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Best Practices for Environmental Cleaning

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1 Best Practices for Environmental Cleaning
MODULE 3 –Cleaning Products and Tools Welcome to Module 3 – Cleaning Products and Tools. My name is insert name and title and I will be your presenter for this module.

2 Learning Objectives Define and describe cleaning and disinfection
Explain the difference between detergents and disinfectants and indicate their appropriate use. Describe the importance of proper chemical dilutions. Explain the need for dedicated equipment/space and care of equipment. Have an increased awareness of new technologies. At the end of this session, the participant will be able to: Read from slide

3 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. You play a critical role in the prevention and control of infection in your facility. As such it is important that you understand the principles of cleaning and disinfecting environmental surfaces. We will begin with some definitions: Cleaning - read from slide Always remember: the key to cleaning is the use of friction or mechanical action to remove microorganisms and debris. Detergent – read from slide Disinfection – read from slide Always remember: the key to disinfection is that an item or surface be free from visible soil and other items that might interfere with the action of the disinfectant, such as adhesive products

4 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 Disinfectant - read from slide Always remember: a disinfectant is only to be used to disinfect and must not be used as a general cleaning agent, unless combined with a cleaning agent as a detergent-disinfectant. Skin antiseptics must never be used as an environmental disinfectant (e.g. alcohol-based hand rub) Cleaning and disinfection should be done as soon as possible after items have been used Hospital-grade disinfectant – read from slide Finally, whenever possible, cleaning and disinfection should be done as soon as possible after items have been used

5 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. Hotel Clean – read from slide The “hotel component” is the area not involved in client care; this includes public areas such as lobbies and waiting rooms, offices, corridors, elevators, stairwells and service areas. Hospital Clean – read from slide The “hospital component” is the area that is involved in client care; this includes client units (including nursing stations), procedure rooms, bathrooms, clinic rooms and diagnostic and treatment areas.

6 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) The above list represents the different hospital grade disinfectants available on the market. Although “Hospital Grade” terminology is used, many of these disinfectants are used in other health care organizations. A Hospital Grade disinfectant may be used for environmental surfaces and items that do not come in contact with skin and may also be used for equipment that only touches intact skin (non-critical equipment/devices); examples include intravenous pumps and poles, hydraulic lifts, blood pressure cuffs, apnea monitors and sensor pads, electrocardiogram (ECG) machines/cables and crutches, etc. Some disinfectants such as Quaternary Ammonium Compounds (Quats) and Accelerated Hydrogen Peroxide (AHP) are more commonly used than others listed here, but each disinfectant has its own unique properties, advantages and disadvantages. For more information on Hospital-grade Disinfectants and Sporicides please refer to the PIDAC Best Practices document.

7 Hospital-grade Disinfectants and Sporicides
Process Option Uses/Comments Advantages Disadvantages Quaternary ammonium compounds (QUATs) - Floors, walls and furnishings - Blood spills prior to disinfection 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) Focus on those products that are used in your facility, describe primary use and 1 or 2 advantages and disadvantages for each.

8 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, carbon-tipped devices and some aluminum 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 - 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 - Safe for the environment copper, zinc, brass, aluminum - Store in cool place, protect from light

9 Hospital-grade Disinfectants and Sporicides
Process Option Uses/Comments Advantages Disadvantages Chlorines -Non-critical equipment Hydrotherapy tanks Blood spills Dilution Undilute 5.25% Blood spill -1:10 (major) or 1:100 (minor) Surface cleaning 1:50 Low cost Rapid acting Readily available Sporicidal - Corrosive - Irritant to mucous membranes - Use immediately after diluted - Need good ventilation

10 Hospital-grade Disinfectants and Sporicides
Process Option Uses/Comments Advantages Disadvantages Alcohols (70-95%) - External equipment surfaces (e.g., stethoscopes) - Noncritical equipment used for home health care - Disinfection is after 10 minutes contact. - Fire code restrictions for storage - Non-toxic - Low cost - Rapid action - Non-staining - No residue - Effective on clean equipment/devices that can be immersed - 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.

11 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) DO NOT use phenolics in nurseries - 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

12 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”) Read bullet 1 Read bullet 2 The frequency with which you should change your cleaning solution will depend on the product and how it’s being used. Always check with your supervisor. Read bullet 3

13 Learning Checkpoint Here is a learning checkpoint. Ask the group the question on the next slide. 13

14 Learning Checkpoint What are the key components of cleaning and
disinfection? mechanical action / friction contact time / dwell time proper chemical dilution all of the above Read question

15 Learning Checkpoint Answer
The answer is all of the above Chemical The answer is: all of the above The application of the chemical in the proper dilution, combined with friction, supplied by you, and the appropriate contact time, as directed by the manufacturer, will ensure that surfaces are properly cleaned and disinfected. We call this the “golden triangle”. Additional Facility discussion: What cleaners are used in this facility? What disinfectants are used in this facility? Contact / Dwell time Action / Friction

16 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 It is equally important to ensure that the equipment you are using for cleaning and disinfecting of the environment must itself be cleaned and disinfected between uses. Read from slide.

17 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. Read bullet 1 Read bullet 2 and sub-bullets Safety audits conducted by the Ministry of Labour include a visual check to ensure that cleaning carts are well maintained, clean and in good repair Finally, remember that even though your automatic scrubber or cleaning cart may have a cup holder, you should never use it

18 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 Read from slide Bullet 3 – Remember that you have a role to play in ensuring that you neither bring germs into your facility nor take them home with you

19 Densely constructed polyester and nylon fibres
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 As with all things, new technology is appearing all the time. Some, such as the use of microfibre technology for surface cleaning and mopping have been quite successful and are now widely used. Other technologies are still evolving and we will review some of these today. In all cases, we work with Infection Prevention and Control and Occupational Health and Safety when making decisions relating to changes in cleaning and disinfection methods and products. Read from slide

20 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 Read from slide

21 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 Read from slide

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

23 Learning Checkpoint Here is a learning checkpoint. Ask the group the question on the next slide. 23

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

25 Learning checkpoint answer
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. The correct answer is a and c – read answer

26 Learning checkpoint How often should the housekeeping cart be cleaned?
Weekly Daily Does not need routine cleaning Read question

27 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. The correct answer is b – read answer

28 When you return to your job, what will you do differently as a result of this session?
Read question… Make a list of three things you will do differently. Ask question. Offer suggestions. May also be used as small group activity with larger groups. Another option would be ask participants to write their ideas on paper – collect and read back. Note: This is an important application activity. Be sure to allow time for it. 28 28

29 Thank You! This concludes module 3 on Cleaning Products and Tools. Thank you! 29

30 Image Sources – Module 3 Microsoft Clipart used in slides 13 & 23
Images in slides 16 & 17 are © PHO 2013

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