office of epidemiology and prevention services division of infectious disease epidemiology ...

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Environmental Cleaning

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Objectives

• Understand types of cleaners most commonly used in long term care facilities

• Understand how to write a policy and procedure for environmental cleaning in a patient room

• Understand how to monitor environmental cleaning

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Environmental Cleaning and Its Relevance to Infection Prevention & Control

• Primary focus must remain on protection of client/resident, staff and visitors

• Practices must help minimize spread of infection• Practices are understandable and attainable• Practices must incorporate workflow measurement• Practices must be reviewed regularly to keep them

current

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

How Long Can Germs Live???

• Entercocci and staphylococci on hospital fabrics and plastics up to 90 days

• MRSA outbreak strains-up to 9 weeks after drying• Gram-negative bacteria (pseudomonas aeruginosa,

salmonella, E.coli etc)-on hospital fabrics and plastics up to 60 days

• VRE-58 days on countertops• Influenza-48 hours on nonporous surfaces

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Principles of Effective Cleaning

• Apply to all settings where care is delivered– Process – Selection of appropriate product for the task– Frequency

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Environmental Cleaning PrinciplesHighest point and work towards the lowest

From the outside to the inside

From the cleanest to the dirtiest

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Environmental Cleaning Principles

• Cleaning in a determined pattern will ensure that all surfaces are being cleaned

• You will know where you left off if you are interrupted during cleaning

CLEAN IN AN ESTABLISHED PATTERN

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Choosing a Disinfectant

• Type of microorganism, number and presence of spores• Physical situation (e.g., surface type)• Contact available between disinfectant and microorganisms• Possible interaction between disinfectant and materials• Contact time allowable• Concentration• EPA registered

Microorganisms present a range of resistances to chemical disinfectants and no single disinfectant is effective in all situations.

Consider the following points when selecting a disinfectant:

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Choosing a Disinfectant

• “Hospital disinfectant” effectiveness– Pseudomonas aeruginosa– Staphylococcus aureus– Salmonella choleraesuis

• “Tuberculocidal” indicator of effectiveness– Broad spectrum

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Types of Disinfectants

• Chlorine compounds– Generally used in the form of sodium hypochlorite

• Alcohols– Ethanol (80% v/v ethyl alcohol) or 2-propanol (60-70% v/v

isopropyl alcohol) solutions are used to disinfect skin and decontaminate clean surfaces

• Hydrogen Peroxide– A concentration of 3% (weight/volume) generally used for

disinfection

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Types of Disinfectants

• Phenolics– Synthetic phenolics (clear soluble fluids) can be used as

general disinfectants in the laboratory

• Quaternary Ammonium Compounds– Quaternary ammonium compounds are positively charged

surface active disinfectants

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Advantages and Disadvantages of Common Disinfectants

Disinfectant Advantages Disadvantages

Sodium hypochlorite(household bleach)

InexpensiveFast-actingWidely availableActive against bacteria, spores, Mtb, viruses

Odor can be irritatingCorrosive to metalsInactivated by organic materialMay discolor fabrics

Ethyl or isopropyl alcohol (70-90%)

InexpensiveWidely availableRapidly effectiveActive against bacteria, Mtb, viruses

Not effective against bacterial sporesNot for large surfaces

Rutala WA et al. CDC Guideline for Disinfection & Sterilization In Healthcare Facilities, 2008

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Advantages and Disadvantages of Common Disinfectants

Disinfectant Advantages Disadvantages

Quaternary ammonium compounds

Not too expensiveWidely availableGood cleaning agents

Not effective against bacterial spores, Mtb, non-enveloped virusesMay become contaminated

Phenolics Widely available Use on bassinets may be toxic to infantsPoor activity against bacterial spores and non-enveloped viruses

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Using Disinfectants Wisely

• Item or surface must first be free of visible soil (unless using a combined cleaner/disinfectant)

• Use according to the manufacturer instructions:– Dilution, temperature, contact time, etc.

• No double dipping• No spraying disinfectants• Use proper PPE to prevent exposure to chemical as

on MSDS

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Frequency of Cleaning

High/low touch items

Level of contamination

Client/resident risk level

FREQUENCY OF CLEANING

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Frequency of Cleaning: High-touch Surfaces

Determine your own high-touch surfaces!

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Frequency of Cleaning

• Heavy contamination– Exposed to major amounts of blood or body fluids

(bathrooms of client/resident with diarrhea)

• Moderate contamination– Exposed to some amounts of blood or body fluids

(client/resident room or bathroom)

• Light contamination– Not exposed to blood or body fluids (offices, lounge,

library)

Level of Contamination

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Frequency of Cleaning

• More at risk persons– Chemotherapy, dialysis, burns or other major wounds,

indwelling devices, etc.– MDRO patients, CDI patients

• Less at risk persons– All others

Client/Resident Risk Group

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Determining How Often To CleanProbability of contamination with pathogens

Potential for Exposure

High touch surface =3 Low touch surface = 1

At risk persons = 1

Less at risk persons = 0

At risk persons = 1

Less at risk persons = 0

Heavy contam = 3 7 6 5 4

Moderate contam = 2 6 5 4 3

Light contam = 1 5 4 3 2

= cleaning once a day and when soiled.

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Applying the Scores

Total Cleaning Score

Risk Type Minimum Cleaning Frequency

7 High Risk Clean after each case/event/procedure and at least 2x per day and when soiled

4-6 Moderate risk Clean at least once a day and when soiled

2-3 Low risk Clean on a regular schedule < 1x per day and when soiled

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Documenting Cleaning Policies• Plan components– Defined responsibilities for items and areas– Procedures for various cleaning tasks– Procedures for specific organisms that transmit well in the

environment– Procedures for outbreaks– Cleaning standards including how often to clean– Monitoring process– Education

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Is It Really Clean?

• Not just a visible check!• Must include audits of actual work• May use “markers” e.g. glo germ solution to

check for “missed” spots• Cultures are not generally recommended

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Exercises

DISCLAIMER: The product insert(s) used for the exercises in no way imply endorsement or recommendations of these products by the West Virginia Department of Health and Human Resources. They are used for educational purposes only.

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Reading a Product Insert

• Which category of cleaner is this product?• What are the ingredients and concentrations?• What organisms is this effective against?• What is the contact time?• How should the product be applied?• Is any PPE needed to use the product?• Are there special instructions for specific

organisms?

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Group Exercise – Writing a Cleaning Plan for Long Term Care• Scenario: – 86 year old with VRE infection of the urine.– Limited mobility; uses bedside commode and

community showers– Incontinent of urine and stool usually contained

with adult briefs– Has to be reminded to wash hands

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Writing a Cleaning Plan

• Materials:– Exercise Worksheet (in notebook)– One copy for each table:• Pictures of patient room• Product Inserts

• Using the exercise sheet and the materials provided, write a cleaning plan

• Be prepared to discuss your plan

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Discussion

• Bed rails, call light, TV remote– Product:– How to use:– Contact time:– How frequently?– Who?– (why?)

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Discussion

• Sink and fixtures:– Product: – How to use:– Contact time:– How frequently?– Who?– (why?)

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Discussion

• Bedside commode:– Product:– How to use:– Contact time:– How frequently?– Who?– (why?)

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Discussion

• Bathroom:– Product:– How to use:– Contact time:– How frequently?– Who?– (why?)

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

Acknowledgments and References

• Ontario Public Health Agency of Canada• CDC Environmental Guidelines for Health

Care Facilities• APIC Guide to Elimination of MRSA in the

Long Term Care Facility

Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov

QUESTIONS?

THANK YOU!