Cleaning of healthcare environment

Video transcript

Effective and detailed cleaning of healthcare settings is important to provide a safe environment for patients, residents, visitors and staff. Information on how to clean is contained in two documents, the Queensland Health Environmental Cleaning guidelines and the Australian Infection Prevention and Control guidelines.

The action of cleaning allows for the physical removal of dirt, organic matter, dust and germs from surfaces. This reduces the risk of cross contamination of other surfaces and equipment in the environment. Effective cleaning also reduces the risk of others getting an infection. When watching this video, please keep in mind that this video is a meant to be a guide only. Roles and responsibilities of operational cleaning staff and the order of tasks may vary due to local procedures, layout of the room or placement of items to be cleaned.

We will start with some basic principles and techniques which should be followed each time you clean.

First, you will need to know the difference between full cleaning and spot cleaning.

Full cleaning involves a thorough clean of all surfaces, making sure every area is cleaned. Spot cleaning is where there is cleaning of specific areas that need immediate attention, like visible spills or stains.

You may also hear of terms such as routine cleaning which should occur daily or weekly, or periodic cleaning that is undertaken less often on a schedule.

Frequently touched surfaces, like bed rails, call bells, door handles and light switches need frequent cleaning. They are a higher risk of transfer of germs because they are touched by so many people.

To clean properly, use a combination of detergent and water and the correct technique. It is important to clean all sides, edges and undersurfaces, making sure there is enough downward pressure to ensure a detailed clean.

Detergents contain a substance called a surfactant that helps to remove dirt and organic matter from surfaces. Detergent cleaning is recommended for most room cleaning.

Disinfectants are chemicals which quickly kill most germs on surfaces, or slow their growth. They should be used following risk assessment or  if requested by your Infection Prevention and Control Nurse. A disinfectant can only be used after an item has been cleaned with a detergent. If both cleaning and disinfection is needed, a combined cleaning and disinfectant product should be used.

Unless requested by the Infection Prevention and Control Nurse, pre-packaged cleaning or disinfectant wipes should not be used for cleaning a patients room.

Disinfectant wipes or chemicals should be approved to be used on surfaces within a healthcare setting.They also must be included on the Australian Register of Therapeutic Goods (ARTG). They should always be used in line with the manufacturer’s instructions to ensure safe handling and storage, correct contact time and to adhere to shelf life conditions.

Always ensure cleaning solutions are labelled and stored in their original bottles or containers. Never mix any type of cleaning chemicals together, as this can create dangerous reactions.

Spray bottles are not to be used for cleaning the healthcare environment as they pose an infection and workplace health and safety risk. Sprays may aerosolise the matter they are designed to clean.

Detergents are mostly diluted through a dispensing system. Chemical disinfectants are usually in a liquid or tablet form depending on your healthcare setting. Flip top bottles can be used for dispensing detergent. Manufacturers will provide a dedicated bottle or similar for making up chemicals as these need to be labelled.

When handling any detergents or chemicals. Follow the manufacturer’s instructions carefully. Wear the correct personal protective equipment or PPE, and use cold or warm water as instructed to avoid potential hazards. Most chemical disinfectants are made up using cold water. Chemicals need to be made up in areas with good ventilation to prevent risks from inhalation. Chemical solutions may not work correctly if exposed to light, when they are not diluted correctly or if they have expired. Remember, once made up, chemicals should be discarded as per manufacturer instructions so make sure you write date and time on solution.

When using detergent or chemical solutions, dampen the disposable cloth by pouring solution from a flip top bottle or one provided by manufacturer. Make sure the solution covers all areas of the cloth without dripping.  The cloth should be folded into quarters to maximise its use. Fold and unfold the cloth to allow use of different surfaces of the cloth. Surfaces should be left damp after cleaning with no pools of liquid.

After using chemical disinfectants and on completion of all cleaning tasks. Empty and fully clean buckets and disinfectant bottles as per local work instructions so they are ready for next use. The outside surfaces of detergent and chemical bottles should be wiped over with with a damp cloth and detergent. These should be stored for the next day.  Mop buckets where used, should be emptied, fully cleaned inside and out and stored upright to dry.

When cleaning large surfaces, and to make sure all parts of the surface are cleaned, use a straight line or an S-shaped technique. Clean all parts of the surface. Rotate the cloth regularly to avoid re-contaminating a surface. Make sure the cloth remains damp. Cleaning should be done from clean‑to‑dirty and high‑to‑low. Use a new cloth surface and clean one surface at a time. Discard cloth or send to laundry after use.

A surface is considered to be a single, continuous area that can be cleaned without moving to another object or surface. Examples of one surface include one bedside table top or one patient bed rail. The same cloth must not be re-dipped into cleaning solution or used across multiple surfaces. Surfaces should be left to dry on their own to ensure enough contact time with chemical agents.

When spot cleaning surfaces such as windows or mirrors, use glass cleaners and gentle pressure to remove dirt and smudges. When full cleaning, use detergent, window squeegie and hand held tool with wool or microfibre cover.

Window blinds should be open and lights turned on. Clutter, adhesives or other items that make it difficult to clean should be removed from ledges, surfaces or equipment before cleaning commences.

By following these steps and using the recommended cleaning techniques, you can maintain a clean environment. Make sure you refer to your supervisor or manufacturer’s instructions if you have any quesitons.

During your shift, you may need to switch tasks to clean a patients room. This may take time to complete, so you may not get back to finishing the last task you commenced. It is important to complete this task without being interrupted. If you won’t have enough time to finish the task for any reason, ensure that you provide handover about the unfinished cleaning tasks to the next cleaner on duty or to your supervisor.

Before cleaning commences, check with the nurse or healthcare worker and ask questions about the cleaning task to be performed. Ensure the room is ready for cleaning and that personal items have been removed. Ask about the type of cleaning required, if transmission-based precautions are needed, and who will clean electrical and medical equipment in the room. Depending on local protocols, the nurse may need to clean the bed. Check that this has been done.

Prepare equipment for cleaning the room. Check your cleaning trolley. Only use cleaning products and chemicals supplied by your supervisor. Ensure cleaning equipment is clean and in good condition and working order. All cleaning supplies such as chemicals, cleaning cloths or wipes, mops, waste bags, and linen skip should be ready for use.

If there are any issues with furniture, cleaning equipment or dispensers, report this to your supervisor.

You may need to find alternative cleaning equipment if possible. Report any issues with broken or damaged furniture which may not be able to be cleaned correctly. When you cannot clean items properly, this may contribute to a patient infection

Chemicals should be made up as per manufacturer’s instructions. This means you need to make chemicals up to the correct dilution, so they work properly to kill germs and are safe for staff and patients. Using the wrong dilution can make the chemical too weak, so it doesn’t work properly. Chemicals made up too strong may be unsafe.

Hand hygiene is one of the best ways to stop the spread of infections in hospitals and must always be done before putting on your PPE. Hand hygiene must be performed, before starting to clean or touch equipment, after finishing a cleaning task, between each patient room or bedspace. Also clean hands if you are worried about contact with contaminated surfaces or items. Gloves do not replace the need for hand hygiene and hand hygiene should occur before putting on or after removing gloves.

PPE should be worn according to the transmission-based precautions signage, and work health and safety requirements. It can become hot when wearing PPE during cleaning. Take a break if needed when cleaning larger areas like a 4-bedded room.

Be careful not to touch your eyes or your face with your unclean or gloved hands during cleaning. If you have long hair, make sure your hair is tied back. away from your face. If you need to, use the bathroom and have a drink of water prior to applying PPE.

Inspect privacy screens for blood, body fluids or marks. Check the expiry date panel for disposable curtains and change as required or instructed.

The room is ready for cleaning. Inspect surfaces for visible dust or marks. Damp dust surfaces only, never dry dust. This is to prevent dust from falling and becoming airborne. Use extendable tools to reduce ladder use. Items should be cleaned in the order of your local or statewide guidelines. Working from high to low, spot clean or damp dust ceilings and walls, television,  skirting boards, curtain rails, overhead lights, blinds and frequently touched surfaces including dispensers, light switches and door handles.

Damp wipe the wall surface which surrounds the light switch plate, taking care to avoid excess moisture where there are electrical components. Wipe light switch plate including edges, paying close attention to high-touch areas such as switch toggles and buttons.

Damp wipe tops of door surfaces and all door frames taking care to change cloths after wiping hinges. Change cloth to wipe all surfaces of door handles, push plates, latch. Use enough pressure to make sure all surfaces of the door are cleaned.

Damp wipe entire surface of the medical services panel with cleaning solution from top to bottom using an S motion.

Depending on your facility. A nurse may be responsible for cleaning the bed. If this is a cleaning task, Position bed to the correct height to reduce bending. Lower bed into a flat position. Using damp cloths wipe all surfaces of the bed including drip pole, overhead support bar, and triangle rotating the cloth surfaces.

Damp wipe the top of mattress surfaces, ensure that all parts of the surfaces and seams are cleaned. Tilt the mattress onto its side to wipe the underside of the mattress and allow to dry off. Leave the mattress on its side against a raised bed rail. If the mattress is too heavy, ask for assistance. Do not fold mattresses as this may damage and crack matress. Take care if mattresses have electrical cords or components to prevent accidental electrocution. Damp wipe pillows. Change cloth or cloth sides between different surfaces of the pillows. Move the bedrails into an upright position and wipe all surfaces of the rail.

Wipe over bed base, underside frame and bed head, with damp disposable cloth, rotating cloth as needed. Use extra cloths if required to make sure the cloth remains damp. Inspect bed ensuring all surfaces of the bed have been damp dusted correctly.

Damp wipe all below shoulder height ledges and horizontal surfaces with cleaning solution using the straight line or s-shaped motion depending on the surfaces size.

When cleaning dispensers, open and wipe inside of the paper towel dispenser with a clean cloth dampened with cleaning solution. Ensure attention to corners and crevices within the dispenser. Close dispenser and fully wipe all external surfaces with a damp cloth and cleaning solution. For soap dispensers: Remove hand soap pod, clean bracket internal and external surfaces with a dampened cloth and cleaning solution, check stock is in date and replace in dispenser.

Open and damp wipe all surfaces of the bedside locker, including shelves, handles, inside drawers and edges. Use different surfaces of the cloth. Change cloths for internal and external surfaces. Leave drawers slightly open to dry

Damp wipe all surfaces of the patient overbed table, including tabletop, underside, legs, and adjustment mechanisms using consistent pressure and straight line or s motion depending on the surfaces size).

Damp wipe all surfaces of the patient chair with selected cleaning solution using consistent pressure straight line or s motion depending on the surfaces size.

Commence rear surface of seat, back rest, seat, handles (top and under), including crevices, and then move to wipe over the chair legs. If the chair has a removable cushion this must be removed and all surfaces damp wiped with the selected cleaning solution.

Damp wipe all components of the hand basin starting with the splashback, taps and fittings, then moving to the basin and plug hole. Using a new damp cloth clean external and under surfaces of the sink and pipes working from high to low clean to dirty.

Place wet floor signs outside the room in the door way to show others that mopping is occurring in the room and the floor will be wet.  Move bed to a suitable location in the room to maximise mopping and move back once mopped. Damp mop the floor using your facilities selected method, working from the cleanest area toward the dirtiest. Use overlapping strokes to ensure full coverage.

All mops should be changed after cleaning the patient’s room and ensuite.

Where sodium hypochlorite or bleach solution is used as the cleaning solution, disposable microfibre should be used (unless the type of reusable microfibre is guaranteed by the manufacturer to be able to withstand bleach).

Now you are ready to clean the bathroom. Shower curtains will need to be managed as per local protocols. In the same way as you cleaned the patient room, clean from high to low, spot clean ceilings, vents, walls, mirror, dispensers and surfaces such as as light switches.

Damp wipe shower rails thoroughly, ensuring all sides are wiped over.

Damp wipe walls, taps and fittings within the shower.

Bathroom chemical disinfectants works best if given enough time to sit in the toilet bowl. This should be the first task completed so solution can sit in the toilet for at least 10 minutes prior to cleaning. Damp wipe all surfaces inside and out of the toilet. Commencing with the cistern top and flush button, move to the vertical surfaces of the cistern, top of seat cover, internal seat cover, top of seat, under surface of seat, top of toilet bowl rim, and under side of toilet bowl rim. Use all surfaces of the cloth and change when soiled. Use brush to agitate toilet cleaner and rinse off brush before replacing back in holder. Damp wipe all external surfaces of the toilet pedestal with bathroom cleaner and disposable cloth. Close lid and flush. Clean the toilet brush.

To finish, empty bins, wipe inside and outside of bin surfaces. Replace the bin liner. Mop floors using the same principles as within the patient room such as working from the cleanest area toward the dirtiest. Use overlapping strokes to ensure full coverage.

Thank you for watching the video on the correct technique for cleaning of the patient environment.

By following this advice, you are helping to maintain a safe and clean environment for patients, visitors, and staff.