1 |1 | Module 7 Cleaning & Disinfection WASH FIT Module 7 Cleaning & Disinfection WASH FIT

2 |2 | Overview 1.Cleaning, disinfection, decontamination 2.When to use cleaning, disinfection, or sterilization 3.The cleaning, disinfection and sterilization process 4.The safe management of used linen 5.Cleaning of reusable PPE (Ebola)

3 |3 | What is decontamination? Decontamination is the process of making an object or area safe by removing contaminants such as micro- organisms or hazardous materials, including chemicals, radioactive substances, and infectious substances. Decontamination process: Cleaning, Disinfection and Sterilization

4 |4 | Why is decontamination important? To prevent the spread of micro-organisms and other contaminants that may threaten the health of human beings or animals or damage the environment.

5 |5 | Principles of cleaning and disinfection Always move from cleanest area to dirtiest area Always be sure to clean patient care equipment between each patient use One bucket = One job –Buckets for specific purposes must be labeled and/or colored Cleaning supplies for isolation should be kept and only used in isolation Where possible, the isolation area should be cleaned last..

6 |6 | Cleaning General removal of debris (dirt, food, feces, blood, saliva and other body secretions) Reduces amount of organic matter that contributes to proliferation of bacteria and viruses. By removing organic matter, increases effectiveness of chemical disinfection

7 |7 | Cleaning process (6 steps) 1.PULL TRASH / Recycle –Remove liners and reline all waste containers. –Remove soiled linen. Change the bag when ¾ full or if the area is closed for the day. –Check sharp containers (change when ¾ full). –Clean waste containers. 2.HIGH DUST –Always use a wet cloth to dust –High dust everything above shoulder level or out of reach. Use an extension pole with duster head. Never high dust around people.

8 |8 | Cleaning process (6 steps) 3.DAMP WIPE –Wipe everything you are able to reach. –Use germicide for all surfaces except glass. –Use a dry cloth or paper towel to polish interior and low-level glass to a streak free appearance. –Start with the door and work around the room in a circular pattern. –Be sure to include: wall spotting, light switches, call buttons, telephones, wall moldings, dispensers, windowsills, and furniture. 4.CLEAN BATHROOM –Start at the door and end with the toilet. Use a bowl mop inside the bowl and wipe the outside with a disinfectant damp wiper. –Do not use the cleaning wiper on any other surface after cleaning the toilet.

9 |9 | Cleaning process (6 steps) 5.DAMP MOP –Place a ‘Wet Floor’ sign at the entrance before you begin. –Start with the corner furthest from the door and work your way out. –Mop the corners to prevent build up of dust and dirt. 6.INSPECT THE ROOM –Report any repairs that are needed. –Correct any deficiencies. –Is the room ready for another patient?

10 | Disinfection Removes most organisms present on surfaces that can cause infection or disease

11 | Disinfection process (4 steps) 1.CLEAN using soap or detergent and water –Remove visible soil –May need to disconnect or separate instrument parts –Avoid organic material drying on equipment by rinsing or soaking in an enzymatic solution 2.DISINFECT using an effective and approved disinfectant 3.WASH OFF any remaining disinfectant using clean water 4.Let air DRY or take outside to dry in the sun NEVER SPRAY disinfectant directly on spill body fluid, it can create splashes or make the spill bigger Use towel or cloth to remove any spill

12 | Materials for cleaning and disinfection Risk appropriate personal protective equipment Detergent and water Cloths and towels Bucket and mop Disinfectant Non-infectious waste bag Infectious waste bag

13 | Sterilization The killing or removal of all organisms

14 | Sterilization (Steam Autoclave) Achieves rapid heating and penetration –Short exposure times(<20minutes) but temperature must be maintained throughout –No toxicity to workers –Can damage delicate instruments Items to be sterilized must be –Cleaned –Packaged so that the steam can penetrate Autoclave must be loaded correctly Liberia hospital, November 2015

15 | Rapid Cycle or Flash Sterilization “Unwrapped” steam sterilization Should only be used when necessary –Do not flash whole trays of instruments –Items must be used immediately Items to be sterilized must be cleaned Must be loaded correctly

16 | Cleaning and disinfecting an Isolation Area Cleaners should always wear the recommended PPE when cleaning the isolation area Isolation areas should have their own cleaning supplies that are separate from clean patient care areas All waste from the isolation area is considered infectious waste

17 | How to manage used linen (in the Ebola context ) All linen should be handled as if contaminated with blood or body fluids When handling used linen wear PPE (face shield or mask and goggles, gown and gloves) Place linens, at point of use, into leak-proof bags or buckets labeled “soiled” for transport to laundry Before washing the linen remove any waste and rinse excess blood Use a washing machine (preferable) Laundry equipment must be maintained functional

18 | How to Clean Reusable PPE 1.Collect PPE items (boots, rubber glove, aprons, and goggles) from the doffing area 2.Remove any waste and wash off any blood 3.Wash with soap and water 4.Soak in appropriate disinfectant 5.Rinse with clean water 6.Hang to dry

19 | ItemFrequency High hand touch surfaces (any surface with frequent contact with hands) Clean with detergent followed by disinfectant between cases Minimal touch surfaces (floors, walls, tables, chairs) Regularly cleaning (at least daily) with detergent only or when soiling occurs Clean after a patient has been discharged Medical equipment (axillary thermometers) After every patient Refer to manufacturer's instructions Plates and utensilsAfter every patient Reusable PPE (aprons, boots) After procedures After exiting an isolation area When visibly soiled Linens and mattressesAfter every patient When visibly soiled Recommended frequency of cleaning

20 | PlaceFrequency Screening areaAt least twice daily After a patient with a suspected infectious disease Isolation areaAt least once daily After every patient Non-Patient care areasAt least once daily Latrines/toiletsAt least twice daily When visibly soiled All areasImmediately following possible contamination with blood or body fluids Recommended frequency of cleaning

21 | Cleaning staff REMEMBER! Cleaners and support staff should be valued as much as clinical staff

22 | Questions