains, slop sinks, Deodorant urinals, toilets & (daily) slop sinks. (Twice weekly) urinals, toilets & lavatories. (Twice weekly) lavatories. (Twice weekly) (Twice weekly) 402 Bio- *RTU Opening clogged or Opening clogged or Opening clogged or Opening clogged or Opening clogged Enzymatic slow drains & slow drains & slow drains & slow drains & or slow drains & Drain Opener cleaning/purging cleaning/purging cleaning/purging cleaning/purging cleaning/purging grease traps. grease traps. grease traps. grease traps. grease traps. 410 Acidulous 5 oz./ } For deep For deep For deep Quarry Tile gal. cleaning of cleaning of cleaning of Renovator cement & quarry cement & quarry cement & quarry 3410 Tile, Grout 1cart/ tile floors. tile floors. tile floors. Bathrm. Clr/Deo. 30 oz (Interim (Interim (Interim 9030 Multi-Surf. bottle maintenance) maintenance) maintenance) Bathroom Clnr. 415 Foaming N Y 4 oz./ Shower room/stall Shower room/stall Disn. Clnr. Con. gal. cleaning & disn. cleaning & disn. } 420 Glass, Plastic *RTU For cleaning Show cases, For cleaning For cleaning For cleaning & Screen Clr. RTU & static glass, shelves, & static & static & static 421 Glass, Plastic 6 oz./ control of windows, control of control of control of & Screen Cleaner gal. screens, mirrors, screens, screens, screens, Concentrate equipment surrounding equipment equipment equipment 3421 Glass & Hard Surface 1cart/ 30 oz key pads, fragile work areas & cash key pads, fragile key pads, fragile key pads, fragile Cleaner spray plastics register. plastics plastics plastics bottle & windows. (Daily) & windows. & windows. & windows. 430 Creme Yes *RTU Used to clean sinks, Used to clean sinks, Used to clean sinks, Used to clean sinks, Cleanser chrome & stainless chrome & stainless chrome & stainless chrome & stainless steel. (Non-food steel. (Non-food steel. (Non-food steel. (Non-food contact areas only) contact areas only) contact areas only) contact areas only) * RTU = Ready to use 04/11

16 Product Listing by Department (continued) Broad Gen. TB Dilu. Environmental Product Spec. Disn. Claim Rates Services Dietary ER/OPS Maintenance Laundry 440 Soft 1 oz./ For hand washing Lotion Hand gal. pots, pans, knives, Dishwashing spoons, glasses, Concentrate dishes & cooking USDA A1 utensils. (Daily) 470 Oven *RTU Deep cleaning ovens, & Grill Cleaner vents, hoods, deep fat fryers, & grills. (Daily or weekly) } 9700 All Purpose 1 oz./ Deep cleaning Deep cleaning Deep cleaning Deep cleaning Cleaner gal. of resilient of resilient of resilient of resilient 701 Economy 3 oz./ tile flooring tile flooring tile flooring tile flooring Multi-Purpose gal. with blue with blue with blue with blue Synthetic Deterg. pad pad pad pad Complex before before before before 3700 Deep Scrub 4 oz. recoating. recoating. recoating. recoating. Multi-Purpose pouch/ (Interim (Interim (Interim (Interim Cleaner 4 gal. maintenance) maintenance) maintenance) maintenance) 6700 All Purpose 1-4 oz./ Cleaner gal. 702 No Rinse 2 oz./ } Daily damp Daily damp Daily damp Daily damp Damp Mop gal. mopping of mopping of mopping of mopping of Cleaner resilient tile floors resilient tile floors resilient tile floors resilient tile floors 3702 Neutral 4 oz. & deep cleaning & deep cleaning & deep cleaning & deep cleaning Damp Mop pouch/ of resilient tile of resilient tile of resilient tile of resilient tile Cleaner 4 gal. flooring with blue flooring with blue flooring with blue flooring with blue 9072 Neutral.5 oz./ pad before pad before pad before pad before Damp Mop Cleaner gal. recoating. (Interim recoating. (Interim recoating. (Interim recoating. (Interim 6072 Neutral Damp.5-2oz./ maintenance) maintenance) maintenance) maintenance) Mop Cleaner gal. 703 Low Suds 3 oz./ Deep cleaning of Automatic gal. resilient tile flooring Scrubber Floor with blue pad on Cleaner automatic scrubber before recoating. (Interim maintenance) 704 Rinse Free 32 oz./ Stripping finished Floor Stripper gal. floors. (Interim maintenance) 706 Butyl Free, 32 oz./ For low odor Low Odor gal. removal of heavy UHS Floor build-up of finish Stripper on floors & base- GS709 Low Odor boards. (Interim Floor Fin. Remover oz./gal. maintenance) 707 Super 12 oz./ Stripping finished Charged Rinse gal. floors. (Interim Free Floor maintenance) Stripper 710 Floor 2 oz./ For removal of Cleaner & gal. alkaline residue Neutralizer from resilient tile floors after * RTU = Ready to use stripping. 04/11

17 Product Listing by Department (continued) Broad Gen. TB Dilu. Environmental Product VRE MRSA Spec. Disn. Claim Rates Services Dietary ER/OPS Maintenance Laundry 725 Water *RTU For daily dust Based Dust mopping of most Mop Treatment hard floors & surfaces. 800 N/D Y 2 oz./ } Germicidal gal. Cleaner 801 H/D/Q Yes.5 oz./ For general For general For general For general Germicidal Clnr. gal. hospital-type hospital-type hospital-type hospital-type 802 H/F Disn Y Y Yes 4 oz./ disinfection disinfection disinfection disinfection Cleaner gal. of resilient of resilient of resilient of resilient 805 Neutral Y Y Yes 1 oz./ floors & floors & floors & floors & Disnf. Cleaner gal. other other other other 806 Neutral Y Y Yes.5 oz./ hard hard hard hard Hospital Disnf. gal. surfaces. surfaces. surfaces. surfaces Germicidal Y Y Yes 1 cart/ Cleaner 30 oz 3806 Neutral Y Y Yes 1 oz./ Dis. Damp Mop gal. 891 Arena Y Y Yes 1 oz./ Disinfectant gal Disinfectant Y Y Yes 1/2 oz./ Cleaner gal Disinfectant Y Y Yes 1/2 oz./ Cleaner gal. 803 S/V Yes.25 } Use in third sink Disinfectant oz./ for sanitizing pots USDA D2 gal. & pans. Final 830 Food Serv. *RTU application if Sanitizer sanitizer to all surfaces that require it. (Daily) 804 G/P Yes *RTU } For general Excellent Non-Acid spray & for post- Disinfectant wipe exam Cleaner cleaning & cleaning & 814 Q/T Tuber- Y Y Yes Yes RTU disinfection. disinfection. culocidal Spray Disnf. Clnr. 810 T/B Yes Yes 1 oz./ For TB kill, general For TB kill, general For TB kill, general For TB kill, general For TB kill, general Concentrate gal. disinfection & disinfection & disinfection & disinfection & disinfection & Hospital bloodborne bloodborne bloodborne bloodborne bloodborne Disnf. Clnr. pathogen pathogen pathogen pathogen pathogen standard standard standard standard standard compliance. compliance. compliance. compliance. compliance. 820 H/B/V Y Y Yes Yes 2 oz./ For HBV kill, For HBV kill, For HBV kill, For HBV kill, For HBV kill, Concentrated gal. general disinfection general disinfection general disinfection general disinfection general disn. Hospital & bloodborne & bloodborne & bloodborne & bloodborne & bloodborne Disinfectant pathogen standard pathogen standard pathogen standard pathogen standard pathogen standard compliance. compliance. compliance. compliance. compliance. 901 Solvent 12 For extra heavy For extra heavy Based oz./ degreasing degreasing Industrial gal. operations such as operations such as Cleaner/ equipment & equipment & Degreaser stationary power stationary power tools. tools. * RTU = Ready to use 04/11

18 Product Listing by Department (continued) Product Broad Gen. TB Dilu. Environmental Spec. Disn. Claim Rates Services Dietary ER/OPS Maintenance Laundry 902 Non-Butyl 8 oz./ Removal of heavy For extra heavy For extra heavy Industrial gal. organic grease/oil degreasing degreasing Detergent build up on floors, operations such as operations such as Complex walls, equipment, equipment & equipment & 911 Non- 8 oz./ conveyors, service stationary power stationary power Chlorinated carts, display cases tools. tools. Industrial gal. & spot cleaning. Solvent USDA A-1 (Daily) 903 Food 12 Removal of heavy Service oz./ organic grease/oil Foaming gal. build up on floors, Degreaser USDA A1 walls, equipment, conveyors, service carts, display cases & spot cleaning. (Daily) 906 O/O RTU Multi *RTU } For heavy For heavy For heavy Purpose Clr & Deg duty duty duty 907 O/O Conc. Conc. degreaser degreaser degreaser Multi-Purpose spray spray spray Cleaner & Degrs. & wipe & wipe & wipe 908 O/G Conc. Multi-.5-4 application & application & application & Purpose Clnr. & Deg. oz./gal. permanent permanent permanent 910 Industrial *RTU ink ink ink Strength Spray & remover. remover. remover. Wipe Cleaner Degreaser 3910 Multi-Purpose 8 oz./ Degreaser gal Heavy Duty *RTU Degreaser Cleaner **1000 Semi-Perma- *RTU } For sealing nent Resilient Floor resilient tile & Concrete Sealer before applying **1001 Resilient *RTU floor finish. Floor Sealer **1018 High *RTU } Applying Gloss Economy finish Floor Finish to GS1018 Floor *RTU the Sealer/Finish floor **1020 High Gloss *RTU after Premium Flr. Fin. sealing. **1022 Ultra *RTU Versatile Premium Floor Finish **1025 High Per- *RTU formance UHS Premium Floor Finish GS1025 Low Odor *RTU Floor Finish 1041 Multi- 42 oz./ For spray buffing, Purpose gal. mop-on, restoring Rejuvenator & auto scrubbing to restore gloss. (Daily) * RTU = Ready to use **Exceeds UL Standards 04/11

19 Product Listing by Department (continued) Broad Gen. TB Dilu. Environmental Product Spec. Disn. Claim USDA Rates Services Dietary ER/OPS Maintenance Laundry 1100 Traffic *RTU For spot cleaning/ Lane, Bonnet spot bonnet cleaning or Cleaner & Solvent 16 oz./ pre-spraying of walk- Spotter gal. off mats & carpeting bonnet in non-food processing areas. (Daily) For pre-spray treatment before extraction Extraction 2 oz./ For extraction cleaning Carpet gal. of walk-off mats, Concentrate upholstery & carpeting in non-food processing areas. (Interim mnt.) 1120 Dry Foam 16 For rotary shampoo Carpet Shampoo oz./ cleaning of walk-off gal. mats, upholstery & carpeting in non-food processing areas. (Interim maintenance) 1130 Foam 1 oz./ Defoaming agent for Control Agent 5 gal. extractors w/d vacs & auto scrubbers in nonfood processing areas. (Interim maintenance) 1140 Bio-Clenz *RTU Walk-off mat/carpet Spot Cleaner spotter for organic food-based stains in non-food processing areas. (Interim mntce.) 1150 Tannin *RTU Walk-off mat/carpet Spotter spotter for rust, urine stains & water spots nonfood processing areas C/S 2 oz./ Extraction shampoo Carpet gal. for EPA- registered Extraction sanitization of walk- Concentrate off mats & carpets in non-food processing areas Carpet & 42 oz./ For stain protection Upholstery gal. of all walk-off mats Protectant & carpeted areas in non-food processing areas. *1200 Furniture NA *RTU For daily/weekly For daily/weekly For daily/weekly For daily/weekly Polish application to application to application to application to wooden surfaces. wooden surfaces. wooden surfaces. wooden surfaces. } 3604 Liquid Malodor Conc. Utilized to eradicate Utilized to eradi- Utilized to eradicate Utilized to eradicate Counteractant eradicate unwanted cate unwanted unwanted odors unwanted odors (mountain fresh) odors from carpets, odors from from carpets, from carpets, *1202 Fresh Linen C1 *RTU upholstery, defined carpets, upholstery, upholstery, defined upholstery, defined Scent Air Freshener Equi. spaces. defined spaces. spaces. spaces. & Neutralizer * RTU = Ready to use 04/11

20 Product Listing by Department (continued) Health Care Seminar Broad Gen. TB Dilu. Environmental Product Spec. Disn. Claim USDA Rates Services Dietary ER/OPS Maintenance Laundry *1205 Dust Mop C1 *RTU For regular applica- For regular applica- For regular applica- For regular applica- Treatment Equi. tion to dust mops tion to dust mops tion to dust mops tion to dust mops & dusting tools to & dusting tools to & dusting tools to & dusting tools to enhance the ability enhance the ability enhance the ability enhance the ability to attract & hold dust. to attract & hold dust. to attract & hold dust. to attract & hold dust. *1207 Gelled C1 *RTU For quick removal For quick removal Baseboard Equi. of floor finish & dirt of floor finish & dirt Stripper from baseboards & from baseboards & hard to reach areas. hard to reach areas. *1210 Stainless A7 *RTU For use when For use when For use when For use when Steel Clnr. Polish Equi. polishing stainless polishing stainless polishing stainless polishing stainless *1211 Stainless C1 *RTU steel dispensers, steel dispensers, steel dispensers, steel dispensers, Steel Clnr. Polish Equi. sinks & decor. sinks & decor. sinks & decor. sinks & decor. *1220 Glass, Plastic C1 *RTU For cleaning of For cleaning of For cleaning of For cleaning of For cleaning of & CRT Cleaner Equi. mirrors, glass, walls, mirrors, glass, walls, mirrors, glass, walls, mirrors, glass, walls, mirrors, glass, walls, doors & signs. doors & signs. doors & signs. doors & signs. doors & signs. *1225 All Purpose C1 *RTU For general For general For general For general Spray & Wipe Equi. degreaser spray & degreaser spray & degreaser spray & degreaser spray & wipe application wipe application wipe application wipe application where no disinf. where no disinf. where no disinf. where no disinf. is required. is required. is required. is required. *1226 Industrial C1, C2 *RTU For heavy duty For heavy duty For heavy duty For heavy duty Cleaner Equi. degreaser spray & degreaser spray & degreaser spray & degreaser spray & Degreaser wipe application wipe application wipe application wipe application where no disinf. where no disinf. where no disinf. where no disinf. is required. is required. is required. is required. *1229 Vandalism C1 *RTU Removal of paint, Removal of paint, Mark & Stain Equi. ink and other ink and other Remover graffiti from most graffiti from most hard surfaces. hard surfaces. *1230 Disinfectant Y Y C1 *RTU Daily surface spray Daily surface spray Daily surface spray Daily surface spray Daily surface spray Deodorant Equi. disinfection & disinfection & disinfection & disinfection & disinfection & deodorizing of deodorizing of deodorizing of deodorizing of deodorizing of toilets, sinks, toilets, sinks, toilets, sinks, toilets, sinks, toilets, sinks, urinals, knobs, urinals, knobs, urinals, knobs, urinals, knobs, urinals, knobs, handles & handles & handles & handles & handles & dispensers. dispensers. dispensers. dispensers. dispensers. *1240 Foaming Y C1 *RTU Daily cleaning & Daily cleaning & Daily cleaning & Daily cleaning & Daily cleaning & Disinfectant Equi. disinfection of all disinfection of all disinfection of all disinfection of all disinfection of all Cleaner hard, non-porous hard, non-porous hard, non-porous hard, non-porous hard, non-porous surfaces. surfaces. surfaces. surfaces. surfaces. *1250 Chewing NA *RTU Removal of Removal of Removal of Gum Remover chewing gum from chewing gum from chewing gum from fabrics & carpet. fabrics & carpet. fabrics & carpet. *1260 Flying F1 *RTU Nicely fragranced Nicely fragranced Nicely fragranced Nicely fragranced Insecticide Equi. flying insecticide. flying insecticide. flying insecticide. flying insecticide. *1270 Residual F2 *RTU For crawling For crawling For crawling insects. Insecticide Equi. insects. insects. *1280 Wasp & F2 *RTU Wasp & Hornet Wasp & Hornet Wasp & Hornet Hornet Equi. Long-Range Long-Range Long-Range Killing. Insecticide Killing. Killing. RTU = Ready to use 04/11

21 Product Listing by Department (continued) Antimi- Petro- Product VRE crobial MRSA Antiseptic Aloe Vera leum Dist. USDA Auth. Uses 500 Lotion Hand Y N E-4 Regular hand washings not requiring antibacterial claims. Cleaner Equiv. 501 Premium N N N Y N E-4 Luxury hand washing - not requiring antibacterial claims Hand Wash Equiv. 505 Antiseptic Y Y Y Y N E-4 Regular hand washings requiring antibacterial, antimicrobial or antiseptic Lotion Cleanser Equiv. claims. 510 Antimicrobial Y Y Y N N E-2 Regular hand washings requiring antibacterial, antimicrobial or antiseptic Food Service claims. Hand Wash 514 Non-Alcohol Y Y SKIN N N E-4 Utilized when multiple hand washings are required or running water and/or Foaming Instant sanitizer Equiv. towels are not accessible & alcohol rubs are not acceptable. Hand Sanitizer 515 Instant Hand Y Y SKIN Y N E-4 Utilized when multiple hand washings are required or running water and/or Sanitizer (gel-type) sanitizer Equiv. towels are not accessible. 520 Gentle Hair N N N Y N E-4 Hair and body wash or utilize as a luxury hand soap. and Body Wash Equiv. 570 Foaming Premium Y N E-4 Utilized for grease, oil and heavy soil removal from hands when a water Hand Wash Equiv. source is not accessible. 571 Foaming N N N Y N E-2 Utilized for grease, oil and heavy soil removal from hands when a water Antimicrobial Food Equiv. source is not accessible. Service Hand Wash 575 Foaming N N N N N E-4 Utilized for removing inks, paints, oils and soils. Typically chosen by users Antiseptic Hand Equiv. requiring non-petroleum, solvent based hand cleaners, with grit. Cleaner Dilution Product Rates All Departments Requiring Deodorization 600 Liquid Malodor 1 oz./gal. Utilized to eradicate unwanted odors from carpets, upholstery, defined spaces. Counteractant 12 oz./gal. (Lemon) *RTU 602 Liquid Malodor 1 oz./gal. Utilized to eradicate unwanted odors from carpets, upholstery, defined spaces. Counteractant 12 oz./gal. (Peach Kiwi) *RTU 603 Liquid Malodor 1 oz./gal. Utilized to eradicate unwanted odors from carpets, upholstery, defined spaces. Counteractant 12 oz./gal. (Harmony) *RTU 3604 Liquid Malodor 1 cartridge per Utilized to eradicate unwanted odors from carpets, upholstery, defined spaces. Counteractant 30 oz. spray (Mountain Fresh) bottle 9060 Odor Counteractant 1 oz./gal. Utilized to eradicate unwanted odors from carpets, upholstery, defined spaces. (Lemon Scent) 9064 Odor Counteractant 1 oz./gal. Utilized to eradicate unwanted odors from carpets, upholstery, defined spaces. (Tropical Breeze) * RTU = Ready to use 04/11

22 Floor Care Methodization CAUTION WET FLOOR A. Preparation 1) Collect all supplies required (see materials requirement planning list) 2) Ensure that equipment is operational 3) Pick up walk-off mats after they are vacuumed B. Post Caution signs C. Choose appropriate safety apparel 1) Review all MSDS, labels and caution statements D. Dust mop area (see dust mop procedure) E. Damp mop area (see damp mop procedure) F. Perform preventative, interim or restorative cleaning task 1) System 1 Restorative maintenance a. Strip b. Seal c. Refinish 2) System 2 Preventative maintenance a. Clean and restore 3) System 3 Interim maintenance a. Deep scrub & recoat G. Return all caution signs and equipment to their appropriate storage locations 1) Ensure that all chemicals are refilled 2) Ensure that all equipment is cleaned and rinsed out

23 Floor Care Methodization Floor Care Procedures A. Preparation 1) Collect all supplies required (see materials requirement planning list) 2) Ensure that equipment is operational 3) Pick up walk-off mats after they are vacuumed CAUTION WET FLOOR B. Post Caution signs C. Choose appropriate safety apparel 1) Review all MSDS, labels and caution statements D. Dust Mop Procedures 1) Acquire dust mop of choice a. Choose appropriate size 1. Handle size and diameter 2. Dust mop length should be small enough to maneuver, yet large enough to allow for labor-saving operation b. Ensure that dust mop is clean 2) Choose start/stop points to allow for completion of the task nearest the exit or trash receptacle 3) Treat dust mop with a water-based dust mop treatment a. Use approximately 1 oz. of treatment per 6 of dust mop length 4) Hold dust mop handle at approximately a 45 0 angle 5) Push or plow straight ahead from one end of the area to the next a. Do not allow mop head to leave the floor 6) Pivot mop at appropriate turning point a. Avoid changing the leading edge of dust mop b. Overlap last pass by at least 6-10 inches 7) Utilize a dust pan and brush to dispose of soil/dirt not held by the mop yarns a. Remove gum/tar from floor with a putty knife b. Utilize brush to remove dust from corners 8) Remove dust mop frame and head from handle, and shake or brush loose dirt from mop head into a plastic liner a. Place in storage area b. Launder when brushing is no longer effective

24 Floor Care Methodization Floor Care Procedures (continued) E. Damp Mop Procedures 1) Dust mop area 2) Choose appropriate wet mop size and type 3) Fill mop bucket to desired level with water 4) Add chemical to water at proper dilution a. Utilize a neutral ph cleaner b. A second bucket for rinsing may be required for double bucket mopping 5) Submerse mop into bucket 6) Wring out mop to desired dampness a. Use legs, not your back, to apply wringer pressure 7) Confirm all safety signs and apparel are properly located 8) Begin mopping at furthest point from door a. Outline or picture frame area b. Mop in a figure 8 motion 9) Change water when needed to avoid redepositing dirt on floor 10) Repeat steps 1-9 as necessary

25 Floor Care Methodization F. Performing Preventative, Interim or Restorative Cleaning Tasks Floor Care Materials Requirement Planning (MRP) System 1 - Restorative maintenance (strip, seal, refinish) 1) Strip a. Mop buckets and wringers b. Cotton wet mops & handles c. Scrubbing machine d. Strip pack & machine pad holder e. Dust mop & dust pan f. Putty knife or scraper g. Dust mop treatment H 2 0 (water based) h. Wet/Dry vacuum i. Extension cords j. Clean rags k. Stripper slippers l. Gloves m. Clean rinsed cotton mop & handle n. Trigger sprayer o. Wet Floor signs p. Measuring cup q. Stripper r. Neutralizer s. Towels & tape t. Squeegee 2) Seal a. Mop buckets with wringer b. Plastic liners to fit bucket c. Rayon mops & handles (looped) d. Floor sealer e. Wet Floor signs 3) Refinish a. Mop bucket & wringer b. New plastic liner to fit bucket c. New or clean rayon mops (looped) d. Mop handles e. Wet Floor signs f. Floor finish

26 Floor Care Methodization F. Performing Preventative, Interim or Restorative Cleaning Tasks Floor Care Materials Requirement Planning (MRP) System 2 - Clean & Restore 1) Clean & Restore a. Mop buckets with wringers b. Cotton mop & handle c. Neutral cleaner d. Dust mop & dust pan e. Dust mop treatment f. Measuring cup g. Wet Floor signs h. Spray buff in trigger sprayer i. Floor restorer j. Rayon mop & handle k. Liner for restorer l. Putty knife m. Burnisher with red pad System 3 - Deep Scrub & Recoat 1) Deep Scrub & Recoat a. Dust mop & dust pan b. Dust mop treatment c. Pads - blue or brown d. Automatic or hand-held floor scrubber e. All purpose cleaner (low suds) f. Mop bucket & wringer g. Cotton mop & handle h. Floor finish i. Mop bucket & wringer with liner j. Putty knife k. Rayon mop l. Neutralizer m. Stripper slippers n. Wet Floor signs

27 Floor Care Methodization F. Performing Preventative, Interim or Restorative Cleaning Tasks Floor Care Procedures System 1 Strip, Seal & Refinish 1) Stripping Semi-Manual a. Choose appropriate mop handle b. Properly mix mop bucket of stripping solution When pouring out of a 5 gal. pail, pour with bung at the top of the pail c. Apply stripper liberally with mop to a 200 square foot area of floor as well as baseboards d. Let stand for 5 minutes e. Agitate floor with 17 floor machine and black pad. Agitate baseboard and corners with baseboard tool and bladed scrapers 1. Stay away from walls to avoid splashing 2. Overlap passes by at least ten inches while stripping f. Pick up emulsified floor finish solution via wet/dry vacuum g. Utilize a detail mop to absorb stripper from corners, baseboards and all squeegee trails h. If a non-rinse-free stripper is being utilized, rinsing with a floor neutralizer is required to assure an alkaline-free floor i. Repeat c - h as required to complete job j. Wipe down all baseboards, if needed 2) Stripping Semi-Automated a. Choose appropriate mop and handle b. Properly mix mop bucket of stripping solution When pouring out of a 5 gal. pail, pour with bung at the top of the pail c. Apply stripper liberally with mop to a 200 square foot area of floor as well as baseboards d. Let stand for 5 minutes e. Agitate baseboards f. Scrub aforementioned area with automatic scrubber equipped with black stripping pads 1. Pads down 2. Solution control on; disperse properly diluted stripping solution 3. Squeegee up, vac off g. Overlap each pass until 200 square feet of area is scrubbed completely h. Make second pass with automatic scrubber and pick up emulsified stripping solution 1. Pads down 2. Solution control off 3. Squeegee down, vac on i. Utilize a detail mop to absorb stripper from corners, baseboards and all squeegee trails j. If a non-rinse-free stripper is being utilized, rinsing with a floor neutralizer is required to assure an alkaline-free floor k. Repeat c - j as required to complete job l. Wipe down all baseboards, if needed

28 Floor Care Methodization F. Performing Preventative, Interim or Restorative Cleaning Tasks Floor Care Procedures System 1 Strip, Seal & Refinish (continued) 3) Seal/Refinish Method (with mop) a. Establish start/stop points Choose start location as the furthest point from the door/water source b. Place plastic liner in seal/finish bucket c. Utilize rayon mop with looped ends and sewn tailband 1. Shake mop out in a plastic liner to prevent manufacturing lint (off mop) from adhering to the floor 2. Use separate mop for sealing and finishing d. Dip mop in sealer/finish bucket; remove excess sealer/finish by pressing mop with a one quarter turn into wringer e. Apply sealer/finish 1. Outline or picture frame area on first coat and last coat 2. Stay 6 inches away from wall on all subsequent coats 3. All coats should be thin and without dry streaks f. See sealer/finish application guide for correct number of coats of the finish you are utilizing 1. Allow at least minutes to dry between coats 2. Allow 1 hour or more dry time between coats on very humid days System 2 Clean & Restore 1) Spray buffing a. Choose appropriate product b. Properly prepare spray buff to recommended dilution c. Spray solution lightly ahead of buffing machine 1. Overspraying will result in excessive pad buildup and poor gloss 2. Turn/replace pad as required d. Dust mop with a water-based dust mop treatment, if necessary e. For a higher gloss, repeat letters c and d with a lighter-colored pad 2) Mop on restorer a. Choose appropriate pad and mount to machine Utilize a high speed ( RPM) or ultra high speed buffer b. Prepare a mop bucket and wringer equipped with a plastic liner c. Apply a thin, level coat of restorer to floor, utilizing a looped-end rayon mop Allow to dry to a light haze d. Buff floor with previously prepared machine e. Dust mop Utilize water-based dust mop treatment f. For a higher gloss, repeat letters a - e with a lighter-colored pad

29 Floor Care Methodization F. Performing Preventative, Interim or Restorative Cleaning Tasks Floor Care Procedures System 3 Deep Scrub & Recoat 1) Scrub Method Semi-Manual a. Choose appropriate mop handle b. Properly mix mop bucket of neutral cleaner solution 1. When pouring out of a 5 gal. pail, pour with bung at top of pail c. Apply neutral cleaner liberally with mop to a 200 square foot area of floor d. Let stand for 5 minutes e. Agitate floor with 17 floor machine and blue pad 1. Stay away from walls to avoid splashing 2. Overlap passes by at least ten inches while scrubbing f. Pick up scrubbing solution via wet/dry vacuum g. Utilize a detail mop to absorb scrubbing solution from corners, baseboards and all squeegee trails h. Repeat c - g as required to complete job i. Wipe down all baseboards, if needed 2) Scrub Method Semi-Automated a. Choose appropriate mop and handle b. Properly mix automatic scrubber solution tank with scrubbing solution When pouring out of a 5 gal. pail, pour with bung at top of pail c. Scrub 200 square foot area with automatic scrubber equipped with blue scrubbing pads 1. Pads down 2. Solution control on; disperse properly diluted scrubbing solution 3. Squeegee up, vac off d. Overlap each pass until 200 square foot area is scrubbed completely e. Make second pass with automatic scrubber and pick up scrubbing solution 1. Pads down 2. Solution control off 3. Squeegee down, vac on f. Utilize a detail mop to absorb scrubbing solution from corners, baseboards and all squeegee trails g. Repeat c - f as required to complete job h. Wipe down all baseboards, if needed 3) Recoat Method (with mop) a. Establish start/stop points Choose start location as the furthest point from the door/water source b. Place plastic liner in seal/finish bucket c. Utilize rayon mop with looped ends and tailband 1. Shake mop out in a plastic liner to prevent manufacturing lint (off mop) from adhering to the floor d. Dip mop in finish bucket, remove excess finish by pressing mop with a 1/4 turn into wringer

30 Floor Care Methodization F. Performing Preventative, Interim or Restorative Cleaning Tasks Floor Care Procedures System 3 Deep Scrub & Recoat (continued) 3) Recoat Method (with mop) e. Apply finish 1. Outline or picture frame area on first coat and/on last coat 2. All coats should be thin and without dry streaks 3. Allow at least minutes to dry between coats 4. Allow 1 hour dry time or more between coats on very humid days

31 Carpet Care Procedures A. Preparation 1) Collect all supplies required (see equipment list) 2) Assure that equipment is not leaking and wheels are clean 3) Assure that your shoes are clean 4) Pre-test all chemicals in inconspicuous area of carpet to confirm dye fastness B. Clear Area of Furnishings 1) Lift safely 2) Protect furnishings that cannot be moved 3) Unplug all electrical items 4) Pick up all walk-off mats C. Post Caution Signs D. Choose Appropriate Safety Apparel 1) Review all MSDS, Labels, and caution statements E. Vacuum Area F. Perform Restorative, Interim or Preventative Cleaning Task 1) System 1 Restorative Maintenance a. Extraction Method b. Rotary Floor Machine Shampooing 2) System 2 Interim Maintenance a. Bonnet Cleaning 3) System 3 Preventative Maintenance a. Carpet Spotting b. Upright Vacuum Method G. Inspect Your Work H. Return Furnishings, Supplies & Equipment 1) Return furnishings on dry carpet if at all possible. If not, utilize furniture tabs to shield furniture from dampness remaining in the carpet 2) Refill any chemical containers at this time 3) Clean up & rinse out all equipment 4) Replace all supplies to their original storage location

32 Carpet Care Procedures Carpet Care A. Materials Requirement Planning (MRP) a. Clean rags b. Mop bucket and wringer c. Carpet spotting brush d. Pump-up sprayer e. Wet Floor signs f. Iron g. Putty knife h. Carpet bonnets i. Can liner (bonnet only) j. Gloves k. Goggles l. Clean tennis shoes or equivalent m RPM Floor Machine with gravity feed tank and shower feed drive block n. 17 Carpet brush o. Carpet Extractor p. Vacuum Cleaner q. Products 1) Traffic Lane and Bonnet Cleaner 2) Extraction Carpet Concentrate 3) Dry Foam Carpet Shampoo 4) Foam Control Agent 5) Biological Spot Cleaner 6) Tannin Spotter 7) Carpet Sanitizer Concentrate 8) Carpet and Upholstery Protectant

33 Carpet Care Procedures (continued) Carpet Care Health Care Seminar System 1 Restorative Maintenance Extraction Method 1) Vacuum the carpet thoroughly. Be sure any foreign material stuck to the carpet, such as chewing gum or tape, has been removed. Always wear clean tennis shoes when extracting. 2) Using a pump-up sprayer, pre-spray high traffic areas as well as any noticeable spots on the carpet with Traffic Lane and Solvent Spotter. 3) To begin the extraction process, add deep-cleaning, quick-impact carpet shampoo to the machine. 4) Be sure to use our Foam Control agent in the recovery tank. 5) Start extracting at a point farthest from the entrance to the room. Make one pass with the feed valve open while pulling the extractor toward you. Release the control valve before you reach the end of your pass. 6) To pick up more moisture, go over the same pass with the control valve closed. Continue to work across the carpet until the area is completely cleaned. 7) Rinse the carpet with fresh, clean water. 8) Apply a fast-drying carpet and fabric protectant using a pump-up sprayer, paying close attention to any high-traffic areas. Rotary Floor Machine Shampooing 1) Vacuum the carpet thoroughly. Be sure any foreign material stuck to the carpet, such as chewing gum or tape, has been removed. Always wear clean tennis shoes when shampooing. 2) Mix the cleaning solution and pour it into the dispenser, (which is attached to the handle of the floor machine). 3) Clean the carpet, moving left to right, overlapping each pass. 4) Use Rotary Floor Machine in two directions to brighten extra-soiled carpeted floors. The foam left on the carpet will evaporate and leave the soil on the top of the carpet. 5) Vacuum up the soil, which now rests on the surface of the carpet. 6) Use a nylon hand brush for corners, projections and other areas that cannot be reached with the rotary shampoo machine. 7) Wipe any extra shampoo from furniture, baseboards and doors, using a clean, damp cloth or sponge. 8) Set carpet pile with carpet brush or rake. 9) Apply our revolutionary, fast-drying Carpet and Fabric Protectant, using a pump-up sprayer, paying close attention to any high, traffic areas. System 2 Interim Maintenance Bonnet Cleaning 1) Thoroughly vacuum the carpet and all entrance mats. Remove any foreign material stuck to the carpet, such as gum, wax or tar. Always wear clean tennis shoes to bonnet clean. Remove any furniture as necessary. 2) Spray about 100 square feet with the Traffic Lane and Bonnet Cleaner, using a pump-up sprayer. Pay close attention to any spots or stains. 3) While wearing gloves, dip the bonnet into the shampoo. Wring it out and place your machine on the bonnet. 4) Clean the carpet, moving left to right, overlapping each pass. 5) When both sides of bonnet are filled with soil, rinse it out, reload with shampoo, and keep cleaning until the entire carpet is done. 6) To speed dry the carpet, go over it again with clean, dry bonnets, turning and changing them often. 7) After the carpet is dry, vacuum thoroughly and replace the furniture in its original position.

34 Carpet Care Procedures (continued) Carpet Care System 3 Preventative Maintenance Carpet Spotting 1) Obtain required supplies and safety gear. 2) Identify stain if possible. a. Utilizing spotting chart, choose correct chemical. 3) Pick up any large particles of dirt. 4) Apply spotter around outer perimeter of stain, then fill in area. 5) Agitate with blunt end of a plastic carpet spotter brush; always direct brush strokes towards center of stain; wipe brush handle clean and put aside. 6) Using a clean white cloth, apply pressure in a blotting fashion to transfer the stain from carpet to cloth. 7) Repeat steps 3 6, if needed. 8) Rinse affected area with clean water and sponge. Blot dry and lift nap with carpet brush. a. If stain is unidentified, begin with a solvent spotter and rinse. b. If solvent spotter is ineffective, utilize an organic spotter and rinse. c. If unsuccessful with organic spotter, choose a tannin spotter and rinse. Upright Vacuum Method 1) Collect all equipment and safety signs 2) Post Caution signs 3) Vacate area of obstacles, if necessary a. Include walk-off mats and soil/dirt/filth such as gum 4) Plug vacuum into 3-prong grounded outlet a. Inspect power card for broken or worn insulation b. Be certain that all 3 prongs are present on power cord c. Insure that sweeper bag is not full 5) Begin vacuuming at wall edge a. Utilize side of vacuum with edge cleaning capability if so equipped b. Utilize the lawn-mower method of long, overlapping passes if area to be swept is large 6) Replace all furnishings to original location 7) Replace all equipment

35 Procedures Hand Washing Wall Chart 4 Steps to a Healthier World Health Care Seminar Wet your hands and wrists with warm water. Apply cleaner to hands and wrists (2 above exposed area) and lather at least 15 seconds. Include back of hands, between fingers and around nails and cuticles. Rinse thoroughly with comfortably hot water for at least 15 seconds. Rinse from wrists toward the finger tips. Dry hands with a single-use towel or air dryer. Use towel to turn off water and open exit door to protect your hands from resoiling. Be Healthy, Be Clean, Wash Your Hands

36 Health Care Cleaning and Sanitation Procedures Module Handwashing 3 Handwashing is the single most important procedure for preventing nosocomial infections. Handwashing is defined as a vigorous, brief rubbing together of all surfaces of lathered hands, followed by rinsing under a stream of water. Although various products are available, handwashing can be classified simply by whether plain soap and/or detergents or antimicrobial-containing products are used. Handwashing with plain soaps or detergents (in bar, granule, leaflet, or liquid form) suspends microorganisms and allows them to be rinsed off. This process is often referred to as mechanical removal of microorganisms. Handwashing with antimicrobial-containing products kills or inhibits the growth of microorganisms. This process is often referred to as chemical removal of microorganisms. When gloves are worn, handwashing is still recommended because gloves may become perforated during use and because bacteria can multiply rapidly on gloved hands. Recommendations from the Center for Disease Control (C.D.C.) A. Handwashing indications 1) In the absence of a true emergency, personnel should always wash their hands. a. Before performing invasive procedures. (Category 1) * b. Before taking care of particularly susceptible patients, such as those who are severely immunocompromised and newborns. (Category 1) c. Before and after touching wounds, whether surgical, traumatic, or associated with an invasive device. (Category 1) d. After situations during which microbial contamination of hands is likely to occur, especially those involving contact with mucous membranes, blood or body fluids, secretions, or excretions. (Category 1) e. After touching inanimate sources that are likely to be contaminated with virulent or epidemiologically important microorganisms. These sources include urine-measuring devices or secretion-collection apparatuses. (Category 1) f. After taking care of an infected patient or one who is likely to be colonized with microorganisms of special clinical or epidemiologic significance; e.g., multiple-resistant bacteria. (Category 1) g. Between contact with different patients in high-risk units. (Category 1) 2) Most routine, brief patient-care activities involving direct patient contact other than that discussed in A.1 above do not require handwashing; e.g., taking blood pressure. (Category 2) 3) Most routine hospital activities involving indirect patient contact do not require handwashing; e.g., handing a patient medications, food, or other objects. (Category 1) B. Handwashing technique For routine handwashing, a vigorous rubbing together of all surfaces of lathered hands for at least 10 seconds, 15 seconds preferred, followed by thorough rinsing under a stream of water. (Category 1) * See definitions of categories on following page 3 Information taken from Guideline for Handwashing and Hospital Environmental Control U.S. Dept. of Health and Human Services - Center for Disease Control

37 Health Care Cleaning and Sanitation Procedures Module Handwashing 3 (continued) C. Handwashing with plain soap 1) Plain soap should be used for handwashing unless otherwise indicated. (Category 2) 2) If bar soap is used, it should be kept on racks that allow drainage of water. (Category 2) 3) If liquid soap is used, the dispenser should be replaced or cleaned and filled with fresh product when empty. Liquids should not be added to a partially full dispenser. (Category 2) D. Handwashing with antimicrobial-containing products (Health-Care Personnel Handwashes) 1) Antimicrobial handwashing products should be used for handwashing before personal care for newborns and when otherwise indicated during their care, between patients in high-risk units, and before care of severely immunocompromised patients. (Category 3) Ranking Scheme for Recommendations of the C.D.C. Category 1 Measures in Category 1 are strongly supported by well-designed and controlled clinical studies that show their effectiveness in reducing the risk of nosocomial infections, or are viewed as effective by a majority of expert reviewers. Measures in this category are viewed as applicable for most hospitals regardless of size, patient population, or endemic nosocomial infection rates. Category 2 Measures in Category 2 are supported by highly suggestive clinical studies in general hospitals or by definitive studies in specialty hospitals that might not be representative of general hospitals. Measures that have not been adequately studied but have a logical or strong theoretical rationale indicating probable effectiveness are included in this category. Category 2 recommendations are viewed as practical to implement in most hospitals. Category 3 Measures in Category 3 have been proposed by some investigators, authorities, or organizations, but, to date, lack supporting data, a strong theoretical rationale, or an indication that the benefits expected from them are cost-effective. Thus, they are considered important issues to be studied. They might be considered by some hospitals for implementation, especially if the hospitals have specific nosocomial infection problems, but they are not generally recommended for widespread adoption. 3 Information taken from Guideline for Handwashing and Hospital Environmental Control U.S. Dept. of Health and Human Services - Center for Disease Control

38 Health Care Cleaning & Sanitation Procedures Module Occupied Patient Room 1 Cleaning Procedures A. Perform high dusting B. Clean ledges and sills C. Clean and disinfect patient restroom (sec: Patient Restroom Procedure) D. Empty and line wastebaskets E. Clean bed rails and footboard F. Clean furniture G. Clean furnishings H. Spot-clean walls I. Dust mop floor J. Place Wet Floor sign K. Wet mop floor L. Clean door hardware and metal plates A. Step 1 Perform high dusting 1) Always clean objects and areas by beginning at the higher surfaces and working toward the lower surfaces. 2) Use your high duster and clean the ceiling fixtures, the molding above doorways, the high areas around the windows, and anything higher than your shoulder. B. Step 2 Clean ledges and sills 1) The windowsill is a common place for dirt. Wipe it clean. 2) Clean the framework around the window as high as you can reach. Remove spots and smudges from the window itself by using your glass cleaner. Before leaving the window, examine the drapes for dirt and water. If they need cleaning or repair, notify your supervisor. 3) Remove spots from the wall as you move around the room. For a stubborn spot, spray your cloth with the disinfectant-detergent solution and then rub the spot with the saturated part of your cloth. 4) Never spray the solution directly on the wall or surface. The solution is strong and might cause permanent damage to the surface. Use your treated cleaning cloth at all times. C. Step 3 Clean and disinfect patient restroom (sec: Patient Restroom Procedure) D. Step 4 Empty and line wastebaskets 1) Start by picking up trash and wastepaper around the wastebasket. You are now ready to dispose of the wastebasket s plastic liner and its contents. 2) Be careful of any hypodermic needles that may pierce the plastic liner. Even though hospital rules call for the special handling and disposal of hypodermic needles, someone could always forget and wrongly allow one to fall into a wastebasket. Remember to remove the liner carefully and treat liners as though they actually contained a needle or other sharp object. 1 - Information taken from ISSA Hospital Housekeeping Training Manual

39 Health Care Cleaning & Sanitation Procedures Module Occupied Patient Room 1 (continued) D. Step 4 Empty and line wastebaskets (continued) 3) Gather the open end with both hands and tie it closed with a knot. Then dispose of it in the housekeeping cart s trash bin. When handling a full plastic liner, try to hold it away from you, as it may contain contaminated articles as well as needles and other sharp objects. Never reach inside the liner for any reason. 4) Afterwards, clean the wastebasket inside and out with a damp cloth dipped and rung out in the disinfectant-detergent solution. Throughout the cleaning process, keep in mind that germs are everywhere in corners, small openings, grooves, and the underside of objects. You must be thorough in order to get rid of them. You are now ready to insert a clean liner into the wastebasket. 5) Be sure the liner is drawn back far enough over the rim of the wastebasket that it will not fall inside. If the liner is too big, tie one end in a knot. E. Step 5 Clean bed rails and footboard 1) Dip your cleaning cloth into the five-quart pail of disinfectant-detergent on your cart. Then clean the side rails and the footboard. 2) If you are in doubt about what to clean in a patient s room, ask your supervisor. 3) Under no circumstances should the patient be disturbed while cleaning the bed, even if he or she seems relaxed and friendly. 4) Never lean on the mattress or bump the bed while cleaning it. Putting weight on the mattress or hitting the bed could disturb the patient and may cause pain. F. Step 6 Clean furniture 1) The bedside cabinet might present some difficulty as you damp-dust the objects in the room. The top of the cabinet may be cluttered with some personal articles of the patient. Handle the articles carefully as you clean under them and then return them to where they were. 2) Occasionally the top of the bedside cabinet will be too cluttered and you will have to skip it. But ordinarily, you will be able to clean the surface by raising objects with one hand and cleaning with the other. 3) Finish cleaning the bedside cabinet by damp-dusting the sides, the front, the drawer pulls and the legs, always working from the higher surfaces to the lower surfaces. 4) Move to the over-bed table and clean it thoroughly, again working from the upper surfaces to the lower surfaces. 5) Clean the table s surface, pedestal, base, and the casters, which are a favorite hangout for dirt and bacteria. 6) Next, thoroughly damp-dust the chair, seat, back, legs and rungs. 1 - Information taken from ISSA Hospital Housekeeping Training Manual

40 Health Care Cleaning & Sanitation Procedures Module Occupied Patient Room 1 (continued) G. Step 7 Clean furnishings 1) Damp-wipe the over-the-bed lamp reflector and hood and other wall fixtures as directed by your supervisor. 2) Be careful not to damp-dust electrical outlets or electrical connections. Always dry-dust switchplates, sockets and electrical connections. 3) Damp-dust the telephone, paying special attention to the receiver since the patient makes direct contact with the handle, the mouthpiece, and the earpiece. These areas are more likely to become contaminated or become a source of cross-contamination. H. Step 8 Spot-clean walls 1) Wall mirrors and wall hangings should be damp-dusted as you move around the patient unit. I. Step 9 Dust mop floor 1) Begin this step after the restroom has been serviced (see Restroom Procedures). 2) When using either the dust mop or the damp mop, work in a clockwise or counter-clockwise pattern as you did while damp-dusting in order not to skip an area or clean the same area twice. In using the dust mop, never lift the mop head from the floor once you have started dusting. This causes a vacuum that pulls dirt and dust away from the mop head, thus causing recontamination of the area. 3) When the mop head becomes too dirty, dispose of it in the appropriate plastic bag, then attach a clean one and continue dusting. 4) If your dust mop does not pick up all the debris on the floor, use your dustpan and brush to remove the pile of debris. J. Step 10 Place Wet Floor sign 1) To warn anyone who enters or leaves the patient s unit, place a Wet Floor caution sign in the doorway. Remove the sign later when you know the floor is thoroughly dry. K. Step 11 Wet mop floor 1) Work in a clockwise or counter-clockwise figure eight pattern as you did while dust mopping. 2) Rinse and wring the wet mop head often. The mop water should contain a disinfectant which is designed to kill germs on contact. 3) Push the wet mop under the bed and under all furniture to clean as much of the floor area as possible. 4) When finished with wet mop, wring as dry as possible, and dispose of in an appropriate bag for laundering. 1 - Information taken from ISSA Hospital Housekeeping Training Manual

41 Health Care Cleaning & Sanitation Procedures Module Occupied Patient Room 1 (continued) L. Step 12 Clean door hardware and metal plates 1) Do not overlook the doorway hardware. This area can become contaminated very easily. Thoroughly clean the door knob. 2) The kickplate should be cleaned with stainless steel cleaner. 3) Switchplates and other electrical units must be handled with extreme care. 1 - Information taken from ISSA Hospital Housekeeping Training Manual

42 Health Care Cleaning & Sanitation Procedures Module Occupied Patient Isolation Room 2 A) Materials Requirement Planning (MRP) a. Supply of clean cloths b. Hand pads c. Lip light d. Mop bucket with wringer e. Disposable gloves f. High dusting tool g. Hand pail (3 gallon) h. Approved germicidal detergent solution appropriate to the area i. All-purpose spray cleaner solution j. Plastic liners k. Paper towels l. Toilet tissue m. Dust pan and brush n. Wet mop handle and looped-end banded wet mop o. Door stop p. Dust mop q. Putty knife r. Toilet bowl brush/bowl swab s. Toilet bowl cleaner t. Creme cleanser u. Germicidal spray solution v. Window cleaner spray solution w. Rinse water x. Hand soap 2 Information taken from ISSA Hospital Housekeeping Procedures

43 Health Care Cleaning & Sanitation Procedures Module Occupied Patient Isolation Room 2 CAUTION WET FLOOR A. Steps to cleaning occupied patient isolation room (See CDC Isolation Precautions) in Appendix 1) Prepare to enter room - Read isolation card on door to determine the protective clothing to be worn. Put on gown, mask, gloves and over-shoe booties, as required. 2) Prepare area - Knock on door. Open slightly and announce your intention to enter. If occupied, wait. When empty, open and stop door. Carry all equipment and supplies into the room and close door. Once you ve been in the room, do not leave with the gown on. 3) Clean bathroom - See Patient Restroom section. When cleaning outside toilet surfaces, use a towel saturated with a germicidal detergent solution. Wipe down all surfaces. Discard towel/towels in the waste container. Rinse surfaces with towel saturated in clear water. Discard in waste container. 4) Clean patient s room - See Occupied Patient Room section. Nursing personnel are responsible for bed and bedside table cleaning. 5) Floor cleaning - Flood floor (as in Operating Room cleaning) with a germicidal solution. Let stand for recommended length of time and vacuum up with wet-vacuum. If not practical, wet mop using the two pail method: That is, use one bucket and one mop for the solution and a second bucket and second mop for the rinse water. Dip mop in germicidal solution and spread on floor. Mop up dirty solution, wringing mop out frequently in solution bucket. Using a second mop, rinse floor with clear water. Use solution bucket to wring out mop. Mop up thoroughly. 6) Gather waste - Place sealed plastic bags from the room s waste containers into a second clearly tagged or labeled liner; then seal the labeled liner. 7) Wash hands and arms - See Handwashing section. Wash for at least 10 seconds. 8) Leaving isolation room - Open door with a clean paper towel. Discard in wastebasket. Remove all equipment and supplies from room. Dispose of bagged waste in proper receptacle. Remove protective clothing. Remove mask by strings. Remove gown gently, folding it inside out, and dispose in proper receptacle. 9) Wash hands and arms - See Handwashing procedure in this module. 10) Service equipment - Transport all equipment to appropriate housekeeping storage area. Wash all equipment used in room with a germicidal solution. 11) Wash hands and arms - See Handwashing section. Wash for at least 10 seconds. 2 Information taken from ISSA Hospital Housekeeping Procedures

44 Health Care Cleaning & Sanitation Procedures Module Patient Restroom 1 Patient Restroom Cleaning Steps A. Disinfect toilet bowls and urinals B. Perform high dusting C. Clean sink and counter D. Clean shower and/or tub E. Clean mirrors F. Re-stock paper and soap supplies G. Clean wall splash marks H. Empty and insert plastic liners in baskets I. Dust mop floor J. Wet mop floor K. Place Wet Floor sign in doorway A. Step 1 - Disinfect toilet bowls and urinals 1) Remove all urinal screens and blocks from respective receptacles and flush before cleaning. 2) Evacuate water from bowl. Using a bowl mop, force water over the trap. 3) Apply toilet bowl cleaner and disinfectant to toilet and urinal interiors only. Allow disinfectant cleaner to stand while other cleaning tasks are completed. 4) Clean toilet bowls and urinals - inside a. If required, add an additional ounce of toilet bowl cleaner and disinfectant to bowl mop prior to cleaning. b. Clean the rim and waterline areas carefully and move into the exposed trap area. c. Check under rim for missed mineral deposits and rust stains with lip light. d. HINT: Acid bowl cleaners are required for mineral deposits and rust. Routine cleaning can include non-acid cleaner disinfectants. 5) Clean toilet bowls and urinals - outside a. Spray outside and bottom surfaces with non-acid disinfectant solution and wipe. b. Wipe toilet seat with non-acid disinfectant solution. B. Step 2 - Perform high dusting 1) This includes high dusting of the door frame and door hinges, ceiling vents, lights, and tops of mirrors. 1 Information taken from ISSA Hospital Housekeeping Training Manual

45 Health Care Cleaning & Sanitation Procedures Module Patient Restroom 1 (continued) C. Step 3 - Clean sink and counter 1) Start by spraying a small amount of cleaner in the sink. 2) Rub the cleaner around the top and inside of the sink. 3) Wipe the bowl and top of the sink dry. 4) Wipe and polish all metal fixtures and faucet handles. 5) Take your cloth dampened in the germicidal solution and wipe the countertop, being careful to clean under personal items left by the patient. Clean under the items and place them back in a neat arrangement. Clean the counter front, inside sink doors, the piping, and generally all the exposed surfaces of the entire unit. D. Step 4 - Clean shower or tub 1) Spray the tile and rub the disinfectant cleaner around all shower walls, starting at the top and working your way to the bottom. Do not forget to clean the soap dish. 2) Wipe the shower head, faucet handles, and other fixtures clean. 3) Do not forget to wipe clean the shower rod, handrails and shower curtains. All areas must be cleaned. Wipe the shower floor clean to complete the task. E. Step 5 - Clean mirrors 1) Use glass cleaner sprayed directly onto the mirror and wipe clean with your cloth or a paper towel. Remove fingerprints, splash marks and smudges. F. Step 6 - Re-stock paper and soap supplies 1) Start with paper towels. 2) Your supervisor will give you the necessary keys needed to open and re-load paper towel dispensers. 3) Make sure you have the proper size and type of paper towels to fill the dispenser you are servicing. Open the dispenser door and remove the paper towel wrapper. Be careful that the bottom fold of the new paper towels is in its proper place; otherwise the dispenser will jam. 4) Once re-loaded, close and lock the cover. 5) The job is finished by removing one towel to insure another will take its place. 6) Refill the soap dispenser. Then, close the cover and wipe clean the entire unit. 7) Do not forget to replace the used bar soap with a new one. 8) Next, check the supply of toilet paper. It is necessary to replace the old roll with a new one. 9) An important key point to remember is to wipe the toilet paper holder clean before re-loading with a fresh roll of paper. 10) The new roll is inserted with the fold over the top toward the toilet seat. 1 Information taken from ISSA Hospital Housekeeping Training Manual

46 Health Care Cleaning & Sanitation Procedures Module Patient Restroom 1 (continued) G. Step 7 - Clean wall splash marks 1) Clean walls with your cloth dampened in germicidal cleaner. Clean only the wall areas that need to be cleaned. If the wall needs thorough cleaning, clean the whole wall. 2) Clean the towel dispenser with disinfectant cleaner and a clean cloth. 3) Wipe the grab bars clean as well as the wall behind these grab bars. 4) Be sure also to clean door knobs and all switch plates in the restroom. H. Step 8 - Empty and insert plastic liners in wastebasket 1) Start by picking up loose debris around the basket, such as paper towels.! Danger: Needles May Be In Trash! 2) Be very careful how you remove any liner containing the trash. The liner is made of plastic and it is very easy for a needle to poke through. 3) You must be very careful not to allow the liner to brush against your body, for obvious reasons. Start by folding the liner off the basket sides. Touch only the top of the liner. Lift the liner well clear of your arms and body, tie it closed, and dispose in the trash cart. 4) Take your cloth, dampened in germicidal solution, and clean the entire basket in and out. This is a key point and is often overlooked. 5) Now you re ready to re-line the basket. Folding the liner over the top neatly completes this task. Some hospitals will place spare plastic liners in the bottom of the basket before a new liner is inserted in the basket. Your housekeeping supervisor will go over the exact procedure set for your hospital. I. Step 9 - Dust mop floor 1) Before you dust mop, check the floor for obstructions like gum stuck to the floor. Use your scraper to remove the gum before you begin dust mopping. 2) Work the dust mop over the floor area in a pattern around the room. 3) Keep the dust mop head on the floor, working it into the corners and edges to pick up the loose dust. Place the dust mop on your cart. J. Step 10 - Wet mop floor 1) Prepare a single bucket of solution while at supply closet. 2) The bucket is filled about half full with cool or warm water. A pre-measured disinfectant floor cleaning chemical capsule is added to the water to dissolve and is then mixed with the wet mop head. Your supervisor will explain your exact procedure for mixing chemicals in your hospital. 3) To wet mop the restroom floor, dip the mop into the cleaning solution, wring and take mop to the restroom. 4) Continue mopping the floor until the floor surface is clean. 5) Remember, it is important that the entire floor surface be mopped, including corners and behind fixtures, being careful not to splash or rub against the baseboards. 1 Information taken from ISSA Hospital Housekeeping Training Manual

47 Health Care Cleaning & Sanitation Procedures Module CAUTION WET FLOOR Patient Restroom 1 (continued) K. Step 11 - Place Wet Floor sign in doorway 1) Now is a good time to wash your hands following the handwashing standards set up for your hospital. Protecting your good health is important and must not be ignored. 2) This restroom is now clean and ready for use. The next patient to use this restroom will appreciate your cleaning efforts. 1 Information taken from ISSA Hospital Housekeeping Training Manual

48 Health Care Cleaning and Sanitation Procedures Module Patient Discharge Room 1 Steps to cleaning patient discharge room A. Perform high dusting B. Clean ledges and sills C. Service wastebaskets D. Clean room furnishings E. Clean patient restroom F. Put on bed linen G. Spot clean walls H. Dust mop floor I. Stock patient brochures J. Wet mop floor K. Inspect room L. Clean door M. Remove Wet Floor sign N. Inform supervisor Always clean discharge units by cleaning the higher surfaces first and then working toward the lower surfaces. A. Step 1- Perform high dusting 1) For this step you will use your long-handled high duster. Some facilities use high dusters with cloth strands or insist that all high dusting be done with a damp cloth dipped in disinfectant detergent. Please check with your supervisor to determine your required procedure. 2) Use your high duster and clean the ceiling fixtures. 3) Dust the molding above doorways, the high areas around the windows, and anything shoulder high or higher, such as ceiling mounted television sets. 4) High dust tops of picture frames, wall hangings such as mounted light fixtures, signs and wall mirrors to complete the high dusting step. B. Step 2 - Clean ledges and sills 1) For this step you will need the 5-quart pail with disinfectant-detergent solution and a clean wiping cloth. Dip the cloth in the cleaning solution and hand wring excess solution from the cloth. 2) The windowsill is a common place for germs to hide. Wipe it clean. 3) Using your glass cleaner, clean the framework around the windows and remove spots and smudges from the window itself. 4) Before leaving the window, examine the drapes, shades or blinds for dirt and moisture. If they need cleaning, you should wipe them off. If they need repair, notify your supervisor. 5) Wipe clean the heating and cooling unit and any ledges. Damp-wipe the over-the-bed lamp reflector and hood and other wall fixtures, such as the oxygen wall unit, as directed by your supervisor. 1 Information taken from ISSA Hospital Housekeeping Training Manual

49 Health Care Cleaning and Sanitation Procedures Module Patient Discharge Room 1 (continued) B. Step 2 - Clean ledges and sills (continued) 6) Do not spray and wipe electrical outlets or electrical connections. Always damp dust switch plates, sockets and electrical connections. 7) Wipe clean the shelf in the closet and the hanger pole. Use stainless steel cleaner and a clean cloth to clean all stainless steel corner plates. C. Step 3 - Empty and line wastebaskets 1) Start by picking up trash and wastepaper around the wastebasket. You are then ready to dispose of the wastebasket s plastic liner and its contents in the trash container on your cart. 2) Be careful of any hypodermic needles that may pierce the plastic liner. 3) Even though hospital rules call for the special handling and disposal of hypodermic needles, someone could always forget and wrongly allow one to fall into a wastebasket. 4) Remember to remove the liner carefully and treat every wastebasket as though it actually contains a needle or other sharp object. Gather the open end with both hands, tie it closed with a knot, then dispose of it in the housekeeping cart s trash bin. 5) When handling a full plastic liner, try to keep it from rubbing against you, as it may contain contaminated articles as well as needles and other sharp objects. Never reach inside the liner for any reason. 6) Clean the wastebasket inside and out with a damp cloth dipped and rung out in the disinfectant-detergent solution. Throughout the cleaning process, you must be thorough as germs are everywhere in corners, small openings, grooves, and the underside of objects. You are now ready to insert a clean liner into the wastebasket. 7) The liner should be drawn back far enough over the rim of the wastebasket that it will not fall inside. It the liner is too big, tie one end in a knot. D. Step 4 - Clean room furnishings 1) Dip your cleaning cloth into the 5-quart pail of disinfectant-detergent and hand wring. Before cleaning the bed, raise it to a comfortable height to eliminate any unnecessary bending of your back. 2) Remove the pillow and place aside. Wipe clean all surfaces of the mattress, including the top, sides and bottom. Remember to inspect the mattress for any damage, such as tears in the fabric. Report damaged mattresses to your supervisor. 3) Fold the mattress in half and clean the exposed springs underneath. Clean all rails, posts, and foot controls during this process. 4) Fold the mattress the opposite way to get at the other uncleaned surfaces. 5) Damp-wipe and disinfect the pillow, wiping all surfaces clean. 6) Damp-wipe the headboard of the bed and then clean the side rails, including bed controls, and the foot board. 7) Clean bed legs and casters to complete the bed cleaning tasks. 8) Damp-wipe and disinfect the bedside cabinet by damp-wiping the top, inside the drawers, the pulls, the sides, the front and back, and the legs. 1 Information taken from ISSA Hospital Housekeeping Training Manual

50 Health Care Cleaning and Sanitation Procedures Module Patient Discharge Room 1 (continued) D. Step 4 - Clean room furnishings (continued) 9) Leave the drawers open for airing after you have cleaned this unit. When all your other cleaning items are done, go back and close these drawers. 10) Rinse and wring your cloth often as you damp-wipe to do a thorough job of disinfection. 11) Damp-wipe the telephone, paying special attention to the receiver, since the patient makes direct contact with the handle, the mouthpiece, and the earpiece. These areas are more likely to become a source of cross-contamination. 12) Move on to the over-bed table and clean it thoroughly, again working from the upper surfaces to the lower surfaces, including the mirror and compartment inside. 13) Wipe clean the pedestal, base, and the casters. 14) Damp-wipe chairs, thoroughly cleaning the seat and back, legs and rungs. E. Step 5 - Clean Patient Restroom - See Patient Restroom Procedure F. Step 6 - Put on bed linen In some facilities the nurses make the beds. However, you may have to make beds in discharge units which you clean. Check with your supervisor and follow directions. 1) Your supervisor will give you an exact list of linens that you will need to make beds in your facility. This list may include a-f below. 2) Gather the linen needed for making a bed. a) Mattress cover or pad b) Draw sheet c) Contour and flat sheets d) Bedspread e) Pillow slip f) Blankets (one or two) 3) Place the contour sheet over the mattress. If you are not using a contour sheet for your bottom sheet, you may use a flat sheet. Be sure to make the proper mitered corners. 4) A draw sheet may be placed across the middle of the bed one foot below the head of the mattress. This is over the bottom sheet. (This sheet is used to move a patient off the bed to a gurney.) Ensure that the draw sheet hangs evenly on both sides of the bed. 5) Affix the top sheet to the bed. See that the hem is even with the mattress at the head of the bed. The sheet must be centered evenly on both sides. 6) Put the spread on the bed. The top edge should be even with the top edge of the mattress and should be centered on the mattress. Tuck in the sheet and the spread at the foot of the bed. 7) Make mitered corners on both sides of the bed. 8) Fold the top sheet and spread together to form a small cuff. Put the pillow case on the pillow. Hold the pillow and case away from your face and clothing as you cover the pillow. 9) Fit the pillow snugly into the corners of the pillow case. See that one edge of the pillow fits firmly against the seamless edge of the case. Fold any excess material in the case under the pillow. Put the pillow flat on the bed with the open end away from the door. 1 Information taken from ISSA Hospital Housekeeping Training Manual

51 Health Care Cleaning and Sanitation Procedures Module Patient Discharge Room 1 (continued) G. Step 7 - Spot clean walls 1) Remove spots on the wall with your cloth dipped and wrung in your disinfectant-detergent solution as you move around the room. 2) For a stubborn spot, wet your cloth with the disinfectant-detergent solution and then rub the spot with the saturated part of your cloth. 3) At times you will use a spray can of foaming disinfectant. Spray wall or surface directly, using a liberal amount. Allow dwell time for product to work and then wipe clean. You are now ready to clean the patient restroom. See Patient Restroom section. H. Step 8 - Dust mop floor 1) When using either the dust mop or the damp mop, use a figure eight motion, working clockwise or counter-clockwise around the room so you will not skip an area or clean the same area twice. When using the dust mop, never lift the mop head from the floor once you have started dusting. This creates a vacuum that pulls dirt and dust away from the mop head, thus re-contaminating the area. When the mop head becomes too dirty, dispose of it in the plastic bag to be laundered. Then, attach a clean mop head and continue dusting. 2) When dust mop does not pick up all the debris from the floor, use your dustpan and broom to remove the pile of debris. I. Step 9 - Stock patient brochures 1) When a new patient checks into the room you have just cleaned, your hospital may have brochures, pamphlets, and instruction sheets for the patient to read. Place these items as directed by your supervisor. J. Step 10 - Wet mop floor 1) To begin this step, place a Wet Floor sign to warn that the floor is wet and possibly slippery. 2) When wet mopping, work in a clockwise or counter-clockwise pattern, using a figure eight motion as you did while dust mopping. 3) Rinse and wring the wet mop head often to get the floor really clean. The mop water contains a disinfectant-detergent which is designed to kill germs on contact. 4) Push the wet mop under the bed and under all furniture, including heating and cooling units, to clean as much of the floor area as possible. 5) When you have finished using the wet mop, wring as dry as possible and dispose of it in a plastic bag for laundering. 1 Information taken from ISSA Hospital Housekeeping Training Manual

52 Health Care Cleaning and Sanitation Procedures Module Patient Discharge Room 1 (continued) K. Step 11 - Inspect room 1) Before you leave, inspect your room according to your checklist and make sure you did not forget to perform any required cleaning task. If you find an error, correct it at this time. L. Step 12 - Clean door 1) Do not overlook the doorway hardware. Clean the door knob as this area is easily contaminated. 2) Use your furniture polish sprayed on a clean cloth to clean the door itself. The kickplate should be cleaned with stainless steel cleaner. CAUTION WET FLOOR M. Step 13 - Remove Wet Floor sign 1) Remove Wet Floor sign when the floor is dry. N. Inform Supervisor 1 Information taken from ISSA Hospital Housekeeping Training Manual

53 Health Care Cleaning and Sanitation Procedures Module Patient Discharge Isolation Room 2 A. Materials Requirement Planning (MRP) a. Supply of clean cloths b. Hand pads c. Hand mirror d. Mop bucket with wringer e. Disposable gloves f. High dusting tool g. Hand pail (3-gallon) h. Approved germicidal detergent solution appropriate to the area i. Spray disinfectant j. Spray all-purpose cleaner solution k. Plastic liners l. Paper towels m. Toilet tissue n. Dust pan and brush o. Wet mop handle and 12 oz. looped-end banded wet mop p. Door stop q. Dust mop r. Putty knife s. Toilet bowl brush/bowl swab t. Toilet bowl cleaner u. Creme cleanser v. Spray germicidal solution w. Spray window cleaner solution x. Rinse water y. Hand soap Note: All bedding, curtains, and drapes should have been bagged and removed from the room before cleaning begins. This may be a nursing staff responsibility. CAUTION WET FLOOR B. Step 1- Steps to cleaning 1) Prepare to enter room - Read isolation card on door to determine the protective clothing to be worn. Put on gown, mask, gloves and over-shoe booties, as required. Also note any special requirements the type of isolation may require. Flat surfaces may need wet cleaning with a germicidal detergent solution. Walls may need a damp cleaning with a germicidal detergent. 2) Prepare area - Knock on door. Open slightly and announce your intention to enter. If occupied, wait. When empty, open and stop door. Check to assure non-isolation. Check for personal articles left by the patient. Return any articles to the Nursing Supervisor with patient s room number. Move any special equipment into hall and advise Nursing Supervisor. Carry all equipment and supplies into the room and close door. Once in the room do not leave with 2 Information taken from ISSA Hospital Housekeeping Procedures

54 Health Care Cleaning and Sanitation Procedures Module Patient Discharge Isolation Room 2 (continued) B. Step 1 - Steps to cleaning (continued) protective clothing on. Collect all waste from waste containers immediately and double bag when removing from room. 3) When cleaning bathroom - Follow Patient Restroom Cleaning Procedures. When cleaning outside toilet surfaces, use a paper towel saturated with germicidal detergent solution. Wipe down all surfaces. Dispose properly of toweling. Rinse surfaces with towel saturated in clear water. Dispose of towels. 4) Proceed with steps in Patient Discharge Room. 5) Floor cleaning - Flood floor, as in operating room cleaning, with a germicidal solution. Let stand for recommended length of time and vacuum up with wet-vacuum. If not practical, wet mop using two pail method. Dip mop in germicidal solution and spread on floor. Mop up dirty solution. Using a second mop, rinse floor with clear water. Use solution bucket to wring out mop, and mop up thoroughly. If floor is heavily soiled, use rotary floor scrubber. 6) Wash hands and arms - After all steps have been completed, wash hands and arms using Handwashing procedure. 7) Leaving isolation - Remove all equipment and supplies. Dispose of bagged waste in proper receptacle. Remove protective clothing. Remove mask by strings. Remove gown gently, folding it inside out, and dispose in proper receptacle. 8) Wash hands and arms - See Handwashing procedures. 9) Service equipment - Transport all equipment to appropriate housekeeping storage area. Wash all equipment used in room with a germicidal solution. 10) Wash hands and arms - See Handwashing procedures. 2 Information taken from ISSA Hospital Housekeeping Procedures

55 Health Care Cleaning & Sanitation Procedures Module Waste Removal 2 A. Materials Requirement Planning (MRP) a. Trash truck b. Plastic liners c. Disposable gloves Waste removal cleaning steps B. Step 1 - Accumulation 1) Personnel on each unit or floor should transport bagged materials to designated accumulation point. Sharps must be collected in approved containers only. Maintain proper procedure to isolate infectious materials. C. Step 2 - Transportation to disposal area 1) Collection time and schedule are dependent on various departments requirements. Begin and move collected materials through halls and elevators when there is a minimum of traffic. Maintain proper procedures to isolate infectious material. 2) After materials are unloaded at disposal site, return cart to an appropriate area for immediate cleaning with a germicidal solution. 2 Information taken from ISSA Hospital Housekeeping Procedures

56 Food Service Clean Up Dietary/Department Clean Up A. Remove Scraps Remove products, wrapping paper and all packaging material from areas to be cleaned. Sweep floor with appropriate broom. B. Cover Electrical Equipment Cover and unplug all wrapping or weighing equipment, as they may be water sensitive. C. Collect Hand Tools Put all scrapers, knives, trays, hand saws, grinding parts, etc., in sink for manual washing. 1) Utilize USDA A-1 pot & pan wash in first compartment of 3-stage sink. 2) Utilize USDA D-2 Sanitizer in the 3rd compartment of 3-stage sink. D. Cleaning Procedure 1) Use Foaming Degreaser USDA A-1. 2) Mix 1:20 with warm water. 3) Apply with foam gun, pressure sprayer or deck brush to all surfaces to be cleaned, such as walls, tables, counters, saws, etc. a. Walls Clean from bottom to top. b. Floors Agitate, let stand, squeegee to drain, or pick up with wet dry vac. Rinse, squeegee or wet dry vac. 4) Allow foaming degreaser to remain on the surfaces for five minutes to loosen fats, oils, grease and other hard-to-remove soils. 5) Agitate if necessary. 6) Thoroughly rinse all surfaces being cleaned with the warmest water available. Rinse walls from top to bottom. 7) Squeegee excess water into drains. E. Sanitizing Procedure 1) Use Sanitizer/Virucidal Disinfectant USDA D-2. 2) Mix 1:500 with water (1 oz. to 4 gallons water). 3) Apply with sanitizing gun or pump-up sprayer to all surfaces previously cleaned. 4) Allow all food contact surfaces to air dry no potable water rinse required. F. Add Drain Maintainer 1) Use Liquid Life Forms Bacterial Digestant/Deodorant. 2) Pour 4 oz. of Drain Maintainer twice weekly in each drain. 3) Pour 4 oz. daily into grease traps. Display Cases A. Remove all Product from Display Case B. Remove all Shelving, Storage Pans, and Stage to 3-Sink Area

57 Food Service Clean Up Dietary/Display Cases (continued) C. Cleaning Procedure 1) Use Foaming Degreaser USDA A-1. 2) Mix 1:20 with warm water. 3) Apply with foam gun, pump-up sprayer or spray bottle to all surfaces to be cleaned. Clean from bottom to top. 4) Allow foam degreaser to remain on the surfaces for five minutes to loosen fats, oils, grease and other hard-to-remove soils. 5) Agitate if necessary. 6) Thoroughly rinse all surfaces being cleaned with the warmest water available, from top to bottom. D. Sanitizing Procedure 1) Use Sanitizer/Virucidal Disinfectant USDA D-2. 2) Mix 1:500 with water (1 oz. to 4 gallons water). 3) Apply with sanitizing gun or pump-up sprayer to all surfaces previously cleaned. 4) Allow all food contact surfaces to air dry no potable water rinse required. 5) Clean any glass with Film Free Glass Cleaner. E. Return all caution signs and equipment to appropriate storage locations 1) Ensure that all chemicals are refilled. 2) Ensure that all equipment is cleaned and rinsed out.

58 Health Care Cleaning & Sanitation Procedures Module Operating Room A. Materials Requirement Planning (MRP) a. Supply of clean cloths b. Hand pads c. Wet/dry vacuum d. Mop bucket with double wringer e. Disposable glove f. Hand pail (3 gallon) g. Approved germicidal detergent solution appropriate to the area h. All-purpose spray cleaner solution i. Plastic liner j. Wet mop handle and looped-end banded wet mop k. Door stop l. Germicidal spray solution m. Rinse water n. Antimicrobial hand soap and Instant hand sanitizer o. Wet Floor signs p. Step ladder 2 Information taken from ISSA Hospital Housekeeping Procedures

59 Health Care Cleaning & Sanitation Procedures Module Operating Room 1 Operating room cleaning steps A. Remove soiled linen from operating room B. Remove trash and debris C. Clean overhead lights D. Clean operating room table E. Clean operating room furnishings F. Clean operating room walls G. Clean operating room floors H. Arrange operating room furnishings I. Inspect for cleaning errors You should clean every room using a pattern. Moving clockwise around the room from high places to low places is usually best to ensure that nothing is overlooked. This also ensures that each area is not re-contaminated and that leaning one area does not re-contaminate another area. Put on rubber gloves to protect your hands from coming in direct contact with blood, body substances and contaminated linen and debris. A. Step 1 - Remove soiled linen from operating room 1) Gather the soiled linen from the operating room and place in a sealed plastic bag for laundering. 2) Take plastic liners with soiled linen to the laundry hamper. B. Step 2 - Remove trash and debris 1) Lift the used suction containers, place them in double red plastic liners, and tie the top of the outer red bag of waste. 2) Lift the bag and carry it out of the operating room to the pick-up point for this trash. C. Step 3 - Clean overhead lights 1) Get a ladder and set it up under the lights. 2) Place your pail of detergent-germicide on the ladder utility platform. 3) Clean the overhead lights, starting at the top part of the ceiling attachment. Clean the stem, all surfaces of the piping, and all surfaces of the light housing. 4) Rotate the lights, and clean the light fixture lenses. It is not unusual to find blood stains on the light fixture. Wipe all lens surfaces clean and then clean the second overhead light in the room. D. Step 4 - Clean the operating room table 1) Start by cleaning the warming pad with your cleaning cloth dipped and squeezed in the five-quart pail containing detergent-germicide solution. 2) Clean the table pads on all sides, being careful not to miss any stains. 3) Clean the operating room table attachments, wiping all sides and ends clean. 1 Information taken from ISSA Hospital Housekeeping Training Manual

60 Health Care Cleaning & Sanitation Procedures Module Operating Room 1 (continued) D. Step 4 - Clean the operating room table (continued) 4) Store attachments back on the table in the proper location. 5) Wipe the metal surfaces under the pads, being careful to wipe all contours of the metal surfaces. 6) Notice that you can re-assemble the parts of the operating room table as you clean them. 7) After the table has been wiped clean, replace the warming pad on the table. 8) Be sure to rinse and wring the cleaning cloth often in the detergent-germicide solution as you wipe the outer surfaces and base sections of the table. The operating room table is one of the most critical items in cleaning the operating room. Therefore, take the time to do a good job. E. Step 5 - Clean operating room furnishings 1) Clean the stainless steel tables and trays with your cloth dipped and wrung in the detergent-germicide solution. 2) Be careful to do a thorough job, including wiping the legs. 3) Clean the stainless steel back-up table and do not forget to clean the shelf. 4) Clean the MAYO stands, which contain the trays that surgeons use to lay out their operating instruments. Wipe both sides of the trays, as well as the entire unit. 5) Be sure to rinse and hand-wring your cleaning cloth often in the detergent-germicide solution. 6) Clean the suction unit, taking care to wipe all surfaces of the containers, the stand, and the pedestal. Do not forget to wipe clean the tubing attached to the suction units. All outer parts of this piece of equipment must be cleaned. 7) Clean all parts and surfaces of the waste liner stands, including the lower parts of the stand. 8) Change the solution in your five-quart pail if you see the liquid getting contaminated as you rinse your cleaning cloth. 9) When cleaning items like this portable stand, be sure to lift and clean under items stored there. 10) Clean the stools from top to bottom. Some of these are very close to the actual operations and can be sprayed with blood. 11) Clean all the I.V. poles and stands. Again, work from top to bottom. 12) Clean the chairs found in the operating room. Wipe all surfaces clean, including the bottom chair supports. 13) Clean cabinets with your detergent-germicide. 14) Clean the blanketrol machine, including the tubing and all sides of the unit. 15) Clean the valley lab unit, starting at the top, moving down to the drawer pull, under objects left on the shelf, and then clean all sides of the unit. This completes the cleaning of the room furnishings. F. Step 6 - Clean operating room walls 1) Walls should be cleaned if there is visible contamination. 2) They should be cleaned on a regular schedule and not less than once a week. 3) Rinse and wring your mop head in a bucket of detergent-germicide solution. 4) Walls should be cleaned in an even pattern using four-foot strokes. It will take practice not to miss any areas. 1 Information taken from ISSA Hospital Housekeeping Training Manual

61 Health Care Cleaning & Sanitation Procedures Module Operating Room 1 (continued) G. Step 7 - Clean operating room floor 1) Start by clearing half of the operating room of all furnishings. 2) Since all these items are mounted on casters, the job of moving things can be done in minutes. Just remember the original placement of all the items you have moved. 3) Dip the wet mop head into the detergent-germicide solution, and wring out the excess solution. Then, go to the far corner of the floor and begin mopping. 4) Mop in a pattern that will ensure that all parts of the floor are thoroughly mopped. 5) Dip and wring the mop head in the bucket often to keep your mop head as clean as possible. 6) Use a figure eight pattern when mopping a floor. This ensures better coverage of the mopping solution. 7) If you see blood stains, they can easily be removed by your mopping action. Once you have covered the entire area with your mopping solution, let the solution stand for ten minutes. This will ensure that the cleaning chemical will have time to kill all germs present on the floor. 8) The best method available to remove the floor cleaning solution is with a wet vacuum cleaner. These machines save time and eliminate the possibility of re-contamination. Use the wet-vac wand to pick up all of the solution on the floor, moving the wand forward to the wall, and then pulling back toward your feet to remove the solution from the floor. 9) If you do not have a wet-vacuum, use two freshly laundered mops and a two-bucket system: one bucket will contain the cleaning solution and the other bucket will contain clear rinse water. Use a separate mop for each bucket. 10) When you are through with that side of the floor, move all operating room furnishings back on the cleaned area of the floor in preparation for clearing the other half of the floor. 11) Mop around furniture legs, if necessary, to clean the entire/whole floor. 12) Rinse and wring your mop head often and continue the mopping until the entire operating room floor has been disinfected. 13) Again, you will use the wet-vac to pick up the solution off the floor. 14) When you are through, move your mop and bucket out the door. H. Step 8 - Arrange operating room furnishings 1) You should put operating room equipment back in their start positions. 2) If you have any doubts as to where things should be placed, ask your supervisor who will instruct you on the proper arrangement of all furnishings. 3) Next, put a clean sheet on the operating room table and place a second sheet over the center of the table. Check with your supervisor if you have any questions about your duties in the hospital. 4) Put a clear liner in the trash stand, along with a second bag to ensure double thickness plastic bags in each stand. 5) Do the same with the red liner in the trash stand, and again, place a second liner in the first to ensure the double bagging of all infectious waste. 1 Information taken from ISSA Hospital Housekeeping Training Manual

62 Health Care Cleaning & Sanitation Procedures Module Operating Room 1 (continued) I. Step 9 - Inspect for cleaning errors 1) Always take the time to look around the operating room you have just cleaned to make sure nothing was missed. Look at the overhead lights, the walls and everything else. If you see something that still needs to be cleaned, clean it before you leave. 2) When you do leave, you should have the confidence that you have provided a sanitary environment for the next procedure. 3) Take off your rubber gloves and throw them away in the assigned container. 4) Wash your hands in the prescribed manner. 1 Information taken from ISSA Hospital Housekeeping Training Manual

63 Health Care Cleaning & Sanitation Procedures Module Emergency Room A. Materials Requirement Planning (MRP) a. Supply of clean cloths b. Hand pads c. Wet/dry vacuum d. Mop bucket with double wringer e. Disposable gloves f. Hand pail (3 gallon) g. Approved germicidal detergent solution appropriate to the area h. All-purpose spray cleaner solution i. Plastic liner j. Wet mop handle and looped-end banded wet mop k. Door stop l. Germicidal spray solution m. Rinse water n. Antimicrobial hand soap and Instant hand sanitizer o. Wet Floor signs p. Step ladder 2 Information taken from ISSA Hospital Housekeeping Procedures

64 Health Care Cleaning & Sanitation Procedures Module Emergency Room 1 Emergency room cleaning steps A. Remove soiled linen from operating room B. Remove trash and debris C. Clean overhead lights D. Clean operating room table E. Clean operating room furnishings F. Clean operating room walls G. Clean operating room floors H. Arrange operating room furnishings I. Inspect for cleaning errors You should clean every room using a pattern. Moving clockwise around the room from high places to low places is usually best to ensure that nothing is overlooked. This also ensures that each area is not re-contaminated and that leaning one area does not re-contaminate another area. Put on rubber gloves to protect your hands from coming in direct contact with blood, body substances and contaminated linen and debris. A. Step 1 - Remove soiled linen from operating room 1) Gather the soiled linen from the operating room and place in a sealed plastic bag for laundering. 2) Take plastic liners with soiled linen to the laundry hamper. B. Step 2 - Remove trash and debris 1) Lift the used suction containers, place them in double red plastic liners, and tie the top of the outer red bag of waste. 2) Lift the bag and carry it out of the operating room to the pick-up point for this trash. C. Step 3 - Clean overhead lights 1) Get a ladder and set it up under the lights. 2) Place your pail of detergent-germicide on the ladder utility platform. 3) Clean the overhead lights, starting at the top part of the ceiling attachment. Clean the stem, all surfaces of the piping, and all surfaces of the light housing. 4) Rotate the lights, and clean the light fixture lenses. It is not unusual to find blood stains on the light fixture. Wipe all lens surfaces clean and then clean the second overhead light in the room. D. Step 4 - Clean the emergency room table 1) Start by cleaning the warming pad with your cleaning cloth dipped and squeezed in the five-quart pail containing detergent-germicide solution. 2) Clean the table pads on all sides, being careful not to miss any stains. 3) Clean the emergency room table attachments, wiping all sides and ends clean. 1 Information taken from ISSA Hospital Housekeeping Training Manual

65 Health Care Cleaning & Sanitation Procedures Module Emergency Room 1 (continued) D. Step 4 - Clean the emergency room table (continued) 4) Store attachments back on the table in the proper location. 5) Wipe the metal surfaces under the pads, being careful to wipe all contours of the metal surfaces. 6) Notice that you can re-assemble the parts of the emergency room table as you clean them. 7) After the table has been wiped clean, replace the warming pad on the table. 8) Be sure to rinse and wring the cleaning cloth often in the detergent-germicide solution as you wipe the outer surfaces and base sections of the table. The emergency room table is one of the most critical items in cleaning the emergency room. Therefore, take the time to do a good job. E. Step 5 - Clean emergency room furnishings 1) Clean the stainless steel tables and trays with your cloth dipped and wrung in the detergent-germicide solution. 2) Be careful to do a thorough job, including wiping the legs. 3) Clean the stainless steel back-up table and do not forget to clean the shelf. 4) Clean the MAYO stands, which contain the trays that surgeons use to lay out their operating instruments. Wipe both sides of the trays, as well as the entire unit. 5) Be sure to rinse and hand-wring your cleaning cloth often in the detergent-germicide solution. 6) Clean the suction unit, taking care to wipe all surfaces of the containers, the stand, and the pedestal. Do not forget to wipe clean the tubing attached to the suction units. All outer parts of this piece of equipment must be cleaned. 7) Clean all parts and surfaces of the waste liner stands, including the lower parts of the stand. 8) Change the solution in your five-quart pail if you see the liquid getting contaminated as you rinse your cleaning cloth. 9) When cleaning items like this portable stand, be sure to lift and clean under items stored there. 10) Clean the stools from top to bottom. Some of these are very close to the actual operations and can be sprayed with blood. 11) Clean all the I.V. poles and stands. Again, work from top to bottom. 12) Clean the chairs found in the emergency room. Wipe all surfaces clean, including the bottom chair supports. 13) Clean cabinets with your detergent-germicide. 14) Clean the blanketrol machine, including the tubing and all sides of the unit. 15) Clean the valley lab unit, starting at the top, moving down to the drawer pull, under objects left on the shelf, and then clean all sides of the unit. This completes the cleaning of the room furnishings. F. Step 6 - Clean emergency room walls 1) Walls should be cleaned if there is visible contamination. 2) They should be cleaned on a regular schedule and not less than once a week. 3) Rinse and wring your mop head in a bucket of detergent-germicide solution. 4) Walls should be cleaned in an even pattern using four-foot strokes. It will take practice not to miss any areas. 1 Information taken from ISSA Hospital Housekeeping Training Manual

66 Health Care Cleaning & Sanitation Procedures Module Emergency Room 1 (continued) G. Step 7 - Clean emergency room floor 1) Start by clearing half of the emergency room of all furnishings. 2) Since all these items are mounted on casters, the job of moving things can be done in minutes. Just remember the original placement of all the items you have moved. 3) Dip the wet mop head into the detergent-germicide solution, and wring out the excess solution. Then, go to the far corner of the floor and begin mopping. 4) Mop in a pattern that will ensure that all parts of the floor are thoroughly mopped. 5) Dip and wring the mop head in the bucket often to keep your mop head as clean as possible. 6) Use a figure eight pattern when mopping a floor. This ensures better coverage of the mopping solution. 7) If you see blood stains, they can easily be removed by your mopping action. Once you have covered the entire area with your mopping solution, let the solution stand for ten minutes. This will ensure that the cleaning chemical will have time to kill all germs present on the floor. 8) The best method available to remove the floor cleaning solution is with a wet vacuum cleaner. These machines save time and eliminate the possibility of re-contamination. Use the wet-vac wand to pick up all of the solution on the floor, moving the wand forward to the wall, and then pulling back toward your feet to remove the solution from the floor. 9) If you do not have a wet-vacuum, use two freshly laundered mops and a two-bucket system: one bucket will contain the cleaning solution and the other bucket will contain clear rinse water. Use a separate mop for each bucket. 10) When you are through with that side of the floor, move all emergency room furnishings back on the cleaned area of the floor in preparation for clearing the other half of the floor. 11) Mop around furniture legs, if necessary, to clean the entire/whole floor. 12) Rinse and wring your mop head often and continue the mopping until the entire emergency room floor has been disinfected. 13) Again, you will use the wet-vac to pick up the solution off the floor. 14) When you are through, move your mop and bucket out the door. H. Step 8 - Arrange emergency room furnishings 1) You should put emergency room equipment back in their start positions. 2) If you have any doubts as to where things should be placed, ask your supervisor who will instruct you on the proper arrangement of all furnishings. 3) Next, put a clean sheet on the emergency room table and place a second sheet over the center of the table. Check with your supervisor if you have any questions about your duties in the hospital. 4) Put a clear liner in the trash stand, along with a second bag to ensure double thickness plastic bags in each stand. 5) Do the same with the red liner in the trash stand, and again, place a second liner in the first to ensure the double bagging of all infectious waste. 1 Information taken from ISSA Hospital Housekeeping Training Manual

67 Health Care Cleaning & Sanitation Procedures Module Emergency Room 1 (continued) I. Step 9 - Inspect for cleaning errors 1) Always take the time to look around the emergency room you have just cleaned to make sure nothing was missed. Look at the overhead lights, the walls and everything else. If you see something that still needs to be cleaned, clean it before you leave. 2) When you do leave, you should have the confidence that you have provided a sanitary environment for the next procedure. 3) Take off your rubber gloves and throw them away in the assigned container. 4) Wash your hands in the prescribed manner. 1 Information taken from ISSA Hospital Housekeeping Training Manual

68 Health Care Cleaning and Sanitation Procedures Module Delivery/OB Note: The O.B. room will be thoroughly cleaned following use to reduce contamination of the area and to prepare it for the next delivery. The cleaning of the O.B. room following a delivery is the responsibility of nursing and housekeeping. A. Materials Requirement Planning (MRP) a. Hospital approved disinfectant/ cleaning solution b. Mop c. Bucket/ wringer d. Clean linen e. Gloves, scrub hat, and shoe covers f. Wet Floor signs B. Delivery/OB Procedure: Following delivery, nursing will normally: 1) Always wear the proper protective equipment 2) Place all soiled linen in linen bag which is lined with plastic bag. Place bag on bottom shelf of case cart. 3) Place all disposable materials, soiled sponges and materials from kickbasin, into a large plastic bag. Tie securely. Place on bottom shelf of case cart. If there is excessive blood and/or fluid, double a bio-hazard bag and mark with a contamination sticker found in dirty utility room. 4) Placentas are placed in proper container and identified. See placenta policy. 5) Place all instuments, pans and trays on top of case cart and take to the dirty utility room. 6) All needles and syringes should be placed in sharp container. 7) All instruments, pans and trays should be rinsed well (free of blood and tissue) unclamped, and placed in a plastic bag. Place on shelf of case cart. Use caution that no instruments fall into the drain. 8) Place case cart on the contamination dumb-waiter and send to the proper department. Housekeeping will normally: 1) Use appropriate disinfectant solution to clean room. Note: Clean the infant warmer first, starting with the probe, utilizing appropriate hard surface disinfecting procedures (see O.B. room procedures). 2) Mop floor. 3) Wash hands in the prescribed manner. Nursing will normally then: 1) Replace linen on infant warmer and delivery table. 2) Check that the delivery suite is in order and that supplies have been replaced, including the NRPR bag and suction containers. Order case carts from CSR and place in room after checking completeness of contents. 3) Enter apropriate charges in computer. 4) Wash hands in the prescribed manner.

69 Health Care Cleaning and Sanitation Procedures Module Elevators 2 A. Materials Requirement Planning (MRP) a. Mop bucket with wringer b. Wet mop handle with 16 oz. looped-end banded mop c. Polish d. Putty knife e. Dust mop f. Graffiti remover g. Hand pail h. Lobby dust pan and toy corn broom i. Germicidal solution j. Supply of clean cloths k. Approved germicidal detergent solution l. Vacuum equipment CAUTION WET FLOOR B. Steps to cleaning elevators 1) Prepare area - Using a cloth dampened with a germicidal solution, clean wall area around signal button outside of elevator doors. Signal for elevator. 2) Clean elevator car - When elevator arrives, turn elevator switch to off position. Remove any trash. Using a germicidal solution, damp-wipe interior surfaces. Clean control panels, vents, ceiling and lights. Remove any graffiti. Polish metals as needed. 3) Clean floor - Vacuum door grooves. Either damp mop using damp mop procedures or vacuum using vacuuming procedures. 4) When cleaning is complete - Remove all cleaning equipment and materials. Turn elevator switch to on position. 2 Information taken from ISSA Hospital Housekeeping Procedures

70 Health Care Cleaning and Sanitation Procedures Module Stairways 2 A. Materials Requirement Planning (MRP) a. Germicidal spray solution b. Mop handle with 16 oz. looped-end banded mop c. Set of Wet Floor signs d. Putty knife e. Dust mop f. Dustpan and brush g. Mop bucket with wringer h. Clean cloths i. Approved germicidal detergent solution CAUTION WET FLOOR B. Steps to cleaning stairways 1) Prepare area - Set up Wet Floor signs. Locate signs at the top, middle and bottom of the flight of stairs to be cleaned. Clean one flight at a time. 2) Dust mop floor -Work down the stairs. Dust mop each step. Damp-dust each bannister. Collect dust and debris at each landing. Empty dust pan in waste container. Use putty knife to remove materials sticking to stair. 3) Damp mop - Mop steps with germicidal solution. Start at top of the flight. Wipe walls if splashed by mop. 4) When steps are dry - Remove signs. Return all equipment and supplies to storage. 2 Information taken from ISSA Hospital Housekeeping Procedures

71 Health Care Cleaning and Sanitation Procedures Module CAUTION WET FLOOR Wall Washing A. Materials Requirement Planning (MRP) a. RTU Spray & wipe cleaner b. Concentrated Neutral (germicidal if possible) cleaner c. Clean, dry towels d. Wall wash tool e. Wall wash head f. Wall wash bucket & wringer g. Safety signs h. Personal protective equipment B. Steps to Wall Washing 1) Obtain proper equipment. Include proper safety garb as standard equipment. 2) Prepare approved germicidal cleaner to appropriate dilution while wearing personal protective equipment (PPE). 3) Post Caution signs. 4) Clear area to be cleaned of furniture, equipment and wall hangings. 5) Grossly soiled areas may require a stronger spot-type cleaner prior to wall washing. 6) Immerse wall washing tool into germicidal cleaner bucket. 7) Wring wall washing tool into germicidal cleaner wringer. 8) Clean an area not wider than your arm-span (including tool) beginning at the bottom of the wall, overlapping previous pass. a. Change to fresh solution at least once per room b. Change wall wash head at least once per room c. If rinsing is required, rinse from the top down 9) Replace all furnishings to original positions. 10) Replace all chemicals and equipment to appropriate storage areas. a. Refill any chemicals required b. Clean all equipment c. Send wall wash heads to laundry d. If wall washing heads and/or safety garb were subjected to patient isolation rooms or OPIM s, dispose of them properly.

72 Health Care Cleaning and Sanitation Procedures Module Locker Rooms/Shower Rooms 2 A. Materials Requirement Planning (MRP) a. 50 ft. hose with proper connection b. Foam gun nozzle c. All angle scrub brush/extension handle d. Squeegee scrubber sponges and/or hand pads e. Putty knife f. Clean rags g. Boots/shreds/overshoes h. Safety goggles i. Gloves j. Wet Floor sign k. Clean towel l. Utility suit m. Multi acid disinfectant cleaner concentrate B. Steps to cleaning locker rooms/showers 1) Fill any soap dispensers. 2) Remove any disposable materials. 3) Spot clean any heavily soiled areas. 4) Fill foam gun reservoir with high foaming, multi-acid shower room disinfectant cleaner. 5) Apply or insert appropriate dilution control mechanism. 6) Attach foam gun to hose and hose to nearest water source. * Before beginning, please refer to product s personnel protective equipment instructions and wear equipment as needed before mixing chemicals. 7) Spray section of wall no more than one arm span s width. Begin at the floor and move upward until you reach the ceiling. Move to next section. 8) After spraying walls, spray ceiling in a similar manner, making sure the entire ceiling has been sprayed with disinfectant solution. 9) Spray entire floor with disinfectant solution. 10) Using an all angle scrub brush, start at the first area that was sprayed with the disinfectant and scrub all contact surfaces. Wash from bottom up. 11) Dismantle foam gun from hose and replace with standard spray nozzle. Starting with the ceiling and working down the walls, rinse thoroughly with water, paying special attention to any metal fixtures. Rinse from top down. 12) Rinse off non-slip boots. 13) Disconnect hose from water source and roll up. 14) Return all cleaning equipment to proper storage area. 2 Information taken from ISSA Hospital Housekeeping Procedures

73 Health Care Cleaning and Sanitation Procedures Module Lounges 2 A. Materials Requirement Planning (MRP) a. Mop bucket with wringer b. Wet mop handle with 20 oz. looped-end banded mop c. Set of Wet Floor signs d. Putty knife e. Dust mop f. Dustpan and brush g. Hand pail h. Clean cloths i. Spray window cleaner j. Spray polish k. Approved germicidal detergent solution l. Vacuum equipment B. Steps to cleaning the lounge 1) Empty ashtrays and wastebaskets. Clean all receptacles. Remove dated newspapers and damaged magazines. 2) Dust furniture - tables, legs of chairs, lamps, etc. Damp-wipe plastic-covered furniture. Vacuum cloth upholstery. 3) Dust window sills and light fixtures. 4) Dust mop floor - Use dust mop of an appropriate size. Treat with a water-base treatment when working in heavier soil load area. Start at one end of area. Hold mop handle at an approximately 45 degree angle. Push mop straight ahead. Avoid lifting mop from floor or moving it backwards. Remove gum with putty knife. Pivot at end of area and mop in opposite direction. Overlap about ten inches. 5) Clean floor - Either damp mop using damp mop procedure or vacuum using vacuuming procedure. 6) Polish - Polish metals and furniture. Use appropriate polish and clean cloths. 7) Spot clean soiled areas - Check walls and doors. Spot clean only areas that are no larger than your hand. Notify supervisor if complete wall washing is necessary. Clean windows. Clean telephone. 8) Straighten furniture - Arrangement should conform to established pattern. 2 Information taken from ISSA Hospital Housekeeping Procedures

74 Health Care Cleaning and Sanitation Procedures Module Physical Therapy/Fitness Room 1 (continued) PT/Fitness Room Cleaning Steps 1) Perform high dusting 2) Disinfecting PT/ fitness equipment 3) Clean shower or tub, if present 4) Clean mirrors 5) Clean wall splash marks, grab bars, and other support equipment 6) Empty and insert plastic liners in wastebaskets 7) Dust mop floor 8) Wet mop floor and rubber matting 9) Place Wet Floor sign in doorway 10) Vacuum if carpet is present 11) Inspect room 12) Clean door 13) Remove Wet Floor sign 14) Wash hands 15) Re-stock A. Step 1 - Perform high dusting 1) This includes high dusting of the door frame and door hinges, ceiling vents, lights, tops of mirrors, and tops of all PT Room equipment.. B. Step 2 - Disinfecting PT/ Fitness equipment 1) Start by spraying a small amount of neutral disinfectant cleaner on the vinyl/naugahide surfaces. 2) Wipe the vinyl/ naugahide surfaces dry. 3) Wipe and polish all metal fixtures and handles. Clean from the bottom up on all vertical surfaces. C. Step 3 - Clean shower or tub if present 1) Spray the tile and agitate the disinfectant cleaner around all shower walls, starting at the top and working your way to the bottom. 2) Wipe the shower head, faucet handles, and other fixtures clean. 3) Do not forget to wipe clean the shower room handrails. All areas must be cleaned. Mop the shower floor clean to complete the task. 4) If whirlpool tub exists see Whirlpool Cleaning Procedures. D. Step 4 - Clean mirrors 1) Use glass cleaner sprayed directly onto the mirror and wipe clean with your cloth or a paper towel. Remove fingerprints, splash marks and smudges. 1 Information taken from ISSA Hospital Housekeeping Training Manual

75 Health Care Cleaning and Sanitation Procedures Module Physical Therapy/Fitness Room 1 (continued) PT/Fitness Room Cleaning Steps E. Step 5 - Clean wall splash marks, grab bars, and other support equipment 1) Clean walls with your cloth dampened in neutral disinfecting cleaner. Clean only the wall areas that need to be cleaned. If the wall needs thorough cleaning, see Wall Washing Procedures 2) Wipe the grab bars clean as well as the wall behind these grab bars and walking track area. 3) Be sure also to clean door knobs and all switch plates in the room. F. Step 6 - Empty and insert plastic liners in wastebasket 1) Start by picking up loose debris around the basket. Danger: Needles May Be In Trash! 2) Be very careful how you remove any liner containing trash. The liner is made of plastic and it is very easy for a needle or sharp objects to poke through. 3) You must be very careful not to allow the liner to brush against your body, for obvious reasons. Start by folding the liner off the basket sides. Touch only the top of the liner. Lift the liner well clear of your arms and body, tie it closed, and dispose in the trash cart. 4) Take your cloth, dampened in germicidal solution, and clean the entire basket in and out. This is a key point and is often overlooked. 5) Now you re ready to re-line the basket. Folding the liner over the top neatly completes this task. Some hospitals will place spare plastic liners in the bottom of the basket before a new liner is inserted in the basket. Your housekeeping supervisor will go over the exact procedure set for your hospital. G. Step 7 - Dust mop floor 1) Before you dust mop, check the floor for obstructions such as gum. Use your scraper to remove the gum before you begin dust mopping. 2) Work the dust mop over the floor area in a pattern around the room. 3) Keep the dust mop head on the floor, working it into the corners and edges to pick up the loose dust. Place the dust mop on your cart. 1 Information taken from ISSA Hospital Housekeeping Training Manual

76 Health Care Cleaning and Sanitation Procedures Module Physical Therapy/Fitness Room 1 (continued) PT/Fitness Room Cleaning Steps H. Step 8 - Wet mop floor and rubber matting 1) Prepare a single bucket of neutral disinfecting solution while at supply closet. 2) The bucket is filled about half full with cool or warm water. Your supervisor will explain the exact procedure for mixing chemicals in your hospital. 3) To wet mop the restroom floor, dip the mop into the cleaning solution, wring and take mop to the restroom. 4) Continue mopping the floor until the floor surface is clean. 5) Remember, it is important that the entire floor surface be mopped, including corners and behind fixtures, being careful not to splash or rub against the baseboards. CAUTION WET FLOOR I. Step 9 - Place Wet Floor sign in doorway 1) Now is a good time to wash your hands following handwashing standards set up for your hospital. Protecting your good health is important and must not be ignored. 2) This restroom is now clean and ready for use. The next patient to use this restroom will appreciate your cleaning efforts. J. Step 10 - Vacuum if carpet is present 1) If carpet is present see Vacuuming 2) Spot clean if necessary K. Step 12 - Clean doors 1) Do not overlook the doorway hardware. Clean the door knob as this area is easily contaminated. 2) Use your furniture polish (if door is wooden) sprayed on a clean cloth to clean the door itself. The kickplate should be cleaned with stainless steel cleaner. L. Step 11 - Inspect room 1) Before you leave, inspect your room according to your checklist, and make sure you did not forget to perform any required cleaning task. If you find an error, correct it at this time. M. Step 13 - Remove Wet Floor sign 1) Remove Wet Floor sign when the floor is dry. N. Step 14 - Wash hands O. Step 15 - Re-stock 1 Information taken from ISSA Hospital Housekeeping Training Manual

77 Health Care Cleaning and Sanitation Procedures Module Whirlpools A. Materials Requirement Planning (MRP) a. Measuring cup b. Trigger sprayer c. Soft scrub pad d. Clean cloths e. Gloves f. Wet mop and handle g. Wet mop bucket with wringer h. Sanitizer/Virucidal Disinfectant i. Germicidal Cleaner j. Hospital Disinfectant CAUTION WET FLOOR B. Whirlpool sanitation procedure 1) Place proper room Closed for Cleaning sign 2) Obtain and wear proper PPE (Personal Protective Equipment) 3) If whirlpool has not been drained for cleaning, do so now. 4) Fill whirlpool with new water. Bring water line 1 / 2 above water intake orifice. a. Dilute sanitizer in the water according to manufacturer s directions on label. b. Turn on whirlpool for 30 seconds, allowing sanitizer solution to circulate through the self-contained plumbing. Turn off pump. c. Allow sanitizer solution to stand for at least 10 minutes of contact time before draining. d. Evacuate the sanitizer solution. 5) Disinfect the following areas with a disinfectant cleaner and a soft scrub pad if needed: a. Handrails, steps, faucets b. Patient assistant devices c. Sides of whirlpool 6) Rinse all surfaces with clear water. 7) Wipe dry with a clean cloth. 8) Damp mop floor around whirlpool to prevent slip hazards. 9) Remove safety gear, but do not remove safety sign until floor is dry. 10) Replace all cleaning supplies and take refuse to proper location. 11) If heavy scum, rust or hard water stains exist, you may choose to utilize a mild acidulous cleaner to remove such deposits. After the acidulous wash, rinse with water and follow with steps 4 10 above.

78 Health Care Cleaning & Sanitation Procedures Module Ward Recovery 1 Cleaning Procedures A. Perform high dusting B. Clean ledges and sills C. Clean and disinfect patient restroom (sec: Patient Restroom Procedure) D. Empty and line wastebaskets E. Clean bed rails and footboard F. Clean furniture G. Clean furnishings H. Spot-clean walls I. Dust mop floor J. Place Wet Floor sign K. Wet mop floor L. Clean door hardware and metal plates A. Step 1 Perform high dusting 1) Always clean objects and areas by beginning at the higher surfaces and working toward the lower surfaces. 2) Use your high duster and clean the ceiling fixtures, the molding above doorways, the high areas around the windows, and anything higher than your shoulder. B. Step 2 Clean ledges and sills 1) The windowsill is a common place for dirt. Wipe it clean. 2) Clean the framework around the window as high as you can reach. Remove spots and smudges from the window itself by using your glass cleaner. Before leaving the window, examine the drapes for dirt and water. If they need cleaning or repair, notify your supervisor. 3) Remove spots from the wall as you move around the room. For a stubborn spot, spray your cloth with the disinfectant-detergent solution and then rub the spot with the saturated part of your cloth. 4) Never spray the solution directly on the wall or surface. The solution is strong and might cause permanent damage to the surface. Use your treated cleaning cloth at all times. C. Step 3 Clean and disinfect patient restroom (sec: Patient Restroom Procedure) D. Step 4 Empty and line wastebaskets 1) Start by picking up trash and wastepaper around the wastebasket. You are now ready to dispose of the wastebasket s plastic liner and its contents. 2) Be careful of any hypodermic needles that may pierce the plastic liner. Even though hospital rules call for the special handling and disposal of hypodermic needles, someone could always forget and wrongly allow one to fall into a wastebasket. Remember to remove the liner carefully and treat liners as though they actually contained a needle or other sharp object. 1 - Information taken from ISSA Hospital Housekeeping Training Manual

79 Health Care Cleaning & Sanitation Procedures Module Ward Recovery 1 (continued) D. Step 4 Empty and line wastebaskets (continued) 3) Gather the open end with both hands and tie it closed with a knot. Then, dispose of it in the housekeeping cart s trash bin. When handling a full plastic liner, try to hold it away from you, as it may contain contaminated articles as well as needles and other sharp objects. Never reach inside the liner for any reason. 4) Afterwards, clean the wastebasket inside and out with a damp cloth dipped and rung out in the disinfectant-detergent solution. Throughout the cleaning process, keep in mind that germs are everywhere in corners, small openings, grooves, and the underside of objects. You must be thorough in order to get rid of them. You are now ready to insert a clean liner into the wastebasket. 5) Be sure the liner is drawn back far enough over the rim of the wastebasket that it will not fall inside. If the liner is too big, tie one end in a knot. E. Step 5 Clean bed rails and footboard 1) Dip your cleaning cloth into the five-quart pail of disinfectant detergent on your cart. Then clean the side rails and the footboard. 2) If you are in doubt about what to clean in a patient s room, ask your supervisor. 3) Under no circumstances should the patient be disturbed while cleaning the bed, even if he or she seems relaxed and friendly. 4) Never lean on the mattress or bump the bed while cleaning it. Putting weight on the mattress or hitting the bed could disturb the patient and may cause pain. F. Step 6 Clean furniture 1) The bedside cabinet might present some difficulty as you damp-dust the objects in the room. The top of the cabinet may be cluttered with some personal articles of the patient. Handle the articles carefully as you clean under them and then return them to where they were. 2) Occasionally the top of the bedside cabinet will be too cluttered and you will have to skip it. But ordinarily, you will be able to clean the surface by raising objects with one hand and cleaning with the other. 3) Finish cleaning the bedside cabinet by damp-dusting the sides, the front, the drawer pulls and the legs, always working from the higher surfaces to the lower surfaces. 4) Move to the over-bed table and clean it thoroughly, again working from the upper surfaces to the lower surfaces. 5) Clean the table s surface, pedestal, base, and the casters, which are a favorite hangout for dirt and bacteria. 6) Next, thoroughly damp-dust the chair, seat, back, legs and rungs. 1 - Information taken from ISSA Hospital Housekeeping Training Manual

80 Health Care Cleaning & Sanitation Procedures Module Ward Recovery 1 (continued) G. Step 7 Clean furnishings 1) Damp-wipe the over-the-bed lamp reflector and hood and other wall fixtures as directed by your supervisor. 2) Be careful not to damp-dust electrical outlets or electrical connections. Always dry-dust switchplates, sockets and electrical connections. 3) Damp-dust the telephone, paying special attention to the receiver since the patient makes direct contact with the handle, the mouthpiece, and the earpiece. These areas are more likely to become contaminated or become a source of cross-contamination. H. Step 8 Spot-clean walls 1) Wall mirrors and wall hangings should be damp-dusted as you move around the patient unit. I. Step 9 Dust mop floor 1) Begin this step after the restroom has been serviced (see Restroom Procedures). 2) When using either the dust mop or the damp mop, work in a clockwise or counter-clockwise pattern as you did while damp-dusting in order not to skip an area or clean the same area twice. In using the dust mop, never lift the mop head from the floor once you have started dusting, as this causes a vacuum that pulls dirt and dust away from the mop head, thus causing recontamination of the area. 3) When the mop head becomes too dirty, dispose of it in the appropriate plastic bag, then attach a clean one and continue dusting. 4) If your dust mop does not pick up all the debris on the floor, use your dustpan and brush to remove the pile of debris. J. Step 10 Place Wet Floor sign 1) To warn anyone who enters or leaves the patient s unit, place a Wet Floor caution sign in the doorway. Remove the sign later when you know the floor is thoroughly dry. K. Step 11 Wet mop floor 1) Work in a clockwise or counter-clockwise figure eight pattern as you did while dust mopping. 2) Rinse and wring the wet mop head often. The mop water shall contain a disinfectant which is designed to kill germs on contact. 3) Push the wet mop under the bed and under all furniture to clean as much of the floor area as possible. 4) When finished with wet mop, wring as dry as possible, and dispose of in an appropriate bag for laundering. 1 - Information taken from ISSA Hospital Housekeeping Training Manual

81 Health Care Cleaning & Sanitation Procedures Module Ward Recovery 1 (continued) L. Step 12 Clean door hardware and metal plates 1) Do not overlook the doorway hardware. This area can become contaminated very easily. Thoroughly clean the door knob. 2) The kickplate should be cleaned with stainless steel cleaner. 3) Switchplates and other electrical units must be handled with extreme care. 1 - Information taken from ISSA Hospital Housekeeping Training Manual

82 Health Care Cleaning and Sanitation Procedures Module Carts, Closets, Equipment & Supplies 1 A. Materials Requirement Planning (MRP) a. Supply closets b. Cleaning equipment c. Chemical supplies d. Supply item care e. Dust mops f. Wet mops g. Buckets and wringers h. Housekeeping carts i. Power equipment j. Floor machines k. Vacuum cleaners l. Auto-scrubbers B. Step 1- Supply closets 1) It is the responsibility of the housekeeper to keep an adequate amount of supplies properly stored in the housekeeping supply closet and also to care for, clean and store the various items of equipment that are used in your daily housekeeping work. 2) Keep a list in your storage area of supplies needed. 3) Schedule weekly checks of your housekeeping supply closet in order to make sure that you will always have adequate supplies on hand. 4) Keep a list in your storage area of what you need. 5) Allow for some lead time when ordering additional supplies from your supervisor. 6) Stock your supplies in a neat and orderly fashion with the items most frequently used nearest at hand. 7) When you enter your storage area or closet, you should know exactly where everything is located to prevent searching for supplies. 8) Supplies should be used efficiently and economically. Avoid wasting liners, paper towels, toilet paper, stripping chemicals and finish, other cleaning chemicals, and so on. Treat the supplies as though you had personally purchased them. 9) You should not skimp on using supplies, but always use only the proper amount as indicated. 10) Always wear safety goggles (glasses) and gloves when mixing chemicals. Your care will pay off in years of accident-free employment. C. Step 2 - Cleaning equipment 1) Proper storing of your equipment is your responsibility. 2) A large amount of money has been invested in labor-saving cleaning devices which your hospital requires to ensure that the hospital environment is aseptically and esthetically clean, safe, and sanitary. 3) To store and protect the large investment of cleaning supplies and equipment, your hospital has cleaning closets equipped with hooks, racks, shelves, sinks, and other items located in each department or on each floor. 1 Information taken from ISSA Hospital Housekeeping Training Manual

83 Health Care Cleaning and Sanitation Procedures Module Carts, Closets, Equipment & Supplies 1 (continued) C. Step 2 - Cleaning equipment (continued) 4) Your hospital may also have a central equipment room, perhaps in the housekeeping supervisor s area. Equipment is brought to this area at the end of each shift. 5) Storage areas should be cleaned regularly and should be set up with a special place for every cleaning item. This includes regular space for hanging brooms and mops, shelves for cleaning agents and brushes, areas for power-operated equipment and attachments, and facilities for washing and cleaning these items. D. Step 3 - Chemical supplies 1) Periodically, plastic spray bottles will need your attention. Clean the exterior with a damp rag. 2) A trigger-type spray bottle must be taken apart regularly and cleaned to avoid clogging. 3) The contents of these bottles and all cleaning chemical containers should always be labeled clearly. 4) Store these bottles in a clean, dry place. E. Step 4 - Supply item care 1) Caution signs should be cleaned at least daily, and they should not receive any rough treatment in their use. 2) Never have dirty cloths lying around, as they are a disease and safety hazard. 3) Discard greasy or oily rags promptly. 4) Be careful of the dustpan edges. Careless handling or laying heavy objects on the pan can cause the edges to become bent or ragged. 5) The dustpan should be cleaned with detergent-germicide solution to ensure disinfection. 6) Small items such as a putty knife should always be wiped clean of moisture and debris after each day s use. F. Step 5 - Dust mops 1) Dust mops should not be used to pick up liquids. 2) Remove loose dust and debris from the mop head with a vacuum, or comb the mop head with a dust pan brush over the trash container on your cart. 3) Do not shake a dust mop head on any floor in hospital rooms or corridors. 4) Dust mop heads should be placed in plastic bags and sent to the hospital laundry when they become very dirty or after each shift. G. Step 6 - Wet mops 1) Wet mop heads need some special attention. Soak new mop heads in a bucket of warm, clear water for several minutes to remove fabric sizing and to toughen the mop head fibers. 2) When using a wet mop head, never allow it to remain in the bucket of solution except when being used. This will prevent rotting of strands or souring. 3) When you have finished using a wet mop head, wring it out as dry as you can, and then place it into a plastic liner and send it to the laundry for a thorough cleaning. 1 Information taken from ISSA Hospital Housekeeping Training Manual

84 Health Care Cleaning and Sanitation Procedures Module Carts, Closets, Equipment & Supplies 1 (continued) H. Step 7 - Buckets and wringers 1) Keep buckets and wringers in good repair. Use a bucket and wringer of the proper size for the mop head. 2) Remove any loose mop head yarn, string or foreign matter that may have become tangled in the wringer. 3) Empty all buckets of their contents after each use, and avoid storing buckets with water or cleaning solution in them. 4) Wash and scrub all surfaces of the bucket and wringer; rinse with warm water and wipe dry. 5) Keep parts of the bucket casters oiled so they rotate freely. A drop of oil on the wringer mechanism will also keep the wringer in good shape. 6) Store the wringer in the release position only. Report any defects in the wringer to your supervisor. I. Step 8 - Housekeeping carts 1) Wipe shelves at least once a week in order to keep them clean. 2) See that the entire cart is cleaned with disinfectant-detergent solution at least once a week. 3) Keep the casters running freely by applying a drop of oil to each caster. 4) Keep the cart neatly stocked with all supplies and equipment for the next shift. J. Step 9 - Power equipment 1) Power-driven equipment must be given the same care and attention as your automobile. Keep your cleaning equipment clean and free of dirt; keep it oiled; keep screws and nuts tight. 2) Operate the equipment so as not to dent the metal housing, and check the power cords for defects and wear. Never abuse your cleaning equipment. 3) Always follow manufacturer s instructions for operation and maintenance. 4) If you are ever in doubt as to how to use a piece of powered cleaning equipment, ask your housekeeping supervisors for technical advice.! Do Not Use Faulty Equipment! K. Step 10 - Floor machines 1) Floor machines, also referred to as buffers, should receive regular cleaning and routine maintenance. 2) Always disconnect the power machine from the wall socket while performing any routine maintenance. 3) Always remove brushes and pads from the drive chuck after each use. 4) Clean the floor pads in your deep sink with warm running water and then hang to dry for the next shift s use. 5) Rinse out all drive blocks and brushes in a similar manner and store them in a dry place. 6) Tilt the floor machine back on its handle. Using a cloth dipped in a disinfectant-detergent solution, wipe the inside housing and the entire exterior clean. 1 Information taken from ISSA Hospital Housekeeping Training Manual

85 Health Care Cleaning and Sanitation Procedures Module Carts, Closets, Equipment & Supplies 1 (continued) K. Step 10 - Floor machines (continued) 7) Remove any strands or debris from the wheels and wipe clean. 8) At least once a week, put a drop of oil on each wheel bearing to keep the wheel running freely. If you ignore this, wheels can lock over time from foreign matter collecting on the shaft. 9) Use your cloth to wipe the entire length of power cord free of any dried floor stripper and dirty water spots. 10) Store the floor machine upright with its power cord neatly wrapped around the storage brackets on the handle. L. Step 11 - Vacuum cleaners 1) To replace a belt, unplug the unit from the wall socket and turn the unit over to expose the bottom housing of the vacuum. 2) Push the two retaining clips to free the belt cover. 3) Pull up the drive beater brush and remove it from the housing; remove dirt, lint and debris found in this area. 4) Use your cleaning cloth dipped in disinfectant-detergent to wipe out the inside of the housing. 5) Take the new belt and insert the drive brush in the loop, or center of the belt. 6) Replace the drive beater brush, ringed with the new belt, and push it back into the retainers. 7) Pull the belt back and wrap it around the drive shaft of the motor. 8) Make sure the lower portion of the belt follows the arrow on the housing. 9) Be careful not to put this belt on backwards doing so would cause the beater bar to rotate backwards. 10) To finish, place the cover back on the housing and push the clips back in place. 11) Turn the unit over and plug it in to be sure it operates properly. 12) Disposable vacuum bags should be emptied after each shift in order for the vacuum cleaners to operate at peak efficiency. 13) Check the power cord plug and wire for cracks and defects. Report any noticeable damage to your supervisor. 14) Once a week, wipe the entire length of power cord clean with your disinfectant-detergent, and neatly wrap the cord on the storage brackets of the vacuum. 15) Wipe all outer metal surfaces of the vacuum cleaner with your cloth dipped in disinfectantdetergent. 16) Lastly, put a drop of oil on the vacuum wheels to keep them running freely, and wipe the wheels clean with your cloth. 1 Information taken from ISSA Hospital Housekeeping Training Manual

86 Health Care Cleaning and Sanitation Procedures Module Carts, Closets, Equipment & Supplies 1 (continued) M. Step 12 - Automatic scrubbers 1) Battery-operated power equipment, like an automatic floor scrubber, needs special care and maintenance. See owners manual before proceeding. 2) These units compare in price to that of compact automobiles. Because of that, they should be treated with utmost care and according to manufacturer s instructions. 3) It is advisable to grease the casters once every week. Oil all moving parts, such as the control bars, squeegee control rods, pressure points and hinges once every month. 4) Make sure that each drive wheel tire is inflated to the recommended tire pressure. Unequal tire pressures can adversely effect the total operation of the machine. 5) Drive brushes should be removed and cleaned after each use. The drive brush mechanism needs to be adjusted and lubricated according to the manufacturer s instructions. 6) The squeegee assembly should be adjusted and lubricated. The reversible squeegee blades also need regular cleaning and adjusting. 7) An automatic scrubber has a solution tank, a recovery tank, and filters that should be flushed and cleaned on a regular schedule. live Battery maintenance 1) When working with batteries, leave the battery compartment covered up and work in a wellventilated area. Do not wear rings, because they can become welded to metal wrenches if a terminal is accidentally touched. 2) Check the fluid level in the battery cells at least weekly. The battery caps are easily removed by pressing the ends of the white plastic extensions. 3) Check the electrolyte status of each battery cell with a hydrometer every 15 operating hours. 4) Periodically, check all battery cable and wiring for signs of damage or wear. Replace as needed. Once a month, remove all batteries from your machine. Clean all batteries, battery tray, and battery compartment with a solution of baking soda and water. 5) On the bottom of the battery compartment cover is a battery wiring diagram. Follow this diagram when you put the battery wires on the terminals. To prevent corrosion, apply a film of grease or Vaseline to battery lugs and bolt studs. Do not reverse connections when servicing or replacing the batteries. Battery Charger 1) When actively using an automatic scrubber, you will use a battery charger to re-charge the batteries. With the charger unplugged from the electrical wall outlet, find the main connector that is marked Connect To Charger. Firmly push the two connectors together. When laying the charging cables across the batteries, be careful not to allow the metal parts of the connectors touch any battery terminals. Set the battery charger control according to the rate of current desired. After charging, remove the charger plug from the wall outlet and disconnect the charging cable. Reconnect main battery terminals. 1 Information taken from ISSA Hospital Housekeeping Training Manual

87 Restroom Overview: Important Areas to Disinfect Walls/Floor 5. Mirror 9. Toilet Paper Dispenser 13. Shower 17. Faucets 2. Urinal & Toilet 6. Air Care 10. Outlet 14. Drain 18. Toilet Seat Covers 3. Lavatory 7. Soap Dispenser 11. Waste Basket 15. Light 19. Kickplate 4. Air Vent 8. Paper Towels 12. Light Switch 16. Door Handle 20. Lock Holes

88 Health Care Cleaning and Sanitation Procedures Module Public Restrooms A. Materials Requirement Planning (MRP) a. Clean rags b. Mop buckets and wringers c. Cotton wet mops and handles d. Dust mop and dustpan e. Wet Floor signs f. Trigger spray bottles g. Toilet bowl swabs h. Waste receptacle liners i. Gloves, goggles and appropriate shoes j. Products 1) Disinfectant cleaner 2) Toilet bowl cleaner 3) Hand soap 4) Creme cleanser 5) Glass cleaner 6) Paper towels and tissue paper 7) Porcelain and metal cleaner 8) Drain maintainer

89 Health Care Cleaning and Sanitation Procedures Module Public Restrooms CAUTION WET FLOOR A. Prepare area properly 1) Knock on door and announce your intention to enter. If restroom is occupied, wait until it is empty. When empty, enter. 2) Immediately post Restroom Closed sign. 3) Wear proper clothing. 4) Prop door open with doorstop. B. Toilet bowls and urinals 1) Remove all urinal screens and blocks from respective receptacles and flush before cleaning. 2) Evacuate water from bowl. Using a bowl mop, press water over the trap. 3) Apply toilet bowl cleaner and disinfectant to toilet and urinal interiors only. Allow disinfectant cleaner to stand at least 10 minutes while other cleaning tasks are completed. C. Dust all areas high to low 1) Clean all dust from ceiling fans and vents, utilizing appropriate dusting tool. 2) Dust tops of doors and stall partitions. 3) Sweep floor, remove all loose trash, and empty into waste receptacles. 4) Use a putty knife to remove gum from floors and partitions. D. Wet cleaning 1) Clean all light fixtures, mirrors, and glass surfaces with glass cleaner. 2) Wipe all partitions, tops and bottoms of doors, doorknobs, receptacles, and dispensers with disinfectant solution. 3) Spot clean all other above-ground surfaces with disinfectant solution. E. Clean wash basins 1) For most effective cleaning, use creme cleanser, mild phosphoric acid solution or disinfectant solution. 2) Clean interior of sink, allowing disinfectant solution a full ten minutes of contact time for efficacy. HINT: High foaming cleaners will make cleaning and contact time easier. 3) Spot clean exterior surfaces, faucets, pipes and under basins. Wipe all metal surfaces dry. 4) Check operation of faucets and drains. 5) Treat drains with bacterial digestant/deodorant. F. Clean toilet bowls and urinals inside 1) If required, add an additional ounce of toilet bowl cleaner and disinfectant to bowl mop prior to cleaning. 2) Clean the rim and waterline areas carefully and move into the exposed trap area. 3) Check under rim for missed mineral deposits and rust stains with lip light. 4) HINT: Acid bowl cleaners are required for mineral deposits and rust. Routine cleaning can include non-acid cleaners. G. Clean toilet bowls and urinals outside 1) Spray outside and bottom surfaces with non-acid solution and wipe. 2) Wipe toilet seat with non-acid disinfectant solution.

90 Health Care Cleaning and Sanitation Procedures Module Public Restrooms (continued) H. Clean and empty all waste receptacles 1) Remove can liners from receptacles, wash the interiors and exteriors with disinfectant solution, and replace can liner. 2) Empty and clean sanitary napkin receptacles with disinfectant solution. Replace liner to comply with OSHA Bloodborne Pathogen Standards. 3) Never use your hand to press trash overflow down and into the waste receptacle. I. Replenish all supplies 1) Refill hand soaps, toilet tissue, towels, deodorizers, and sanitary napkin dispensers. 2) If restroom has condom dispensers or other ancillary dispensers, make sure that these are refilled. 3) Check operation of all dispensers and report malfunctions properly. 4) Check urinal screens, deodorant blocks, and gel/mist deodorants. J. Damp mop 1) Clear area of supply cart and equipment. 2) Start in the area farthest from the door and work towards the door. a. Make sure to mop with fresh, clean mop water. b. HINT: Using a Neutral ph Disinfectant Cleaner can provide effective bacteria elimination with odor counteraction. c. A mild acidulous tile cleaner may be required for grout lines on quarry tile floors. 3) Place mop in solution and wring out, leaving mop damp. When mopping floor area around toilets and urinals, mop thoroughly and wring out often. Change solution when necessary. K. Odor counteraction 1) Spray bacteria-based odor counteractants liberally around toilets and urinals and let air dry. 2) Pour four ounces into each floor drain before leaving the area. 3) HINT: Saturating a paper towel with bacterial digestant deodorant and placing into waste receptacle will aid in counteracting odors long after you have left the restroom.

91 Health Care Cleaning and Sanitation Procedures Module Other Public Areas 2 CAUTION WET FLOOR A. Materials Requirement Planning (MRP) a. Automatic floor machine with pad assembly or brush b. Wet mop handle with looped-end banded mop c. Set of Wet Floor signs d. Putty knife e. Dust mop f. Dustpan and brush g. Hand pail h. Clean cloths i. Spray window cleaner j. Spray polish k. Approved germicidal detergent solution l. Floor machine with pad assembly or brush m. Squeegee with handle B. Steps to cleaning other public areas 1) Service ashtrays and waste receptacles: Empty and clean ashtrays. Place butts in separate covered container. Empty waste receptacles; clean and replace liners. 2) High dust walls: Remove all dust webs. 3) Dust mop floor: Use dust mop of an appropriate size. Treat with a water-based treatment when working in heavier soil load area. Start at one end of area. Hold mop handle at an approximately 45 degree angle. Push mop straight ahead. Avoid lifting mop from floor or moving it backwards. Remove gum with putty knife. Pivot at end of area and mop in opposite direction. Overlap about ten inches. 4) Clean floor with automatic scrubber: Set up Wet Floor signs. Use light brush pressure and scrub with the squeegee in the down position. Shut off solution a few feet prior to making any turns. Remove any puddles with wet mop, or squeegee to a point that can be reached by the automatic scrubber.! Be alert to the safety of patients, visitors and employees. 5) Machine buff: To spray buff, place floor machine in position. Spray floor with solution and spread with machine. Use a side-to-side motion, being careful to avoid bumping walls and furniture. Allow a slight overlapping on each pass. Buff until haze is gone. 6) High speed burnishing: Place machine in position. Apply solution to floor. Move in a straight line forward and back. Allow a slight overlapping on each pass. One complete pass forward and back should be sufficient. 7) Clean windows and polish metals: Using a cloth dampened with window cleaner, clean and polish windows. Using a cloth dampened with polish, clean and polish metals. 8) When finished, remove signs. Return equipment and refill supplies. 2 Information taken from ISSA Hospital Housekeeping Procedures

92 Glossary of Terms Used in Facility Housekeeping Acid A water soluble substance with ph less than 7. Health Care Seminar Acrylic Acrylic Styrene Acute Dermal LD 50 Test Acute Inhalation LC 50 Test Acute Oral LD 50 Test Acute Primary Dermal Irritation Test Acute Primary Eye Irritation Test Aerobes Aerosol Algae Algaecide Algistat Type of polymer popular for floor finishes. Type of polymer popular blend for floor finishes. Test used to determine the toxicity and hazard of compound when applied to the skin. Reported as LD 50 - lethal dose which will kill 50% of the animals. Test used to define general toxicity of a compound when inhaled. Reported as LC 50, i.e., lethal concentration for 50% of the test animals. Test used to define general toxicity and hazard of compound when ingested. Reported as LD 50 - lethal dose which kills 50% of the animals. Test used to define general skin irritation. Test used to define general irritation to the eye. Organisms requiring oxygen to live. An extremely fine mist or fog consisting of solid or liquid particles suspended in air. Also, term used for products which mechanically produce such a mist. Plants similar to fungi, but containing chlorophyll and other pigments A chemical agent that kills algae Product used to inhibit algae growth. Alkali A water soluble substance with ph greater than 7. Amphoteric Anaerobes Anionic Antibiotic Antifoulant Antimicrobial Agent/Pesticide Material capable of being anionic or cationic depending on ph. Organisms that grow without oxygen. Negatively charged material. A substance produced by a living organism which has the power to destroy or inhibit the multiplication of other organisms, especially pathogens A chemical agent that prevents growth of organisms on underwater structures Any substance or mixture of substances intended for preventing, destroying, repelling, or mitigating any pest Antimicrobial Agent which inhibits or destroys bacteria, fungi or viruses.

93 Glossary of Terms (continued) Used in Facility Housekeeping Antisepsis Health Care Seminar The destruction of microorganisms that cause disease, fermentation, or putrefacation; use of antiseptic methods and procedures Antiseptic Autoclave Antistat Antitoxin Asepsis Attenuated Organism Avian Acute Oral LD 50 Test Bacilli Bacillus Bacteremic Bacteria Bactericide Bactericidal Bacteriolysin Bacteriophage Bacteriostat A chemical agent that kills microbes. The term is often used for agents that act on organisms associated with the body and applied to products regulated by FDA. An apparatus for sterilizing by means of super-heated steam under pressure Substance which reduces static electricity. An antibody capable of uniting with and neutralizing a specific toxin. Refers to the absence of pathogenic microorganisms. One whose virulence has been decreased. Test used to determine lethal dosage for 50% of test birds for products marketed for outdoor use. Cylindrical or rod-shaped bacteria. Any rod-shaped bacterium. Loosely used, any disease-producing bacterium Bacteria in the blood stream. A wide range of microorganisms, usually one-celled. Many are disease producing; others are active in processes such as fermentation or the conversion of dead organic matter of soluble food for plants An agent that destroys disease germs, but not necessarily spores Pertaining to or having the characteristics of a bactericide An agent or substance which causes disintegration (lysis) or bacteria. A virus that infects bacteria. A chemical agent that prevents bacteria from multiplying. Base (see Alkali) A water soluble substance with ph greater than 7. Biodegradable Broad Spectrum Buffer Capability of substance to be broken down by microorganisms. Effective against a wide range of different types of microorganisms Any substance in a fluid which tends to resist a change in ph when acid or alkali is added.

94 Glossary of Terms (continued) Used in Facility Housekeeping Builders Butyl Cellosolve Cationic Caustic Chelating Agent Chlorine Chronic Chronic Feeding Test Chronic Toxicity Cide or Cidal Cleanser Cocci Communicable Disease Concurrent Conductive Corrosion Inhibitor Corrosives Cross Infection Culture Chemicals used to improve cleaning performance. A trade mark name for a water soluble solvent. Actual name of slang term butyl. Material that are positively changed. Highly alkaline material. Chemicals in a cleaner that increase the performance of the product by combining chemically with insoluble material such as hard water salts, making them soluble so that they (1) Do not steal cleaning power (2) Do not settle out leaving difficult to rinse films, and (3) Do not combine with soap fats to form soap scum. They will dissolve such films that may have built up on a surface by use of deficient cleaners. Powerful oxidizing agent often used as germicide. Continuing for a long time; constant Test used to define toxicity from chronic ingestion exaggerated dose levels of the test material. Observation made by clinical pathology, gross pathology and histopathology. Term used to define toxic effects in an organism upon continuous or repeated exposure over 1/2 the lifetime of that organism. A suffix that means to kill Cleaning agent generally containing abrasives and/or bleach. Spherical shaped bacteria. One whose causative agent is directly or indirectly transmitted from person to person. Happening at the same time; A concurrent odor is one which appears at the same time or as the result of another action such as spillage The property in a surface or material of allowing electricity to flow freely through it Substance which protects against oxidation of metal surfaces. Substances which cause skin and eye damage. The transfer of disease or infection from one person to another Cultivation or growth of bacteria in a prepared nutrient media

95 Glossary of Terms (continued) Used in Facility Housekeeping Culture Test Health Care Seminar To take samplings from a surface and attempt to grow bacteria in a nutrient media from such samplings. Used to determine effectiveness of bactericidal cleaning. See scalpel test and swab test Defoamers Deodorizer Detergent Detergent Disinfectant Disinfectant Economic Poison Emulsification Emulsion Endemic Disease Environment Enzyme Epidemic Exdotoxins Exotoxins Facultative Anaerobe Fade-out Fatty Acid Fish Acute Toxicity Test (LC 50, 96 hours) Substances used to reduce or eliminate foam. A chemical agent that prevents the formation of odors by acting upon microorganisms Synthetic cleaning agent which is useful in physical removal of soils. A product that is both a cleaner and a disinfectant A less lethal process than sterilization. It eliminates virtually all recognized pathogenic microorganisms but not necessarily all microbial forms (e.g., bacterial endospores) on inanimate objects. Pesticide. The action of breaking up fats, oils and other soils into small particles which are then suspended in water. A dispersion of small oil particles in a solution. A disease that is constantly present in a community. Surroundings; any area where there are organisms outside the human body. Proteins produced within an organism that are used as catalysts for biochemical reactions. Often used to enhance cleaning preparations. A condition in which a large number of persons in a community contract the same disease within a short time. Toxins which are formed within the microbial cell and then released into the surrounding medium. Toxins which are formed within the cell and are released from it. A bacterium that grows under either aerobic or anaerobic conditions. The loss of effectiveness of cleaning and/or disinfectant agents while in use An organic substance which reacts with a base to form soap. Test used to define toxicity and hazard potential to fish. Results reported as LC 50, i.e., the concentration which will kill 50% of the fish.

96 Glossary of Terms (continued) Used in Facility Housekeeping Formaldehyde Preservative and disinfecting agent. Fungi Fungicide Fungistat Germ Germicide Germistatic Gram - (Negative) Gram + (Positive) Halogens Hard Water Hard Water Herpes Simplex Hexachlorophene ID50 Incinerate Inert Group of non-green plants that live by feeding on living or dead organisms A chemical agent that destroys fungi. A chemical agent that inhibits the growth of fungi. Catch-all term for microorganisms A disinfectant. Same as bacteriostatic Refers to chemical difference in certain bacteria which shows up by the Gram staining procedure. These bacteria stain red. Pseudomonas and salmonella are examples of Gram - (Negative) bacteria. A laboratory method of classifying disease by staining. Those bacteria that stain a deep (or negative) violet are gram positive. Those that are discolored and take on a contrast stain are gram negative. Method developed by Hans Christian Joachim Gram, 1853 The elements chlorine, bromine, iodine, fluorine which have strong disinfecting properties. Water containing soluble salts of calcium and magnesium and sometimes iron. Hardness is the solution in water of both calcium and magnesium ions. It is usually expressed in terms of calcium carbonate (CaCO 3 ). Since hardness ions carry a positive charge, their presence can diminish the germicidal efficacy of quats by competing for the negative sites on the microorganism s cell wall. The adverse affect of hardness cations can be reduced with the addition of hardness chelants, such as EDTA, which form chemical bonds with the calcium and magnesium ions. In the United States, approximately 80% of the municipalities supply water with less than 250 ppm hardness Virus causing fever blisters and other infections One of the synthetic phenol compounds currently used in prescription antiseptic soaps. The dose (number of microorganisms) which will infect 50 percent of the experimental animals in a test series. Flame, burn, or reduce to ashes Substance not active in a formula.

97 Glossary of Terms (continued) Used in Facility Housekeeping Infection Invasion of living disease organisms into a part of the human body where conditions are favorable to their growth and where their toxins act injuriously on the tissues Infective Dose (ID) Influenza A2 Inorganic Insulating Residue Invertebrate Acute Toxicity Test In vitro In vivo Iodine Iodophores Isolation LD 50 Lethal Concentration (LC) Lethal Dose (LD) Leveling Agent MRSA Metabolism Test Metal Interlock Microorganism Mildewcide Mixed Infection The number of microorganisms required to infect a host. Virus causing the acute infectious disease influenza, or grippe A substance not made of the combination of carbon and hydrogen. Any deposit or residue that prevents static electricity from being conducted Test used to define toxicity to aquatic in vertebrates, such as the water flea Daphnia magnia. Term applied to biological experiments performed in test tubes. Term applied to experiments performed in living organisms. A disinfectant agent. Combinations of iodine and detergent used as disinfectant cleaners. To separate a patient with an infectious disease from persons not similarly infected The dose (number of organisms) that will kill 50 percent of the animals in a test series. The concentration required to cause death in a given species of animals or plant. Measured in milligram per kilogram of body weight (mg/kg). The dosage required to cause death in a given species of animal or plant. Measured in milligram per kilogram of body weight (mg/kg). Substance added to coating which allows it to flow evenly in application. Methicillin Resistant Staph Aureus - a pathogen resistant to all antibiotics except Vancomycin Test used to determine if plants or animals can convert the test chemical into other chemicals or chemical forms. Detergent resistant type of floor finish removable with ammonia. Bacteria, Fungi, Algae A chemical agent that kills mildew (a defacing fungus) One due to two or more organisms.

98 Glossary of Terms (continued) Used in Facility Housekeeping Molecule Health Care Seminar The smallest unit into which a substance can be divided that retains all of the chemical identity of that substance i.e., one molecule of water. Monomer Muriatic Mutagen Mutagenicity Test Neurotoxicity Test Non-ionic Non-Selective Nosocomial Oncogenicity Opacifier Optical Brightener Organic Organic Soil Oxidation Oxidize Pandemic Pathogen Pathogenic Pesticide A single building block starting material from which a polymer is formed. Many monomers combined create a polymer. Commercial name given to hydrochloric acid. Substance which causes gene damage that is transferable from generation to generation. Test used to evaluate a substance s mutagenicity potential. Test use to determine the effect of a substance on the nervous system. Materials with no charge. A chemical agent or combination of Chemical Agents which are destructive to a broad range of pathogens Relating to a Hospital; from the Greek - Nosos (Disease), Kome (I take care of), Nosocomion (A hospital). Thus, a nosocomial infection is one acquired in a hospital. Test used to define the tumor producing potential of a substance. Substance which does not permit the transmission of light; a cloudy agent. Substance which makes color appear brighter in the presence of sunlight and ultraviolet light. A substance composed of carbon and hydrogen. See Soil The reaction of oxygen with a metal. Rusting. To bleach. A condition in which a disease becomes epidemic in several countries at the same time (influenza in W.W.I.) A disease producing organism. Disease producing. Agent which prevents, repels, destroys or mitigates pests and includes insecticides, disinfectants and sanitizers, rodenticides and herbicides.

99 Glossary of Terms (continued) Used in Facility Housekeeping ph The measure of relative acidity or alkalinity of a solution. Using a scale from 0 to 14, 7 indicates neutral, below 7 indicates acidity and above 7 indicates alkalinity. Phenol Coefficient Phenols Phenolics Pine Oil Plasmid Mediation Plasticizer Polymer PPB PPM Precipitate Preservative Propellant Pseudomonas Aeruginosa Putrefaction Quats or Quaternaries Quaternary Ammonium Compounds Rinse Aids Salmonella Choleraesuis Obsolete term used for comparison of activity of a disinfectant to phenol. Class of chemicals often used for disinfecting. A general term for bactericides based on synthetic phenols or phenolic derivatives Disinfectant and emulsifying agent. When resistant genes are transferred to other gram-positive organisms through a sharing of or movement between cell plasma An ingredient added to a wax to modify its properties. A large molecule of multiple units of a single building block linked together. Parts per billion. One part per billion equals 1 pound in 500,000 tons. Parts per million which equals 1 mg. per liter. One part per million equals 1 pound in 500 tons. Material settled out of solution. A chemical agent that inhibits microbial growth. An agent used to expel contents from an aerosol under pressure. A pathogenic bacteria used to assess hospital strength activity of a disinfectant. The decomposition of organic matter, especially by the action of bacteria, with the formation of foul-smelling, incompletely oxidized products A general term for bactericides bases or quaternary ammonium compounds A class of chemicals used as disinfectants, antistat and softening agents. Surfactants which aid in the rinsing property of water by lowering its surface tension. Organism used in antimicrobial testing.

100 Glossary of Terms (continued) Used in Facility Housekeeping Salt Cake Sodium sulfate. Sanitizer Scalpel Test Sealer Selective Sepsis Septicemia Sequestrants Skin Sensitization Test Slimicide Soap Soda Ash Sodium Bicarbonate Sodium Hypochlorite Soil Solvents Spores Sporicide An agent that reduces the number of bacteria to a safe level as judged by public health requirements. A method of testing the effectiveness of a bactericidal cleaner by taking scrappings from a surface with a scalpel and incubating the scrappings in a nutrient medium to determine whether living bacteria remain after cleaning. See Swab Test A coating designed to penetrate and seal a floor surface. A chemical agent or combination of chemical agents which are destructive to a narrow range or specific group of pathogens Putrefactive. The invasion of bodily tissue by pathogenic bacteria Condition in which bacteria in the blood have multiplied. (Referred to as blood poisoning ). See chelating agent. Test used to determine the potential of a compound to cause allergic reactions. A chemical preparation that prevents, inhibits, or destroys biological slimes composed of combinations of microorganisms. A natural cleaning agent produced by the reaction of a fat and an alkali. Sodium carbonate. Baking Soda. Bleaching and disinfecting agent. Matter out of place. Organic Soil relates to that which is or was living. Inorganic Soil relates to, or composed of, matter other than animal or vegetable Substances used to solubilize other materials. Reproductive bodies (or resistant resting cells) produced by certain bacteria not usually effected by bactericides. A chemical agent that destroys bacterial spores as well as vegetative forms of microorganisms Staphylococcus Highly resistant Gram + (Positive) organism used in the evaluation of disinfectants. (Staph) Are pathogenic.

101 Glossary of Terms (continued) Used in Facility Housekeeping Staphylococcus Epidermidis Stat Sterilant Sterile Sterilize Sterlizer Steptococcus Viridans Streptococcus (Strep) Subacute Dermal Toxicity Test Subacute Inhalation Toxicity Test 90-Day Subacute Suppurative Diseases Surface Tension Surfactant Suspension Swab Test Bacteria causing pus-forming infections of skin tissues Inhibitor. The use of agents generally known as sporicides intended to destroy or eliminate living microorganisms in a given environment. The highest level of disinfection available. The condition of being free from all forms of life, especially microorganisms To destroy all organisms, including bacteria, spores, fungi and viruses An agent or device that destroys all living things, including vegetative bacteria, spores, fungi and viruses. Bacteria causing local infection, normally in the mouth, which in turn leads to symptoms of arthritis, neuritis and endocarditis Common disease organism that microscopically appear as Gram + (Positive) chains. Test used to determine the adverse effects of multiple exposure for less than one-half the lifetime of the test animal. Test used to define toxicity and hazard of compound when conditions of use may result in repeated exposure by inhalation. Test used to help define general and specific toxicity from prolonged or Oral Test multiple dose exposure. Those which generate pus The attractive forces which water molecules have for each other. Surface active agent which increases the emulsifying, foaming, dispersing, spreading and wetting properties of a product. An evenly dispersed mixture of insoluble particles in a liquid. A method of testing effectiveness of a bactericidal cleaner by taking samples from a surface with a swab and incubating them in a nutrient medium to determine whether living bacteria remain after cleaning. Not an effective test since the swab removes only what is on the surface and may not pick up bacteria protected by soil. Scalpel test is preferred

102 Glossary of Terms (continued) Used in Facility Housekeeping Teratogen Titration Toxic Toxin Tuberculin Type 2 adenovirus Use Dilution Use Dilution Test Vaccinia Vancomycin Viricide Virulence Viruses VRE Water Softener Wax Wetting Agent Substance which produces birth defects. The process of determining the strength of a solution, or the concentration of a substance in solution, in terms of the smallest amount required to bring about a given reaction with another known solution of substance Substance causing adverse effects. A poison formed and secreted during the growth of pathogenic microorganisms. An extract of the tubercle bacillus, capable of eliciting an inflammatory reaction in the animal body which has been sensitized by the presence of living or dead tubercle bacilli. Used in a skin test for tuberculosis. Virus causing numerous types of infections in man The ratio of product to water at which the product performs effectively, expressed in ounces per gallon or parts per 100. Test used to determine antimicrobial activity of a hard surface disinfectant in its final use concentration. A pox virus used for vaccination of man for immunity against smallpox The last line of antibiotic defense when fighting off certain pathogens Any agent which is destructive to a virus. The disease producing ability of an organism. The term for a group of pathogens which are barely visible or invisible under the ordinary microscope. They are not capable of growth or reproduction apart from living cells. Vancomycin Resistant Enteroccus (VRE) A significant pathogen for two reasons: 1. No rapidly bactericidal antibiotic is available 2. Plasmid Mediated resistance to other pathogens such as MRSA Substances which removes or counteracts the hardness of water. A protective coating for hard surfaces. A chemical which reduces surface tension of water, allowing it to spread more freely.

103 Canberra Corporation 1994