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