Best Practices for Environmental Cleaning MODULE 3 Cleaning

Best Practices for Environmental Cleaning MODULE 3 –Cleaning Products and Tools

Learning Objectives 1. Define and describe cleaning and disinfection 2. Explain the difference between detergents and disinfectants and indicate their appropriate use. 3. Describe the importance of proper chemical dilutions. 4. Explain the need for dedicated equipment/space and care of equipment. 5. Have an increased awareness of new technologies. 2

Glossary of terms • 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. • Detergent – A synthetic cleaning agent that can emulsify oil and suspended soil. • Disinfection – The inactivation of disease-producing microorganisms. Disinfection does not destroy bacterial spores. Equipment must be cleaned thoroughly before effective disinfection can take place. 3

Glossary of terms • Disinfectant – A product that is used on surfaces or medical equipment/devices which results in disinfection of the surface. Some products combine a detergent with a disinfectant. • Hospital-grade disinfectant – A low-level disinfectant that has a drug identification number (DIN) from Health Canada indicating its approval for use in Canadian hospitals 4

Glossary of terms • Hotel Clean: A measure of cleanliness based on visual appearance that includes dust and dirt removal, waste disposal and cleaning of windows and surfaces. Hotel Clean is the basic level of cleaning that takes place in all areas of a health care setting. • Hospital Clean: A measure of cleanliness routinely maintained in client care areas of the health care setting. Hospital Clean is “Hotel Clean” with the addition of disinfection, increased frequency of cleaning, auditing and other infection control measures in client care areas. 5

Cleaning and Disinfectant Agents • Hospital Grade Disinfectants • Alcohols (60 -90% ethyl or isopropyl) • Chlorine - sodium (bleach) and calcium hypochlorite • Phenolics • Quaternary Ammonium Compounds (Quats) • Iodophors • Accelerated Hydrogen Peroxide (AHP) 6

Hospital-grade Disinfectants and Sporicides Process Option Uses/Comments Quaternary ammonium compounds (QUATs) - Floors, walls and furnishings - Blood spills prior to disinfection Advantages Disadvantages -Non corrosive -Non-toxic, low irritant - Good cleaning ability, usually have detergent properties - May be used on food surfaces -Not to be used to disinfect instruments - Limited use as disinfectant because of narrow microbicidal spectrum - Diluted solutions may support the growth of microorganisms - May be neutralized by various materials (e. g. , gauze) 7

Hospital-grade Disinfectants and Sporicides Process Option Uses/Comments Advantages Disadvantages Accelerated Hydrogen Peroxide 0. 5% (7% solution diluted 1: 16) - Isolation room Surfaces - Clinic and procedure room surfaces Low level disinfection is achieved after 5 minutes of contact at 20°C. - Safe for environment - Non-toxic - Rapid action - Available in a wipe - Active in organic materials - Excellent cleaning due to detergent properties - Contraindicated for use on copper, brass, carbontipped devices and some aluminum Accelerated Hydrogen Peroxide 4. 5% - Disinfection of washrooms/commodes C. difficile patients Following cleaning, sterility is achieved with a 4. 5% solution after 10 minutes of contact. - Sporicidal - Available in a gel format - Safe for environment - Non-toxic - Expensive - Contraindicated on surfaces as above -Do not use on monitors Hydrogen peroxide 3% - home health care equip - Floors, walls, furnishings Disinfection after 30 minutes of contact - Rapid action - Safe for the environment - Non-toxic - Contraindicated for use on copper, zinc, brass, aluminum - Store in cool place, protect from light 8

Hospital-grade Disinfectants and Sporicides Process Option Uses/Comments Advantages Disadvantages Chlorines -Non-critical equipment -Hydrotherapy tanks - Blood spills Low cost Rapid acting Readily available Sporicidal - Corrosive - Irritant to mucous membranes - Use immediately after diluted - Need good ventilation Dilution Undilute 5. 25% Blood spill -1: 10 (major) or 1: 100 (minor) Surface cleaning 1: 50 9

Hospital-grade Disinfectants and Sporicides Process Option Uses/Comments Advantages Disadvantages Alcohols (7095%) - External equipment surfaces (e. g. , stethoscopes) - Noncritical equipment used for home health care - Disinfection is after 10 minutes contact. - Fire code restrictions for storage - Evaporates quickly not a good surface disinfectant - Evaporation may diminish concentration - Flammable storage of large volumes problematic -Coagulates protein; a poor cleaner -May harm or deteriorate some materials and surfaces - Inactivated by organic material - Contraindicated in the O. R. - Non-toxic - Low cost - Rapid action - Non-staining - No residue - Effective on clean equipment/devices that can be immersed 10

Hospital-grade Disinfectants and Sporicides Process Option Uses/Comments Advantages Disadvantages Iodophors (Non-antiseptic formulations) Hydrotherapy tanks Thermometers Hard surfaces • Rapid action Non-toxic Corrosive to metal unless combined with inhibitors Inactivated by organic Phenolics - Floors, walls and furnishings - Hard surfaces and equipment that do not touch mucous membranes (e. g. , IV poles, wheelchairs, beds, call bells) - Leaves residual film on environmental surfaces - Commercially available with added detergents to provide one-step cleaning and disinfecting - Slightly broader spectrum of activity than QUATs - Cannot use is some settings (nurseries, food contact surfaces) -May be absorbed through skin - May be toxic if inhaled - Corrosive -Some synthetic flooring may become sticky DO NOT use phenolics in nurseries 11

Importance of chemical dilutions For effective cleaning and disinfecting ensure that: • Manufacturer’s instructions for dilution and contact time are followed • Disinfectant solution is frequently changed to reduce contamination and maintain the proper dilution • Cloths do not re-enter the disinfectant solution once removed (i. e. no “double dipping”) 12

Learning Checkpoint 13

Learning Checkpoint What are the key components of cleaning and disinfection? a) mechanical action / friction b) contact time / dwell time c) proper chemical dilution d) all of the above 14

Learning Checkpoint Answer • The answer is all of the above Chemical Contact / Dwell time Action / Friction 15

Storage and cleaning of housekeeping equipment • Cleaning equipment requires attention to avoid cross -transmission of microorganisms and growth of microorganisms in dirty environments • Tools and equipment used for cleaning and disinfecting must be cleaned and dried between uses (e. g. buckets, mop handles, squirt bottles, wet floor signs) • Mop heads and cloths should be laundered daily and dried thoroughly before storage 16

Storage and cleaning of housekeeping equipment • Cleaning equipment shall be well maintained, clean and in good repair • Cleaning carts: Should have a separation between clean and soiled items; Should never contain personal clothing or grooming supplies, food or beverages; Should be thoroughly cleaned at the end of the day; In long-term care homes, cleaning carts shall be equipped with a locked compartment for storage of hazardous substances and each cart shall be locked at all times when not attended. 17

Storage and cleaning of housekeeping equipment • All cleaning products should be appropriately labeled and stored safely • Chemicals must be clearly labeled with Workplace Hazardous Materials Information System (WHMIS) information and MSDS must be readily available for each item • Housekeeping Rooms/Closets should never contain personal clothing or grooming supplies, food or beverages 18

New Technologies Microfibres: • • • Densely constructed polyester and nylon fibres Positively charged microfibres attract dust and bacteria and hold it tightly so that it is not redistributed around the room during cleaning Available as cloths, floor mops and high dusters 19

New Technologies Air Disinfection/Fogging: • Not currently in general use in Canada • Vapourized Hydrogen Peroxide (VHP) – vapour is delivered by computer-controlled distribution system that ensures even distribution throughout the room • Ozone Gas – should only be used in areas that may be completely sealed off for the duration of treatment • Super-oxidized Water – use as a disinfectant fog shows promise but requires more study before applying it to the health care environment 20

New Technologies Steam Vapour • Portable steam generators may be used to clean kitchens, bathrooms, floors, walls and other surfaces using steam delivered with a nozzle brush • Steam vapour effectively travels through biofilm to kill microorganisms that may be unreachable by the surface application of disinfectants 21

New Technologies Anti-microbial impregnated Supplies and Equipment: • Treated surfaces and equipment have not been well studied and little data exists to show these antimicrobial chemicals will endure after exposure to hospital-grade cleaners and disinfectants or whether they will prevent disease • These products are not recommended 22

Learning Checkpoint 23

Learning Checkpoint 1. Things that belong in a housekeeping closet are: (check all that apply) a) Properly labelled cleaning products b) A cup of coffee and bottle of water c) Cleaning tools d) Personal clothing 24

Learning checkpoint answer 1. Correct answer is: a and c The PIDAC best practice document and the Occupational Health and Safety Act state that personal clothing, beverages and food should not be on a housekeeping cart. This is to protect the housekeeper and other staff/clients/residents/patients from transfer of microorganisms. 25

Learning checkpoint 2. How often should the housekeeping cart be cleaned? a) Weekly b) Daily c) Does not need routine cleaning 26

Learning checkpoint answer 2. Correct answer is b The PIDAC best practice document recommends that housekeeping carts are cleaned daily to reduce the risk of contamination with microorganisms. 27

When you return to your job, what will you do differently as a result of this session? 28

Thank You! 29