Approved by: Corporate Director, Environmental Supports Discharge and Transfer Cleaning Environmental Services Operating Standards Manual Number: 3.1.1.2 Date Approved Next Review March 3, 2018 Purpose Applicability Responsibility Principles Procedures This Operating Standard provides guidance for the expectations of appropriate steps to clean a regular patient/resident room discharge or transfer to ensure safety and maintain quality. This Operating Standard applies to all Covenant Health Environmental Services staff. All Environmental Services employees are required to follow the steps outlined when doing a discharge or transfer clean of a patient/resident room in order to maintain a clean and safe environment. It is the Employee s responsibility to perform proper hand hygiene prior to starting step one of the cleaning protocol. A standard cleaning process for Discharge/Transfer Bed cleaning ensures sanitation of the environment after patient/resident discharge and aids in the prevention of cross contamination. Treat each patient/resident area as if it was a single room. TOOLS NEEDED Cleaning cart, linen hamper, hand pail, clean cloths, dry mop, wet mop, bucket and wringer or Microfiber System, cleaning/disinfecting product(s), dispenser refills, dispenser keys, dustpan and broom, wet floor signs, scraper/putty knife, dusting tool(s), garbage bags, linen bags (for soiled linen), radiator brush, gloves and safety goggles/glasses. SAFETY PRACTICES Place floor sign where it is readily seen at all entrances and exits and remove when floors are dried. Carry garbage bags away from body. Raise bed to avoid bending causing strain on back. Follow proper ergonomic practice as per training. Cleaning carts are to be stored appropriately in housekeeping supply rooms when not needed or not in use. Cleaning carts are not to be used to hold or store foodstuff and/or beverages. Change PPE as necessary to prevent cross contamination. If any questions regarding safe practices, please consult with your immediate supervisor. STEPS 1. Removal of all utensils, meal trays, and linen should be done by Unit staff prior to request for Discharge/Transfer clean. Items to be removed are: wash basins, soap dish, glass, and urinal, etc. Suction containers and medical supplies must be removed by nursing/unit staff before Environmental Services staff begins cleaning the room. 2. Wash/sanitize hands, put on gloves. Put on (don) appropriate PPE as per risk assessment. Review How to Put on and Take off Personal Protective Equipment (PPE).
3. Assemble equipment. 3.1.1.2 Page 2 of 5 4. Prepare approved cleaning/disinfecting product(s) for hand pail and mop bucket, diluting as required. All products must be used in accordance with the manufacturer s instructions including preparation, dilution and contact time. Review MSDS sheets for product handling and precautions. PPE must to be worn when preparing cleaning/disinfecting solution(s). Soiled cloths must not be double dipped into any cleaning /disinfecting solution(s), and must be discarded into soiled linen bag on cart immediately after use. 5. Place wet floor sign appropriately at all entrances/exits. Remove when finished and floor is dry. 6. Check for articles patient/resident may have left in room and, if articles are found, notify Nursing Desk. Notify Nursing Desk. Indicate room and bed number where found. 7. Pick up all waste. Magazines and books should be recycled where possible or disposed of. Do not re-circulate. Empty waste container by removing bag. Remove recyclable waste to appropriate disposal area where applicable. Remove garbage bags from room and place directly into waste receptacle located on cleaning cart. Refer to site specific policy regarding recyclable materials. 8. Unlock bed wheels, pull away from wall. Raise bed to high position and lower rails. Utilize proper ergonomics. 9. Assess if cubicle curtain is soiled and change as required. Otherwise, change as per cleaning frequency standard. 10. Remove gloves; perform hand hygiene and apply new gloves. 11. Damp wipe headwall top to bottom, and fixtures including over bed light, etc. Damp wipe cubicle curtain rods and tops of closets. Damp wipe Blood Pressure cuff/suction, etc, with the exception of all technical equipment including computers. 12. Damp wipe over-bed table and bedside table. Clean inside, outside and underside. Ensure legs and wheels of tables are wiped. 13. Damp wipe call-bell and cord. Damp wipe light cord. 14. Damp wipe patient/resident dedicated I.V. pole (if applicable). Damp wipe side-chair and foot stools and other furniture in room.
3.1.1.2 Page 3 of 5 15. Wipe sharps container and the brackets if not at ¾ fill line. Care must be taken when wiping external surface of sharps container as these are puncture-resistant, not puncture-proof. This may present a risk of sharps injury. 16. Damp wipe window ledges and spot wash windows. Polish windows after washing, to remove streaks. Including interior glass windows, doors and partitions. 17. Damp wipe inside of patient/resident closet/locker. Make sure to remove scuff marks from inside walls. 18. Damp wipe handles and wall fixtures from top to bottom. 19. Clean sinks/fixtures, plumbing pipes, dispensers and mirrors. Clean internal surfaces of the dispenser. 20. Damp wipe waste container inside and out if soiled. Replace bag. 21. After air-drying, use a clean, dry cloth to polish streaks from mirrors and chrome, etc. left from cleaning chemicals. Chemical will leave streaks when dry. When polishing surfaces pay particular attention to mirror, etc. 22. Damp wipe bed, headboard, footboard, side-rails, under bed frame, cribs, and cots. Allow to air dry. Damp wipe both sides of mattress and report if damaged to Unit staff and your Supervisor. Utilize proper ergonomics. Clean each bed area separately. Follow training for mattress turning/cleaning. Do not remove cardiac bed locks. 23. Orthopedic-Balkan Frames Lower bed to lowest level. Wrap damp cloth around radiator brush or long handled brush. Start at bar and wipe frame from one end of the bed to the other. When dusting, extend handle and bend at top to get the right angle. When able to reach the frame by hand, remove radiator brush or long tool. Continue to damp dust by hand until all areas are covered. Change cloths for each patient/resident bed. 24. Remove gloves, perform hand hygiene and apply new gloves. 25. Clean washroom. Follow Washroom Cleaning Protocol. Note: For Discharge/Transfer cleaning leave damp mopping of floor until last after completing patient/resident area floor. 26. Dry mop floors. Damp mop (wash) patient/resident room floors. DO NOT dry mop washrooms floors.
3.1.1.2 Page 4 of 5 Dry and damp mop floor using concept of far corner to door. Pay particular attention to corners, edges, and baseboards (scraper may be needed) and washroom floors. Follow Dry Mopping and Damp Mopping protocols. 27. Remove (Doff) Personal Protective Equipment (PPE). Remove gloves. Wash/sanitize hands. Review How To Put On And Take Off Personal Protective Equipment (PPE). Remove wet floor sign when floor is dry. 28. Replace furniture in standard location after gloves are taken off and hand hygiene is performed. 29. Arrange in a neat and orderly fashion. 30. Replenish dispenser supplies (soap, hand sanitizers and paper supplies). 31. Re-make bed, re-position bed and lock wheels. 32. Wash/sanitize hands. 33. Let Nursing Desk know that room has been completed. Treat each patient/resident area as if it was a single room. Change water in mop pail every three rooms or before if visibly soiled. Not applicable if using the Microfiber System. 34. Continue to next assignment. 35. Clean and store equipment. Footnotes: Order of Cleaning: All items/areas MUST be cleaned from the cleanest item/area to the dirtiest item/area and from high to low. Mop head and water MUST BE CHANGED every three rooms, or before if visibly soiled. *Exception: Mop head and water MUST BE CHANGED every room for isolation cleans. Microfibre Mop heads MUST BE CHANGED every room, or before if visibly soiled. Double dipping Soiled cloth must not be re-dipped into /disinfecting solution(s). Soiled clothes must be discarded into soiled linen bags on carts immediately after use. Cloths and rags MUST be changed frequently within each patient environment in order to prevent cross contamination. Maintenance report plugged or damaged toilets, urinals, sinks/fixtures, lights, walls, etc. to unit staff and to your Supervisor or submit maintenance requisition where appropriate. Cleaning/Disinfecting Products Never mix chemicals. Review MSDS sheets for product handling and precautions. Product(s) must be measured properly and changed after every case. Chemical must remain on surface for entire kill cycle / contact time. Refer to specific chemical directions. Ensure proper solution concentration testing Standard Operating Procedures are followed and documented. Use only hospital approved cleaning and disinfecting products. If at any time you are unsure of which tool(s) and/or product(s) to use for a task, consult your Supervisor.
3.1.1.2 Page 5 of 5 Personal Protective Equipment (PPE) Clothing or equipment worn by staff for protection against hazards. To Don is to put on, and to Doff is to remove. Additional Precautions (AP) Precautions (i.e. Contact Precautions, Droplet Precautions, Airborne Precautions) that are necessary in addition to Routine Practices for certain pathogens or clinical presentations. These precautions are based on the method of transmission (e.g. contact, droplet, airborne). Damp Cloth Cloth must be wet to ensure that the surface stays wet for the required contact time of a disinfectant to be effective. Cleaning The physical removal of foreign material (e.g. dust, soil) and organic material (e.g. blood, secretions, excretions, microorganisms). Cleaning physically removes rather than kills microorganisms. It is accomplished with water, detergents and mechanical action. Disinfection The inactivation of disease-producing microorganisms. Disinfection does not destroy bacterial spores. Medical equipment/devices must be cleaned thoroughly before effective disinfection can take place. Hazard Assessment Health and Safety Hazard Assessments mitigate the risk of incident/injury or illness from exposure to biological, chemical, or physical contaminants. To reduce the risk of incident/injury or illness appropriate controls must be put into place. Health and Safety Hazard Assessments must be completed and reviewed before an ES employee is exposed to contaminants which may pose incident/injury or illness. This is done to protect the health and safety of ES employee, other staff and patients/residents. Employee Incident/Injury Reporting Report incidents or unsafe work to your Supervisor and/or to OHS through the incident management process as required. Risk Assessment Assessment conducted before each interaction with a patient/resident or their environment to determine the risk of exposure to infectious agents, and the appropriate interventions (additional precautions, PPE etc.) to reduce the risk of transmission. Two-Step Clean A two-step process is used to clean and then disinfect surfaces. First wipe surfaces thoroughly to clean the surfaces of visible organic material (dirt you can see) and then wipe again with a clean cloth saturated with disinfectant to remove invisible microorganisms (things you cannot see). Organic materials that are not properly removed during the first step may inactivate the disinfectant used in the second step, therefore both steps are essential. Cleaning Frequency Based on the Cleaning Frequency Standard. References Alberta Health Services, Linen and Environmental Services, Cleaning Protocol Standard # ES-PROT-CLN-006