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Hospital Environmental

Cleaning & Disinfection


Procedures & Practices
Environmental cleaning depends on Infection Control risk Assessment as High,
Moderate & Low Risk Areas
By
Dr Anjum Hashmi MBBS,CCS(USA), MPH
Infection Prevention & Control Director and Employees Health Director
East Najran Hospital Najran Saudi Arabia
2014
Reviewed By
Al Scoggins
CEO at Janus Solutions, LLC
Great Atlanta, USA.

The contamination of the environment (surfaces in patient care areas and


mobile medical equipment) play a major role in the transmission of
potential pathogens.
TERMINOLOGIES & DEFINITIONS:

Antisepsis: Chemical destruction of vegetative pathogens on living tissue.


Degerming: Mechanical removal of microbes from limited area.
Sanitization: Lowering microbial counts on eating and drinking utensils to safe levels.
Sepsis: Bacterial contamination
Asepsis: Absence of significant contamination
Aseptic technique: To minimizes contamination.
Cleaning: Physical removal of foreign material, e.g., dust, soil, organic material such as blood, secretions,
excretions and microorganisms. It is accomplished with water, detergents and mechanical action.
Decontamination: The removal of disease-producing microorganisms to leave an item safe for further
handling
Sterilization: Complete elimination or destruction of all forms of microbial life accomplished in healthcare
facilities by either physical or chemical processes.
Disinfection: Cleaning some or all pathogenic organisms from an article of which may cause infection.
A perfect disinfectant should offer complete and full sterilization, without harming other forms of life,
inexpensive, and non-corrosive.
Unfortunately ideal disinfectants do not exist.
High level disinfectants: Destroy vegetative bacteria, mycobacteria, fungi, enveloped (lipid) and
nonenveloped (non lipid) viruses and bacterial spores but not necessarily all bacterial spores.
Intermediate level disinfectants: Kill vegetative bacteria, most viruses and most fungi but not the bacterial
spores.
Low level disinfectants: Kill most vegetative bacteria and some fungi as well as enveloped (lipid) viruses
(e.g., hepatitis B, C, hantavirus, and HIV). Low level disinfectants do not kill mycobacteria or bacterial
spores. Low level disinfectants are typically used to clean environmental surfaces.
Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com

SPAULDING CLASSIFICATION THREE DEVICE CATEGORIES FOR DISINFECTION AND


STERILIZATION:

Critical Device enters sterile tissue or vasculature, therefore pose a high risk of infection if contaminated
with microorganisms: Require: Sterilization.
Semi-critical Device comes in contact with mucous membranes or skin that is not intact, therefore pose a
moderate risk of infection if contaminated with microorganisms: Require: High Level Disinfection.
Non-critical Device comes in contact with intact skin but not with mucous membranes, therefore, pose little
to no risk of infection if contaminated with microorganisms: Require: Disinfection.

MANAGEMENT OF BLOOD AND BODY FLUID SPILL:


TOOLS OF SPILLAGE KIT:1. Protective clothing, gloves, gowns, masks and goggle.
2. Tissue papers (Roll paper towels)
3. Forceps for removal of broken glass or other sharps.
4. Container of Sodium Hypochlorite (Clorox/Bleach) or Presept, Haz Tabs.
5. Biohazard disposal bag for infectious waste.
6. Measuring jar
CHLORINE-RELEASING AGENTS:
Fall into two groups:
1. Sodium dichloroisocyanurate (NaDCC), e.g. Presept, Haz Tabs
NaDCC is recommended for spillages. It is less resistant than hypochlorite to organic matter, less corrosive, and has
a longer shelf life, as it is manufactured as tablets or granules.
2. Sodium hypochlorites (NaOCl), e.g. Clorox / Household bleach.

Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com

HOW TO CLEAN BLOOD AND BODY FLUIDS SPILL:


1
2.
3.
4.

Place Wet Floor sign near the area of spill.


Wear protective clothing and gloves.
Put on goggles if splashing is likely.
Put on shoe cover to protect shoes if they are likely to become contaminated with the
blood spill.
5. If broken glass or any other sharp object is involved, use forceps to pick up and
throw into a sharp container before any cleaning or disinfecting is ever attempted.
6. Cover spill with paper towels, pure Clorox solution 1:10 dilution over spill starting
from periphery leave for 3-5 minutes. This will ensure ample Contact Time for
disinfection. Then wipe all the blood or body fluid from the surface.
7. Again pour or spray the disinfectant 1:10 dilution bleach solution on the area of spill and leave it for 3-5
minutes. This will ensure ample Contact Time for disinfection.
8. Wiped clean with paper towels.
9. Discard all contaminated paper towels into the infectious yellow bag.
10. Dispose all disposable PPE into yellow infectious waste bag.
11. Dispose yellow plastic bag into infectious waste container.
12. Wash hands with antiseptic detergent.
13. Replace and replenish supplies in the Spill Kit
CLEANING BLOOD AND BODY FLUID STAINS:
Wear gloves and others PPE as needed.
Clean the items with detergent and water.
Make Clorox solution (100ml of Clorox in 900ml water/5000 - 6000ppm available Chlorine) in spray bottle and do
heavy spray so that it can take 5 minutes to air dry than clean it.

Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com

MANAGEMENT OF OTHER BODY FLUID SPILLS (VOMIT, URINE, FECES):


Wear disposable gloves and apron.
Use disposable paper towels, to mop up spillage.
Dispose of paper towels into clinical waste bag.
Wash area with detergent and water.
After washing one can disinfect area with Clorox solution (40-50 ml of Clorox in 1 Liter water 2500-2700ppm
available Chlorine).
Discard protective apparel into clinical waste bag.
Wash and dry hands thoroughly.
ENVIRONMENTAL DECONTAMINATION:
Cleaning MUST precede decontamination
Disinfectant is ineffective if any organic matter present.
Use mechanical force
Scrubbing
Brushing
Flush with water
Wipe nonporous surfaces with sponge or wet cloth.
Allow to dry.
CENTER FOR DISEASE CONTROL [CDC] RECOMMENDED DILUTIONS FOR DISINFECTION
(HOW TO MAKE CLOROX/BLEACH SOLUTION):
Clorox solution must always be freshly prepared and use within 4-8 hours.
1. 100 ml Clorox + 900 ml water = (1:10 dilution/5000-6000 parts per million (ppm) available Chlorine)
2. 40-50 ml Clorox + 1 Liter water = (2500-2700 ppm available Chlorine).
3. Clorox/bleach solution for sanitizing cooking and eating utensils 15 ml (1 Tablespoon) in 4 liter Water = 200 ppm
(must not exceed 200 parts per million available chlorine).
The bleach solution must be applied by spraying, soaking or scrubbing. Let air dry (contact time at least one minute
4. Clorox/bleach solution for sanitizing fruits and raw vegetables 7.5 ml (1 teaspoon) in 4 liter of water = 100 ppm
(must not exceed 100 parts per million available chlorine). After washing dip them for 15 minutes than wash again
with filtered water.

Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com

HOW TO MOP FLOOR

Use a mop or bucket system with a floor cleaner solution, beginning in the far corner of the area, under the bed and
then moving toward the bathroom and the door.
Mop the floor in 1-2 meter square sections.
Mop edges with straight strokes, and then continue working from side to side in a backwards direction, using a
figure-of-eight pattern on the remainder of the section, turning the mop frequently.
The floor should be fairly dry on completion.

HOW TO CLEAN AND DISINFECT BATHROOM

Wash with water and detergent.


Make Clorox/bleach sol (40-50 ml Clorox + 1 liter water)
Disinfect all precleaned hard, nonporous bathroom surfaces.
Start with the highest surface (like the mirror) and leave the toilet for last.
Ensure that all surfaces, including the sink area, mirrors, grab bars and shower fixtures, are thoroughly
disinfected.
Disinfect and clean toilet exterior, toilet seat surface, and outer of bowl.
For inner bowel use 250ml pure bleach contact time 2 min.
Ensure all surfaces stay wet.
Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com

BATHROOM CLEANING PROTOCAL


It is usually best to start with the highest surface (often the mirror) and leave the toilet for last. Clean and disinfect
all hard, nonporous surfaces:
Mirror, sink area, and grab bars, shower fixtures, toilet exterior, toilet seat surface and outer and inner bowl.

CLEAN AND DISINFECT ISOLATION ROOM

Using a clean mop, mop the entire floor surface, working your way from the far corner back to the entrance.
Visually inspect the room and ensure all surfaces have been cleaned and disinfected.
Then disinfect any cleaning equipment (like mop handles) before returning to the cleaning cart.
Remove PPE and put in a yellow trash bag prior to leaving the room.
Wash your hands.
Return with clean linens and make bed.

Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com

Cleaning Levels for Different Clinic Areas


It depend on Infection Control risk assessment of that areas
Low-Risk Areas:
These areas are usually not contaminated with blood or body fluids or with associated infectious
microorganisms so the risk of infection is minimal.
Routine cleaning- the kind of cleaning you would do in your home is usually good enough for these
areas.
Clean these areas with a mop dampened with detergent and water.
These functional areas included:
1) Administrative areas
2) Waiting rooms
3) Non-sterile supply areas
4) Medical records
5) Engineering workshop
6) Central store
7) Library
8) Conference and Meeting area
9) Staff Change facilities (Staff lounge)
Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com

Intermediate (Moderate) Risk Areas:


These are areas used for the care of patients who are not obviously infectious and not highly susceptible.
These areas are cleaned by procedures that control dust, such as damp mopping with detergent cleaners.
Dry sweeping or vacuum cleaners are not recommended.
The use of detergent solution improves the quality of cleaning.
This functional areas includes:
1) Patient Wards
2) Out Patient Department
3) Physiotherapy
4) Pharmacy
5) Laboratories
6) Mortuary
7) Radiology
8) Accommodation (Housing)
9) Employee Health Clinic
10) Cardiology
High Risk Areas:
This functional areas includes:
1)
2)
3)
4)
5)
6)
7)

CSSD (Central sterilization and supply department)


Emergency Department (ER)
Catering facilities (includes all kitchen and cafeteria)
Day surgery unit
Treatment room.
Maternity Ward
Pedia Surgery Ward

Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com

Very High Risk Areas:


In these areas there is a greater potential pathogen contamination with infectious materials and more of a
concern about potential infection transmission to both patient and clinic staff.
These areas must be cleaned with care using a cleaning solution and separate cleaning equipment; disinfectant
detergent solutions are used as needed, according to hospital policy.
This functional areas includes:
1)
2)
3)
4)
5)
6)
7)

Isolation Room
Intensive Care Unit (ICU/PICU)
Operating Room
Neonatal Care unit (NICU and Nursery)
Pharmacy IV Preparation room
Delivery Room
Immuno-compromised patients areas

Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com

DECONTAMINATION OF ENVIRONMENT & EQUIPMENTS


STAFF RESPONSIBLE

NO
ITEMS
1
Airways/
ventilator tubes
2
Ambu bags

CLEANING PROCESS
Disposable or disinfect with 100ml of Clorox in 900ml
water solution dip for 10 minutes.
Disposable or disinfect with 100ml of Clorox in 900ml
water solution dip for 5 minutes.

Baby Baths

House-keeping personnel

Bed frames,
cradles etc.
Blood-pressure
cuff
Tourniquets
Ceilings

Clean bath after use with detergent and water. Disinfect


with 100ml of Clorox in 900ml water solution spray.
Disinfect with 100ml of Clorox in 900ml water solution
spray.
Clean with damp cloth soaked in detergent and water,
dry thoroughly. If contaminated with blood/body fluids
spray with 100ml of Clorox in 900ml water solution.
When visibly soiled, wash with detergent and water.
Clean with detergent and water and disinfect with 250
ml of Clorox (pure) contact time 2 minutes.
Should be laundered at least 6 monthly and when
visibly soiled. Some curtains may need to be laundered
more regularly (high risk area)
If unable to send to central laundry clean with detergent
and water.
Wash with detergent and hot water and dry before and
after use. If contaminated with blood/body fluids or
used for a patient with a transmissible infection refer to
policy / guidance. 70% alcohols wipes can be used to
disinfect trolley between uses if visibly clean/use 100ml
Clorox in 900ml of water solution spray.

House-keeping personnel

8
9
10

11

Commodes/
urinal
Curtains

Dressing
trolleys

Nursing staff
Nursing staff

Housekeeping personnel
Nursing staff

Maintenance Department

Nursing staff &


Laundry Dept

Nursing staff

Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com

12

Drip (IV) stands

Start from top to down clean with water and detergent.


Rinse and dry thoroughly. If contaminated with
blood/body fluids or used for a patient with a
transmissible infection use Clorox solution 1:10 dilution
/100ml Clorox in 900ml of water solution spray contact
time 3 -5 min, wipe or let air dry.

Nursing staff

13

Examination
couch

Nursing staff

14

Floors

Use Clorox solution 1:10 dilution /100ml Clorox in


900ml of water spray contact time 3 -5 min, wipe or let
air dry.
1) Dry Cleaning Dust-attracting mop. Sweeping
machine must not be used in clinical areas.
2) Wet Cleaning wash with Clorox solution (25002700ppm of chlorine/40-50ml Clorox in 1 L of water).

15

Housekeeping
Equipment
Buffers (Floor
polishing
machine)
Pads

Buckets
Mops Heads
16

Incubators
(baby)

House-keeping personnel

House- keeping
personnel
The outside of the machine should be washed with
detergent and water and dried after use.
Buffing pads should be washed with detergent and
water and drip-dried. Pads must not be left under the
machine between uses.
Clean with water and detergent after use. Disinfect with
100ml Clorox in 900ml water. Dry and store inverted.
Disinfect with 100ml Clorox in 900ml of water /Change
daily or send to laundry.
If disinfection required refer to manufacturer's
instructions. As some allow wash with water and
detergent only (better use Savalon) and other allow use
of Clorox solution 1:10 dilution/100ml Clorox in 900ml
of water solution.

Nursing staff

Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com

Decontamination of Incubators After Patient Use


Incubators should be disinfected between each baby.
The incubator shall also be disinfected after every 7 days
of hospitalization (every 5 days for babies less than 1
kilogram).
After use all removable parts must, be washed and
thoroughly cleaned with detergent (better use
Savalon).Then soaked in 1: 10 Clorox (5000 ppm
available chlorine) for 5 minutes. Rinse
and dry thoroughly using paper roll.
Then clean incubator with water and detergent (better
use Savalon) wipes.
Disinfect incubator with 1: 10 Clorox /100ml Clorox in
900ml of water solution wipes and dried using paper
roll.
Wash outside of incubator, including drip stands
shelves, infusion pumps / syringes and dry thoroughly
with paper roll.
Dispose Clorox wipes and paper roll in the infectious
waste bag.
Aerate the incubator before re-use.
Humidification Chambers
Disassemble the humidifier.
Clean humidifier and reservoir with Clorox/Bleach 1: 10
dilutions /100ml Clorox in 900ml of water solution.
Thoroughly dry parts before reassembly.
Decontamination of Incubators in Use
All incubators that are occupied should be cleaned daily
from the inside and outside. Clean incubator with
detergent (better use Savalon) wipes and dries it with
paper towels.
Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com

17

18

19
20

Always clean inside of incubator first.


Dispose wipes and paper roll in the infectious waste
bag.
Humidification Chambers
Humidification chambers not in use should be kept
clean and dry.
Humidification chambers in use should be checked at
the start of each shift and topped up with distilled sterile
water as necessary.
Humidification chamber in use should be weekly and
disinfected with Clorox/Bleach 1: 10 dilution /100ml
Clorox in 900ml of water solution.
Blood & Body
Empty contents carefully down sluice or toilet. Wash
fluids suction
carefully in warm water and detergent avoiding
containers
splashing and disinfect accordingly. Dip in 100ml of
Clorox in 900ml of water solution for 10 minutes.
Laryngoscope
Handle: wash with detergent and hot water and dry
and blade
thoroughly. If contaminated with blood/body fluids or
used on an infectious patient, use 100ml Clorox in 900ml
of water solution spray/use disinfectant approved by
Infection Control Department
Blade: send to CSSD for reprocessing or dip in 100ml
Clorox in 900ml of water solution for 10 minutes.
Lockers
Clean with detergent and water. Disinfect with 100ml of
Clorox in 900ml water solution spray.
Cot/Incubator
Check regularly to ensure the cover is intact. If damaged
Mattresses , Bed it must be discarded and changed. The mattress cover
Mattresses and
should be washed with detergent and water on patient
pillows
discharge and disinfect with 100ml Clorox in 900ml of
water solution spray.

Nursing staff

Nursing staff

House-keeping personnel
House-keeping personnel

Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com

21
22
23

Medical
Equipment
Resuscitation
Trolley
Scales
(weighing)

24

Scissors

25

Sinks/wash
hand basins
Waste bin for
infectious waste
Soap dispenser

26
27

28
29
30

Sphygmomano
meter
Stethoscopes
Suction bottles

31

Telephones

32

Thermometers
Electronic

Refer to manufacturer's instructions

Nursing staff

Clean with detergent and water. Disinfect with 100ml


Clorox in 900ml of water spray.
Clean with detergent and water & disinfect with 100ml
Clorox in 900ml of water solution heavy spray let it air
dry to met contact time of 3-5 minutes.
Clean with detergent and water, if disinfection required
use a 70% alcohol swab following cleaning with
detergent and water or 100ml Clorox in 900ml of water
spray.
Clean with detergent and disinfect with (2500-2700 ppm
available chlorine /40-50ml Clorox in 1L water)
Wipe clean with 100ml of Clorox in 900ml of water
solution and let air dry.
The casing and the nozzle of the soap dispenser should
be cleaned daily with water and detergent. Wipe clean
with 100ml of Clorox in 900ml of water solution and let
air dry. Clean inner casing of dispenser when changing
the cartridge. Do not top up liquid soap.
Clean with detergent and water.

Nursing staff

Wipe with 70% alcohol wipes between each patient.


If not disposable these should be emptied carefully and
disinfect with 100ml Clorox in 900ml of water solution
by dipping for 10 minutes.
Damp dust with detergent and water or 100ml Clorox in
900ml of water spray.
Disinfect screen with alcohol. Disinfect with 100ml
Clorox in 900ml water wipe, if allowed by manufacturer.

Nursing staff
Nursing staff

Nursing staff

Nursing staff

House-keeping personnel
Nursing staff
House-keeping personnel

Nursing staff

Nursing staff
Nursing staff

Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com

33

Toilets/Bidets

Use detergent and water and disinfect with Clorox and


water (2500-2700 ppm chlorine concentration/40-50ml
Clorox in 1L water)

House- keeping
personnel

35

Walls

All surfaces should be cleaned with Clorox and water


(2500-2700 ppm of Chlorine/40-50ml in One Liter
water).

House-keeping personnel

37

Ventilators

Nursing staff
Wipe the surfaces of the ventilator clean, working from
the top to the bottom. For greasy or stubborn soiling, use
the non-abrasive pad. Wipe the screen with alcohol.
Body can be wiped with alcohol or Clorox 1:10 dilutions.
Allow to dry. Only detergent and water can be used if
advised by manufacturer.

38

Clean bath after use with detergent and water.

Housekeeping personnel

39

Baths (shower
cubicles)
Bedpans

Housekeeping personnel

40

Bowls (patient)

41

Wheelchairs

42

Toys-Hard
(Soft toys not
suitable for
hospital use)

Empty contents carefully down sluice or toilet and


disinfect and rinse with 100ml of Clorox in 900ml water
solution.
Clean with detergent and water. Rinse and dry
thoroughly. Disinfect with 100ml of Clorox in 900ml of
water solution and let air dry. Store inverted.
Clean with detergent and water. Disinfect with 100ml of
Clorox in 900ml of water solution and let air dry.
Toys must be cleaned if visibly soiled, weekly and on
patient discharge. Disinfect with 1:100 dilution of a
hypochlorite solution (10ml in 1 L water/500600 ppm
free chlorine). If visibly soiled with blood/body fluids.
Dispose if grossly contaminated.

Housekeeping personnel

Housekeeping personnel
Housekeeping personnel

Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com

43

Dialysis Unit
noncritical
surfaces (e.g.,
dialysis bed,
external
surfaces of
dialysis unit )

Wipe the unit screen with alcohol. Disinfect with 1:10


dilution of a hypochlorite solution (100 ml in 1 L water /
5000 ppm free chlorine) after every dialysis event /Use
EPA approved disinfectant.
Ref: Guideline for the Prevention and Control of Infections in Dialysis Settings

44

Cardiac
Monitor

Nursing staff

45

Diagnostic
Imaging
Portable Machine
Portable portable grid/
film cassette
Mammography
- paddles
ECG Machine
and Cables
Glucometer
Ophthalmoscope
Otoscope
Handle
Ear speculum
Reflex Hammer
Defibrillator

Wipe the screen with alcohol. Body can be wiped with


alcohol or Clorox 1:10 dilutions. Allow to dry. Only
detergent and water can be used if advised by
manufacturer.
Disinfect with 100ml Clorox in 900ml water damp wipe.
When soiled and on leaving Contact precaution room
Ideally should be covered (e.g., pillowcase )between
patients if not covered

X ray technician

46
47
48
49

50
51

Nursing staff

Version 3 May 2013; Centre for Healthcare Related Infection Surveillance and
Prevention & Tuberculosis Control, Queensland Australia

Between patients
Damp wipe with 100ml Clorox in 900ml water solution.

ECG technician

Damp wipe with 100ml Clorox in 900ml water solution.


Damp wipe with 100ml Clorox in 900ml water solution.

Nursing staff
Nursing staff

Damp wipe with 100ml Clorox in 900ml water solution.


Damp wipe with 100ml Clorox in 900ml water solution.
Damp wipe with 100ml Clorox in 900ml water solution.
Damp wipe with 100ml Clorox in 900ml water solution .

Nursing staff
Nursing staff
Nursing staff

Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com

52

Stretcher

53

Suction
Machines

54
55

56
57

58

59

Wash with soap and water and disinfect spray of 100ml


Clorox in 900ml water solution and let air dry.
Damp wipe with 100ml Clorox in 900ml water solution

Housekeeping staff

Stethoscope

Alcohol swab/100ml Clorox in 900ml water damp wipe

Doctor/Nursing staff

Telemetry
Equipment
Monitor and
Cables
Tourniquet
Ultrasound
Transducers
Handle and
Cable
External
Wall-mounted
Oxygen and
Suction Fixtures
Intravenous
(IV)
Pumps, Poles,
Warmers

Damp wipe with 100ml Clorox in 900ml water solution.

Nursing staff

Alcohol swab/100ml Clorox in 900ml water damp wipe


Alcohol swab

Nursing staff
Ultrasound technician

Damp wipe with 100ml Clorox in 900ml water solution

Nursing staff

Damp wipe with 100ml Clorox in 900ml water solution

Nursing staff

Nursing staff

Personal Protective Equipment (PPE) Advised in Environmental Cleaning:


1. Gloves.
2. Face Mask
3. Gown if splashes of disinfectant expected.
Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com

MINIMUM CLEANING & DISINFECTION FREQUENCIES IN HOSPITAL


No.
Element
Very High Risk
1
Weighing scales, manual handling Clean contact points
equipment
each use, 1 full clean
daily & between patient
use

High Risk
Clean contact points
each use, 1 full clean
daily & between patient
use

Medical equipment including


intravenous infusion pumps, drip
stands and pulse oximeters (not
connected to a patient)
Patient washbowls

1 full clean daily and


between patient use

1 full clean daily and


between patient use

1 full clean daily and


between patient use

1 full clean daily and


between patient use

Bedside oxygen and suction


Connectors.

1 full clean daily and


between patient use

1 full clean daily and


between patient use

Oxygen Cylinders

1 full clean daily

1 full clean

Alcohol hand gel / soap


container / dispenser /
bracket / clipboard

1 full clean daily and


between patient use if
contaminated

1 full clean daily and


between patient use if
contaminated

Moderate Risk
Clean contact
points each use, 1
full clean
daily & between
patient use
1 full clean
daily and
between
patient use
1 full clean
daily and
between
patient use
1 full clean
daily and b/w
patient use
1 full clean
daily
1 full clean daily
and between
patient use

Chart trolley / Drug trolley

1 full clean weekly

1 full clean weekly

1 full clean weekly

NA

Patient personal items

1 full clean daily

1 full clean daily

NA

Switches, sockets and data


points

1 full clean daily

1 full clean daily

1 full clean
daily
1 full clean
daily

Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com

Low Risk
NA

NA

NA

NA

NA
NA

1 full clean
weekly

10

Walls

Check clean daily, wash


twice yearly

Check clean daily, wash


twice yearly

11

Ceiling

Wash yearly

Wash yearly

12

All doors

13

All internal glass

1 full clean daily and 1


check clean
1 full clean daily

14

All external glass

1 full clean yearly

1 full clean daily and 1


check clean
Check clean daily
1 full clean weekly
1 full clean yearly

15

Mirrors

16

Television

1 full clean daily and


1 check clean
1 full clean daily

1 full clean daily and


1 check clean
1 full clean daily

1 full clean daily


and 1 check clean
Check clean daily 1
full clean weekly
1 full clean every
second year
1 full clean daily
1 check clean
1 full clean daily

17

Ventilation grilles, extracts


and inlets

18

Floor - polished

1 full external clean


weekly and full clean
twice yearly
2 full cleans daily

1 full external clean


weekly and full clean
twice yearly
1 full cleans daily,1 clean
check daily

1 full external clean


monthly and full
clean yearly
1 full cleans daily, 1
clean check daily

19

Floor - Non-slip

2 full cleans daily,

1 full cleans daily, 1 clean


check daily.

1 full cleans daily, 1


clean check daily

20

Soft Floor (Carpet not


recommended in clinical area)

NA

NA

NA

Check clean
weekly, wash
yearly
Wash yearly

Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com

Check clean
weekly, wash,
every third yearly
Wash every third
yearly
1 full clean
weekly
1 full clean
weekly
1 full clean every
3rd yr
Full clean daily
1 full clean
weekly
1 full external
clean monthly &
full clean yearly
1 clean check
daily
1 full cleans
weekly
1 full cleans
weekly, 1 clean
check daily

1 check clean
daily, 1 full clean
weekly, wash
yearly

21

Pest control devices

1 full clean daily

1 full clean daily

1 full clean daily

1full clean
weekly

22

Electrical items, e.g. overhead


lights

1 check clean daily and 1


full clean monthly

1 check clean daily and 1


full clean monthly

1 check clean daily


and 1 full clean
monthly

1 check clean
weekly & 1 full
clean monthly

23

Cleaning equipment

Full clean after each use

Full clean after each use

24

High surfaces

2 full cleans weekly

25

Low surfaces

2 full cleans daily

26

Chairs (Note: no soft fabric


covered chairs in clinical areas)
Beds / Patient couches /
Trolleys / Mattresses

1 full clean daily and 1


check clean daily

1 full clean weekly and 1


check clean weekly
1 full clean daily and 1
check clean daily
1 full clean daily and 1
check clean daily

Full clean after each


use
1 full clean weekly

Full clean after


each use
1 full clean
weekly
1 full clean
weekly
1 full clean
weekly

27

Bed frame, including all


component parts daily,
mattress weekly and on
discharge, total full clean
on discharge
1 full clean daily and 1
check clean daily
1 full clean daily and 1
check clean daily

Bed frame, including all


component parts daily,
mattress weekly and on
discharge, total full clean
on discharge
1 full clean daily

28

Lockers / Wardrobes /Drawers

29

Tables / Bed tables

30

All dispensers / holders

1 full clean daily

1 full clean daily

31

Waste receptacles / Sani-bins /


Nappy bins

1 full clean daily and1


check clean daily and 1
deep clean weekly

1 full clean daily and1


check clean daily and 1
deep clean weekly

1 full clean daily

1 full clean daily


1 full clean daily
Bed frame, with
all component
parts daily,
mattress weekly
and on discharge
1 check clean daily
1 full clean weekly
1 check clean daily
and 1 full clean
weekly
1 full clean
daily
1 full clean daily
and 1 deep clean
week

Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com

NA

1 full clean
weekly
1 full clean
weekly
1 full clean
daily
1 full clean
weekly & 1 deep
clean monthly

32

Curtains (window and cubicle) and Clean, change or replace


Blinds
yearly. Bed curtains
quarterly

Clean, change or
Replace yearly. Bed
curtains twice a year

Clean, change or
replace all
curtains yearly

Clean, change or
replace two
yearly

33

Fridge / Freezer

3 check cleans daily and 1


full clean weekly

3 check cleans daily


and 1 full clean weekly

34

Drinking water fountain / water


cooler

1 full clean daily and 1


check clean daily

1 full clean daily and 1


check clean daily

3 check cleans daily


and 1 full clean
weekly
1 full clean daily
and 1 check clean
daily

1 check clean
daily and 1 full
clean weekly
1 full clean
daily and 1
check clean
daily

35

Baths

1 full clean and 1 check


clean daily

1 full clean and 1 check


clean daily

1 full clean daily


1 check clean daily

36

Showers

1 full clean and 1 check


clean daily

1 full clean and 1 check


clean daily

1 full clean daily


1 check clean daily

37

Wash Hand Basins

3 full clean, 2 check cleans

3 full clean, 2 check cleans

38

Toilets / Urinals / Bidets

3 full clean, 2 check cleans

3 full clean, 2 check cleans

39

1 full clean daily

1 full clean daily

40

Computers / Telephones /
Office Equipment
Dirty Utility room

3 full clean, 2 check


cleans
3 full clean, 2 check
cleans
1 full clean daily

1 full clean daily


1 check clean
daily
1 full clean daily
1 check clean
daily
3 full clean, 2
check cleans
3 full clean, 2
check cleans
1 full clean
weekly

1 full clean and 1 check


clean daily

1 full clean and 1 check


clean daily

1 full clean daily

1 full clean daily

41

Cleaning Store /Janitor room

Full clean after each use

Full clean after each use

Full clean after


each use

42

Entrance / Exit

2 full cleans daily

2 full cleans daily

Full clean after each


use
2 full cleans daily

Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com

1 full clean daily

43

Stairs (internal and external)

2 full cleans daily

2 full cleans daily

2 full cleans daily

1 full cleans daily

44
45

External areas
Dishwasher / microwave

46

Kitchen Cupboards /
Presses
Cleaning equipment (Catering)

1 full clean daily


1 full clean daily and 2
check cleans daily, and
emptied after use
1 full clean weekly

1 full clean daily


1 full clean daily and 2
check cleans daily, and
emptied after use
1 full clean weekly

Full clean after each use

Full clean after each use

When soiled and on


leaving
Contact precaution room
Ideally should be covered
(e.g., pillowcase )between
patients if not covered
Between patients
Daily
Between patients
Between patients
Between patients
Between patients

When soiled Ideally


should be covered (e.g.,
pillowcase) between
patients if not covered.
Between patients

1 full clean daily


1 full clean
daily, emptied
after use
1 full clean 4
monthly
Full clean after
each use
NA

Daily
Between patients
Between patients
Between patients
Between patients

1 full clean daily


1 full clean daily
and emptied
after use
1 full clean
monthly
Full clean after
each use
When soiled
Ideally should be
covered (e.g.,
pillowcase) b/w
patients if not
covered.
Between patients
Daily
Between patients
Between patients
Between patients
Between patients

NA
NA
NA

Between patients
Between patients
Between patients
Between patients
Between patients
Between patients

Between patients
Between patients
Between patients
Between patients
Between patients
Between patients

Between patients
Between patients
Between patients
Daily
Between patients
Between patients

NA
NA
NA
NA
NA
NA

47
48

Diagnostic Imaging
Portable - Machine
Portable - portable grid/
film cassette
Mammography - paddles

49

ECG Machine
Cables
Glucometer
Ophthalmo- scope
Otoscope: Handle and
Ear speculum
Reflex Hammer
Defibrillator
Stretcher
Suction Machines
Stethoscope
Telemetry Equipment
Monitor and Cables

50
51
52
53
54
56
57
58
59

Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com

NA

60
51

62
63
64

Tourniquet
Ultrasound Transducers
Handle and Cable
External
Wall-mounted Oxygen and
Suction Fixtures
Intravenous (IV)
Pumps, Poles, Warmers
Call Bell

Between patients
Between patients

Between patients
Between patients

Between patients
Between patients

NA
NA

Between patients

Between patients

Between patients

NA

Between patients

Between patients

Between patients

NA

Daily /between patients

Daily /between patients

Daily /between
patients

Daily

Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com

Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com

ENVIRONMENTAL CLEANING OF THE OPERATION THEATER


S.NO FREQUENCY
TASKS
At
the
1
Clean floors and all horizontal surfaces operating / procedure tables, examination couches, chairs,
beginning
trolley tops or Mayo stands, anesthesia machine, lamps, counters, and office furniture with a cloth
of the day
dampened with water to remove dust and lint that have accumulated over night.
Between
2
Clean operating/procedure tables, examination couches, trolley tops or Mayo stands, lamps, counters,
patients
anesthesia machine and any other potentially contaminated surfaces in operating theatres and
procedure rooms with a cloth dampened with a Clorox/ Bleach solution (100ml Bleach in 900ml water).
Immediately clean spills of blood or other body fluids with a Clorox / Bleach solution (100ml Bleach in
900ml water).
Clean visibly soiled areas of the floor, walls, or ceiling with a mop or cloth dampened with Clorox /
Bleach solution (40-50 ml Bleach in One liter water).
Discard waste when plastic bags of waste containers are full.
Discard safety (sharps disposal) boxes, when they are full.
Do not perform special cleaning or closing of the operating theatres after contaminated or dirty
operations. Thorough, routine cleaning is sufficient to provide a safe environment for subsequent cases
At the end
3
Clean all surfaces including counters, tables, lights, door handles with detergent, water and
of each
disinfect with Clorox / Bleach solution (100ml Bleach in 900ml water) allow it to dry. Pay particular
session or
attention to Anesthesia machine operating/procedure tables, making sure to clean the sides, base,
day
and legs thoroughly.
Clean sinks & sluice with water and detergent finally disinfect (40-50 ml Bleach in One liter water).
Wipe over non-metallic surfaces and equipment with Clorox solution (100ml Bleach in 900ml water).
Clean the floors with a mop soaked in a disinfectant solution (40-50 ml Bleach in One liter water).
Check safety boxes and remove and replace them if they are full.
Remove medical or hazardous chemical waste. Make sure to discard it properly and as soon as
possible in order to limit contact with potentially infectious waste.
Clean non-clinical equipment, and containers with Clorox/Bleach solution (100 ml Bleach in 900ml
water).
Each
4
Clean all the areas inside the operating theatre complex with warm water, detergent & Clorox/Bleach
week
solution (40-50 ml Bleach in One liter water). Allow it air dry.
Empty the storage shelves, wipe them, dry them, and then restack.
Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com

INFECTION CONTROL PROCEDURES FOR IMAGING CENTERS AND HOSPITAL RADIOLOGY DEPARTMENTS
The cleanliness of imaging centers and hospital radiology departments is crucial for reducing the spread of MRSA and other
acquired infections. The following are 11 simple procedures to implement that can prevent the spread of these infections.
1. Have a written infectious control policy to include MRI cleaning procedures as well as the cleaning schedule and have it
posted throughout the center.
2. Implement a mandatory hand washing / hand sanitizing procedure between patient exams for technologists and any others
who come into contact with patients.
3. Clean the MRI tables, inside the bore of the magnet and any other items that come into contact with a patient. Infection control
experts recommend this be done between each patient.
4. Clean all pads and positioners with an approved disinfectant. Infection control experts recommend cleaning after each patient.
5. Periodically inspect the pads with a magnifying glass, particularly at the seams, to identify fraying or tearing. If present, the
pads should be replaced.
6. Regularly check all padding material with an ultraviolet (black) light and make sure that any biological material detected on
the pads can be removed.
7. Replace damaged or contaminated pads with new pads incorporating permanent antimicrobial agents.
8. Use pillows with a waterproof covering that is designed to be surface wiped. Replace pillows when their barrier is
compromised.
9. Promptly remove body fluids, and then surface disinfect all contaminated areas.
10. If a patient has an open wound or any history of MRSA/other infection:
a. Gloves and gowns should be worn by all staff coming in contact with the patient. These barriers must be removed before
touching other areas not coming in contact with the patient, i.e. door knobs, scanner console, computer terminals, etc.
b. The table and all the pads should be completely cleaned with disinfectant before the next patient is scanned, if it is not already
being performed between every patient. For patients with any known infectious process add 10-15 minutes onto the scheduled
scan time to assure there is enough time to thoroughly clean the room and all the pads.
11. All furniture should be periodically cleaned. Ideal surfaces are those that are waterproof and wipe-able. Infection control
experts recommend this be done between each patient.
Disinfectant Used: Bleach solution 1:10 dilution (100ml bleach in 900ml water) wipes can be use or EPA approved use
disinfectant allowed by infection control dept
Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com

MATERIAL SAFETY DATA SHEET OF CLOROX / BLEACH:


Description: Clear, thin liquid with a mild bleach odor
Health Hazard Data
Causes moderate eye irritation. Avoid contact with eyes or clothing. Wash thoroughly with soap and water after handling. No
medical conditions are known to be aggravated by exposure to this product.
FIRST AID:
EYE CONTACT: Rinse slowly and gently with water for 15-20 minutes. Remove contact lenses, if present, after the first 5
minutes, and then continue rinsing. If irritation persists, call a doctor.
SKIN CONTACT: Rinse with plenty of water. If irritation persists, call a doctor.
INHALATION: Remove to fresh air. If breathing problems develop, call a doctor.
INGESTION: Drink a glassful of water. Call a doctor.
REFERENCES:
1. Peninsula Community Health, Cleaning Policy & Manual, 2012.
2. Environmental hygiene Vol. 16, No. 9 September 2012, available at www.infectioncontroltoday.com.
3. PIDAC: Best Practices for Environmental Cleaning for Infection Prevention and Control, May 2012
4. Clorox service bulletin, 2011.
5. Birmingham Womens Hospital (2009) Neonatal Unit Policy for Cleaning and Disinfection on Incubators/Cots.
6. Liverpool Women's Hospital NHS Foundation (2009) Infection Control Policy.
7. Carling PC, Parry MM, Rupp ME, Po JL, Dick B and Von Beheren S. Improving Cleaning of the Environment Surrounding
Patients in 36 Acute Care Hospitals. Infect Control Hosp Epidem. Vol. 29, No.11. November 2008.
8. Feidhmeannacht na seirbhise Slainte, Health Service Executive, National Cleaning Manual Appendices, September 2006.
9. Centers for Disease Control and Prevention (CDC). Guidelines for Environmental Infection Control in HealthCare Facilities.
Recommendation of CDC and the Healthcare Infection Control Advisory Committee (HICPAC), 2003.
10. Article 3-2.6 of NAVMED P-5010 Manual of Preventive Medicine USA.
11. Preventing Infection in MRI -Best Practices: Infection Control in and around MRI Suites. Peter Rothschild, MD 2008.
12. Operating Theatre, faculty. ksu.edu.sa.

Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com

Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com

Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com

Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com

Generated by Dr Anjum Hashmi MBBS, CCS (USA), MPH. Infection Prevention & Control Director and Employees Health Director
EAST NAJRAN HOSPITAL, MINISTRY OF HEALTH, NAJRAN KSA. Reviewed By Al Scoggins CEO Janus Solutions USA.
E.mail:anjumhashmi61@hotmail.com