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Environmental Cleaning Guidance

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Environmental Cleaning Guidance Powered By Docstoc
					 Guidance on Environmental Cleaning
     for Independent Contractors




Contents
Guidance on cleaning standards for surgeries, clinics and pharmacies   2

Cleaning equipment and products                                        2

Cleaning Schedules                                                     2

Laundry                                                                4

Use of chemical disinfectants                                          4

A practice checklist for monitoring cleaning standards                 6


Jane Beckford
Head of Infection Prevention
Updated November 2009
Guidance on cleaning standards for surgeries, clinics and pharmacies


The purpose of cleaning is to remove dust, dirt and organic matter that may contain micro-
organisms and will support their growth. The most important component of an effective cleaning
programme is the regular removal of dust from horizontal surfaces. Washing with hot water and
detergent will remove 80% of micro-organisms. Routine disinfection of hard surfaces, e.g. with
bleach, is not required, except in cases of blood or body fluid spillage (see infection control policy
ICC 04). Furnishings and surface finishes should be selected with consideration of the ease and
efficiency that they can be cleaned.

A written cleaning schedule (which may be based on this guidance) should specify the frequency
and method of cleaning, and the member of staff responsible for training and supervising cleaning
staff and monitoring standards. An audit tool is provided on page 6, which can be used to monitor
cleaning standards on a weekly or monthly basis.

Cleaning staff should be made aware of the hazards specific to the health care envoronment, e.g.
used needles and blood, control measures, including hand washing, protective clothing and
hepatitis B vaccination, and the action to take in the event of a sharps injury. Positive feedback and
the recognition of being a valued member of the healthcare team will help to motivate and retain
good cleaning staff.



Cleaning equipment and products


Cleaning equipment should be stored in a dedicated, clean, locked cupboard. COSHH (Control of
Substances Hazardous to Health Regulations) assessments should be carried out for all cleaning
agents, and control measures implemented as appropriate. Cleaning products required are:

       general purpose detergent (for general cleaning)
       cream cleaner (for wash basins and sinks)
       multi-purpose cleaner (for kitchens and paintwork)
       toilet cleaner (non-bleach)
       chlorine-based disinfectant, e.g. Chlor-Clean (for surfaces contaminated with blood/body
       fluids)

Separate cleaning equipment (household gloves, cloths, mops and buckets) should be used for
kitchen, toilet and clinical areas. It is mandatory that these are marked or colour-coded to avoid
confusion and cross-contamination, i.e.

       kitchen                 green
       toilets                 red
       clinical areas          blue


Cleaning Schedules


   1. Daily cleaning

If in regular use, the following areas should be cleaned daily with hot water and detergent / cream
cleaner using disposable cloths:

hard floors    work surfaces           sinks and basins       showers        toilets         kitchens
                                                   2
Attention should be paid to frequently touched surfaces, such as door handles, phones, computer
keyboards, taps, light switches and soap / alcohol gel dispensers. During a flu pandemic these
surfaces should be cleaned twice daily.

In all areas, clutter should be kept to a minimum for ease of cleaning and to avoid the build-up of
dust. Closed cupboards are preferable to open shelving for this reason. If a room is not in use,
cleaning may be reduced to weekly.

Clinical equipment such as examination couches and lamps, dressing trolleys, blood pressure
monitors, dental chair equipment, and optometry examination equipment, will also need to be
cleaned daily. A local decision will need to be made as to whether this is the responsibility of
clinical or domestic staff. Plastic dust covers may be useful for some clinical equipment, such as
optometry examination equipment. In community pharmacies, areas where there is significant
customer contact and handling of goods and money, such as tills and counter tops, should also be
cleaned daily.



   2. Twice weekly cleaning

In offices, carpets should be vacuumed at least twice a week and desks wiped over. Areas under
desks and behind computers must not be neglected.



   3. Periodic cleaning

Cleaning schedules should include a rolling programme for less frequent but regular cleaning of
areas such as:

woodwork, i.e. skirting, doors and window frames
windows and mirrors                                   carpets (steam cleaning)
fridges and food cupboards                            seating
curtains and blinds                                   toys*
entrance matting                                      microwave ovens / cookers / grills
fans, extractors and air conditioning units           high surfaces, e.g. curtain rails

*In general, only hard toys should be kept in the surgery. They should be cleaned weekly with hot
water and detergent and dried with paper towels. Soft and wooden toys should be avoided
because of the potential for transmission of infection.

Manufacturers may provide advice on how to clean certain products, e.g. floors and furnishings
with special finishes. This advice should be followed whenever possible.

Some equipment, such as air conditioning units, may need have specialised requirements, e.g.
needing filters to be changed– check with the manufacturer.



   4. Cleaning during building work

If building work is being carried out at the practice and it is not possible to re-locate services, then
the frequency of cleaning will need to be increased. Areas where work is going on should be
sealed off to reduce dispersal of dust, and certain clinical procedures will need to be suspended for
the duration of the work, e.g. minor surgery. Once building work is finished, the whole premises
should be thoroughly cleaned, including high surfaces and all fixtures such as lighting. This may
need to be done more than once as the dust settles.
                                                    3
   5. Cleaning of clinical / domestic waste store

If there is an external store for clinical waste and / or domestic waste, e.g. in larger health centres,
this should be cleaned by hosing down. The store will require a water supply for hosing and a
drain. Measures must be taken to prevent any spillage of waste, such as storing waste bags in
wheelie bins rather than loose on the floor. Waste must be segregated by type, e.g. infectious,
domestic, sharps. Access to the store by unauthorised persons or by pests must be prevented.



   6. Cleaning / running of showers and infrequently used taps

Shower heads should be cleaned daily and de-scaled as necessary. Showers and taps not used
on a daily basis should be run twice weekly for a minimum of 3 minutes to reduce the risk of
colonisation with Legionella.



   7. Decontamination of cleaning equipment


All equipment should be kept clean and stored dry as follows:


Equipment         Method of cleaning
Mop bucket        Empty after use down a toilet or sluice, wash, rinse and dry. Store inverted.
Mop heads         Disposable – wash, rinse and wring after use and hang up to dry. Replace at
                  least weekly.
Cloths            Single use disposable.
Household         Wash inside and out after use and hang inverted to dry. Replace as required.
gloves
Vacuum            Should be fitted with filters, which should be changed as per manufacturer’s
cleaners          instructions.
Dry mops          Should be dust-attracting to reduce dispersal of dust. Mop heads should be
                  changed daily. Avoid using brooms, which will disperse dust.
Lavatory          Rinse after use in flushing water and store dry. Change regularly.
brushes



Laundry

The use of laundry should be avoided in community healthcare as a daily laundry service is not
generally available to independent contractors. Disposable products, such as paper couch roll, are
recommended and should be disposed of after each patient. Pillows and couches must be covered
with an impervious covering to facilitate cleaning.

It is recommended that washable roller blinds are used rather than window curtains. Couch
curtains, if needed, should either be replaced with disposable curtains, for example from:
http://www.marlux.co.uk/product_specifications/index.php
or should be laundered every 3 months.


Use of chemical disinfectants

Chemical disinfectants are limited in their efficacy and should only be used when heat disinfection
is not applicable, for example to decontaminate the environment after body fluid spillage.
                                                   4
In order to be effective, disinfectant solutions must be used in accordance with the manufacturer’s
instructions; they should be in date, or freshly prepared daily if tablets, and used at the appropriate
strength for the contact time specified. Contact with detergents, soaps and organic matter may
inactivate disinfectants, so the surface to be disinfected should ideally be physically clean and free
of smears or stains.


Examples of chemical disinfectants used in the community

Chemical                  Advantages                   Disadvantages            Uses
Chlorine-based:            Wide range of               Inactivated by         1. Decontamination of
1. Hypochlorites              activity against            organic matter        blood or body fluid
e.g. Domestos                 micro-organisms           Corrosive to           spillage at 1% solution
                           Rapid action
                           1. E                           metals                (10,000 ppm)
                           Non-toxic
                              .                         Bleaches fabrics       2. Decontamination of
                           Cheap                                               equipment / surfaces
                                                                                at 0.1% solution
                                                                                (1,000 ppm)

Chlorine-based:              As above                 As above but to a        As above
2. Sodium                    More resistant to        lesser degree
Dichloroisocyanurate          organic matter
(NaDCC)                      Less corrosive
e.g. Presept, Haz tabs,      Longer shelf-life
Chlor Clean                   (generally tablets
                              or granules)
Alcohol 70%                  Good activity               Flammable            Decontamination of
e.g. Isopropanol              against bacteria,           Does not penetrate   metal surfaces, skin
                              viruses and fungi            organic matter       and hands
                             Rapid action                Non-sporicidal
                             Leaves surfaces
                              dry
                             Non-corrosive


COSHH (Control of Substances Hazardous to Health Regulations, 2002) assessments must be
carried out for all chemical disinfectants in use, and staff should be aware of the implications of
these assessments for storage and use of the disinfectant, protective clothing, and first aid in the
event of exposure, e.g. a splash to the eye.

Hypochlorites should not be mixed with acids, as chlorine gas will be released.




                                                   5
TWENTY QUESTIONS: A Checklist for Monitoring Cleaning Standards


Standard
The following areas should be cleaned daily. They should appear clean and free of dust, smears
and stains.

Area                                Tick if clean       Comment if dirty
1. Hard floors

2. Work surfaces

3. Sinks, basins and showers

4. Toilets

5. Clinical equipment



Standard
Carpets should be vacuumed twice weekly, including areas under desks. Desks should be cleaned
twice weekly, including areas behind computers. Staff may need to be asked to clear their papers
at a particular time so that their desk can be cleaned.

Area                                Tick if clean       Comment if dirty
6. Carpets and desks



Standard
Periodic cleaning is carried out as described on page 3 – check key areas, e.g. toys, food fridge,
microwave, windows, mirrors, entrance matting, fans, seating, curtains, blinds and woodwork.

Area                                Tick if clean       Comment if dirty
7. Periodic cleaning areas



Standard
Domestic waste bins and kitchen bins should be emptied daily, cleaned and the bin liner replaced.

Area                                Tick for yes        Comment if no
8. Have bins been emptied and
bin liners been replaced?

9. Are the bins clean?




Please turn over




                                                    6
Standard
Each room used for treating patients must have a clinical waste bin and a sharps bin (except for
optometry). These should not be overfilled. Once clinical waste bins are ¾ full, or sharps bins full
to the “fill line”, they should be sealed and removed to a secure storage area.

Sharps bins must never be kept on the floor where children could gain access to them.

Area                                 Tick for yes       Comment if no
10. Are sharps bins and clinical
waste bins less than ¾ full?
11. Have full sharps bins and
clinical waste bins been sealed
and removed to a secure storage
area?
12. Are sharps bins kept off the                        PLEASE LIFT OFF FLOOR AND ONTO
floor?                                                  WORK SURFACE


Standard
Cleaning equipment should be stored in a clean, locked cupboard. Buckets should be emptied
and washed after use and stored dry and inverted. Mop heads should be rinsed, wrung out and
stored inverted - they should be replaced weekly.

Area                                 Tick for yes       Comment if no
13. Is the cleaning cupboard kept
clean and locked?
14. Are mop buckets clean and
dry?
15. Are mop heads stored dry
and inverted and changed
weekly?


Standard
Separate cleaning equipment should be used for kitchen, clinical and toilet areas.

Area                                 Tick for yes       Comment if no
16. Are there separate gloves,
cloths, mops and buckets for the
different areas?
17. Are these items colour coded
accordingly (see page 2)?

Evaluation

18. Identify question numbers with a negative response

19. Identify action to be taken

20. What was the outcome of this action?




Signature____________________Date completed____________Review date____________
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