1. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.dide.wv.gov Environmental Cleaning

2. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.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

3. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.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

4. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.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

5. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.dide.wv.gov Principles of Effective Cleaning Apply to all settings where care is delivered – Process – Selection of appropriate product for the task – Frequency

6. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.dide.wv.gov Environmental Cleaning Principles Highest point and work towards the lowest From the outside to the inside From the cleanest to the dirtiest

7. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.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

8. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.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:

9. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.dide.wv.gov Choosing a Disinfectant “Hospital disinfectant” effectiveness – Pseudomonas aeruginosa – Staphylococcus aureus – Salmonella choleraesuis “Tuberculocidal” indicator of effectiveness – Broad spectrum

10. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.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

11. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.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

12. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.dide.wv.gov Advantages and Disadvantages of Common Disinfectants DisinfectantAdvantagesDisadvantages Sodium hypochlorite (household bleach) Inexpensive Fast-acting Widely available Active against bacteria, spores, Mtb, viruses Odor can be irritating Corrosive to metals Inactivated by organic material May discolor fabrics Ethyl or isopropyl alcohol (70-90%) Inexpensive Widely available Rapidly effective Active against bacteria, Mtb, viruses Not effective against bacterial spores Not for large surfaces Rutala WA et al. CDC Guideline for Disinfection & Sterilization In Healthcare Facilities, 2008

13. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.dide.wv.gov Advantages and Disadvantages of Common Disinfectants DisinfectantAdvantagesDisadvantages Quaternary ammonium compounds Not too expensive Widely available Good cleaning agents Not effective against bacterial spores, Mtb, non-enveloped viruses May become contaminated PhenolicsWidely availableUse on bassinets may be toxic to infants Poor activity against bacterial spores and non- enveloped viruses

14. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.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

15. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.dide.wv.gov Frequency of Cleaning High/low touch items Level of contamination Client/resident risk level FREQUENCY OF CLEANING

16. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.dide.wv.gov Frequency of Cleaning: High-touch Surfaces Sink tops Door handles Support rails Toilet handles Toilet seat Light switches Bed pan cleaners Remote controls Over bed tables Telephones Bed rails Patient/visitor chairs Dressers Computer stations Determine your own high-touch surfaces!

17. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.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

18. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.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

19. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.dide.wv.gov Determining How Often To Clean Probability of contamination with pathogens Potential for Exposure High touch surface =3Low touch surface = 1 At risk persons = 1 Less at risk persons = 0 At risk persons = 1 Less at risk persons = 0 Heavy contam = 37654 Moderate contam = 26543 Light contam = 15432 = cleaning once a day and when soiled.

20. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.dide.wv.gov Applying the Scores Total Cleaning Score Risk TypeMinimum Cleaning Frequency 7High RiskClean after each case/event/procedure and at least 2x per day and when soiled 4-6Moderate riskClean at least once a day and when soiled 2-3Low riskClean on a regular schedule < 1x per day and when soiled

21. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.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

22. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.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

23. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.dide.wv.gov

24. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.dide.wv.gov

25. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.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.

26. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.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?

27. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.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

28. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.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

29. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.dide.wv.gov

30. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.dide.wv.gov Discussion Bed rails, call light, TV remote – Product: – How to use: – Contact time: – How frequently? – Who? – (why?)

31. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.dide.wv.gov Discussion Sink and fixtures: – Product: – How to use: – Contact time: – How frequently? – Who? – (why?)

32. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.dide.wv.gov Discussion Bedside commode: – Product: – How to use: – Contact time: – How frequently? – Who? – (why?)

33. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.dide.wv.gov Discussion Bathroom: – Product: – How to use: – Contact time: – How frequently? – Who? – (why?)

34. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.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

35. Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY www.dide.wv.gov QUESTIONS? THANK YOU!