Hospital Environmental Cleaning & Disinfection, Procedures & Practices

Environmental cleaning depends on Infection Control risk Assessment as High, Moderate & Low Risk Areas. This document includes Procedures & Practices in Hospital for Environmental Cleaning & Disinfection based on cheapest hospital grade disinfectant i.e Clorox / Household Bleach available for especially third world countries.

1. Hospital Environmental
Cleaning & Disinfection
Procedures & Practices

Environmental cleaning depends on Infection Control risk Assessment as High,
Moderate & Low Risk Areas
By
Dr Anjum Hashmi MBBS,CCS(USA), MPH
Infection Prevention & Control Director and Employees Health Director
East Najran Hospital Najran Saudi Arabia
2014
Reviewed By
Al Scoggins
CEO at Janus Solutions, LLC
Great Atlanta, USA.

2. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]

The contamination of the environment (surfaces in patient care areas and
mobile medical equipment) play a major role in the transmission of
potential pathogens.

TERMINOLOGIES & DEFINITIONS :
• Antisepsis: Chemical destruction of vegetative pathogens on living tissue.
• Degerming: Mechanical removal of microbes from limited area.
• Sanitization: Lowering microbial counts on eating and drinking utensils to safe levels.
• Sepsis: Bacterial contamination
• Asepsis: Absence of significant contamination
• Aseptic technique: To minimizes contamination.
• Cleaning: Physical removal of foreign material, e.g., dust, soil, organic material such as blood, secretions,
excretions and microorganisms. It is accomplished with water, detergents and mechanical action.
• Decontamination: The removal of disease-producing microorganisms to leave an item safe for further
handling
• Sterilization: Complete elimination or destruction of all forms of microbial life accomplished in healthcare
facilities by either physical or chemical processes.
• Disinfection: Cleaning some or all pathogenic organisms from an article of which may cause infection.
A perfect disinfectant should offer complete and full sterilization, without harming other forms of life,
inexpensive, and non-corrosive.
Unfortunately ideal disinfectants do not exist.
• High level disinfectants: Destroy vegetative bacteria, mycobacteria, fungi, enveloped (lipid) and
nonenveloped (non lipid) viruses and bacterial spores but not necessarily all bacterial spores.
• Intermediate level disinfectants: Kill vegetative bacteria, most viruses and most fungi but not the bacterial
spores.
• Low level disinfectants: Kill most vegetative bacteria and some fungi as well as enveloped (lipid) viruses
(e.g., hepatitis B, C, hantavirus, and HIV). Low level disinfectants do not kill mycobacteria or bacterial
spores. Low level disinfectants are typically used to clean environmental surfaces.

3. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]


SPAULDING CLASSIFICATION THREE DEVICE CATEGORIES FOR DISINFECTION AND
STERILIZATION:

• Critical Device enters sterile tissue or vasculature, therefore pose a high risk of infection if contaminated
with microorganisms: Require: Sterilization.
• Semi-critical Device comes in contact with mucous membranes or skin that is not intact, therefore pose a
moderate risk of infection if contaminated with microorganisms: Require: High Level Disinfection.
• Non-critical Device comes in contact with intact skin but not with mucous membranes, therefore, pose little
to no risk of infection if contaminated with microorganisms: Require: Disinfection.

MANAGEMENT OF BLOOD AND BODY FLUID SPILL:

TOOLS OF SPILLAGE KIT:-
1. Protective clothing, gloves, gowns, masks and goggle.
2. Tissue papers (Roll paper towels)
3. Forceps for removal of broken glass or other sharps.
4. Container of Sodium Hypochlorite (Clorox/Bleach) or Presept, Haz Tabs.
5. Biohazard disposal bag for infectious waste.
6. Measuring jar

CHLORINE-RELEASING AGENTS :

Fall into two groups:
1. Sodium dichloroisocyanurate (NaDCC), e.g. Presept, Haz Tabs
NaDCC is recommended for spillages. It is less resistant than hypochlorite to organic matter, less corrosive, and has
a longer shelf life, as it is manufactured as tablets or granules.
2. Sodium hypochlorites (NaOCl), e.g. Clorox / Household bleach.

4. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]



HOW TO CLEAN BLOOD AND BODY FLUIDS S PILL:

1 Place “Wet Floor” sign near the area of spill.
2. Wear protective clothing and gloves.
3. Put on goggles if splashing is likely.
4. Put on shoe cover to protect shoes if they are likely to become contaminated with the
blood spill.
5. If broken glass or any other sharp object is involved, use forceps to pick up and
throw into a sharp container before any cleaning or disinfecting is ever attempted.
6. Cover spill with paper towels, pure Clorox solution 1:10 dilution over spill starting
from periphery leave for 3-5 minutes. This will ensure ample Contact Time for
disinfection. Then wipe all the blood or body fluid from the surface.
7. Again pour or spray the disinfectant 1:10 dilution bleach solution on the area of spill and leave it for 3-5
minutes. This will ensure ample Contact Time for disinfection.
8. Wiped clean with paper towels.
9. Discard all contaminated paper towels into the infectious yellow bag.
10. Dispose all disposable PPE into yellow infectious waste bag.
11. Dispose yellow plastic bag into infectious waste container.
12. Wash hands with antiseptic detergent.
13. Replace and replenish supplies in the “Spill Kit”

CLEANING BLOOD AND BODY FLUID STAINS:
Wear gloves and others PPE as needed.
Clean the items with detergent and water.
Make Clorox solution (100ml of Clorox in 900ml water/5000 - 6000ppm available Chlorine) in spray bottle and do
heavy spray so that it can take 5 minutes to air dry than clean it.

5. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]

MANAGEMENT OF OTHER BODY FLUID SPILLS (VOMIT, URINE, FECES):
Wear disposable gloves and apron.
Use disposable paper towels, to mop up spillage.
Dispose of paper towels into clinical waste bag.
Wash area with detergent and water.
After washing one can disinfect area with Clorox solution (40-50 ml of Clorox in 1 Liter water 2500-2700ppm
available Chlorine).
Discard protective apparel into clinical waste bag.
Wash and dry hands thoroughly.

ENVIRONMENTAL DECONTAMINATION :

• Cleaning MUST precede decontamination
• Disinfectant is ineffective if any organic matter present.
• Use mechanical force
– Scrubbing
– Brushing
– Flush with water
• Wipe nonporous surfaces with sponge or wet cloth.
• Allow to dry.
CENTER FOR DISEASE CONTROL [CDC] RECOMMENDED DILUTIONS FOR DISINFECTION
(HOW TO MAKE CLOROX /BLEACH SOLUTION):
Clorox solution must always be freshly prepared and use within 4-8 hours.
1. 100 ml Clorox + 900 ml water = (1:10 dilution/5000-6000 parts per million (ppm) available Chlorine)
2. 40-50 ml Clorox + 1 Liter water = (2500-2700 ppm available Chlorine).
3. Clorox/bleach solution for sanitizing cooking and eating utensils 15 ml (1 Tablespoon) in 4 liter Water = 200 ppm
(must not exceed 200 parts per million available chlorine).
The bleach solution must be applied by spraying, soaking or scrubbing. Let air dry (contact time at least one minute
4. Clorox/bleach solution for sanitizing fruits and raw vegetables 7.5 ml (1 ½ teaspoon) in 4 liter of water = 100 ppm
(must not exceed 100 parts per million available chlorine). After washing dip them for 15 minutes than wash again
with filtered water.

6. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]

HOW TO MOP FLOOR


Use a mop or bucket system with a floor cleaner solution, beginning in the far corner of the area, under the bed and
then moving toward the bathroom and the door.
Mop the floor in 1-2 meter square sections.
Mop edges with straight strokes, and then continue working from side to side in a backwards direction, using a
figure-of-eight pattern on the remainder of the section, turning the mop frequently.
The floor should be fairly dry on completion.
HOW TO CLEAN AND DISINFECT BATHROOM
• Wash with water and detergent.
• Make Clorox/bleach sol (40-50 ml Clorox + 1 liter water)
• Disinfect all precleaned hard, nonporous bathroom surfaces.
• Start with the highest surface (like the mirror) and leave the toilet for last.
• Ensure that all surfaces, including the sink area, mirrors, grab bars and shower fixtures, are thoroughly
disinfected.
• Disinfect and clean toilet exterior, toilet seat surface, and outer of bowl.
• For inner bowel use 250ml pure bleach contact time 2 min.
• Ensure all surfaces stay wet.

7. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]


BATHROOM CLEANING PROTOCAL
It is usually best to start with the highest surface (often the mirror) and leave the toilet for last. Clean and disinfect
all hard, nonporous surfaces:
• Mirror, sink area, and grab bars, shower fixtures, toilet exterior, toilet seat surface and outer and inner bowl.



CLEAN AND DISINFECT ISOLATION ROOM

• Using a clean mop, mop the entire floor surface, working your way from the far corner back to the entrance.
• Visually inspect the room and ensure all surfaces have been cleaned and disinfected.
• Then disinfect any cleaning equipment (like mop handles) before returning to the cleaning cart.
• Remove PPE and put in a yellow trash bag prior to leaving the room.
• Wash your hands.
• Return with clean linens and make bed.

8. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]


Cleaning Levels for Different Clinic Areas
It depend on Infection Control risk assessment of that areas
Low-Risk Areas:
These areas are usually not contaminated with blood or body fluids or with associated infectious
microorganisms so the risk of infection is minimal.
Routine cleaning- the kind of cleaning you would do in your home – is usually good enough for these
areas.
Clean these areas with a mop dampened with detergent and water.
These functional areas included:
1) Administrative areas
2) Waiting rooms
3) Non-sterile supply areas
4) Medical records
5) Engineering workshop
6) Central store
7) Library
8) Conference and Meeting area
9) Staff Change facilities (Staff lounge)

9. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]

Intermediate (Moderate) Risk Areas:

These are areas used for the care of patients who are not obviously infectious and not highly susceptible.
These areas are cleaned by procedures that control dust, such as damp mopping with detergent cleaners.
Dry sweeping or vacuum cleaners are not recommended.
The use of detergent solution improves the quality of cleaning.

This functional areas includes:
1) Patient Wards
2) Out Patient Department
3) Physiotherapy
4) Pharmacy
5) Laboratories
6) Mortuary
7) Radiology
8) Accommodation (Housing)
9) Employee Health Clinic
10) Cardiology

High Risk Areas:

This functional areas includes:

1) CSSD (Central sterilization and supply department)
2) Emergency Department (ER)
3) Catering facilities (includes all kitchen and cafeteria)
4) Day surgery unit
5) Treatment room.
6) Maternity Ward
7) Pedia Surgery Ward

10. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]

Very High Risk Areas:
In these areas there is a greater potential pathogen contamination with infectious materials and more of a
concern about potential infection transmission to both patient and clinic staff.
These areas must be cleaned with care using a cleaning solution and separate cleaning equipment; disinfectant
detergent solutions are used as needed, according to hospital policy.

This functional areas includes:

1) Isolation Room
2) Intensive Care Unit (ICU/PICU)
3) Operating Room
4) Neonatal Care unit (NICU and Nursery)
5) Pharmacy IV Preparation room
6) Delivery Room
7) Immuno-compromised patients areas

11. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]

DECONTAMINATION OF ENVIRONMENT & EQUIPMENTS
NO ITEMS CLEANING PROCESS STAFF RESPONSIBLE
1 Airways/
ventilator tubes
Disposable or disinfect with 100ml of Clorox in 900ml
water solution dip for 10 minutes.
Nursing staff
2 Ambu bags Disposable or disinfect with 100ml of Clorox in 900ml
water solution dip for 5 minutes.
Nursing staff


3 Baby Baths

Clean bath after use with detergent and water. Disinfect
with 100ml of Clorox in 900ml water solution spray.
House-keeping personnel
4 Bed frames,
cradles etc.
Disinfect with 100ml of Clorox in 900ml water solution
spray.
Housekeeping personnel

7 Blood-pressure
cuff
Tourniquets
Clean with damp cloth soaked in detergent and water,
dry thoroughly. If contaminated with blood/body fluids
spray with 100ml of Clorox in 900ml water solution.
Nursing staff
8 Ceilings When visibly soiled, wash with detergent and water. Maintenance Department

9 Commodes/
urinal
Clean with detergent and water and disinfect with 250
ml of Clorox (pure) contact time 2 minutes.
House-keeping personnel
10 Curtains Should be laundered at least 6 monthly and when
visibly soiled. Some curtains may need to be laundered
more regularly (high risk area)
If unable to send to central laundry clean with detergent
and water.
Nursing staff &
Laundry Dept



11 Dressing
trolleys
Wash with detergent and hot water and dry before and
after use. If contaminated with blood/body fluids or
used for a patient with a transmissible infection refer to
policy / guidance. 70% alcohols wipes can be used to
disinfect trolley between uses if visibly clean/use 100ml
Clorox in 900ml of water solution spray.

Nursing staff

12. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]

12 Drip (IV) stands Start from top to down clean with water and detergent.
Rinse and dry thoroughly. If contaminated with
blood/body fluids or used for a patient with a
transmissible infection use Clorox solution 1:10 dilution
/100ml Clorox in 900ml of water solution spray contact
time 3 -5 min, wipe or let air dry.
Nursing staff






13 Examination
couch
Use Clorox solution 1:10 dilution /100ml Clorox in
900ml of water spray contact time 3 -5 min, wipe or let
air dry.
Nursing staff
14 Floors 1) Dry Cleaning –Dust-attracting mop. Sweeping
machine must not be used in clinical areas.
2) Wet Cleaning – wash with Clorox solution (2500-
2700ppm of chlorine/40-50ml Clorox in 1 L of water).
House-keeping personnel
15 Housekeeping
Equipment
Buffers (Floor
polishing
machine)
Pads


Buckets

Mops Heads


The outside of the machine should be washed with
detergent and water and dried after use.

Buffing pads should be washed with detergent and
water and drip-dried. Pads must not be left under the
machine between uses.
Clean with water and detergent after use. Disinfect with
100ml Clorox in 900ml water. Dry and store inverted.
Disinfect with 100ml Clorox in 900ml of water /Change
daily or send to laundry.
House- keeping
personnel
16 Incubators
(baby)
If disinfection required refer to manufacturer's
instructions. As some allow wash with water and
detergent only (better use Savalon) and other allow use
of Clorox solution 1:10 dilution/100ml Clorox in 900ml
of water solution.
Nursing staff

13. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]

Decontamination of Incubators After Patient Use
Incubators should be disinfected between each baby.
The incubator shall also be disinfected after every 7 days
of hospitalization (every 5 days for babies less than 1
kilogram).
After use all removable parts must, be washed and
thoroughly cleaned with detergent (better use
Savalon).Then soaked in 1: 10 Clorox (5000 ppm
available chlorine) for 5 minutes. Rinse
and dry thoroughly using paper roll.
Then clean incubator with water and detergent (better
use Savalon) wipes.
Disinfect incubator with 1: 10 Clorox /100ml Clorox in
900ml of water solution wipes and dried using paper
roll.
Wash outside of incubator, including drip stands
shelves, infusion pumps / syringes and dry thoroughly
with paper roll.
Dispose Clorox wipes and paper roll in the infectious
waste bag.
Aerate the incubator before re-use.
Humidification Chambers
Disassemble the humidifier.
Clean humidifier and reservoir with Clorox/Bleach 1: 10
dilutions /100ml Clorox in 900ml of water solution.
Thoroughly dry parts before reassembly.
Decontamination of Incubators in Use
All incubators that are occupied should be cleaned daily
from the inside and outside. Clean incubator with
detergent (better use Savalon) wipes and dries it with
paper towels.

14. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]

Always clean inside of incubator first.
Dispose wipes and paper roll in the infectious waste
bag.
Humidification Chambers
Humidification chambers not in use should be kept
clean and dry.
Humidification chambers in use should be checked at
the start of each shift and topped up with distilled sterile
water as necessary.
Humidification chamber in use should be weekly and
disinfected with Clorox/Bleach 1: 10 dilution /100ml
Clorox in 900ml of water solution.
17 Blood & Body
fluids suction
containers
Empty contents carefully down sluice or toilet. Wash
carefully in warm water and detergent avoiding
splashing and disinfect accordingly. Dip in 100ml of
Clorox in 900ml of water solution for 10 minutes.
Nursing staff
18 Laryngoscope
and blade
Handle: wash with detergent and hot water and dry
thoroughly. If contaminated with blood/body fluids or
used on an infectious patient, use 100ml Clorox in 900ml
of water solution spray/use disinfectant approved by
Infection Control Department
Blade: send to CSSD for reprocessing or dip in 100ml
Clorox in 900ml of water solution for 10 minutes.
Nursing staff
19 Lockers Clean with detergent and water. Disinfect with 100ml of
Clorox in 900ml water solution spray.
House-keeping personnel
20 Cot/Incubator
Mattresses , Bed
Mattresses and
pillows
Check regularly to ensure the cover is intact. If damaged
it must be discarded and changed. The mattress cover
should be washed with detergent and water on patient
discharge and disinfect with 100ml Clorox in 900ml of
water solution spray.

House-keeping personnel

15. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]

21 Medical
Equipment
Refer to manufacturer's instructions Nursing staff
22 Resuscitation
Trolley
Clean with detergent and water. Disinfect with 100ml
Clorox in 900ml of water spray.
Nursing staff
23 Scales
(weighing)
Clean with detergent and water & disinfect with 100ml
Clorox in 900ml of water solution heavy spray let it air
dry to met contact time of 3-5 minutes.
Nursing staff


24 Scissors Clean with detergent and water, if disinfection required
use a 70% alcohol swab following cleaning with
detergent and water or 100ml Clorox in 900ml of water
spray.
Nursing staff
25 Sinks/wash
hand basins
Clean with detergent and disinfect with (2500-2700 ppm
available chlorine /40-50ml Clorox in 1L water)
House-keeping personnel
26 Waste bin for
infectious waste
Wipe clean with 100ml of Clorox in 900ml of water
solution and let air dry.
Nursing staff
27 Soap dispenser The casing and the nozzle of the soap dispenser should
be cleaned daily with water and detergent. Wipe clean
with 100ml of Clorox in 900ml of water solution and let
air dry. Clean inner casing of dispenser when changing
the cartridge. Do not top up liquid soap.
House-keeping personnel
28 Sphygmomano
meter
Clean with detergent and water.

Nursing staff
29 Stethoscopes Wipe with 70% alcohol wipes between each patient. Nursing staff
30 Suction bottles If not disposable these should be emptied carefully and
disinfect with 100ml Clorox in 900ml of water solution
by dipping for 10 minutes.
Nursing staff
31 Telephones Damp dust with detergent and water or 100ml Clorox in
900ml of water spray.
Nursing staff
32 Thermometers
Electronic
Disinfect screen with alcohol. Disinfect with 100ml
Clorox in 900ml water wipe, if allowed by manufacturer.

Nursing staff

16. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]

33 Toilets/Bidets Use detergent and water and disinfect with Clorox and
water (2500-2700 ppm chlorine concentration/40-50ml
Clorox in 1L water)

House- keeping
personnel
35 Walls All surfaces should be cleaned with Clorox and water
(2500-2700 ppm of Chlorine/40-50ml in One Liter
water).

House-keeping personnel
37 Ventilators Wipe the surfaces of the ventilator clean, working from
the top to the bottom. For greasy or stubborn soiling, use
the non-abrasive pad. Wipe the screen with alcohol.
Body can be wiped with alcohol or Clorox 1:10 dilutions.
Allow to dry. Only detergent and water can be used if
advised by manufacturer.

Nursing staff
38 Baths (shower
cubicles)
Clean bath after use with detergent and water. Housekeeping personnel
39 Bedpans Empty contents carefully down sluice or toilet and
disinfect and rinse with 100ml of Clorox in 900ml water
solution.
Housekeeping personnel
40 Bowls (patient) Clean with detergent and water. Rinse and dry
thoroughly. Disinfect with 100ml of Clorox in 900ml of
water solution and let air dry. Store inverted.
Housekeeping personnel
41 Wheelchairs Clean with detergent and water. Disinfect with 100ml of
Clorox in 900ml of water solution and let air dry.
Housekeeping personnel
42 Toys-Hard
(Soft toys not
suitable for
hospital use)
Toys must be cleaned if visibly soiled, weekly and on
patient discharge. Disinfect with 1:100 dilution of a
hypochlorite solution (10ml in 1 L water/500–600 ppm
free chlorine). If visibly soiled with blood/body fluids.
Dispose if grossly contaminated.

Housekeeping personnel

17. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]

43 Dialysis Unit
noncritical
surfaces (e.g.,
dialysis bed,
external
surfaces of
dialysis unit )
Wipe the unit screen with alcohol. Disinfect with 1:10
dilution of a hypochlorite solution (100 ml in 1 L water /
5000 ppm free chlorine) after every dialysis event /Use
EPA approved disinfectant.
Ref: Guideline for the Prevention and Control of Infections in Dialysis Settings
Version 3 – May 2013; Centre for Healthcare Related Infection Surveillance and
Prevention & Tuberculosis Control, Queensland Australia

Nursing staff
44 Cardiac
Monitor

Wipe the screen with alcohol. Body can be wiped with
alcohol or Clorox 1:10 dilutions. Allow to dry. Only
detergent and water can be used if advised by
manufacturer.
Nursing staff
45 Diagnostic
Imaging
Portable -
Machine
Portable -
portable grid/
film cassette
Mammography
- paddles
Disinfect with 100ml Clorox in 900ml water damp wipe.

When soiled and on leaving Contact precaution room
Ideally should be covered (e.g., pillowcase )between
patients if not covered


Between patients


X ray technician
46 ECG Machine
and Cables
Damp wipe with 100ml Clorox in 900ml water solution. ECG technician
47 Glucometer Damp wipe with 100ml Clorox in 900ml water solution. Nursing staff
48 Ophthalmo-
scope
Damp wipe with 100ml Clorox in 900ml water solution. Nursing staff
49 Otoscope
Handle
Ear speculum

Damp wipe with 100ml Clorox in 900ml water solution.
Damp wipe with 100ml Clorox in 900ml water solution.

Nursing staff
50 Reflex Hammer Damp wipe with 100ml Clorox in 900ml water solution. Nursing staff
51 Defibrillator Damp wipe with 100ml Clorox in 900ml water solution . Nursing staff

18. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]

52 Stretcher

Wash with soap and water and disinfect spray of 100ml
Clorox in 900ml water solution and let air dry.
Housekeeping staff
53 Suction
Machines

Damp wipe with 100ml Clorox in 900ml water solution Nursing staff
54 Stethoscope

Alcohol swab/100ml Clorox in 900ml water damp wipe Doctor/Nursing staff
55 Telemetry
Equipment
Monitor and
Cables
Damp wipe with 100ml Clorox in 900ml water solution. Nursing staff


56 Tourniquet Alcohol swab/100ml Clorox in 900ml water damp wipe Nursing staff
57 Ultrasound
Transducers
Handle and
Cable
External
Alcohol swab Ultrasound technician
58 Wall-mounted
Oxygen and
Suction Fixtures
Damp wipe with 100ml Clorox in 900ml water solution Nursing staff
59 Intravenous
(IV)
Pumps, Poles,
Warmers
Damp wipe with 100ml Clorox in 900ml water solution Nursing staff


Personal Protective Equipment (PPE) Advised in Environmental Cleaning:
1. Gloves.
2. Face Mask
3. Gown if splashes of disinfectant expected.

19. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]

MINIMUM CLEANING & DISINFECTION FREQUENCIES IN HOSPITAL
No. Element Very High Risk High Risk Moderate Risk Low Risk
1 Weighing scales, manual handling
equipment
Clean contact points
each use, 1 full clean
daily & between patient
use
Clean contact points
each use, 1 full clean
daily & between patient
use
Clean contact
points each use, 1
full clean
daily & between
patient use
NA
2 Medical equipment including
intravenous infusion pumps, drip
stands and pulse oximeters (not
connected to a patient)
1 full clean daily and
between patient use

1 full clean daily and
between patient use

1 full clean
daily and
between
patient use
NA
3 Patient washbowls 1 full clean daily and
between patient use
1 full clean daily and
between patient use

1 full clean
daily and
between
patient use
NA



4 Bedside oxygen and suction
Connectors.
1 full clean daily and
between patient use

1 full clean daily and
between patient use

1 full clean
daily and b/w
patient use
NA
5 Oxygen Cylinders 1 full clean daily 1 full clean 1 full clean
daily
NA
6 Alcohol hand gel / soap
container / dispenser /
bracket / clipboard
1 full clean daily and
between patient use if
contaminated

1 full clean daily and
between patient use if
contaminated
1 full clean daily
and between
patient use
NA

7 Chart trolley / Drug trolley 1 full clean weekly

1 full clean weekly 1 full clean weekly NA
8 Patient personal items

1 full clean daily

1 full clean daily

1 full clean
daily
NA

9 Switches, sockets and data
points
1 full clean daily 1 full clean daily 1 full clean
daily
1 full clean
weekly

20. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]

10 Walls Check clean daily, wash
twice yearly
Check clean daily, wash
twice yearly
Check clean
weekly, wash
yearly
Check clean
weekly, wash,
every third yearly
11 Ceiling Wash yearly Wash yearly Wash yearly Wash every third
yearly
12 All doors 1 full clean daily and 1
check clean
1 full clean daily and 1
check clean
1 full clean daily
and 1 check clean
1 full clean
weekly
13 All internal glass 1 full clean daily Check clean daily
1 full clean weekly
Check clean daily 1
full clean weekly
1 full clean
weekly
14 All external glass 1 full clean yearly 1 full clean yearly 1 full clean every
second year
1 full clean every
3
rd
yr
15 Mirrors 1 full clean daily and
1 check clean
1 full clean daily and
1 check clean
1 full clean daily
1 check clean
Full clean daily

16 Television 1 full clean daily 1 full clean daily 1 full clean daily 1 full clean
weekly
17 Ventilation grilles, extracts
and inlets
1 full external clean
weekly and full clean
twice yearly
1 full external clean
weekly and full clean
twice yearly
1 full external clean
monthly and full
clean yearly
1 full external
clean monthly &
full clean yearly
18 Floor - polished 2 full cleans daily 1 full cleans daily,1 clean
check daily
1 full cleans daily, 1
clean check daily
1 clean check
daily
1 full cleans
weekly
19



Floor - Non-slip 2 full cleans daily, 1 full cleans daily, 1 clean
check daily.
1 full cleans daily, 1
clean check daily
1 full cleans
weekly, 1 clean
check daily
20 Soft Floor (Carpet not
recommended in clinical area)

NA NA NA 1 check clean
daily, 1 full clean
weekly, wash
yearly

21. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]

21 Pest control devices

1 full clean daily 1 full clean daily 1 full clean daily 1full clean
weekly

22

Electrical items, e.g. overhead
lights

1 check clean daily and 1
full clean monthly
1 check clean daily and 1
full clean monthly

1 check clean daily
and 1 full clean
monthly
1 check clean
weekly & 1 full
clean monthly
23 Cleaning equipment Full clean after each use

Full clean after each use

Full clean after each
use
Full clean after
each use
24 High surfaces 2 full cleans weekly

1 full clean weekly and 1
check clean weekly
1 full clean weekly

1 full clean
weekly
25 Low surfaces 2 full cleans daily 1 full clean daily and 1
check clean daily
1 full clean daily

1 full clean
weekly
26
Chairs (Note: no soft fabric
covered chairs in clinical areas)
1 full clean daily and 1
check clean daily
1 full clean daily and 1
check clean daily
1 full clean daily 1 full clean
weekly
27 Beds / Patient couches /
Trolleys / Mattresses
Bed frame, including all
component parts daily,
mattress weekly and on
discharge, total full clean
on discharge
Bed frame, including all
component parts daily,
mattress weekly and on
discharge, total full clean
on discharge
Bed frame, with
all component
parts daily,
mattress weekly
and on discharge
NA




28 Lockers / Wardrobes /Drawers

1 full clean daily and 1
check clean daily
1 full clean daily

1 check clean daily
1 full clean weekly
1 full clean
weekly
29 Tables / Bed tables 1 full clean daily and 1
check clean daily
1 full clean daily

1 check clean daily
and 1 full clean
weekly
1 full clean
weekly

30 All dispensers / holders 1 full clean daily 1 full clean daily 1 full clean
daily
1 full clean
daily
31
Waste receptacles / Sani-bins /
Nappy bins
1 full clean daily and1
check clean daily and 1
deep clean weekly

1 full clean daily and1
check clean daily and 1
deep clean weekly

1 full clean daily
and 1 deep clean
week
1 full clean
weekly & 1 deep
clean monthly

22. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]

32 Curtains (window and cubicle) and
Blinds
Clean, change or replace
yearly. Bed curtains
quarterly

Clean, change or
Replace yearly. Bed
curtains twice a year
Clean, change or
replace all
curtains yearly
Clean, change or
replace two
yearly
33 Fridge / Freezer 3 check cleans daily and 1
full clean weekly
3 check cleans daily
and 1 full clean weekly
3 check cleans daily
and 1 full clean
weekly
1 check clean
daily and 1 full
clean weekly
34
Drinking water fountain / water
cooler

1 full clean daily and 1
check clean daily

1 full clean daily and 1
check clean daily

1 full clean daily
and 1 check clean
daily

1 full clean
daily and 1
check clean
daily

35 Baths 1 full clean and 1 check
clean daily
1 full clean and 1 check
clean daily
1 full clean daily
1 check clean daily
1 full clean daily
1 check clean
daily
36 Showers 1 full clean and 1 check
clean daily
1 full clean and 1 check
clean daily
1 full clean daily
1 check clean daily
1 full clean daily
1 check clean
daily
37 Wash Hand Basins 3 full clean, 2 check cleans 3 full clean, 2 check cleans 3 full clean, 2 check
cleans
3 full clean, 2
check cleans
38 Toilets / Urinals / Bidets 3 full clean, 2 check cleans 3 full clean, 2 check cleans 3 full clean, 2 check
cleans
3 full clean, 2
check cleans
39 Computers / Telephones /
Office Equipment
1 full clean daily

1 full clean daily

1 full clean daily 1 full clean
weekly
40 Dirty Utility room 1 full clean and 1 check
clean daily
1 full clean and 1 check
clean daily
1 full clean daily

1 full clean daily

41 Cleaning Store /Janitor room Full clean after each use Full clean after each use

Full clean after each
use
Full clean after
each use
42 Entrance / Exit 2 full cleans daily

2 full cleans daily

2 full cleans daily 1 full clean daily

23. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]

43 Stairs (internal and external) 2 full cleans daily

2 full cleans daily

2 full cleans daily 1 full cleans daily

44 External areas 1 full clean daily 1 full clean daily 1 full clean daily 1 full clean daily
45 Dishwasher / microwave 1 full clean daily and 2
check cleans daily, and
emptied after use
1 full clean daily and 2
check cleans daily, and
emptied after use
1 full clean daily
and emptied
after use
1 full clean
daily, emptied
after use
46 Kitchen Cupboards /
Presses
1 full clean weekly 1 full clean weekly 1 full clean
monthly
1 full clean 4
monthly
47 Cleaning equipment (Catering) Full clean after each use Full clean after each use Full clean after
each use
Full clean after
each use
48 Diagnostic Imaging
Portable - Machine
Portable - portable grid/
film cassette
Mammography - paddles
When soiled and on
leaving
Contact precaution room
Ideally should be covered
(e.g., pillowcase )between
patients if not covered
Between patients
When soiled Ideally
should be covered (e.g.,
pillowcase) between
patients if not covered.
Between patients
When soiled
Ideally should be
covered (e.g.,
pillowcase) b/w
patients if not
covered.
Between patients
NA
49 ECG Machine
Cables
Daily
Between patients
Daily
Between patients
Daily
Between patients
NA
50 Glucometer Between patients Between patients Between patients NA
51 Ophthalmo- scope Between patients Between patients Between patients NA
52 Otoscope: Handle and
Ear speculum
Between patients

Between patients Between patients NA
53 Reflex Hammer Between patients Between patients Between patients NA
54 Defibrillator Between patients Between patients Between patients NA
56 Stretcher Between patients Between patients Between patients NA
57 Suction Machines Between patients Between patients Daily NA
58 Stethoscope Between patients Between patients Between patients NA
59 Telemetry Equipment
Monitor and Cables
Between patients

Between patients Between patients NA

24. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]

60 Tourniquet Between patients Between patients Between patients NA
51 Ultrasound Transducers
Handle and Cable
External
Between patients

Between patients Between patients NA
62 Wall-mounted Oxygen and
Suction Fixtures
Between patients

Between patients Between patients NA
63 Intravenous (IV)
Pumps, Poles, Warmers
Between patients

Between patients Between patients NA
64 Call Bell

Daily /between patients Daily /between patients Daily /between
patients
Daily

25. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]

26. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]

ENVIRONMENTA L CLEANING OF THE OPERATION THEATER
S.NO FREQUENCY TASKS
1 At the
beginning
of the day
Clean floors and all horizontal surfaces operating / procedure tables, examination couches, chairs,
trolley tops or Mayo stands, anesthesia machine, lamps, counters, and office furniture – with a cloth
dampened with water to remove dust and lint that have accumulated over night.
2 Between
patients
Clean operating/procedure tables, examination couches, trolley tops or Mayo stands, lamps, counters,
anesthesia machine and any other potentially contaminated surfaces in operating theatres and
procedure rooms with a cloth dampened with a Clorox/ Bleach solution (100ml Bleach in 900ml water).
• Immediately clean spills of blood or other body fluids with a Clorox / Bleach solution (100ml Bleach in
900ml water).
• Clean visibly soiled areas of the floor, walls, or ceiling with a mop or cloth dampened with Clorox /
Bleach solution (40-50 ml Bleach in One liter water).
• Discard waste when plastic bags of waste containers are ¾ full.
• Discard safety (sharps disposal) boxes, when they are ¾ full.
• Do not perform special cleaning or closing of the operating theatres after contaminated or dirty
operations. Thorough, routine cleaning is sufficient to provide a safe environment for subsequent cases
3 At the end
of each
session or
day
• Clean all surfaces – including counters, tables, lights, door handles– with detergent, water and
disinfect with Clorox / Bleach solution (100ml Bleach in 900ml water) allow it to dry. Pay particular
attention to Anesthesia machine operating/procedure tables, making sure to clean the sides, base,
and legs thoroughly.
• Clean sinks & sluice with water and detergent finally disinfect (40-50 ml Bleach in One liter water).
• Wipe over non-metallic surfaces and equipment with Clorox solution (100ml Bleach in 900ml water).
• Clean the floors with a mop soaked in a disinfectant solution (40-50 ml Bleach in One liter water).
• Check safety boxes and remove and replace them if they are ¾ full.
• Remove medical or hazardous chemical waste. Make sure to discard it properly and as soon as
possible in order to limit contact with potentially infectious waste.
• Clean non-clinical equipment, and containers with Clorox/Bleach solution (100 ml Bleach in 900ml
water).
4 Each
week
• Clean all the areas inside the operating theatre complex with warm water, detergent & Clorox/Bleach
solution (40-50 ml Bleach in One liter water). Allow it air dry.
• Empty the storage shelves, wipe them, dry them, and then restack.

27. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]

INFECTION CONTROL PROCEDURES FOR IMAGING CENTERS AND HOSPITAL RADIOLOGY DEPARTMENTS
The cleanliness of imaging centers and hospital radiology departments is crucial for reducing the spread of MRSA and other
acquired infections. The following are 11 simple procedures to implement that can prevent the spread of these infections.
1. Have a written infectious control policy to include MRI cleaning procedures as well as the cleaning schedule and have it
posted throughout the center.
2. Implement a mandatory hand washing / hand sanitizing procedure between patient exams for technologists and any others
who come into contact with patients.
3. Clean the MRI tables, inside the bore of the magnet and any other items that come into contact with a patient. Infection control
experts recommend this be done between each patient.
4. Clean all pads and positioners with an approved disinfectant. Infection control experts recommend cleaning after each patient.
5. Periodically inspect the pads with a magnifying glass, particularly at the seams, to identify fraying or tearing. If present, the
pads should be replaced.
6. Regularly check all padding material with an ultraviolet (black) light and make sure that any biological material detected on
the pads can be removed.
7. Replace damaged or contaminated pads with new pads incorporating permanent antimicrobial agents.
8. Use pillows with a waterproof covering that is designed to be surface wiped. Replace pillows when their barrier is
compromised.
9. Promptly remove body fluids, and then surface disinfect all contaminated areas.
10. If a patient has an open wound or any history of MRSA/other infection:
a. Gloves and gowns should be worn by all staff coming in contact with the patient. These barriers must be removed before
touching other areas not coming in contact with the patient, i.e. door knobs, scanner console, computer terminals, etc.
b. The table and all the pads should be completely cleaned with disinfectant before the next patient is scanned, if it is not already
being performed between every patient. For patients with any known infectious process add 10-15 minutes onto the scheduled
scan time to assure there is enough time to thoroughly clean the room and all the pads.
11. All furniture should be periodically cleaned. Ideal surfaces are those that are waterproof and wipe-able. Infection control
experts recommend this be done between each patient.
Disinfectant Used: Bleach solution 1:10 dilution (100ml bleach in 900ml water) wipes can be use or EPA approved use
disinfectant allowed by infection control dept

28. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]

MATERIAL SAFETY DATA SHEET OF CLOROX / BLEACH:
Description: Clear, thin liquid with a mild bleach odor
Health Hazard Data
Causes moderate eye irritation. Avoid contact with eyes or clothing. Wash thoroughly with soap and water after handling. No
medical conditions are known to be aggravated by exposure to this product.
FIRST AID:
EYE CONTACT: Rinse slowly and gently with water for 15-20 minutes. Remove contact lenses, if present, after the first 5
minutes, and then continue rinsing. If irritation persists, call a doctor.
SKIN CONTACT: Rinse with plenty of water. If irritation persists, call a doctor.
INHALATION: Remove to fresh air. If breathing problems develop, call a doctor.
INGESTION: Drink a glassful of water. Call a doctor.
REFERENCES:
1. Peninsula Community Health, Cleaning Policy & Manual, 2012.
2. Environmental hygiene Vol. 16, No. 9 September 2012, available at www.infectioncontroltoday.com.
3. PIDAC: Best Practices for Environmental Cleaning for Infection Prevention and Control, May 2012
4. Clorox service bulletin, 2011.
5. Birmingham Women’s Hospital (2009) Neonatal Unit Policy for Cleaning and Disinfection on Incubators/Cots.
6. Liverpool Women's Hospital NHS Foundation (2009) Infection Control Policy.
7. Carling PC, Parry MM, Rupp ME, Po JL, Dick B and Von Beheren S. Improving Cleaning of the Environment Surrounding
Patients in 36 Acute Care Hospitals. Infect Control Hosp Epidem. Vol. 29, No.11. November 2008.
8. Feidhmeannacht na seirbhise Slainte, Health Service Executive, National Cleaning Manual Appendices, September 2006.
9. Centers for Disease Control and Prevention (CDC). Guidelines for Environmental Infection Control in Health‐Care Facilities.
Recommendation of CDC and the Healthcare Infection Control Advisory Committee (HICPAC), 2003.
10. Article 3-2.6 of NAVMED P-5010 Manual of Preventive Medicine USA.
11. Preventing Infection in MRI -Best Practices: Infection Control in and around MRI Suites. Peter Rothschild, MD 2008.
12. Operating Theatre, faculty. ksu.edu.sa.

29. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]

30. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]

31. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]

32. Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:[email protected]