The Importance Of Surface Cleaning In Hospitals

The frequency of surface wiping in hospitals varies depending on several factors, including the type of surface, the level of contamination, and the vulnerability of patients to infection. Hospitals must maintain clean environments to reduce germ exposure and keep patients, visitors, and staff safe. High-touch surfaces, such as tray tables, bed rails, and medical equipment, are particularly important to disinfect regularly as they pose a higher risk for pathogen transmission. The cleaning methods can range from using antibacterial wipes to implementing a multi-barrier approach, including hand hygiene and proper reprocessing of medical devices. The optimal timing and frequency of wipe cleaning are still subjects of ongoing research.

High-touch surfaces

The frequency of surface wiping in hospitals varies depending on the type of surface, the level of contamination, and the vulnerability of patients. High-touch surfaces, which are frequently touched by patients and healthcare workers, require more frequent cleaning and disinfection to prevent the spread of healthcare-associated infections (HAIs).

The cleaning and disinfection of high-touch surfaces should be performed using a risk-based approach. This involves considering the probability of contamination and the vulnerability of patients in the specific care area. For example, surfaces in intensive care units (ICUs) or areas with immunocompromised patients may require more frequent cleaning and disinfection compared to low-risk areas.

Hospitals should establish standardized cleaning and disinfection protocols for high-touch surfaces, including the use of appropriate cleaning and disinfection technologies and products. Environmental services staff should be properly trained and educated on cleaning and disinfection policies, infection control practices, and the proper use of personal protective equipment (PPE) and cleaning chemicals.

Monitoring and auditing the effectiveness of cleaning and disinfection practices are crucial to ensuring the cleanliness of high-touch surfaces. Hospitals can utilize various methods, such as direct observation, fluorescent markers, and adenoside triphosphate (ATP) assays, to assess the cleanliness of surfaces and identify areas for improvement. By implementing comprehensive cleaning and disinfection strategies, hospitals can maintain a safe and hygienic environment for patients, visitors, and healthcare personnel.

Disinfecting methods

The cleaning and disinfection of surfaces in hospitals are critical for preventing infections and reducing the risk of healthcare-associated infections (HAIs). HAIs are a leading cause of illness and death worldwide, and contaminated surfaces contribute to the spread of pathogens. Therefore, hospitals must maintain a clean environment and reduce germ exposure to keep patients, visitors, and staff safe.

A risk-based approach is often used to determine the cleaning frequency and methods, considering the potential for exposure, the probability of contamination, and the vulnerability of patients to infection. Heavily contaminated surfaces require more frequent and thorough cleaning, and high-touch surfaces with frequent hand contact should be prioritized.

To ensure effective disinfection, hospitals should implement the following:

• Proper training and instruction for all personnel responsible for cleaning and disinfecting: This includes education on hospital cleaning and disinfection policies, infection control, proper use of personal protective equipment (PPE), and safe handling of chemicals.
• Selection of appropriate cleaning and disinfection technologies and products: Choosing the right products and technologies is essential for ensuring effective disinfection.
• Standardization of setting-specific cleaning and disinfection protocols: Consistent and standardized protocols help maintain cleanliness and reduce the risk of infections.
• Monitoring and auditing of cleaning and disinfection procedures: Regular monitoring and auditing help identify areas for improvement and ensure adherence to protocols. Methods such as direct observation, fluorescent markers, and adenoside triphosphate (ATP) assays can be used for monitoring.

Some specific disinfecting methods and strategies include:

• Using disinfectant solutions: Disinfectant solutions, such as chlorine-based disinfectants or facility-approved intermediate-level disinfectants, should be applied to surfaces after cleaning with a detergent and water solution. Allow the disinfectant to remain wet on the surface for the required contact time, then rinse with clean water if needed.
• Wipe cleaning of touched surfaces: This involves using disinfectant wipes or cloths to clean high-touch surfaces, such as bed rails, tray tables, and medical equipment.
• Whole-room cleaning: Cleaning the entire room, including hard, non-porous surfaces, before the first patient care activities of the day can be effective in reducing contamination.
• Hand hygiene practices: Proper hand hygiene is essential to prevent the spread of pathogens.
• Reprocessing of medical devices: Ensuring the proper cleaning and reprocessing of medical devices can help reduce the risk of infections.

Cleaning strategies

Risk-Based Approach

Hospitals should adopt a risk-based approach to cleaning, as outlined by the CDC. The risk level determines the cleaning frequency, method, and process. High-risk areas, such as those with heavily contaminated surfaces or vulnerable patients (e.g., immunosuppressed), require more frequent and rigorous cleaning. Probability of contamination and vulnerability of patients to infection are key factors in assessing risk.

High-Touch Surfaces

Frequent cleaning of high-touch surfaces is crucial. High-touch surfaces are those frequently touched by patients and healthcare workers, such as bed rails, medical equipment, tray tables, and mobile phones. Cleaning these surfaces has been shown to reduce contamination and the spread of pathogens.

Training and Education

All personnel responsible for cleaning and disinfection must be properly trained and educated. This includes understanding their roles and responsibilities, hospital cleaning policies and procedures, infection control, proper use of personal protective equipment (PPE), and safe chemical handling. Regular and ongoing training ensures a consistent understanding and application of cleaning strategies.

Monitoring and Feedback

Hospitals should implement monitoring strategies to assess the effectiveness of cleaning and disinfection procedures. This can include direct observation, fluorescent markers, and ATP assays. Monitoring helps identify areas for improvement and ensures adherence to cleaning protocols. Providing feedback to staff and stakeholders is essential for maintaining high standards and making any necessary adjustments.

Standardization and Protocols

Standardizing setting-specific cleaning and disinfection protocols is vital. This includes defining clear program responsibilities and integrating environmental services into the hospital's safety culture. Standardization ensures consistency and compliance with cleaning procedures, reducing the risk of HAIs.

Selection of Cleaning Technologies and Products

Hospitals should select appropriate cleaning and disinfection technologies and products. This includes choosing effective disinfectants, such as chlorine-based solutions or facility-approved intermediate-level disinfectants, and ensuring their proper use and contact time on surfaces.

By implementing these comprehensive cleaning strategies, hospitals can maintain a safe and hygienic environment for patients, visitors, and healthcare personnel, reducing the risk of HAIs and promoting overall health and safety.

Cleaning cloth techniques

Preparation:

Before beginning to clean surfaces, it is crucial to prepare the cleaning cloth properly. Start by folding the cleaning cloth in half and then in half again, creating eight sides. This ensures that you can utilise the entire surface area of the cloth efficiently. Thoroughly wet or soak the folded cloth in the appropriate environmental cleaning solution or disinfectant.

Cleaning Technique:

When wiping surfaces, follow a systematic approach. Start with cleaner areas and move towards dirtier ones. This strategy helps prevent the spread of microorganisms and dirt from highly contaminated areas to cleaner surfaces. Additionally, work from high to low areas to avoid having cleaned surfaces recontaminated by falling or dripping dirt. Ensure that you regularly rotate and unfold the cleaning cloth to utilise all sides.

Disposal and Reprocessing:

Once all sides of the cleaning cloth have been used, or it is no longer saturated with the cleaning solution, properly dispose of the cloth or store it for reprocessing. For higher-risk areas, such as intensive care units, use a new cleaning cloth for each patient zone. Never leave soiled cleaning cloths soaking in buckets, and always change them when they are no longer saturated.

Training and Standardisation:

Proper training and standardisation of cleaning procedures are vital. All personnel involved in cleaning and disinfection must understand their roles and responsibilities. This includes providing education on hospital cleaning policies, infection control, and the proper use of personal protective equipment (PPE) and cleaning chemicals. Standardising setting-specific cleaning and disinfection protocols ensures consistent cleanliness throughout the hospital.

Monitoring and Feedback:

Implement a monitoring strategy to assess the effectiveness of cleaning procedures. This can include direct observation, fluorescent markers, and adenoside triphosphate (ATP) assays. Provide feedback to staff and stakeholders on the adequacy of cleaning to drive continuous improvement.

By following these cleaning cloth techniques and incorporating them into a comprehensive hospital cleaning programme, healthcare facilities can maintain a safe and hygienic environment for patients, visitors, and healthcare personnel.

Monitoring and auditing

Environmental Cleaning and Disinfection Monitoring Strategy:

Hospitals should develop and implement a comprehensive monitoring strategy to assess the adherence to and effectiveness of cleaning and disinfection procedures. This strategy should include defining the monitoring methods, frequency, data validation processes, areas, and surfaces to be monitored. For example, direct observation, fluorescent gel, and adenoside triphosphate (ATP) assays can be used to assess the cleanliness of surfaces.

Risk-Based Approach:

The frequency and intensity of cleaning and disinfection should be determined by a risk assessment. High-risk areas, such as those with vulnerable patients (e.g., immunosuppressed individuals), require more frequent and rigorous cleaning. Additionally, heavily contaminated surfaces necessitate more thorough and regular cleaning compared to moderately or lightly contaminated surfaces.

Training and Education:

Proper training and instruction for personnel responsible for cleaning and disinfection are crucial. Administrators should provide education on hospital cleaning policies, infection control, proper use of personal protective equipment (PPE), and safe handling of chemicals. Regular and sustainable training ensures that cleaning staff are equipped with the necessary skills and knowledge to perform their roles effectively.

Audits and Feedback:

Routine audits of cleaning and disinfection procedures should be conducted to identify gaps and areas for improvement. Feedback on the adequacy and effectiveness of cleaning practices should be provided to staff and stakeholders. This feedback loop helps to ensure that any issues are addressed promptly and that cleaning protocols are adapted as needed.

Multidisciplinary Participation:

A defined management structure with multidisciplinary participation should be established. Regular meetings should be held to review practices, evaluate quality measures, and set facility goals. This collaborative approach allows for continuous improvement and ensures that cleaning and disinfection are integrated into the hospital's safety culture.

By implementing robust monitoring and auditing procedures, hospitals can maintain a clean and safe environment for patients, visitors, and healthcare personnel, reducing the risk of healthcare-associated infections (HAIs) and contributing to positive health outcomes.

Frequently asked questions