CleaningProtocol Guidelines for Frontline Staff Healthy Measures Ι www.healthymeasuresonline.com Network Services Company Ι 1100 E. Woodfield Road, Suite 200 Ι Schaumburg
This document assumes environmental services frontline staff has received training in accordance with the facility s infection control and prevention policies and procedures. It is not intended as a training tool, rather a compendium of critical items intended to reinforce best practices in environmental hygiene and support the Healthy Measures facility assessment.
Follow facility protocol for proper hand hygiene. Always perform hand hygiene when changing gloves. Cleaning carts remain in hall positioned so as to not block walkway. Always take cleaning materials from cart into the room. Check each room for signage indicating special precautions. Knock before entering all patient rooms. Enter rooms slowly. Be courteous to patients, visitors, and staff Be alert for sharps and sharp objects. Never reach into or push on trash in waste containers. Use chemicals as directed by the manufacturer s label. Be knowledgeable regarding necessary dwell times. When using an open-bucket system, do not immerse cleaning cloths in disinfectant solution. Stack cloths next to the bucket. Prior to use, immerse one cloth in cleaning solution then wring out ensuring thorough saturation. Place Wet Floor sign outside of room when cleaning floors. Limit the number of surfaces touched whenever possible. Never move a patient. STANDARDS RECOMMENDED EQUIPMENT & SUPPLIES Prior to start of a shift, ensure that cleaning cart is stocked appropriately with equipment and supplies to prevent unnecessary return trips to the supply closet. Goggles or safety glasses Step stool Cleaning cloths or disposable wipers Bucket with disinfectant solution Dust pan and broom Vacuum cleaner Mop High dust tool Wet Floor sign Toilet bowl/johnny mop CHEMICALS EPA registered hospital grade disinfectant General purpose detergent solution Ammonia free glass cleaner Toilet bowl cleaner PATIENT CONSUMABLES Paper towels Hand soap Toilet tissue Facial tissue Large trash liners Small trash liners Hand sanitizer STAFF CONSUMABLES Disposable gloves Disposable masks Hand sanitizer
Patient Room Terminal Clean RULES TO REMEMBER 1. CHANGE GLOVES BETWEEN ROOMS 2. CLEAN TOP TO BOTTOM 3. DRY BEFORE WET 3. STACK WIPING CLOTHS, DON T SOAK 4. WORK CLEANEST TO DIRTIEST 5. USE A CONSISTENT PATTERN APPLY PERSONAL PROTECTIVE EQUIPMENT according to posted precautions. KNOCK AND ENTER ROOM CAREFULLY. ANNOUNCE YOURSELF if patient and/or visitor is present, return another time. REMOVE ALL LOOSE TRASH REMOVE SOILED LINEN including gowns, towels, and washcloths. PERFORM HIGH DUSTING dust curtain rods, tops of doors, recessed lights. INSPECT WALLS for spots and soil. Clean with cloth using a consistent pattern. DAMP DUST ALL VERTICAL SURFACES counters, ledges and sills, tv and cabinet. CLEAN WINDOW with glass cleaner. TURN DOWN MATTRESS and disinfect by wiping top, sides and bottom. Work top to bottom, head to foot. DISINFECT exposed frame, bed panels, top and front of headboard and side rails, in between rails, top and front panel of footboard, nurse call device, and tv remote. DISINFECT PATIENT HIGH TOUCH SURFACES focus on bedside table and inner drawer, telephone, and desktops. DISINFECT OTHER HIGH TOUCH AREAS focus on arm chairs, door, cabinet and closet handles and light switches. CLEAN VENTS and returns. IF DIRECTED BY POLICY REMAKE BED WITH CLEAN LINENS performing hand hygiene and putting on new gloves before and after. CLEAN BATHROOM carefully pour bowl cleaner in the toilet under the rim, allow to soak. CLEAN MIRROR with glass cleaner. CLEAN AREA WITH SATURATED WIPER focus on sink, faucet and handles, sink basin, and drain. CLEAN DOORS and door handles. Spot clean walls. CLEAN SHOWER STALL/TUB including grab bars, shower fixtures and shower floor. CLEAN THE TOILET EXTERIOR including seat, base, outer bowl, and handle CLEAN TOILET BOWL INTERIOR using Johnny mop. Do not flush. REMOVE GLOVES perform hand hygiene and put on new gloves. REPLENISH RESTROOM CONSUMABLES including toilet tissue, paper towels, hand soap/sanitizer. IF DIRECTED BY POLICY PROVIDE CLEAN BATH LINEN. REPLENISH CONSUMABLE SUPPLIES at bedside. MOP FLOOR begin in far corner of room cleaning under furniture and bed. Move toward bathroom and door. MOP BATHROOM FLOOR, flush toilet. PLACE CLEANING CLOTHS IN DIRTY LINEN CONTAINER. REMOVE GLOVES, discard and perform hand hygiene.
Isolation Room Terminal Clean REFER TO FACILITY PROTOCOL FOR DISINFECTANT USED FOR EACH ISOLATION CASE. PERFORM HAND HYGIENE AND APPLY PERSONAL PROTECTIVE EQUIPMENT required for the type of isolation. PPE will be available outside room. Put on PPE and check fit before entering the room. KNOCK AND ENTER ROOM CAREFULLY. ANNOUNCE YOURSELF if patient and/or visitor is present, return another time. CLOSE THE DOOR AFTER ENTERING. REMOVE ALL LOOSE TRASH REMOVE RED BAG WASTE (INFECTIOUS), if directed by policy. REMOVE SOILED LINEN including gowns, towels, and washcloths. PERFORM HIGH DUSTING dust curtain rods, tops of doors, recessed lights. INSPECT WALLS for spots and soil. Clean with cloth using a consistent pattern. DAMP DUST ALL VERTICAL SURFACES counters, ledges and sills, tv and cabinet. CLEAN WINDOW with glass cleaner. TURN DOWN MATTRESS and disinfect by wiping top, sides and bottom. Work top to bottom, head to foot. DISINFECT exposed frame, bed panels, top and front of headboard and side rails, in between rails, top and front panel of footboard, nurse call device, and tv remote. DISINFECT PATIENT HIGH TOUCH SURFACES focus on bedside table and inner drawer, telephone, and desktops. DISINFECT OTHER HIGH TOUCH AREAS focus on arm chairs, door, cabinet and closet handles and light switches. CLEAN VENTS and returns. IF DIRECTED BY POLICY REMAKE BED WITH CLEAN LINENS performing hand hygiene and putting on new gloves before and after. CLEAN BATHROOM carefully pour bowl cleaner in the toilet under the rim, allow to soak. CLEAN MIRROR with glass cleaner. CLEAN AREA WITH SATURATED WIPER focus on sink, faucet and handles, sink basin, and drain. CLEAN DOORS and door handles. Spot clean walls. CLEAN SHOWER STALL/TUB including grab bars, shower fixtures and shower floor. CLEAN THE TOILET EXTERIOR including seat, base, outer bowl, and handle CLEAN TOILET BOWL INTERIOR using Johnny mop. Do not flush. REMOVE GLOVES perform hand hygiene and put on new gloves. REPLENISH RESTROOM CONSUMABLES including toilet tissue, paper towels, hand soap/sanitizer. IF DIRECTED BY POLICY PROVIDE CLEAN BATH LINEN. REPLENISH CONSUMABLE SUPPLIES at bedside. MOP FLOOR begin in far corner of room clean under furniture and bed. Move toward bathroom and door. MOP BATHROOM FLOOR, flush toilet. PLACE CLEANING CLOTHS IN DIRTY LINEN CONTAINER. REMOVE PPE BEFORE LEAVING THE ROOM. Immediately perform hand hygiene.
Public Restroom SWITCH TO A FRESH CLOTH WHEN THE ONE YOU RE USING IS VISIBLY SOILED OR ONCE YOU VE CLEANED THE DIRTIEST PART OF A ROOM. PUT ON FRESH GLOVES. PLACE Wet Floor sign outside of room REMOVE ALL LOOSE TRASH DUST WALL HANGINGS, shelves, and pictures with a damp cloth. CLEAN ALL MIRRORS, surrounding walls and fixtures with glass cleaner. CLEAN ALL SINK COUNTERTOPS, faucets and handles, sink basin, and drain with disinfectant solution. WIPE THE UNDERSIDE OF SINKS, including pipes and walls. WIPE STALL WALLS and partitions with disinfectant solution. CAREFULLY POUR BOWL CLEANER in toilet(s) under the rim. CLEAN THE TOILET(s) EXTERIOR including base and outer bowl. CLEAN TOILET BOWL INTERIOR using Johnny mop. Rinse by flushing. FOR URINAL(s) SQUIRT WITH DISINFECTANT using squirt bottle. Flush, repeat and wipe with cloth. Discard cloth. REMOVE GLOVES perform hand hygiene and put on new gloves. CHECK AND REFILL DISPENSERS including toilet tissue, paper towels, hand soap/sanitizer. DUST MOP FLOOR DAMP MOP FLOOR with disinfectant solution. Begin at rear corner of room and working toward the exit. WIPE DOOR, KICK PLATE, AND DOOR FRAME with a fresh cloth saturated in disinfectant solution. Pay particular attention to the push plate and handles or knobs on both sides of door. REMOVE GLOVES, discard and perform hand hygiene.
Main Entrance & Waiting Areas BE THOROUGH IN CLEANING VISITOR HIGH TOUCH SUR FACES REGISTRATION OR INFORMATION COUNTER ELEVATOR BUTTONS DOOR KNOBS AND HANDLES PUT ON FRESH GLOVES. REMOVE ALL LOOSE TRASH DUST WALL HANGINGS, shelves, pictures, and tv with a damp cloth. SPOT CLEAN WALLS. DAMP WIPE SILLS AND LEDGES. WITH VACUUM BRUSH, vacuum lamp shades, and all furniture fabrics. WITH DISINFECTANT SOLUTION, DAMP WIPE HORIZONTAL SURFACES desks, tables, lamp bases, furniture arms, play tables, any public tv remote(s). IN ELEVATOR BANKS, wipe elevator buttons with disinfectant solution. DUST MOP HARD FLOOR SURFACES. DAMP MOP FLOOR with disinfectant solution. Begin at furthest corner of room. VACUUM CARPETED AREAS. Spot clean as necessary. CHECK AND REFILL DISPENSERS including facial tissue, hand soap/sanitizer, public use wipes. REMOVE GLOVES, discard and perform hand hygiene.
Nurses Station NEVER DISTURB CHARTS, FILES, OR PAPERS IN THE NURSES STATION PUT ON FRESH GLOVES. REMOVE ALL LOOSE TRASH. WITH DISINFECTANT SOLUTION, WIPE HORIZONTAL SURFACES desk, counter, chairs and chair arms. CHECK AND REFILL DISPENSERS including facial tissue, hand soap/sanitizer, staff use wipes. REMOVE GLOVES, discard and perform hand hygiene.
RULES TO REMEMBER 1. DEDICATE TOOLS & EQUIPMENT TO O-R 2. USE LINT FREE CLOTHS IN THE O-R 3. DO NOT USE SPRAY BOTTLES IN THE O-R Operating Room 4. CLEAN MULTIPLE TIMES DAILY BEFORE 1st CASE BETWEEN CASES AFTER LAST CASE APPLY PERSONAL PROTECTIVE EQUIPMENT according to posted precautions. WHEN REMOVING TRASH AND SOILED LINENS always be aware of sharps or protruding objects. OUTSIDE THE O-R CLEAN THE SCRUB ROOM, HALLS, AND UTILITY ROOM WIPE SINK, SHELVES AND SURROUNDING SURFACES. Include the counter, faucet and handles, sink basin, spout, under the sink, and all pipes. CHANGE GLOVES, PERFORM HAND HYGIENE BEFORE 1st CASE DAMP DUST LIGHTS AND REFLECTORS with disinfectant solution. DAMP WIPE ALL FURNITURE back table, prep table, stands, lights, flat surfaces, and operating table DAMP MOP FLOOR BETWEEN CASES & AFTER LAST CASE ENTER O-R, CLOSE DOOR BEHIND YOU LOOK FOR WASTE INVOLVING BLOOD OR BLOOD SOAKED LINENS. Most should have been removed by OR staff, though some may be left behind. Place in appropriate bio-hazardous container. REMOVE ALL LOOSE TRASH EMPTY INFECTIOUS WASTE CONTAINER be aware of tears. Double bag to prevent potential leaks. Wipe all surfaces of waste container, replace liner. TAKE INFECTIOUS WASTE TO APPROPRIATE CONTAINER FOR PICK UP REMOVE ALL LINEN including gowns, towels, and washcloths. SPOT CLEAN AREAS VISIBILY SOILED WITH BLOOD, TISSUE, OR BODILY FLUIDS. PERFORM HIGH DUSTING dampen high dusting tool with disinfectant. Dust ceiling-mounted equipment, surgical lights, external tracks and other high dust areas. WIPE LIGHT REFLECTORS, WALLS, LEDGES, CABINETS, CLOSET DOORS AND HANDLES with a disinfectant INSPECT AIR EXHAUST AND INTAKE VENTS. They must be kept free of lint and dust. CLEAN AND DISINFECT EQUIPMENT AND FURNITURE stands, booms, foot pedals and cords, light switches, push plates and all horizontal surfaces. UNLOCK THE OR TABLE AND BREAK DOWN clean and disinfect all surfaces joints, table attachments, frame legs and rails. TURN DOWN MATTRESS and disinfect by wiping top, sides and bottom. Work top to bottom, head to foot. WIPE BOTH SIDES of coated pillow. FLOOD ENTIRE FLOOR WITH CLEANER DISINFECTANT, roll casters of equipment and tables through disinfectant solution. Wet vacuum or use fresh microfiber cloth to take up the solution. REMOVE GLOVES perform hand hygiene and put on new gloves. PLACE CLEANING CLOTHS IN DIRTY LINEN CONTAINER. REMOVE GLOVES, discard and perform hand hygiene.
RULES TO REMEMBER 1. ALWAYS DISPLAY WET FLOOR SIGNS 2. NEVER DOUBLE DIP CLOTHS 3. DO NOT USE SPRAY BOTTLES Emergency Department 4. LEAVE CLEANING CART IN HALL 5. BE AWARE OF POSTED PRECAUTIONS. PERFORM HAND HYGIENE, PUT ON GLOVES AND GOGGLES. ALWAYS ANNOUNCE YOURSELF BEFORE ENTERING A TREATMENT AREA. IF TREATMENT AREA IS OCCUPIED, OFFER A FRIENDLY GREETING AND EXPLAIN WHY YOU RE THERE. IF OTHER STAFF IS WITH THE PATIENT, COME BACK LATER. APPLY PERSONAL PROTECTIVE EQUIPMENT according to posted precautions. REMOVE ALL LOOSE TRASH LOOK FOR WASTE INVOLVING BLOOD OR BLOOD SOAKED LINENS. Most should have been removed by OR staff, though some may be left behind. Place in appropriate bio-hazardous container. EMPTY INFECTIOUS WASTE CONTAINER be aware of tears. Double bag to prevent potential leaks. Wipe all surfaces of waste container, replace liner. TAKE INFECTIOUS WASTE TO APPROPRIATE CONTAINER FOR PICK UP REMOVE ALL LINEN including gowns, towels, and washcloths. SPOT CLEAN AREAS VISIBILY SOILED WITH BLOOD, TISSUE, OR BODILY FLUIDS. CHECK CURTAIN FOR VISIBLE SOIL OR DIRT. If present, change the curtain. DAMP WIPE ALL VERTICAL SURFACES Wipe counters, ledges, and sills. TURN DOWN MATTRESS and disinfect by wiping top, sides and bottom. Work top to bottom, head to foot. Be sure to wipe both sides of mattress. Allow to air dry. WIPE BOTH SIDES of coated pillow. Allow to air dry. CLEAN AND DISINFECT FURNITURE desktops, bedside table, arm chairs, doors, cabinets, light switches, closet handles and other high touch surfaces. CLEAN AND DISINFECT EQUIPMENT blood pressure cuff and tubing, other applicable equipment. REMOVE GLOVES, PERFORM HAND HYGIENE, CHANGE GLOVES TO CHANGE LINENS ON TREATMENT BED. REMOVE GLOVES, PERFORM HAND HYGIENE, CHANGE GLOVES. DAMP MOP FLOOR with disinfectant solution. Begin at furthest corner of room. Be sure to move furniture, clean under the bed, moving toward exit. REMOVE GLOVES perform hand hygiene and put on new gloves. PLACE CLEANING CLOTHS IN DIRTY LINEN CONTAINER. REMOVE GLOVES, discard and perform hand hygiene.
Addressing Patient Care Equipment All patient care furniture/equipment is divided into Classifications and the furniture/equipment classification determines the schedule of cleaning and procedure for cleaning. The following table defines specific furniture/equipment classifications, schedule for cleaning for that specific classification, and examples of furniture/equipment that falls under the classification: CLASS EQUIPMENT DEFINITION STAFF RESPONSIBLE FREQUENCY EQUIPMENT EXAMPLES I Patient Furniture EVS Daily Patient Bed Overbed table Bedside Table Bedside Cabinet Night Stand Chair Footstool Sleep Chairs EquipmentCabinets-Outside Scales Gurney (ED specific) IV Poles Wall Suction Units Dust Vents Commodes Room Service Menu II III IV Stationary/Mobile Clinical Staff Between patients Multi-Patient Use Clinical Staff Daily Continuous Use Clinical Staff Commodes Hover Mats Hoyer Lift Sleep Chairs Warming Tables Equipment carts Mobile CardiacMonitors Isoletes High Chairs Bedside/Sling Scales & tubing Wall Suction Canisters Dynamap/ElectronicBP* Pulse Oximeters* IVAC/ElectronicThermometer *Except dedicated equipment for contact precautions Wheelchairs(Transport Dept) Walkers (PT/OT ) Weekly terminal Gurneys Clean and when Top and sides of Crash Cart & visibly soiled Defibrillators EKG machine Oxygen Regulators C-Section Cart (Labor and Delivery) SCD Compression Hover Mats Hoyer Lift Sleep Chairs Warming Tables Equipment carts Mobile Cardiac Monitors Traction Equipment (Orthopedics) Keyboards Glucometer Case & Machine (10% bleachpads) EKG Machine Leads Inside Supply Bins O2 tanks Inside Cabinets Patient/Pantry Refrigerators (EVS) Staff Refrigerators (Staff)
Sources Association for the Healthcare Environment Practice Guidance for Healthcare Environmental Cleaning, 2008 Association for Professionals in Infection Control & Epidemiology Infection Prevention Manual for Hospitals, 2010 Centers for Disease Control and Prevention Healthcare Infection Control Practices Advisory Committee (HIPAC) Guideline for Environmental Infection Control in Health-Care Facilities, 2008 Joint Commission Resources, Inc. Toolkit for Preventing Healthcare Associated Infections, 2010 Healthcare Infection Control Practices Advisory Committee (HIPAC)
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